To promote group support, create comfort, safety

Provide structure, guidelines, skilled facilitator

All groups assembled to provide patient support need to be structured in a way that helps people feel safe and comfortable. It's best to have a consistent facilitator, a time structure, a regular place to meet, and guidelines for members, says Elizabeth Carson, PhD, staff psychologist and group facilitator for the stroke self-help group at St. Joseph's Hospital of Atlanta.

"There is always a juggling act between the amount of pain and risk-taking when exposing themselves in a group vs. how safe and rewarding that feels, so you need some structure and nonjudgmental empathy," explains Carson. The facilitator must be nonjudgmental to set an example of the way group members should relate to one another.

Many of the counseling techniques needed to run a group can be taught, whether the meetings are face-to-face, on the telephone via a conference bridge, or on-line on the Internet. For example, the facilitator needs to know how to use mirroring techniques, which are the ability to listen to how a person feels and to reflect those feelings accurately so they are clear to the group, says Carson. The facilitator needs to be knowledgeable on the subject, either a professional or someone who has experienced the same health problems.

Facilitator keeps group on track

"A facilitator has to have a good ear and the ability to direct the conversation. It's the facilitator's responsibility to make sure the group stays on track," says Fran Demar, lead facilitator for the bone marrow transplant telephone discussion groups at Kaiser Permanente of Northern California in Oakland. Facilitators for these telephone conferencing support groups are bone marrow transplant patients themselves. Kaiser developed a six-hour training course, which includes role-playing, so facilitators can experience difficult situations and learn how to handle them.

Facilitating on a telephone is slightly different from in person. "They have different cues," explains Beth Eshelman, LCSW, project manager for the telephone discussion groups. "They listen to the tone of voice and to sighs. There are also the people who are talking a lot and people who are silent. Primarily, it is tuning into verbal cues."

Once a month, Eshelman and Demar hold a telephone conference with the other three peer facilitators to solve problems, discuss what went well, and answer questions.

In addition to explaining to group facilitators what is expected, it is important to let participants know as well, advises Demar. Kaiser developed group guidelines. Instructions include:

· Contact the facilitator if you can't attend a meeting.

· Information shared by group members is to be kept confidential.

· All conversations are to be constructive, supportive, and nonjudgmental.

· No medical advice is to be given. Everyone shares from his or her own experience.

· There is to be no gossip or criticism of one another.

· Group discussions should initiate conversations with your health care provider. Only you and your health care provider can decide what is appropriate for you.