The programme was established in Detroit in 1985. The founder was Joanne Verbanic, who was diagnosed with schizophrenia in 1970. Shortly before forming SA, Verbanic publicly disclosed her diagnosis and discussed her illness on national television in an effort to challenge the stigma associated with the condition. She was a 2006 recipient of a Lilly Reintegration Award in recognition of her lifetime contributions to the mental health community, and she continued to be active as a spokesperson for persons with schizophrenia and other mental illness until her death on 07 May 2015.
By 2007, more than 150 local SA groups operated in 31 of the 50 United States, and in Australia, Brazil, Canada, Mexico, France, India and Venezuela.
Technical support for Schizophrenics Anonymous was provided by the National Schizophrenia Foundation (NSF) until 2007 when NSF ceased operations. In response to the loss of a national sponsor, a group of consumers, family members, and mental health providers came together to form a not-for-profit organisation, Schizophrenia and Related Disorders Alliance of America (SARDAA).
SARDAA promotes recovery for persons with schizophrenia and related brain disorders including bipolar disorder, schizoaffective disorder, depression with psychosis, and experience with psychosis. They envision a future in which every person with a schizophrenia-related brain disorder has the opportunity to recover from their disorders. The name Schizophrenics Anonymous was changed to Schizophrenia Alliance in 2015 and added Psychosis Support and Acceptance in 2018. They provide an online directory of SA groups, sponsor five weekly SA conference calls, and one Family and Friends conference call. At their annual conference, the group trains individuals and groups who have started or would like to start an SA group.
Although some SA groups are organised by mental health professionals, research has suggested that peer-led SA groups are more sustainable and longer lasting. Some groups are organised in psychiatric hospitals or jails and are not open to the public.
The SA programme is based on the twelve-step model, but includes just six steps. The organisation describes the programme’s purpose of helping participants to learn about schizophrenia, “restore dignity and sense of purpose,” obtain “fellowship, positive support, and companionship,” improve their attitudes about their lives and their illnesses, and take “positive steps towards recovery.”
Joanne Verbanic wrote the original “Schizophrenics Anonymous” book, better known as “The Blue Book,” which describes the six steps to recovery. The steps require members to admit they need help, take responsibility for their choices and consequences, believe they have the inner strength to help themselves and others, forgive themselves and others, understand that false beliefs contribute to their problems and change those beliefs, and decide to turn their lives over to a higher power.
One study about the risks of professional partnerships centres on the partnership between Schizophrenics Anonymous (SA) and the Mental Health Association of Michigan (MHAM) over a 14-year period. The study shows that the professional partnership resulted in increased access to SA Groups across Michigan and organisation expansion and development within SA. The professional influence also lead more SA Groups to be held in more traditional mental health treatment settings and led to more professional-led SA groups.
Self-help groups are more available to people who live independently. Researchers at Michigan State University studied whether SA would be successful in group homes. The results were positive: the groups had high attendance and participation and were well liked. However, staff members controlled who could lead and who could attend the meetings, and how the meetings should be run. The programs fell apart. The same obstacle occurred in SA groups started in prisons and monitored by employees.
GROW is a peer support and mutual-aid organisation for recovery from, and prevention of, serious mental illness. GROW was founded in Sydney, Australia in 1957 by Father Cornelius B. “Con” Keogh, a Roman Catholic priest, and psychiatric patients who sought help with their mental illness in Alcoholics Anonymous (AA).
Consequently, GROW adapted many of AA’s principles and practices. As the organisation matured, GROW members learned of Recovery International, an organisation also created to help people with serious mental illness, and integrated pieces of its will-training methods. As of 2005 there were more than 800 GROW groups active worldwide. GROW groups are open to anyone who would like to join, though they specifically seek out those who have a history of psychiatric hospitalisation or are socioeconomically disadvantaged. Despite the capitalisation, GROW is not an acronym. Much of GROW’s initial development was made possible with support from Orval Hobart Mowrer, Reuben F. Scarf, W. Clement Stone and Lions Clubs International.
GROW’s literature includes the Twelve Stages of Decline, which indicate that emotional illness begins with self-centeredness, and the Twelve Steps of Personal Growth, a blend of AA’s Twelve Steps and will-training methods from Recovery International. GROW members view recovery as an ongoing life process rather than an outcome and are expected to continue following the Steps after completing them in order to maintain their mental health.
The Twelve Stages of Decline
We gave too much importance to ourselves and our feelings.
We grew inattentive to God’s presence and providence and God’s natural order in our lives.
We let competitive motives, in our dealings with others, prevail over our common personal welfare.
We expressed our suppressed certain feelings against the better judgement of conscience or sound advice.
We began thinking in isolation from others, following feelings and imagination instead of reason.
We neglected the care and control of our bodies.
We avoided recognising our personal decline and shrank from the task of changing.
We systematically disguised in our imaginations the real nature of our unhealthy conduct.
We became a prey to obsessions, delusions and hallucinations.
We practised irrational habits, under elated feelings of irresponsibility or despairing feelings of inability or compulsion.
We rejected advice and refused to co-operate with help.
We lost all insight into our condition.
The Twelve Steps of Recovery and Personal Growth
We admitted to personal disorder in our lives.
We firmly resolved to restore order in our lives and co-operated with the help that we needed.
We surrendered to the healing power God or We surrendered to the healing power of truth.
We made personal inventory and accepted ourselves.
We made moral inventory and cleaned out our hearts.
We endured until ‘cured’.
We took care and control of our bodies.
We learned to think by reason rather than by feelings and imagination.
We trained our wills to regulate our feelings.
We took our responsible and caring place in the wider community.
We grew daily closer to maturity.
We carried GROW’s hopeful, healing, and transforming message to others in need.
GROW suggests atheists and agnostics use “We became inattentive to objective natural order in our lives” and “We trusted in a health-giving power in our lives as a whole” for the Second Stage of Decline and Third Step of Personal Growth, respectively.
Results of Qualitative Analysis
Statistical evaluations of interviews with GROW members found they identified self-reliance, industriousness, peer support, and gaining a sense of personal value or self-esteem as the essential ingredients of recovery. Similar evaluations of GROW’s literature revealed thirteen core principles of GROW’s program. They are reproduced in the list below by order of relevance, with a quote from GROW’s literature, explaining the principle.
Be Reasonable: “We learned to think by reason rather than by feelings and imagination.”
Decentralize, participate in community: “…decentralization from self and participation in a community of persons is the very process of recovery or personal growth.”
Surrender to the Healing Power of a wise and loving God: “God, who made me and everything connected with me, can overcome any and every evil that affects my life.”
Grow Closer to Maturity: “Maturity is a coming to terms with oneself, with others, and with life as a whole.”
Activate One’s Self to Recover and Grow “Take your fingers off your pulse and start living.”
Become Hopeful: “I can, and ultimately will, become completely well; God who made me can restore me and enable me to do my part. The best in life and love and happiness is ahead of me.”
Settle for Disorder: “Settle for disorder in lesser things for the sake of order in greater things; and therefore be content to be discontent in many things.”
Be Ordinary: “I can do whatever ordinary good people do, and avoid whatever ordinary good people avoid. My special abilities will develop in harmony only if my foremost aim is to be a good ordinary human being.”
Help Others: We carried the GROW message to others in need.
Accept One’s Personal Value: “No matter how bad my physical, mental, social or spiritual condition I am always a human person, loved by God and a connecting link between persons; I am still valuable, my life has a purpose, and I have my unique place and my unique part in my Creator’s own saving, healing and transforming work.”
Use GROW: “Use the hopeful and cheerful language of GROW.”
Gain Insight: “We made moral inventory and cleaned out our hearts.”
Accept Help: “We firmly resolved to get well and co-operated with the help that we needed.”
Participation in GROW has been shown to decrease the number of hospitalisations per member as well as the duration of hospitalisations when they occur. Members report an increased sense of security and self-esteem, and decreased anxiety. A longitudinal study of GROW membership found time involved in the programme correlated with increased autonomy, environmental mastery, personal growth, self-acceptance and social skills. Women in particular experience positive identity transformation, build friendships and find a sense of community in GROW groups.
The Programme of Growth to Maturity, generally referred to as the ‘Blue Book’, is the principal literature used in GROW groups. The book is divided into three sections based on the developmental stages of members: ‘Beginning Growers’, ‘Progressing Growers’ and ‘Seasoned Growers’. Additionally, there are three related books written by Cornelius B. Keogh, and one by Anne Waters, used in conjunction with the Blue Book.
GROW (1983). GROW: World Community Mental Health Movement: The Program of Growth to Maturity (the “Blue Book”). Sydney, Australia: GROW Publications. OCLC 66288113.
Keogh, Cornelius B. (1975). Readings for mental health (the “Brown Book”). Sydney, Australia: GROW Publications. ISBN 0-909114-00-5. OCLC 47699449.
Keogh, Cornelius B.; GROW (Australia) (1967). Readings for recovery (the “Red Book”). Sydney Australia: GROW. OCLC 154602570.
Keogh, Cornelius B. (1967). Recovery. Sydney, Australia. OCLC 57499165.
Waters, Anne (2005). GROWing to Maturity: A Potpourri of Readings for Mental Health (the “Lavender Book”). GROW in Ireland Ltd. ISBN 0-9529198-2-6.
Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing.
This article focuses on groups for which members do not need to share a common diagnosis or aetiology of their mental illness. Improving mental health and wellbeing is also a desired outcome of groups like, for example, Alcoholics Anonymous and Survivors Network of those Abused by Priests. In those cases, for example, members share the trait of alcoholism or traumatic experiences of abuse by priests and those groups focus on improving the mental health and wellbeing of members while acknowledging their shared circumstances.
Despite the different approaches, many of the psychosocial processes in the groups are the same. Self-help groups have had varying relationships with mental health professionals. Due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population.
Mutual Support and Self-Help
Mutual support or peer support is a process by which people voluntarily come together to help each other address common problems. Mutual support is social, emotional or instrumental support that is mutually offered or provided by persons with similar mental health conditions where there is some mutual agreement on what is helpful.
Mutual support may include many other mental health consumer non-profits and social groups. Such groups are further distinguished as either Individual Therapy (inner-focused) or Social Reform (outer-focused) groups. The former is where members seek to improve themselves, where as the latter set encompasses advocacy organisations such as the National Alliance on Mental Illness and Psychiatric Rehabilitation Association.
Self-help groups are subsets of mutual support and peer support groups, and have a specific purpose for mutual aid in satisfying a common need, overcoming a shared handicap or life-disrupting problem. Self-help groups are less bureaucratic and work on a more grassroots level. Self-help Organisations are national affiliates of local self-help groups or mental health consumer groups that finance research, maintain public relations or lobby for legislation in favour of those affected.
Behaviour Control or Stress Coping Groups
Of individual therapy groups, researchers distinguish between Behaviour Control groups (such as Alcoholics Anonymous and TOPS) and Stress Coping groups (such as mental health support groups, cancer patient support groups, and groups of single parents). German researchers refer to Stress Coping groups as Conversation Circles.
Significant differences exist between Behavioural Control groups and Stress Coping groups. Meetings of Behaviour Control groups tend to be significantly larger than Stress Coping counterparts (by more than a factor of two). Behaviour Control group members have a longer average group tenure than members of Stress Coping groups (45 months compared to 11 months) and are less likely to consider their membership as temporary. While very few members of either set saw professionals concurrently while being active in their group, Stress Coping members were more likely to have previously seen professionals than Behaviour Control group members. Similarly, Stress Coping groups worked closer with mental health professionals.
Member vs Professional Leadership
In Germany, a specific subset of Conversation Circles are categorised as Talking Groups (Gesprächsselbsthilfegruppen). In Talking Groups all members of the group have the same rights, each member is responsible only for themselves (group members do not make decisions for other group members), each group is autonomous, everyone attends the group on account of their own problems, whatever is discussed in the group remains confidential, and participation is free of charge.
Professionally Led Group Psychotherapy
Self-help groups are not intended to provide “deep” psychotherapy. Nevertheless, their emphasis on psychosocial processes and the understanding shared by those with the same or similar mental illnesses does achieve constructive treatment goals.
Interpersonal learning, which is done through processes such as feedback and confrontation, is generally deemphasized in self-help groups. This is largely because it can be threatening, and requires training and understanding of small group processes. Similarly, reality testing is also deemphasized. Reality testing relies on consensual validation, offering feedback, seeking feedback and confrontation. These processes seldom occur in self-help groups, though they frequently occur in professionally directed groups.
Professional Affiliation and Group Lifespan
If self-help groups are not affiliated with a national organisation, professional involvement increases their life expectancy. Conversely, if particular groups are affiliated with a national organisation professional involvement decreases their life expectancy. Rules enforcing self-regulation in Talking Groups are essential for the group’s effectiveness.
Typology of Self-Help Groups
In 1991 researchers Marsha A. Schubert and Thomasina Borkman created five conceptual categorizations for self-help groups.
Unaffiliated groups are defined as self-help groups that function independently from any control at state or national levels, and from any other group or professionals. These groups accept all potential members, and everyone has an equal opportunity to volunteer or be elected. Leaders serve to help the groups function by collecting donations not through controlling the members. Experiential knowledge is mostly found, and there is a high emphasis on sharing. An example of an unaffiliated group includes Wildflowers’ Movement in Los Angeles.
Federated groups have superordinate levels of their own self-help organisation at state or national levels which makes publicity and literature available. The local unit of the federated self-help group retains full control of its decisions. These groups tend to rely on experiential knowledge, and professionals rarely directly interact. The leaders of these groups would be any members comfortable with the format and willing to accept responsibilities. Leaders do not need to have formal training to gain their title. Examples of a federated self-help group would be Depression and Bipolar Support Alliance (DBSA) and Recovery International.
Affiliated groups are subordinate to another group, a regional or national level of their own organisation. Local groups conform to the guidelines of the regional/national groups. Leaders are self-helpers not professional caregivers, and meetings included educational activities and sharing, supplemented by research and professionals. Examples of an affiliated self-help group would be the National Alliance on Mental Illness (NAMI).
Managed groups are based on a combination of self-help and professional techniques. These groups are populated generally through referrals and group activities are led by group members. Managed groups do not meet all the criteria for self-help groups, and so should be designated professionally controlled support groups. Examples of managed groups are common with support groups in hospitals, such as those with breast cancer survivors and patients that may be managed by a nurse or therapist in some professional fashion.
The hybrid group has characteristics of the affiliated and managed groups. Like affiliated groups, hybrid groups are organised by another level of their own organisation. To participate in specialised roles, training is developed by a higher level and enforced through trained leaders or facilitators. Like a managed group, a hybrid group cooperates and interacts with professionals, and that knowledge is highly valued alongside experiential knowledge.
No two self-help group are exactly alike, the make-up and attitudes are influenced by the group ideology and environment. In most cases, the group becomes a miniature society that can function like a buffer between the members and the rest of the world. The most essential processes are those that meet personal and social needs in an environment of safety and simplicity. Elegant theoretical formulations, systematic behavioural techniques, and complicated cognitive-restructuring methods are not necessary.
Despite the differences, researchers have identified many psychosocial processes occurring in self-help groups related to their effectiveness. This list includes, but is not limited to: acceptance, behavioural rehearsal, changing member’s perspectives of themselves, changing member’s perspectives of the world, catharsis, extinction, role modelling, learning new coping strategies, mutual affirmation, personal goal setting, instilling hope, justification, normalisation, positive reinforcement, reducing social isolation, reducing stigma, self-disclosure, sharing (or “opening up”), and showing empathy.
Five theoretical frameworks have been used in attempts to explain the effectiveness of self-help groups.
Having a community of people to give physical and emotional comfort, people who love and care, is a moderating factor in the development of psychological and physical disease.
Members obtain specialised information and perspectives that other members have obtained through living with severe mental illness. Validation of their approaches to problems increases their confidence.
Social Learning Theory
Members with experience become credible role models.
Social Comparison Theory
Individuals with similar mental illness are attracted to each other in order to establish a sense of normalcy for themselves. Comparing one another to each other is considered to provide other peers with an incentive to change for the better either through upward comparison (looking up to someone as a role model) or downward comparison (seeing an example of how debilitating mental illness can be).
Those helping each other feel greater interpersonal competence from changing other’s lives for the better. The helpers feel they have gained as much as they have given to others. The helpers receive “personalized learning” from working with helpees. The helpers’ self-esteem improves with the social approval received from those they have helped, putting them in a more advantageous position to help others.
A framework derived from common themes in empirical data describes recovery as a contextual nonlinear process, a trend of general improvement with unavoidable paroxysms while negotiating environmental, socioeconomic and internal forces, motivated by a drive to move forward in one’s life. The framework identified several negotiation strategies, some designed to accommodate illnesses and others designed to change thinking and behaviour. The former category includes strategies such as acceptance and balancing activities. The latter includes positive thinking, increasing one’s own personal agency/control and activism within the mental health system.
Relationship with Mental Health Professionals
A 1978 survey of mental health professionals in the United States found they had a relatively favourable opinion of self-help groups and there was a hospitable climate for integration and cooperation with self-help groups in the mental health delivery system. The role of self-help groups in instilling hope, facilitating coping, and improving the quality of life of their members is now widely accepted in many areas both inside and outside of the general medical community.
The 1987 Surgeon’s General Workshop marked a publicised call for egalitarian relationships with self-help groups. Surgeon General C. Everett Koop presented at this workshop, advocating for relationships that are not superordinate-subordinate, but rather emphasizing respectful, equal relations.
A survey of psychotherapists in Germany found that 50% of the respondents reported a high or very high acceptance of self-help groups and 43.2% rated their acceptance of self-help groups as moderate. Only 6.8% of respondents rated their acceptance of self-help groups as low or very low.
Surveys of self-help groups have shown very little evidence of antagonism towards mental health professionals. The maxim of self-help groups in the United States is “Doctors know better than we do how sickness can be treated. We know better than doctors how sick people can be treated as humans.”
A large majority of self-help users use professional services as a gateway to self-help services, or concurrently with professional service or the aftercare following professional service. Professional referrals to self-help groups thus can be a cost-effective method of continuing mental health services and the two can co-exist within their own fields. While twelve-step groups, such as Alcoholics Anonymous, make an indispensable contribution to the mental and/or substance use (M/SU) professional services system, a vast number of non-twelve-step groups remain underutilised within that system.
Professional referrals to self-help groups for mental health are less effective than arranging for prospective self-help members to meet with veterans of the self-help group. This is true even when compared to referrals from professionals familiar with the self-help group when referring clients to it. Referrals mostly come from informal sources (e.g. family, friends, word of mouth, self). Those attending groups as a result of professional referrals account for only one fifth to one-third of the population. One survey found 54% of members learned about their self-help group from the media, 40% learned about their group from friends and relatives, and relatively few learned about them from professional referrals.
Self-help groups are effective for helping people cope with, and recover from, a wide variety of problems. German Talking Groups have been shown to be as effective as psychoanalytically oriented group therapy. Participation in self-help groups for mental health is correlated with reductions in psychiatric hospitalisations, and shorter hospitalisations if they occur. Members demonstrate improved coping skills, greater acceptance of their illness, improved medication adherence, decreased levels of worry, higher satisfaction with their health, improved daily functioning and improved illness management. Participation in self-help groups for mental health encourages more appropriate use of professional services, making the time spent in care more efficient. The amount of time spent in the programmes, and how proactive the members are in them, has also been correlated with increased benefits. Decreased hospitalisation and shorter durations of hospitalisation indicate that self-help groups result in financial savings for the health care system, as hospitalisation is one of the most expensive mental health services. Similarly, reduced utilisation of other mental health services may translate into additional savings for the system.
While self-help groups for mental health increase self-esteem, reduce stigma, accelerate rehabilitation, improve decision-making, decrease tendency to decompensate under stress, and improve social functioning, they are not always shown to reduce psychiatric symptomatology. The therapeutic effects are attributed to the increased social support, sense of community, education and personal empowerment.
Members of self-help groups for mental health rated their perception of the group’s effectiveness on average at 4.3 on a 5-point Likert scale.
Social support, in general, can lead to added benefits in managing stress, a factor that can exacerbate mental illness.
Select List of Organisations
Depressed Anonymous (DA) is based on the model pioneered by Alcoholics Anonymous and open to anyone who wants to stop saddening themselves.
Emotions Anonymous (EA) is a derivative programme of Neurotics Anonymous and open to anyone who wants to achieve emotional well-being. Following the Twelve Traditions, EA groups cannot accept outside contributions.
GROW was founded in Sydney, Australia, in 1957 by a Roman Catholic priest, Father Cornelius Keogh, and people who had sought help with their mental illness at Alcoholics Anonymous (AA) meetings. After its inception, GROW members learned of Recovery, Inc. (the organisation now known as Recovery International, see below) and integrated its processes into their programme. GROW’s original literature includes the Twelve Stages of Decline, which state that emotional illness begins with self-centeredness, and the Twelve Steps of Recovery and Personal Growth, a blend of AA’s Twelve Steps and will-training methods from Recovery International. GROW groups are open to anyone who would like to join, though they specifically recruit people who have been in psychiatric hospitals or are socioeconomically disadvantaged. GROW does not operate with funding restrictions and have received state and outside funding in the past.
Neurotics Anonymous is a twelve-step programme open to anyone with a desire to become emotionally well. According to the Twelve Traditions followed in the programme, Neurotics Anonymous is unable to accept outside contributions. The term “neurotics” or “neuroses” has since fallen out of favour with mental health professionals, with the movement away from the psychoanalytic principles of a DSM-II. Branches of Neurotics Anonymous have since changed their name to Emotions Anonymous, which is currently the name in favour with the Minnesota Groups. Groups in Mexico, however, called Neuróticos Anónimos still are referred to by the same name, due to the term “neuroticos” having a less pejorative connotation in Spanish. This branch continues to flourish in Mexico City as well as largely Spanish-speaking cities in the United States, such as Los Angeles.
Recovery, Inc. was founded in Chicago, Illinois, in 1937 by psychiatrist Abraham Low using principles in contrast to those popularised by psychoanalysis. During the organisation’s annual meeting in June 2007 it was announced that Recovery, Inc. would thereafter be known as Recovery International. Recovery International is open to anyone identifying as “nervous” (a compromise between the loaded term neurotic and the colloquial phrase “nervous breakdown”); strictly encourages members to follow their physician’s, social worker’s, psychologist’s or psychiatrist’s orders; and does not operate with funding restrictions.
Fundamentally, Low believes “Adult life is not driven by instincts but guided by Will,” using a definition of will opposite of Arthur Schopenhauer’s. Low’s programme is based on increasing determination to act, self-control, and self-confidence. Edward Sagarin compared it to a modern, reasonable, and rational implementation of Émile Coué’s psychotherapy. Recovery International is “twelve-step friendly.” Members of any twelve-step group are encouraged to attend Recovery International meetings in addition to their twelve-step group participation.
There are several limitations of self-help groups for mental health, including but not limited to their inability to keep detailed records, lack of formal procedures to follow up with members, absence of formal screening procedures for new members, lack formal leadership training, and likely inability of members to recognise a “newcomer” presenting with a serious illness requiring immediate treatment. Additionally, there is a lack of professional or legal regulatory constraints determining how such groups can operate, there is a danger that members may disregard the advice of mental health professionals, and there can be an anti-therapeutic suppression of ambivalence and hostility. Researchers have also elaborated specific criticisms regarding self-help groups’ formulaic approach, attrition rates, over-generalisation, and “panacea complex”.
Researchers have questioned whether formulaic approaches to self-help group therapy, like the Twelve Steps, could stifle creativity or if adherence to them may prevent the group from making useful or necessary changes. Similarly others have criticised self-help group structure as being too rigid.
High Attrition Rates
There is not a universal appeal of self-help groups; as few as 17% of people invited to attend a self-help group will do so. Of those, only one third will stay for longer than four months. Those who continue are people who value the meetings and the self-help group experience.
Since these groups are not specifically diagnosis-related, but rather for anyone seeking mental and emotional health, they may not provide the necessary sense of community to evoke feelings of oneness required for recovery in self-help groups. Referent power is only one factor contributing to group effectiveness. A study of Schizophrenics Anonymous found expert power to be more influential in measurements of perceived group helpfulness.
There is a risk that self-help group members may come to believe that group participation is a panacea – that the group’s processes can remedy any problem.
Sexual Predation and Opportunism
Often membership of non-associated self-help groups is run by volunteers. Monitoring of relationships and standards of conduct are seldom formalised within a group and are done on a self-regulating basis. This can mean undesirable and unethical initiation of sexual and intimate encounters are facilitated in these settings. Predatory and opportunistic behaviour in these environments which by association involve divulging volatile mental states, medication changes and life circumstances mean opportunities by those willing to leverage information that is often normally guarded and deeply personal, is a risk more-so than in other social meetup settings or professionally governed bodies.
“a talking group, a place for men to come together in a safe environment to talk about issues and problems they have faced or are currently facing”.
It was formed by Luke Ambler and his mother-in-law Elaine after his brother-in-law took his own life.
The club, with its slogan “it’s okay to talk”, started in early 2016 in Halifax with a first meeting of nine men. Since then, the group has expanded across the country and by February 2020 had over 800 men attending every week. Each group meeting is led by a volunteer “group facilitator” who has been trained by the organisation.
Other similar organisations have come to exist, some with a local focus and others with a national.
In 2021 they earned the Queens’s award for voluntary service.
It’s tricky to talk.
Men Walk Talk.
Proper Blokes Club.
It’s Worth Talking About.
There are a variety of locations (as of November 2021):
Role suction is a term introduced in the United States by Fritz Redl in the mid-20th century to describe the power of a social group to allocate roles to its members.
W.R. Bion’s group dynamics further explored the ways whereby the group (unconsciously) allocates particular functions to particular individuals in order to have its covert emotional needs met; and the process has recently been highlighted anew within the systems-centred therapy of Yvonne Agazarian.
Among regularly occurring group roles are those of the scapegoat for the group’s troubles; the joker; the peacemaker; the critic/spokesperson for group standards; the idol, or upholder of the group ideal; and the identified patient. In mixed gender groups, women may be disproportionately pressured by role suction into playing a nurturing/peacemaker role.
The ease whereby people pick out those who play complementary games, and the psychological splitting of good and bad help fuel such role differentiation.
Behind role suction, such forces as projective identification and countertransference have been singled out as operating at an unconscious level in the group.
Role lock – confirming mutual suction into complementary roles, such as victim and abuser – is ensured by the intermeshing of projective identifications.
The British anti-psychiatrists explored the theme of group suction in connection with role attribution in the family nexus, as well as with the allocations of roles in the wider social system, David Cooper suggesting that ‘there are always good or bad, loved or hated ‘mothers’ and ‘fathers’, older or younger ‘brothers’ and ‘sisters’…in any institutional structure”.
A wider variety of roles can however be found in organisational life, the person-in-role acting as a container for the (unconscious) group forces.
Role of the Therapist
Bion has described his experience as a group therapist when he “feels he is being manipulated so as to be playing a part, no matter how difficult to recognise, in somebody else’s phantasy…a temporary loss of insight, a sense of experiencing strong feelings, and at the same time a belief that their existence is quite adequately justified by the objective situation”. Bion’s work has also been used to illustrate the part played by role suction in the selection of group leaders – dependent groups favouring narcissistic leaders, the fight/flight group paranoids.
R.D. Laing considered that a central part of the therapist’s job was “not to allow himself to collude with the patients in adopting a position in their phantasy-system: and, alternatively, not to use the patients to embody any phantasy of their own” – to resist role suction. Later therapists however have explored how a measure of adaptation to patients’ role suction – a degree of role responsiveness – can be a useful element in the therapeutic use of the countertransference.
From the point of view of systems-centred therapy, the debate relates to the interface between a personal system and the psycho-dynamics of social systems themselves.
Debate has arisen about how far the group imposes roles, and how far the individual’s own personality goes to meet the group halfway. Earl Hopper has used the term personification to challenge Redl’s concept, suggesting instead that group roles reflect the underlying personality of the individual involved. However, Kibel objects that in many cases the roles imposed are in fact ego-dystonic; with others pointing to how personal tendencies combine with group expectations with varying degrees of fit.
Helper theory or the helper therapy principle was first described by Frank Riessman (1965) in an article published in the journal Social Work. The principle suggests that when an individual (the “helper”) provides assistance to another person, the helper may benefit.
Riessman’s model has inspired subsequent research and practice by scholars, clinicians, and indigenous populations to address a variety of social and health-related issues plaguing individuals and communities around the world.
Riessman’s seminal article explored how non-professionals supported one another in self-help/mutual-aid support groups based on Riessman’s observations of a sample of these groups, as well as his summary of the findings of research in the areas of social work, education, and leadership. This article suggested that although the “use of people with a problem to help other people who have the same problem in [a] more severe form” is “an age-old therapeutic approach,” the traditional focus on outcomes for those receiving help to the exclusion of considering outcomes for those providing help is too narrow; instead, Riessman (1965, p.27) advocated for increased consideration of the experience of “the individual that needs the help less, that is, the person who is providing the assistance” because “frequently it is he who improves!”
Although Riessman expressed doubt that individuals receiving help always benefit from the assistance provided to them, he felt more sure that individuals providing help are likely experiencing important gains; thus, according to Riessman, the helping interaction at least has the potential to be mutually beneficial for both parties involved (i.e. for both the individual giving and for the individual receiving aid), but it is not absolutely necessary for the “helpee” to benefit in order for the “helper” to enjoy the benefits of helping. In instances where true mutual benefit occurs, the helper and helpee benefit in different ways, such that the person receiving help benefits by way of receiving whatever specific form of assistance is offered to them (e.g. emotional support, information, etc.) while the person providing help benefits by the very act of providing help, regardless of the type of aid they provide.
Riessman posited several different mechanisms which may facilitate the benefits experienced by an individual engaged in a helping role:
Gaining an improved self-image;
Becoming more committed to a position through the process of advocating it (i.e. “self-persuasion through persuading others”);
Experiencing meaningful development of abilities after having been given a stake in a system and learning through teaching others;
Gaining access to a socially-valued role and the resultant sense of social status and importance;
Enjoying opportunities to affirm one’s own wellness following placement in a system as a role model; and
Shifting one’s focus from self-concerns and problems to assisting others (and thus distracting oneself from ongoing difficulties).
Lepore, Buzaglo, Liberman, Golant, Greener, and Davey (2014) investigated the helper-therapy principle in a randomised control trial of a “prosocial”, other-focused Internet Support Group (P-ISG) designed to elicit peer-instigated, supportive interactions online among female breast cancer survivors. When compared to female breast cancer survivors who participated in a standard, self-focused Internet Support Group (S-ISG), which was not designed to explicitly provide opportunities for helping interactions to take place, analyses found that individuals in the P-ISG condition did provide more support to others yet P-ISG participants experienced a higher level of depression and anxiety following the intervention than those in S-ISG. These results fail to provide support for the helper-therapy principle which posits that “helping others is effective at promoting mental health” (Lepore et al., 2014, p.4085). In accounting for these results, Lepore et al. (2014) suggest that it is possible that women in the P-ISG condition felt hesitant to express their negative feelings out of fear that doing so might impact others adversely, whereas women in the S-ISG felt more able to unburden themselves of emotional pain and thus enjoyed better mental health outcomes.
Arnold, Calhoun, Tedeschi, and Cann (2005) explored both the positive and negative sequelae of providing psychotherapy to clients who had experienced trauma and subsequent posttraumatic growth by conducting naturalistic interviews with a small sample of clinicians (N = 21). Although all interviewees indicated experiencing some degree of negative experience as a result of engaging in trauma-focused psychotherapy (such as intrusive thoughts, negative emotional responses, negative physical responses, and doubts about clinical competence), all participants also indicated some sort of positive personal outcome occurred as a result of assisting psychotherapy clients with these types of experiences. The positive reactions experienced by clinicians engaged in trauma work included: enjoying the gratification that comes through watching others grow and triumph following difficult times; increasing recognition of one’s own personal growth and development; expanding ability to connect emotionally with others; impacting one’s own sense of spirituality; increased awareness of one’s own good fortune in life; and increasing appreciation for the strength and resiliency of human beings. This finding suggests that the helper-therapy principle may operate in a clinical context whereby therapists (i.e. the helpers) benefit from engaging in the process of providing treatment to psychotherapy clients who have survived traumatic experiences.
Pagano, Post, and Johnson (2011) reviewed recent evidence examining “helper health benefits” among populations experiencing problematic involvement with alcohol, other mental health conditions, and/or general medical problems. In brief, their review suggests that when individuals with chronic health conditions (e.g. alcohol use disorder, body dysmorphic disorder with comorbid alcohol dependence, multiple sclerosis, chronic pain) help others living with the same chronic condition, the individual helper benefits (e.g. longer time-to-relapse, remission, reduced depression and other problematic symptoms, and increased self-confidence, self-esteem, and role functioning).
Additionally, Post’s (2005, p.73) review of the literature on altruism, happiness, and health indicates that “a strong correlation exists between the well-being, happiness, health, and longevity of people who are emotionally kind and compassionate in their charitable helping activities”. However, Post also notes that individual helpers may become overwhelmed by over-involvement in the lives of others, and that giving assistance beyond a certain variable threshold may lead to deleterious rather than beneficial outcomes for helpers.
Melkman, Mor-Salwo, Mangold, Zeller, & Benbenishty (2015) used a grounded theory approach to understand:
The motivations and experiences which led young adult “careleavers” (N = 28, aged 18-26) in Israel and Germany to assume a helper role; and
The benefits they report enjoying as a result of helping others through volunteerism and/or human-service focused careers.
Participants reported that observing role models involved in helping roles, being exposed to prosocial values, and having opportunities to volunteer within the system in which they were simultaneously receiving care all contributed to later assumption of more stable and regular helping roles. These participants felt obliged to provide assistance to others, desired to provide this assistance to others, and felt sufficiently competent to carry out the tasks required of them in their helping role. These participants reported that helping others provided them with a sense of purpose in their lives, and also increased self-efficacy, social connectedness, and ability to cope with personal issues. Additionally, participants reported that assuming a helping role provided a sense of normalcy to their lives, as well as providing a sense of perspective on their own journey and outcomes. As one participant (a volunteer with a police department who was assigned to work with at-risk youth) shared with the researchers:
“The fact that I could bring a runaway girl back to her home and I made her trust me, the fact that I located a missing girl, the fact that I escorted a rape victim to hospital and I managed to give her strength and support her, these are the things that give me meaning, tell me that I’m in a much better situation than others” (Melkman et al., 2015, p.45).
Roberts, Salem, Rappaport, Toro, Luke, and Seidman (1999, p.859) found support for the helper-therapy principle among participants of GROW, a mutual-help group for individuals with serious mental illness, whereby “participants who offered help to others evidenced improvement over time in psychosocial adjustment”.
Maton (1988) reports that occupying both “helper” and “helpee” roles in a self-help/mutual-aid group (i.e. bidirectional support) was positively correlated with psychological well-being and positive perceptions regarding the benefits of group membership, and that these members with dual-roles had a greater sense of well-being and a more favourable opinion of the group than members who were helpees (i.e. recipients of assistance) only.
Olson, Jason, Ferrari, and Hutcheson (2005) reviewed the existent literature on four mutual-help organisations (Alcoholics Anonymous, Oxford House, GROW, and Schizophrenics Anonymous). They suggest that the processes of change framework found within the transtheoretical model of intentional behaviour change (Prochaska, Diclemente, and Norcross, 1992) is a useful model to conceptualise the activities of mutual-help organization members throughout their journey of mental health recovery. They explicitly link social liberation, the last of the ten processes of change articulated by the model (the others being: consciousness raising, self-re-evaluation, helping relationships, self-liberation, environmental re-evaluation, dramatic relief/emotional arousal, stimulus control, reinforcement management, and counterconditioning) to the helper-therapy principle, along with a related concept known as bidirectional support (Maton, 1988). Per Olson et al. (2005), social liberation “involves the person in recovery focusing attention away from oneself and developing a broader recognition of social issues that contributed to the targeted problem” which encourages “recovering individuals to take more helping-related attitudes toward others who face similar problems” (Olson et al., 2005, p.174). In reviewing the research conducted among members of these four self-help/mutual-help organisations, they identify three different mechanisms which might underlie the therapeutic effect of mutual-help:
When an individual helps another, the helper’s social functioning improves because the act of providing help to another allows the helper to work through their own difficulties;
When an individual helps another, the helper’s social functioning improves because the act of providing help to another allows the helper to reinforce their own personal learning about recovery; and/or
When an individual helps another, the helper experiences an increase in their own sense of competence and usefulness to others and enables the helper to adopt a “strength-based roles that have not been fully exercised in other areas of life” (Olson et al., 2005, p.175).
In reviewing the research on GROW, specifically, 67% of members of this organisation sampled by Young and Williams (1987) who were asked how they most benefited from participation reported that involvement in GROW “taught [them they] could help others” (the most endorsed answer among all listed categories). As suggested by a study by Maton and Salem (1995), this idea is most succinctly expressed by way of an axiom of GROW which is often recited at meetings: “If you need help, help others.”
A review of empirical studies investigating the effect of mutual help group participation for individuals with mental health problems by Pistrang, Barker, and Humphreys (2008, p.110) provides “limited but promising evidence that mutual help groups benefit people with three types of problems: chronic mental illness, depression/anxiety, and bereavement”.
Arnold, D., Calhoun, L. G., Tedeschi, R. & Cann, A. (2005). Vicarious posttraumatic growth in psychotherapy. Journal of Humanistic Psychology. 45(2), pp.239-263.
Lepore, S.J., Buzaglo, J.S., Liberman, M.A., Golant, M., Greener, J.R. & Davey A. (2014) Comparing standard versus prosocial internet support groups for patients with breast cancer: A randomized controlled trial of the helper therapy principle. Journal of Clinical Oncology. 32(36), pp.4081-4086.
Maton, K.I. (1988). Social support, organization characteristics, psychological wellbeing and group appraisal in three self-help populations. American Journal of Community Psychology. 16(1), pp.53-77.
Maton, K.I. & Salem, D.A. (1995). Organizational characteristics of empowering community settings: A multiple case study approach. American Journal of Community Psychology. 23(5), pp631-656.
Melkman, E., Mor-Salwo, Y., Mangold, K., Zeller, M. & Benbenishty, R. (July 2015). Care leavers as helpers: Motivations for and benefits of helping others. Children and Youth Services Review. 54, pp.41-48.
Olson, B.D., Jason, L.A., Ferrari, J.R. & Hutcheson, T.D. (2005). Bridging professional and mutual-help: An application of the transtheoretical model to the mutual-help organization. Applied and Preventive Psychology. 11(3), pp.167-178.
Pagano, M.E., Post, S.G. & Johnson, S.M. (2011). Alcoholics Anonymous-Related Helping and the Helper Therapy Principle. Alcoholism Treatment Quarterly. 29(1), pp.23-34.
Pistrang, N., Barker, C. & Humphreys, K. (2008). Mutual Help Groups for Mental Health Problems: A Review of Effectiveness Studies. American Journal of Community Psychology. 42(1-2), pp.110-121.
Post, S.G. (2005). Altruism, happiness, and health: it’s good to be good. International Journal of Behavioral Medicine. 12(2), pp.66-77.
Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist. 47(9), pp.1102-1114.
Riessman, F. (1965) The ‘Helper’ Therapy Principle. Social Work. 10(2), pp.27-32.
Roberts, L., Salem, D., Rappaport, J., Toro, P.A., Luke, D.A. & Seidman, E. (1999). Giving and receiving help: Interpersonal transactions in mutual-help meetings and psychosocial adjustment of members. American Journal of Community Psychology. 27(6), pp.841-868.
Young, J. & Williams, C.L. (1987). An Evaluation of Grow, a Mutual-Help Community Mental Health Organisation. Community Health Studies. 11(1), pp.38-42.
A peer support specialist is a person with “lived experience” who has been trained to support those who struggle with mental health, psychological trauma, or substance use. Their personal experience of these challenges provide peer support specialists with expertise that professional training cannot replicate.
Some roles filled by peer support specialists include assisting their peers in articulating their goals for recovery, learning and practicing new skills, helping them monitor their progress, supporting them in their treatment, modelling effective coping techniques and self-help strategies based on the specialist’s own recovery experience, supporting them in advocating for themselves to obtain effective services, and developing and implementing recovery plans.
In 2007, the US Department of Health and Human Services recognised peer support services as an evidence-based practice. It also informed all 50 state Medicaid directors that The Centres for Medicare and Medicaid Services would pay for peer support services, provided that peer support specialists – like other types of healthcare providers – were governed by a statewide training and credentialing programme. As of 2016, 42 US states, the District of Columbia, and the Veterans’ Administration have adopted such programmes to train and certify individuals to work as peer support specialists.
Recovery plans can take many forms. A key component of the recovery management model is a personal recovery plan which is drawn up by the individual looking for support, and reviewed with an RSS. This plan is instrumental for individuals in the process of their recovery.
Central to such plans are the overall health and well-being of each individual, not just their mental health. Components often include support groups and individual therapy, basic health care maintenance, stable housing, improvements in family life and personal relationships, and community connections. The plan may also include education goals, vocational development and employment. Some plans outline a timetable for monitoring, and/or a plan for re-engagement when needed to balance the health and overall quality of life of each individual.
Peer recovery support specialists can be found in an increasing variety of settings, including community-based recovery centres. Funding for peer recovery programmes comes from a combination of federal and state agencies as well as local and national charities and grant programmes, such as Catholic Charities and the United Way.
Training and Certification
When peer support specialists work in publicly funded services, they are required to meet government and state certification requirements. Since the adaptation of the Recovery Management Model by state and federal agencies, peer support specialist courses have been offered by numerous state, non-profit and for-profit entities such as Connecticut Community for Addiction Recovery, PRO-ACT (Pennsylvania Recovery Organisation-Achieving Community Together), The McShin Foundation, Tennessee Certified Peer Recovery Specialist Training and Programme, Appalachian Consulting Group, and the State of New York’s Office of Addiction Services. PARfessionals has developed the first internationally approved online training programme for peer support specialists in the fields of mental health and addiction recovery. In addition, numerous for-profit firms offer peer support specialist training. Training includes courses on the ethics of a recovery coach, recovery coaching core competencies, clinical theories as stages of change, motivational interviewing, and co-occurring disorders.
Adapted for the recovery support specialist by William L. White:
Identifies and engages hard-to-reach individuals.
Offers living proof of the transformative power of recovery and makes recovery attractive.
Exhibits faith in client’s capacity for change, encourages and celebrates their recovery achievements, and mobilises internal and external recovery.
Encourages the client’s self-advocacy and economic self-sufficiency.
Ally and confidant:
Genuinely cares and listens to the client, can be trusted with confidences, and can identify areas of potential growth.
Provides feedback on the recovery progress.
Identifies areas which have presented or may present roadblocks to continued abstinence.
Role model and mentor:
Offers their life as living proof of the transformative power of recovery and provides stage-appropriate recovery education.
Facilitates the transition from a professionally directed treatment plan to a client-developed and directed personal recovery plan.
Assists in structuring daily activities around this plan.
Helps resolve personal and environmental obstacles to recovery.
Is knowledgeable of information, for individuals or for their families, about sources of sober housing, recovery conducive employment, health and social services, and recovery support.
Matches the individuals with particular support groups or twelve-step meetings.
Monitor or companion:
When the client will be best served with regular, around the clock attendance, or attendance for a set number of hours per day, the client may need a sober companion.
This companion can be available for travel in and out of the country.
The sober companion processes each client’s response to professional services and mutual aid exposures to enhance engagement, reduce attrition, and resolve problems in the relationship.
The companion provides early re-intervention and recovery re-initiation services.
Introduces newcomers into the culture of recovery; provides an orientation to recovery roles, rules, rituals, language, etiquette; and opens doors for opportunities for community participation.
Provides an invaluable service for those resistant to remaining abstinent from drugs and/or alcohol, but who must do so due to legal, medical, family or contractual obligations.
Helps the individual’s families navigate complex social, service and legal systems.
Provides a client with normative information about the stages of recovery.
They can facilitate the process necessary to remain free from the addiction, inform client of the professional helpers within the community and about the prevalence, pathways, and lifestyles of long-term recovery.
Every member of the community support centre helps develop and expand recovery support resources, enhances cooperative relationships between professional service organisations and local recovery support groups, cultivates opportunities for people in recovery to participate in volunteerism, and performs other acts of service to the community.
Supports the client through challenges arising from everyday activities.
For some, this is done through several one-on-one sessions each week, while some clients prefer daily telephone contact.
Assists individuals and their families to develop sobriety-based rituals of daily living; and encourages activities across religious, spiritual, and secular frameworks that enhance life’s meaning and purpose.
Provides sober companionship; a social bridge from the culture of addiction and mental illness to the culture of recovery.
In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic. Members with the same issues can come together for sharing coping strategies, to feel more empowered and for a sense of community.
Help may take the form of providing and evaluating relevant information, relating personal experiences, listening to and accepting others’ experiences, providing sympathetic understanding and establishing social networks.
A support group may also work to inform the public or engage in advocacy.
Formal support groups may appear to be a modern phenomenon, but they supplement traditional fraternal organisations such as Freemasonry in some respects, and may build on certain supportive functions (formerly) carried out in (extended) families.
Other types of groups formed to support causes, including causes outside of themselves, are more often called advocacy groups, interest groups, lobby groups, pressure groups or promotional groups. Trade unions and many environmental groups, for example, are interest groups.
The term support group in this article refers to peer-to-peer support.
Support groups maintain interpersonal contact among their members in a variety of ways. Traditionally, groups meet in person in sizes that allow conversational interaction. Support groups also maintain contact through printed newsletters, telephone chains, internet forums, and mailing lists. Some support groups are exclusively online (see below).
Membership in some support groups is formally controlled, with admission requirements and membership fees. Other groups are “open” and allow anyone to attend an advertised meeting, for example, or to participate in an online forum.
Management by Peers or Professionals
A self-help support group is fully organised and managed by its members, who are commonly volunteers and have personal experience in the subject of the group’s focus. These groups may also be referred to as fellowships, peer support groups, lay organisations, mutual help groups, or mutual aid self-help groups. Most common are 12-step groups such as Alcoholics Anonymous and self-help groups for mental health.
Professionally operated support groups are facilitated by professionals who most often do not share the problem of the members, such as social workers, psychologists, or members of the clergy. The facilitator controls discussions and provides other managerial service. Such professionally operated groups are often found in institutional settings, including hospitals, drug-treatment centres and correctional facilities. These types of support group may run for a specified period of time, and an attendance fee is sometimes charged.
Types of Support Group
In the case of a disease, an identity or a pre-disposition, for example, a support group will provide information, act as a clearing-house for experiences, and may serve as a public relations voice for sufferers, other members, and their families. Groups for high IQ or LGBTQIA+ individuals, for example, differ in their inclusivity, but both connect people on the basis of identity or pre-disposition.
For more temporary concerns, such as bereavement or episodic medical conditions, a support group may veer more towards helping those involved to overcome or push through their condition/experience.
Some support groups and conditions for which such groups may be formed are:
Sexual abuse survivors.
Online Support Groups
Since at least 1982, the Internet has provided a venue for support groups. Discussing online self-help support groups as the precursor to e-therapy, Martha Ainsworth notes that “the enduring success of these groups has firmly established the potential of computer-mediated communication to enable discussion of sensitive personal issues.”
In one study of the effectiveness of online support groups among patients with head and neck cancer, longer participation in online support groups were found to result in a better health-related quality of life.
Appropriate Groups Still Difficult to Find
A researcher from University College London says the lack of qualitative directories, and the fact that many support groups are not listed by search engines can make finding an appropriate group difficult. Even so, he does say that the medical community needs “to understand the use of personal experiences rather than an evidence-based approach… these groups also impact on how individuals use information. They can help people learn how to find and use information: for example, users swap Web sites and discuss Web sites.”
It is not difficult to find an online support group, but it is hard to find a good one. In the article What to Look for in Quality Online Support Groups, John M. Grohol gives tips for evaluating online groups and states: “In good online support groups, members stick around long after they’ve received the support they were seeking. They stay because they want to give others what they themselves found in the group. Psychologists call this high group cohesion, and it is the pinnacle of group achievement.”
Benefits and Pitfalls
Several studies have shown the importance of the Internet in providing social support, particularly to groups with chronic health problems. Especially in cases of uncommon ailments, a sense of community and understanding in spite of great geographical distances can be important, in addition to sharing of knowledge.
Online support groups, online communities for those affected by a common problem, give mutual support and provide information, two often inseparable features. They are, according to Henry Potts of University College London, “an overlooked resource for patients.” Many studies have looked at the content of messages, while what matters is the effect that participation in the group has on the individual. Potts complains that research on these groups has lagged behind, particularly on the groups which are set up by the people with the problems, rather than by researchers and healthcare professionals. User-defined groups can share the sort of practical knowledge that healthcare professionals can overlook, and they also impact on how individuals find, interpret and use information.
There are many benefits to online support groups that have been found through research studies. Although online support group users are not required to be anonymous, a study conducted by Baym (2010) finds that anonymity is beneficial to those who are lonely or anxious. This does not pertain to some people seeking support groups, because not all are lonely and/or anxious, but for those who are, online support groups are a great outlet where one can feel comfortable honestly expressing themselves because the other users do not know who they are.
A study was conducted by Walther and Boyd (2000) and they found a common trend to why people find online support groups appealing. First, the social distance between members online reduced embarrassment and they appreciated the greater range of expertise offered in the larger online social network. Next, they found that anonymity increased one’s confidence in providing support to others and decreased embarrassment. The users of the social support websites were more comfortable being able to reread and edit their comments and discussion forum entries before sending them, and they have access to the website any time during the day. Each of these characteristics of online support groups are not offered when going to an in-person support group.
In a study conducted by Gunther Eysenbach, John Powell, Marina Englesakis, Carlos Rizo, and Anita Stern (2004), the researchers found it difficult to draw conclusions on the effectiveness of online peer-to-peer support groups. In online support groups, people must have the desire to support and help each other, and many times participants go on the sites in order to get help themselves or are limited to a certain subgroup.
An additional benefit to online support groups is that participation is asynchronous. This means that it is not necessary for all participants to be logged into the forum simultaneously in order to communicate. An experience or question can be posted and others can answer questions or comment on posts whenever they are logged in and have an appropriate response. This characteristic allows for participation and mass communication without having to worry about time constraints. Additionally, there are 24-hour chat rooms and spaces for focused conversation at all times of the day or night. This allows users to get the support they need whenever they need it, while remaining comfortable and, if they so wish, anonymous.
Although there has been relatively little research on the effectiveness of online support groups in mental health, there is some evidence that online support groups can be beneficial. Large randomised controlled trials have both found positive effects and failed to find positive effects.
Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters (although it can be provided by peers without training), and can take a number of forms such as peer mentoring, reflective listening (reflecting content and/or feelings), or counselling. Peer support is also used to refer to initiatives where colleagues, members of self-help organisations and others meet, in person or online, as equals to give each other connection and support on a reciprocal basis.
Peer support is distinct from other forms of social support in that the source of support is a peer, a person who is similar in fundamental ways to the recipient of the support; their relationship is one of equality. A peer is in a position to offer support by virtue of relevant experience: they have “been there, done that” and can relate to others who are now in a similar situation. Trained peer support workers such as peer support specialists and peer counsellors receive special training and are required to obtain Continuing Education Units, like clinical staff. Some other trained peer support workers may also be law-enforcement personnel and firefighters as well as emergency medical responders.
The effectiveness of peer support is believed to derive from a variety of psychosocial processes described best by Dr. Karen Fortuna in 2019 as “social support, experiential knowledge, social learning theory, social comparison theory, the helper-therapy principle, and self-determination theory.”
Social support is the existence of positive psychosocial interactions with others with whom there is mutual trust and concern. Positive relationships contribute to positive adjustment and buffer against stressors and adversities by offering:
Emotional support (esteem, attachment, and reassurance);
Instrumental support (material goods and services);
Information support (advice, guidance, and feedback).
Experiential knowledge is specialised information and perspectives that people obtain from living through a particular experience such as substance abuse, a physical disability, chronic physical or mental illness, or a traumatic event such as combat, a natural disaster, domestic violence or a violent crime, sexual abuse, or imprisonment.
Experiential knowledge tends to be unique and pragmatic and when shared contributes to solving problems and improving quality of life.
Social learning theory postulates that peers, because they have undergone and survived relevant experiences, are more credible role models for others.
Interactions with peers who are successfully coping with their experiences or illness are more likely to result in positive behaviour change.
Social comparison means that individuals are more comfortable interacting with others who share common characteristics with themselves, such as a psychiatric illness, in order to establish a sense of normalcy.
By interacting with others who are perceived to be better than them, peers are given a sense of optimism and something to strive toward.
The helper-therapy principle proposes that there are four significant benefits to those who provide peer support:
Increased sense of interpersonal competence as a result of making an impact on another person’s life;
Development of a sense of equality in giving and taking between himself or herself and others;
Helper gains new personally-relevant knowledge while helping; and
The helper receives social approval from the person they help, and others.
Self-determination means that individuals have the right to determine their own future – people are more likely to act on their own decisions rather than decisions made by others for them.
Peer mentoring takes place in learning environments such as schools, usually between an older more experienced student and a new student. Peer mentors appear mainly in secondary schools where students moving up from primary schools may need assistance in settling into the whole new schedule and lifestyle of secondary school life. Peer mentoring is also used in the workplace as a means of orienting new employees. New employees who are paired with a peer mentor are twice as likely to remain in their job than those who do not receive mentorship.
This form of peer support is widely used within schools. Peer supporters are trained, normally from within schools or universities, or sometimes by outside organisations, such as Childline’s CHIPS (Childline In Partnership With Schools) programme, to be “active listeners”. Within schools, peer supporters are normally available at break or lunch times.
Peer mediation is a means of handling incidents of bullying by bringing the victim and the bully together under mediation by one of their peers.
Peer Helper in Sports
A peer helper in sports works with young adults in sports such as football, soccer, track, volleyball, baseball, cheerleading, swimming, and basketball. They may provide help with game tactics (e.g. keeping your eye on the ball), emotional support, training support, and social support.
Peer support can occur within, outside or around traditional mental health services and programmes, between two people or in groups. Peer support is increasingly being offered through digital health like text messaging and smartphone apps. Peer support is a key concept in the recovery approach and in consumer-operated services programmes. Consumers/clients of mental health programmes have also formed non-profit self-help organisations, and serve to support each other and to challenge associated stigma and discrimination. The role of peer workers in mental health services was the subject of a conference in London in April 2012, jointly organised by the Centre for Mental Health and the NHS Confederation. Research has shown that peer-run self-help groups yield improvement in psychiatric symptoms resulting in decreased hospitalisation, larger social support networks and enhanced self-esteem and social functioning. There is considerable variety in the ways that peer support is defined and conceptualised as it relates to mental health services. In some cases, clinicians, psychiatrists, and other staff who do not necessarily have their own experiences of receiving psychiatric treatment are being trained, often by psychiatric survivors, in peer support as an approach to building relationships that are genuine, mutual, and non-coercive.
For Anxiety and Depression
In Canada, the LEAF (Living Effectively with Anxiety and Fear) Programme is a peer-led support group for cognitive-behavioural therapy of persons with mild to moderate panic disorders.
In a 2011 meta-analysis of seven randomised trials that compared a peer support intervention to group cognitive-behavioural therapy in patients suffering from depression, peer support interventions were found to improve depression symptoms more than usual care alone and results may be comparable to those of group cognitive behavioural therapy. These findings suggest that peer support interventions have the potential to be effective components of depression care, and they support the inclusion of peer support in recovery-oriented mental health treatment.
Several studies have shown that peer support reduces fear during stressful situations such as combat and domestic violence and may mitigate posttraumatic stress disorder. The 1982 Vietnam-Era Veterans Adjustment Survey showed that PTSD was highest in those men and women who lacked positive social support from family, friends, and society in general.
For First Responders
Peer support programmes have also been implemented to address stress and psychological trauma among law-enforcement personnel and firefighters as well as emergency medical responders. Peer support is an important component of the critical incident stress management programme used to alleviate stress and trauma among disaster first responders.
For Survivors of Trauma
Peer support has been used to help survivors of trauma, such as refugees, cope with stress and deal with difficult living conditions. Peer support is integral to the services provided by the National Centre for Trauma-Informed Care. Other programmes have been designed for female victims of domestic violence and for women in prison.
Survivor Corps defines peer support for trauma survivors as “Encouragement and assistance provided by a colleague who has overcome similar difficulties to engender self-confidence and autonomy and to enable the survivor to make his or her own decisions and implement them.” Peer support is a fundamental strategy in the rehabilitation of landmine survivors in Afghanistan, Bosnia, El Salvador and Vietnam. A study of 470 amputee survivors of war-related violence in six countries showed that nearly one hundred percent said they had benefited from peer support.
A peer support program operated by the Centre d’Encadrement et de Développement des Anciens Combattants in Burundi with support from the Centre for International Stabilization and Recovery and Action on Armed Violence has assisted survivors of war-related violence, including women with disabilities, and female ex-combatants since 2010. A similar programme in Rwanda works with survivors of the Rwandan genocide. Peer support has been recommended as a fundamental part of victim assistance programmes for survivors of war-related violence.
A 1984 study on the impact of peer support and support groups for victims of domestic violence showed that 146 battered women found women’s peer support groups the most helpful source of a range of available treatments. The women in these groups appeared to give direct advice and to act as role models. A 1986 study on 70 adolescent mothers considered to be at risk for domestic violence showed that peer support improved cognitive problem-solving skills, self-reinforcement, and parenting competence.
Pandora’s Aquarium, an online support group operating as part of Pandora’s Project, offers peer support to survivors of rape and sexual abuse and their friends and family.
Twelve-step programmes for overcoming substance misuse and other addiction recovery groups are often based on peer support. Since the 1930s Alcoholics Anonymous has promoted peer support between new members and their sponsors: “The process of sponsorship is this: an alcoholic who has made some progress in the recovery programme shares that experience on a continuous, individual basis with another alcoholic who is attempting to attain or maintain sobriety through AA.” Other addiction recovery programmes rely on peer support without following the twelve-step model.
In Chronic Illness
Peer support has been beneficial for many people living with diabetes. Diabetes encompasses all aspects of people’s lives, often for decades. Support from peers can offer emotional, social, and practical assistance that helps people do the things they need to do to stay healthy. Peer support groups for diabetics complement and enhance other health care services. J.F. Caro is the co-founder and Chief Scientific Officer of one of such groups named Peer for Progress.
Peer support has also been provided for people with cancer and HIV. The Breast Cancer Network of Strength trains peer counsellors to work with breast cancer survivors.
For People with Disabilities
Peer support is considered to be a key component of the independent living movement and has been widely used by organisations that work with people with disabilities, including the Amputee Coalition of America (ACA) and Survivor Corps. Since 1998 the ACA has operated a National Peer Network for survivors of limb loss. The Blinded Veterans Association has recently launched Operation Peer Support (OPS), a programme designed to support men and women returning to the US blinded or experiencing significant visual impairment in connection with their military service. Peer support has also benefited survivors of traumatic brain injury and their families. There is also FacingDisability for Families Facing Spinal Cord Injuries, which has a peer counselling programme in addition to 1,000 videos drawn from interviews of people with spinal cord injuries, their families, caregivers and experts.
For Veterans and Their Families
Several programmes exist that provide peer support for military veterans in the US and Canada. In 2010 the Military Women to Women Peer Support Group was established in Helena, Montana.
The Tragedy Assistance Programme for Survivors (TAPS) provides peer support, crisis care, casualty casework assistance, and grief and trauma resources for families of members of the US military. Operation Peer Support (OPS) is a programme for US military veterans who were blinded or have significant visual impairment.
In January 2013 Senator Patty Murray, Chairman of the United States Senate Committee on Veterans’ Affairs, sponsored an amendment of the National Defence Authorisation Act (S.3254) that would require peer counselling as part of a comprehensive suicide prevention programme for US veterans.
For Veterans with PTSD
Peer support outreach for those exposed to traumatic events refers to programmes that seek to identify and reach out to those suffering from or at risk for mental health problems following a traumatic event as a means of connecting those people to mental health services. Paraprofessional peers are defined as having a shared background as the target population and work closely with and supplement the services of the mental healthcare team. These peers are trained in certain interventions (such as Psychological/Mental Health First Aid) and are closely supervised by professional mental healthcare personnel. Peer support for recovery from PTSD refers to programmes in which someone with lived experience of PTSD, who experienced a significant reduction in symptoms, provides formal services to those who have not yet made significant steps in recovery from his or her condition. The peer support for recovery model focuses on improvement in overall health and wellness, and has long been successful in the treatment of SMI (serious mental illness) but is relatively new for PTSD.
A further review of existing literature found that carefully recruited, trained, supervised, and supported paraprofessionals can deliver mental health interventions effectively, and may be valuable in communities with fewer resources for mental healthcare.
Researchers at the Palo Alto VA National Center for PTSD also conducted focus groups at the VA Palo Alto Health Care System Trauma Recovery Programmes, a PTSD Residential Rehabilitation Programme, and a Women’s Trauma Recovery Programme to determine veteran and staff perceptions of informal peer support interventions already in place. Four themes were identified, including:
Peer support contributing to a feeling of social connectedness;
Positive role modelling by the peer support provider;
Peer support augmenting care offered by professional providers; and
Peer supporter acting as a ‘culture broker’ and orienting recipients to mental health treatment.
These findings have been put into practice through a peer support programme for veterans in the Sonora, Stockton, and Modesto VA outpatient clinics. The clinics are part of the Palo Alto Veterans Affairs Healthcare System that extend to more rural parts of northern California. The program is funded through grants in support of new treatment approaches to serve veterans in rural, traditionally underserved areas. Leadership for the program comes from the Menlo Park division of the Palo Alto VA system.
The peer support programme has been operational since 2012 with over 268 unique veterans seen between 2012 and 2015. The two peer support providers involved in the programme are veterans of the Vietnam and Iraq wars, respectively, and after having recovered from their own mental health disorders utilize their experiences to help their fellow veterans. The two providers have been responsible for leading between 5 and 7 groups each week as well as conducting telephone outreach and one-on-one engagement visits. These services have successfully helped to augment the often overburdened mental health treatment teams at the central valley outpatient VA clinics.
The peer support programme has been described in several publications. A personal story of success was featured in Stanford Medicine magazine and the collaborative nature of the programme was described in the recently published book, Partnerships for Mental Health.
For People at Work
Trauma risk management (TRiM) is a work-place based peer support for use in helping to protect the mental health of employees who have been exposed to traumatic stress. The TRiM process enables non-healthcare staff to monitor and manage colleagues. TRiM peer support training provides TRiM Practitioners with a background understanding of psychological trauma and its effects. TRiM was developed in the UK by military mental health professionals including Professor Neil Greenberg. There have been numerous scientific publications into the use of TRiM which have demonstrated it to be an acceptable and effective method of peer support. Similar to TRiM, the sustaining resilience at work (StRaW) peer support system is delivered by trained peers who are able to assist colleagues exposed to significant non-traumatic stressors, originating either at work or at home, and either support and mentor them or help them access professional support. StRaW was developed by March on Stress Ltd and early research again shows it to be a credible and effective way of supporting staff at work.
Several peer based organisations exist for sex workers. The aim of these organisations is to support the health, rights and well being of sex workers and advocate on their behalf for law reform in order to make working safer. Sex work is work and there are many people who willingly choose it as a job/career. While sex trafficking does exist, not everyone who does sex work is doing so under duress. Social stigma is a major hurdle sex workers encounter, with many people trying to ‘save’ them. Peer support workers and peer educators are seen as best practice by the Sex Industry Network (SIN) when engaging with community members because peers can understand that someone could willingly choose to do sex work.