NEW DIRECTIONS’ 2004
LEADERSHIP TRAINING WORKSHOP
By Ruth Z. Deming, MGPGP
Director, New Directions Support Group, Inc.
New Directions offers 2 leadership training sessions per year. This is the handout we provide with each 2-1/2 hour training workshop.
We are indeed pleased that you have decided to come forward and join Our Team. Please familiarize yourself with all aspects of New Directions, including the separate sheet Quik Facts. Also thoroughly read our web site. It contains our philosophy, which is of incomparable value to people – like us – who seek to conquer the devastation that is mental illness.
THE NEW DIRECTIONS MEETING
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, to the air of friendliness and tolerance that abounds. The presence of the Leaders of the group send out unending positive energy to the group. The members who attend that particular evening lend their energy to the totality of the group.
Know that you, as a leader in the group, should have as your mindset: I am an integral part of what makes this group run. 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 show them around. You can think of it as a party, where you want everyone to feel comfortable. Also, because you are an integral part of the group, do small things that show you care. If you see a piece of paper lying on the carpet, pick it up and throw it away. Treat the room as if it were your own.
There are 2 official facets to the meeting: Large Group Discussion (1/2 hour) and Small Group Discussion (75 minutes). The Small Group is at the heart of the meeting. This is what people come for.
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 – 10-minute break – meet back in Small Group at 8:30 – finish up at 9:45. Group also needs to know which small group to go to.
Another purpose of the Large Group is that it lets our members have a good look at who’s there: the vast variety of people with from all different walks of life, different ages, ethnic groups, all of whom share similar mindsets and the desire to share their own personal worlds with others who understand.
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.
LEADING THE SMALL DISCUSSION GROUP
Thank you for stepping forward to become a leader of the Small Discussion Group. Your role is an important one. 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.
We like to have as many trained leaders as possible. When it’s time to break into the Small Group make sure you find a group where there’s already no leaders. Also, decide if you wish to lead that particular night or not. Sometimes we just don’t feel like being a leader on a particular night, but would rather be part of the group. This is fine.
One of the main problems I see at the meeting is the gathering together into the Small Group after the break. You, as a leader, should take initiative to make sure people get into their groups.
As to the meeting proper, there is really no right way to run a group. Each group is as different as the members who constitute the group: Their blend of spontaneity, wisdom, humor and desire to prevail over hard circumstances is what makes the Small Group so effective.
“Talking” is one of the most important ways of healing. It’s called “storytelling.” Everybody has a story. And everybody needs to tell it. To the right person. That’s why New Directions is so important. We are the perfect place for people to tell their story.
As with life itself, there is always something new to be learned. Keep your eyes and ears open and you will learn new things at every meeting you attend. This is what we want to do: learn new things and new approaches to dealing with our illness or those of our family members. This includes information on: doctors, medication, family relationships, job relationships, alternative solutions. We have a great advantage. We can share information with others. We are a network of committed intelligent individuals.
GROUPS, BRIEF HISTORY
New Directions is only one of many groups in our society in which we participate. Our foremost group is our family group, the basis of all other groups. Think of other groups you may be part of – a book discussion club, bridge club, bowling team, etc. Each of these groups has a reward or a goal.
New Directions’ goal is: How to live with our illness – or that of our family member. There are other rewards as well: friendship, getting out of the house, feeling accepted and not alone or “different,” knowing that other people share your same condition.
Read our mission statement: “To help individuals reach their highest potential; to move beyond their diagnosis to lead meaningful, productive and joyous lives, even if that means changing our goals and our lifestyles to accommodate our illness. Our highest priority is for our members to participate in society to the fullest: through work, volunteerism, involvement in the community, and by developing lasting and loving relationships in our lives. We are also committed to community education programs to instill education and dispel prejudice.”
Focus of group is on “problem-solving” and “compassionate caring.”
The group is conducted by “lay” people.
New Directions has 2 types of groups: the “large group” and the “small discussion group.” This guidebook discusses your role as leader of Small Group.
The small discussion group – 6 to 8 people – is the core of ND. This is where people open up and talk. They tell their story. Again, storytelling is a great healing process. It’s best done with no interruptions.
Everyone in the group adds their own personality, their own ideas and wisdom to the group. These individual differences among people give color, depth and richness to the group.
Note from Amy, veteran group leader: “I believe very strongly in explaining “the role of ND” to newcomers – and reinforcing it for others. The concept of a support group is sometimes unfamiliar. Research shows that support groups help with the patient’s recovery. Sometimes I refer to the 3-legged stool that props us up during recovery: meds, clinical caregivers, social supports.
GUIDE TO BEING A LEADER
Here are some guidelines to help you… some important points to be aware of. We’re including “scripts” to help you verbalize things. Feel free to vary them as you express your own personality.
In essence, being a good leader includes: Good eye contact – relaxed and in-tune body language – careful listening – empathy – remembering what people have said and tying these things in with what new members say – look around an gauge members’ responses to things. Mostly, rely on your own personal thoughts and feelings about what is going on around you in the group. As stated earlier, you are no doubt doing ALL of these things. But by reading it in print, you will have a surer sense of your own competency as leader. Don’t be afraid at the end of the group to take a friend aside and ask, How did I do? Also, after you lead your first group, please call Ruth to discuss and get feedback.
Just be yourself. Be yourself the way you would when you’re with a group of friends. Be relaxed and comfortable. Body language is very important in conveying that you are relaxed and are actively listening. The group will then follow your lead. They, too, will feel relaxed and comfortable enough to share their stories.
Be a good listener. Focus on what each person has to say. By listening carefully, you are setting the tone that we listen carefully to each person.
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?” Should the group continue to interrupt, hold up your hand (body language) and say, “Please. Let’s let Joan finish her story.”
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.”
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. This includes bringing the group back to focus if they go off track. Also, discourage “side conversations” if they last too long.
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.”
As we said, although you are the group leader, the group should do most of the talking, as in a group of friends talking together. If people look toward only you for an answer, it’s
often a good idea to turn to the group. “Well, let’s hear what the group has to say about this.”
Starting out. The leader gives an opening statement. Even though he or she has said this at other meetings, it’s important to repeat it at the beginning of each group. “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. We have until 9:45 to talk. Everybody will have a chance to speak.”
Why is this statement important? What points does it cover? First you are reassuring people it’s okay to be honest because confidentiality is assured. You are setting limits – the group will go for an hour. 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.
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.
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.)This is a good opportunity to practice tactfulness, not only in group but in life as well.
Silence is OK. As a leader, don’t feel that you need to talk to keep the discussion going. Silence is okay. The group leader may encourage a faltering discussion by saying, “Well? What else?” Or make a joke about it. “Well, I guess we’re all cured now and can go home.” The group will talk when they are ready. If the group remains unresponsive suggest, “Maybe we’re finished now and ought to stop. What do you think?”
Should the group leader share? Yes. Throw in details of your own experience. Monitor yourself and don’t talk too much.
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.
Take turns at being leader. You needn’t lead the group each time. Share the leader role with other trained leaders. Figure out at the beginning of group who wants to lead.
A number of points are repeated here, but it is helpful to have them re-stated, this time from the perspective of “Group.”
Meeting format. Each group is different. There is no specific way to run a group. All that’s important is that the group “works.” The running of a group depends on (1) the leadership, as well as (2) the input of the members. It is a partnership between the two.
Two basic ways of running a group: The (1) “going around the circle” way and the
(2) “open-ended” way.
“The circle approach.” In this style of group, each person speaks in turn, passing on from person to person. This way the group flows systematically from one person to another. Each person talks in their turn. Order is maintained. Everyone knows what the next step will be. The regularity of the circle approach can be reassuring to both leader and group members, thus avoiding the anything-can-happen, spontaneity of the “open” group.
The leader may start off the circle by saying, “Okay, let’s go around the circle. Nancy would you like to begin?”
The “open-ended” group. This approach encourages spontaneity and a lively give-and take. One person’s comments spur another person to respond. The leader of this type of group may work harder than in the “circle group” as she keeps track in her head of who has spoken and who hasn’t. Again, everyone should have an opportunity to talk, so the leader needs to create opportunities for every individual to speak.
Karen may open this group by saying: “Okay, who would like to start? Who has something they would like to share?”
As mentioned, Karen must be aware of who has talked or not talked. She then needs to bring in those people who have not talked or haven’t been heard from much. “Bill, you haven’t had said much. Is there anything you’d like to share?” Or you can specifically bring Bill in by saying, “Bill, how do you feel about what we’ve been talking about? Is there anything you’d like to add?” Or, “Bill, you look like you have something to say?”
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.”
Establish a climate of listening. The leader is the role model. He or she establishes a climate of listening. By her body language, by her comments, she gives the message, “You are all important. I am listening to what you have to say.”
Be aware of limits and boundaries. Tell members at the outset how much time you have. “We have an hour to talk. The group will end at 9:45.”
Limits also include how much time people have to talk. Most people will figure this out for themselves and conform to the style of the group. It’s OK, however, if one person needs more time than another. Just make sure that you hear from other people as well.
There also may be the “silent person.” Respect their silence if they insist. It’s a good idea to give them an opportunity to speak later on in the group when they’ve had a chance to “size up” the group and feel more comfortable. “Judy, would you be interested in saying a few words now?”
Welcome the newcomer. Do this at the outset. “Ronnie and Cilantro, we’re glad you came tonight.” If the newcomer doesn’t feel like talking this is fine. You can always stimulate their participation by asking, “Where did you hear of us?”
Immediately identify which people have pressing issues. You can ask by saying, “Does anybody here need to talk first?” If they are really in distress, satisfy these members’ needs first. They are in need and are probably eager to talk. 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.
Allow a person to fully tell their story. Make sure a person can speak without interruption as they tell their story. The person needs to make sure they are heard. After that, the group may chime in.
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.”
Is it OK to talk about doctors and about medication? Absolutely. Doctors and meds are probably the 2 top things people want to discuss.
Medication: Patients are hungry to discuss their medication with other people on psychiatric 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.” This is extremely important for every group member to know, even while they gather the names of all available drugs that can possibly help them. 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 CallTeam to give telephone reassurance or in-person reassurance to the person who is waiting for their new med to kick in.
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. Other times, the group member needs to express frustration about their doctor or doubts that their doctor 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 efficacious. 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 it needs to be done for the patient’s mental health.
At the mention of feeling doubtful about one’s doctor, the group will offer good commentary on what constitutes a good doctor. It’s not a good idea for leader or members to outright tell a person to change doctors (or medication). 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 side effects. How shall we handle this in the future?”
Encourage partnership between doctor and patient. This is a whole new concept to many psychiatric patients and should be said again and again. In the old days, people put their psychiatrists on a pedestal and felt it was wrong to question them. In today’s society, we take a different approach. 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.”
Encourage problem-solving. This is one of the most important functions of the group. The group is a fabulous resource to help people with daily problems –
acknowledging that they are not the only ones that have this problem – such as getting out of bed in the morning. Group members represent a broad spectrum of practical experience. “Sam, I really like that idea of starting your day with a walk around the block.”
Our steps to recovery. These common-sense, universal wellness techniques are listed in our ND brochure and on our web site www.NewDirectionsSupport.org 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.”
Group follow up. Many times a person is going through a life change (moving, having an operation) that will take time to complete. If Alice wishes, set up a Call Team to check in with her on how she is doing. Some people just naturally refuse help. So try and apply slight pressure to see if she really indeed wants help but is too shy to ask.
Encourage “group talk.” Foster connections and conversation between group members. “Lisa, you’re talking about much the same thing Ray was speaking about a moment ago. Why don’t you and Ray talk more now about how it felt coming out of the hospital.” Their experiences will then be shared and everyone else can chime in.
Reality checking. The group is a valuable resource for “reality checking.” This means that some people need to hear from others if they are on the right track; if their perceptions are correct, rather than being skewed. In other words, how does their “subjective” view of reality compare with an “objective view?” Here are some examples that members might ask help for: “Am I doing the right thing about my getting a job?” Or, “Does it sound like I’m getting manic?”
Reality checking also means that the group itself may find something amiss with the person’s behavior and needs to tactfully inform that person. “You know, Mary, I think you really ought to see your doctor. It seems like you’re spiraling downward and need to be around people.” Have the group confirm this, so Mary is really convinced – through reality checking – that she needs to see her doctor. Again, tactfulness is the key. No one will listen to advice if they think they are being attacked.
Ask Mary for confirmation that she has heard you. “What do you think, Mary? Will you see the doctor?”
Tactful talk. This is very important. 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. “You know, Kathy, it seems to me like you need to talk to your doctor.” Or, “You know, Kathy, if it were me, I would definitely get in touch with my doctor.”
An untactful approach would be to say, “Kathy, if you don’t see your doctor, you’re really going to get in trouble.”
Kathy may perceive the latter as a threat and resist getting help.
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.”
Different opinions. People will inevitably have different opinions and experiences. If they 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.”
Talking about God. It’s fine to talk about God and anything else that gives us strength and inspiration. People have numerous ways of gaining inspiration throughout the day or in their darkest hours. We at New Directions are interested in any approach that helps us get through our illness.
Wrap up everything within group. 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.
Closing moments. Thank the group members for coming and sharing. Be sure to give a special thanks to the newcomers and encourage them to return. Also, mention to the people who are struggling that our thoughts are with them and, for all the members, encourage them to use the phone list between meetings.
PROBLEMS YOU’LL ENCOUNTER IN GROUP
…Difference in opinions. Not everybody is going to think alike. This is fine. 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.”
…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. “Hey, guys, let’s get back to being part of the whole group.”
…The monopolizer is often the dread of the group and the leader. 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 the monopolizer.
Dealing with a monopolizer is usually the leader’s greatest challenge. The monopolizer is probably unaware she is monopolizing.
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.”
You can always cut the person off simply by speaking quickly when the monopolizer takes a breath and interrupt them. This is fine. Simply turn your body and your attention to someone else: “Jim, you look like you have something to say. What’s on your mind.” These behaviors will become second nature after practicing them.
The early warning method. If you recognize an experienced monopolizer will be in your group that evening, take him aside and say, “Bill, I know you have a lot to say to the group, but we need to monitor your talking so other people have a chance to speak. I’d like to work with you on this.” Then suggest you and Bill come up with a system whereby Bill will check in with you while he’s talking. You can suggest, for example, that he watch you for signs that he’s doing OK: thumbs up. Or, perhaps, the universal cough or clearing of throat to let him know his time is up.
…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. “Emily, we appreciate your enthusiasm and your comments, but it’s better not to respond to everything that is said.” She is also a candidate to be taken aside before the meeting. Again, this is difficult to do, but to run a good group this issue has to be taken care of.
…Negative people. Some people have a negative turn of mind and don’t say anything positive. You can’t change them. While they’re talking you might say, “Well, Jane, all that certainly is a problem. Can you see anything positive about your situation?” Or just, “Well, Jane, we certainly understand what a problem that is for you.”
…Crisis. Infrequently, someone may be in crisis and needs immediate attention from their doctor or needs to go to the emergency room. 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 help or you can simply drive her to the emergency room, or follow her in your car. Don’t worry. This happens rarely. Again, be sure to mention this to the group director.
…Give a brief report to Ruth after the meeting. “Good group. Things went well. One person is having some difficulty. We set up a ‘call team.’” Ruth, as the director, needs to know what’s going on at all times. Not in intricate detail, just the basics.
SOME CONCEPTS AND QUOTES USED BY THE GROUP
Each case is different. No two cases are alike.
No medication works the same on everybody.
There is a great variation in the way medication works for different people.
Make a list of questions or problems when you see your doctor.
It often takes time for medication to kick in. Be patient.
If you have doubts about your psychiatrist, get a consultation with another one.
SOME TERMS & CONCEPTS USED IN GROUP
Caring – compassionate
“Check with your doctor”
No medication works the same for everybody. There is a great variation
“Let’s see what the group thinks about this”
Having a bad day – struggling
Consultation with another doctor
Check it out on the Internet
Common Daily Problems for Group Members
Many group members have trouble with family members. Or work situations (co-workers, boss). Family members may be described as:
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 this – and also how they can educate their family on their needs! Ask for suggestions from people who have good relationships with their family members. Use their wisdom as a guide.
Suggest the family member attend a meeting.
PROMOTE ND AND THE HELP YOU CAN GET FROM US
Encourage buddy system, suggest people may wish to be buddies
Encourage networking among members, suggest people exchange phone numbers
Encourage use of our resources (library, volunteer jobs, social events, morning meeting )
Brag about the group, how wonderful it is. This will allow people to feel they’re
in good, capable hands, and that by listening to our philosophy, they will get better.
Send people to our always-evolving website.
Ask people for their feedback – good and bad.
Ask people for ideas.