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Facilitator must be self-reflective about how their position of power,  economic privilege or perception of being an expert, may be viewed to be like medical professionals who have negatively stereotyped them before (Loumpa, 2012). Facilitator must explore their ideas and experiences with mental illness and question how these issues impact their ability to anti-oppressively engage with participants. They should explore their verbal and non-verbal communication for potential oppressive actions (Lindsay & Orton, 2014). Once an instructor can understand how their values and beliefs relate to oppression towards people in recovery, they can openly communicate and effectively empower members of a group.

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The facilitator must create a democratic space in which peers can exchange experiences and break down dominant discourses about mental health together (Loumpa, 2012). This could be achieved through “identity groups” activities, in which peers break out into groups based on their mental health disorder and identify together unhelpful stereotypes (Lindsay & Orton). For example, a group of people with schizophrenia together conclude they dislike being called “crazy”. Facilitator could then promote further discussion in which peers discuss alternative narratives involving shared experiences. For example restructuring dominant medical discourses to presenting individuals as survivors of poverty, trauma, violence, etc. (Loumpa, 2012).

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Oppression commonly  occurs in people recovering from mental health disorders through stigmatization, particularly by medical professionals (Loumpa, 2012). The facilitator of peer support groups must tackle this social exclusion with participation and empowerment (Lindsay & Orton, 2014).

The facilitator must first acknowledge the effects of dominant mental health discourses, as the medical model which focuses on illness becomes internalized as a means of social control (Loumpa, 2012).  Facilitator should actively encourage participants to re-author their narrative, and particularly to exchange experiences with peers, making them the experts of their own lives. This fosters self-determination and responsibility.

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When beginning support groups, introductions should be used to further the cohesion and purpose of the group, and activities should fit the type of group and purpose (Pelech, Basso, Lee, & Gandarilla, 2016). For persons in recovery for mental health, facilitator should start by acknowledging that everyone has something in common; for example schizophrenic diagnosis, having living in group homes, or having been in a psychiatric hospital (Kurtz, 2014). Facilitator should allow members to speak to what their goals are and what they hope to discuss (Kurtz, 2014). Adding a fun element, for example encouraging members to share a hobby, may help humanize group members an create cohesion (Pelech, et. al., 2016).

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The advantage to co-facilitation, that is having a partner to lead group sessions, is diversity, as having a co-facilitator of a different gender or ethnicity helps participants feel included and safe (Lindsay & Orton, 2014). For a mixed group participant for persons in recovery from mental health disorders, this inclusivity can encourage open sharing and increase group cohesion (Loat, 2011). Also in line with this philosophy of mutual support is the advantage of collaborating with professionals from other fields (Kurtz, 2014). For example, bringing in a psychologist, nurse, occupational therapist, etc. can help provide participants with a different professional perspective, advice and support. However, the facilitator must ensure professional partner avoids lecturing and maintains the mutual aid perspective, especially for people recovering from mental illness (Kurtz, 2014).

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It is important to examine your goal of the group and how the composition of the group will influence behaviour (Lindsay & Orton, 2014). Having a broad group structure, such as participants with any mental illness, will require a great deal of structure and focus as people’s experiences are fragmented (Loat, 2011). The more common the qualifications for the group, such as only members who suffer from schizophrenia, will create a more cohesive group aim (Kurtz, 2014). When structuring a mental health support group, considerations should also be made to qualifications and limitations. For example an actively psychotic individual might be better to stabilize before attending a support group (Kurtz, 2014).

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When facilitating groups of persons in recovery from mental illness, confidentiality is an important ethical concern, in relation to keeping members confidentiality and ensuring members are keeping one another’s confidences (Corey, Corey, & Corey, 2018). People with mental illness face stigma, that is perception that their illness is an undesirable flaw, and therefore may fear sharing stories for risk that members will breach confidentiality (DeAndrea, 2014).  Many people with mental illness turn to technology for online support groups to maintain anonymity. Like with face-to-face groups, facilitators must educate members of the importance and advantages of maintaining confidentiality (Corey, et. al., 2018).

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Week Eight: Mitigating Stereotyping and Prejudice 

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Week Eight: Mitigating Stereotyping and Prejudice 

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Individuals recovering from mental illness who have faced social stigma can strongly benefit from positive self-esteem achieved in a support group setting (Crabtree, Haslam, Postmes & Haslam, 2010). However, if intergroup relations are seen to be insecure, group members may engage in conflict though social competition by challenging the status quo (Crabtree, et. al., 2010). Group facilitators can mitigate perceived prejudice of members by members by using role reversal activities (Zastrow, 2009). Facilitators can engage members in a dialogue in which one member expresses their ideas and feelings, and the other member will restate their feelings in their own words (Zastrow, 2009). Members practice empathy in this exercise by rejecting stereotypes and gaining an understanding of each other, thus mitigating conflict.

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In the beginning stages of group work, it is important for facilitators to distinguish the roles of the facilitator and members (Pelech, et. al., 2016). Members may expect the facilitator be the leader, especially coming from traditional medical models of mental health, where persons in recovery have been influenced by experts who diagnose (Loumpa, 2012).  Facilitator should promote shared control, power and agenda to promote mutual support and a client-driven approach (Loumpa, 2012). Facilitator must be clear that power hierarchies are non-existent and collaboration is encouraged, thus reclaiming members expertise on their own mental illness (Loumpa, 2012). This will also mitigate power differentials between members, for example equalizing someone on social assistance and someone in a distinguished profession (Pelech, et. al., 2016).

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Week Eight: Fostering Empathy to Combat Conflict

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Week Eight: Fostering Empathy to Combat Conflict

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Individuals in recovery from certain mental illnesses, like psychopathy, may experience empathetic dysfunction, in which they do not have the ability to affectively respond to and show understanding of someone’s situation (Farrow & Woodruff, 2007). This may defer them to utilize a ‘win-lose’ approach to conflict in which they deny the legitimacy of other’s interests and concerns (Zastrow, 2009). These individuals may be focused on their own needs and lack the ability to emotionally respond to others (Farrow & Woodruff, 2007). The facilitator may reinforce and empower individuals to use empathetic phases which mirror others feelings in a non-judgemental way (Zastrow, 2009). Individuals with psychopathy struggle to recognize other emotions, so the facilitator can create an open dialogue in which others can express and explain their emotions (Farrow & Woodruff, 2007).

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Week Nine: Awareness of Patterns of Scapegoating

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Week Nine: Awareness of Patterns of Scapegoating

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Individuals who have been have been victims of scapegoating often maintain an unhealthy identity and maladaptive culture that can lead to mental health problems (Kacso, 2015). Facilitators in support groups of those in recovery of mental illness need to be especially sensitive to patterns of scapegoating as it may mirror maladaptive culture of individual's past and negatively reinforce mental illness (Kacso, 2015). Oppressed and scapegoated people tend to blame and scapegoat others, therefore the role of scapegoat is likely to form in a support group (Kacso, 2015). Given the oppression and stigmatization likely experienced by all members of individuals recovering from mental illness, members are likely to reject their own negative elements onto another (Shulman, 2012). As such, the facilitator should not criticize actions, but engage in dialogue in which members reflect on their stigmatization and explore their own experience with being a scapegoat to gain empathy (Shulman, 2012).

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Corey, M.S. , Corey, G. & Corey, C. (2018). Groups: Process and practice, 10thed. Boston, MA: Cengage Learning.

Crabtree, J. W., Haslam, S. A., Postmes, T., & Haslam, C. (2010). Mental Health Support Groups, Stigma, and Self-Esteem: Positive and Negative Implications of Group Identification. Journal of Social Issues, 66(3), 553–569.

Davidson, L., Shahar, G., Lawless, M. S., Sells, D., & Tondora, J. (2006). Play, Pleasure, and Other Positive Life Events: "Non-Specific" Factors in Recovery from Mental Illness? Journal of Psychiatry, 69(2), 151–163.

DeAndrea, D. C. (2014). Testing the Proclaimed Affordances of Online Support Groups in a Nationally Representative Sample of Adults Seeking Mental Health Assistance. Journal of Health Communication, 20(2), 147–156.

Farrow, T. F. D., & Woodruff, P. W. R. (2007). Empathy in Mental Illness. Cambridge: Cambridge University Press.
Kurtz, L. F. (2014). Recovery Groups: A Guide to Creating, Leading, and Working with Groups for Addictions and Mental Health Conditions. New York: Oxford University Press.
Lindsay, T. & Orton, S. (2014)    Groupwork practice in social work, 3rded.  Thousand Oaks, CA: Sage Publications.
Loumpa, V. (2012). Promoting Recovery Through Peer Support: Possibilities for Social Work Practice. Social Work in Health Care, 53–65.
Loat, M. (2011). Mutual Support and Mental Health: A Route to Recovery (Vol. 18). London: Jessica Kingsley Publishers.
Pelech, W., Basso, R. , Lee, C.D. &  Gandarilla, M. (2016). Inclusive group work. New York, N.Y.: Oxford University Press

Zastrow, C.H. (2009). Social work with groups, 7th ed. Brooks/Cole: Belmont, CA.

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Week Nine: Awareness of Monopolizers and Reinforcement of Mutual Aid

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Week Nine: Awareness of Monopolizers and Reinforcement of Mutual Aid

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Individuals in recovery from mental illness strongly benefit from a mutual aid process of support groups, in which members participate in an equal exchange of information (Kurtz, 2014). Therefore, a monopolizer in the groups can be detrimental for fostering growth of all group members (Kurtz, 2014). Often two members engage in a therapist and client relationship in which they speak solely to each other while the rest of the group observes (Kurtz, 2014). It is the facilitators duty to intervene and shift the topic or engage with other members (Shulman, 2012). Those recovering from mental illness may be particularly sensitive to being submissive when others are monopolizing because they are vulnerable to those in authoritarian roles in medicine having control over their diagnosis (Loumpa, 2012).

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Week Ten: Utilizing Activities in Groups

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Week Ten: Utilizing Activities in Groups

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The experience of pleasure, play and positive life events have been shown to have crucial roles in the recovery of those with mental illness (Davidson, Shahar, Lawless, Sells & Tondora, 2006). Engaging in positive activities reward individuals with a sense of hope, meaning and purpose, and a sense of community (Davidson, et. al., 2006). Therefore, in a support group, the facilitator may plan activities that are not structured to have purpose in the group’s goals, such as bowling or dancing, but indirectly contribute to recovery and to group cohesion (Lindsay & Orton, 2014). Engaging in these activities in a trusting environment with group members can help mitigate insecurity gained from stigma, and foster skills and confidence to re-engage with society (Lindsay & Orton, 2006). The interaction with one another have attendant benefits in the mutual aid process of the support group (Lindsay & Orton, 2014).

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Mutual aid is the foundation of group work, in which helping is reciprocal in nature, as members offer insights to others and in turn gain insight on their own needs and challenges (Pelech, et. al., 2016). The facilitator should focus on guiding the process, not on creating content (Kurtz, 2014). For a group of individuals in recovery from mental illness, the facilitator may rotate through members as informal group leaders and information brokers in each session (Kurt, 2014). This reinforces mutual aid in that there is no authority figure, as everyone is equal (Pelech et. al., 2016). Involvement in leadership roles contribute to recovery from mental illness as individuals gain empowerment and a confidence that may have been lost in the navigation of their mental illness (Loat, 2011).

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Week Ten: Creating Trust and Celebrating Diversity

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Week Ten: Creating Trust and Celebrating Diversity

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Support groups for individuals in recovery from mental illness can show strong cohesion through their middle stages, as their shared struggles and life circumstances allow for trust to form (Kurtz, 2011). Their concerns may have been at near-crisis level, as they faced diagnosis with serious mental illness, so they will value this commonality as they may have felt ostracized by society (Kurtz, 2011). However, the facilitator should be aware of diversity in belief systems that may create obstacles and endanger the trust created from shared experiences (Pelech, et. al., 2016). The facilitator should reframe the differences as contributions and frame them into the context of mental illness to help relate to the group as a whole (Pelech, et. al., 2016).