Karla T. Washington, Ph.D., LCSW
I’m writing this from what will need to pass for a home office for the foreseeable future. For the time being, we’ve been asked to pause many of the activities we once took for granted. As we grieve the loss of dinners out and movies at the theater, we recognize many are grieving much more. Another reality we’re facing in this era of social distancing is that much of our lives are shifting online. Not surprisingly, interest in facilitating online support groups (OSGs) is skyrocketing.
A body of research
At the Lab for Caregiving Innovation, we’ve been researching OSGs for family caregivers for years. We have several peer-reviewed publications on OSGs, both for individuals actively engaged in caregiving and those who are bereaved. In addition to original studies, our team has extensively reviewed other teams’ research on internet-based group support for family caregivers. You can learn more about this body of research on our website, which has an entire section just on OSGs. What is the take-away of all those studies? It’s that OSGs—done well—hold tremendous potential as a source of meaningful family caregiver support.
Facilitating online support groups
Many individuals in the helping professions have been trained to facilitate support groups. It’s one of the most common options for social support offered to patients and their families in healthcare settings. While facilitating online support groups is different than facilitating groups face-to-face, the core skills are largely the same. They just need a little tweaking to make sense online. Core skills for group facilitators—whether in person or online—include the following:
- Attending – Paying attention and showing it
- Communicating clearly– Using straightforward language to promote accurate interpretation
- Modeling – Demonstrating behaviors you want to see in group members
- Linking – Connecting group members so they don’t just talk to (or through) you
- Regulating – Making sure the group stays on track and remains a safe place for all members
- Facilitating entrances and exits – Helping new members feel welcome and honoring those exiting
Let’s take a look at how you can move these skills online, using the example of an asynchronous, text-based group. “Asynchronous” just means group members aren’t all in the group at the same time. Members hop on the group as they have time, which can be really important for busy family caregivers. “Text-based” groups use mostly written content (e.g., posts or comments) to communicate among members. While someone may share an occasional video, most of the time members type messages to one another in the group platform. Online adaptations are discussed below, followed by a table summarizing key points.
Many of the skills used to attend in face-to-face groups are not an option when facilitating online support groups. You can’t make eye contact or lean in to communicate interest. Online attending looks more like a reaction (e.g., “liking” a Facebook post) or a comment on another’s post. Active “listening” skills are also helpful. Asking clarifying questions is one such example. Facilitators should be thoughtful about the timeliness of their reactions. When groups are newly forming, members are still learning how to connect. There may be quite some time between a post and another’s member’s response. On the one hand, you don’t want to leave someone “hanging,” particularly if they’ve communicated something personal. Conversely, if you always respond first, you can create channels of communication that flow only through you rather than member-to-member. Thoughtful balance ensures members are recognized, while allowing sufficient space for others’ direct interaction.
You know how email communication can easily result in miscommunication? The same is true in online support groups (OSGs). So much of how we communicate in person involves tone of voice and non-verbal behaviors. None of these are available in text-based, online communication. In addition, the back-and-forth dialogue in asynchronous OSGs rarely happens in real time. Someone can comment on a post made hours or days earlier. For all these reasons, clear communication is imperative in OSGs. Especially early in the group or when new members join, using plain, straightforward language is best. Humor should be used with care, and sarcasm may be best skipped all together.
The specific skills a facilitator models in an OSG depend a lot on the group content. In OSGs for family caregivers, modeling validation can be extremely helpful. It can be really hard to know what to say when someone is hurting. Some people feel an inclination to nudge the hurting person into problem-solving. This can feel invalidating if the hurting person was in fact seeking understanding. And sincere, heartfelt statements can come off as trite; “sending thoughts and prayers” is a great example. Facilitators who model validating messages (e.g., “your response makes perfect sense”) show members how to offer support.
We are currently studying OSGs for family caregivers of people who are at the very end of life. Members are sometimes in our OSGs for just weeks before their family member dies. Thus, our facilitators are quite intentional in linking members to one another because it needs to happen quickly. Furthermore, in OSGs, many opportunities for organic connections (e.g., chatting before group) are missing. As a result, group members naturally tend to communicate with the facilitator rather than one another.
To encourage member-to-member interactions, we sometimes “call on” specific group members. For example, if Rick were to mention a problem, we might comment, “Joan mentioned a similar challenge last week. Joan, do you have any thoughts for Rick?” Facebook makes this really easy with its tagging feature; similar capabilities exist in other OSG platforms. Linking members is one of the most significant challenges in OSGs, and one you should remain mindful of.
Group rules and guidelines are a must. In longer-running groups, you may choose to involve members in developing the rules. Even then, it’s a good idea to have a very basic list available before inviting members at all, particularly if you lack an offline relationship with group members. (Facebook provides some great suggestions for OSG rules.) If you’re facilitating an online support group in your professional capacity, you will likely want to encourage privacy among members. However, you should always be clear that you cannot guarantee any member’s privacy. Encourage members to share accordingly.
In addition to regulating members’ behavior via group rules, you should mind the tone of your groups. Support groups by definition include people in need of support; these are often people in stressful, sad, and scary situations. OSGs exist to provide space to talk about tough topics. But it can get to be too much. You can balance a heavy group with inspirational or uplifting messages, practical tips or education, or even thoughtful humor. Checking in with members from time to time can help you know what’s needed.
Facilitating entrances and exits
Many groups run for a prescribed period of time. But for support groups, there’s often not a definite start or end date. Members come and go at various times based on their specific circumstances and needs. And it’s important to control group membership to ensure everyone’s involvement is aligned with the group’s intended purpose and composition. It can be helpful to announce group entrances. We use welcome posts to encourage new members to share a bit about themselves and to allow existing members to welcome new folks. Group exits can also be acknowledged. While some members naturally pull back over time, others exit for life circumstances they wish to share with others. For example, in our OSGs for hospice family caregivers, members often exit shortly after the death of their family member. Posting of an obituary has become a group norm, followed by a brief period of time for goodbyes.
Moving group facilitation skills online
Many of these tips and lessons learned are summarized in the table below. The bottom line, though, is that with appropriate preparation, skilled facilitators of face-to-face groups can run effective OSGs. There is a learning curve, but it’s manageable. For many of us, working from home is a novelty, and one we hope is short-lived. But family caregivers of seriously ill patients often can’t get away from home, and offering online support can help. We wish you the best as you bring support to people’s homes when (and where) they need it most.