Saturday, September 11, 2010


In speaking with people who are forming cancer support groups, I’ve regularly encountered one particular issue: who’s qualified to facilitate?

Doesn’t what occurs in a support group, after all, constitute psychotherapy? Is the facilitator someone who’s able to handle whatever arises? What if a participant comes unstrung? Can a facilitator also be a friend of participants, or is that what’s called in therapy circles a “dual relationship,” something to be avoided?

Such questions fascinate me, addressing, as they do, the interface between therapy, support and friendship.

If you’ve been sick, you’ve probably noticed that those close to you react variously to your situation. Some drift up to you with tented eyebrows, crooning, “How aaaaaaaaaaaare you?” Right away, you feel worse. They go on to say, “My cousin’s uncle had that, and he lasted three months.” Or, “Hang in there. I just know you’re gonna be okay.” To say the least, they’re not helpful.

A number of others simply drift away. Either your illness frightens them or they want to help but don’t know what to say. 

A few, though, are tangibly healing. By their language and demeanor, it’s obvious they’re there with you. You feel better afterward for having been with them.

Now, they are friends in the fullest sense. A friend is someone who stays by you no matter what; who accepts what you’re going through without trying to fix you; who listens to you at the core level; who tells you not what they think you want to hear, but their truth.

This high-quality friendship is identical to what we call “support.” Some of us have never in our lives experienced this degree of intimacy and honesty. When we finally encounter it, say in an effective support group, it’s like having been blind and now suddenly granted the gift of sight. We demand more of it, and in fact begin to question why we’d choose to associate with anyone who’s less than supportive.

Psychotherapy’s a little different. We engage a therapist to challenge us, push us, delve into parts of ourselves we haven’t sufficiently explored. That’s a deeper agreement than support groups maintain. We’re not in a group to turn ourselves inside out, however useful that process can be, but only to find navigational aid for a currently difficult challenge.

I’ve been facilitating support groups for over thirty years, doing it before there was even a name for it, yet I have no training in it. I’m a family practitioner, not a psychiatrist. I approach it simply as friendship, and work constantly on my own friendship skills. To “practice,” after all—whether to practice medicine or to practice piano—isn’t simply to do it repeatedly, but to improve. (In his eighties, Pablo Casals was asked why he still practiced cello three hours daily. “I’m beginning to make progress,” he replied.)
From persisting in this work, I find most of my friends these days are staggeringly thorough human beings. Some even happen to be therapists.


  1. Very interesting article. Here at the NJ Self Help Group Clearinghouse we help people free of charge to start and facilitate all types of self-help support groups. Most of the groups that we help start, and list in our database, are peer-run.

  2. Thanks for the comment,Barbara. It's great to know these skills are finally being widely taught. For the NJ Self Help Group Clearinghouse training schedule, go to