Guide to the Development of Mutual Aid Groups

The guide below is aimed at professionals who want to support the development and utilization of mutual support groups. This guide to utilizing mutual aid groups was developed by Linda and Ernie Kurtz. Linda Kurtz, D.P.A., is the author of Self-help and Support Groups: A Handbook for Practitioners; Ernest Kurtz, Ph.D., authored Not God: A History of Alcoholics Anonymous and is co-author of The Spirituality of Imperfection.

Evidence of Mutual Support Group Effectiveness

It is not easy to capture the value of self-help groups through quantitative, empirical studies. But some researchers have partnered with self-help groups to find appropriate methods of evaluation. What follows summarizes the extant research.

Extensive evaluations using before-after measures, comparison groups, and time-series designs, have found that more intense and longer term participation in a wide variety of self-help/mutual-aid groups contributes to better outcomes. These outcomes include reduced psychiatric symptoms, reduced use of professional services, increased coping skills, increased life satisfaction, and shorter hospital stays. Members of health-related groups reported better adjustment, more effective coping skills, higher self- esteem, and improved acceptance of the illness than self-assessments of less active and non members. For specifics, see this study, the results of which are summarized in the next five paragraphs:

  1. Patients DISCHARGED FROM A PSYCHIATRIC HOSPITAL who participated in a Community Network Development (CND) Program required one-half as much re-hospitalization, ten months after discharge, as a comparable group of non-participating ex-patients. CND ex-patients also required one-third as many patient days of re-hospitalization (7 vs. 25 days) and a significantly smaller percentage of them needed to continue to attend Community Mental Health Centers and other mental health agencies for services (48% vs 74%).
  2. VOLUNTEER LEADERS IN RECOVERY, INC., a self-help group for people who have been treated for mental health problems (half of whom had been hospitalized for mental illness) rate their overall satisfaction with life and health, as well as their satisfaction with work, leisure, and community as high, equivalent to the general public's levels of satisfaction.
  3. CHILDREN OF PARENTS WITH DRINKING PROBLEMS who participated in Alateen, a self-help group sponsored by Al-Anon, suffered less emotional and social disturbance than peers who did not belong.
  4. Participants in a national self-help group for parents of young drug and alcohol abusers -- (PRIDE - Parent Resources Institute for Drug Education) -- reported that their participation was associated with improvement in their children's DRUG PROBLEM. A majority of the participants also reported improvements in their children's general discipline problems and in adjustment outside the home.
  5. Participating in a self-help group for FAMILIES OF PSYCHIATRIC PATIENTS reduced the family's sense of burden. Members found the group helpful because it provided them with information about schizophrenia and coping strategies that professionals did not provide. Participation also helped parents to develop supportive social bonds with others who were experiencing similar problems.

Recent studies by reputable researchers have supported 12-STEP GROUP effectiveness (Project Match Research Group, 1997). A multi-state, rigorous research project funded by the NIAAA contrasted outcomes of three treatment conditions, one of which was 12-Step facilitation. The sole objective of 12- Step facilitation was to connect with and reinforce use of community AA. Findings showed that persons who received this treatment approach were as successful in reaching treatment goals as those who received the two other professional treatments. Another study found that individuals treated in a 12-Step-oriented program have higher levels of engagement with 12-Step programs and 64% lower utilization of professional mental health services than patients treated where there was little emphasis on 12-Step principles and involvement. (Humphreys, K. & Moos, R. (2001). Can encouraging substance abuse patients to participate in self-help group reduce demand for health care? A quasi-experimental study. Alcoholism: Clinical and Experimental Research, 25 [5] (May 2001), 711-716).

All studies suggest that success in any program correlates with more intense mutual help involvement. Therefore, encourage your client to become as active as possible.

Encouraging Local Group Development

Don't Re-invent the Wheel
Find a national group that already exists and request a starter packet or "how to" guide. Ask nearby group leaders to help. Attend meetings of that association in other locations to get a feel for how they operate; borrow from their successful techniques.
Find a Suitable Meeting Place and Time
Try to obtain free meeting space at a local church, library, community center, hospital, or social service agency. Chairs should be arranged in a circle; avoid a lecture set-up. Consider holding initial meetings in members' homes. Also, try to set a convenient time for people to remember the meeting, e.g., the first Tuesday of the month or every Tuesday at 7:30 p.m.
Publicize and Run your First Public Meeting
To reach potential members, consider where they might go to seek help and get the word out to those persons and places. Don't start before you have a core group of committed founders. The first meeting should be arranged so that there will be ample time for you and other core group members to describe your interest and work, while allowing others the opportunity to share their view of how they would like to see the group function. Identify common needs the group can address. Make plans for the next meeting; have an opportunity for people to talk and socialize informally after the meeting.
Future Meeting Tasks
Establish the purpose of the group. Is the purpose clear? Groups often focus upon providing emotional support, practical information, education, and sometimes advocacy.

Also determine any basic guidelines your group will have for meetings (e.g., insure that group discussions are confidential, non-judgmental, and informative).

Membership: Who can attend meetings and who cannot? Do you want membership limited to those with the problem? Will there be membership dues? If so, how much?

Meeting Format: How will the meeting be structured? How much time will be devoted to business affairs, discussion, planning future meetings, socializing? What topics will be selected? Can guest speakers be invited? If the group grows too large, consider breaking down into smaller sub-groups of 7 to 12.

Roles and Responsibilities: Continue to share and delegate the work and responsibilities in the group. Who will be the phone contact for the group? Do you want officers? Consider additional roles members can play in making the group work. In asking for volunteers, it is sometimes easier to first ask the group what specific tasks they think would be helpful.

Phone Network: Many groups encourage the exchange of telephone numbers or an internal phone list to provide help to members between meetings. Ask your membership if they would like this arrangement.

Use of Professionals: Consider using professionals as advisors, consultants, or speakers to your groups, and as sources of continued referrals and information.

Projects: Always begin with small projects, then work your way up to more difficult tasks.

Problems and Pitfalls In Working With Mutual-Aid Groups

Taking Over the Peer Helper Role
Do not do for the client what the community can do. Assist your clients to find peers who can help them instead of keeping clients dependent on you. Think of your role as one of linking your clients to a life of continuing growth, not as merely a treatment provider who will produce a finished product at the end of your treatment plan.
Over-identification with Resistance
Beware of over-identifying with your client's resistance to attending meetings. You must be firm in insisting that the need for lifestyle change includes finding a new support system.
Problems with Religion
One common problem with AA/NA affiliation is objection to the religious atmosphere in some 12-Step groups. It is important to be knowledgeable about the differences between spiritual and religious and to read the chapter in the Big Book, "We Agnostics" (AA, 1976). Some groups are more openly religious than others. AA's beginnings were rooted in evangelical Protestantism, but its teachings are compatible with Catholicism, Judaism, and Islam. For example, there is an organization called JACS (Jewish Alcoholics, Chemically Dependent Persons and Significant Others) headquartered in New York City that helps Jewish addicts understand the 12-Step program as compatible with Judaism. They can be contacted at JACS, 850 Seventh Ave., New York, NY 10019. Phone: (212)397-4197. Web: http://www.jacsweb.org
Gender Issues
Women often express discomfort about AA/NA groups, although this difficulty is diminishing as more women are becoming AA members. The most recent survey indicates that one-third of members are women (AA, 1999). One way to help a woman client adjust to AA is to link her to an all-women's group or to a group with a large number of women in attendance. It is also appropriate to help the client learn to deal with male prejudice and sexist comments.
Discomfort in groups
An important characteristic of successful members is capacity for group dependency. One researcher found that people with high affiliation needs bond quickly with groups, whereas those with low affiliation needs do not. Some people described themselves as "loners" or "misfits". For such people integration into the mutual-aid social world can be more difficult. Those who pay attention to what is said in meetings and read the literature are able to participate more and to engage in dyadic relationships within groups. Continued attendance allows the less extroverted members to become involved and develop a sense of belonging. A dyadic relationship is often required before the less sociable person is able to be involved in an AA group.
Lack of transportation and other logistical barriers
Such things as no transportation and other barriers to attendance need to be considered and resolved. Rides can be obtained to deal with transportation problems. One definition of an AA meeting is simply "one drunk talking to another". Anywhere you can find one other person who has a story to tell, you can find a meeting. Thus, your client might find someone who he or she can talk to in person or by telephone at times when a regular meeting is not available.
Working at Cross Purposes With the Group
One of the biggest problems that can occur when a professional's client belongs to a peer support group is the possibility that what you are doing with your client may be undermined by peer helpers. This happens most often with the issue of the use of medication for psychiatric disorders. While it is true that addicts tend to use chemicals to solve their problems, it is also true that some addicts need medications of various kinds. An AA pamphlet states, "It becomes clear that just as it is wrong to enable or support any alcoholic to become re-addicted to any drug, it's equally wrong to deprive an alcoholic of medication which can alleviate or control other disabling physical and/or emotional problems" (AA, 1984, p. 13). Despite this warning in AA's own literature, some newcomers may be instructed by peer helpers not to use their medications. You can do two things to remedy this. First, you can obtain the AA brochure quoted above and share it with your clients. Secondly, you can recommend to your clients that they not discuss medications in their groups or informally with the friends they meet in AA or NA.

Indicators of Mutual Help Involvement

  • Meeting attendance
  • Participation in social activities
  • Service roles: elected to office, contributions of refreshments, setting up meeting rooms, etc.
  • Telephone calls to members
  • Friendships with members
  • Reading literature
  • Following group recommendations written exercises, taking inventories, prayer and meditation
  • Having a sponsor
  • Being a sponsor

Aids to Working With Mutual-Aid Groups

There exist a vast variety of resource aids, many of them available online or easily ordered online. Virtually all the web sites listed above contain many articles and recommend other readings. Many of these sites also offer links to chat-rooms and virtual meetings as well as further detailed information. Below are some resources that we have found especially helpful.

Note: Some of the pages referenced seem to be no longer available. Those that no longer load have been given a strike-through format but you may try them anyway if you like.

General

American Self Help Clearinghouse Self-help Sourcebook online: http://mentalhelp.net/selfhelp/

Champaign, IL, area: http://www.prairienet.org/selfhelp/homepage.phtml

National Mental Health Consumers' Self-Help Clearinghouse: http://www.mhselfhelp.org/

This is a consumer-run technical assistance center. It provides training materials for advocacy and starting new groups. It disseminates information on legislation, provides links to government resources and to other related organizations. Links on this site provide an amazing amount of free training materials.

Chemical Dependency

AA: AA World Services publishes books, pamphlets, videos, periodicals, and workbooks. Periodicals include a newsletter, BOX 459 (News and Notes from the General Service Office of A.A.); About AA: A Newsletter for Professionals; and the AA Grapevine ("our meeting in print"). The first offers news about the AA organization such as number of members and groups, decisions made in conferences, and the like. About AA contains information about the fellowship that might be of interest to professionals, such as results of member surveys, information about AA's history, available literature and other products. The AA Grapevine contains writings by members that reveal aspects of their spiritual journeys in recovery. AA's General Service Office can be reached by mail at A.A. World Services, P.O. Box 459, Grand Central Station, New York, NY 10163. Phone: (212) 870-3400. See http://www.aa.org/. We suggest also checking out "Your First AA Meeting: An Unofficial Guide For the Perplexed" at http://www.bma-wellness.com/papers/First_AA_Meeting.html

NA:Narcotics Anonymous World Services is headquartered in Van Nuys, California. It also publishes literature: books, booklets, pamphlets, handbooks and guides, directories, audio cassettes and one video, Just For Today. NA also publishes The NA Way Magazine: The International Journal of Narcotics Anonymous. The magazine's mission is to provide service information, recovery-related entertainment related to current issues and events relevant to and written by members. You can order from NA at their address: N.A., P.O. Box 9999, Van Nuys, CA 91409. Call: (818)773-9999.

Mental Illness

EA: EA publishes a text, Emotions Anonymous, and numerous pamphlets. A catalog of its publications may be found at http://www.mtn.org/ea/catalog1.html

Grohol, J.M.: PsychCentral and other resources: http://www.grohol.com/

GROW: Publishes numerous books and pamphlets. Contact their headquarters for informational packets and assistance in developing groups.

NAMI: Publishes local and state newsletters as well as the NAMI Advocate, a bi-monthly newsletter that reports on national mental health policy news, organizational news, book reviews, order forms for NAMI publications. Available to all dues-paying members.

NDMDA: Publishes the National DMDA Newsletter containing news of national public policy and organizational news and sells brochures and articles with information on manic depressive illness. See web site to order.

Obsessive-Compulsive Foundation, Inc.: Publishes a bi-monthly newsletter, free packets with treatment and support group information, annual conference, books, audio and video tapes. Trains mental health professionals in the latest treatment techniques. See ocfoundation.org

Recovery, Inc.: Publishes a basic text, Mental Health Through Will Training by founder Abraham Low, Selections from Dr. Low's Works, Peace Versus Power in the Family. Also a bi-monthly publication, The Recovery Reporter, containing many examples of recovery practice. There are also pamphlets, a group directory, and other aids to Recovery leaders. The headquarters office has videos for helping new groups get started. Recovery offers a special site with links to literature for professionals at www.recovery-inc.com/professionals.html

The Question of Responsibility

Some have asked questions concerning the responsibility of a professional for what happens to people one has referred to a non-professional site or group. We suggest the following principles:

  1. The professional is responsible for being knowledgeable about the group or the website so that harm is unlikely to occur;
  2. The professional should make it clear to the person being referred that the group is a non-professional, mutual aid group made up of non-professionals with similar problems;
  3. The professional should remain available to the person if something potentially harmful happens.

When possible, this Guide provides group mission statements and suggestions about whom to refer to groups. One of the most harmful things we have seen professionals do is to refer someone to a group for which they were not really qualified; i.e, they did not share the problem with which the group deals. We have seen this in happen often in Al-Anon when someone who was depressed came in referred by a professional who thought Al-Anon was a nice group of supportive people and did not know of a group for people with depression. The innocent person, who is in pain, goes to the group and is asked to leave. The group is also harmed because they have had to struggle with whether to include someone for whom they have nothing to offer or reject them thus increasing the level of pain for the newcomer. When this occurs, a group member usually takes the person aside and tried to soften the rejection, but the harm is done.

As noted elsewhere in this Guide, there is no credible evidence that any of the groups listed here have been harmful to any person or category of persons. It is, however, important to monitor your referee's experience. Any individual group could develop destructive group dynamics that could be harmful to individual members.

The groups listed above as "Group-Based" generally have proven track records and are generally well-known. Those listed above as "Internet-Focused" are in general newer, or are geographically limited, and we have less information about them and no direct experience with them. We nevertheless think that they are likely to be helpful. We ask that you inform us if your experience with these groups provides information you deem helpful to others.

mailto:kurtzern@umich.edu

Recommended Reading

  • Humphreys, K. (2004). Circles of Recovery: Self-Help Organizations for Addictions. Cambridge, UK: Cambridge University Press.
  • Grohol, J.M. (2002). The insider's guide to mental health resources online: 2002/2003 edition. New York: Guilford Press.
  • Kurtz, E. (1991 ed.). Not-God: A history of Alcoholics Anonymous. Center City, MN: Hazelden.
  • Kurtz, L. F. (1997). Self-help and support groups: A handbook for practitioners. Thousand Oaks, CA: Sage.
  • Kurtz, L.F. and Chambon, A. (l987). A comparison of self-help groups for mental health, Health and Social Work, 12, 275-283.
  • Nowinski, J. & Baker, S. (1992). The Twelve-Step facilitation handbook: A systematic approach to early recovery from alcoholism and addiction. New York: Lexington Books.

References

  • Alcoholics Anonymous World Services. (1999). Alcoholics Anonymous 1998 membership survey. New York: Author.
  • Alcoholics Anonymous World Services. (1984). The AA member -- medications and other drugs. New York: Author.
  • Coombs, R.H. (2001). Addiction recovery tools: A handbook for practitioners. Thousand Oaks, CA: Sage.
  • Humphreys, K. & Moos, R. Can encouraging substance abuse patients to participate in self help groups reduce demand for health care? A quasi-experimental study. Alcoholism: Clinical and Experimental Research. Special Issue: Vol. 25(5), 711-716, May 2001.
  • Kyrouz, E.M., Humphreys, K. and Loomis, C.L. (2002). A review of research on the effectiveness of self-help mutual aid groups; expanded and updated. Kyrouz, Humphreys and Loomis
  • Project Match Research Group. (1997). Matching alcoholism treatments to client heterogeneity: Project MATCH post-treatment drinking outcomes. Journal of Studies on Alcohol, 59, 513-522.
  • White, B.J. & Madara, E.J. (Eds.). (2002). The self-help sourcebook: Your guide to community and online support groups (7th ed.). Cedar Knolls, NJ: American Self-Help Group Clearinghouse.