Section 2. Creating and Facilitating Peer Support Groups

Image of hands with a seedling in them and the words Donate Now below them.

The Tool Box needs your help
to remain available.

Your contribution can help change lives.
Donate now.

Learn how to bring together and facilitate support and encouragement among a group of people who share common problems and experiences.

Group therapy holding hands

Portions of this section adapted from The Self-Help Leader's Handbook: Leading Effective Meetings by Adrienne Paine-Andrews, Yolanda Suarez-Balcazar, Stephen B. Fawcett, and Leslie Borck Jameson, with the collaboration of Melody G. Embree, published by the Research and Training Center on Independent Living at the University of Kansas.

Did you know that there are over 500,000 support groups in the United States? Because they are both inexpensive and effective ways to offer assistance to people dealing with a variety of concerns, support groups have become a common method of serving the needs of people who are experiencing problems in their lives.

Support groups can be found in big cities, small towns, and even rural areas, dealing with anything from substance use and gambling addiction to surviving domestic violence to gender issues.

If your group or initiative does service work with people who might benefit from talking to others who have similar experiences to their own, perhaps you should consider adding a peer support group to the services you offer.

What are peer support groups?

Support groups - also often referred to as self-help groups - are groups of people who gather to share common problems and experiences associated with a particular problem, condition, illness, or personal circumstance. In a support group, people are able to talk with other folks who are like themselves - people who truly understand what they're going through and can share the type of practical insights that can only come from firsthand experience.

Some of the common characteristics of support groups include:

Why create and facilitate a peer support group?

There are many benefits to peer support groups:

Who can be served by peer support groups?

Almost anyone! At any given time, over 6.25 million Americans are using self-help groups, and about 15 million have participated in such a group at some time in their lives. Support groups are used to address a myriad of concerns, such as:

Besides serving people directly affected by a problem, support groups often welcome family members or friends of those experiencing illnesses or difficulties. Also, many independent support groups exist just for family members or friends: for example, one such group is Al-Anon, a group for families and friends of alcoholics.

How do you create a peer support group?

Think about what you want to accomplish

Decide what your group's purpose will be and who you want to reach. You might find it helpful to write vision and mission statements for your support group.

Find out whether there are existing national, regional, or local groups your group can be involved with

There are several benefits to setting up your support group under the auspices of a larger organization, if you can. A larger organization can often offer resources and assistance in setting up a new support group. The name recognition that comes with affiliating with a big, well-known organization can give your group more credibility. It can also make it easier for people who need your support group services to find you. Finally, working with a larger organization keeps you from having to "reinvent the wheel" in deciding how the group will operate - you can take advantage of a tried and true model.

Using a fictional example, let's look at how someone might set up a support group with the help of a larger organization.

Yoshiko's support group

Yoshiko's sister was recently diagnosed with muscular dystrophy. Feeling frustrated and isolated, Yoshiko wanted to start a support group for the disease's sufferers and their families. After carefully studying this section of the Community Tool Box, Yoshiko decided to find out whether the Muscular Dystrophy Association, a national organization, sponsored a support group in her town.

She visited the MDA's website and found out that they offered a group in a nearby town, but there wasn't one in her city. After Yoshiko called the organization's national office and found out the many ways that they could help her new support group, Yoshiko decided to start a local MDA support group rather than an independent one.

Consider whether the group will meet for a specific period of time or for an indefinite period of time

Support groups can be long-running, or they can be restricted for certain periods of time. For example, the local crisis center may offer a six-week support group twice yearly for people who have lost a family member to suicide, rather than a single, year-round group. This type of time-limited format is best suited to crisis situations, such as bereavement or divorce. A drawback of this format is that the group may not be available at a time that someone needs it. Problems that are more long-term in nature - a chronic disease, for example - are better served by ongoing, long-term support groups.

Decide whether the group will be open or closed

Open support groups are those in which new members are welcome to join at any time during the life of the group. This may also mean that anyone can join the group - friends, family members, etc.

In closed groups, people are only allowed to join the group at certain times (e.g., for the first three weeks only) or under certain circumstances (e.g., groups that are only for women). Some organizations offer both types of meetings - open meetings, which anyone can attend, and closed meetings, which are only for people going through the program.

If you plan on working on a very specific issue and want the entire group to go through the process at the same time, you may want to consider having a closed group. However, open groups are best for most kinds of support groups.

Set a time and place for your support group to meet

Decide on a time that will make it possible for the most people to be there; for example, if your group members are likely to be church-goers, it wouldn't be a good idea to schedule meetings for Sunday mornings. Mid-afternoon on weekdays won't be good for most people who work during the day. Usually, early evenings on weekdays are the best times for the most people.

Picking a good location is far more crucial than you might think. If you work with an organization or coalition that has meeting space of its own, you might want to have your support group meet there, but don't automatically assume that this is the best space for it. You might find that a school, church, restaurant, library, or some other public building is better suited to your needs. Depending on the type of group, members may want to be discreet about their attendance, and may therefore be less likely to come if the group meets in some heavily-traveled place where they might be seen. A support group for former child molesters might want to be as nearly invisible as possible, for instance. While that's a particularly outrageous example, the same might be true for Al-Anon or a group for pregnant teens.

First and foremost, the location should be easily accessible for the people who will be coming to the support group. Is the building in an easy place to find? Is it accessible to people who use wheelchairs, canes, or service dogs? Is there adequate parking nearby?

The location should also be somewhere where people can feel comfortable enough to talk about their problems and able to offer each other support. If you're working with survivors of violent crimes, meeting in a high crime section of town or next door to the county jail might make people in your group uneasy or reluctant to even show up.

While the location you decide on should be accessible and comfortable, it also needs to fit the type of group you want yours to be. For example, meeting in a member's home can add an element of comfort, but groups are much more accessible to newcomers if held in public places; therefore, meeting in somebody's home should probably only be done if it's a closed group.

When you finally have a location picked out, make any needed room reservations or other arrangements, and you're ready to move on!

Select a group leader or facilitator

Picking the right person to lead your support group is of utmost importance. The group leader or facilitator opens and closes the meetings, sets the tone for the discussion, helps members learn how to listen and offer support to each other, and deals with any problems that come up during the meeting. The ideal facilitator will possess the following qualities:

The details of the facilitator's job - running the meetings - are explained later on in this section; you may wish to refer to that when selecting somebody for the position.

Decide on any remaining details

Going back to step one, think about what you want this group to be like. This can help you make up your mind about whatever other ins and outs of the group are left, such as:

Recruit members for your support group

Consider how large you want the support group to be before you start recruiting. Generally, it's best to have a group that's large enough to function well even when some of the members are absent, but small enough for all the members to feel comfortable. As a rule, 5 to 15 people is a pretty good number; anything larger too easily becomes unmanageable and impersonal.

There are many ways to get the word out about your group, and the most successful support groups usually use some combination of all of them.

Use referrals

Use the media

Use personal invitations and word-of-mouth

Once you have enough members, contact them to let them know the date and time of the first meeting. Give them a couple of weeks' advance notice so they can make any necessary adjustments in their schedule, and follow up with a postcard or telephone reminder a few days before the meeting.

How do you facilitate a peer support group?

You've put in a lot of hard work in preparing for your support group to begin, and now the day has arrived. If you are the group's facilitator, here are some helpful guidelines for running these meetings.

Prepare yourself for the meeting

Take a few minutes to think about possible topics for discussion. If this isn't your first meeting, review the topics that were talked about last time. Go over any notes you took. This can help you remember to bring up things that members might want to revisit or give updates on. If you plan to make any announcements of community events or activities that may be of interest to the group, make sure you have them ready.

Prepare the room for the meeting

Arrive 20 to 30 minutes early to arrange the room. Put the chairs in a circle large enough for latecomers to fit in, with enough room for folks who use wheelchairs to easily join. If you're going to have refreshments, set them up on a table to the side or back of the room. If you're going to use name tags, have them ready. Have a pen and paper to take notes.

Start the meeting

As people begin arriving, be sure to make eye contact and say hello, greeting them by name if you've met them before. Call the meeting to order on time, or at least within five minutes of the designated time. This encourages other members to be prompt. It also rewards those who are punctual; if you always start the meeting late because you're waiting for that one person who shows up 15 minutes late every time, you risk alienating those who made the effort to be there on time. A simple "Let's get started," or "Well, it's five minutes after seven o'clock, why don't we begin the meeting," is adequate.

Give preliminary introductions and information

Introduce yourself briefly; if you have some experience with the group topic, be sure to mention it. Make any announcements and ask the group if they have anything to add.

Opening a support group meeting

At the first meeting for Yoshiko's MD support group, she was pleasantly surprised to see that 15 people showed up. Opening the meeting, Yoshiko introduced herself: "Hello everyone. My name is Yoshiko Hatori and my sister Miho has been living with muscular dystrophy for over a year now. I'm happy to see so many of you came tonight."

She had only one announcement: "By the way, there'll be a car wash fundraiser for the local chapter of the MDA next Saturday from noon to four p.m. at First Baptist Church, so tell as many people as you can about it."

If this is a new group or there are new members present for the first time, explain the ground rules. The most common ground rule for support groups is that everything discussed in the group must be kept confidential. Reminding the group of this from time to time is very important. Explain whether the group is open or closed and what that means. Be sure that everyone understands the rules.

Have everyone introduce themselves, stating their names and a little bit about why they were interested in the group. Then begin the discussion, either by touching on something that was mentioned by one of the members or by bringing up a prepared topic.

Starting a discussion

When members of Yoshiko's group were introducing themselves, one young man named Brian mentioned that his family was planning a trip to the Rockies and that he was concerned about his ability to withstand the higher altitudes. She had planned to talk about family issues in general, but Brian's comment gave Yoshiko an idea. When introductions were finished, she began the discussion this way:

"Brian, you mentioned your apprehension about this upcoming family trip. Could you tell us more about your concerns?" After the group discussed Brian's trip for a while, Yoshiko said, "I found that Christmas with my family was overshadowed by Miho's MD diagnosis. We were all worried about her, and it really made it hard to just enjoy being together as a family. Would anyone like to talk about what effect MD has had on their own family gatherings?" This prompted several members to jump into the discussion.

Encourage members to listen to each other

Being a good listener - and acting as an example to group members in this regard - means being an active listener, one who is obviously listening and understanding what is being said. How do you let people know that you're listening?

Encourage members to offer support to one another

While being supportive yourself, you must also help others in the group learn how to be so as well. Demonstrate the active listening skills listed above while the member is speaking. Wait 10 seconds or so and then, if no other members have done so, offer support. Group members will usually pick up on this and start offering support themselves. If they don't you may have to ask them questions about how they are affected by the discloser's experience.

For example, Yoshiko might say the following things in her group:

Encourage members to talk about themselves

One advantage of support groups is that they can create an atmosphere in which members feel comfortable talking about and working through very personal issues and experiences. Disclosure - the act of revealing personal information - gives other members a chance to offer support, ideas, and assistance. It also encourages other members to share their own experiences and fosters an atmosphere of trust in the group. To maintain that trust, facilitators may find that they also need to disclose information from time to time.

When a member discloses information, the facilitator may have to guide the discussion to make the member comfortable or encourage others to join the discussion. Asking open-ended questions - those which cannot be answered with a simple "yes" or "no" - is very useful at this point.

You can also plan topics ahead of time. Some support groups do things like have their members do reading or keep journals of their experiences to help spark discussion.

Offer support

This is the main reason your group exists! Fortunately, offering support is one of the simplest things to do in the course of running a support group. Giving members support can help them realize that reaching their goals is possible, give them hope, or just let them know that you empathize with what they're going through.

Support consists of making statements that show your understanding, sympathy, and concern. Listen for the feelings expressed by the member, and address those feelings. Support can also be expressed through body language (such as making eye contact or smiling) or touch (hugging, patting the member's arm). Care should be taken in using touch as a form of support - in some circumstances, such as a support group for survivors of child sexual abuse, touch may be threatening and uncomfortable instead of comforting.

Usually, members will offer support to each other on their own, or they will quickly pick up on how to do so by following your example. However, you may have to ask questions to coax them into offering support by asking questions.

Help members solve problems

While solving problems shouldn't be the only goal of a support group, it is something that many members hope for and expect. All members should take part in the problem -solving process so that no single person is seen as the solution to their difficulties. It's the facilitator's job to help members learn how to help each other with problem solving.

Here are the steps to problem solving:

Close the meeting

Most support group meetings last between an hour and two hours. If the group is caught up in a particularly intense discussion or in helping a member solve a problem, you might go a few extra minutes, but generally it's best to stop before everyone is tired and eager to leave. When the discussion is winding down or when a previously agreed-upon ending time has arrived, wrap things up. Here are some ways you can close the meeting:

Closing the meeting

After the discussion had wound down, Yoshiko followed the above steps in this way:

Making a summary statement:

"I see it's getting to be about the time we'd agreed that we'd stop, and I know many of you would like to get home, so I think we'd better wrap up for the evening."

Asking for additional comments or questions:

"We talked a lot about our families tonight. Are there any last thoughts anyone would like to add?"

Reminding members about the next meeting:

"Our next meeting will be on Wednesday the 23rd at 7:00 p.m. I hope you can all be there."

Requesting volunteers:

"Can someone volunteer to call everyone on the phone list a couple of days before the meeting to remind them about it?"

Giving a final greeting:

"I'm so glad you all came, and I think we got into some really interesting subjects tonight. I hope to see you on the 23rd!"

Making final notes:

After she got home, Yoshiko sat down with a cup of coffee and wrote some notes on the meeting: "Brian talked about his concerns about how MD will affect his upcoming family trip; Camilla talked about how tough it is to be a single mom with MD. Next time maybe we should focus more on issues that affect the people who are single or not close to their families."

Tips on Keeping a Support Group Going

Tips on Handling Difficult Group Members

In dealing with difficult group members, support group facilitators must learn a delicate combination of control mixed with kindness. This sort of assertive caring directly addresses problems with the group without insulting or offending members. You may use assertive caring during a meeting to get the discussion back on track, or you may wish to speak to the member in private after the meeting.

Times to use assertive caring:

The steps to assertive caring:

In Summary

Support groups are a great way to provide a service to the people your organization or initiative works with, without a huge investment of time or money. Moreover, running a support group is a good way to reach out and get people interested in the other things your organization or initiative does. It's also a way to give back to the community - improving or supporting a good public image for your group. Finally, it's just a good thing to do. With relatively little effort and cost, a support group can make a significant impact in the lives of people dealing with a problem. What better reason can there be?