Adam Blatner

Words and Images from the Mind of Adam Blatner

Not Therapy: Support!

Originally posted on August 12, 2017

People need people. J. L. Moreno, who is best known as a pioneer of psychodrama, really promoted people helping people. His notion of group therapy didn’t require fancy training of the group leader. For almost twenty-five years his journal—mainly concerning psychodrama—was titled Group Psychotherapy, and when he introduced someone to his groups, he called them each “Doctor…” and their last name, because they were all therapists to each other!

Moreno advocated groups for support. Nobody says this is “therapy.” People helping people. It isn’t necessary to imply anything at all “wrong” with group members, except that they’re human and we are all “herd” animals. We need each other.

Alas, Moreno slipped into psychiatry and psychiatry slipped into the medical model as it stands today. But really he wanted something less commercial and innocent. No therapy for real psycho-pathology. Most folks sooner or later go through trying times, and as people need people!

Moreno began around 1911 (before he started medical school) organizing groups of street-walking women in support groups! All kinds of self-help groups may be noted: Parents or siblings of those who are handicapped. People who are handicapped enough to be awkward, but not enough to claim to be handicapped! The elderly, now that I’m one and have my cricks and creeks and feel the embarrassment of not easly keeping up with the more nimble. Parents of kids—certainly handicapped kids, but even normal kids are a handful. Spouses married to people with different temperaments. Group leaders of all types. Group members who feel strange and unanticipated anitpathies to others in the group. The oldest or tallest or most sexually mature in a pre-teen group; the youngest, shortest, or least sexually mature. All kinds of groups!

For example, take Rosemary Nourse,  a counselor at an agency called WellElder in Wellington, NZ. She writes: “All our clients are 60 and over or, if younger, the carer for someone over 60.  We offer a 4 week group which we call Saying YES to Today and a 6 week therapeutic group.  I lead both groups.  These are not limited to carers but all clients. In every group we have offered there have been some carers.

We have considered offering groups for carers—those who take care of the identified patient—; but found the administrative/supporting arrangements beyond our resources. The biggest obstacle for carers is having someone doing the caring while they attend a group and we are not equipped to provide this.  Nor can other small NGOs necessarily change the day on which they offer care programs so carers from different groups can attend.   (There are day programmes  available for people with a dementia and their carers could attend a group on those days.  There are no regular programmes for day respite for people with Parkinsons , multiple sclerosis, etc.)
So what we do is include carers in general groups and offer our counselors to talk for 1 or 2 sessions at carer groups at other agencies.  Where there are not carer groups we sometimes arrange that carers and cared will separate on the occasions we meet and carers have an informal group for a couple of hours while the staff and volunteers engage with the cared eg at an MS or Parkinson’s morning. (Viv Pender, a psychodramatist offers groups at the hospice and she is happy for me to pass you her email, if you’d like.)
But what of our groups? Our groups ALWAYS include carers, not because we advertise them for carers but because the group always attracts carers. For example, we have a group of 10 which included a man mid 60s caring for his wife with MS; a woman in her 80s, herself hardly mobile with arthritis, caring for her husband with dementia; a woman in her 80’s, bipolar and with arthritis, caring for wheelchair bound husband in late 90s and with adult son living at home (no diagnosis but once she had hers, recognising he has bipolar and getting treatment and support in place for him); a woman in her 80s, widowed, after many years caring for husband with Parkinsons; a woman, mid 60s giving ongoing support to daughter who had recently left abusive relationship; a woman in her late 60s, some health issues herself, husband with early stage dementia, adult son with schizophrenia living at home.  Also in the group physically generally well people, some people with degenerative conditions in reasonably early stages, including one with early dementia.

Another example: A group of 6, all women.  One person caring for husband with dementia (fairly advanced, he at home and very reluctant to attend day programmes or respite); another caring for husband with Parkinsons; a third not considering herself a carer, husband has bipolar which not currently managed.  Also  someone widowed after caring for husband with Parkinsons.  In the same group – and some overlap with these people – someone who volunteers in a dementia day programme, someone who has worked in a level 5 dementia ward for many years, someone who has managed a rest home.
Here’s a third group: a group of 7.  A woman, late 50s, caring for her parents at home; a couple, one blind and with limited hearing, the other long term mental health issues and recent head injury; one person widowed after long term care of husband with MS.
These are wonderful groups to lead: while the challenges people face are enormous, so too is their resilience, grit and humanity; and the resources in the group enable participants to develop their own self appreciation and self care, as well as connecting with others at a deep level.  This is particularly important when their own physical capacities and their caring roles (and sometimes their life stage – ie loss of partner and friends) mean their social atoms are shrinking.
(One thing we quite commonly hear is that people have attended support groups soon after their diagnosis/partner’s diagnosis and have been scared away.  It is sometimes too early – when they are coming to terms with a diagnosis, they are faced with seeing people in later stages of an illness.  They often return later.)
I find the widowed people bring a particular strength to the groups.  They are familiar with the complexity and conflict of emotions – loving someone deeply and feeling relief that their caring role is over/ resentment while still caring.  Their presence assists others to share some of their conflict/guilt, be accepted and not receive advice, usually not their experience in “the outside world.”

My comment: What this illustrates is just having a group of people with similar predicaments is enough: No use of special techniques is needed. Maybe some, but often it’s enough to allow people just to talk about their predicament in a group and find they’re not alone. It’s good to find that other people have experience mixed feelings, hate for the job and even (dare I say) for the person being cared for; feelings of inadequacy in the role, mixed with elaborate or perhaps only half-imagined fantasies that others could surely do the job better.

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