How to Create A Healthy Support Group

Reader’s Question

How would you define the parameters of a healthy support group? For example, many so-called support groups have leaders with a certain agenda that may or may not be shared by the members. If questioned, egos and emotion get in the way of being supportive. I have seen it happen to every group from church to clubs to advice to political or legal support groups. What can be done to prevent or guide the group so this does not happen and subsequently hurt other members of the group or cause them to leave or divide the group in two?

Psychologist’s Reply

The boundaries of a support group are often defined by the nature of the group. Some support groups are informal and nonprofessional. In these groups, leaders may be selected by the group or emerge over several meetings. As you describe, leaders in these groups can often guide the discussion, establish boundaries, and even censor members within the group. Other support groups may be professionally supervised or monitored, often by group-experienced professionals who work to meet the goals of the group — which might be to provide information, share experiences, discuss lifestyle issues, etc. Professional group facilitators recognize that individual issues and needs will surface in a group and do their best not to allow one individual to dominate the group or change the original purpose of the group.

Support groups also vary in other ways. For example, many support groups have a specific topic, condition, situation, or agenda. This is especially true in medical support groups where the group might focus on diabetes, breast cancer, head injury, multiple sclerosis, etc. In these groups, the specific topic often creates and enforces the boundaries. Some groups, such as AA, have a well-defined format. Some groups have long-standing traditions or rituals, while others involve a gathering of people at a prearranged time to discuss a topic.

Whenever groups are formed, a table of organization informally develops. Over several meetings, leaders emerge who tend to guide the group toward a selected agenda and sometimes their agenda. We see this in churches, social organizations, high school reunion committees, school support groups, etc. When we’re lucky, those leaders are positive and want the best interests of the group. As you describe, that doesn’t always happen.

What can we do when we are involved in a support-group where multiple agendas develop?

  • We might take the bureaucratic approach and form a sub-committee or sub-group. In planning a high school reunion, for example, the larger group often separates into subcommittees who address 1) locating classmates and invitations, 2) food/beverage, and 3) reunion arrangements. It might be appropriate to offer something like “It seems several of us have an interest in (whatever topic). Can those individuals meet at another time to review our topic?” This is at least a polite approach.
  • Privately discuss topics that should be addressed with the identified leader. These private discussions are helpful and nonthreatening, especially when the leader/leaders are ego-involved and defensive. It allows them the opportunity to still control the group process yet move it in a more productive direction.
  • When participating in the group, redirect conversations from a personal agenda to the group agenda. It’s not uncommon in medical-based support groups to have a member who is very attention-seeking, using an “organ recital” of sorts to keep the group attention focused on them. When this happens, politely interrupt (if that’s possible?) with something like “I’m glad you brought knee pain up. Anyone else have knee pain?”
  • Support groups often are informal groups related to professional organizations. In church groups, inviting the church authority (pastor, priest, etc.) to participate in the group often provides a model for group conduct. Inviting a physician/nurse into a medical support group does the same thing.
  • Recognize that some groups are facilitated by controlling personalities who have tremendous investment in their role as a group leader. When their leadership is threatened, even by someone only wanting a group agenda, that can get ugly. It’s like going to a Star Trek fan club to find one person has been the “Commander” for the past 10 years. Threatening a controller’s hold on a group can actually get you expelled from the group. That much drama may not be worth your effort.

Support groups can be very helpful but as you discussed, the success and helpfulness of a support group is often directly related to the leadership. Even “leaderless” groups have a leader — it’s just not on their name tag. You may need to pick and choose groups as you seek advice on specific topics.

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