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What are support groups and
what can they do for participants?

by Dr. Alison Darcy 18 February 2008

The terms support group, self-help group and mutual-help group all identify a similar group formation and the terms are used interchangeably. A group of this type consists of people who come together seeking and offering help and support. Participants share a common problem, and the group is usually initiated by a citizen or user (Adamsen, 2002). Participation costs its members little or nothing and the collective wisdom is born out of the shared experience of members rather than the professional input of the leader (Davison et al., 2000). Though the original principle of support groups was reciprocity in the absence of a professional, Lieberman and Snowden (1994) have reported that over 60% of support groups are professionally facilitated.

Thus, there is considerable diversity across support groups, and attempting to precisely categorise them is both difficult and impractical (Davison et al., 2000). Similarly, attempts to study support groups are hampered by a number of factors inherent in their composition. Few support groups insist on any form of proof of diagnosis making inclusion criteria difficult. Attempting to obtain informed consent can be seen by group members as at best odd, and at worst, threatening (Lykes, 1989). The nature of participation is typically irregular and on an as-needed basis (Powell, 1994). And if attempting to adopt a positivist (experimental) approach, it is impossible to assign people to a control group since attempting to do so would change the phenomenon that one attempts to understand (Rappaport, 1994).

Having said that, there have been some outcome studies conducted with other illnesses that have shown positive effects. The most famous of these is the study of 88 metastatic breast cancer patients assigned either to group psychotherapy or informational and nutritional support. Those who participated in the support condition had survival times of about twice those of controls (Spiegel, Bloom, Kraemer, & Gottheil, 1989). This group was professionally established and run, and as such differs from most conceptualisations of true support.

The conceptualisation of support groups has changed dramatically from some patronising professional views of them as “hand holding” or “huddle together groups” (Sagarin, 1969) in the 1970s to the understanding that some groups have sophisticated ideological underpinnings (such as Alcoholics Anonymous; AA), and the more recent conceptualisations of support groups as communities of beliefs (Kennedy, Humphreys, & Borkman, 1994).

The very existence of a support group is a measure of its value to its participants. If people stop coming, the group ceases to exist. In this way, participation is its own index of success (Davison, Pennebaker, & Dickerson, 2000). Despite their value, the same attention that has been paid to the efficacy of treatment has not been paid to support. While factors relating to curative processes are of interest, very little attention has been paid to the experiences of people with EDs in self-help or support groups.

Support groups construct their own narrative through the telling of their member’s stories and their collective experience, and this constitutes a social identity (Rappaport, 1994). Participants begin to identify with the community narrative, and adopt it as their own personal narrative even with similar structural features (Rappaport, 1994). This personal narrative becomes the person’s identity, and this worldview transformation is considered to be one of many curative processes at work.

People attending groups such as AA have been shown to demonstrate worldview transformation in the domains of the experience of the self, universal order or God, relations with others, and the problem itself (Ronel & Libman, 2003). Analyses of these processes have revealed that members’ experience of self before participation in the group was largely composed of an excessive need for perfection and control, causing low self-esteem, and through recognising their powerlessness over their addiction (according to the 12 step model) they were subsequently freed from the need for total control and leading inevitably to improved self esteem. This is consistent with other conceptual frameworks that do not involve the addiction or medical model of the problem. For example, Kingree and Rubrack’s (1994) propose that “status embracement” is central to a person’s self-concept. Thus the transformation of the individual’s concept of self, is one of the most powerful curative factors that can operate in support groups, as well as therapy groups.

Groups provide a platform for personal and interpersonal learning, and a safe platform for social experimentation (Yalom, 1995). For many people with mental health difficulties, their interpersonal lives were characterised by vicious circles of loneliness and alienation whereas participation in the group led to an enhancement of social networks considered a major element of worldview transformation during recovery (Ronel & Libman, 2003). For members, the support group constitutes the third social network (Adamsen, 2002). A support group can act as forum for social experimentation, where an individual can experiment with their new emerging identity, in a safe environment.

A reconsideration of the problem is also a necessary mechanism in the recovery process with group members often arriving (after failing in treatment) viewing their problems as evidence of failure, and after adopting a pragmatic view of the problem, accept responsibility for change (Ronel & Libman, 2003).

This is but one very well-defined ideology that exists within the AA movement. But presumably support groups promote well-being and facilitate recovery through a variety of psychological and psychosocial mechanisms. Support-group participants adopt a generally more positive view of themselves (Adamsen, 2002; Kingree & Ruback, 1994) as well as a more positive view of their problems (Kingree & Ruback, 1994). More experienced members can act as role models of recovery or coping, providing new coping strategies (Trojan, 1989). Members can also benefit from the feedback and interpretations that other group members provide (Humphreys & Rappaport, 1994), while the providers themselves benefit from imparting information (Yalom, 1995). Participants can also find themselves with a role transformation from a receiver, to a giver of help (Rappaport, 1994). Altruism is identified by Yalom (1995) as a curative factor, and part of this process seems to be the refocusing of members’ perspectives from an egocentric view to one that considers other people (Ronel & Libman, 2003).

Similar to the AA concept of taking responsibility for one’s illness, there is an element of empowerment associated with the support group that is necessarily absent from formal treatment. This empowerment allows members to master aspects of their lives (Omark, 1982; Powel, 1985; Jurick, 1987). People with depression for example, commonly hold the belief that they are powerless to affect change (Bowers, 2000). The support group allows people to experience autonomy and a recognition that they are experts on their own problem. At the same time, other members provide a sense of universality, as well inspiration, hope, information and resources (Finn & Lavitt, 1994).

Support groups are commonly viewed as an alternative to psychiatric treatment, and this “professional centrism” is condemned by Rappaport, (1994, p. 117) as an application of a medical or human services model that tends to define the group more by the specific needs of the specific professional community than in the context in which the groups are embedded. Trying to understand members of a group in terms of recipients of treatment is inherently flawed or as Kurtz (1992) puts it; “ Examining [groups such as] Alcoholics Anonymous under the heading of ‘treatment’ is like studying the formation patterns of bears flying South for the winter” (p. 397). Others have more accurately described users of support groups as “prosumers” since they themselves are involved in the production of that which they consume (Gartner & Reissman, 1984). However, in moderation, the concept of support groups providing some therapeutic value is actually quite reasonable. Rather than being at odds with the world of treatment, support group environments seem to be equipped with some of the same tools for aiding recovery.

In the group psychotherapeutic setting for example, patients receive similar benefit from other members at varying levels of recovery (Bowers, 2000). The focus of cognitive group therapy is on challenging the individual’s view of the world that they have as a result of their distorted cognitions so that they can come to a new understanding of their disorder (Bowers, 2000). This is reminiscent of the worldview transformation considered integral to support group participation. Support groups share some fundamental therapeutic foundations such as providing opportunity for disclosure, empathic connection, and adjusting to life challenges (Davison, Pennebaker & Dickerson, 2000). If similar mechanisms that are the focus of the most successful known treatment of EDs are also at work in support groups, then it is not unreasonable to ask whether participation in a support group may afford a person some improvement in symptomology.