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Understand the important difference between therapy groups and support groups — and establish boundaries

Published March 2018

Todd Sigler, licensed psychologist and nationally certified counselor, offers his response to the MissionBox DoubleTake — a column that offers opinions about the peskier aspects of working in the nonprofit sector. The opinions offered here are based on the author's personal nonprofit experience and may not reflect the opinions of MissionBox, Inc.

These opinions should not be considered legal advice or used as a substitute for professional legal consultation. MissionBox readers are invited to submit alternative responses, which may be published here as well.

I have a new job at a nonprofit as a general office manager while I am studying for a bachelor's degree in social work. The nonprofit provides support to families suffering from grief and loss, specifically related to the death of a child. Volunteers facilitate sibling and parent support groups. This is my area of study, so I was excited to have the opportunity to join this small organization.

Every volunteer has experienced the loss of a child and seems deeply committed. Volunteers are provided with basic facilitation training and attend monthly seminars for grief and loss-related education. The prevailing wisdom here is that each volunteer’s own experience of loss makes them uniquely able to understand grieving families’ needs.

I became concerned, however, once I began sitting in on the support groups. Some of the family members attending these group sessions bring not only their profound grief but other issues related to mental health problems, family violence and substance misuse into the discussions. A few of the volunteers seem to cross acceptable boundaries, such as personally befriending some members and not others.

I know volunteer facilitation models are used in other programs such as Alcoholics Anonymous. I don’t know what the research shows, but its effectiveness seems questionable.

While I can choose to leave this organization, and probably will, I remain anxious about what is happening to these vulnerable families. I don’t believe volunteers without clinical training should be providing what amounts to untrained, unsupervised "treatment."

Todd says . . .

The short answer to your question is no. No one — volunteer or licensed — should be providing treatment without appropriate training and supervision when necessary.

Your question gets to the heart of a long-standing and difficult aspect for service organizations providing emotional support to clients (versus traditional therapy). There are essentially two "types" of groups one might look for when grieving or in need of any mental health support. One type is usually called something like a "therapy group" and the other is referred to as a "support group."

There are several commonalities between these two types of groups. Both groups members share some common life experience/diagnoses which brought them to the group, both establish rules which outlines group expectation, limitations and norms, and both types have a "facilitator/leader" to guide the meeting.

The are some very important and relevant differences between the groups. The therapy group is facilitated/conducted by a licensed mental health professional. Each licensed profession has a code of ethics and facilitator is bound by that code and their licensure to provide the standard of care in the professional environment. Additionally, the facilitator/leader is bound by their organizations' rules/expectations. For example, when a therapy group member demonstrates a change in mental health status like worsening of mental health symptoms, the professional must approach the individual to further assess the situation and assist with accessing additional support/services if necessary.

Support groups conversely are not facilitated by a licensed mental health professional. The level of education, training and experience varies and not defined by an external licensing or monitoring board. The facilitator/leader is bound only by an understanding of the organization's expectations of the person filling that role.

There are several courses of action to consider before deciding to leave the organization. You bring a fresh perspective to this issue, and leaving before the organization understands the potential of unintended consequences of the group dynamics you described leaves group members vulnerable.

I encourage you to have a conversation with the facilitator/leader about your observations. This will clue you into whether the leader also sees these issues but is just uncertain what to do about it, or does not have an awareness of the potential problems about what you described. Either way, the intervention is the same — the facilitator/leader (and organization) needs information and training in this area.

It is typical for many support groups (and therapy groups) to review the "rules" at the start of each session; especially when the membership is open, meaning people come and go. This process helps establish group norms and reminds each member of the importance of their role in the group and to respect group norms.

Consider working with the facilitator/leader to develop a set of group rules with special attention to the issues you identified. There are many examples of support group rules available online to reference. I encourage you to keep a copy posted in group areas and provide all new members with a copy. Another important resource a support group should have is information on where a client of the organization can obtain professional help when they want/need it.

Ultimately, the group facilitator/leader must perform their function in the group, which is to mediate, guide and direct the group as needed. In my opinion, this includes speaking privately with a group member who may be presenting with an increased level of distress about whether additional professional support is needed and know how to access it. The facilitator/leader should also ask to speak privately to group members that appear to have greater needs than what the support group can offer and encourage or assist the person to find the needed services or resources.

In your situation, the facilitator/leader should ask to speak privately with the person(s) who raises issues in the support group which cause concern for their or others safety (e.g., domestic violence, addiction). The group member can be offered information about resources/services to address the concerns raised.

In closing, I am always reminded that working with people’s emotional pain brings out our own individual feelings and reactions. Leaning into this work is never neat and tidy; especially in how we help people get through their most painful times. Loss, grief and sorrow bring out some of our most intensely felt emotions. Many books and papers have been written about grief and treating grief when people get "stuck." But ultimately, it is the interactions we have with the people and the world around us which is the canvas/backdrop for our healing. Support groups are one important part of that journey for some people.

Dr. Todd M. Sigler is a licensed psychologist, who began working in non-profit organizations serving vulnerable populations in the early 1990s. Currently, in his private practice, he conducts psychological evaluations for a variety of population and has extensive experience in assessing refugees and immigrants.

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