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Ask the Mental Health Expert Archives 2001-2004

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Running a Support Group

Q. I offer support in group sessions and individually to people recovering from mental illness, or suffering loss of dignity and self esteem through accident, illness, alienation, developmental disability, or situational depression or anxiety. I, myself, am also recovering from mental illness, and still periodically experience the following enquiry.

The most common issue that comes up in our support groups is feeling unheard, unseen, and unsafe. A sense of feeling dismissed, or rejected, no matter how many self help tools have been learned, is overwhelming. The old suicide ideation tapes kick back in, like nothing has been learned.

I expect PTSD (post-traumatic stress disorder) plays a part in this, so expectations have to be realistic, about the definition of "manageable lifestyle". But is there anything that has been found that works for a person when they once again find themselves in the Valley of Shadow? People are waiting patiently as I do my monthly task of providing reading material, exercises, and techniques to try out in the real world.

A. It sounds like you provide an extremely important, even life-saving, service. You have my respect and admiration for that! Of course, as a psychiatrist, I believe that the best approach to severe, chronic psychiatric illness is a bio-psycho-social one. This integrates medication and talk therapy, depending on the individual's diagnosis and symptoms.

I realize this is a different model than you use in your support group, in which your main goals are to help people feel heard, seen, and safe rather than unheard, unseen, and unsafe. That's fine, but when people begin to report persistent and chronic suicidal ideation, I worry that they may be in the midst of a major depressive episode, which requires very careful professional evaluation and treatment. (Since I don't know your professional credentials, I don't know if you already provide some of those services).

Antidepressant or mood-stabilizing medication can be essential during such periods, and for many people, on an indefinite basis. Post-traumatic stress disorder (PTSD) may also respond favorably to medication, in combination with various kinds of cognitive-behavioral therapies. So, when your group members "once again find themselves in the Valley of Shadow" for more than a few days, or whenever they are talking seriously about self-harm or suicide, I would ordinarily advise a complete evaluation by a mental health professional.

That said, what can you do to help? There isn't one specific thing that will help people get out of these dark periods, but in addition to your own support group, a few options are worth noting. I often recommend a number of self-help books, such as "Feeling Good", by Dr. David Burns; and my personal favorite, "A Guide to Rational Living", by Drs. Albert Ellis and Robert Harper.

On-line chat rooms and support groups may or may not be helpful--much depends on whether they are appropriately monitored, and how helpful the feedback is. But, the internet is another tool to consider, if you check the website out carefully before recommending it to your group. If your group members have religious or spiritual affiliations, pastoral counseling can also be helpful as an adjunct to your own work, in some cases. (This may not be true if there is a history of abuse by clergy, of course).

Finally, there is, of course, the Samaritans, who (I am sure you know) provide telephone support for those feeling suicidal, on an anonymous basis. Beyond these suggestions, helping your group members understand that these dark periods are often par for the course--that they do not necessarily mean a major breakdown is at hand--may help them to get through it.

I always use the analogy of climbing up the steps of a steep stairway. When you are halfway up, you may trip and fall down a few steps--but that doesn't mean you are starting all over again from the bottom.

November 2002

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