What are Personal Boundaries?

Introduction

Personal boundaries or the act of setting boundaries is a life skill that has been popularised by self help authors and support groups since the mid 1980s.

It is the practice of openly communicating and asserting personal values as way to preserve and protect against having them compromised or violated. The term “boundary” is a metaphor – with in-bounds meaning acceptable and out-of-bounds meaning unacceptable. Without values and boundaries our identities become diffused and often controlled by the definitions offered by others. The concept of boundaries has been widely adopted by the counselling profession.

Usage and Application

This life skill is particularly applicable in environments with controlling people or people not taking responsibility for their own life.

Co-Dependents Anonymous recommends setting limits on what members will do to and for people and on what members will allow people to do to and for them, as part of their efforts to establish autonomy from being controlled by other people’s thoughts, feelings and problems.

The National Alliance on Mental Illness (NAMI) tells its members that establishing and maintaining values and boundaries will improve the sense of security, stability, predictability and order, in a family even when some members of the family resist. NAMI contends that boundaries encourage a more relaxed, non-judgemental atmosphere and that the presence of boundaries need not conflict with the need for maintaining an understanding atmosphere.

Overview

The three critical aspects of managing personal boundaries are:

AspectOutline
Defining ValuesA healthy relationship is an “inter-dependent” relationship of two “independent” people. Healthy individuals should establish values that they honour and defend regardless of the nature of a relationship (core or independent values). Healthy individuals should also have values that they negotiate and adapt in an effort to bond with and collaborate with others (inter-dependent values).
Asserting BoundariesIn this model, individuals use verbal and nonverbal communications to assert intentions, preferences and define what is inbounds and out-of-bounds with respect to their core or independent values. When asserting values and boundaries, communications should be present, appropriate, clear, firm, protective, flexible, receptive, and collaborative.
Honouring and DefendingMaking decision consistent with the personal values when presented with life choices or confronted or challenged by controlling people or people not taking responsibility for their own life.

Having healthy values and boundaries is a lifestyle, not a quick fix to an relationship dispute.

Values are constructed from a mix of conclusions, beliefs, opinions, attitudes, past experiences and social learning. Jacques Lacan considers values to be layered in a hierarchy, reflecting “all the successive envelopes of the biological and social status of the person” from the most primitive to the most advanced.

Personal values and boundaries operate in two directions, affecting both the incoming and outgoing interactions between people. These are sometimes referred to as the ‘protection’ and ‘containment’ functions.

Scope

The three most commonly mentioned categories of values and boundaries are:

  • Physical: Personal space and touch considerations; physical intimacy.
  • Mental: Thoughts and opinions.
  • Emotional: Feelings; emotional intimacy.

Some authors have expanded this list with additional or specialised categories such as spirituality, truth, and time/punctuality.

Assertiveness Levels

Nina Brown proposed four boundary types:

Boundary TypeOutline
SoftA person with soft boundaries merges with other people’s boundaries. Someone with a soft boundary is easily a victim of psychological manipulation.
SpongyA person with spongy boundaries is like a combination of having soft and rigid boundaries. They permit less emotional contagion than soft boundaries but more than those with rigid. People with spongy boundaries are unsure of what to let in and what to keep out.
RigidA person with rigid boundaries is closed or walled off so nobody can get close either physically or emotionally. This is often the case if someone has been the victim of physical, emotional, psychological, or sexual abuse. Rigid boundaries can be selective which depend on time, place or circumstances and are usually based on a bad previous experience in a similar situation.
FlexibleSimilar to spongy rigid boundaries but the person exercises more control. The person decides what to let in and what to keep out, is resistant to emotional contagion and psychological manipulation, and is difficult to exploit.

Unilateral vs Collaborative

There are also two main ways that boundaries are constructed:

  • Unilateral boundaries: One person decides to impose a standard on the relationship, regardless of whether others support it. For example, one person may decide to never mention an unwanted subject and to make a habit of leaving the room, ending phone calls, or deleting messages without replying if the subject is mentioned by others.
  • Collaborative boundaries: Everyone in the relationship group agrees, either tacitly or explicitly, that a particular standard should be upheld. For example, the group may decide not to discuss an unwanted subject, and then all members individually avoid mentioning it and work together to change the subject if someone mentions it.

Setting boundaries does not always require telling anyone what the boundary is or what the consequences are for transgressing it. For example, if a person decides to leave a discussion, that person may give an unrelated excuse, such as claiming that it’s time to do something else, rather than saying that the subject must not be mentioned.

Situations that can Challenge Personal Boundaries

Communal Influences

Freud described the loss of conscious boundaries that may occur when an individual is in a unified, fast-moving crowd.

Almost a century later, Steven Pinker took up the theme of the loss of personal boundaries in a communal experience, noting that such occurrences could be triggered by intense shared ordeals like hunger, fear or pain, and that such methods were traditionally used to create liminal conditions in initiation rites. Jung had described this as the absorption of identity into the collective unconscious.

Rave culture has also been said to involve a dissolution of personal boundaries, and a merger into a binding sense of communality.

Unequal Power Relationships

Also unequal relations of political and social power influence the possibilities for marking cultural boundaries and more generally the quality of life of individuals. Unequal power in personal relationships, including abusive relationships, can make it difficult for individuals to mark boundaries.

Dysfunctional Families

Overly Demanding ParentsIn the dysfunctional family the child learns to become attuned to the parent’s needs and feelings instead of the other way around.
Overly Demanding ChildrenParenting is a role that requires a certain amount of self-sacrifice and giving a child’s needs a high priority. A parent can, nevertheless, be codependent towards a child if the caretaking or parental sacrifice reaches unhealthy or destructive levels.
Codependent RelationshipsCodependency often involves placing a lower priority on one’s own needs, while being excessively preoccupied with the needs of others. Codependency can occur in any type of relationship, including family, work, friendship, and also romantic, peer or community relationships.
While a healthy relationship depends on the emotional space provided by personal boundaries, codependent personalities have difficulties in setting such limits, so that defining and protecting boundaries efficiently may be for them a vital part of regaining mental health.
In a codependent relationship, the codependent’s sense of purpose is based on making extreme sacrifices to satisfy their partner’s needs. Codependent relationships signify a degree of unhealthy clinginess, where one person does not have self-sufficiency or autonomy. One or both parties depend on the other for fulfilment. There is usually an unconscious reason for continuing to put another person’s life first - often the mistaken notion that self-worth comes from other people.
Mental Illness in the FamilyPeople with certain mental conditions are predisposed to controlling behaviour including those with obsessive compulsive disorder, paranoid personality disorder, borderline personality disorder, and narcissistic personality disorder, attention deficit disorder, and the manic state of bipolar disorder.
Borderline personality disorder (BPD): There is a tendency for loved ones of people with BPD to slip into caretaker roles, giving priority and focus to problems in the life of the person with BPD rather than to issues in their own lives. Too often in these relationships, the codependent will gain a sense of worth by being “the sane one” or “the responsible one”. Often, this shows up prominently in families with strong Asian cultures because of beliefs tied to the cultures.
Narcissistic personality disorder (NPD): For those involved with a person with NPD, values and boundaries are often challenged as narcissists have a poor sense of self and often do not recognise that others are fully separate and not extensions of themselves. Those who meet their needs and those who provide gratification may be treated as if they are part of the narcissist and expected to live up to their expectations.


Anger

Anger is a normal emotion that involves a strong uncomfortable and emotional response to a perceived provocation. Often, it indicates when one’s personal boundaries are violated. Anger may be utilised effectively by setting boundaries or escaping from dangerous situations.

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What is Social Support?

Introduction

Social support is the perception and actuality that one is cared for, has assistance available from other people, and most popularly, that one is part of a supportive social network. These supportive resources can be:

  • Emotional (e.g. nurturance);
  • Informational (e.g. advice);
  • Companionship (e.g. sense of belonging);
  • Tangible (e.g. financial assistance); and/or
  • Intangible (e.g. personal advice).

Social support can be measured as the perception that one has assistance available, the actual received assistance, or the degree to which a person is integrated in a social network. Support can come from many sources, such as family, friends, pets, neighbours, co-workers, organisations, etc.

Government-provided social support may be referred to as public aid in some nations.

Social support is studied across a wide range of disciplines including psychology, communications, medicine, sociology, nursing, public health, education, rehabilitation, and social work. Social support has been linked to many benefits for both physical and mental health, but “social support” (e.g. gossiping about friends) is not always beneficial.

Social support theories and models were prevalent as intensive academic studies in the 1980s and 1990s, and are linked to the development of caregiver and payment models, and community delivery systems in the US and around the world. Two main models have been proposed to describe the link between social support and health: the buffering hypothesis and the direct effects hypothesis. Gender and cultural differences in social support have been found in fields such as education “which may not control for age, disability, income and social status, ethnic and racial, or other significant factors”.

Refer to Social Support Questionnaire, Communal Coping, and Invisible Support.

Categories and Definitions

Distinctions in Measurement

Social support can be categorised and measured in several different ways.

There are four common functions of social support:

  • Emotional support is the offering of empathy, concern, affection, love, trust, acceptance, intimacy, encouragement, or caring. It is the warmth and nurturance provided by sources of social support. Providing emotional support can let the individual know that he or she is valued.
  • Tangible support is the provision of financial assistance, material goods, or services. Also called instrumental support, this form of social support encompasses the concrete, direct ways people assist others.
  • Informational support is the provision of advice, guidance, suggestions, or useful information to someone. This type of information has the potential to help others problem-solve.
  • Companionship support is the type of support that gives someone a sense of social belonging (and is also called belonging). This can be seen as the presence of companions to engage in shared social activities. Formerly, it was also referred to as “esteem support” or “appraisal support,” but these have since developed into alternative forms of support under the name “appraisal support” along with normative and instrumental support.

Researchers also commonly make a distinction between perceived and received support. Perceived support refers to a recipient’s subjective judgement that providers will offer (or have offered) effective help during times of need. Received support (also called enacted support) refers to specific supportive actions (e.g. advice or reassurance) offered by providers during times of need.

Furthermore, social support can be measured in terms of structural support or functional support. Structural support (also called social integration) refers to the extent to which a recipient is connected within a social network, like the number of social ties or how integrated a person is within his or her social network. Family relationships, friends, and membership in clubs and organisations contribute to social integration. Functional support looks at the specific functions that members in this social network can provide, such as the emotional, instrumental, informational, and companionship support listed above. Data suggests that emotional support may play a more significant role in protecting individuals from the deleterious effects of stress than structural means of support, such as social involvement or activity.

These different types of social support have different patterns of correlations with health, personality, and personal relationships. For example, perceived support is consistently linked to better mental health whereas received support and social integration are not. In fact, research indicates that perceived social support that is untapped can be more effective and beneficial than utilised social support. Some have suggested that invisible support, a form of support where the person has support without his or her awareness, may be the most beneficial. This view has been complicated, however, by more recent research suggesting the effects of invisible social support – as with visible support – are moderated by provider, recipient, and contextual factors such as recipients’ perceptions of providers’ responsiveness to their needs, or the quality of the relationship between the support provider and recipient.

Sources

Social support can come from a variety of sources, including (but not limited to): family, friends, romantic partners, pets, community ties, and co-workers. Sources of support can be natural (e.g. family and friends) or more formal (e.g. mental health specialists or community organisations). The source of the social support is an important determinant of its effectiveness as a coping strategy. Support from a romantic partner is associated with health benefits, particularly for men. However, one study has found that although support from spouses buffered the negative effects of work stress, it did not buffer the relationship between marital and parental stresses, because the spouses were implicated in these situations. However, work-family specific support worked more to alleviate work-family stress that feeds into marital and parental stress. Employee humour is negatively associated with burnout, and positively with, stress, health and stress coping effectiveness. Additionally, social support from friends did provide a buffer in response to marital stress, because they were less implicated in the marital dynamic.

Early familial social support has been shown to be important in children’s abilities to develop social competencies, and supportive parental relationships have also had benefits for college-aged students. Teacher and school personnel support have been shown to be stronger than other relationships of support. This is hypothesized to be a result of family and friend social relationships to be subject to conflicts whereas school relationships are more stable.

Online Social Support

Social support is also available among social media sites. As technology advances, the availability for online support increases. Social support can be offered through social media websites such as blogs, Facebook groups, health forums, and online support groups.

Early theories and research into Internet use tended to suggest negative implications for offline social networks (e.g. fears that Internet use would undermine desire for face-to-face interaction) and users’ well-being. However, additional work showed null or even positive effects, contributing to a more nuanced understanding of online social processes. Emerging data increasingly suggest that, as with offline support, the effects of online social support are shaped by support provider, recipient, and contextual factors. For example, the interpersonal-connection-behaviours framework reconciles conflicts in the research literature by suggesting that social network site use is likely to contribute to well-being when users engage in ways that foster meaningful interpersonal connection. Conversely, use may harm well-being when users engage in passive consumption of social media.

Online support can be similar to face-to-face social support, but may also offer convenience, anonymity, and non-judgmental interactions. Online sources such as social media may be less redundant sources of social support for users with relatively little in-person support compared to persons with high in-person support. Online sources may be especially important as potential social support resources for individuals with limited offline support, and may be related to physical and psychological well-being. However, socially isolated individuals may also be more drawn to computer-mediated vs. in-person forms of interaction, which may contribute to bidirectional associations between online social activity and isolation or depression.

Support sought through social media can also provide users with emotional comfort that relates them to others while creating awareness about particular health issues. Research conducted by Winzelberg et al. evaluated an online support group for women with breast cancer finding participants were able to form fulfilling supportive relationships in an asynchronous format and this form of support proved to be effective in reducing participants’ scores on depression, perceived stress, and cancer-related trauma measures. This type of online communication can increase the ability to cope with stress. Social support through social media is potentially available to anyone with Internet access and allows users to create relationships and receive encouragement for a variety of issues, including rare conditions or circumstances.

Coulson claims online support groups provide a unique opportunity for health professionals to learn about the experiences and views of individuals. This type of social support can also benefit users by providing them with a variety of information. Seeking informational social support allows users to access suggestions, advice, and information regarding health concerns or recovery. Many need social support, and its availability on social media may broaden access to a wider range of people in need. Both experimental and correlational research have indicated that increased social network site use can lead to greater perceived social support and increased social capital, both of which predict enhanced well-being.

An increasing number of interventions aim to create or enhance social support in online communities. While preliminary data often suggest such programmes may be well-received by users and may yield benefits, additional research is needed to more clearly establish the effectiveness of many such interventions.

Until the late 2010s, research examining online social support tended to use ad hoc instruments or measures that were adapted from offline research, resulting in the possibility that measures were not well-suited for measuring online support, or had weak or unknown psychometric properties. Instruments specifically developed to measure social support in online contexts include the Online Social Support Scale (which has sub scales for esteem/emotional support, social companionship, informational support, and instrumental support) and the Online Social Experiences Measure (which simultaneously assesses positive and negative aspects of online social activity and has predictive validity regarding cardiovascular implications of online social support).

Links to Mental and Physical Health

Benefits

Mental Health

Social support profile is associated with increased psychological well-being in the workplace and in response to important life events. There has been an ample amount of evidence showing that social support aids in lowering problems related to one’s mental health. As reported by Cutrona, Russell, and Rose, in the elderly population that was in their studies, their results showed that elderly individuals who had relationships where their self-esteem was elevated were less likely to have a decline in their health. In stressful times, social support helps people reduce psychological distress (e.g. anxiety or depression). Social support can simultaneously function as a problem-focused (e.g. receiving tangible information that helps resolve an issue) and emotion-focused coping strategy (e.g. used to regulate emotional responses that arise from the stressful event) Social support has been found to promote psychological adjustment in conditions with chronic high stress like HIV, rheumatoid arthritis, cancer, stroke, and coronary artery disease. Whereas a lack of social support has been associated with a risk for an individuals mental health. This study also shows that the social support acts as a buffer to protect individuals from different aspects in regards to their mental and physical health, such as helping against certain life stressors. Additionally, social support has been associated with various acute and chronic pain variables (for more information, see Chronic pain).

People with low social support report more sub-clinical symptoms of depression and anxiety than do people with high social support. In addition, people with low social support have higher rates of major mental disorder than those with high support. These include post traumatic stress disorder, panic disorder, social phobia, major depressive disorder, dysthymic disorder, and eating disorders. Among people with schizophrenia, those with low social support have more symptoms of the disorder. In addition, people with low support have more suicidal ideation, and more alcohol and (illicit and prescription) drug problems. Similar results have been found among children. Religious coping has especially been shown to correlate positively with positive psychological adjustment to stressors with enhancement of faith-based social support hypothesized as the likely mechanism of effect. However, more recent research reveals the role of religiosity/spirituality in enhancing social support may be overstated and in fact disappears when the personality traits of “agreeableness” and “conscientiousness” are also included as predictors.

In a 2013 study, Akey et al. did a qualitative study of 34 men and women diagnosed with an eating disorder and used the Health Belief Model (HBM) to explain the reasons for which they forgo seeking social support. Many people with eating disorders have a low perceived susceptibility, which can be explained as a sense of denial about their illness. Their perceived severity of the illness is affected by those to whom they compare themselves to, often resulting in people believing their illness is not severe enough to seek support. Due to poor past experiences or educated speculation, the perception of benefits for seeking social support is relatively low. The number of perceived barriers towards seeking social support often prevents people with eating disorders from getting the support they need to better cope with their illness. Such barriers include fear of social stigma, financial resources, and availability and quality of support. Self-efficacy may also explain why people with eating disorders do not seek social support, because they may not know how to properly express their need for help. This research has helped to create a better understanding of why individuals with eating disorders do not seek social support, and may lead to increased efforts to make such support more available. Eating disorders are classified as mental illnesses but can also have physical health repercussions. Creating a strong social support system for those affected by eating disorders may help such individuals to have a higher quality of both mental and physical health.

Various studies have been performed examining the effects of social support on psychological distress. Interest in the implications of social support were triggered by a series of articles published in the mid-1970s, each reviewing literature examining the association between psychiatric disorders and factors such as change in marital status, geographic mobility, and social disintegration. Researchers realised that the theme present in each of these situations is the absence of adequate social support and the disruption of social networks. This observed relationship sparked numerous studies concerning the effects of social support on mental health.

One particular study documented the effects of social support as a coping strategy on psychological distress in response to stressful work and life events among police officers. Talking things over among co-workers was the most frequent form of coping utilized while on duty, whereas most police officers kept issues to themselves while off duty. The study found that the social support between co-workers significantly buffered the relationship between work-related events and distress.

Other studies have examined the social support systems of single mothers. One study by D’Ercole demonstrated that the effects of social support vary in both form and function and will have drastically different effects depending upon the individual. The study found that supportive relationships with friends and co-workers, rather than task-related support from family, was positively related to the mother’s psychological well-being. D’Ercole hypothesizes that friends of a single parent offer a chance to socialise, match experiences, and be part of a network of peers. These types of exchanges may be more spontaneous and less obligatory than those between relatives. Additionally, co-workers can provide a community away from domestic life, relief from family demands, a source of recognition, and feelings of competence. D’Ercole also found an interesting statistical interaction whereby social support from co-workers decreased the experience of stress only in lower income individuals. The author hypothesizes that single women who earn more money are more likely to hold more demanding jobs which require more formal and less dependent relationships. Additionally, those women who earn higher incomes are more likely to be in positions of power, where relationships are more competitive than supportive.

Many studies have been dedicated specifically to understanding the effects of social support in individuals with post traumatic stress disorder (PTSD). In a study by Haden et al., when victims of severe trauma perceived high levels of social support and engaged in interpersonal coping styles, they were less likely to develop severe PTSD when compared to those who perceived lower levels of social support. These results suggest that high levels of social support alleviate the strong positive association between level of injury and severity of PTSD, and thus serves as a powerful protective factor. In general, data shows that the support of family and friends has a positive influence on an individual’s ability to cope with trauma. In fact, a meta-analysis by Brewin et al. found that social support was the strongest predictor, accounting for 40%, of variance in PTSD severity. However, perceived social support may be directly affected by the severity of the trauma. In some cases, support decreases with increases in trauma severity.

College students have also been the target of various studies on the effects of social support on coping. Reports between 1990 and 2003 showed college stresses were increasing in severity. Studies have also shown that college students’ perceptions of social support have shifted from viewing support as stable to viewing them as variable and fluctuating. In the face of such mounting stress, students naturally seek support from family and friends in order to alleviate psychological distress. A study by Chao found a significant two-way correlation between perceived stress and social support, as well as a significant three-way correlation between perceived stress, social support, and dysfunctional coping. The results indicated that high levels of dysfunctional coping deteriorated the association between stress and well-being at both high and low levels of social support, suggesting that dysfunctional coping can deteriorate the positive buffering action of social support on well-being. Students who reported social support were found more likely to engage in less healthy activities, including sedentary behaviour, drug and alcohol use, and too much or too little sleep. Lack of social support in college students is also strongly related to life dissatisfaction and suicidal behaviour.

Physical Health

Social support has a clearly demonstrated link to physical health outcomes in individuals, with numerous ties to physical health including mortality. People with low social support are at a much higher risk of death from a variety of diseases (e.g. cancer or cardiovascular disease). Numerous studies have shown that people with higher social support have an increased likelihood for survival.

Individuals with lower levels of social support have: more cardiovascular disease, more inflammation and less effective immune system functioning, more complications during pregnancy, and more functional disability and pain associated with rheumatoid arthritis, among many other findings. Conversely, higher rates of social support have been associated with numerous positive outcomes, including faster recovery from coronary artery surgery, less susceptibility to herpes attacks, a lowered likelihood to show age-related cognitive decline, and better diabetes control. People with higher social support are also less likely to develop colds and are able to recover faster if they are ill from a cold. There is sufficient evidence linking cardiovascular, neuroendocrine, and immune system function with higher levels of social support. Social support predicts less atherosclerosis and can slow the progression of an already diagnosed cardiovascular disease. There is also a clearly demonstrated link between social support and better immune function, especially in older adults. While links have been shown between neuroendocrine functionality and social support, further understanding is required before specific significant claims can be made. Social support is also hypothesized to be beneficial in the recovery from less severe cancers. Research focuses on breast cancers, but in more serious cancers factors such as severity and spread are difficult to measure in the context of impacts of social support. The field of physical health often struggles with the combination of variables set by external factors that are difficult to control, such as the entangled impact of life events on social support and the buffering impact these events have. There are serious ethical concerns involved with controlling too many factors of social support in individuals, leading to an interesting crossroads in the research.

Costs

Social support is integrated into service delivery schemes and sometimes are a primary service provided by governmental contracted entities (e.g. companionship, peer services, family caregivers). Community services known by the nomenclature community support, and workers by a similar title, Direct Support Professional, have a base in social and community support “ideology”. All supportive services from supported employment to supported housing, family support, educational support, and supported living are based upon the relationship between “informal and formal” supports, and “paid and unpaid caregivers”. Inclusion studies, based upon affiliation and friendship, or the conversely, have a similar theoretical basis as do “person-centred support” strategies.

Social support theories are often found in “real life” in cultural, music and arts communities, and as might be expected within religious communities. Social support is integral in theories of aging, and the “social care systems” have often been challenged (e.g. creativity throughout the lifespan, extra retirement hours). Ed Skarnulis’ (state director) adage, “Support, don’t supplant the family” applies to other forms of social support networks.

Although there are many benefits to social support, it is not always beneficial. It has been proposed that in order for social support to be beneficial, the social support desired by the individual has to match the support given to him or her; this is known as the matching hypothesis. Psychological stress may increase if a different type of support is provided than what the recipient wishes to receive (e.g. informational is given when emotional support is sought). Additionally, elevated levels of perceived stress can impact the effect of social support on health-related outcomes.

Other costs have been associated with social support. For example, received support has not been linked consistently to either physical or mental health; perhaps surprisingly, received support has sometimes been linked to worse mental health. Additionally, if social support is overly intrusive, it can increase stress. It is important when discussing social support to always consider the possibility that the social support system is actually an antagonistic influence on an individual.

Two Dominant Models

There are two dominant hypotheses addressing the link between social support and health: the buffering hypothesis and the direct effects hypothesis. The main difference between these two hypotheses is that the direct effects hypothesis predicts that social support is beneficial all the time, while the buffering hypothesis predicts that social support is mostly beneficial during stressful times. Evidence has been found for both hypotheses.

In the buffering hypothesis, social support protects (or “buffers”) people from the bad effects of stressful life events (e.g. death of a spouse, job loss). Evidence for stress buffering is found when the correlation between stressful events and poor health is weaker for people with high social support than for people with low social support. The weak correlation between stress and health for people with high social support is often interpreted to mean that social support has protected people from stress. Stress buffering is more likely to be observed for perceived support than for social integration or received support. The theoretical concept or construct of resiliency is associated with coping theories.

In the direct effects (also called main effects) hypothesis, people with high social support are in better health than people with low social support, regardless of stress. In addition to showing buffering effects, perceived support also shows consistent direct effects for mental health outcomes. Both perceived support and social integration show main effects for physical health outcomes. However, received (enacted) support rarely shows main effects.

Theories to Explain the Links

Several theories have been proposed to explain social support’s link to health. Stress and coping social support theory dominates social support research and is designed to explain the buffering hypothesis described above. According to this theory, social support protects people from the bad health effects of stressful events (i.e. stress buffering) by influencing how people think about and cope with the events. An example in 2018 are the effects of school shootings on the well being and future of children and children’s health. According to stress and coping theory, events are stressful insofar as people have negative thoughts about the event (appraisal) and cope ineffectively. Coping consists of deliberate, conscious actions such as problem solving or relaxation. As applied to social support, stress and coping theory suggests that social support promotes adaptive appraisal and coping. Evidence for stress and coping social support theory is found in studies that observe stress buffering effects for perceived social support. One problem with this theory is that, as described previously, stress buffering is not seen for social integration, and that received support is typically not linked to better health outcomes.

Relational regulation theory (RRT) is another theory, which is designed to explain main effects (the direct effects hypothesis) between perceived support and mental health. As mentioned previously, perceived support has been found to have both buffering and direct effects on mental health. RRT was proposed in order to explain perceived support’s main effects on mental health which cannot be explained by the stress and coping theory. RRT hypothesizes that the link between perceived support and mental health comes from people regulating their emotions through ordinary conversations and shared activities rather than through conversations on how to cope with stress. This regulation is relational in that the support providers, conversation topics and activities that help regulate emotion are primarily a matter of personal taste. This is supported by previous work showing that the largest part of perceived support is relational in nature.

Life-span theory is another theory to explain the links of social support and health, which emphasizes the differences between perceived and received support. According to this theory, social support develops throughout the life span, but especially in childhood attachment with parents. Social support develops along with adaptive personality traits such as low hostility, low neuroticism, high optimism, as well as social and coping skills. Together, support and other aspects of personality (“psychological theories”) influence health largely by promoting health practices (e.g. exercise and weight management) and by preventing health-related stressors (e.g. job loss, divorce). Evidence for life-span theory includes that a portion of perceived support is trait-like, and that perceived support is linked to adaptive personality characteristics and attachment experiences. Lifespan theories are popular from their origins in Schools of Human Ecology at the universities, aligned with family theories, and researched through federal centres over decades (e.g. University of Kansas, Beach Centre for Families; Cornell University, School of Human Ecology).

Of the Big Five Personality Traits, agreeableness is associated with people receiving the most social support and having the least-strained relationships at work and home. Receiving support from a supervisor in the workplace is associated with alleviating tensions both at work and at home, as are inter-dependency and idiocentrism of an employee.

Biological Pathways

Many studies have tried to identify biopsychosocial pathways for the link between social support and health. Social support has been found to positively impact the immune, neuroendocrine, and cardiovascular systems. Although these systems are listed separately here, evidence has shown that these systems can interact and affect each other.

  • Immune system: Social support is generally associated with better immune function. For example, being more socially integrated is correlated with lower levels of inflammation (as measured by C-reactive protein, a marker of inflammation), and people with more social support have a lower susceptibility to the common cold.
  • Neuroendocrine system: Social support has been linked to lower cortisol (“stress hormone”) levels in response to stress. Neuroimaging work has found that social support decreases activation of regions in the brain associated with social distress, and that this diminished activity was also related to lowered cortisol levels.
  • Cardiovascular system: Social support has been found to lower cardiovascular reactivity to stressors. It has been found to lower blood pressure and heart rates, which are known to benefit the cardiovascular system.

Though many benefits have been found, not all research indicates positive effects of social support on these systems. For example, sometimes the presence of a support figure can lead to increased neuroendocrine and physiological activity.

Support Groups

Refer to Support Group.

Social support groups can be a source of informational support, by providing valuable educational information, and emotional support, including encouragement from people experiencing similar circumstances. Studies have generally found beneficial effects for social support group interventions for various conditions, including Internet support groups. These groups may be termed “self help” groups in nation-states, may be offered by non-profit organisations, and in 2018, may be paid for as part of governmental reimbursement schemes. According to Drebing, previous studies have shown that those going to support groups later show enhanced social support… in regard to groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), were shown to have a positive correlation with participation in their subsequent groups and abstaining from their addiction. Because correlation does not equal causation, going to those meeting does not cause one to abstain from divulging back into old habits rather that this been shown to be helpful in establishing sobriety. While many support groups are held where the discussions can be face to face there has been evidence that shows online support offers the same amount of benefits. Coulson found that through discussion forums several benefits can be added such as being able to cope with things and having an overall sense of well being.

Providing Support

There are both costs and benefits to providing support to others. Providing long-term care or support for someone else is a chronic stressor that has been associated with anxiety, depression, alterations in the immune system, and increased mortality. Thus, family caregivers and “university personnel” alike have advocated for both respite or relief, and higher payments related to ongoing, long-term care giving. However, providing support has also been associated with health benefits. In fact, providing instrumental support to friends, relatives, and neighbours, or emotional support to spouses has been linked to a significant decrease in the risk for mortality. Researchers found that within couples where one has been diagnosed with breast cancer, not only does the spouse with the illness benefit from the provision and receipt of support but so does the spouse with no illness. It was found that the relationship well being was the area that benefited for the spouses of those with breast cancer. Also, a recent neuroimaging study found that giving support to a significant other during a distressful experience increased activation in reward areas of the brain.

Social Defence System

In 1959 Isabel Menzies Lyth identified that threat to a person’s identity in a group where they share similar characteristics develops a defence system inside the group which stems from emotions experienced by members of the group, which are difficult to articulate, cope with and finds solutions to. Together with an external pressure on efficiency, a collusive and injunctive system develops that is resistant to change, supports their activities and prohibit others from performing their major tasks.

Gender and Culture

Gender Differences

Gender differences have been found in social support research. Women provide more social support to others and are more engaged in their social networks. Evidence has also supported the notion that women may be better providers of social support. In addition to being more involved in the giving of support, women are also more likely to seek out social support to deal with stress, especially from their spouses. However, one study indicates that there are no differences in the extent to which men and women seek appraisal, informational, and instrumental types of support. Rather, the big difference lies in seeking emotional support. Additionally, social support may be more beneficial to women. Shelley Taylor and her colleagues have suggested that these gender differences in social support may stem from the biological difference between men and women in how they respond to stress (i.e. flight or fight versus tend and befriend). Married men are less likely to be depressed compared to non-married men after the presence of a particular stressor because men are able to delegate their emotional burdens to their partner, and women have been shown to be influenced and act more in reaction to social context compared to men. It has been found that men’s behaviours are overall more asocial, with less regard to the impact their coping may have upon others, and women more prosocial with importance stressed on how their coping affects people around them. This may explain why women are more likely to experience negative psychological problems such as depression and anxiety based on how women receive and process stressors. In general, women are likely to find situations more stressful than males are. It is important to note that when the perceived stress level is the same, men and women have much fewer differences in how they seek and use social support.

Cultural Differences

Although social support is thought to be a universal resource, cultural differences exist in social support. In many Asian cultures, the person is seen as more of a collective unit of society, whereas Western cultures are more individualistic and conceptualise social support as a transaction in which one person seeks help from another. In more interdependent Eastern cultures, people are less inclined to enlist the help of others. For example, European Americans have been found to call upon their social relationships for social support more often than Asian Americans or Asians during stressful occasions, and Asian Americans expect social support to be less helpful than European Americans. These differences in social support may be rooted in different cultural ideas about social groups. It is important to note that these differences are stronger in emotional support than instrumental support. Additionally, ethnic differences in social support from family and friends have been found.

Cultural differences in coping strategies other than social support also exist. One study shows that Koreans are more likely to report substance abuse than European Americans are. Further, European Americans are more likely to exercise in order to cope than Koreans. Some cultural explanations are that Asians are less likely to seek it from fear of disrupting the harmony of their relationships and that they are more inclined to settle their problems independently and avoid criticism. However, these differences are not found among Asian Americans relative to their Europeans American counterparts.

Different cultures have different ways of socials support. In African American households support is limited. Many black mothers raise their children without a male figure. Women struggle with job opportunities due to job biases and racial discrimination. Many Black women face this harsh reality causing them to go through poverty. When there is poverty within home, the main focus is to make sure the bills are paid. Sometimes causing children to play adult roles at a very young age. Women trying to balance the mom and dad role, takes away from the moral support certain kids need.

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What is BPDFamily.com?

Introduction

BPDFamily.com is an online support group for the family members of individuals with borderline personality disorder (BPD).

The group is one of the first “cyber” support groups to be recognised by the medical providers and receive professional referrals.

Outline

BPDFamily.com provides articles and message boards for family members to learn and share their experiences. The articles explain borderline personality disorder in understandable terms, and the discussion groups help to normalise the experiences of family members. The site appeals to family members who care about someone with BPD, but are frustrated with the relationship demands and conflict.

The site educates its members on concepts developed by Shari Manning PhD, Margalis Fjelstad PhD, Robert O. Friedel MD, and the NEA-BPD Family Connections Programme and reached out to academia for collaborations. The site has an interactive web program that teaches the basic principles of cognitive behavioural therapy (CBT).

The website and support group are certified as a reputable health information resource by the Health On the Net Foundation.

Funding has come from benefactors and member donations.

Use by Healthcare Professionals

BPDFamily.com is a listed reference site of the National Health Service (England), the National Alliance on Mental Illness, the National Education Alliance for Borderline Personality Disorder, and the Personality Disorders Awareness Network.

The group’s services and programmes are recommended in Primer on Borderline Personality Disorder, Abnormal and Clinical Psychology: An Introductory Textbook, Resources to Improve Emotional Health and Strengthen Relationships, I Hate You–Don’t Leave Me: Understanding the Borderline Personality, The Essential Family Guide to Borderline Personality Disorder, Stop Walking on Eggshells, and Discovering Your Inner Child: Transforming Toxic Patterns and Finding Your Joy. The site has been recommended by about.com expert Kristalyn Salters-Pedneault, PhD, Salon advice columnist Cary Tennis, PsychCentral columnist Kate Thieda, and by Randi Kreger at BPDCentral.

The organisation has been involved and referenced in clinical research studies conducted by: Columbia University, University of Wollongong (Australia), California State University, Sacramento, University of Toronto (Canada), University of Nevada, Bowling Green State University, Wright Institute (California), Colorado School of Professional Psychology, Long Island University, Alliant International University (California), Macquarie University (Australia), Middle Tennessee State University, Simon Fraser University (Canada) and Walden University. The organisation also supports industry research studies conducted by the Treatment and Research Advancements Association for Personality Disorder (TARA-APD).

In a January 2013 column, Kristalyn Salters-Pedneault at Boston University School of Medicine says that although she highly recommends this group for family members, readers with borderline personality disorder should keep in mind that some people have been hurt by their family member with BPD and are speaking from this perspective

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What is Schizophrenics Anonymous?

Introduction

Schizophrenics Anonymous is a peer support group to help people who are affected by schizophrenia and related disorders including bipolar disorder, schizoaffective disorder, psychotic depression and psychosis.

Brief History

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.

Programme Principles

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.

Research

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.

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What is GROW (Support Group)?

Introduction

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.

Processes

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

  1. We gave too much importance to ourselves and our feelings.
  2. We grew inattentive to God’s presence and providence and God’s natural order in our lives.
  3. We let competitive motives, in our dealings with others, prevail over our common personal welfare.
  4. We expressed our suppressed certain feelings against the better judgement of conscience or sound advice.
  5. We began thinking in isolation from others, following feelings and imagination instead of reason.
  6. We neglected the care and control of our bodies.
  7. We avoided recognising our personal decline and shrank from the task of changing.
  8. We systematically disguised in our imaginations the real nature of our unhealthy conduct.
  9. We became a prey to obsessions, delusions and hallucinations.
  10. We practised irrational habits, under elated feelings of irresponsibility or despairing feelings of inability or compulsion.
  11. We rejected advice and refused to co-operate with help.
  12. We lost all insight into our condition.

The Twelve Steps of Recovery and Personal Growth

  1. We admitted to personal disorder in our lives.
  2. We firmly resolved to restore order in our lives and co-operated with the help that we needed.
  3. We surrendered to the healing power God or We surrendered to the healing power of truth.
  4. We made personal inventory and accepted ourselves.
  5. We made moral inventory and cleaned out our hearts.
  6. We endured until ‘cured’.
  7. We took care and control of our bodies.
  8. We learned to think by reason rather than by feelings and imagination.
  9. We trained our wills to regulate our feelings.
  10. We took our responsible and caring place in the wider community.
  11. We grew daily closer to maturity.
  12. 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.

  1. Be Reasonable: “We learned to think by reason rather than by feelings and imagination.”
  2. Decentralize, participate in community: “…decentralization from self and participation in a community of persons is the very process of recovery or personal growth.”
  3. 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.”
  4. Grow Closer to Maturity: “Maturity is a coming to terms with oneself, with others, and with life as a whole.”
  5. Activate One’s Self to Recover and Grow “Take your fingers off your pulse and start living.”
  6. 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.”
  7. 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.”
  8. 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.”
  9. Help Others: We carried the GROW message to others in need.
  10. 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.”
  11. Use GROW: “Use the hopeful and cheerful language of GROW.”
  12. Gain Insight: “We made moral inventory and cleaned out our hearts.”
  13. Accept Help: “We firmly resolved to get well and co-operated with the help that we needed.”

Effectiveness

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.

Literature

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.

What are Self-Help Groups for Mental Health?

Introduction

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.

Types

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

Member 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

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

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

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

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.

Hybrid Groups

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.

Group Processes

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.

TheoryOutline
Social SupportHaving 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.
Experiential KnowledgeMembers 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 TheoryMembers with experience become credible role models.
Social Comparison TheoryIndividuals 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).
Helper TheoryThose 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.”

Referrals

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.

Effectiveness

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

Depressed Anonymous (DA) is based on the model pioneered by Alcoholics Anonymous and open to anyone who wants to stop saddening themselves.

Emotions Anonymous

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

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

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 International

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.

Criticism

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”.

Formulaic Approach

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.

Overgeneralisation

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.

Panacea Complex

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.

What is Andy’s Man Club?

Introduction

Andy’s Man Club is described as:

“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”.

Background

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.

Similar Charities

  • It’s tricky to talk.
  • Talk Club.
  • MenSpeak.
  • Men Walk Talk.
  • Proper Blokes Club.
  • It’s Worth Talking About.
  • Man-Down.

Locations

There are a variety of locations (as of November 2021):

  • Altrincham.
  • Batley.
  • Bradford.
  • Brighouse.
  • Dewsbury.
  • Doncaster.
  • Dundee.
  • Dunfermline.
  • Edinburgh.
  • Exeter.
  • Glenrothes.
  • Gosport.
  • Halifax Central.
  • Halifax North.
  • Hartlepool.
  • Hebden Bridge.
  • Huddersfield Ainley Top.
  • Huddersfield Central.
  • Hull Central.
  • Hull North.
  • Leeds East.
  • Leeds West.
  • Manchester.
  • Newton Abbot.
  • Oldham.
  • Perth.
  • Peterborough.
  • Plymouth.
  • Porthcawl.
  • Preston.
  • Rhondda.
  • Rochdale.
  • Rotherham.
  • Scarborough.
  • Sheffield.
  • Stafford.
  • St. Andrews.
  • Sunderland.
  • Torbay.
  • Wakefield.

What is Role Suction?

Introduction

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.

Refer to Karpman Drama Triangle.

Driving Forces

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.

Wider Systems

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.

Criticism

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.

What is Helper Theory?

Introduction

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.

Refer to Peer Support and Skills and Abilities Required for Peer Support.

Riessman’s Formulation

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).

Health Care

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.

Social Work

Melkman, Mor-Salwo, Mangold, Zeller, & Benbenishty (2015) used a grounded theory approach to understand:

  1. The motivations and experiences which led young adult “careleavers” (N = 28, aged 18-26) in Israel and Germany to assume a helper role; and
  2. 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).

Self-Help/Mutual-Help

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:

  1. 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;
  2. 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
  3. 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”.

References

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.

What is a Peer Support Specialist?

Introduction

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.

Refer to Peer Support and Support Groups.

Recovery Planning

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.

Core Competencies

Adapted for the recovery support specialist by William L. White:

  • Outreach worker:
    • Identifies and engages hard-to-reach individuals.
    • Offers living proof of the transformative power of recovery and makes recovery attractive.
  • Motivator:
    • Exhibits faith in client’s capacity for change, encourages and celebrates their recovery achievements, and mobilises internal and external recovery.
  • Resources:
    • 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.
  • Truth-teller:
    • 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.
  • Planner:
    • 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.
  • Problem solver:
    • Helps resolve personal and environmental obstacles to recovery.
  • Resource broker:
    • 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.
  • Tour guide:
    • 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.
  • Advocate:
    • 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.
  • Educator:
    • 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.
  • Community organiser:
    • 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.
  • Lifestyle consultant/coach:
    • 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.
  • Friend:
    • Provides sober companionship; a social bridge from the culture of addiction and mental illness to the culture of recovery.