a Self-Help Group
The fact that there is no organized
self-help movement for depression is really quite remarkable in these
days when you can find self-help groups for everyone - from victims
of Satanic ritual abuse to the death of a pet. The fact that more
and more people are only getting minimal psychotherapy, or medication
prescribed by their general practitioner, certainly makes it seem
as if the need is there. Perhaps the nature of the illness makes it
difficult to believe that much help can come from other sufferers.
But I've been using the principles described in this book in a group
in my clinic in which I am both a member and the convenor. I take
responsibility for presenting some helpful material in every meeting
but it's not group therapy. The same responsibility is shared by other
If you'd like to start a self-help
group in your area, I strongly encourage you to first find a mental
health professional who (1) is experienced in treatment of depression;
(2) supports medication as part of treatment; and (3) is open to sharing
his/her own experience with depression. You need a professional because
sometimes people will show up who the group can't help, and the professional
has to be responsible for getting those people the help they need.
Once you've got a good professional enlisted, starting a self-help
group for depression is really not as intimidating as it sounds. Churches
will donate space, mental health centers will help spread the word.
All you really have to do is distribute some flyers and make up the
agenda for the first meeting. After the first meeting, group members
should come up with their own agenda, which might include some time
for sharing problems and experiences, educational programs on topics
of interest, sharing of activities, and advocacy. Basic rules should
include respect for members' confidentiality, a prohibition against
criticism, an encouragement but not a requirement to share. Other
useful resources are The Depression Workbook, by Mary Ellen
Copeland, and The Feeling Good Handbook, by David Burns. Both
have many exercises helpful in recovery which can easily be adapted
to serve as exercises for a group.
Background and goals: With public awareness of depression rising,
at the same time that limitations on mental health insurance benefits
restrict more individuals to short-term or medication-only treatment,
there is greater than ever need for ways to provide emotional support,
educate about medication, teach cognitive restructuring, and other
techniques to assist depressed patients in recovery.
Format: The group meets weekly for 75 minutes. There is no
charge for participation. The group is advertised in the community
and is open to all comers. The group leader reserves the right to
insist that members seek additional treatment as a condition of attendance
if they appear to be unable to benefit from the group.
Target Population: Individuals with major depression, dysthymic
disorder, adjustment disorder with depression, or DDNOS. People with
accompanying substance abuse are not excluded, but there is strong
group pressure to monitor medication and control substance use. Individuals
with personality disorders which grossly affect self-control and self-disclosure
will not benefit.
- Depression is a disease, but like heart disease or diabetes,
self-care is essential to recovery.
- Depression is not an emotion. Emotions are self-limiting.
- Depression affects every aspect of ourselves - our thinking,
behavior, emotions, self-esteem, and relationships with others -
but we can identify and control or accept those effects.
Principles for Recovery: The group borrows from Alcoholics
Anonymous in adopting a set of principles, discussion and application
of which become the guidelines for recovery. These principles are
from Richard O'Connor, Undoing Depression (Little, Brown, 1997):
- Feel Your Feelings
- Nothing Comes Out of the Blue
- Challenge Depressed Thinking
- Establish Priorities
- Communicate Directly
- Take Care of Your Self
- Take, and Expect, Responsibility
- Look for Heroes
- Be Generous
- Cultivate Intimacy
- Practice Detachment
- Get Help When You Need It
- Maintaining a running list of quick "mood changers"--simple things
to do when the blues are creeping up on you
- Learning how and when to get professional help, and how to communicate
- Understanding the effects of our depression on our families,
and helping to teach them about the disease
- Learning about stress and how to cope with it more effectively
- Identification of depressive thinking habits and behavior patterns
and strategizing more constructive alternatives
- Understanding depressive shame, guilt, and self-blame, and learning
to cultivate feelings such as pride and joy
- Provision of emotional support as members go through difficult
- Understanding the effects of antidepressant medications, and
other medications and drugs
Role of the Therapist: In this group, the therapist identifies
himself as a sufferer from depression and a consumer of mental health
services. He is open, within certain limits, about his progress in
recovery. This allows him an authority in offering hope and understanding
to depressed patients that does not come with the traditional therapeutic
role. Other group members also learn the importance of lending hope
and empathy, and benefit from their caregiving behavior in the group.
In our experience, many clinicians are in treatment or have been in
treatment for depression, either major depression or dysthymia, but
hold back from sharing their experience with clients because of beliefs
about the necessity of anonymity or objectivity. While objectivity
must be maintained, too much distance makes it difficult for the depressed
patient to engage. We find that limited self-revelation helps make
this group effective.
Economics: This group is run as a free community education
program instead of a therapeutic group. We find that the time saved
in not billing and not keeping clinical records, plus the ability
to keep engaged patients who would otherwise drop out of individual
therapy, plus the ability to informally monitor medication, makes
it a cost-effective use of a clinician's time.