Self-help groups, also known as mutual help, mutual aid, or support groups, are groups of people who provide mutual support for each other. In a self-help group, the members share a common problem, often a common disease or addiction. Their mutual goal is to help each other to deal with, if possible to heal or to recover from, this problem. While Michael K. Bartalos (1992) has pointed out the contradictory nature of the terms “self-help” and “support,” the former U.S. surgeon general C. Everett Koop has said that self-help brings together two central but disparate themes of American culture, individualism and cooperation (“Sharing Solutions” 1992).
In traditional society, family and friends provided social support. In modern industrial society, however, family and community ties are often disrupted due to mobility and other social changes. Thus, people often choose to join with others who share mutual interests and concerns. In 1992, almost one in three Americans reported involvement in a support group; more than half of these were Bible study groups (“According to a Gallup Poll” 1992). Of those not involved in a self-help group at the time, more than 10 percent reported past involvement, while another 10 percent desired future involvement. It has been estimated that there are at least 500,000 to 750,000 groups with 10 million to 15 million participants in the United States (Katz 1993) and that more than thirty self-help centers and information clearinghouses have been established (Borman 1992).
Basic Self-Help Group Models
Self-help groups may exist separately or as part of larger organizations. They may operate informally or according to a format or program. The groups usually meet locally, in members’ homes or in community rooms in schools, churches, or other centers.
In self-help groups, specific modes of social support emerge. Through self-disclosure, members share their stories, stresses, feelings, issues, and recoveries. They learn that they are not alone; they are not the only ones facing the problem. This lessens the isolation that many people, especially those with disabilities, experience. Physical contact may or may not be part of the program; in many support groups, members informally hug each other.
Using the “professional expert” model, many groups have professionals serve as leaders or provide supplementary resources (Gartner and Riessman 1977). Many other groups, using the “peer participatory” model, do not allow professionals to attend meetings unless they share the group problem and attend as members or unless they are invited as speakers (Stewart 1990).
Comparing the self-help peer participatory model with the professional expert model, experiential knowledge is more important than objective, specialized knowledge in the peer model. Services are free and reciprocal rather than commodities. Equality among peers, rather than provider and recipient roles, is practiced. Information and knowledge are open and shared rather than protected and controlled.
Peers can model healing for each other. By “the veteran helping the rookie,” the person who has “already ‘been there’” helps the newer member (Mullan 1992). Through peer influence, the newer member is affected (Silverman 1992). Although the newer member learns that the problem can be dealt with and how, the older member who helps also benefits (Riessman 1965).
One possible effect of this peer model is empowerment. Self-help group members are dependent on themselves, each other, the group, perhaps a spiritual power. Together they learn to control the problem in their lives.
Those who share a common shame and stigma can come together, without judging, to provide an “instant identity” and community (Borman 1992). They can give emotional, social, and practical support to each other. They can explore and learn to understand and to combat the shame and stigma together, enhancing their self-esteem and self-efficacy. Through participation, they can enhance their social skills, promoting their social rehabilitation (Katz 1979).
Through “cognitive restructuring” (Katz 1993), members can learn to deal with stress, loss, and personal change (Silverman 1992).
The original model self-help group was Alcoholics Anonymous (AA), founded in 1935 by “Bill W.” (William Griffith Wilson) and “Dr. Bob” (Robert Holbrook Smith). It is now estimated that 1 million people attend more than 40,000 groups in 100 countries (Borman 1992). AA has come to be known as a “twelve-step group” because its program for sobriety involves the following twelve steps:
1. We admitted we were powerless over alcohol—that our lives had become unmanageable.
2. Came to believe that a Power greater than ourselves could restore us to sanity.
3. Made a decision to turn our will and our lives over to the care of God as we understood him.
4. Made a searching and fearless moral inventory of ourselves.
5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.
6. Were entirely ready to have God remove all these defects of character.
7. Humbly asked Him to remove our shortcomings.
8. Made a list of all persons we had harmed and became willing to make amends to them all.
9. Made direct amends to such people wherever possible, except when to do so would injure them.
10. Continued to take personal inventory and when we were wrong promptly admitted it.
11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and power to carry that out.
12. Having had a spiritual awakening as the result of these steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.
There are numerous twelve-step groups modeled after AA, including Adult Children of Alcoholics, Al-Anon, Alateen, Cocaine Anonymous, Codependents Anonymous, Debtors Anonymous, Divorce Anonymous, Emotions Anonymous, Gamblers Anonymous, Narcotics Anonymous, Neurotics Anonymous, Overeaters Anonymous, and Workaholics Anonymous. Families Anonymous is a fellowship of relatives and friends of people involved in the abuse of mind-altering substances. These “anonymous” groups help their members to recover from their various addictive behaviors while maintaining member confidentiality. This confidentiality extends to not recognizing members as members when they meet outside meetings. Most groups are self-supporting, do not have dues, and decline all outside support to maintain their independence; they do not engage in any controversy, and they neither endorse nor oppose any cause.
Increasingly, there are groups that work toward recovery from addictions but reject certain tenets of twelve-step programs. Charlotte Davis Kasl (1992) has written about the need to fashion different models for recovery for people with different needs. For example, Rational Recovery Systems (affiliated with the American Humanist Association) and Secular Organization for Sobriety both reject AA’s emphasis on spirituality.
Several self-help groups that specifically work with families are Parents Anonymous (for family members, to combat child abuse and neglect), Al-Anon (for relatives and friends of persons with alcoholism), and Alateen (for teenage relatives of persons with alcoholism).
Parents Anonymous (PA), founded in 1971 by “Jolly K.” and Leonard Lieber (Borman 1979), assures anonymity but is not a twelve-step group. There is no religious commitment. Members provide suggestions and referrals to each other and may work toward solving problems together. PA is the oldest and only national parent self-help program with specialized groups for children. Approximately 15,000 parents and 9,200 children participate in its support groups in the United States each week. There are specialized groups in various states—for example, groups for homeless families. In several states there are groups for grandparents and grandchildren. Weekly meetings are representative of the communities in which they are held (Parents Anonymous 1993).
Al-Anon and Alateen, twelve-step groups affiliated with AA, welcome and give comfort to families of persons with alcoholism and give understanding and encouragement to the person with alcoholism. Meetings are held weekly. “The Al-Anon Family Groups are a fellowship of relatives and friends of alcoholics who share their experience, strength and hope in order to solve their common problems,” believing that “alcoholism is a family illness and that changed attitudes can aid recovery” (Al-Anon 1981).
Support and Information Groups
Another type of self-help group focuses on medical diseases or problems. Examples of such groups that help families include AFTER AIDS (for people who have lost a loved one to AIDS), Candlelighters (for parents of young children with cancer), Make Today Count (for persons with cancer and their families), Mended Hearts, Inc. (for persons recovering from heart surgery, and their family and friends), the National Alliance for the Mentally Ill (for families and friends of persons with serious mental illness), National Federation of the Blind (for blind persons and their families), and National Society for Children and Adults with Autism (for children with autism and their families).
The Compassionate Friends (for bereaved parents), Parents Without Partners (for single parents and their children), and Tough Love (providing support and mutual problem solving for parents troubled by teenage behavior) are examples of other types of family-oriented groups.
Many of these organizations have other services in addition to self-help groups, such as information and referral, advocacy and lobbying, grant funding, research support, and practical assistance (e.g., providing hospital beds for home care).
Leonard D. Borman (1992, p. xxv) has written that “the underlying mechanism” of the self-help group is love, “a selfless caring.” However, dangers that the self-help “movement” must guard against include dependence, victim-blaming, antiprofessionalism, further medicalization, and co-optation by the medical system.
Nevertheless, Victor W. Sidel and Ruth Sidel (1976, p. 67) have called self-help groups “the grassroots answer to our hierarchical, professionalized society,” to its alienation and depersonalization.