SUPPORT GROUP GUIDELINES

Last month’s webinar outlined the Code of Ethics for Abortion Healing Providers with four principles stemming from our core values using the acronym H.O.P.E. – Healing, Ownership, Purpose, and Excellence.

The second item under Purpose is to use best practices when conducting a group; for instance, employing proper participant screening tools and guidelines for support groups.

In today’s webinar, we explore the best practice Group Guidelines that Support After Abortion uses for its virtual support groups and offer them as a starting point for abortion healing providers to discern what guidelines would be most effective for their own groups. These guidelines are designed for structured support groups, although many (other than those dealing with attendance) may be useful for drop-in groups, as well.

Support After Abortion CEO and licensed mental health therapist Lisa Rowe led the discussion with Karin Barbito, Special Projects Manager, and Heidi Inlow, Case Manager.

WHY ARE SUPPORT GROUP GUIDELINES IMPORTANT?

Group Guidelines are essential to create safety, structure, and consistency for clients. Guidelines that are communicated well and implemented consistently enhance group dynamics by helping to create a safe environment for all participants to share openly, honestly, and vulnerably.

Guidelines are also an important tool for facilitators. When the conversation “goes off-topic or gets into rescuing,” Heidi shared, “I can say, I think we’ve stepped into rescuing, let’s see how we’ve gone off track.” and pivot the discussion back to safe ground.

Guidelines “help with the structure and structure allows security,” one of the webinar attendees said in the chat.

“We’re asking people to really dig into some traumatic stuff. [Support groups] let people know that they’re not alone,” Karin said. “It helps us to get outside of ourselves and show compassion and empathy for others who have gone through a similar situation. So being able to openly share vulnerably, transparently, and honestly, is key to the success of a group.”

Without group guidelines in place, Karin cautioned that clients may shut down and not participate. Heidi explained that if you don’t have guidelines and negative behavior is allowed, participants won’t feel safe and facilitators can become resentful.

HOW SHOULD FACILITATORS COMMUNICATE GUIDELINES TO THE GROUP?

Heidi advised providers to explain their Group Guidelines early in the first group session and then to briefly remind participants at the start of each subsequent session.

Lisa shared that when she presents the guidelines in the first meeting, she has participants take turns reading them. Then she explains and gives examples after each one.

HOW DID THESE UPDATED GROUP GUIDELINES EVOLVE?

“We don’t ever want to remain stagnant, just doing things the way we’ve always done them,” Lisa said. She encouraged providers to regularly (at least annually) review their guidelines for the best interests of clients and facilitators. Some questions she offered for reflecting on each guideline: Is it accurate? Is it necessary? What have we learned throughout the year? What are our clients and facilitators telling us?

“Two important changes in the abortion landscape,” Karin said, “drove our recent need to reevaluate our guidelines.” The rise in medication abortion has seen more clients reaching out for help mere days or weeks after their abortion experiences instead of years or decades as in the past. They’re also commonly in a different place emotionally. They often describe themselves as traumatized because of what they experienced and/or saw during the process of administering their own abortion. The other change is the effect of abortion restrictions and bans in some states. Both clients and facilitators have shared their concern over being identified due to their fear of prosecution. This led to an internal discussion of the need to revise our previous guideline requiring all virtual participants to have their video on. This new development is an extension of our desire to offer anonymous options for the majority of both women and men who our research shows want anonymity when reaching out for help, and we want to respect that need.

As part of Support After Abortion’s review process, “We leaned on our volunteer facilitators for feedback,” Heidi said, “It’s important to listen to the people doing groups.”

Karin explained that many of the old guidelines were worded negatively – don’t do this, no to that. She explained that they were revamped so that the expectations are stated in a positive way.

WHAT ARE BEST PRACTICE SUPPORT GROUP GUIDELINES?

Support After Abortion’s Group Guidelines cover three areas: confidentiality, boundaries, and commitment to your own healing and to the group.

MAINTAIN CONFIDENTIALITY

It is essential that we create and maintain a safe space for group members to share personal thoughts, experiences, and opinions. What is said in the group, stays in the group. This includes not repeating what was said in group or talking about members in places where others may overhear.
For virtual groups, facilitators will explain the confidentiality protections the group will follow. These may include keeping Zoom video on and audio connected, using headphones to ensure audio is only heard by participants, and not recording group sessions. There may be options for participants who want anonymity.

Lisa shared how she might explain confidentiality guidelines with an in-person group: “If you see someone from the group in the mall, you wouldn’t point them out to your friends and say that person is in my support group. Or, She’s experienced abortion three times. That would be a breach of confidentiality.”

Lisa also said she looks to the makeup of the group to decide how to explain a guideline. For example, if the group has mainly young 20-somethings who commonly make calls while driving, she might say something like, Participants will share their most private thoughts and experiences, so you need to be in a private, safe place where no one can overhear and where you can give your full attention to your fellow group members.

Heidi also suggested that providers be willing to bend. For example, if they have an expectation that all virtual participants have their video on, but someone really wants to attend, yet is afraid of repercussions due to their state laws, then consider what accommodations you can make.

RESPECT BOUNDARIES

Actively listen to what others say. Speak with compassion and without judgment.
Allow space for others to speak. This includes letting one person speak at a time, holding silence to give a speaker time to think and share, not interrupting, and allowing everyone to have a turn to share.
Support others without trying to “fix.” This includes not giving advice and not rescuing (like giving a tissue or hug, supplying an answer for someone, etc.). These can interfere with their healing process.
When sharing your opinion, refrain from trying to persuade others to agree with your opinion. Differences of opinion are welcome and respected.
Keep your sharing focused on your own thoughts and feelings. Use “I” or “me” statements.
Do not discuss members who are absent.

The most important thing, Karin said, is to “create an environment conducive to healing.” She shared that a “facilitator’s job is to help draw out what a participant is saying.” In order to do that, she said it’s important to “check our judgment or agenda – leave those at the door, so we can lead with compassion.”

Lisa spoke about how people often listen while thinking about how they’ll respond, but active listening is different. She suggested that participants and facilitators keep a notepad near them to write down their thoughts, so they can truly listen to the other person without worrying they’ll forget something if they don’t interrupt and say it right then.

“Allow space for others to speak,” Karin shared, is part of our positively worded new language. “Our old language was Don’t rescue.” She talked about the importance of holding silence when someone gets emotional and how interrupting interferes with their ability to let their thoughts flow naturally and to process their feelings.

“We do more damage when we talk over someone, when we want to speak our mind,” Lisa said. “Often it’s the first time for some to share about their trauma, relationship difficulties, or abortion experiences. When another participant or facilitator says, “Oh that happened to me,” it affirms their inner voice that their experience isn’t as important as someone else’s. It takes the focus off of the person sharing and moves it to the person who interrupted.

“People get energized and lose sight of the impact of their interrupting someone,” Lisa said. “As a facilitator, I’ll say, Remember we’re listening to Melissa right now.”

“This goes for facilitators too,” Karin said. “They rescue when they think a client is emotional.”

“We’re not there to fix anybody,” Heidi said. “Many participants have never experienced these healthy boundaries. They’re used to people speaking over or down to them. We need to let them be able to walk through their pain at their pace.” She shared a memory of a healing group she once participated in when “someone got up and gave me a tissue, it stopped the conversation.”

Lisa shared that when she facilitates in-person groups, she has a guideline that no one is allowed to give anyone a tissue. She places a box of tissues in the center of the group for them to help themselves to if they need it. “Some struggle to identify their needs,” she said, “this way they know the box is there and it empowers them to meet their own needs. We need to not be fixers or codependent in groups.” Lisa also explained that the equivalent in virtual groups to giving a tissue is saying something like It’s okay. Thanks for sharing.”

Several providers mentioned in the chat that they put an individual packet of tissues on each chair.

“It’s important to allow them to figure out on their own what works for them,” Heidi said. “Don’t push our way, or what worked for us, onto other people.”

Other times, Heidi said, the interruption may be from some participants questioning a decision or action of another participant. She said she emphasizes that we all make different decisions. Sometimes after this happens, she asks What was it like to hear the group members being unhappy with your choice? or They think they’re being friendly, how did you receive that?

We also need to “be careful not to throw our judgment in,” Heidi said. She gave an example of a group where most members were Christian, and one member who wasn’t talked about spending time in a meditation garden and the others jumped on that.

The speakers discussed the importance of participants each staying focused on their own thoughts and feelings, using “I” and “me” statements. “This goes with trying not to fix somebody, cross-talking, giving advice” and comparing our grief to others, Karin said.

Lisa added that “should” or “shouldn’t” statements are “condescending” and don’t create a safe space.

COMMIT TO YOUR HEALING & TO THE GROUP

Attend each session, show up on time, complete all homework and journaling, and participate in the group discussion. Share from your heart and let down walls. This takes time and trust and may be easier for some people and more challenging for others.
Trust in the process. Everyone grieves differently, so don’t compare your progress to someone else’s.
Please note that this support group does not replace professional therapy. If you are currently in therapy, we recommend that you notify your therapist and that they support your participation in this support group.
Each group session is valuable to your personal healing and to the group support. Your facilitator will inform the group of the number of allowed absences. If you will miss a session, notify your facilitator ahead of time and follow your group’s protocol, which may include scheduling a make up.
Do not use alcohol or drugs while preparing for and participating in the group sessions. These can interfere with your ability to feel and grieve and can create an unsafe space for others. If you need help in this area,please contact your facilitator outside of the group. Your facilitator can connect you to the help you deserve.

“A participant’s success in the process requires a commitment to their healing and to the support group,” Karin explained. “They have to be willing to sit in this space, to work on this journey.”

“Six weeks sounds like a lot, but you’re so worth it,”Heidi said she often tells clients.

Lisa cautioned that this is not to be confused with requiring participants to talk, or say why they’re crying, or an expectation that they answer every question. “If you feel like sharing, please do,” she tells clients. “It’s about being ready, prepared, and interested in being there.”

Heidi shared that it’s common to need to encourage participants not to compare themselves to others. “They’ll ask, Why can’t I get past this, she’s past this,” she said, “I’ll say, remember we all grieve differently.”

Lisa said, “Sometimes the pain is so great.” She described a metaphor she likes to use: Picture a shaken two-liter soda bottle. Before our clients get to us, something has shaken and stirred it up, and the top came off. They exploded and came to you looking for the help they need. Now here they are, entering the group, and it’s not nearly as bursting out of them at this point. She uses this to remind clients what compelled them to come in the first place and encourages them, even though it may get harder before it gets easier, to allow the process to take shape.

Karin explained that many of our guidelines resulted from situations that arose in groups over the years. The guideline on alcohol and drug use is one of those. Lisa shared that this happened enough that we added it to the guidelines. “It’s not uncommon to have coping mechanisms for your grief,” Heidi says she tells clients, “You’re safe here, you don’t need to use a coping mechanism to be here. Be completely present, to feel, to allow breakthroughs.”

HOW SHOULD FACILITATORS TALK WITH CLIENTS WHEN GUIDELINES AREN’T FOLLOWED?

“I’ve been on the receiving end of a facilitator correcting my actions when I was late or distracted or they thought I wasn’t participating. They never made it feel personal. They’d say, Lisa I want to remind you that the group guidelines are for everyone’s benefit. It appears you’re struggling with this one. Would you like to discuss what’s going on, and how you might be able to fix it for the next session?”

“As a facilitator, I’m the first to say, it’s not comfortable. But it’s leading with the heart. We’re not villainizing a client for breaking a guideline. I might say I really want this experience to be great for you, what could we do differently?

Heidi said, “I share I’m really nervous to talk to you about this, but I care about you too much not to have this conversation. I know you can do this, and just want to have a conversation.” She also said the outcome is always something like, Thank you for having this conversation with me. No one has ever held me accountable like this before.

Attendees agreed in the chat about the importance of accountability. “Don’t put your head in the sand,” Lisa said, “Hold participants to the level of care we requested in the beginning” for the good of everyone in the group. She also encouraged providers who may have experienced “out of control groups” to try again using guidelines to create safe space.

Q&A

SHOULD ABORTION HEALING SUPPORT GROUPS BE HELD ON CHURCH GROUNDS?

Attendee Chris Rainey, who is a member of the Support After Abortion National Men’s Task Force, said he never recommends holding after-aborting healing groups at church. He described the difficulty in trying to protect anonymity and the uncomfortable, exposed feeling that many participants have when groups meet in their church. He strongly encourages church-sponsored after-abortion healing groups to be held off campus. A number of providers agreed in the chat. One provider shared that they had success in holding their groups during off times when the church was otherwise closed.

SHOULD PARTICIPANTS BE REQUIRED TO SIGN AN AGREEMENT TO THE GROUP GUIDELINES?

While some providers said they’ve had success doing this, others felt it conflicted too much with the need for anonymity, respect, and comfort. Lisa said she believes that when group members show up and abide by the rules that is their agreement to them. She suggested that providers consider why they want a signed agreement to the guidelines, what they’re trying to accomplish, and if this is the best way to do that.

WEBINAR ATTENDEE SURVEY RESULTS

Do you currently have Support Group Guidelines in place?

65% YES, 35% NO

What are the most common problems you experience with group participants?

Monopolizing conversation
Not attending all sessions
Giving advice
Filling silence

What are the least common problems you experience with group participants?

Interrupting
Not digging deep
Not coming prepared

Do you currently require make-up sessions when a participant is absent?

>50% NO

NEXT MONTH’S WEBINAR

Facilitation in Action

We will continue our focus on putting ethics into practice with a look at what it’s really like to be a facilitator.

Click here to access the Group Guidelines in pdf format.

Click here to watch the video.

Click here to register for the next Abortion Healing Provider webinar.

Click here to access Support After Abortion’s Resource Library.

Click here to explore Support After Abortion’s services, resources, and training for Abortion Healing Providers.