October / November 2006

PEER SUPPORT GROUPS: The Missing Ingredient in Healing from Depression
— Douglas Bloch

Anyone who has ever experienced an episode of clinical depression understands its nightmarish qualities. A depressive illness is a “whole body” disorder that affects the way one eats and sleeps, the way one thinks about oneself, others, and the world. Clinical depression is not a passing blue mood or a sign of personal weakness—subtle changes in the brain’s chemistry create a terrible malaise in the body–mind– spirit that can affect every dimension of being.

Those who suffer from depression will tell you that it is a lonely experience. They 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. As a result, depression is a horribly isolating experience. In this context, experiencing the support of others who know and understand can be a lifeline to healing.

When a person is diagnosed with clinical depression, he is usually offered medication, cognitive therapy, or a combination of the two. The purpose of this article is to show how depression support groups can act as a third element in recovery, working synergistically with therapy and medication to make them more effective.

THE PURPOSE OF A SUPPORT GROUP
In his groundbreaking book A General Theory of Love, psychiatrist Thomas Lewis demonstrates that human beings are biologically hardwired for connection. Lewis coins the term “limbic integration” to describe the positive effect that two individuals have on each other’s limbic systems (the limbic system corresponds to the emotional brain). According to Lewis, anything that promotes emotional connection has a healing effect on the brain and nervous system. Conversely, separation and isolation lead to illness and dysfunction.
Because they supply the missing ingredient of connection, depression support groups complement the traditional treatment modalities of medication and psychotherapy. Here is how group members have described the benefits of being in a group.

* It is a place where I am heard and listened to.
* Hearing others’ stories helps me realize I am not alone.
* Listening to people’s stories gives me hope.
* I can express my pain and have it validated by others.
* The group provides a format to connect with people who UNDERSTAND what I am going through because they are there—or have been there.
* This is the family I never had.
* Joining this depression support group has made my recovery possible.

I have been facilitating depression support groups since the spring of 2001. My clients report that before they joined the group, they were unable to find other people who truly understood their condition. In this context, they greatly appreciate the contact and support they receive from their fellow group members.

What follows are some ground rules and guidelines that I have found helpful in setting up and running these groups.

Go to www.voicedialogue.org

CHARACTERISTICS OF THE GROUP
A depression support group is designed for the following people:

* those who are in the middle of a depressive episode and want to get well.
* those who have recovered from previous episodes of depression and are working on staying well. These people can offer hope to those who are still in the “dark house.”
* those dealing with other mood disorders such as anxiety, bipolar disorder, and PTSD (post-traumatic stress disorder).

The two criteria for joining a group are a sincere desire to get well and a commitment to attend meetings regularly. In addition, if someone is in moderate to extreme emotional stress, I ask that he or she be connected with a psychiatrist or other mental health professional before entering the group. A depression support group is an adjunct, not a replacement for a professional mental health treatment.

THE STRUCTURE OF THE MEETING
It has been my experience that a depression support group can have anywhere from four to ten members, with six to eight being an ideal number. Set a regular time to meet. Weekly meetings are ideal, although every other week will also work. The length of the meeting can vary but should be 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:

1) For the first block of time (usually seven to eight minutes), the person gives an update on his mood 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 (three to four 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 or suggestions.
3) Finally, the facilitator asks the person if he would like to make a request for support for the coming week. Examples of requests for support include, “exercising three times a week,” or “saying my affirmations on a weekly 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.” At the end of the group meeting, we usually close with a group prayer, affirmation, or positive intention. Here is a lovely meditation which is popular among group members.

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.

In between meetings, each group member holds an image of healing support for each other member. 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, e-mail, or in person. This helps to overcome the natural tendency of many depressed people to isolate.

Go To Saybrook.edu

For you to intervene effectively to alleviate suffering and build a sustainable society, you 'll need not only a passion for positive change but high-level skills, knowledge and leading-edge tools. At Saybrook Graduate School you can acquire the advanced degree you need in Psychology, Human Sciences or Organizational Systems. Our humanistic approach uniquely deepens your learning in such concentrations as Social Transformation, Humanistic and Transpersonal Psychology, Consciousness and Spirituality, and Integrative Health Studies. We offer more than 200 courses. Saybrook.edu

WHO SHOULD FACILITATE A DEPRESSION SUPPORT GROUP
Since 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 focused 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 of working with groups. Such a person should ideally work under the direction of a clinical supervisor. From week to week, the group facilitator will:
* keep the group focused on healing from depression * keep the group on track and following the structure * Respond to any member’s symptoms of distress (each member should also have their own individual counselor to turn to)
* Pair up group members to serve as each other’s coach/ buddy in between sessions
* Pick the topic of discussion, if there is an educational component to the group

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 per session per person), but still far below the cost of individual therapy.

Since people who have long-term depression may be limited in their ability to work, I have tried to be flexible in my approach to fees. If a group member has a strong intention to heal and has good outside mental health support (through a counselor 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 contact me.

STORIES OF RECOVERY
Perhaps the best way that I can demonstrate the healing potential of depression support groups is to share some personal accounts of mutual support. The following accounts were taken from the dozens of examples that I have witnessed over the past five and a half years.

Example 1. One group member whom I will call Donald slipped into a depression shortly after retirement. He became so depressed that he stayed in bed all day long. Fortunately, Donald had become friends with two other retired men in the group. One Friday morning his friends showed up on his porch and announced to Donald that they were taking him on a day hike in the Columbia River Gorge (twenty minutes outside of Portland) and that they were not leaving until he agreed to go.

Reluctantly, Donald stumbled out of bed and let his friends into the house where they helped him to dress, prepare breakfast, and get his hiking gear together. Donald found that once he began to hike, his energy increased and his mood improved. By the end of the day, his depression had lifted.

At the next group meeting, the men shared stories and photos of their outing. Thereafter, they made the Friday hike their weekly ritual. This continued for six months, at which time Donald made a complete recovery.

Example 2. One member of our weekly Wednesday group whom I will call Carol was particularly averse to doing any kind of paperwork. When she began group, she was just emerging from a six-week depressive episode, during which her mail had gone unopened. The prospect of having to deal with all the unopened mail overwhelmed her. After hearing about Carol’s situation, a group member named Wendy volunteered to spend an hour a week opening the mail with her.

A few weeks later, Wendy told the group that she was having a particularly bad flashback of a past traumatic event (she suffered from PTSD, post-traumatic stress disorder). Carol offered to drive Wendy home and stay with her until her anxiety subsided. This example of one group member being helped by another and then returning the favor is a key component of the mutual support system created by depression support groups.

Example 3. During our afternoon group, a young adult whom I will call Nancy shared that she was hearing voices that told her to kill herself. Angela, a group member who had experienced similar symptoms, shared her experience that these voices always pass. She encouraged Nancy not to listen to the voices and to call her as often as she needed to. Nancy agreed to stay in contact, and by the next morning the voices had subsided.

Three weeks later, Angela came to the group and said that she was being told by an “inner force” to harm herself. She told the group: “I don’t feel safe going home and being by myself.” Now it was Nancy’s turn to be the helper. She responded, “I’ll hang out with you this evening if you buy me dinner.” The two went out and had a great time. By the next day, Angela’s self-harm impulses had passed.

This example shows that mutual support among peers works even for people who are having severe symptoms such as suicidal ideation. Over the past five years, I have seen dozens of people who experienced unrelenting pain and sought suicide as an option for ending that pain. Fortunately, all of them were able to reach out to other group members (and the rest of their support system). The support and concern they received allowed them to refrain from acting on suicidal thoughts, while the impulses passed.

These observations are validated by sociologist Emile Durkheim. At the end of 19th century, Durkheim performed a huge cross-cultural study of suicide and found that people who had fewer social constraints, bonds, and obligations were more likely to kill themselves. The more connected we are to other people, the less likely we are to succumb to despair.

In summary, peer support groups offer a critical piece in mental health recovery for those suffering from depression, anxiety, and other mood disorders. It is my hope that the millions of people who suffer from depression and anxiety can join together in healing communities and accomplish together what they cannot accomplish alone.

DOUGLAS BLOCH, MA, is an author, teacher, and counselor who writes and speaks on psychology, healing, and spirituality. He has a BA in Psychology from New York University and an MA in Counseling from the University of Oregon. His wrote the book Healing from Depression: 12 Weeks to a Better Mood. Douglas makes his home in Portland, Oregon. (1) 503-284-2848 dbloch@teleport.com http://www.healingfromdepression.com

First Cover Story:

The Blossom and the Rose Stem: The Relationship of Spirituality and Religion
—Sharon G. Mijares