Appendix B

HOW TO START A “HEALING FROM DEPRESSION” SUPPORT GROUP IN YOUR AREA

In addition to its nightmarish qualities, depression is a lonely experience. Those possessed by melancholy feel cut off from God, removed from themselves, and misunderstood by others. Even family and friends often fail to appreciate the disability and despair of the clinically depressed person. In this context, experiencing the support of others who know and understand can be a lifeline to healing.

During my life-threatening depressive illness, I bemoaned the fact there were no institutional structures (i.e., a healing from depression support group) designed to help someone with my kind of emotional pain. (As I explained in my personal narrative, there were plenty of chemical dependency treatment programs, but nothing for someone suffering “just from depression.”)

After my recovery, I decided to do fill this void through creating a course on healing from depression and anxiety. The purpose of this class was to impart practical tools and coping strategies in a caring and supportive environment that will allow members to reduce their symptoms of anxiety and depression. After putting the word out, I expected three or four people to attend the course—instead, thirty showed up. Over the next twelve weeks, I witnessed how the combination of healing information and group support could transform people's moods and lives. I have written this chapter so that others can duplicate these healing circles in their own communities.

Strengths and Limitations of a Support Group

“It is amazingly empowering to have the support of a strong, motivated and inspirational group of people.”

—Susan Jeffers, Fear the Fear and Do It Anyway

I would like to begin my discussion of a healing from depression support group by looking at what it can and cannot do.

A depression support group can:

A depression support group cannot:

Although these groups are therapeutic, they are not a substitute for psychotherapy. Many people who suffer from depression experienced trauma in early childhood—such as loss, abandonment, neglect or abuse. If during the course of the group, a person goes into crisis or becomes overwhelmed by emotions arising from the unconscious, it is essential to have a place to go—i.e., a mental health therapist—to process those feelings.

In addition, being in a support group is only one piece of the recovery puzzle. Just as recovering alcoholics go to AA meetings and “work the program,” your involvement in a depression support group should function as part of the overall better recovery program described in the second half of this book. Practicing this program includes:

Composition of the Group

Your support group can have anywhere from four to ten members, with 6-8 being an ideal number. The group should include those who have had previous episodes of anxiety or depression and are working on staying well, as well as those who are in the middle of an episode and want to get well. In this way, the folks who are further along on the path can serve as role models and coaches for their fellow sufferers.

Ground Rules

As in any group experience, there are certain ground rules that when observed will contribute to the success of the experience. Here are the basics:

Confidentiality.

Because of the stigma that still exists around depression and “mental illness,” it is absolutely essential that group members respect each other's privacy and that whatever is revealed stays in the room. For example, it would be okay to state that one of the members of the group is bipolar, and like yourself is taking Lithium. But you would not say that Steve Jones is bipolar. Perhaps Steve Jones is an attorney who fears that his clients would lose their trust in him if they learned about his condition. No matter what his profession, Steve's confidentiality must be assured.

Respectful communication.

It is the function of the support group to create a safe space where people can feel free to open up and share their deepest feelings. To support this process, communication needs be respectful, nonviolent, compassionate and nonjudging. If any disagreement arises, members should use “I” statements as opposed to blaming or putting others down. Many who suffer from depression and anxiety were raised by critical parents and have internalized the parental criticism. A support group can provide an antidote to the self put-downs by modeling loving and respectful communication.

Avoiding sexual or romantic interactions.

Much of the healing in a group arises through the loving, supportive relationships that members develop among themselves. These relationships work best if they remain friendships and do not involve sexual or romantic interactions.

This is a basic ground rule in all group therapy, and there is a good reason for it. The group is a sanctuary in which people feel safe and unconditionally accepted. Romantic involvement brings with it a different kind of energy—one in which we are appraised and evaluated. In this context, someone invariably ends up feeling rejected or having unfulfilled expectations, which in turn disrupts feelings of safety and trust in the group. To avoid this kind of a morass, it is best to keep the relationships on a friendship level.

Consistent attendance.

While traditional 12-step groups are run on a drop-in basis, I have found that group cohesion is best facilitated when the same people show up week to week. Hence, I make it a requirement that members of my support groups attend all of the meetings (unless, of course things come up such as out of town trips, unforeseen events, etc.) I suggest that you begin with a set number of group members and encourage them to come every week. This will create the safety and stability which people need in order to open up and be vulnerable with each other.

When in doubt, communicate.

When people come together in a group, it is inevitable that concerns will arise. If at any point in time, a member is having difficulty with anything in the group process, it is important that he or she voice his questions or concerns. A cardinal issue for people with depression is feeling powerless. Thus, a person might think, “Why bother to speak up as nothing is going to change anyway.”

The other way to respond is to let one's needs and wishes be known. In this way, each member can have impact on the group and shape it to his or her liking. This sense of empowerment, in itself, is an antidote to depression.

The Structure of the Meetings

Set a regular time to meet. Weekly meetings are ideal, although every other week will also work. The length of the meeting can vary. Give yourself at least 90 minutes; two hours is more realistic.

During the meeting, each group member will have the opportunity to share and to receive support from the group. After the facilitator opens the group, the first person begins his sharing according to the following format, which parallels the format we used in chapter 14:

1) For the first block of time (usually 7-8 minutes), the person gives an update on his mood (using the -5 to +5 mood scale on page 171) and shares how he is faring in his recovery—reporting any successes, challenges, insights, etc. During this sharing, it is the role of each group member to listen attentively. The process works best if people do not interrupt or give advice at this time.

2) After the person's sharing time is up, the facilitator asks the person if he or she would like some feedback (3-4 minutes worth) from the group. If the person requests feedback, group members can then validate the person's experience (“I can hear your frustration”), show compassion (“I'm sorry that you hurt”) or offer reassurance and suggestions.

3) Finally, the facilitator asks the person if he would like to make a request for support for the coming week. Examples include, “I would like support for exercising three times a week,” or “saying my affirmations on a daily basis,” or “being more consistent with my daily meditation.” The group then affirms the person silently or by using an affirmation such as, “I see you attaining your goal and hold for you a vision of your success.”

In between meetings each group member holds an image of healing support for each other member. Members can stay in touch with each other by phone, email, etc. or participate in social activities. I find it helpful to pair people up as coaches/buddies and ask them to pick a particular time when they will check in with each other by phone, email or in person.

With six to eight members in the group, the meeting should last ninety minutes to two hours. In addition, you may wish to add an educational component to the group experience through choosing a “topic for discussion” at the beginning of each meeting. Examples include, exercise, diet, spirituality, medication, dealing with family members, etc. (Any topic from the “better mood program” will do.) In addition, you may wish to bring in outside speakers who can share their areas of expertise.

Finally, here is a lovely meditation which can be used at the close of each meeting.

I put my hand in yours, and together we can do what we could never do alone.

No longer is there a sense of hopelessness; no longer must we depend on our own unsteady willpower.

We are all together now, reaching out our hands for power and strength greater than our own, and as we join hands we find love and understanding beyond our wildest dreams.

Who Should Facilitate the Group?

Since the alcoholics anonymous began in 1935, AA and the other anonymous groups have been run by lay people in recovery and not by professional drug and alcohol counselors. Can this model be replicated by people who suffer from depression and anxiety? I have come to believe that in most cases, one or two people in the group need to assume a leadership position and “keep their eyes on the prize,”—i.e. keep the group focus on the vision of healing and recovery. The group facilitator can either be:

1) a mental health professional.

2) a layperson who is in recovery and has a background in working with groups. Such a person should ideally work under the direction of a clinical supervisor.1

From week to week, the group facilitator will:

Professional leadership, of course, introduces the factor of cost. If the group is run through a hospital, it will usually be free or low cost. If you find someone to run the group privately, fees will be a bit higher ($25 to $40 a session), but still far below the cost of individual therapy.

Since people who have long-term depression may be limited in their ability to work (or be on disability), I have tried to be flexible in my approach to fees. If the individual has a strong intention to heal and has good outside mental health support (through a counselor and/or medical prescriber), I will offer a partial scholarship or let the person make payments over a longer period of time.

If you are a counselor or therapist who wishes to start a depression support group in your community, I highly encourage you to do so. There is a real need for this kind of group. If I can be of any help, please feel free to call or email me. (My contact information is in the “About the Author” page at the back of the book.)

Length of the Group: Time Limited or Ongoing?

Because I run my “depressives anonymous” support groups as classes, I teach them in 6 month terms. Most support groups, on the other hand, meet on an ongoing basis. Whoever facilitates the depression support group can decide which time frame he or she wants to use. The advantage of a class is that it has a clearly defined structure with a specified beginning and end. The advantage of a support group is that it can go for a longer term and allow the participants more time to bond.

Changes in Membership

Groups are organic living organisms which like all living systems go through cycles of death a rebirth. If the depression group is run as a class, the beginning and end of the course will be predetermined. If the group is structured as an ongoing support group, there will come a time when either 1) a group member wishes to leave, or 2) someone new wishes to join. Similarly, there may come a time in your recovery program when you (or another member) will decide to take break.2 If this occurs, the person wanting to leave should pick a time to do closure and to say good-bye to the group.3 If a new member expresses interest in joining, the facilitator should ask him or herself the following questions:

If the answer to these two questions is “yes,” the facilitator should set up an intake meeting with the prospective member. In addition to taking a case history, he can ask the applicant why he wants to attend the group and what he hopes to get out of it. If the individual seems like a good fit, he or she can attend a group to test the waters.

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In the year since I began running healing from depression support groups, the greatest complaint I have heard from my clients is their inability to find others outside the group who truly understand their condition. In this context, they greatly appreciate the contact and support they receive from their fellow group members. As one client commented, “Joining this depression support group has made my recovery possible.” It is my hope that the millions of people who suffer from depression and anxiety can follow suit and join together in healing community, thereby accomplishing together what they cannot do alone.

1 Although I have an MA in counseling, I consider myself to fall in the second category. I co-facilitate the groups with my partner Joan and work under a clinical supervisor.

2 How does one know when it is time to leave? M. Scott Peck says that the time to begin therapy is when you feel stuck, and the time to end is when you can become your own therapist.

3 Because depression is a recurrent disorder, you may wish to continue attending your support group on a weekly basis, even when you are feeling well.