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Post-Polio Health (ISSN 1066-5331)

Vol. 4, No. 4, Fall 1988

Support Groups: Is Our Group Normal?

Ruth Wilder Bell, PhD, Columbia, Maryland

When support group leaders share experiences and describe their support groups, it quickly becomes apparent that a separate and unique personality exists for each group. Group theorists use the term "syntality" to describe for a group what the term "personality" describes for an individual. And, just as individuals progress through relatively discrete developmental stages, each with its own growth-producing task to be accomplished, groups too pass through developmental stages on the way to becoming a mature group.

An awareness of the stages of group development and the work to be accomplished at each stage is useful to support group leaders as they facilitate effective group functioning.

Overview of Group Stages

Individuals are attracted to groups when they believe that they can meet their needs and achieve specific goals better in the group than individually. However, to become involved with a group means a willingness to be identified with that group and to risk closeness with other group members.

Closeness, a central theme of group life, increases as a group progresses through the developmental stages. While there are multiple theories of group development, all theorists describe similar characteristics of a group as it deals with intimacy in progressing from a young to a mature group. The categories used by the Boston University School of Social Work (Bernstein 1965, 1973) are those used in the following discussion. The five stages of group development are:

Pre-affiliation. This first phase is characterized by what psychologists term "approach-avoidance behavior. That is, individuals at brie moment seem involved and ready to make a commitment to the group and at the next moment, they withdraw and may not seem interested at all. Attendance may be sporadic, reflective of the general ambivalence regarding identification with other members of the group or with the goals and activities of the group. The role of the leader during this phase is to allow and support this "cautious arm's length" exploration while at the same time patiently inviting trust and involvement.

Power and Control. During this stage, members who have now resolved their ambivalence about involvement in the group begin to make arrangements to handle the work of the group. The leader is seen as the one holding the power and is still held responsible by the members for the group's success. Jockeying among the members for favor and attention from the leader is characteristic member behavior. An effective leader, however, does not respond to the competition for attention and treats all members as equals encouraging them to take increasing responsibility for the success of the group. As this stage closes, members have made a significant investment in the group and have accepted some responsibility for the group's outcomes.

Intimacy. Group cohesion and a sense of belonging flourish during the third stage. The group is now seen as a safe place in which feelings can be expressed and new experiences tried. The group looks less and less to the leader as a source of gratification or for solutions to problems. Members increasingly accept and share responsibility for group functioning and are able to carry out the work of the group.

Differentiation. During this stage, the growth of closeness and the level of intimacy between members that became apparent during the preceding stage continues. There is increasing recognition and acceptance of individual needs. A unique situation has been created in that while the group is cohesive with its own personality and expectations for members, the integrity of individual members is fully respected. The leader is needed less and less and the group increasingly runs itself.

Separation. Separation occurs when the group has met its purpose and the members are ready to move on, taking with them what they have learned from the group. As members prepare to leave the group they may revert to old behaviors, looking once again to the leader for direction. An appropriate role for the leader is to "let go," encouraging members to review both the group's accomplishments and what they as individuals have learned from the group. Particularly useful is a discussion of how experiences in the group can be transferred to new situations.

Implications for Post-Polio Groups

Guiding a support group through these stages, mobilizing the strengths that come with the cohesion and closeness of the later stages is no easy matter. A characteristic of support groups which makes the task more difficult is that while there may be a core of members who attend regularly and as such are the "culture bearers" of the group, there is also a pool of people who cycle in and out, perhaps not having been able to resolve their initial ambivalence about attending. They need to be caught up or reoriented each time they come. And at any meeting there are likely to be those who are attending for the first time and aren't sure what the group is about and whether they even want to participate.

These three groups, the core members, those who cycle in and out, and the newcomers, are in different places emotionally. It is the leader's task to respect their need to be close or not close and set the stage for an environment in which individual differences are respected and individual needs can be met.

A few suggestions to help create such an environment are:

Have someone available to greet newcomers, provide introductions and a brief orientation to the group.

Encourage core members to discuss what it was like for them when they first began attending. Hopefully, this will encourage sensitivity toward those who are not ready for the same level of intimacy they are.

Watch new members, or those who attend sporadically for signs of uncomfortableness if the discussion involves significant sharing.

At the end of the meeting the leader might speak privately to these folks, letting them know that they will not be pressured to share.

Respect the right of members to attend at intervals, depending on their need and readiness for the group. The leader can express interest in these members by making arrangements for another member to call periodically just to say "Hello." Delegating to another member conveys the notion that members share responsibility for the group. It is not the leader's job alone.

Begin each meeting with a "check in" time, a time when members catch up with each other since the last meeting. Because sharing is voluntary, it protects those who are not ready to participate, but also communicates that the meeting is a safe place for members to share with each other, should they desire to do so.

There are many other things that a leader and the members can do to provide for an environment in which needs can be met. It might be interesting to have a discussion with the entire group about ways the group can meet the needs of those who are at different levels of intimacy and identification with the group. Such a discussion communicates a sense of shared responsibility for the life of the group and, in fact, in and of itself facilitates the group's growth and development. Time spent nurturing the group as a whole, as well as the individuals in the group, is time well spent.


Bernstein, S. (Ed.). (1976). Further explorations in group work. Boston: Charles River Books.

Ruth Wilder Bell, PhD, polio survivor, is leader of the Polio Society of Howard County, Columbia, Maryland, and Assistant Professor at the School of Nursing, University of Maryland. 

Support Group Program Ideas

International Polio Network (IPN) receives many requests for program ideas. Below is a listing of possible programs. Remember, it is not necessary to have a speaker at every meeting. If a speaker is invited, try to find a professional who will talk and listen and not pontificate. Plan for no more than 10 minutes of speaking time and allow plenty of additional time for questions and discussion.

Speakers from: