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Bridging professional and mutual-help: An application of the transtheoretical model to the mutual-help organization

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Abstract

The authors suggest that the mental health system of the nation could benefit by more fully embracing the idea of mutual-help (i.e., self-help), and this collaboration could be facilitated by the utilization of a well-established clinical theory to elucidate the psychological processes at work within mutual-help organizations. The processes of change of the transtheoretical model is offered as one potential framework. This well-established model has been used to help psychologists better understand clinical and professional phenemonena, but, to date, has been used less frequently with non-professional interventions. This article applies the ten processes of change of the transtheoretical model to mutual-help organizations, focusing on four groups, including Alcoholics Anonymous (AA), Oxford House, GROW, and Schizophrenics Anonymous. The advantages of the transtheoretical model and its potential ability to act as a common language across clinical professionals and mutual-help organizations are discussed. In addition, advantages of bolstering the present mental health system using combinations of both forms of care along the recovery continuum are described.

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... DiClemente (22) og Olson et al. (29) analyserer AA i lys av den transteoretiske endringsteorien (transtheoretical model of change; TTM) 6 . Begge viser at mekanismer både ved 12-trinnsprogrammet og ved aktiviteter i disse fellesskapene bidrar positivt i et endringsperspektiv. ...
... Dersom helsepersonell opptrer devaluerende til selvhjelpsgrupper, vil det selvsagt føre til at pasientene i mindre grad deltar. Olson et al. fremhever at det er helseprofesjonene sitt ansvar å forsøke å bygge broer mot aktuelle grupper (29). Det kan skje både ved å utvide den teoretiske forståelsen og gjennom praktisk samarbeid. ...
... DiClemente (22) og Olson et al. (29) analyserer AA i lys av den transteoretiske endringsteorien (transtheoretical model of change; TTM) 6 . Begge viser at mekanismer både ved 12-trinnsprogrammet og ved aktiviteter i disse fellesskapene bidrar positivt i et endringsperspektiv. ...
... Dersom helsepersonell opptrer devaluerende til selvhjelpsgrupper, vil det selvsagt føre til at pasientene i mindre grad deltar. Olson et al. fremhever at det er helseprofesjonene sitt ansvar å forsøke å bygge broer mot aktuelle grupper (29). Det kan skje både ved å utvide den teoretiske forståelsen og gjennom praktisk samarbeid. ...
... Processes within the transtheoretical model of change used in the addiction literature may provide insight into increases in tolerance (Prochaska, Norcross, & DiClemente, 1993). In a review of self-help literature, transtheoretical processes such as self-reevaluation, environmental reevaluation, social and self liberation, and emotional factors may be developed within self-help models and are likely to even be more effective in 24-hour self-help living than they are in weekly groups ( Olson et al., 2005). Olson et al., in fact, proposed that the Oxford House model provides an excellent field-based setting for exploring transtheoretical processes for men and women in addiction recovery. ...
... Oxford House settings should not only be thought of as developing new reference groups, but also new family units, and this involves far more extensive interactions than mere social contact. Participants in Oxford House share their background, discuss drug histories, talk about personal and group goals, eat together, engage in chores, and attend 12-step meetings and go on other outings with one another ( Olson et al., 2005). ...
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The authors examine differential changes in values of tolerance among 150 participants discharged from inpatient treatment centers, and randomly assigned to either a self-help-based, communal living setting (i.e., Oxford House), or usual aftercare. Participants were interviewed every 6 months for a 24-month period. Hierarchical linear modeling (HLM) was used to examine the effect of condition (therapeutic communal living versus usual aftercare) on wave trajectories of tolerance (i.e., universality/diversity scores). Over time, residents of the communal living model demonstrated significantly greater values of tolerance than usual aftercare participants. Communal living participants who resided in the house for over 6 months showed the most substantial increases in tolerance. Results support the notion that communal living residents may develop more tolerant attitudes by striving toward superordinate community goals (objectives held by (a) the whole group and (b) which individual members could not achieve alone).
... Furthermore, health professionals in Norway are quite uneasy with linking the concept of spirituality to their professional practice; it is considered to belong to the domain of religion (Furman, Zahl, Benson, & Canda, 2007;Vederhus, 2017). Thus, to enhance cooperation between formal treatment services and these peer-based recovery resources, an effort should be made to examine how the religious wording in the 12-step program is used and understood by members, potentially bridging the professional and mutual-help gap (Olson, Jason, & Hutcheson, 2005). ...
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Health policy organizations recommend that health professionals refer patients with a substance use disorder to addiction-related self-help groups. However, the most common groups, the 12-step groups (e.g., Narcotics Anonymous [NA]) have religious wording (e.g., God, Higher Power, prayer) in their program that may cause potential participants to be sceptical, especially in secular cultures. From seven interviews with seasoned members of NA in Norway, we explored how the Higher Power concept of NA’s 12-step program is understood, how the respondents relate to their Higher Power in daily life, and whether they describe it as helpful in their recovery. A cross-case thematic analysis with systematic text condensation was used to analyze the data. Even the highly integrated NA members recounted an initial problem with the Higher Power concept. Eventually, the respondents realized that it was up to them to define the nature of their Higher Power. The respondents also defined the concept in secular or pseudo-religious ways. They were pragmatic believers; from early on they practised the recommended spiritual principles in NA (e.g., honesty and altruism), and dogmatism was considered unnecessary. The respondents presented relating to their Higher Power as vital for recovery, as they found motivation and strength to cope with the everyday process of staying clean and to continue in a recovery process. The present study sheds light on how secular and/or pragmatic, pseudo-religious worldviews can function similarly to specific religious views by helping people cope with demanding life experiences. The openness in NA toward diverse worldviews facilitates mutual support between members in a recovery process, despite differences in religious or spiritual persuasions. Health professionals should help potential participants overcome initial scepticism towards 12-step groups in order to gain access to the abstinence-based support obtainable in these fellowships.
... AA is the most widespread and available MHG for addiction in both the U.S. and in Europe [1]. To increase utilization of these peer-based recovery resources in European contexts, researchers and clinicians should engage themselves and attempt to "bridge the gap" to these organizations [10,11]. In this sense, Kelly's review admirably provides professionals with comprehensive and evidence-based information regarding the behavior change mechanism at work in AA, which may minimize some of the existing ambivalence and enhance the potential of making referrals. ...
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Commentary to: Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavior change research
... Thirdly, some authors have argued for the development of clinical theoretical models that support and explain the psychological mechanisms underpinning the efficacy of self-help groups (Olson, Jason, Ferrari, & Hutcheson, 2005). In particular, it might be interesting to further investigate the link between specific HVN principles and group outcomes. ...
Article
Hearing Voices Network (HVN) support groups have proliferated in the last decade, with anecdotal evidence suggesting they contribute significantly to the recovery trajectory of the voice-hearer members who attend them. However, to date there remains little empirical research into the efficacy of these groups and the processes that might underpin their efficacy. This article describes a small project evaluating the HVN groups in the large Australian state of New South Wales. Twenty-nine group members completed questionnaires exploring self-reported recovery-related and clinical outcomes, aspects of group process, and the extent to which core HVN principles were promoted within the group. Results indicate that HVN groups are associated with reported improvements across a number of recovery-related outcomes including feeling less isolated and more skilled in being with others, having improved self-esteem, and having a better understanding of their voice experiences. Positive changes were also noted in outcomes that are more traditionally associated with clinical improvements, such as decreased need for emergency help and medication, and increased hope in personal recovery. Although this study is small and based on self-report, the findings are promising and contribute to the small but growing literature on peer-supported interventions for psychosis and psychotic-like experiences.
... The processes of change are a common set of strategies and techniques for modifying a health behavior (4) and are considered important recommendations for the de-velopment of interventions (5). These processes, including two subgroups of cognitive and behavioral processes, are activities and experiences that occur during the behaviorchange process (6). The cognitive processes focus on the individual feeling and experiences, while the behavioral processes focus on the behavior and its reinforcement (7). ...
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Background: The use of weight-loss dieting has always been overemphasized as the first modality to treat obesity. Success in weight loss is considered a major problem in obese individuals. The processes of behavior change have been used to facilitate intervention promoting change. Only a minority of studies have employed this construct for weight loss. Objectives: The purpose of this study was to assess the effect of a balanced low-calorie diet with or without nutrition education on the weight loss and processes of change among obese women. Patients and Methods: In a randomized clinical trial, 90 apparently healthy obese women age 18 - 50 with body mass index (BMI) of 30 - 40 kg/m2 were recruited from the nutrition clinic in Ardabil, located in the northwest of Iran. Participants were assigned randomly to receive a balanced low-calorie diet with or without nutrition education. Participants completed a processes of change questionnaire at baseline and at three and six months after intervention. A generalized linear model repeated measures analysis of variances was used to assess the time effect as well as the interaction between the time and the group effect. Results: Significant differences were found in the time effect for weight (F = 12.64, df = 2, P < 0.001), BMI (F = 10.90, df = 2, P = 0.001), andcounterconditioning (F = 22.82, df = 2, P < 0.001), and helping relationships (F = 5.47, df = 2, P = 0.006), reinforcement management (F = 3.65, df = 2, P = 0.03), self-liberation (F = 5.05, df = 2, P = 0.008), stimulus control (F = 12.12, df = 2, P < 0.001), and substance abuse subscales (F = 6.72, df = 2, P = 0.002). Significant differences were shown in interaction time and group effect for weight (F = 5.69, df = 2, P = 0.011), BMI (F = 4.91, df = 2, P = 0.018) and counterconditioning (F = 5.11, df = 2, P = 0.008) and stimulus control (F = 5.50, df = 2, P = 0.006) subscales. Conclusions: The findings support the use of nutrition education for more weight loss and improvement in the counter conditioning and stimulus control subscales among obese women attending the nutrition clinic. It seems that nutrition education should be considered important in effective weight-loss interventions.
... Extant research has shown that individuals with substance abuse histories who live in Oxford Houses are less likely to reoffend, are less likely to use substances, are more likely to be employed, and spend less time engaged in criminal activities (Jason and Ferrari 2010;Jason et al. 2006). Peer-led, mutual help models like Oxford Houses have been shown to provide positive peer networks (Olson et al. 2005;Wexler 1995), which are associated with reduced recidivism among the formerly incarcerated (Broome et al. 1996). Yet, while the research support is strong and provides evidence on what aspects of the housing relate to positive outcomes (i.e., peer support), the Oxford House model is appropriate for only a subset of those released from prisons and jails (i.e., those released with substance abuse issues who agree to a peer-led recovery model). ...
... The authors of this paper are part of a university-based research entity. We are organizationally independent of Oxford House, although our relationship with the group, its houses, and individual members organization can often be considered involved and intense (Jason, Davis, Ferrari, & Bishop, 2001;Olson, Jason, Ferrari, & Hutcheson, 2005). We do not consider ourselves "consultants" for the organization. ...
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Community program evaluations, visioning and assessments must always endeavor to attain useful information in the most sensitive way. Most community-based organizations form, grow and continue on their own without the help of outside experts. Participatory approaches should respect the historical evolution of these groups and understand the positive factors that underlie their organizational beliefs. A group's mission, values and identity should inform any community program evaluation, consulting project, and the design of any research study. Narrative methods have been used with mutual-help groups and many other organizations to good effect. Such methods have great potential to avoid hierarchical and unidirectional forms of evaluation, encouraging the group's collective psychology and identity-based constructs to emerge. We developed a participatory, narrative technique called Community Narration (CN), which is described here. The technique utilizes personal stories and community narratives as an entry into the evaluation process or other work involved in understanding an organization. The community's participants were able to use the technique successfully, found it enriching, and the constructs obtained have led to many discussions and member-guided research related to the organization.
... on professionals' roles in mutual-help groups (Kurtz 1990;Shepherd et al. 1999;Stewart et al. 1994;Toseland and Hacker 1982), professionals' views of mutual-help groups (Kurtz et al. 1987;Meissen et al. 1991;Stewart et al. 1994), mutual-help members' views of professional involvement (Lotery and Jacobs 1994;Stewart et al. 1994), and mechanisms of successful collaboration (Chinman et al. 2002;Gartner 1997;Olson et al. 2005;Toseland and Hacker 1982). ...
Article
The effects of partnership between Schizophrenics Anonymous (SA, a mutual-help organization) and the Mental Health Association in Michigan (MHAM, a professionally staffed advocacy organization) on SA's growth and development were explored. Following the initiation of a formal partnership, SA groups were more available throughout the state, more likely to be associated with formal mental health settings, and less likely to have leaders who had been participants in other SA groups. Groups with consumer leaders had significantly greater longevity than groups with professional leaders. Changes in the organizational structure and process of SA were also identified. SA leaders reported that SA moved from a collective to a more bureaucratic structure. As a result, there was greater consistency, administrative capacity, and response capacity. This enhanced capacity came with costs reported by SA leaders. The leadership role of SA members became less defined. SA members expressed concerns about the more hierarchical structure of SA's organization, decreased consumer control, increased professional involvement in SA, and an excessive focus on group development as opposed to group maintenance. Mental Health Association in Michigan staff reported that MHAM was also impacted by the partnership, both with regard to internal functioning and external perception. Implications for effective partnerships between mutual-help and professional organizations are discussed.
... Public treatment systems are typically limited in resources and often cannot provide services of sufficient duration to address effectively the needs of severely dependent individuals. Self-help groups including Twelve Step groups (TSGs) such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) represent a useful complement to formal treatment services that contribute to sustaining treatment gains[2,3]. These organisations offer recovery support that is continuously available and free of charge to those who wish to attend, though small donations are typically made at individual members' discretion. ...
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Addressing substance use disorders effectively requires a long-term approach. Substance abuse treatment is typically of short duration; referring patients to Twelve Step based self-help groups (TSGs) - e.g. Narcotics Anonymous, represents a promising complementary recovery resource. Clinicians' attitudes and referral practices towards the TSGs have mainly been studied in countries with high integration of the 12-step philosophy in their substance abuse services and where the TSGs are widely available, such as the US. In Norway, there are currently 294 weekly TSG meetings (6 per 100,000 inhabitants). This study describes clinicians' attitudes and referral practices to TSGs in Norway where health authorities seek to promote self-help participation, but where the treatment culture is unfamiliar with 12-step fellowships. Data collected by a self-administered questionnaire, adapted from established US and UK instruments. Information covered the attitudes, knowledge and referral practices towards TSGs among addiction treatment professionals in Norway in mid 2008. The return rate was 79.7% (n = 291). Participants had moderately positive attitude scores towards TSGs, but referral to these groups among Norwegian addiction professionals was low, as was the level of knowledge about TSGs. More than six out of ten did not refer any patients to TSGs in the previous week. Local variation with more referrals to TSGs in the county with the one established 12-step treatment facility was observed. Respondents' integration of the 12-steps in their own treatment work, higher self-efficacy for making a successful referral, and greater TSG knowledge were associated with referring patients. Low referral rates to TSGs point to the need for education and training to raise the awareness and knowledge about it among addiction professionals unfamiliar with these 12-step fellowships. Training should focus on the usefulness of these groups for all types of treatment models regardless of therapeutic orientation. Increased knowledge is expected to lead to higher referral rates, which in turn would maximize the likelihood of positive long-term patient outcomes.
... Living in mutually-supportive settings that encourage prosocial behavior among abstinent support networks (Majer, Jason, Ferrari, Venable, & Olson, 2002) and increase self-efficacy and personal responsibility (Davis & Jason, 2005; Ferrari, Jason, Olson, Davis, & Alvarez, 2002) might improve interpersonal relationships. Residents may become more pro-social in their behavior over time and expand their ability to take the perspectives of others (Olson et al., 2005). Perhaps one of the most direct mechanisms by which both criminal and aggressive behaviors can be reduced among individuals in recovery is through continued abstinence, as previous findings suggest (e.g. ...
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Criminal and aggressive behaviors are frequently observed among those recovering from substance abuse problems. In the present one-year longitudinal study, a national sample of residents from self-governed, communal living recovery homes for substance abuse completed baseline and follow-up measures of criminal and aggressive behavior. Results indicated that a length of stay of six months or longer was associated with lower levels of self-reported criminal and aggressive behaviors at the one-year follow-up. Environmental mechanisms proposed as influences for these outcomes, as well as treatment implications, are discussed.
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Proximity between services and groups may influence the self‐help methodology. By means of a qualitative study we tried to highlight the deep meaning of self‐help for members. Through analyzing qualitative data and organizational characteristics of the groups, two sub‐cultures emerged. Suggestions emerged for services and professionals on how to support groups eliciting no distortion. Self‐help groups are generally described as “group[s] composed of individuals who meet on a regular basis to help one another cope with a life problem” (APA, 2019). Yet, it is challenging to find a univocal definition of self‐help groups. Scholars usually use different labels to highlight various features of self‐help groups, suggesting the need for further inquiry regarding commonalities and differences. The level of professional involvement is one of the most disputed factors influencing whether a group is considered to belong to the “self‐help family.” The present qualitative study aimed to understand how professional support in Tuscany, Italy can influence the organizational choices of these groups (place for meetings, admission criteria, timing, etc.), as well as the personal beliefs of members. The study included 17 self‐help groups. During 13 focus groups meetings, 92 participants were interviewed; then, we individually interviewed 19 facilitators and six additional key informants from mental health settings. We used a grounded theory approach, and we discussed the emerging models with participants at a public event. Results show the emergence of two theoretical models to define self‐help groups, not to be interpreted as mutually exclusive. The “relational model” refers to self‐help groups whose main feature is to guarantee the acquisition of specific skills (social comparison skills, active listening, and empathy), while the “therapeutic model” seems to represent a kind of assimilation of other types of interventions.
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It also describes how the way of life offered by NA supports recovery from drug addiction, the way of life which recovering addicts have adopted, and how they have done so. The study also presents results that, based on the study data, emerge from participation in the NA programme, and describes how the NA recovery theory works in practice, i.e. how NA members utilise the tools provided by the fellowship and how the lives of recovering addicts change during their membership. Furthermore, this study also discusses criticism of NA. According to the study, NA affects the lives of recovering drug addicts in a number of ways. People of different ages and with a variety of personal, treatment and drug abuse histories seem to benefit from membership of NA. Viewed from the outside, NA may appear as strictly normative, but in practice each member can adapt the programme in a way that suits him/her best. 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Tutkimusaineisto koostuu episodisesta haastatteluaineistosta (n=24) ja lomakeaineistosta (n=212). Lomakeaineiston keruussa survey-tutkimuksen menetelmiä on käytetty soveltaen. Tutkimuksessa selvitetään NA:n jäsenten taustoja, päihteidenkäyttöhistoriaa, hoitohistoriaa ja NA:han kiinnittymiseen vaikuttaneita tekijöitä ja tekijöitä, jotka ovat estäneet NA:n kiinnittymistä. Tutkimuksessa esitetään NA:n kirjallisesta ja suullisesta perinteestä nouseva toipumisen malli, joka on käsitteellistetty NA:n toipumisteoriaksi. Yksinkertaisimmillaan NA:n toipumisteorian voi kuvata kahdella lauseella: 1) On huumeista riippuvaisia addikteja, joilla on addiktiosairaus. 2) NA-elämäntavan avulla toipuminen on mahdollista. Tutkimuksessa addiktiota ja addiktiosairautta kuvataan NA:ssa kerrottavien toipumistarinoiden avulla sekä kuvataan sitä, miten NA:n tarjoama elämäntapa tukee huumeriippuvuudesta toipumista ja miten ja minkälaisen NA-elämäntavan toipuvat ovat itselleen omaksuneet. Tutkimuksessa otetaan esiin myös niitä tuloksia, joita aineiston valossa voi nähdä tulevan NA:han osallistumisesta ja kuvataan sitä, miten NA:n toipumisteoria toimii käytännössä eli miten NA:laiset käyttävät hyväksi toveriseuran tarjoamia työkaluja ja miten toipuvien elämä muuttuu jäsenyyden aikana. Tutkimuksessa otetaan esiin myös NA:ta kohtaan esitettyä kritiikkiä. Tutkimuksen mukaan NA vaikuttaa toipuvien huumeiden käyttäjien elämään monin eri tavoin. NA:n jäsenyydestä näyttävät hyötyvän eri-ikäiset ja niin henkilö-, hoito- kuin huumeidenkäyttöhistorioiltaankin erilaiset ihmiset. NA voi näyttäytyä ulkopuolelta katsottuna tiukan normatiivisena, mutta käytännössä sen ohjelmaa saa kukin soveltaa itselleen sopivalla tavalla. Joustavuus on NA:n vahvuus, mutta ilman laajempaa toveriseuran tuntemusta teksteistä välittyvät normit tai yksittäisten NA:n jäsenten fanaattisuus voi kuitenkin ajaa joitain ihmisiä pois avun piiristä. NA:n jäsenmäärän kasvun myötä toveriseura pystyy tarjoamaan enemmän vaihtoehtoja. Tutkimus vahvistaa näkemystä sekä vertaistuen merkityksestä että siitä, että vertaistukitoiminnan rinnalle tarvitaan myös virallista hoitojärjestelmää. NA ei voi kokonaan ikinä korvata ammatillista tukea eikä yksin sille saa jättää vastuuta toipuvista. Avainsanat: Nimettömät Narkomaanit, vertaistuki, toipumistutkimus, toipuminen, päihderiippuvuus, huumehoito, huumeet, eksploratiivinen tutkimus
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The Oxford House model for substance abuse recovery has potential economic advantages associated with the low cost of opening up and maintaining the settings. In the present study, annual program costs per person were estimated for Oxford House based on federal loan information and data collected from Oxford House Inc. In addition, annual treatment and incarceration costs were approximated based on participant data prior to Oxford House residence in conjunction with normative costs for these settings. Societal costs associated with the Oxford House program were relatively low, whereas estimated costs associated with inpatient and incarceration history were high. The implications of these findings are discussed.
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Effective nutrition education can decrease the incidence of diet-related chronic diseases, including obesity, type 2 diabetes, cardiovascular disease, and hypertension. African Americans bear a disproportionately higher incidence and prevalence of diet –related chronic diseases. African Americans also have a higher attrition rate in research studies. Evaluating effectiveness, retention rates, educator perceptions of nutrition programs, and the perceived need for culturally relevant strategies for African Americans within nutrition education interventions are important aspects for developing acceptable and appropriate interventions to increase positive outcomes for African American participants. Focus groups and individual interviews were conducted as part of a community needs assessment to determine the perceived needs of an African American community to develop appropriate programming. Using the same community, surveys were distributed to African American participants to assess the perceived need for culturally relevant strategies the African American community. Lastly, focus groups and individual interviews were conducted in this community to assess the implementation of culturally relevant strategies to increase African American participation in Iowa State University Extension programming. Focus groups and individual interviews were also conducted to determine educator perceptions of the use of the Transtheoretical Model of Behavior Change to increase fruit and vegetable consumption in a multi–state study for low income young adults. Data from a multi–state study to increase fruit and vegetable consumption was further analyzed to determine similarities and differences between African American and White participants to predict the characteristics of participant retention. Qualitative data was analyzed using NSR, and quantitative data was analyzed using SPSS, version 15. Themes from the focus groups and survey indicate that culturally relevant strategies are preferred among African American participants. The educators indicated that the Transtheoretical Model of Behavior Change was a useful tool in providing nutrition education materials via the telephone. Similarities and differences between retained African American and White participants and within African American participants were determined. Future studies should examine preferential differences in receiving culturally relevant nutrition education strategies.
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This chapter addresses the recent trend for mutual-help organizations to form collaborative partnerships with professionally run organizations. The focus of the discussion is a multi-method case study of a partnership between Schizophrenics Anonymous (SA) and the Mental Health Association of Michigan (MHAM) over a 14-year period. This study explores how the evolution of a formal partnership between SA and MHAM influenced the organizational expansion and development of SA. The partnership resulted in increased access to SA groups throughout Michigan. It also resulted in changes in how new SA groups were started, with more new groups in traditional mental health service settings and more groups led by professionals. New groups established with professional leaders had significantly lower survival rates than new groups established with consumer leaders. Qualitative analyses of interviews with SA’s consumer leaders suggested that, while SA became a more stable organization, there was an accompanying loss of consumer leadership opportunities, ownership, and control over organizational functions. These results are discussed with regard to the lessons learned for managing mutual-help/professional partnerships. We draw on organizational theories and risk management principles to discuss strategies by which mutual-help organizations can benefit from partnerships with other types of organizations, while minimizing unintended changes to their basic beliefs, processes, and structures.
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The present study investigated the attitudes of neighborhood residents toward a particular type of substance abuse recovery home (i.e., Oxford House). Individuals who lived next to these recovery homes versus those who lived a block away were assessed regarding their attitudes toward substance abuse recovery homes and individuals in recovery. The vast majority of those living next to a self-run recovery home knew of the existence of these recovery homes, whereas most residents living a block away did not know of their existence. Findings suggest that well managed and well functioning substance abuse recovery homes, such as Oxford Houses, elicit constructive and positive attitudes toward individuals in recovery and recovery homes. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 529–535, 2005.
Purpose - To examine the value of approaches to mental health based on creative practice in the humanities and arts, and explore these in relation to the potential contribution to mutual recovery. Design/methodology/approach - Conceptual analysis and literature review Findings - Recovery can embrace carers and practitioners as well as sufferers from mental health problems. Divisions tend to exist between those with mental health needs, informal carers and health, social care and education personnel. Mutual recovery is therefore a very useful term because it instigates a more fully social understanding of mental health recovery processes, encompassing diverse actors in the field of mental health. Research demonstrates the importance of arts for ‘recovery orientated mental health services’, how they provide ways of breaking down social barriers, of expressing and understanding experiences and emotions, and of helping to rebuild identities and communities. Similarly, the humanities can advance the recovery of health and well-being. Originality/value - The notion of mutual recovery through creative practice is more than just a set of creative activities which are believed to have benefit. The idea is also a heuristic that can be useful to professionals and family members, as well as individuals with mental health problems themselves. Mutual recovery is perhaps best seen as a relational construct, offering new opportunities to build egalitarian, appreciative and substantively connected communities – resilient communities of mutual hope, compassion and solidarity.
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Commentary to: Is Alcoholics Anonymous religious, spiritual, neither? Findings from 25 years of mechanisms of behavior change research
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Educational materials are often a key component of recovery in a mutual-help group. However, in order to be helpful to a maximum number of members, these materials must be presented at a reading level that is comprehensible. Two measures of readability, The Flesch Reading Ease score and the Flesch-Kincaid Grade-Level score were applied to 20 random paragraphs chosen from The Twelve Steps and Twelve Traditions of Overeaters Anonymous. Results indicate that the average paragraph is written just below the tenth grade level and close to an optimum level of reading ease. However, due to variability, almost half (45%) of the paragraphs fell in the category of Difficult Reading Ease and half were found to be at a tenth grade reading level or beyond. In order to maximize the utility of this educational text, it is recommended that future editions take into consideration principles of readability.
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Despite the tremendous amount of time, money, and energy spent by practioners and scholars alike to understand, promote, and facilitate effective leadership development, the field is still far from fully understanding what is often regarded as both art and science. That is not to suggest, however, that the field's efforts have failed to result in substantial progress. Indeed, after defining some salient concepts and the overall scope of this chapter, we review some of the major theoretical and empirical advances in leadership development. Furthermore, the trends and best practices" dominant in today's organizations in leadership development are then summarized and considered in light of the current academic trends to identify points of congruence and disconnect. With this foundation, we offer an approach to leadership development that builds on this current understanding. Our model does not offer a specific set of methodologies or instructional tools, but rather a framework to incorporate these modalities in a thoughtful, goal-driven, and comprehensive instructional approach designed to achieve specific, measurable, organizational objectives. Finally, we conclude this chapter with recommendations for future efforts to advance relevant research, to focus the teaching of leadership in the university classroom, and to improve the efficacy of current and future leadership development programs in practice. Introduction:
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As noted throughout this book, the study of a psychological sense of community (PSOC) is an important area of interest to community psychologists. Much of this interest focuses on the theoretical model proposed by McMillan and Chavis (1986) in their refinement of Sarason’s (1974) notion of community. While a growing body of research has also examined the sense of place a person may experience, research on PSOC examines a person’s identification with others and a feeling of belongingness within a physical setting (see Chipuer & Pretty, 1999; Hill, 1996). Consequently, a person may experience multiple layers of PSOC, even while residing in the same physical setting (Brodsky & Marx, 2001). For instance, Davidson and Cotter (1998) assessed a PSOC among sub-groups of city residents based on demographics, home ownership, and level of civic involvement. Prezza and colleagues (Prezza & Constantini, 1998; Prezza, Amici, Roberti, & Tedeschi, 2001) reported levels of PSOC and overall life satisfaction among residents of towns and cities. Zaff and Devlin (1998) found that PSOC was strong among residents of garden apartments and high rises.
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Described a study of the expansion strategies of a successful self- and mutual help organization for persons with mental illness. Resource mobilization and behavior-setting theories were used as conceptual frameworks to guide the investigation. Collaborative methods and a grounded theory approach were used. Archives, reports of contacts outside of the organization, and naturalistic observations were data sources. Of particular interest are the processes used by the organization to mobilize internal and external resources and to start new mutual help groups. Results suggest that the organization mobilizes resources from a variety of sources, displays flexibility in securing resources and defining organizational roles, and creates underpopulated settings to encourage individual involvement. The strategies appear to avoid overtaxing resource pools, reduce role ambiguity, and encourage pluralistic participation. Discussion includes several potential explanations for the successful growth of the organization.
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This study explored the roles of referent power (i.e., influence based on sense of identification) and expert power (i.e., influence based on knowledge and expertise) in Schizophrenics Anonymous (SA), a mutual‐help group for persons experiencing a schizophrenia‐related illness. The study describes SA participants' experience of referent and expert power with SA members, SA leaders, and with mental health professionals. It also examines whether or not referent and expert power ascribed to fellow SA participants predicts the perceived helpfulness of the group. One hundred fifty‐six SA participants were surveyed. Participants reported experiencing higher levels of referent power with fellow SA members and leaders than with mental health professionals. They reported higher levels of expert power for mental health professionals and SA leaders than for SA members. The respondents' ratings of their SA group's helpfulness was significantly correlated with ratings of referent and expert power. Although expert power was the best independent predictor of helpfulness, a significant interaction between referent and expert power indicated that when members reported high referent power, expert power was not related to helpfulness. These results are interpreted to suggest that there are multiple forms of social influence at work in mutual help.
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The helping transactions that occur in group meetings have been theorized to be important therapeutic mechanisms within mutual‐help (or self‐help) groups. Hypothesized links between giving and receiving help and psychosocial adjustment were examined in a mutual‐help group for individuals with serious mental illness (GROW). Participants' adjustment was assessed at two time points and helping behaviors were measured with observational coding of weekly group interactions during the period between assessments. Frequencies of helping behaviors were used to predict Time 2 adjustment after controlling for initial adjustment. Consistent with the helper therapy principle, giving help to others predicted improvements in psychosocial adjustment; giving advice was a unique predictor. Total amount of help received was not associated with adjustment, but receiving help that provided cognitive reframing was associated with better social adjustment. A predicted interaction suggested that receiving help was related to better functioning when members experienced high levels of group integration.
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Over the past 55 years, two longitudinal studies have been monitoring the drinking behaviors and their consequences of several hundred men from adolescence and early adulthood to old age. The studies identified co-occurring sociopathy, cultural factors (e.g., ethnicity), and genetic factors (i.e., a family history of alcoholism) as risk factors for alcoholism. In most alcoholics, the disease had a progressive course, resulting in increasing alcohol abuse or stable abstinence. However, some alcoholics exhibited a nonprogressive disease course and either maintained a stable level of alcohol abuse or returned to asymptomatic drinking. Long-term return to controlled drinking, however, was a rare and unstable outcome. Formal treatment, with the exception of attending Alcoholics Anonymous, did not appear to affect the men's long-term outcomes, whereas several non-treatment-related factors were important for achieving stable recovery.
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"Construct validation was introduced in order to specify types of research required in developing tests for which the conventional views on validation are inappropriate. Personality tests, and some tests of ability, are interpreted in terms of attributes for which there is no adequate criterion. This paper indicates what sorts of evidence can substantiate such an interpretation, and how such evidence is to be interpreted." 60 references. (PsycINFO Database Record (c) 2006 APA, all rights reserved).
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Describes an Ohio Schizophrenics Anonymous (SA) group, a self-help group for persons with schizophrenia or a related illness. SA was developed as a step program with a prescribed meeting format, but groups vary in organization across sites because of differing characteristics of members and sponsors. The development, organization, and interactional processes of the group are discussed, as well as the strengths and limitations of SA as a self-help resource for persons with schizophrenia. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
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Self-help and mutual help groups are defined and the status of the literature described and reviewed. Self-help groups are different from peer and nonprofessional services under the supervision of professionals. Controlled studies of mutual help groups may be neither possible nor desirable as the method of choice by which to understand the phenomena of interest. Other approaches to research, including worldly evaluations, and ways of construing self-help organizations, that is, as normative communities and political action organizations rather than as psychological treatments, are discussed, and suggestions for future research are presented.
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[present] a brief history of the Oxford House Model [of a self-run, self-supported therapeutic community (TC) for recovering alcohol abusers and addicts] / Oxford House . . . combines the traditions of the alcoholism movement with the nontraditional ideas of a self-directed community (that goes beyond the traditional TC) / believe that Oxford House might represent a cost-effective approach for helping individuals who fail to benefit from more traditional therapeutic settings (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Alcoholics Anonymous [AA] is a widely available, widely used, and vastly influential program for alcoholics. Despite its popularity and influence, research on AA has been scattered. In February of 1992 a group of scholars and scientists, representing a range of disciplines and perspectives on AA, gathered in New Mexico for a unique conference dedicated to examining the current state of knowledge about AA, and developing ideas for future research and research strategies. This monograph publishes the formal papers presented at the conference, and the results of participant discussions about future research directions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The book offers a systematic, up-to-date, analytical review of the burgeoning literature in the self-help field, with particularly relevant chapters addressed to the effectiveness of self-help organizations and the relationship between the professional and the self-help unit. Powell introduces a useful conceptual comparison of the three helping systems: professional, informal helping, and self-help, and offers important suggestions for their greater integration. A basic theme threaded throughout the book is the dialectic interpretation of the professional and the self-help modes. A dialectic analysis includes both the unity and struggle of opposites. Thus, professional approaches and aprofessional interventions such as self-help and informal help have complementary and antagonistic potential. The rapidly improving cooperative relationship between the professional and the self-help systems should not obscure the contradictions and opposed emphases of the two interventions. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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focus on the common process of change across addictive behaviors and explore how AA [Alcoholics Anonymous] interacts with this process / [addresses the following questions:] how does AA promote change, with which aspects of the process does AA do best, at which point in the process of change would AA be most helpful, are there any aspects of AA that would interfere with the process of change, are there certain types of people who would change more efficiently and effectively with AA as the promoter of the change process, and are the principles and practices of AA sufficient by themselves to promote change the transtheoretical model of change (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Informal reports on "the use of people with a problem to help other people who have the same problem in more severe form… point to improvement in the givers of help rather than [in] the recipients." The use of this principle may be especially appropriate for low-income clients and students. Cautions and conditions are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This volume is a textbook on drug free treatment of addicts in therapeutic communities. A historic overview is given of the development of this treatment modality, at present offering a life free of drugs to addicts in more than 40 countries in all continents. The treatment methods and their relation to existing theories on addiction are extensively described. Research data are summarized. They support the long term success of therapeutic communities. They also underline the importance of dealing with the addict's fear of intimacy and rejection and the impact of family involvement on successful outcome. The book is written for professionals as well as non professionals interested in the field of addiction. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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disciplines encountered [in this review] included anthropology, sociology, psychology, medicine, theology, and philosophy / participant-observational studies, epidemiological surveys, public opinion surveys, ethnographic investigations, and psychotherapy outcome studies were among the research strategies used in the sources (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Describes dilemmas in a new rehabilitation unit for long-stay patients, run as a therapuetic community. The unit was situated in a conventional psychiatric hospital. Dilemmas included permissiveness; when and how much to hand over responsibility to residents; whether treatment programs should be communal or tailored to individual needs; and whether to go along with patients' wishes to leave the hospital, even at the risk of setbacks or total failure. Important factors in restoring the autonomy of chronic patients are responsibility for each other and the use of group dynamics. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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background of [transtheoretical therapy] / dimensions of change [the processes of change, the stages of change, the levels of change] / the assessment of dysfunction / the practice of therapy / the stance of the therapist / mechanisms of change and treatment applicability (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The author describes a series of vulnerabilities that help account for many of the serious problems facing contemporary society in industrialized countries, including high crime rates; homelessness; alcohol, tobacco, and other drug addictions; and a pervasive sense of isolation and alienation. These vulnerabilities are aggressive tendencies in our genetic makeup; our separation from nature; loss of external moral and religious symbols and guideposts; and loss of connection with the land, crafts, and communities. These vulnerabilities predispose industrialized societies to unacceptable levels of individualism and a breakdown of the psychological sense of community. The author explores anthropological, historical, philosophical, religious, and epistemological explanations for the decline in sense of community and the subsequent emphasis on individual goals as a source of meaning. Implications for US society are highlighted, and possible alternative models for healing our problems are reviewed. These models are illustrated in the final chapters with examples of healing communities and community-based interventions. Applications of community psychology to community building are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This study assessed the impact of professional involvement in mutual help groups for the mentally ill. Social climate data and behavioral data on members in groups led either by a mental health professional ( n = 36) or an indigenous group member ( n = 70) were compared. The results of the study indicated a more formal, psychologically directed approach in the professionally led groups. Although professional involvement in mutual help groups does not necessarily produce different member outcomes, it does seem to affect both the perceptions and the behavior of members. Professionals should be cautious when they get involved in mutual help groups to avoid professionalizing them. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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This study investigated an on-line mutual-help group for persons suffering from depression. Postings from two randomly chosen weeks were content coded (N = 1,863 postings; 533 participants; 273 males, 173 females) based on concepts salient to face-to-face mutual-help groups. Participants in the on-line group communicated in ways characteristic of face-to-face groups (e.g., high levels of support, acceptance, and positive feelings); however, they engaged in more emotional support and self-disclosure. Unexpectedly, the group was more highly used by men than by women. In addition, the content of men's posts were virtually identical to those of women's. On-line mutual help may provide a unique form of support for persons who are not as likely to use traditional forms of helping. © 1997 John Wiley & Sons, Inc.
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Few studies of mutual help have been guided by coherent conceptual frameworks. We introduce a stress and coping model that can guide research on self-help groups and contribute to conceptualizing them as normative social groupings. Our model suggests that coping responses, life stressors, and social resources influence the processes by which persons become involved in mutual help organizations and, in turn, are influenced by involvement in mutual help. To provide initial empirical support for the model, we present a longitudinal study of stress and coping and Alcoholics Anonymous (AA) affiliation among 439 problem drinkers. Problem drinkers who relied more on avoidant coping responses, had fewer work and partner resources, and had more partner stressors became more intensely involved in AA. The results also suggest that AA involvement affects members' coping responses and increases their friendship resources.
Article
The relationship between depressive symptomatology, as measured by the short-form Beck Depression Inventory (BDI), and two social support variables was assessed. Based on a sample of 131 married men and 136 married women, the results indicated that the quality of the marital relationship and the frequency of positive social contact with adults other than the spouse were significantly related to depressive symptomatology for both men and women. These two variables accounted for 16% of the variance in BDI scores. Further, analyses of risk for high BDI scores showed that individuals having the least support were 13 times more likely to be in the high-BDI group than individuals with the highest levels of social support. These results suggest that social isolation and marital discord are related to high BDI scores among married adults.
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Differences in the helping interactions formed by mental health professionals, divorce lawyers, and mutual help group leaders were examined. Fourteen members of each of these three helper groups (N = 42) met independently with a coached client presenting marital difficulties. Using ratings of ability to ameliorate the personal and emotional problems presented, the 42 helpers were divided (using a median split) into successful and less successful outcome groups. The responses of each of the pairs were coded using the Hill Counselor Verbal Response Category System. The sequence of client-helper responses were examined using log-linear analysis as they varied by type of helper and outcome. Results indicated that successful helpers (regardless of type of helper) tended to use directives (e.g., guidance and approval-reassurance) differently from less successful helpers. Successful helpers used directives following client emotional expression and not following factual description. In addition, clear differences in helper responses by helper type and outcome were found. Each helper type had unique patterns of responses that differentiated successful from less successful outcomes. Client responses were found to vary across helper type even when given the same helper preceding response. Results are discussed with respect to the unique goals of each helping relationship and the different shaping process involved in each.
Article
A sizeable body of research has demonstrated that expressed emotion (EE) predicts clinical relapse in a number of distinct psychiatric disorders. These findings have provided the impetus for the development of interventions that attempt to reduce patients' relapse rates by modifying aspects of the family environment believed to be associated with high levels of EE. Despite the efficacy of these treatments, however, we know little about how EE develops in relatives of psychiatric patients or about the mechanisms through which high EE leads to relapse. Moreover, there is not a coherent theory that attempts to integrate findings concerning the impact of high EE on relapse in different disorders. The purpose of this article is to elucidate a diathesis-stress conceptualization of EE to explain both the development and manifestation of high EE in relatives of disordered patients and the impact of high EE on the course of patients' disorders. In this context, we use a diathesis-stress perspective to examine why EE predicts symptom relapse and poor clinical outcome in schizophrenia, depressive disorders, and borderline personality disorder. We conclude by discussing treatment implications of the diathesis-stress perspective and by outlining what we believe are fruitful directions for future research.
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How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key transtheoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages—pre-contemplation, contemplation, preparation, action, and maintenance—and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a transtheoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.
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The abstract for this document is available on CSA Illumina.To view the Abstract, click the Abstract button above the document title.
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Special issue. Incl. tables, graphs, abstracts and bib.
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How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.
Article
Alcohol-related workplace activities are assessed using a short, easy to administer, self-report instrument. Three scales--Adverse Effects of Drinking on Work Performance, Support for Consumption and Support for Abstinence--are derived from it. They have internal reliability, are independent of one another and have face validity as well as discriminant and convergent validities. Some evidence of predictive (criterion-related) validity is presented. Researchers seeking to assess the interrelationship between alcohol-related work factors and drinking behavior can apply this instrument to the task.
Article
Describes the development of a behavioral observation system for mutual help meetings and presents evidence supporting its reliability, validity, and utility. The MHOS-BIC (Mutual Help Observation System-Behavioral Interaction Codes) was used by 10 observers to record the sequential flow of group interaction in 527 meetings. Psychometric analyses indicate that the system performed consistently with measurement objectives. Mean kappas for each of the 12 coding categories ranged from .62 to .87; the system demonstrated sensitivity to setting and time differences; and a predictable pattern of correlations was found among BIC categories and conceptually related participant and observer ratings. Studies using the BIC to address substantive questions about mutual help are reviewed, providing further evidence for its validity and utility. An empirical description of mutual help is presented using BIC data, and the promises and limitations of the system are discussed.
Article
Studied 45 current leaders of local chapters of a medical mutual help organization. Cluster analysis of variables depicting routes to leadership produced six clusters: Health Professionals with a Mission, Connected Health Professionals, Career Leaders, Grass-roots Founders, Connected Grass-roots Leaders, and Obligated Veterans. These clusters differed on criterion measures of burnout, hardiness, and perceived obligation to continue as a leader, e.g., Connected Health Professionals and Career Leaders were less burned out, more hardy, and perceived less of an obligation to continue in the leadership role than Health Professionals with a Mission. In terms of leadership activities, Help Provision and Advocacy constituted less than one fifth of all activities but were rated as most rewarding. In contrast, the activities that made up the bulk of leaders' work--building membership, system maintenance, and organizational growth--were not rated as particularly rewarding. Results are discussed in the context of research directions and practice.
Article
The purpose of this study was to learn how sobriety affected friendship circles of gay men recovering from alcoholism. Twenty gay recovering alcoholic men, each with at least 1 year of sobriety, were interviewed in depth. Before sobriety, the typical picture portrayed by the men was that of losing friends, having many heavily drinking acquaintances, and having difficulty meeting the responsibilities in friendships. In sobriety, the typical gay man realized that most of the gay men that he had thought were his friends were actually only drinking buddies. As sobriety time lengthened, the men reported expanding their friendship circles to include primarily gay men of Alcoholics Anonymous and others who were either normal drinkers or abstainers. Finally, nursing implications of this study are discussed.
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Review of the historical development and current status of mutual aid self-help groups (SHGs) in the U.S. The SHGs social movements received an impetus from the 1987 Surgeon General's Workshop. Some alliances forming to link SHGs with the health care system are described. The Workshop recommended principles to guide these alliances. What direction will linkages actually take? Professional or bureaucratic cooptation and control of SHGs? Professionals can take a stand to respect SHG autonomy and self-determination. Professionals need training about SHGs. Research is needed on usefulness of experiential knowledge created and disseminated in SHGs and their social movement aspects.
Article
This study examined the relationship of three social support and three organizational variables to two well-being and two group appraisal variables among 144 members of Compassionate Friends, Multiple Sclerosis, and Overeaters Anonymous self-help groups. An anonymous questionnaire was the major research instrument. Receiving social support was not significantly related to depression or anxiety but was positively related to perceived group benefits and group satisfaction. Providing social support and friendship were each positively related to one well-being and one group appraisal variable. Bidirectional supporters (i.e., individuals high on both receiving and providing support) reported more favorable well-being and group appraisal than Receivers, Providers, and Low Supporters. At the group level of analysis (n = 15 groups), groups with higher levels of role differentiation, greater order and organization, and in which leaders were perceived as more capable contained members who reported more positive well-being and group appraisal. The implications for future research and professional consultation to self-help groups are discussed.
Article
Mutual help groups for the mentally ill (n = 33) were significantly different from psychotherapy groups (n = 25) on 9 of 10 perceived social climate dimensions from the 90-item Group Environment Scale. The mutual help members perceived that their groups had more active leaders, greater group cohesion, more structure and task-orientation, and fostered more independence. The members of psychotherapy groups perceived that their groups encouraged more expression of negative and other feelings and showed more flexibility in changing the group's activities. The present findings could be used to improve cooperation and referrals between mutual help groups and the mental health community.