LEADERSHIP TRAINING WORKSHOP Revised February 25, 2012
By Ruth Z. Deming, MGPGP
Director, New Directions Support Group, Inc.
Abington, PA and Willow Grove, PA
Thanks for being part of our New Directions Team! Please familiarize yourself with all aspects of our group, including our info-packed website. Our motto is: “People who come to New Directions get better.” That’s because we take a personal interest in every individual who walks through our doors.
I founded the group in 1986, two years after I was 302’d – involuntarily committed – to Montgomery County Emergency Service – diagnosed with manic-depression or Bipolar Disorder I, as it is now known. This is the type of bipolar that consists of true mania and psychosis. As you may know, my illness has resolved itself and I no longer take meds for bipolar.
Our Top Doc/Top Therapist list ensures that we all have the best possible helpers. Most people who are not doing well are on the wrong medication and should be encouraged to get a second opinion.
Our members are encouraged to make friends with like-minded people in the group.
We also offer suggestions in maintaining a healthy lifestyle for our patients, such as:
1 – Eating healthy meals – consultations with a nutritionist – such as Mary Ann Moylen at the Willow Grove Giant Supermarket – 215-784-1960.
2 – Engaging in aerobic exercise to defuse stress and anger, as well as keeping our bodies strong and fit.
3 – Stop smoking. Classes are offered at all major hospitals. An inordinate amount of folks with mood disorders smoke.
4 – Limit alcohol intake. Check with your doctor about alcohol intake. People with substance abuse problems may not attend ND until they are abstinent a year.
In the past we have been funded by the Patricia Kind Family Foundation, van Ameringen Foundation and Montgomery County Office of Behavioral Health, among others. For many years, the Compass was printed and distributed by Janssen Pharmaceutica, LLC. We recently got a three-year-grant from Pat Kind. Montgomery County pays for our phone bill and Internet service, among other things.
Please share any fund-raising resources you are aware of.
THE NEW DIRECTIONS MEETING BEGINS THE MOMENT A PERSON WALKS IN
The New Directions meeting begins the moment a person walks into our church. Everything is important, from the signage that directs newcomers to our meeting place, to the greeting they receive from the greeters at the front table and from the members. The presence of the Leaders of the group send out unending positive energy to the group.
Know that you, as a leader in the group, are an integral part of the group. Feel free to take initiative. If you see a new member who is ill-at-ease when they first come in, go over and talk to them. What I often do is pair them up with someone in the group so they will have someone to talk to. You can think of it as a party, where you want everyone to feel comfortable.
The meeting is divided into two parts: Large Group Discussion (1/2 hour) and Small Group Discussion (75 minutes). The Small Group is at the heart of the meeting. This is why people attend.
Large Group takes care of official business and announcements. It’s particularly important during Large Group that the members know the schedule for the rest of the evening. The person in charge needs to reiterate the schedule: Large group meets for half hour –Small Group until 9:45, although we always go until at least 10 pm.
Nelson is the name of the gentleman who shuts out the lights. Every year I send him a small donation for his help. I also send the church a Christmas donation since they don’t charge us.
We also make announcements: Ada’s Outing – the Willow Grove Giant Daytime Meeting, run by Helen or Johannes. All these are listed on our new brochures. Thanks to Helen for donating the money for them.
We’re still looking for someone to run Mike’s Sunday Hikes. Volunteers?
We also ask people to share anything that might be of interest to the whole group. When I greet people at the door or around the circle, I often glean info that will be helpful for the entire group and ask the person to speak about it.
I often ask for ideas for guest speakers, who donate their time to us. We don’t pay them but always give them a nice gift.
Another purpose of the Large Group is that it lets our members have a good look at who’s there: the diversity of people from all different walks of life, different ages, ethnic groups, all of whom share the desire to overcome mood disorders or that of their loved one.
I think of the Large Group as a warm-up to the Small Group, allowing members to know the range of our openness and tolerance and that it’s OK to laugh at ourselves. The role of humor can’t be overstated.
It’s also a good idea to state at the beginning that members should stay in touch between meetings. “If you meet someone here tonight, feel free to ask for their contact information.”
LEADING THE SMALL DISCUSSION GROUP
You are already doing most of what I’ve written in this guidebook. All we’re doing here is putting it into writing, which confers a certain formality and knowledge-base to the process.
Decide if you wish to lead that particular night or not. Sometimes we just don’t feel like being a leader but would rather be part of the group. This is fine.
One of the main problems at the meeting is the gathering together into the Small Group. Often members don’t know whether to go into the Depression or the Bipolar Group. Either one is fine.
There is really no right way to run a group. Each group is as different as the members who attend that day: their blend of spontaneity, wisdom, resources, humor and desire to prevail over difficult circumstances.
“Talking” or “storytelling” is one of the most important ways of healing. That’s why people see a therapist so they can talk. Talking creates changes in the neurons of the brain just as meds do. Everyone has a story and needs to tell it to the right person, or, in our case, group. Although people may not have spoken in a group before, they soon get used to it and like it! Sometimes they stop seeing a therapist because they get just as much out of ND as in therapy.
Members in the Depression and Bipolar Groups are used to talking about their illness as they see a psychiatrist and therapist.
As with life itself, there is always something new to be learned in group. Keep your eyes and ears open and you will learn new things at every single meeting. If you hear of any good resources, please share them with me.
GUIDE TO BEING A LEADER
Here are some guidelines to help you. I’m including “scripts” to help you verbalize things. Feel free to vary them as you express your own personality.
Please bring a pencil and paper with you to write things down. Some group members also take notes. It’s sort of like being in class. In fact, many members call and say, “When is your next class?”
In essence, being a good leader includes:
Good eye contact – relaxed and sympathetic body language – careful listening – empathy – remembering what people have said and tying these things in with what other members say – look around and gauge members’ responses to things.
Is “Terry” paying attention? If not, what does this mean? Why is he distracted? Depressed? Manic? Find out during group or later.
Also, gauge the body language of group members: relaxed? uptight? arms crossed? legs jiggling? often leaves group? (why)
The Beck Institute in Bala Cynwyd, according to one of our families, asked the family to keep track of the words used by their manic son. When a person moves into mania, his vocabulary changes as he becomes grandiose or delusional.
Rely on your own intuition about what is going on around you in the group. If you think someone is acting strange or out of character, you are most likely correct. Ask them about this. Are they becoming manic? Depressed? Something important on their mind?
Starting out. The leader gives an opening statement.
“Hi, my name is Karen and I’ll be your leader tonight. We want to welcome newcomers and are glad you came tonight. Everything we say in group is confidential. What we say will not leave this room. When a person is speaking, please do not interrupt them. We have until 9:45 to talk. Everybody will have a chance to speak. Does anybody need to talk first or need to leave early?”
Note about the “interruption piece” – if you have a bad interrupter, when they interrupt, you might say, “Oh, Joan, I guess you didn’t hear me when I asked the group not to interrupt when someone is talking.” Or, “Joan, please, Sam needs to finish talking without interruption.”
Why is the group leader’s intro important? First you are reassuring people it’s okay to be honest because confidentiality is assured. You also are setting limits – the group will go for an hour and fifteen minutes. You are acknowledging the newcomers and making them feel welcome. You will also reassure people that you, as leader, will take care that no one gets lost in the group, that everyone will have a chance to speak, should they wish. Nearly everyone does want to talk.
Watch the clock. Pace yourself. The leader must pace herself so that everybody has a chance to talk by group’s end. She must also make sure each person speak for an appropriate amount of time. Not everyone will speak the same amount of time. This is fine. Often one person needs more time than others. This is fine, as long as their topic doesn’t dominate the group.
Just be yourself. Be yourself the way you would when you’re with a group of friends or family. Be relaxed and comfortable. Body language is very important in conveying that you are actively listening. The group will then follow your lead. They, too, will feel relaxed and comfortable enough to share their stories.
In the “patient” groups there is often side-talk. Sometimes it’s productive so you may not want to interrupt. If it goes on too long, simply say, “No side-talk please!”
Let each person have their say. The person needs to talk without interruption. Show this to the group by not interrupting. Occasionally, clarification is needed, and you or someone else may interrupt by saying something like, “Is this your daughter you’re talking about?”
Immediately identify which people have pressing issues or need to leave early. At the start, ask “Does anybody need to talk first or need to leave early?” If they are really in distress, satisfy these members’ needs first. Your group members will be glad to help. Group members rally around people who need help. If need be, talk to the “needy” member after the group. Often, group members will do this spontaneously. Also….
Set up a ‘”call team.” Many members need follow-up due to a difficult situation. During the group, ask for a couple of volunteers to call the individual to “check in” with them to reassure them. Particularly important if a person is suicidal.
If suicidal or badly depressed, insist the individual call their doctor. Then you or a fellow group member call them the following day to make sure they’ve followed up.
You don’t need to be an authority. As a leader, you’re not expected to be an authority or to know everything. Your role is to facilitate discussion. For example, if someone asks a complicated medical question, just say, “That’s a question your doctor needs to answer.” Or, you might say, “Let’s see if the Group has any experience with this.”
When disagreements arise you might say, “Let’s agree to disagree” or “Different strokes for different folks.”
It’s okay to say, “I don’t know.” Feel comfortable with that. Again, turn to the Group to answer specific questions. Utilize the group as much as possible.
Facilitate discussion. As a group, the members should do most of the talking. The leader or facilitator is there to guide them.
You may also sum up what has been said. For example, if 3 people are talking about the same thing – for example, problems with medication – you can say, “The experiences of the 3 of you show us that each case is different, and that no medicine works for everybody.”
Tactful way of talking. We want to find tactful ways of saying things. Often this requires that we practice in our minds what we are going to say before we say it. (See the examples below as “tactful” and “kind” ways of talking to people.)
Should the group leader share? Yes. Throw in details of your own experiences. Set a goal.
When you, as the leader, are having a bad day and need time to talk about your own problems, arrange to have someone else lead the group.
Set goals. We want everyone in the group to move forward. Goals are invaluable. By stating the goal to the entire group, the person feels accountable to his or her peers and will be more motivated to accomplish it. Goals should be slightly challenging but not so difficult that the person won’t be able to do it. Tell them, “It’s okay if you can’t accomplish this.”
Examples of goals are: look for work or volunteer work – go to the gym – stop smoking.
Resources from group members. If you hear of any terrific resources – like good doctors, good partial programs, respite facilities – please let me know.
Keep track of who has spoken. Then bring in folks who haven’t shared. It’s often hard to say something during a lively discussion. “Bill, you haven’t said much. Is there anything you’d like to add?” You might also ask a newcomer, “So, Lisa, what dyou think about the meeting?” I always check with newcomers – either during or after the meeting – to see if they liked us.
I also might say, “John, we missed you. Hope you’ve been doing well since the last time we saw you.” Then John will tell us all what he’s been up to.
Keep the purpose of the meeting in mind at all times. Everything in the group should be in line with: managing the mood disorder, or helping your loved one manage his/her mood disorder. Conversation may stray. This is fine. But bring it back in focus. “OK, thanks for the tips on new movies, but let’s get back to the topic.”
Stay on topic. Make sure that each person finishes their topic before a new one is brought up. In the excitement of the group, a person may be interrupted by someone else. Guide people back to the person who has been interrupted. “Wait a minute, Jim. I don’t think Bob has finished what he wanted to say.”
One time, in my bipolar group, we had a terrible interrupter. She was a newcomer and was really excited to be here. When “Andy” finished talking, she barged in. “Susie,” I said, “I haven’t finished digesting what Andy said. Please wait a minute.” This also lets Andy know how important he is.
Ending the meeting. Tell the group there’s five minutes left. Does anyone have anything to bring up in the short time remaining? Also, if there’s time, ask for feedback about the group. Always get feedback from newcomers.
Follow-up after meeting. Take notes and get everyone’s contact info including email and phone no.
Optional email follow-up after group. For several years, I’ve been sending a follow-up email after group. Not everyone wants to be included, so I always ask if they’d like to be included. In the email I state each person’s goals plus some positive info about them, resources, or things that will help them until the next meeting. This email helps me too. I keep track of the problems and progress of each member. I keep these emails in a “subfolder” in my inbox.
Potential leaders. Be on the lookout for members who have leadership potential. We’re always in need of leaders or phone greeters.
Many group members have trouble with family members who may be described as:
Harsh Judgmental Unaccepting Doesn’t understand Thinks “will power” will get rid of the depression
What can you as a leader say? Realize that many people who are important in our lives will never change their attitudes. Ask the group how they deal with their unaccepting family members. Suggest the family member attend a meeting. Many simply refuse.
People also have trouble at work. Brainstorm as a group on how to relieve stress at work and get along with difficult people.
Is it OK to talk about doctors and about medication? Absolutely. Doctors and meds are popular topics.
Medication: Patients are eager to discuss their medication with other people on meds. They also need to know each and every medication available in the medication arsenal. You, as leader, should, of course, emphasize the dictum “Not every medication works the same for every person.”
It often takes 6 weeks – or up to 12 weeks – to find out if a med is working.
You and the group should also encourage the person to give the new medication time to work. And while this is in progress, the members of your Small Group can set up a Call Team to give telephone reassurance or in-person reassurance to the person who is waiting for their new med to kick in.
My opinion is that a good psychiatrist can find the right medication for almost everyone. If not, the person should see someone else.
Doctors. The support group is a terrific place to talk about our doctors. Sometimes people want to express how much help their doctor has been to them and how the doctor has always been there for them. This is wonderful. People need to hear about all the wonderful doctors out there to treat us.
Be alert for doctors to add to our always-expanding Top Doc list.
Other times, the group member needs to express frustration about their doctor or doubts that she is doing a good job. By just letting the patient get this off their chest, is of immense service to the person, who may have no compass point to determine whether or not the actions of their doctor are helpful.
Be aware that some people feel “disloyal” in talking about their doctors in group, let alone criticizing them. Let them know it’s normal to feel uncomfortable, but if they wish, they can express their feelings.
When a member talks about not being sure if her doctor is good, the group will offer helpful conversation on what constitutes a good doctor.
Always remember that you are hearing one side of the story – from the patient – and there may be other sides as well. Do, however, let the patient know that it’s okay to get a second opinion or consultation, and it’s also okay, should they choose upon reflection, to change doctors. You and the group might try “role playing” with them on how to approach their doctor about problems.
“Dr. S, I was disappointed you didn’t call me back when I said I was suffering bad side effects. How shall we handle this in the future?”
Encourage partnership between doctor and patient. In the old days, people trusted everything a doctor said and felt it was wrong to question him. This is no longer the case. Our doctor and I are partners and are working together on a mutual problem: mental illness, which requires astute input and ideas on both sides.
Encourage group members to go prepared when they see their doctor. Bring in key points that occurred between visits and their version of a “mood chart.”
Tell members we have a Top Doc/Top Therapist List.
Encourage problem-solving within group. Work as a group to brainstorm how to help a member. For example, in one group an estranged wife was not allowing her bipolar husband to see their two children. The group brainstormed and came up with a good strategy to help him: see a mediator rather than a costly attorney.
Our Keys to Recovery. These common-sense, universal wellness techniques are listed on our ND brochure and on our website and should be stressed during the meeting.
Stay positive. When the group finishes up with a person, end on a positive note. “Larry, it looks like you’re really moving forward with sending out your resumes.” Sometimes the situation is so difficult that it’s hard to be positive. If this is the case, the leader might say, “Let’s just hope for the best. We’ll be thinking about you.”
Individual follow-up. Many times a person is going through a difficult life change (moving, going through a divorce, having an operation) that will take time to complete. Set up a Call Team to check in with Mary on how she is doing.
Foster connections and conversation between group members. “Lisa and Ray, both of you just came out of the hospital. Talk to each other and the group about what this was like.” Their experiences will then be shared and everyone else can join in.
Reality checking. The group is a valuable resource for “reality checking” or sizing up a person’s behavior to make sure they are not getting depressed or manic. Talk to the individual if you think they are becoming ill. Get the group’s opinion on this as well as the patient’s thoughts.
Cardinal signs of mania are lack of sleep, constant talking, spending a lot of money. Insist they get in touch with the doctor if these signs occur.
Ask for confirmation she has heard you. “What do you think, Mary? Will you see the doctor?”
Tactful talk. Everyone in the group follows the tone of the leader in speaking tactfully and non-judgmentally to people. For example, instead of directly telling a person what to do, suggest that they do it. Modulate your voice so it doesn’t sound like an attack. “May I suggest, Kathy, you call your doctor as soon as you get home and leave her a message.”
Rely on other people’s personal experiences to guide people. “Kathy, I had the same experience. I forgot to tell my doctor about my side effects and the problem only got worse. I’d suggest you speak to your doctor right away.”
Closing the group. Wrap up everything within group. “Okay, we only have 5 minutes left. Does anyone want to add anything?”
At group’s end, make sure problems have been sewn up. This doesn’t mean that all problems will be solved. Just make sure that key problems have been discussed and solutions suggested. Don’t leave anyone hanging. Make sure everyone has something to take away from group – resources, reassuring words, the telling of their story. Exchange of phone numbers. End on an upbeat note.
Thank the group members for coming and sharing. Be sure to give a special thanks to the newcomers and encourage them to return. Again, ask what they thought of the group. Also, mention to the people who are “struggling” that our thoughts are with them. Encourage people to stay in touch between meetings. People do and many enduring friendships have formed.
PROBLEMS YOU’LL ENCOUNTER IN GROUP
Difference in opinions. Not everybody thinks alike. When people have differences of opinion and are at odds with one another, say something like, “Well, I see we have a difference of opinion here. That’s okay.” Or, “We differ. We don’t all need to think alike.”
Sometimes people know very little or next to nothing about mood disorders. Although this is shocking, be patient and encourage them to learn as much as they can. Advise them to use the Internet, read our website, get handouts from us on mood disorders, check out books from our library, and find books to read on our website.
Side conversations. A few side conversations here and there during group are okay. However, if many side conversations occur and if they are intrusive to the group, put them to an end. “Please! No side conversations.”
The monopolizer is often the dread of the group. Be assured that if you feel someone is monopolizing, your entire group feels the same way. Know that the group wants you to stop the monopolizer and the group will thank you for stepping in and stopping him.
When this occurs, the leader should say to himself, “OK, gotta watch for a way to break in here.” Be bold. Change body positions to signal to the group and the monopolizer that you are going to take charge of the group. Here are some things you can say. “Kristin, I have to break in here. We need to hear from other people.” Or, “Kristin, thanks for sharing, but we need to move on.”
The “Help-Rejecting Complainer” is another group spoiler. Point this out tactfully to the individual. “Bobby, what do YOU think will help you? Obviously none of our suggestions are helpful.”
One-person focus. Sometimes a person will have such a compelling story that the whole group will rally around them – for too long a period of time. Make sure your compelling storytellers do not take over the group. Remember, it’s okay to spend more time on a person who needs it – but, again, make sure you are giving other people a chance to speak.
The intrusive person who knows everything and has to comment on everything that is said. This is a subtle form of monopolization and is also the dread of the group. “Bob, please remember what I said at the beginning of the group: no interruptions, please!”
Negative people. Some people have a negative turn of mind and rarely say anything positive. You can’t change them. When they’re finished, you might say, “Well, Jane, all that certainly is a problem. Can you see anything positive about your situation?” Or “Tell us something good that happened to you today.”
Difficult people. You may want to save them for last. And, if you’ve gone into overtime, you might tell the group, If anyone wants to leave now, please do. We’ve used this tactic with one man in particular, so that he doesn’t annoy the entire group. This same individual leaves long messages on the ND answering machine.
Crisis. Rarely, someone may be in crisis and needs immediate attention from their doctor or needs to go to the ER. The ill individual plus one or two members of the group should leave the group to tend to this person. “Sally, are you feeling really so bad that you might need to see a doctor tonight?” Gauge Sally’s response. (If Sally’s in trouble, tell Ruth.) If necessary, Sally can then call a family member to drive her to the ER. Don’t worry. This rarely happens.
Give a brief report to Ruth after the meeting.
SOME CONCEPTS AND QUOTES USED BY THE GROUP
Brainstorm. Using the group as a whole, tackle a problem and come up with solutions.
Each case is different. No two cases are alike.
No medication works the same on everybody.
Make a list of questions or problems when you see your doctor plus your version of a mood chart.
“Struggling.” We use this term when a person is having a difficult time.
It often takes time for medication to kick in. Be patient. But if six weeks has elapsed and you’re not feeling better, call your doctor. The med is not working. Some doctors do wait an entire 12 weeks.
If you have doubts about your psychiatrist, get a consultation with another one.
What are your “triggers?” In other words, what might trigger you into depression or mania.
INFO TO OBTAIN ABOUT EACH MEMBER
During the course of the 75-minute group session, the leader should attempt to learn as much about the patient as possible. Because I’m a psychotherapist, I like finding out everything I can about the person to suggest solutions. Don’t worry if you’re not so inclined. Also, getting the info must be done subtly, over time.
This info can be gleaned over the course of a meeting or several meetings.
How old are you?
Who do you live with?
Age of onset of mental illness? One of my psychiatrists taught me that if a person is diagnosed as a teenager, they have bipolar disorder, even if the illness has presented as depression. Clinical depression usually occurs after the age of 40.
Bipolar disorder usually occurs in the teens. However, late onset bipolar is also common. I was diagnosed at 38. A woman in our group was 66.
This info is important because many people are misdiagnosed and may be on the wrong meds.
Family history of mental illness and substance abuse.
Where do you work?
If you don’t work, when was the last time you worked?
How do you earn a living? (work, disability, parents or spouse helps you out?)
How often have you been hospitalized?
Ever attempted suicide? (If so, this puts them at higher risk.)
Do you like your doctor and/or therapist?
Hobbies and talents.
EACH INDIVIDUAL NEEDS A LIFE OF MEANING AND HAPPINESS
Good relationships, whether friendships or marriage.
Good job. If they can’t work, we suggest they do volunteer work.
They should take pride in their appearance.
Exercise and eat healthy foods.
Utilize their God-given talents.
Love your home and take care of it.
Do not say, “I’m bipolar.” Say, “I have bipolar disorder.”
You are much more than your illness. You are a whole person with many gifts and talents.
PIVOTAL EVENTS THAT MAY NEED ATTENTION
Having been 302’d or involuntarily committed to the hospital
Discharged from hospital or day program
Divorce or break-up of relationship
Moving to new apartment or house
Spouse prevents you from seeing children (encourage member to contact lawyer)
Loss of job
Problems at job
Kids off to college – empty nest syndrome must be filled
Our support group is a great place to discuss all these events.
For info about the 302 process – invountary commitment – call Montgomery County Emergency Service at 610-279-6100. Available 24 hours a day. They will talk to anyone, but if interested in committing someone, you must live in Montgomery County to use their service. I like talking to Tony Salvatore, who we’ve had many times as a guest speaker. Although his expertise is suicide and involuntary commitment, he’s very knowledgeable about the mental health system in general.
National Alliance on Mental Health (NAMI) – Family-to-Family Group. This 12-week program is invaluable to understanding a loved one’s illness. Find out about these programs online at NAMI.org.
Reading material. Use New Directions’ Library, or go on our website, home page, to find our booklist. We also have booklets on mood disorders at the front table.
Go online to National Institute of Mental Health – nimh.nih.gov/– to find best descriptions of mental illness. You can also order their FREE brochures at http://nimh.nih.gov/health/publications/index.shtml. Or call their info center at 1-866-615-6464.