Potential Risks And Shortcomings Of Support Groups

If prospective participants are geographically dispersed, as is the case for people who reside in rural areas, then logistical difficulties may prevent them from attending a support group. Alternatives that have recently been initiated are to create telephone and electronic mail support groups. By means of teleconferencing and occasional face-to-face visits, much of the experiential knowledge and a substantial amount of emotional and esteem-relevant support can still be exchanged in such groups. A second shortcoming is that support groups do not allow for the individualization of helping. Thus, what is gained in cost efficiency through the group format is lost in personalized attention. However, in many instances, support groups are designed to supplement rather than to substitute for the individual counseling or treatment offered by mental health or medical practitioners, and so members' unique needs are addressed. Moreover, when individual counseling precedes support group participation, the counselor may be able to make more judicious judgments about group assignments. As Gottlieb pointed out in 1988, there are also several types of one-to-one formats for marshaling support that may be better suited to people's needs and preferences than a group intervention. Hence, practitioners should consider and even compare the effectiveness of alternative support strategies.

Third, support groups can have adverse social repercussions. They can threaten natural network members who perceive the group as an affront to the support they offer instead of recognizing that the support of similarly stressed peers is a vital complementary coping resource. The group leaders can guard against such resentment, injury, or backlash from the participants' network members by not only advising the participants to explain the special value of the support group, but also by inviting key network members to attend a meeting of their own in which they can ask questions, air their concerns, and learn how they can optimize the group's impact on their associate. A related social and ethical concern that has not received sufficient attention from group planners is the potential negative effect of withdrawing the peer support when the final group session has ended. In virtually every published report of support groups, the mem

Support Groups bers lament the group's termination. This suggests that many groups do, in fact, terminate prematurely and ought to have a longer course or at least offer the members the option of continuing to meet on their own as a mutual aid group or at least to socialize with one another. Naturally, this will not be possible if the participants are minors or if they are dealing with such sensitive or technical matters that they require professional guidance. In any case, it behooves the group leaders to carefully plan for the group's termination, and to monitor any rebound effects that may result therefrom.

Finally, as is the case for all group interventions, there is the possibility that a negative emotional contagion will spread through the group, especially if the members face circumstances that are known to deteriorate over time or suffer from a condition that has a poor prognosis. Many practitioners question the wisdom of bringing together people with terminal diseases such as cancer because they fear that they will only exacerbate their distress and further demoralize them. Although this adverse development is certainly possible, its likelihood can be minimized by leaders who carefully monitor and control the group's affective tone. Moreover, those who clinicians worry about most are usually people who suffer from both social and emotional isolation, and who therefore are most likely to benefit from the empathic understanding, companionship, and solidarity that a support group can offer. It is also important to keep in mind that people want to be well and that the support group can teach participants how to reinforce one another's wellness rather than their distress.

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