Support groups serve a useful function in helping people deal with stresses related to common crises, life transitions, and chronic conditions. Their proliferation over the past two decades is associated with the increasing need for formal and informal sources of support in the wake of rapid social change, geographic dispersion of families and friends, and cutbacks in funding for human services. When people dealing with common sources of stress join together in support groups, they form social networks that have the potential for bridging gaps in service and for providing emotional support, guidance, and information. The beneficial nature of these experiences tends to be widely accepted, but a review of the literature indicates that neither theory nor research has kept pace with practice. There is no consensus on the conceptualization of support groups and only limited evaluation of their impact.
To address the need for conceptual direction for practice, this article identifies the critical dimensions of support groups and proposes a model for understanding support groups and evaluating their outcomes. Our conception of support groups draws on theoretical formulations related to social support, social networks, group dynamics, ecology, and social systems. We have also examined practice and research literature related to groups that provide support and have obtained pilot data from telephone interviews with support group leaders in developing our model. A review of the literature and a description of the open systems model of support groups are followed by discussion of findings from the pilot study of support group practice.
CURRENT CONCEPTIONS OF SUPPORT GROUPS
As references to "support groups" have become widespread, confusion has arisen over how these groups differ from other groups that provide support. The term generally implies the coming together (that is, face-to-face or over the telephone) of individuals with some pressing common concern who are willing to contribute personal experiences and engage in the development of a cohesive, supportive system. These characteristics are, however, also descriptive of mutual help groups, self-help groups, and treatment groups that provide support. Understanding the distinctions among these group forms is especially important to practitioners, who need conceptual clarity to make informed decisions about which type of group will be most appropriate to meet particular client needs. Thus, clarifying the critical features of support groups becomes an essential first step in model building.
Although a number of authors consider the defining characteristics and problems of overlap among various supportive group forms, Lieberman (1986, 1990b) and Rosenberg (1984) offer the most helpful comparisons of self-help, support, and treatment groups. Drawing on their work, support groups can be conceived of as the center of a continuum overlapping with self-help groups (also referred to as "mutual help groups") at one extreme and treatment groups at the other. The major distinctions drawn by these authors relate to sponsorship, conceptions of participant roles, the basis of leadership, interventive methods or technology, and the view of the group.
Self-help and mutual help groups may be initiated by professionals and frequently are affiliated with a national or regional sponsoring organization. The sanction and control of group activities lies with members, and leader and member roles may be somewhat synonymous (Levy, 1976; Maton, Levanthal, Madara, & Julien, 1989). Experience with a focal life experience is the common denominator that is the basis of shared authority. Professionals may help initiate the group and serve as consultants, make arrangements, and provide resources. Leaders, however, tend to rely on their personal experience with the members' shared concern to develop the emotional understanding necessary to facilitate the group. The interventive technology often involves some standardized format with general procedures for sharing experiences and information that may have been developed by the sponsoring organization. …