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Men in support groups: why they keep coming back Knopp, Peter Alexander 1997

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MEN IN SUPPORT GROUPS: WHY THEY KEEP COMING BACK by PETER ALEXANDER KNOPP B.Sc, Concordia University, Montreal D.V.M., Universite de Montreal A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Counselling Psychology) We accept this thesis as conforming to thej^ qVired standard . THE UNIVERSITY OF BRITISH COLUMBIA April 1997 © Peter Alexander Knopp, 1997 In p resen t ing this thesis in partial fu l f i lment of t h e requ i remen ts f o r an advanced degree at the Universi ty of British C o l u m b i a , I agree that t h e Library shall make it f reely available f o r re ference and study. I fu r ther agree that permiss ion f o r extens ive c o p y i n g of this thesis f o r scholar ly pu rposes may be g ran ted by the head o f m y d e p a r t m e n t or by his o r her representat ives. It is u n d e r s t o o d that c o p y i n g o r pub l i ca t i on o f this thesis fo r f inancial gain shall n o t be a l l o w e d w i t h o u t my w r i t t e n permiss ion . D e p a r t m e n t of CQ<^^^/^^ ^S^C ^ll>^y The Univers i ty of British C o l u m b i a Vancouver , Canada Date A^lz*//???. . DE-6 (2/88) I I A b s t r a c t This was an exploratory study which used Flanagan's critical incident technique to discover the needs being met for men by involvement in men's support groups. The ten participants, representing four different groups, were enlisted by personal contact and by word of mouth referrals. All had participated in a men's group for at least two years at the time of the interviews. Analysis of the taped interviews resulted in a list of needs which were important to the men in these groups. Upon comparison to the theoretical expectations, it was found that having fun, accomplishing something, and experiencing an appropriate balance of supportive and challenging processes had not been previously described as important aspects of group process. Another surprising finding was how important it was to men to establish fr iendships through their group involvement. These results may assist those planning groups and courses to structure them in ways that are more appealing to, and more satisfying for, male participants. i i i TABLE OF CONTENTS Abstract i Table of Contents iii List of Tables v Acknowledgements vi Dedication vii CHAPTER I - INTRODUCTION 1 Background 1 Purpose 1 CHAPTER 2 - REVIEW OF THE LITERATURE 3 Self-help Groups 3 Men's Support Groups 5 Men's Needs 8 Perspectives on Adult Development 9 CHAPTER 3 - METHODOLOGY 13 Method 13 Pilot Interview 14 Participant Recruitment 14 Description of Participants 15 Research Interview 16 Data Analysis 17 Reliability 18 Validity 19 CHAPTER 4 - RESULTS 21 Researcher Expectations 21 Results 21 Table 1 23 Reasons for Joining 24 iv Positive Experiences 28 Negative Experiences 37 Lasting Effects 44 CHAPTER 5 - DISCUSSION 48 Limitations 48 Implications for Theory 48 Implications for Planning Groups 51 Implications for Clinicians 52 Discussion 54 Directions for Future Research 57 References 60 Appendix 1 - Summary of theories in self-help group literature 62 2 - Thesis consent form 65 3 - Range of activities in men's support groups 66 V List of Tables PAGE Table 1. Overview of Results 23 vi Acknowledgements I wish to thank my supervisor, Dr. Marvin Westwood, for guiding me through the thesis process in an enthusiastic and encouraging manner. I would also like to thank the other committee members, Dr. Bill Borgen and Dr. David Kuhl for their kind acquiescence to participate in this endeavour. I would also like to thank those men who participated in this study for contributing their time, energy and support, and for being willing to open themselves up to a relative stranger for the purpose of contributing to the common good. Finally, to my wife Linda, thank you for allowing and helping me to pursue my path while you carried our children and worked to support the family. It's payback time! V Dedication To all the men who continue to make use of men's groups as a means to combat stereotypes rather than adopt new ones. 1 CHAPTER 1 INTRODUCTION Background Men are traditionally seen as reluctant to enter any sort of counselling interaction. However, a 1991 survey of participants in self-help groups in Canada found that 42% were men. The literature also cites a growing involvement in support groups specifically for men resulting from the current wave of interest in the men's movement and men's issues. For example, Promise Keepers is a large Christian men's organization which in 1995 held 13 huge rallies attracting approximately 726,000 men to large stadiums across the United States. In addition to Promise Keepers, in the Vancouver area the Men's Evolvement Network (M.E.N.) has started 100 small groups for men in the past five years. Purpose For counselling psychologists this trend is an indication that important needs are being met in men's groups. The nature of those needs has not been formally investigated. The current literature consists of statements based on the personal experience of the authors, anecdotal evidence and even spousal observations. Therefore, this study addressed the question "what needs of men are met by involvement in a men's support group?" and used the critical incidents interview approach to ask it directly of the participants involved in those groups. Information from this study will be useful for counselling psychologists addressing men's issues in individual sessions; for deciding when referral to men's groups is most appropriate; for focussing the design of therapy and support groups for men; and for structuring continuing education programs designed to be of interest to men. CHAPTER 2 REVIEW OF THE LITERATURE The topics relevant to this study include self-help groups, men's support groups, men's needs and perspectives on adult development. Self-help groups Wong (1978) defines self-help groups as being: "(1) primarily voluntary on the part of its members; (2) organized around the principal theme of mutual self-help toward some mutually agreed upon goals; (3) and usually not engaging any defined professional leadership on a long term basis" (p.46). Further on he relates the paucity of research on the effectiveness of self-help groups, especially as a consciousness-raising medium, and that one of the reasons for this might be the difficulty in defining consciousness-raising. The present study offers a beginning step by grounding the research in the lived experience of participants who feel their needs are being met in men's groups. For an in depth look at the processes which are universally found in groups, please refer to Yalom's (1985) text on group 4 psychotherapy. In her review of research on the Self-Help Movement, Kurtz (1990) gathers supportive evidence for six categories of helping processes responsible for the effects of self-help groups on their members. These processes may be experienced by participants as the means facilitating the satisfaction of a need or as the need itself. The first category, supportive processes, includes acceptance, empathy, affirmation, cohesion within the group, and emotional support. The second, information and education, refers to information-sharing and cognitive instruction processes such as collecting and distributing research findings on a common condition, inviting professionals to impart information, sharing "experiential knowledge", and reframing perceptions of the situation. The third category, identity formation, is particularly relevant to men's groups because a primary aim is the reconstruction of a positive identity given the growing negative perception of masculinity as the cause of many deviant behaviours (Harding, 1992, Sternbach, 1990). The fourth category, affiliation and community, directly addresses feelings of isolation, considered by many to be basic to the 5 experience of being a male socialized in the North American culture. A fifth category, personal transformation, incorporates processes of "feedback, confrontation, insight, interpretation, opportunities for goal setting, and identification with veterans who have made a successful transformation" (p.107). Finally, the category of advocacy and empowerment refers to group activities in public education, policy influence, helping oneself and helping others which lead to feelings of empowerment. Another study of self-help groups (Stewart, 1990) provides a summary of 13 theories invoked in the literature (see appendix), and proposes to add psychoneuroimmunology and social learning theories as valuable perspectives from which to understand group processes. These theories can also be used to generate a list of need-themes and of factors which might help or hinder the satisfaction of those needs. Men's support groups There is agreement on two criteria which characterize this type of self-help group: (1) they are at least for part of their life all male; and (2) their goal is to help men grow by freeing them from 6 the constraints related to the masculine gender role( Guarnaschelli, 1994; Stein, 1983; Sternbach, 1990; Wong, 1978). Stein's (1983) delimitation of six areas of concern for men related to gender role issues and his list of purposes and functions of men's groups are comprehensive and representative of most of the articles I have read. The six areas of concern are: . . . a generalized difficulty and anxiety related to the changing role of women in society, changes in the fathering role, examination of the male role in work and recreation, a wish by men to change affective style, alterations in the nature of adult relationship, and changing patterns of sexual functioning." p.150 He also lists nine purposes which are relevant to this study: (1) to make a statement of non-traditional masculine values by participation in a men's group; (2) to provide an opportunity for men to relate in a setting without women; (3) to demonstrate to participants how they behave with other men; 7 (4) to highlight ways members have related to other significant men in their lives; (5) to provide a setting to explore topics which are frequently difficult for men to talk about; (6) to share men's experiences about special problems for men such as male diseases, divorce, fathering; (7) to alter the nature of adult male-male relationships by promoting caring and friendship; (8) to teach new patterns of relating to women; (9) to increase social and political awareness of men and thus reduce sexism. Another common theme in the work on men's groups is cited in Sternbach's (1990) article. He theorizes that the Seminar leader in his group format provides a corrective fathering experience and the group itself becomes the "good enough mother". Furthermore, the creation and experience of successful safety within the group provides a corrective experience with male peers, healing competition, shaming and bullying often experienced by men as children. 8 Guarnaschelli (1994) elucidates the "shame theory" perspective on unmet childhood needs in his summation of the research on how men's needs are met by support groups. The theory is that when specific developmental needs of children are not met by "important others", shame is internalized and there results a deeply impaired sense of self. The needs he lists include "relationship, touching-holding, identification with, differentiation from, nurture and affirmation" (p.205), all of which are issues raised in one form or another in men's groups. This state of shame is healed, in his view, by the experience of "communal witness", another version of the corrective emotional experience provided by men's groups. Men's needs The third major topic of relevance to this study is men's needs. Little of the research on human adults addresses specifically the needs of men. For example, Maslow's hierarchy of needs, while relevant, has not been studied in direct relation to the context of men in support groups. Sternbach (1990) however, mentions one study (Farrell and Rosenberg,1982) which refers to Erikson's psychosocial developmental needs. That study found that men could 9 be successful on the "outside" but fail to grow in their inner life, more specifically, to attain a capacity for intimacy and generativity. The latter term refers to the need to contribute to the continuation of society through such means as child rearing, caring for others and productive work. Finally, representative of most of my readings on men, a study by Lewis(1978) cited in Reid and Fine's (1992) article on self-disclosure in friendships, found the need to overcome ". . . four barriers to intimacy among males: competition, homophobia, aversion to vulnerability and openness, and a lack of role models." (p.138) Perspectives on adult development This discussion is based on descriptions found in Nemiroff and Colarusso (1981). In beginning this section it is important to note that "the study of adulthood has not yet produced rigorous theories; current perspectives offer interesting but largely untested predictions about the course of adult life (Stevens-Long, 1988)" (Fassinger & Schlossberg, 1992, p.220). Two aspects of Levinson's perspective on adult development, based on a biographical study of 40 men aged 35 to 40, pertain 1 0 directly to the needs of men. First, he states that as the 33 to 40 year old consolidates his identity, he "joins the tribe as a full adult, finding his niche and assuming greater commitment and responsibility in society, raising a family, and exercising his occupation. This includes community, religio-ethnic group and professional activities." (p.41) This type of vision is the foundation upon which Promise Keepers built their mission statement. It involves affirming and supporting men's commitment to God, their church, their families and to society. Secondly, Levinson observes that midlife individuation involves confronting and integrating four pairs of polarities: feelings of youth versus age, of destructiveness versus creativity, of masculinity versus femininity, and of attachment versus separateness. In a second major study described by Colarusso and Nemiroff(1981), Vaillant found support for Erikson's concept that men need to resolve issues of intimacy in their thirties and generativity in their forties. His study, based on data from 268 males followed for forty years, also describes men's internal changes with respect to ego defense mechanisms. In his final 11 summation, he finds that problems of men with poor adjustment to the external world started in childhood with traumatic experiences affecting the establishment of basic trust, autonomy and initiative. These findings support the need for corrective emotional experiences as mentioned earlier in the research on men's groups. In a third major study, also described by Colarusso and Nemiroff(1981), Gould found consistent concerns in four age categories of 520 adult non-patients who answered questionnaires rating various feelings in relation to themselves. In the 35 to 40 year old group, the major concern was complexity and inability to control life and the contradictory internal forces inside oneself. The 40 to 45 year old men needed to resolve issues regarding the existence of evil and death in the world. Men's groups address these issues in various forms outlined by Gould, such as identifying, expressing and integrating emotions; parenting and relationships with one's own parents; getting to know others beyond the surface image; and learning to be less dependent on women, Finally, in the contextualist view of adult development (Steenbarger, 1991), there are several ways in which men's groups 1 2 help participants to meet their needs. One is as a forum to explore and rehearse alternate roles with which to respond to changing societal expectations and conditions. Another is once again the "corrective emotional experience" theme. A third is facilitation of the process of finding ways to achieve a "goodness of fit " between the person and the environment, for example by exposing men to a variety of new ways of framing their personal experiences of manhood. A fourth and final example is by the coconstruction of a fictitious character, a major activity of the mythopoetic groups which explore Jungian archetypes through story, myth and drama. 1 3 CHAPTER 3 METHODOLOGY Method I have chosen to use the critical incident technique for this study. This technique is designed to collect direct observations of incidents that have special significance and which meet systematically defined criteria (Flanagan, 1954). In this approach, "incidents" refers to things which actually happened and were directly observed, and "critical" means they significantly affected the outcome (Woolsey, 1986). These reported experiences are well suited to an exploratory study such as this one because they are more likely to truly and fully represent the perceptions of the participants than succinct answers to a questionnaire. The latter would more likely be filled out in a rapid and superficial manner without really getting to the heart of what occurs for men in support groups. The qualitative approaches have become accepted research methodologies in the field of counselling psychology because the results are more descriptive of the richness and complexity inherent 1 4 in this domain of study and are more relevant to the experiential nature of practice in the field of human relationships. The purpose is not to obtain results which are generalizable to the larger population but which are descriptive and representative of the sample and therefore probably common to other segments of the target population. Pilot Interview As a first step, an audio-taped test interview or pilot study was conducted with one participant, my research supervisor. I then used his feedback and a review of the tape to refine the questions for the actual research interviews, and to improve my ability to help the participants focus on the specific incidents. Participant Recruitment In a qualitative study such as this one, the purpose of the sampling is not to obtain a statistically large enough number to be representative of the population nor to obtain a random and "unbiased" sample per se. The aim is to obtain as full a representation as possible of the range of experiences affecting the outcomes being studied. Woolsey (1986) cites a study by Andersson 1 5 and Nielsson which found this approach valid in representing the content domain to the extent that other means of assessment added no new information. Ten coresearchers were chosen from a list of volunteers obtained through word of mouth referrals. The choice depended on obtaining a variety of participants based on demographics and length of involvement in groups, and representative of as many different groups as possible. The participants were expected to have been in a group for two years or more, have felt that some significant needs had been met through their group involvement, and be able to adequately express their experience verbally. The participants were verbally forewarned at the time of initial contact that the interview would be audio-taped and were given a summary explanation of the focus and method of the study. In addition, at the time of our meeting they were all requested to carefully read and sign a consent form (see appendix 2) which explained the confidential nature of the proposed interview. Description of Participants Of the ten men, one was in the 25 to 35 year old category, 1 6 three were 35 to 45, five were 45 to 55 and one was in the 55 to 65 age range. All except one had a committed partner. All but two had children, and the children ranged from two years old to adult. Nine of the men had been in groups between three and five years and the other for twelve years. There was also a range of career stages including one man newly entering the work force, one in the midst of a career change and a retiree currently doing volunteer work. Five of the men were professionals and two of these were involved in the helping professions. Research Interview The means of data collection was a semi-structured qualitative research interview. It was focussed on eliciting accounts of specific incidents in which the coresearchers felt an increase or a decrease in their motivation to attend the group. The principal questions asked were: 1- What led you to join a men's group? 2- lf you think back over the time you have been involved in men's groups, can you recall and describe particular incidents that occurred within those groups which motivated you to continue 1 7 attending or made it all seem worthwhile? For each incident, please explain what led up to it, what actually happened, and what effects it had afterwards. 3- What were some incidents that detracted from your enjoyment of the group, or which, if they continued, would have led you to leave the group? 4- What were some lasting things you took away from this group experience? In addition to these questions, the interviewer asked whatever questions and made whatever comments were felt would be helpful in eliciting more information and helping focus the discussions without leading the respondent, consistent with an active listening approach. Data Analysis In order to proceed with the analysis, each interview tape was reviewed and the relevant incidents extracted and listed by participant. It was necessary in most cases to reorder the information elicited so that the lead up, event and emotional effects achieved a logical order and coherence. 1 8 The responses were then grouped into clusters corresponding to the four principal questions asked in the interview. The clusters were analyzed as described in Woolsey (1986). First, the frame of reference of this study was the elucidation of needs being met by participation in a men's support group. Therefore, the categories were chosen so as to separate the different kinds of needs being met. Next, the categories were arrived at "...inductively, by sorting the incidents into clusters that seem to group together."(Woolsey). Finally, the level of generality for reporting the results was established in such a way as to maximize the richness and distinctiveness of the categories. Reliability The reliability of the tape analysis was verified by giving two of the tapes to independent raters and comparing the incidents which they extracted to those pulled out by the researcher. One of the raters then placed the information from her tape into the categories formed by the researcher in order to estimate the reliability of the categories. The results of the independent raters' analysis were 1 9 substantially the same as those of the researcher. For the first rater, there was one incident which he had overlooked, and three comments which I had included as the effects of particular incidents and he excluded. The second rater disagreed with my own extraction of elements by only one comment, and the placement in categories differed by only two elements. These disagreements could be accounted for by differences in interpretation of the categories involved. Also, since the disagreements did not qualitatively change the results by requiring the addition or deletion of any of the categories, the process can be said to have produced reliable results. Validity After the tapes were analyzed and the responses categorized, the coresearchers were contacted by telephone and asked to verify that the interpretations and placements of their responses truly reflected what they wanted to say and whether they had any comments to add or delete. The purpose of this step was to verify whether the research method was valid for the purpose intended, which was to determine the needs that these participants felt were met by their involvement in men's support groups. 20 All the men confirmed the accuracy and appropriateness of the reporting and three qualifiers were added to clarify the meaning of possibly ambiguous statements. The critical incidents process used for this study was therefore considered to have been valid for the purpose of eliciting the needs that these men felt were being met by their participation in men's support groups. 21 CHAPTER 4 RESULTS Researcher Expectations In the following paragraph, I describe my expectations, in order to be open about any bias which might affect the interviewing and reporting processes. This step is called "bracketing" in qualitative research methodology. Based on my participation in a men's group for two years, my expectations were that the men would say they needed a structured means of meeting other men for the purpose of friendship and shared activities; that they wanted to get to know other men on a deeper level; and that they needed a forum in which to discuss their changing roles in our society. Results The results will be presented by category following the themes delimited by the four major questions listed in the methodology. 1- What led you to join a men's group? 2- lf you think back over the time you have been involved in 22 men's groups, can you recall and describe particular incidents that occurred within those groups which motivated you to continue attending or made it all seem worthwhile? For each incident, please explain what led up to it, what actually happened, and what effects it had afterwards. 3- What were some incidents that detracted from your enjoyment of the group, or which, if they continued, would have led you to leave the group? 4- What were some lasting things you took away from .this group experience? Each category will be subdivided into the clusters which emerged from analysis of the responses. Each cluster will be described and then illustrated by representative statements from the respondents. Table 1 is an overview of the categories and clusters which will be discussed. 23 Table 1 Overview of Results Reasons for Joining Social Network. Growth Accomplishment Curiosity Fun Positive Group Experiences with Men Negative Experiences None Time Requirements Boredom Lack of Continuity Lack of Honesty/Openness Lack of Commitment Lack of Unconditional Acceptance/ Safety Unmet Friendship Needs Unrealized Political Agenda Emotional Risks Lack of a Leader Positive Experiences Lasting Effects Support Self Challenge Group Personal Growth Community Unmasking Belonging Accomplishment Fun 24 Reasons for Joining The responses to the first question, "What led you to join a men's group?", fell into clusters as follows: social network, growth, accomplishment, curiosity, fun, and positive group experiences with men. The statements made tended to reflect the interaction of specific needs or desires and the presentation of an opportunity for involvement. As a result they were not all strictly descriptions of incidents but rather a mixture of feelings and events which formed the story of their enrollment in a group. Social Network In this study, the term refers mainly to friendships. Some of the men were looking for friends as companions for discussion, activities and projects; others for professional networking; and some to have a community feeling of dropping in on and bumping into each other while out and about. Six of the men specifically mentioned this reason for joining a group. The range went from having no friends and wanting to make some for the first time, through wanting to expand on a small number of existing friends, to having lots of friends but wanting a new type of friendship. 25 e.g. H. had stopped seeing male friends when he "discovered" women and got involved in the world of work. He missed the fun and camaraderie that he had experienced with male friends in his younger days. e.g. D. had avoided making friends with men because of distrust that resulted from abuse experienced as a child. e.g. E. had friends but lost many of them because of the polarization that resulted from his marital breakup. He felt a need for male support and companionship through this difficult time. Growth The next most frequent response centered around learning and growth. The men all referred to personal growth and one respondent also mentioned wanting the group experience to expand his career skills. Personal growth included learning about male roles, discussing men's issues with men, learning about what it means to be a man, continuing previous self-help and counselling work, and exploring social and spiritual issues. e.g. C. sought out a men's group because he had an interest in men's issues and had been reading on the subject for some time. He saw the group as a forum in which to explore his gender roles and 26 saw the group as a forum in which to explore his gender roles and continue the personal growth work he had begun in a 12-step program. He also believed the men's group would be more challenging than the 12-step group. e.g. One of the reasons B. joined a men's group was that he wanted to explore feelings of "strangeness and scariness" and the biases that these reflected, which had come up for him in a previous experience at an all male workshop. Accomplishment One person described his expectation that the group would be a way of getting together as men and "accomplishing something" rather than just going out drinking. For others, this was expressed as having a political agenda. This expression was used to refer to a desire to either change men, or change society's image of men, by working with the group to do positive things in the larger community. e.g. B. described having a political agenda around men's bad reputation. He said he wanted to see men change or see them sell themselves differently so as to change that reputation. Curiosity Three of the respondents listed curiosity as a 27 motivating factor. They referred either to specific areas of being with men or to a general curiosity about the experience of being in a men's group. e.g. A. mentioned both a general curiosity and a specific interest in discovering what were good things about men because the majority of his friends were feminists and had mostly negative comments about the male gender. e.g B. spoke of his curiosity about how dialogue in a group comprised only of men would differ from other conversations he had been in. Fun Two men wanted to have more fun in their lives. e.g. K. relished the experience he had of going to a drop-in group and having "wild, crazy fun" drumming. He liked "really getting into it, getting all hot and sweaty". Positive Group Experiences with Men Three of the men described positive feelings resulting from attendance at all male retreats or workshops prior to joining a group, and two described the first meeting of their new groups as an important reason they decided to come back. 28 e.g. H. had been to a weekend workshop with an inspirational leader who taught them many things including concepts of what a man could be, the importance of working together as men in the community, and provided both an organizational structure and process information to support the establishment of ongoing men's groups. e.g. A. was profoundly affected by the emotional honesty and intensity of the participation in the first meeting he attended with a group of eight other first-timers. He felt that a "bubble" effect was immediately established, ". . .an environment where it was o.k. to talk about certain kinds of things, that was more personal, and where you could risk new behaviours." Positive Experiences The question asked was: If you think back over the time you have been involved in men's groups, can you recall and describe particular incidents that occurred within those groups which motivated you to continue attending or made it all seem worthwhile? For each incident, please explain what led up 29 to it, what actually happened, and what effects it had afterwards. When surveying the large number of positive incidents the men reported, the first category that emerged clearly was support. The next category, challenge, reflected the participants' observations that their group process was a constant quest for the right balance of support and challenge. When the balance was off, the result was either boredom or lack of safety. When the balance was appropriate, the results were the positive effects that kept them coming back: personal growth, unmasking, and belonging. In addition there were two categories which I called "projects" and "fun". Support The following processes contributed significantly to the experience of support: validation, normalization, acceptance, being heard, trust, safety, commitment and structure. e.g. D. felt good about not having to work on people's cars to be a part of the group. "I could just be me and be accepted." e.g. K. explained that it was more meaningful ". . . to hold your own in a group of equals. It's more personal than a therapy group." e.g. G. felt it was important to him that when he wanted to 30 work on negative aspects of himself, he received understanding rather than condemnation. He didn't expect that kind of tolerance in a mixed group. He also valued the times he could "share the mysteries" with his group. He likened it to "show and tell" with the guys. e.g. F. told of how he had been able to bring to the group his issues with the death of his dad at a young age. He was able to bounce ideas and feelings off of them and felt heard, validated, and that they had feelings in common. He said the issue came up as a result of one of the topics in their group plan - "death". He felt the structure and plan they followed helped maintain a sense of growth and challenge. e.g. E. was able to share with the group his difficulties as he was going through divorce. He said "I got a lot of feelings off my chest. It legitimized my emotions. . . .It gave me perspective. . . .It was really validating." e.g. C. conceptualized the process as "building a safe container where I can experiment with how do I 'be' with other men and ultimately other people." 31 Challenge This cluster included such experiences as being involved in or witnessing intense conflict within the group; having to face issues and men one normally would avoid; receiving and giving feedback; being held accountable; and working through issues, feelings and problems that carry over from events outside the group. e.g. H. related two incidents in which the group pressed him to go a little further. The first was to try golf, a game he felt was useless and expensive. It turned out that it was both of these and he enjoyed it anyway. The second was when they threatened to beat him up if he didn't get his income tax done by a certain day (he was five years behind). Fortunately, they also offered to help and suggested that H. & R. Block might be a practical solution. He had never thought of that. e.g. In F.'s group, there had been an incident where one member pressed another for more commitment, and when he refused he told him to leave, and he did. The group then discussed it and the man came back. It made them stronger as a group and moved them closer in a way, he says, but it was a tough period of time. e.g. A. described an experience in which he took a risk and told 32 another member in a careful way about things he disliked about his behaviour and his discomfort with hugging him. The other member processed that feedback about what his behaviour seemed to be showing and realized he wasn't being congruent - he really didn't want to be in the group and left. It was a positive experience for both in the end. Personal Growth The personal growth descriptions involved incidents where participants were learning more about themselves; developing a sense of self; developing their roles, especially as males; learning new skills, new ideas, new perspectives; and clarifying their beliefs and preferences. e.g. One of the men described this process as accumulating experiences through interactions with, and modelling from, other men in the group over four years. For instance, it was a new thing for him to stand up for himself in the group and say "No, this is not what I want, it's not who I am" directly to another man he was having a disagreement with. These interactions gave him a "sense of choice", the ability to let go of the patterns set up in his family of origin. 33 e.g. A. described how in their group culture, there was permission for a man to "flag" his own or someone else's troubled feelings and the group would quickly decide whether or not to allow space for it to be worked through in whatever way and for whatever length of time it took. On one occasion, some very powerful emotions came up for him while in the group so he asked for nonverbal support and ". . .the men helped with soothing noises or touch or whatever. . . That was really, really amazing." e.g. Appreciation for the new perspectives acquired as a result of hearing about each other's lives came up frequently in these interviews. This is E.'s description of how it affected him to hear other men share really important feelings and problems during the group check-in: "When you've looked into the abyss, it kind of gives you more strength to deal with day to day concerns, it gives you more perspective. It gives you a strength to really share in their problems." e.g. The following excerpts will illustrate how one man experienced growth through going to sweat lodges with his group. One group member was willing to teach us about the meaning 34 and rituals of the sweat lodge. . . . It gave us a chance to leave our packaged identities outside. . . . Like the difference between saying you're happy and being happy. I had the chance to experience as experience (I lived my regular life in thought). . . . I felt cleansed; I had a sense of clarity, calmness, and confidence: the way a shirt comes back from the dry cleaners. It was still me, but I felt better about being me. Unmasking "Men are people too!" sums up the meaning of what happens when group members open up. The process of seeing deeper into others, getting behind the masks and images, was highly valued. It helped men feel trusted, privileged, closer to each other, and was an important means of altering stereotypes and fostering increased self-acceptance and acceptance of others. e.g. B. stated that it felt "radical" to see men talking, caring, and nurturing. "It blows my expectations, to do that with men." He observed that the resulting personal growth from the issue resolved might be the same as with a mixed group, but that it.felt exceptional because it was with men's support that it was accomplished. e.g. E. felt privileged to be able to see "the problems which 35 men have, how sad they are and how vulnerable they are, how fragile is this life we weave. . . To see men cry and hear their problems." e.g. C. told the story of having to sit in a drop-in group with men that he disagreed with and normally would not have listened to. It enabled him to look at his reactions and examine what was giving him these prejudices. It was "challenging around his beliefs." In the long run, it made him more understanding of their positions, even if he couldn't agree with them. Belonging In this cluster, men spoke of ongoing friendships, a place of community ("like a small town"), shared history, and bonding. e.g. A. told of how they shared a lot of their lives in and out of the group. With one member in particular he felt that ". . .it was like I was a part of his family. When he had to move, my partner and I went in and basically packed his house. Another time we took care of his daughter for a week." e.g. E. related how the sense of a shared history was very meaningful to him because it helped him remain connected to the group during a period when he was experiencing hard times and 36 withdrawing from most other people as a result. e.g. J. said that when they got together to do fundraisers it helped him to feel bonded to the group. Accomplishment Two of the groups got involved in projects because community involvement was part of their fundamental structure. In another group, a particular member took the initiative and asked for help in putting together a benefit concert and was able to get physical and emotional support from his group members. e.g. In addition to the bonding mentioned above, J. found fundraisers "very satisfying" and helped him feel more involved in the church. e.g. H. : "When you went out into the world as a powerful group of men, at least at the end of the day you had something tangible to show for it. It met my criteria as a warrior in the world trying to do good. . . .and it impressed the women. My wife was proud to tell her family and friends what we were doing and they were impressed." Fun This theme was nearly universal in the interviews. It resulted from planned fun nights, special event nights, group 37 retreats and outings. e.g. F. felt that the fun week activities really cemented the relationships. e.g. K.'s observation was that trying out new activities was socially fun. It was relaxing and easy to be joking and kidding and not having to think about anything in particular. e.g. B. felt that the fun involved ". . .goof ball stuff or even just picnics, hikes, collages and play activities. At first, it came up spontaneously and then we started planning it in, after we realized the importance of it." He described the effects as feeling a sense of connection and of hope: hope that life isn't all work and hard struggle; connection to childlike innocence, hope, spontaneity and gentleness. Negative Experiences "What were some incidents that detracted from your enjoyment of the group? ". This question was meant to elicit experiences and incidents which were drawbacks, which detracted from the enjoyment of the group, or which would lead the respondent to leave the group if they were not corrected. 38 Except for the first two categories, the responses to this question described deficiencies in the processes put forth in the positive experiences listed above. Boredom resulted from deficiencies in the fun and challenge components of the group. An insufficient amount of support could result in lack of continuity, of honesty and openness, of commitment, of unconditional acceptance and safety, and in feeling too much emotional risk. The need for a leader arose from the perception that expertise and experience would have been helpful in correcting deficiencies in support and challenge. Unmet friendship needs reflected a deficit in one aspect of belonging, and unrealized political agenda was related to the accomplishment needs. None One man answered that he could not really think of anything negative about his group experience. Time Requirements Three of the participants talked about the cost in time away from other pursuits such as family and leisure. e.g. G. explained that in his group they took turns being the organizer. That role entailed a lot of phoning around to set up meetings, planning who was hosting, scheduling topics, researching 39 resource materials or guests if needed, and preparing a presentation to the group if there was a topic they wanted to explore more deeply. He was feeling somewhat guilty about not being able to devote as much time as needed to do a really good job and had noticed others having similar problems with it. e.g. For E. , it was clearly a cost-benefit ratio: "One evening a week is a lot of time to commit if the group is not rewarding." Boredom This was the most frequently mentioned problem. It ranged from short spells with a lack of freshness to chronic feelings which led to people leaving the group. e.g. "When our group checks in, sometimes men get into talking about work problems and that is not particularly a men's issue. That's when I have noticed myself actually nodding off" stated E. e.g. D. related feelings of boredom to a decrease in the group's level of activity. They were reluctant to seek new activities or revisit old ones. Lack of Continuity Another common problem in groups was the coming and going of members. When people left, the feelings ranged 40 from relief, if the member had been problematic, to a sense of loss, grief and self-evaluation of the group, if he was a valued longstanding member. When a new member joined, there was a feeling of losing "momentum" as he learned the group's culture, and awkwardness as they attempted to deal with his not being a part of the shared history of the group. e.g. E. remembered how the loss of one particularly strong member resulted in a significant decrease of emotion and drive within the group. The meetings became too comfortable and generally not challenging and stimulating enough. e.g. In B.'s group, there was a noticeable decrease in vitality as the membership dwindled to less than half of what it had been at the start. This created an ongoing concern with the future of the group. Lack of Honesty/Openness This area of frustration referred to men's perceptions of themselves or others as not being open about their genuine feelings, problems, and concerns. It was described variously as "play acting", "not being gutsy", not being "real", and "putting on an image". It usually resulted in feelings of lack of trust and connection with other men. 41 e.g. D. felt a lack of genuine connectedness when ". . .after two years, even the simple dislikes are not being honestly communicated." Lack of Commitment Four of the respondents commented on perceptions that others were placing less importance on attendance at group meetings or special events than previously. e.g. D. : "You kind of wonder about a guy's commitment when he signs up for a course on group night that is available on another night as well. . Do you really want to share intimate details of your life with somebody who may or may not be there next week and who may or may not even be interested." e.g. When A. noticed that the annual road trip marking the anniversary of the group's beginning wasn't getting the response it had in the past, he felt it was "ominous". Lack of Unconditional Acceptance/ Safety This cluster varied from a vague feeling that you always had to think twice before sharing something truly personal, to a clear perception that the group was too confrontational. e.g. F. had been in a group where one man was very intolerant. 42 He was not subtle about it and seemed oblivious to its effect on the group. No one knew how to deal with it and the group finally disbanded. e.g. E. states that when he first joined the group, there was way too much confrontation and he was quite taken aback. The particular incident which illustrated this occurred when two members disagreed on something and one then challenged the other to don the boxing gloves and have it out. He thought "If this is what the group is about, then it's not for me!" Unmet Friendship Needs This set of responses relates to the inability of the five respondents who cited it to extend their in-group relationships to satisfying out-of-group friendships. Given that friendship needs were a common and important reason for men to join groups, it was experienced as a significant disappointment and ongoing frustration. e.g. H. still hurts over the way he was treated: "When I withdrew (from the group) they really turned their backs on me. I went from very involved to very alone." e.g. B reported his discovery of "limits" in relationships with 43 men, i.e. that they had been unable to establish solid, ongoing friendships outside the group meetings. He hypothesized that it was because the group structure was safer. Unrealized Political Agenda Two of the men expressed frustration that discussions about being involved in the larger community as a group never came to a successful conclusion. Emotional Risks This response came from a man who had committed himself deeply to men's groups. His own words will illustrate the meaning. e.g. ". . . Caring about others complicates your life. . . . You invest time and effort and it can all dissolve really fast. . . .I've had experiences where others have taken advantage of the friendship, monetarily for example. There are crooks out there, people who are dishonest." Lack of a Leader Five of the men focussed on the lack of a leader as a problem for them in the group. They believed that an experienced and knowledgeable leader, or at least a group member with significant experience, would have helped tremendously in several ways: dealing with conflict; providing a plan and structure; 44 dealing with problematic members; modelling congruence, risk-taking and group skills; focussing; creating safety; fostering connection. e.g. D. phrased it this way: "Because we had no leader, we had no goals and so we floundered. We needed someone who knew how to foster connection and provide organization and focus in the group." e.g. E. recalled that one member would lead the group occasionally in ". . . spectacular evenings of drumming, chanting, mysticism, music, meditation. . . . We had no replacement for that. So that element was missing." Lasting Effects What were some lasting things you took away from this group experience? This question was meant to elicit thoughts, behaviours and feelings which had changed due specifically to their men's group experience. One man remarked on the difficulty of being certain of the attribution because he was also involved on a continuing basis in other self-help and personal growth activities and was constantly changing as a result of normal life events such as finding a new 45 partner, having a child and developing career options. The style of these responses varied depending on whether or not the person was still with the group he was speaking about. When the respondent was still attending the group, the answer was more of a summary or overview of the responses to the positive experiences question. If not still attending, the participant could more easily separate his present experience from the ongoing effects of being in the group. In either case, the responses did not add much to what was described above except for a few of the spillover effects into other relationships. The responses to this question could be divided into changes in the relationship to self, to the group, and to the larger community. Self This cluster included references to increased self confidence (e.g. knowing how to be one of the guys); increased acceptance of self, of the male gender and of self as a male; increased ability to identify and assert feelings and let go of others' feelings; sense of pride and accomplishment. One man eloquently summed it up this way: It adds a dimension to your life. I mean you're very conscious of being a man, of being worthwhile, of being validated; of not just dwelling in your problems but being able to rise above them and get that sense that you're dealing with them, that you've got them in perspective; that you're being supported, that you can share your crap a little bit. That's really worthwhile. Group The comments in this category expressed feelings of acceptance and belonging, and in some cases reflected a sense of shared struggle over a period of time. e.g. "A forum to talk about myself." e.g. "A tribe." A sense of community that is enduring whether you like them or not. You know their kids, you know the high and low points of their lives. Like a family . . . like being in a little town-knowing where my home is. e.g. A sense of attachment, "a fondness for those guys." Community Changes in relationships with the larger community resulted from new skills learned in the group, changed perceptions of others especially of men, and group activities for the benefit of others. New skills included conflict resolution, clearer 47 verbalizations of feelings, and better organizational skills in setting up socials and other events. New perceptions listed were seeing the commonalities in men, their sadness, their vulnerability, their neediness, that they could feel and could care; feeling a sense of connectedness, a member of the pack. e.g. H. noticed that he was able to take the things he learned in the group into his relationships with all men. He found his relationships with coworkers much more enjoyable, he opened up communication with his father, and he felt much freer in casual situations to go over and hang out with a guy (before it had been 100% women). 48 CHAPTER 5 DISCUSSION Limitations The first limitation of this study is that the respondents were all Caucasian males between the ages of 25 and 65. Therefore, these results would not be representative of younger or older men, nor of racial minorities. A second limitation is the small number of men (10) and groups (5) which were represented. There is an incredible variety of men's groups and each one has its own chemistry depending on the personalities of the participants, the shared history, and the context of that particular group. In this study, it was fascinating to note some strong commonalities in spite of the variety of ages, length of time in groups and types of groups attended. The third constraint is that since the groups were specifically men's support groups, the needs found here would not necessarily apply to mixed groups, therapy groups, self-help groups, nor to men's groups with specific themes or agendas. Implications for theory When comparing the results of this study to the theoretical 4 9 expectations listed in the literature review, the most consistent discrepancies were the absence of the categories of fun, accomplishment, and the need for a balance of support and challenge. In addition, the men's responses did not confirm specific elements from several of the theories. In reference to Stein's list of concerns, the men did not mention any issues with changing patterns of sexual functioning. They also failed to confirm the purpose of "making a statement of non-traditional values by joining a men's group". Since none of the groups used a permanent leader, Sternbach's "corrective fathering experience" could not be addressed. Finally, these results confirmed the needs listed by Guarnaschelli except for "touching-holding". The latter experience occurred but was part of a larger experience of nurturance and support and not a separate need as such. In relation to the broader category of men's needs, these results confirm Maslow's categories of needs but do not suggest any consistent hierarchy of these categories. It was not inherent in the design of this study to elicit information relevant to that kind of prioritization. Both of Erikson's categories of intimacy and 50 generativity were described as important needs. The need for generativity was evidenced by the statements referring to needs for accomplishment and giving and receiving of support. The last study relevant to this section mentions four barriers to self-disclosure in friendships. Only the lack of role models could be confirmed from the results of this study. The barriers of competition, homophobia, and aversion to vulnerability and openness did not appear in any of the incidents described. Focussing now on the adult developmental perspectives, Levinson's polarities of masculinity versus femininity and attachment versus separateness are mirrored in the concerns around male role clarification and expansion and in the issues of belonging and interdependence versus independence or dependence. The first two polarities, youth versus age and destructiveness versus creativity, are less clearly related to any of the responses generated in this study though they may occasionally come up as topics in men's group meetings. Finally, the first three processes described by Steenbarger were clearly evident in the men's responses. The fourth, coconstruction of a fictitious character, is more specifically 51 the domain of mythopoetic groups which was not the focus of any of the groups represented in this study. Implications for planning groups Based on the results described above, it would seem that groups for men are more satisfying the more they incorporate opportunities for action-based learning and initiating friendships, and the clearer they are about structure, goals, and signposts of progress. Challenge fires men up if they have the support to face it. Promise Keepers and Sterling groups for example, are organizations which already use many of these elements. They have a clear purpose, goals, and structured support groups for promoting community. They also have a mission to reach out to other men, and to work at benefitting the communities around them, for example by getting involved in completing projects such as school renovations and fundraising events. I believe their technologies could be used to set up groups whose agenda focussed more specifically on promoting men's overall development rather than the organization's needs. I think it would be of tremendous benefit to men and to society if more groups were organized around these principles of supporting 52 male development and intimacy in a fashion that meets the needs of men . This study has shown the types of needs that must be kept in mind: a balance of support and challenge, lots of active exercises, exposure to new activities, a sense of continuity and commitment, competent leadership, and topics focussed on issues of importance to male development and role definition. The present focus of most groups is the creation of a safe atmosphere for men because of their notoriety as loners who are non-communicative. These results and my own experience demonstrate the passion and openness of men when they are in an atmosphere that challenges them and gives them the modelling of responses that suit their communication style. Many men prefer experiential means of dealing with feelings once they have experienced or witnessed them in action. More of these should be used and demonstrated in the context of men's groups. Implications for clinicians These results suggest several ways men's groups could be useful resources to clinicians. In the medical health field, with the increasing concern for providing emotional support and stress release for beleaguered patient's (and doctors), these respondents 53 clearly present a powerful case for the ability of men's support groups to meet these needs. The groups provide support in many forms and offer a pool of individuals from diverse backgrounds as resources for generating alternative coping strategies. The fun and relaxation activities that are a regular component of many groups are a scheduled form of self care for many overcommitted men. The simple feeling that it is something done "just for me" can be tremendously helpful and nurturing. For mental health professionals, these groups offer the opportunity for clients to be heard and understood on topics ranging from difficulties with communication, relationships, identifying and expressing feelings, coping with feelings of isolation and meaninglessness, as well as a venue in which to share those events of particular relevance to a man's sense of enjoyment of life. They also meet needs for role models in areas of stagnation and the chance to be a role model to others. They are an effective antidote to the pervasive sense of isolation generated by our highly mobile society which encourages hands-off communication through all the modern high tech toys at the expense of hands-on experiences of 54 support, caring, nurturance and person to person connection. I believe that if potential participants are provided the evidence that regular guys just like them are experiencing the kinds of satisfaction described here, the attractiveness of these groups would be greatly enhanced. Discussion "What keeps men coming back?" Many of the same things that keep people coming back to self-help and therapy groups. The differences are that for men in support groups, it is important to also have fun, accomplish something, and feel sufficient challenge and support to stimulate their growth. Another important point is that the needs for belonging and for a social network, bring men to groups, help them feel satisfied with them, and impart significant lasting benefits afterwards when satisfied. This aspect of the findings confirms the cultural view that men feel isolated and lonely, but not that they are loners, uncaring and unwilling to engage in deeper relationships. It signals the need to provide structures which facilitate men making connections with other men and perhaps explains the longstanding popularity of the ubiquitous clubs 55 of various kinds to which men adhere. Men's groups meet the needs for those types of facilitative structures. They promote both self development and community involvement. They do a lot more than run off into the woods chanting, drumming and pretending to be savages. They help men grow and learn to be intimate. They give men support and resources (physical, emotional and experiential) with which to be creative in their lives and develop new ways of being. They encourage men to be responsible for themselves, their lives, and their families. They also help heal the wounds of early experiences at the hands of men and demonstrate new possibilities for relationship. Finally, they assist men in expanding their definition of manhood and provide a forum for them to practice being genuine, congruent and connected to themselves, to other men and ultimately to society. These are the ultimate macho men. The ones who feel supported in their desire to be genuine, including their ability to nurture in a masculine way, and feel challenged to face the responsibilities of life and grow beyond the constraints of background traumas, societal stereotypes, and personal limitations. 56 The stories I have been told by these men confirm that at their best, men's groups stimulate many positive changes in the participants. There is an increase in clarity about what they feel, about what they want, about how they want to respond to the demands of living in today's rapidly changing society. They have the opportunity to clarify their values and feel supported in them in the face of the many pressures to take shortcuts and be competitive at the expense of self and family. From the support and challenge they get in these groups, men develop a sense of confidence to make life-changing decisions that reflect their true values. For example, one man decided to finally switch careers after 15 years in the same profession. For a man to experience his own and other men's nurturing validates his way of caring and fosters a greater commitment to participation in his family's home life. The opportunity to be heard on topics of work and relationship promotes a sense of interdependence with others. For some, this may be the first time they have had the opportunity to develop new ways of relating to other men in a safe environment. This results in better relationships with male coworkers, friends and family members. 57 Their partners also benefit from these improvements in relationship skills. The man is no longer dependent on his wife as the only outlet for his frustrations and worries, so she does not have to continuously bear the brunt of his negative experiences, neither as the only support nor as the scapegoat. He learns to open up the softer sides of his personality and to access support to deal with his fears and weaknesses in healthier ways. Directions for future research It would be useful to duplicate this study with groups consisting of younger men, seniors, women and mixed clients and compare their needs to those found for these men. In addition, it would be helpful to perform outcome studies on these groups to determine more specifically what changes occurred and attempt to isolate which factors were most effective for promoting different kinds of change in men. Further studies could examine whether groups focussed more narrowly on specific needs are more effective; whether there is a sequence in which the needs are met, for example the needs met in two year, four year and longer groups; and finally it would be interesting to determine whether, as 58 one participant envisioned, there comes a time in the evolution of men's groups when the need was felt to open a dialogue with women's groups for the purpose of healing those relationships. Given the profound changes in these men's relationship skills, I would like to see more studies of the spillover effects in work, leisure, and intimate relationships. Outcome studies eliciting feedback from those affected by the changes in these participants might be valuable in confirming the subjective impressions of improvement reported by some of the men in this study. It would be useful to know how these outcomes compare to those from public education courses so as to make better use of the funding aimed at improving family life. Other studies could profitably examine whether similar processes operate in all-male therapy groups, public education groups or classes, and sports organizations. Looking at how men's groups could benefit the next generation, it would seem useful to study the use of groups in which older men mix with younger adults or even teens to create an atmosphere of mutual respect and modelling of healthy role development. It has 59 become apparent that many of today's problem youth come from broken families and single parent households. They could benefit tremendously from the intense support and growth-promoting challenge generated in all male groups, especially if these groups are set up by trained facilitators. At the other end of the spectrum, it would be useful to look into the benefits of men's groups for seniors and mixed generation groups. Many older men experience numerous losses due to the deaths of those close to them, the end of long term work friendships after retirement, and decreased health and mobility. These groups could provide the ongoing sense of community needed to reduce feelings of isolation and to help deal with the grieving. They could also help create a forum for sharing varied experiences thus increasing feelings of worth through what is contributed to peers and to younger generations. 60 References Colarusso, C. A., & Nemiroff, R. A. (1981). Contemporary adult developmentalists. In Adult development: A new dimension in psychodynamic theory. New York: Plenum. Fassinger, R. E., & Schlossberg, N. K. (1992). In S. Brown & R. Lent, (Eds.) Handbook of Counselling Psychology (2nd ed.). New York: John Wiley & Sons. Flanagan, J. C. (1954). The critical incident technique. Psychological Bulletin. 5J_ (4) 327-358. Guarnaschelli, J. S. (1994). Men's support groups and the men's movement: Their role for men and for women. Group. 18(4) 197-211. Harding, C. (1992). What's all this about a men's movement? In C. Harding (Ed.), Wingspan: Inside the Men's Movement (pp. xi xxii). New York: St.Martin's. Kurtz, L. F. (1990). The self-help movement: review of the past decade of research. Social Work with Groups. 13(3) 101-115. Promise Keepers (1996). Break down the walls: Men's conferences [Special Issue]. Promise Keepers: Men of action . Reid, H. M., & Fine, G. A. (1992). Self-disclosure in men's friendships. In P. M. Nardi (ed.) Men's Friendships. Newbury Park, G.B.: Sage. Steenbarger, B. N. (1991). All the world is not a stage: Emerging contextualist themes in counselling and development. Journal of Counselling and Development. 70 288-296. Stein, T. S. (1983). An overview of men's groups. Social Work with 61 Groups.6^3-4) 149-161. Sternbach, J. (1990). The Men's Seminar: An educational and support group for men. Social Work with Groups. 13(2) 23-39. Stewart, M. J. (1990). Expanding theoretical conceptualizations of self-help groups. Social Science and Medicine. 31(9) 1057-1066. Wong, M. R. (1978). Males in transition and the self-help group. The Counselling Psychologist. 7(4) 46-50. Woolsey, L. K. (1986). The critical incident technique: An innovative qualitative method of research. Canadian Journal of Counselling. 20.(4) 242-254. Yalom, I.D. (1985). Theory and practice of group psychotherapy. (3rd ed.). 3-18. NY: Basic Books. 62 Appendix 1 Summary of theories in self-help group (SHG) literature Theory AFFILIATION (Stewart,1990) Elements relevant to self-help/mutual aid groups Affiliation in SHG occurs through creation of new prosocial attachments; SHG meet needs for affiliation and offer opportunity to express feelings. ATTRIBUTION SHG members overcome victim self-blame through a process of situational rather than personal CHANGE COPING attribution regarding the cause of the problems. Some SHG encourage subsystem or member change, while others advocate social or suprasystem change. SHG are vehicles for coping with longterm deficits and life cycle transitions. A range of coping models is available. Levy identified behaviorally oriented processes and nine cognitively oriented processes. 63 Theory Elements relevant to self-help/mutual aid groups DEVIANCE SHG alleviate stigmatized feelings, provide a supportive community for the sharing of a stigmatized attribute, or perceive problems differently than society. EMPOWERMENT Help obtained from joining with others with similar problems creates a sense of control, not EQUITY /SOCIAL EXCHANGE GROUP IDEOLOGY dependency, and'movement towards advocacy. The active promotion of equity and reciprocity in help giving and receiving is a crucial element in SHG. SHG share the properties of small groups, including natural phasic tensions, tasks, growth, and leadership. Fixed communities of belief, sharing of experience plays a central role; members offer advice and thereby indoctrinate themselves. Uniformity increases mutual identification and persuasiveness; cognitizes behavior and change 64 Theory LONELINESS Elements relevant to self-help/mutual aid groups mechanisms. Change in SHG can be best understood as value, belief or ideology transformation. SHG offer compensatory social ties through counteracting feelings of loneliness; SHG for social losses enhance coping with loneliness. SELF-ESTEEM Significant relationships created through SHG promote positive reflected appraisals and hence enhance self-esteem. SOCIAL COMPARISON SOCIAL MOVEMENT SHG members increase their well-being through downward comparison with the less fortunate to enhance self-esteem and upward comparison with effective coping models in the reference group. The self-help movement satisfies some social movement criteria; networks of groups, ideology, opposition from society (real or perceived), sense of common purpose, need for both individual and social change, empowerment. 66 Appendix 3 Range of Activities in Men's Support Groups Regular Meetings Check-ins and check-outs Topics ( men's issues) Therapeutic exercises (experiential, art, body work, etc.) Guest leaders/ presenters Special event nights (drumming, ritual, mysticism) Fun Night Sports, poker, hikes, videos, . . . Social Activities Pot luck dinners, picnics, family outings, movies, plays, . . . Community Action Blood donations, work parties for members or for others, fund raisers for community causes, . . . Retreats, seminars, workshops Focussed on men's issues or on development of group skills. Get Aways Sweat lodges, camping, road trips to the sea or mountains. 

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