Starting 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 group members.

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.

Core Beliefs:

• 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):

1. Feel Your Feelings
   
2. Nothing Comes Out of the Blue
3. Challenge Depressed Thinking
4. Establish Priorities
5. Communicate Directly
6. Take Care of Your Self
7. Take, and Expect, Responsibility
8. Look for Heroes
9. Be Generous
10. Cultivate Intimacy
11. Practice Detachment
12. Get Help When You Need It

Group Objectives:

• 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 with professionals
  
• 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 times
  
• 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.