Self-help groups
Introduction
Self-help groups—also called mutual help or mutual aid groups—are composed of peers who share a similar mental, emotional, or physical problem, or who are interested in a focal issue, such as education or parenting. Historically, people banded together to improve their chances for survival by pooling their social and economic resources; however, contemporary groups are more likely to organize around a theme or problem.
Most self-help groups are voluntary, non-profit associations open to anyone with a similar need or interest; however, spin-off groups also exist to meet the needs of particular types of people; for example, the elderly, women, or Hispanics. Usually, groups are led by peers, have an informal structure, and are free (except for small donations to cover meeting expenses). However, professionals of various kinds lead some self-help groups.
In the past thirty years, the number of self-help organizations and groups operating in communities throughout the U.S. has dramatically risen; some organizations operate in several countries, primarily in the developed world. One of the reasons for the rapid proliferation of groups focusing on health problems may be the advent of managed health care. For individuals with insurance plans offering limited mental health coverage, self-help groups are an economical way to find emotional and social support.
Self-help groups and therapy
Because of the peer-led, informal, and democratic (as opposed to hierarchical and medical) structure, health professionals consider self-help groups for mental or emotional problems to be an adjunct to therapy. While there are therapeutic aspects associated with participation—principally, intimacy as a result of self-disclosure, personal growth in response to others' role modeling, and erosion of denial as a result of social confrontation—the primary value of contemporary groups is in the mutual aid offered by members to one another. Though the nature of self-help groups is outside of the medical realm, doctors and therapists see participation as a way to improve the outcome related to either ongoing or future formal treatment.
Another issue arguing against considering self-help groups as a type of therapy is that the variety of groups is extensive; groups available may include advocacy groups with a focus on legal or social remedies, groups organized around housing or employment needs, and groups focusing on racial or gender issues. Additionally, the self-help movement shares some characteristics with volunteerism and consumerism. In general, members who persevere have experience with other voluntary organizations and believe in the value of donating time and service; also, members may be thought of as consumers who participate in their own care and who have experience and knowledge of relevant goods and services.
Types of self-help groups
Twelve-step groups
The most popular type of self-help group is based on the Twelve Steps and Twelve Traditions of Alcoholics Anonymous (AA), founded in 1935. The Twelve Steps are a guide to recovery from alcoholism or addiction , whereas the Twelve Traditions are a code of ethics. AA and other 12-step programs are based on the spiritual premise that turning one's life and will over to a personally meaningful "higher power," such as God or Spirit, is the key to recovery. Another essential idea is that sobriety or recovery (not cure) depends on the admission of powerlessness with respect to alcohol or the substances(s)
stance(s) abused. This idea is offensive to critics of 12-step groups, but others believe that this admission accurately reflects the contemporary view of addiction as a disease. Furthermore, people with a familial, genetic vulnerability to addiction are particularly at risk. While some studies suggest that 20% of people suffering from alcoholism will experience remission without benefit of therapy or a 12-step group, most will suffer deteriorating health and dysfunctional, if not ruined, social relationships. In other words, most alcoholics need formal therapy or an informal self-help program to recover. While the dropout rate for AA groups during the first three months is high, alcoholics who persevere have a good chance of attaining and maintaining sobriety or abstinence. This is especially true if the person regularly attends a home group (90 meetings in the first 90 days, slowly diminishing to two or three times per week for years thereafter) and finds an experienced and sympathetic sponsor who also is in recovery.
In addition to AA and its sister organizations, Narcotics Anonymous (NA) and Cocaine Anonymous (CA), a number of 12-step organizations exist for a variety of disorders, such as Gambler's Anonymous (GA), Schizophrenics Anonymous (SA), Emotions Anonymous (EA), and Overeaters Anonymous (OA).
Other groups for health problems and diseases
Self-help organizations also provide support for individuals who are ill or have health problems. For example, support exists for people coping with weight management, HIV/AIDS, multiple sclerosis, muscular dystrophy, cancer, incontinence, and for the families of individuals who suffer from these conditions. Also, support exists for people who share interests or circumstances, such as groups for women who breast-feed (LaLeche League), singles, older adults, and new parents.
Self-help groups for family members are available since illness, addiction, and distress affect the entire family. Family members may unwittingly reinforce illness or addictive behaviors, or may need help coping with the person in distress. Al-Anon, an organization for friends and families of alcoholics, is a companion organization to AA, as is Alateen, a program for teenagers who have been hurt by the alcoholism of significant people in their lives. Support groups for caregivers of individuals with life-threatening or terminal illnesses, such as cancer, often meet at treatment centers and hospitals. One popular club for people with cancer, as well as for their friends and family, is Gilda's Club, founded by the actor/comedian Gene Wilder, Gilda Radner's husband. Gilda Radner, the well-known comedienne from Saturday Night Live, died at age 40 from ovarian cancer. Gilda's Clubs can be found in at least a half-dozen cities in the U.S., Canada, and London.
Online groups and clearinghouses
A growing trend in the self-help movement is the online support communities, as well as online resource centers and clearinghouses. Chat rooms, bulletin boards, and electronic mailing lists all provide convenient, around-the-clock access to peer support. Many large-scale, consumer health care web sites provide forums for discussions on numerous diseases and disorders, and major online commercial services, such as America Online (AOL), provide sites for health care and patient support. In some cases, professionals moderate online groups, although many are exclusively organized and populated by peers. There are self-help groups, such as LaLeche League, that hold some meetings online, often at their own web sites.
Features of self-help groups
Accessibility
Accessibility and economy are appealing features of self-help groups. Since the groups are free, organizations such as AA and NA are very cost-effective. In addition, meetings are easy to locate through local newspaper announcements, hospitals, health care centers, churches, school counselors, and community agencies. For AA and sister organizations that encourage frequent attendance, hundreds of meetings may be held each week in large metropolitan areas. Furthermore, with the proliferation of online support communities and growth of connectivity to the Internet, self-help groups are becoming as accessible for individuals in rural areas as they are for those in large cities.
Anonymity
An important characteristic of 12-step groups is the preservation of anonymity by revealing first names only and by maintaining strict confidentiality of stories shared during meetings. Online self-help groups offer even more anonymity since the exchanges are not face to face. The virtual anonymity of online experience helps to reduce social discomfort and discrimination, or stereotyping otherwise associated with real-life perceptions of age, disabilities, race, gender, or culture.
Social support and mutual aid
Self-help groups provide an intact community and a sense of belonging. The social support and mutual aid available in a group may be critical to recovery, rehabilitation, or healthy coping. This is especially true for socially isolated people or people from dysfunctional families, who may have little or no emotional support. Participating in a social network of peers reduces social and emotional isolation and supports healthy behavior. Group members can offer unconditional support and, collectively, are a repository of helpful experiential knowledge.
Self-esteem and self-efficacy
Self-help groups promote self-esteem or self-respect by encouraging reciprocal caring; the concept of self-efficacy, or the belief that one is capable, is promoted by reinforcing appropriate behavior and beliefs and by sharing relevant information regarding the disease or condition. For example, there may be an exchange of information regarding how to cope with failed or disrupted relationships, about what is reasonable to expect from health care professionals, about how to manage pain or public embarrassment, about where to go and to whom for a variety of needs. In groups such as AA, self-efficacy also is promoted by sponsors who act as mentors and role models, and by encouraging rotating leadership roles.
Introspection and insight
Introspection, or contemplation, is another fundamental feature of many self-help groups, particularly for groups that follow a 12-step program of recovery. For example, the fourth step of AA states that members make "a searching and fearless moral inventory" of themselves, and the tenth step states that members continue "to take personal inventory" and admit wrongdoing. Introspection is particularly beneficial to individuals who are not entirely aware of the moral repercussions of and motivation for their behavior. In a sense, working through some of the 12 steps resembles the cognitive restructuring learned in cognitive-behavioral therapy (CBT), as maladaptive ideas and behaviors are transformed.
Spiritual recovery
The final step in a 12-step program recognizes that recovery entails a spiritual awakening; furthermore, recovering addicts are enjoined to spread the message to others suffering from addiction. Recovery depends on giving up both injurious self-will and denial of maladaptive behavior, and turning to a higher power. Members are urged to seek guidance or inspiration from this higher power. For many addicts, the key to recovery is a spiritually guided movement away from self-centeredness or self-absorption, and a turning towards the "Power greater than ourselves" through prayer and meditation .
Advocacy
Some self-help groups meet to advocate or promote social and legislative remedies with respect to the issue of concern. For example, HIV/AIDS groups have lobbied for improved access to prescription drugs. Groups lobby for reforms by identifying key legislators and policy makers; they submit papers or suggestions for more equitable laws and policies to these key people. They also conduct public education programs (including programs meant to redress the harm of stigmatization). There are groups that advocate for more funds for research and for improved services for people who suffer from one of many diseases or mental disorders. The most important grass roots organization of families and consumers of psychiatric services (former or current patients) is the National Alliance for the Mentally Ill (NAMI). This organization was founded in 1979, and blends self-help with advocacy efforts for the improvement of research, services, and public awareness of major mental illnesses. Their advocacy efforts target both the federal and state levels.
Limitations
Advocacy vs. mutual aid
In some organizations, there is a growing overlap between self-help efforts and community development. Critics maintain that focusing on issues such as crime prevention, affordable housing, and economic development drains time and effort from social support and mutual aid. Nevertheless, some organizations continue to develop both advocacy and support.
Lack of professional involvement
The absence of professional guidance may mean that a member in need of formal psychotherapy or treatment may be discouraged from seeking professional help. On the other hand, too much professional involvement in the group may compromise the quality of mutual aid.
The " thirteenth step"
There is a well-known risk associated with attending 12-step groups termed the "thirteenth step." Women new to the groups, especially young women, are at their most vulnerable in the early stages of recovery. Male sexual predators who attend meetings take advantage of the atmosphere of intimacy and mutual trust. To cope with the possibility of sexual exploitation, young females are encouraged to attend meetings with a family member or a trusted adult, and all women are encouraged to find a same-sex sponsor.
Substituting addictions
The early months of a 12-step program are especially difficult. Typically, an addict in early recovery either replaces an addictive substance with a new one, or intensifies his/her concurrent use of another substance.
It is not uncommon for people who are chemically dependent to also have an addictive sexual disorder. (When someone is addicted to sex, there is an intense desire to gratify sexual urges and fantasies or to behave in ways that cause clinically significant distress; sexual indulgence, often compulsive, is a major disruptive force with respect to social relationships.) In one four-year study of a treatment program, 33% of the chemically addicted patients also were sexually compulsive. Some physicians believe that the predatory "thirteenth step" is evidence of turning from one addiction to another—in this case, addictive sexual disorder.
Members at varying stages of recovery
Another common risk is associated with the varying levels of recovery in a self-help group—that of being actively involved in the abuse of alcohol and/or drugs. Newcomers need to realize that not all members are interested in supporting their recovery, and that people in later stages of recovery may be more reliable. Furthermore, some members are required to attend by disciplinary entities, such as employers or correctional authorities.
Ongoing meetings
One criticism of self-help groups, especially 12-step groups, is that in the eyes of families and friends, members who persevere and faithfully attend the seemingly endless number of meetings only to become "addicted" to the program. However, physicians who support self-help groups point out that since addiction is a disease, addicts are particularly vulnerable to relapse, and that ongoing involvement with a self-help community surely
is better than suffering the recurring misery associated with active addiction.
Rational alternatives to 12-step groups
For addicts who find the spirituality of 12-step groups offensive and irrational, and who believe that public proclamation of powerlessness at group meetings is demoralizing, alternative groups exist. For example, a well-known organization, Rational Recovery (RR), is based on the cognitive-behavioral principles of Albert Ellis. RR emphasizes self-reliance, rational thinking as a result of cognitive restructuring, and the development of a new repertoire of behaviors to respond effectively to events that trigger relapse.
Conclusion
Worldwide, self-help groups are becoming increasingly popular. They are effective in providing mutual support and are good resources for finding needed information.
However, when searching for an appropriate group, prospective members should ask their friends, physicians, and counselors for references, and then visit a few groups before deciding on which one to attend. Also, information clearinghouses on the Internet are a good first step.
See also Depression and depressive disorders; Disease concept of chemical dependency; Dual diagnosis; Group therapy; Pathological gambling; Poly-substance abuse; Sedatives and related disorders; Support groups
Resources
BOOKS
American Self-Help Clearinghouse. Self-Help Sourcebook Online. Mental Help Net, 1993–2002.
Borkman, Thomasina Jo. Understanding Self-Help/Mutual Aid: Experiential Learning in the Commons. New Brunswick, NJ: Rutgers University Press, 1999.
DuPont, Robert L. The Selfish Brain: Learning from Addiction. Washington, DC: American Psychiatric Press, Inc., 1997.
Galanter, Marc, Ricardo Castañeda, and Hugo Franco. "Group Therapy, Self-Help Groups, and Network Therapy." In Clinical Textbook of Addictive Disorders,, edited by Richard J. Frances and Sheldon I. Miller. 2nd ed. New York: Guilford Press, 1998.
Hyndman, Brian. Does Self-Help Help? A Review of the Literature on the Effectiveness of Self-Help Programs. Evaluation in Health Promotion Series: Canadian and International Perspectives, no. 7. Toronto: Center for Health Promotion, University of Toronto, 1997.
Lefley, Harriet P. "Advocacy, Self-help, and Consumer-Operated Services." In Psychiatry, edited by Allan Tasman, Jerald Kay, and Jeffrey A. Lieberman. Philadelphia: W. B. Saunders Company, 1997.
Miller, Norman S., ed. The Principles and Practice of Addictions in Psychiatry. Philadelphia: W. B. Saunders Company, 1997.
ORGANIZATIONS
Aloholics Anonymous. Grand Central Station, PO Box 459, New York, NY 10163. <www.alcoholicsanonymous.org>.
Gilda's Club Worldwide. 322 Eighth Avenue, Suite 1402, New York, NY 10001. (888) GILDA-4-U. <http://www.gildasclub.org/>.
Narcotics Anonyomous World Service Office. PO Box 9999, Van Nuys, California 91409. Telephone: (818) 773-9999. Fax (818) 700-0700. <http://www.na.org/>.
National Self-Help Clearinghouse. Graduate School and University Center of The City University of New York, 365 5th Avenue, Suite 3300, New York, NY 10016. (212) 817-1822. <http://www.selfhelpweb.org>.
Tanja Bekhuis, Ph.D. Paula Ford-Martin, M.A.
