For Better or for Worse

Getting “support” provides validation, but does that validation lead to accepting and even exacerbating an issue? Can participants pick up unhealthy behaviors from each other, instead of combating their own?

Gila says that this was her experience when she joined a group for teens dealing with anorexia. The group was organized for parents of these teens, and the girls also attended.

“Some people there just didn’t want to get better,” Gila relates. “Many of them were young girls who were being forced to be there, and that can have a bad influence on you. I didn’t really relate so much to what others were sharing. They made a defined box: You’re like this. But each person is unique.”

She felt that the support group “can take away from your individuality, and cause you to trick yourself into thinking you’re a certain way when you’re not.”

But she qualifies her statement: “I think the group was much more beneficial for the parents than the kids. When girls would talk about their experiences, the parents got a window into understanding their kids. My father took these ideas to heart and practiced validating me, which really helped.”

So how do you avoid a situation where participants have a negative influence on each other? Joan Kristall LCSW, who has been running groups both in America and Eretz Yisrael for decades, says that a screening process for group members is essential so the leaders can ensure that the applicants are already at a certain level of stability before they join. In most cases, they’ll require that the applicant have already done some sort of individual therapy first for a few years, so they’re no longer strongly triggered by an issue.

Dr. Tzachi Fried runs Dialectical Behavioral Therapy (DBT) skill groups, where he has specific rules  that ensure the groups will be “to people’s benefit, and not to their detriment.” The participants are not allowed to discuss contagious behaviors, and instead are supposed to speak in more general terms. Participants are also not supposed to have a relationship outside the group, to prevent them encouraging negative practices between each other.

Chana Esther Schechter, founder of Yad B’Yad, says that she tries her best to put together a cohesive group of people who are at a similar stage and will work well together. Overall, her groups have been tremendously successful; she now has 14 of them, some of which have been running for much longer than initially planned. Gavriel is in one such group at Yad B’Yad. It provides ongoing support and has been meeting for years. Although Gavriel is now divorced, the group still serves an essential function in his life as he faces various challenges. Even after he moved to Israel, he stayed in contact with his group by phone, because it was that important to him.

Chana Esther explains that the members are so appreciative of the opportunity to be part of a free group run by a highly experienced clinician that she rarely hears of any issues. In fact, the most common complaint she gets is, “I wish the group could meet more often!”

The Greatest Hurdle

Groucho Marx famously said, “I refuse to join any club that would have me as a member.”

If the members of the group are like me, do I really want to be associated with them? It can be hard to look in the mirror and admit: “Yes, I have this issue” — and even harder to admit it to others.

One of the reasons Gila says she didn’t enjoy being part of her anorexia support group was that when she was there, she felt shame and frustration. Being exposed, especially in front of her parents, didn’t feel safe. She believes that in her situation, at that time, individual treatment would have been more effective.

But not all groups give this feeling. Miriam didn’t feel exposed, she felt liberated. The environment and the tone of the group helped her to see that she wasn’t a bad parent just because she couldn’t spend more than five minutes playing with her kids, and she wasn’t a bad Jew because she dreaded davening from a siddur. When she completed the group’s eight sessions, she left with a new sense of confidence and pride in the positive aspects of having ADHD.

In the past, there was a lot more stigma associated with support groups. That was part of what led Chana Esther to start her organization nine years ago. She realized that to begin, they had to tackle the issues that were the most prevalent — people dealing with anxiety and spouses of those with mental illness — because for every 100 people struggling, only a few will answer the call. That’s also why Chana Esther feels it is so important that their sessions are free. She didn’t want finances to be even the slightest deterrent for people in joining. Gavriel admits that the fact that the group was free was a big incentive for him to join, especially because the cost of individual therapy was becoming too much of a burden.

Chana Esther explains that her therapists are highly skilled, hired after doing heavy research and checks with agencies. She is able to keep the organization financially viable because the leaders are also volunteers, so there’s very little overhead cost. They consider it a privilege to help so many people by  contributing just one-and-a-half hours a month.

Advertising, especially for highly sensitive and stigmatized disorders, needs to be done in a secure and discreet way. People don’t need to give their names when calling for information, and often they won’t. Mrs. Kristall currently co-facilitates a group for survivors of incest. “I’m very conscious of how I interact with the person because I assume they’re nervous when making the call. I’ll say things like ‘I’m imagining it took a lot of courage to make this call, and that’s huge.’”

Sarah recalls, “When I first went to join Eim Habanim, I felt very uncomfortable that I belonged to a divorced women’s group. It was a total change of status, and that was very hard. Some women never end up joining because they feel this way, but once you get over it, it’s worth it.”

Gavriel’s entire perspective of “sharing” changed once he was part of a group. “I thought it would be scary to reveal my personal life to a room full of people. But once in the group, I realized it was so much easier than opening up to my therapist, because I saw how many others could relate to my struggle.”

It’s ironic that you need to overcome your embarrassment in order to take that giant leap and join. But so much of that embarrassment melts away once you see that there are others like you. As Mrs. Kristall says, “It takes courage to join, but once you do, it’s like you’re home.”

Addition, Not Substitution

Being part of a support group has powerful benefits that individual therapy can’t provide. At the same time, it’s often valuable to seek out individual therapy in conjunction with group work.

From the Professional

Shira Fruchter, MSW:

Attending group therapy provides a magnificent way to learn about one’s own self. To quote an Internal Family Systems (IFS) tenet, “If it’s intense, it’s yours,” meaning that if something in the group creates an intense and heated response in you, it’s clearly touching upon your inner world.

It’s those triggers that will propel you to seek out individual therapy. The interpersonal dynamics of the other participants will provide an opportunity for you to learn about the parts within you that deserve exploration. That work deserves the proper time and space, which can’t sufficiently be provided in a group setting.

It’s the beautiful synthesis of both types of therapy — group and individual — that gives fertile ground to plant the seeds that can then be nurtured.

Shira Fruchter, MSW, maintains a private practice in Ramat Eshkol for adults and couples. Shira’s an international trainer and a certified IFS therapist with over 15 years of clinical experience. She runs IFS support and skills groups.

From the Client

Chava, Jerusalem:

I attended group therapy. Throughout the course, I felt there was so much more I wanted to speak obout with someone privately. In the group, everyone was able to share, but it was limited. We also needed to hear others, which can be hard when you have a lot going on in your own head and no other outlet.

So I started seeing a private therapist, and it’s been life-changing. Group therapy taught me coping skills, and opened up my world by showing me that — behind closed doors — others are coping with a lot too. The time with my therapist allowed me the opportunity to open up on deeper and more challenging issues, to come to a more complete resolution.

Getting off the Ground

Chana Esther Schechter, founder of Yad B’Yad, offers tips on how to start a successful support group in your community:

Spread the word.

The more people who find out, the greater the likelihood you’ll get enough people to start a group.

Reach out to those on the ground.

Let professionals who specialize in dealing with a particular struggle know about your group so that they can refer their clients.

Use “Letters to Editor.”

I recently read a story in a local publication about a woman who many thought was snobby, but in reality she struggled with social anxiety. I wrote in with a letter letting readers know that we were forming a group for social anxiety. After it was published, we had enough calls to start two groups!

Free or minimal donation.

Many people are maxed out financially, especially if they’re already paying for individual therapy. Find ways to cut costs so members aren’t deterred by the price.

Get a great facilitator.

If people hear a big name is running the group, they may be more inclined to get past any discomfort and sign up.

Don’t double-up.

Try not to duplicate groups that already exist. It dilutes each group; people will split between them and then there may not be enough members for either one.

 (Originally featured in Family First, Issue 754)