Partners in Wellness—Self-Help Groups and Professionals

Alfred H. Katz, DSW, UCLA School of Public Health and California Department of Mental Health, Office of Prevention

The oldest and probably best known self-help group for former patients, and other persons with mental health problems, is Recovery, Inc. Founded in 1937 by a Chicago psychiatrist, Dr. Abraham Low, Recovery has about 700 groups in the United States, Canada and other countries, maintains a national headquarters in Chicago, and is increasingly recognized and used by mental health professionals. Recovery carries out ongoing co-operation and education with professionals; its chapters give many panel demonstrations of their work for the staffs of psychiatric hospitals and clinics.

The organization has a well-developed program of leadership training and supervision for members. Weekly meetings are held in public buildings available to all. Patients may be referred by professionals or self-referred, and the meetings are open for observation by anyone interested.

Recovery meetings follow a structured format consisting of member introductions by first names; voluntary participation in reading from Dr. Low's writings; members presenting examples of troublesome everyday incidents followed by "spotting" on the examples; a question period for newcomers; and last, a period of mutual aid where individuals informally discuss Recovery methods. (This latter phase is often carried on in some nearby coffee shop).

The giving of examples of everyday incidents is very important in how Recovery works. It follows four points: (1) a description of the troubling event: who was there, and what was said; (2) the member's description of his/her reactions and discomfort; (3) the member's "spotting" of his/her reactions and working-up process, and (4) how the member would have reacted to this situation before Recovery training. The examples are limited to five minutes and are concerned with "some triviality of everyday life."

Recovery's Basic Premises

To understand the panel examples and the process called "spotting" it is necessary to appreciate four basic Recovery premises.

The first is that although most patients returning home from a psychiatric hospital are greatly improved, they still have "residual symptoms." These symptoms are usually described as various somatic manifestations, or, as "restlessness, tenseness, and preoccupation." Dr. Low developed and modified this later. Low described, "What they (the returning patient) are mostly afraid of are terrifying sensations, threatening impulses, obsessing thoughts and depressing feelings, that is, their own inner experiences."

The second premise is the use of "Recovery Lingo." At Recovery meetings participants may not use psychiatric terms, analytic concepts, nor religious or philosophical expressions. In fact, only Recovery language is used. Dr. Low explained that this was to keep inexperienced people from straying into areas of complexes, childhood memories, dreams and the like, but it also serves to keep the group's attention on those things they can do to exercise the self-help concept.

The third premise is the special system of the Recovery method. In part, this includes reading Low's writings and attending meetings, but most of all it is use of the "spotting" process as a technique for self-help. Here the word "spotting" is used in its dictionary meaning of "to note as suspicious; hence to recognize: detect." Through Low's book and attending meetings, the patient is taught a number of Recovery concepts which he must recognize or detect in himself either as thoughts or behavior. This is "spotting."

The fourth premise or process is self-endorsement. Each member is told that he must endorse himself (give himself praise) every time he makes the effort to use Recovery methods. He endorses the effort, not the success of his practice of the method.

Dr. Stanley Dean, a psychiatrist who has been a leading supporter of Recovery, writes as follows about its helpful features:

"The emotional climate of a group is an effective instrument for combating the feelings of isolation and withdrawal of the patient. Mass suggestion and mass identification help to extrovert a patient's emotions and 'draw him out of his shell.' People who are themselves afflicted are more sympathetic and understanding to fellow sufferers. Most people feel better when they learn to share their troubles with kindred spirits. In Recovery, each patient is encouraged to confront his problems, to air his symptoms, and to examine the validity and appropriateness of his emotions. At home this might meet with arguments, objections, indifference or even pampering. In the group it meets with understanding and support."

"It would appear that as patients confess their fears and eccentricities and observe no reaction of dismay on the faces of others, they feel accepted. They feel safe in the group because the shared secret evokes no condemnation. They are all in the same boat, so to speak. They reinforce each other by their mutual acceptance."

"Still another advantage of Recovery is the competitive element that it provides. Patients consciously or unconsciously compete with one another to see who can improve most completely and quickly and thereby win the approval of the rest of the group. In turn, the actual demonstration of objective improvement from week to week is a source of great encouragement and inspiration to the others. Part of the program for each is the support and reclamation of other patients. This spirit of working together toward a common goal cannot be over emphasized. In union there is strength. Helping others is one of the surest ways to help one's self. These truths have been known through the ages. In Recovery they are brought into sharp focus where patients can actually observe them in practice."(5)

"A major advantage of Recovery, that is rare in the orthodox type of individual or group therapy, is the attendance of family members at meetings. The family is thereby able to obtain greater insight into the problems of the patients. The family realizes that nervous and mental problems are universal and not a unique and personal affliction. As a consequence, they learn not to feel so sorry for themselves. At the same time they acquire a new dimension in sympathy, tolerance and understanding. More important, since disturbed individuals often come from disturbed families, the latte r may learn though Recovery to spot and correct their abnormal reactions." (6)

There have been a few evaluative studies of the ways in which participating in Recovery groups has affected members. They have been largely positive. The most recent of these was reported at the American Psychiatric Association Annual Meeting in 1986, by Marc Galanter, M.D., Department of Psychiatry, Albert Einstein College of Medicine, Galanter concludes: "In the balance, however, it appears that a movement such as Recovery can provide meaningful help to severely distressed patients, while alleviating the need for concomitant professional care. Significantly though, only a small portion of this organization's members are actually referred by mental health professionals. This suggests the need for better understanding of such movements in the psychiatric community and for better ties between groups like Recovery and professional caregivers." (7)

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