Facilitator Training 101

DBSA San Diego

1

Table of Contents

When you help someone up a hill …………………………………………………………………………………..………. 3What is DBSA?............................................................................................................................... 4Activities Currently Sponsored by DBSA San Diego………………………………………………………………….. 5Why Support Groups?.................................................................................................................. 6Why Peer-Led Support Groups?................................................................................................... 7The DOs: What does the Group Do? ............................................................................................ 8 The DON’Ts: The Group does NOT …………….…………....………………..……………………………………………. 9Who are Facilitators?.............................................................................................................…….. 10The DOs: What do Facilitators do?................................................................................................ 11We Listen…………………………………………………………………………………………………………………………………. 12Support Group Guidelines………………………………………………………………………………………………………… 13The DON’Ts: Facilitators do NOT …………………..…………………………………………………………………………. 14If you are interested in becoming a Peer Facilitator, ask yourself……………………………………………... 15You are not alone……..………………………………………………………………………………..……………………………. 16Remember …………………………………………………………………………………..………………………….……………… 17The Basics: What does a facilitator do?......................................................................................... 18Student Observers ………………………………………………………………………………………………………………….. 19One Point of View ……………………………………………………………………………….…………………………………… 20Why Do We Do It? ………………………………………………………………………………….……………….………………… 21Practicalities ……………………………………………………………………….………………………….……………….………… 22Stages of Being a Facilitator ……………………………………………………………………………………..……………… 23Practical Tips on Group Facilitation and Some More Ideas ….……………………………………………... 24-25

2

3

What is DBSA?

• DBSA is the acronym for Depression and Bipolar Support Alliance, a national non-profit organization founded in 1985. DBSA National requires that every facilitator receive training. http://www.dbsalliance.org/

• DBSA San Diego is also a 501(c)(3), a tax-exempt non-profit organization. We are formally affiliated with the national organization and we pay annual dues to maintain that affiliation. http://www.dbsasandiego.org/

• We have 3 professional advisors, Drs. John Kelsoe, Eric Raimo and Colin Depp.

• Our local group was founded over 20 years ago under the auspices of Dr. John Kelsoe. Dr. Kelsoe, Professor of Psychiatry at UCSD, is a highly-respected, world-renown genetics researcher whose work has focused on identifying the specific genes that predispose to bipolar disorder. Dr. Kelsoe is also the Medical Director of the STEP Clinic at the VA, specializing in the treatment of refractory mood disorders.

Our Mission is to improve the lives of people living with mood disorders through support,

education and outreach.

4

Activities Currently Sponsored by DBSA San Diego

•Support groups on Monday and Thursday nights at the VA Hospital in La Jolla –Family & Friends group on Monday–2 or 3 consumer groups each night•Speakers and educational programs for members and the community on a semi-monthly basis•Resource tables at many local mental health events including regular appearances for PERT at San Diego Police Department•An extensive website at http://www.dbsasandiego.org/

•A manned phone and an email box that is checked daily at dbsasandiego@yahoo.com

•Hosted on-line networks: –Yahoo! Group http://groups.yahoo.com/group/dbsasandiego/–Facebook group DBSA San Diego –Twitter group DBSASanDiego•Regular social gatherings for members –4 or 5 summer picnics–2 or 3 holiday buffet luncheons –Padres Baseball Game / Aztec Football Game – Sky Show–Informal after-group meetings at Ralph’s•We have a monthly Board Meeting to conduct the business of the group.

5

Why Support Groups?

We’re all here because we know that Support Groups have worked to help us on our path to recovery and wellness. The ultimate goal for each member of the group is to grow and change in a healthy way.

• Decreased Sense of Isolation

• Freedom to Express Feelings

• Learning to Develop Effective Coping Skills

• Enhanced Self-Esteem

6

Why Peer-Led Support Groups?

• We are all equal in that each of us has experienced mood disorders and their after effects, either in ourselves, in our friends and family or both.

• Peers share what has helped and what has not helped in their own recovery.

• The group’s collective wisdom presents us with different perspectives, expands our range of options, and can help us make informed choices about our recovery.

• Recovering peers inspire the hope that others can recover too.

7

The DO’s: What does the Group do?

• We listen and accept others for who they are.• We offer encouragement, empathy and kindness.• We assist each other while helping ourselves.• We choose to make the journey to wellness in the

company of others headed in the same direction.

We didn’t all come over in the same ship, but here we all are in the same boat.

8

The DON’Ts: What the Group does NOT do:

• We do not do what the professionals do! • We do not diagnose.• We do not provide treatment.• We are not a substitute for professional care.• We are not a therapy group.• We are not a 12-step program nor are we an alternative to 12-

step groups.• We do not offer “quick fixes” or cures.• We do not become dependent on the group or on individual

members in the group.• We do not give advice unless a member requests it.

9

Who are Facilitators?

• Peer Facilitators are peers in recovery and role models for the group.

• They possess the “lived experience” of recovery.• They model an openness that encourages

others to share their journeys.• They are unpaid volunteers.

They have, openly and without shame, begun their journey to recovery.

10

The DO’s: What do Facilitators do?

• Provide safety by enforcing rules and goals.• Keep their emotions under control and put others at ease. • Provide focus by tactfully redirecting the conversation.• Demonstrate acceptance through empathy and respect. • Are genuinely interested in helping others.• Are active listeners.

Facilitators allow the other person to feel exactly what they’re feeling without trying

to change those feelings.

11

We ListenThe ability to listen is not an inborn trait.

It takes a conscious effort to do it well.

Good facilitators:• Listen intently. Their minds do not wander. They concentrate on what the other person is

saying.• Repress their own egos. They don’t interrupt. Nor are they thinking only of what they want

to say when the speaker finishes.• Are patient. Nothing is more annoying than a person who has no patience to hear you out.• Are concerned. They care about what the other person is saying because they care about

that person.• Help others learn how to listen by enforcing limits: ask members not to interrupt, ask

monopolizers to let other people speak, gently ask members to wrap it up if they go on too long. • Let the group know up-front that you may need to close a topic before everyone has had a

chance to speak on that topic. Ask who wants to talk first. Ask the group to let you know if a member needs to speak.

12

Support Group GuidelinesGuidelines must be applied with understanding and compassion.

1. What is said here stays here. This is the essential principle of confidentiality and must be respected by all.

2. Raise your hand and wait your turn to be called upon. No one person should monopolize group time.3. It’s everyone’s responsibility to make the discussion groups a safe place to share. We treat one

another with respect and kindness, and show compassion.4. Use "I" language, that is, speak from your own experience. Do not give advice unless asked to do so.5. We don’t diagnose or prescribe. One person’s experience with a doctor or a medication does not

necessarily tell you how you will react6. It’s okay not to share. 7. Set your cell phone ringer to vibrate, or turn it off entirely.8. If you need to leave the meeting, feel free to do so, but please leave quietly.9. Please, no eating during the meeting. It can be distracting to those trying to speak.

These guidelines are designed for the safety and protection of everyone in the support group.Facilitators should enforce the rules of the group, but not exclusively.

All members have an obligation for the group’s welfare.

If a support group member feels that they need extra help, advise them to speak with a DBSA San Diego board member.

13

The DON’Ts: Facilitators do NOT …

• Facilitators do not recommend any particular course of action, physician, treatment or medication.

• Facilitators do not diagnose.• Facilitators do not take the lead role in another’s

recovery.

As peers, Facilitators cannot lead anyone else into wellness.

14

If you are interested in becoming a Peer Facilitator, ask yourself …

• Have you reached a stable point in your recovery journey?

• Are you dependable?• Do you work well with others?• Do you have a desire to “give back” to others

also on a journey of recovery?

15

You are not alone…•DBSA San Diego, led by the Board, will provide training.

•You do not need to facilitate when you do not feel up to it.

• If you have questions or issues, you can turn to the Board or to other facilitators.

• It's OK to ask for help. Other facilitators and seasoned hands:

–are there to assist–can perform tasks that can be delegated –are available to step in if a facilitator feels overwhelmed–can provide a sounding board after the meeting–can give constructive criticism, if requested

•Facilitators can pair-up successfully.

•The Board allows facilitators to run the group according to their own styles.

•You will have to make judgment calls. The Board will support your ad hoc decisions and stand by DBSA facilitators.

As a facilitator, you are a peer. It is responsible, reasonable, and appropriate to ask the group how to handle a situation.

16

Remember

• It is everyone’s responsibility to make the support group a safe place.

• Wellness is a member’s own personal responsibility and each person’s path to wellness is uniquely their own.

• We are unique individuals. Only we know what is best for our own health in consultation with our doctors and other professionals that we have chosen.

• The group will not find a solution to every problem.

• Not every group will meet your expectations.

• As a Facilitator, you will not meet everyone’s expectations.

17

The Basics: What does a facilitator do?

18

• Give intro/ruleso Location of restroomso Break at 7pm, but you are free at any time to take a break or change rooms

• Take notes during check-in. Whatever you need to remind yourself and keep track.o Circle view w/clockso Listo Color-coded or highlighted

• Attendance Sheet – easy, very important, helps us gauge attendance and allows you to comment on the group• Resource Box – goal is to have materials accessible. Contents:o Kleenexo Name tagso Markerso Clipboard with paper and penso Play-doh, stress toyso “Room Full” signo Folder with DBSA information: provider list, GRAPES, mood pyramido Signs to 2436/2438 and directions to other rooms

• The Boards – dry erase door boardso Purpose: helps identify DBSA roomo Lets people know who is facilitating. No disruption or confusion for people who prefer to avoid certain groupso Allows us to redirect members to rooms that aren’t full. Use the yellow “Room Full” magneto Should be LEGIBLE and at eye level

• Clean up room when you’re doneo Tables to center in 2113, 2108, 2436 and 2438o Tables to the back and chairs stacked in 2011o Pick up any trasho Medi-wipes are NOT DBSA’s tissues

Student Observers

Student observers are often present for DBSA meetings. They are required to attend a certain amount of meetings to see and interact with actual consumers. There is a limit to how many

students are allowed on any given night. They must RSVP beforehand.

• There should ALWAYS be at least one student-free room• Students participate in the introduction like everyone else.• Reassure the group that the student will not be sharing their secrets and that they are there

to learn how to better help other people with mental illnesses.• Tell the student during the into that they are free to have a topic and/or participate in the

group to the extent they feel comfortable.• Remind the student to fill out the student survey.

• If a student has a meltdown, treat him/her like any other group member. Provide support. Ask someone to take them out of the group if necessary until they have calmed down. They’re students but they’re still people.

19

Point of ViewFrom Michelle

Facilitating is an art, not a science. We all have our preferences for how groups are run. We do what works best for us. Some things are concrete, but there is much you get to choose. Things people argue about that is your choice:

• Who talks first• Topic order• How long a topic is• How many comments people get to make• When to break and for how long

Philosophies:

• We’ve been there.• We can help.• Do no harm.

What I Get/Why I Do It• Get to help people – give back• Feel in control• Good distraction – get out of my head• I get to use my illness for something good• Pushes me safely out of my comfort zone*

My Tips• Listening is more important than problem-solving• Keep watching at all times – people will tell you what they need• Follow your gut• Resist the urge to react in panic, no matter how shocked you are• Leading groups is hard. Talk to other facilitators and board members about your concerns and stress. You are NOT alone.• You have the power of free speech and control. Don’t abuse it. Say only what’s necessary. The group is full of knowledge.• Silence is OK!• Facilitators usually don’t get a topic – sucks, but it just is• Watch the time. If you’re going to go over, let people know and call time at 8pm• Remember, it’s not your job to save people

20

21

Peer Led Support Group for Mood Disorders

Demanding - Why we do it?

Rewards of support and insight

The group appreciates and stands behind you

Assisting a group of equals in offering support regarding the impact of

disorders of affect

Format – round of ‘introductions’ with topics, individual sharing with feedbackDifferent from: therapist led, process group, recovery model, NVC – 2 hours, fluid attendance,

circle, personal topics but with ‘crosstalk’, based on experiences vs. feelings, no sponsors / steps

Practicalities• Seating and late arrivals (22 / 16 / 14 / 18)• New people • Guidelines and introductions• Order of topics, too many, too few• Leaving at break, in the middle, finish time• Food, phones, notes, chat, dogs• Nursing students• Court mandated

Challenges• TIME MANAGEMENT: Member talks too much - attention seeking | Sharing vs. feedback• UNSUPPORTIVE: Unwelcome advice, lack of empathy, personal attacks or criticism• RELEVANCE: Mood disorders vs. fur balls & garage door repair• ADULT: Language, drugs, crimes, bowel movement • MEDS VS. HOLISTIC• CRISIS: Member low number vs. hospitalization | Disruptive behavior• ABILITY TO HANDLE: outside 3 – 7 range, anger, severe mania, psychosis, dual diagnosis• REPORTING• CONFIDENTIALITY

22

Stages of Being a Facilitator

FearAvoiding, being a pushover, self-blame

• The first few times that you facilitate you may be anxious but it does not help the group to show fear. You are in control of the group and it gets easier as time goes by. The fear subsides and you will feel that you have helped people. You will feel great to have helped the group and yourself.

Pride and Ego“Hey, I’m good at this stuff!” Insist on facilitating, talk too much/always speak first or last/grandstanding

• It can hurt when people leave the room at break and do not come back. Don’t take it personally since some people just like to change rooms but instead try to focus on those in the room. Also, people may be upset if you cannot get to their topic. Assure them that they can be first at the next meeting if they tell the facilitator.

Exhaustion and BurnoutMake sure you are getting your own support. Target 50% max – group member ½ the time you attend

• This will happen so do not be afraid to let another facilitator know. Try not to facilitate more than once a week but sometimes you may want to do more if you are in a good place. It also helps to facilitate if you are feeling low because you are helping others and yourself at the same time.

Asking for help, delegating, saying NOSelf-assess and ask for feedbackIndividual Facilitator style is goodWe appreciate and support each other

Q&A

I would facilitate at the next group if only …

23

PRACTICAL TIPS ON GROUP FACILITATIONNotes from Jay

Voltaire cautions “The secret of being a bore is to tell everything.”

•Attitude is key. Remember, you are a servant to the group; this is not about you. Let the group do the work and inject your opinions sparingly.

•Use introductions to mentally note who is hurting most and should be first (or second, if the person is new to the group and seems hesitant).

•Ask questions or give direction to keep the group on topic. It is best to guide the group with “what” and “how” questions and avoid “why.” Also, you can influence direction by selecting order of speakers.

•When an upset individual cannot focus, either ask how we can help or ask someone else in the group to intervene to give direction. (Remember some people just want to be heard, so let them vent for a while and move on: “Have you gotten enough? “What other questions might we help with?” Or if all else fails, “We need to work on Henry’s issues.”)

•Watch for signs of group break down or non-work (Wilfred Bion observation)–Fight–Flight—not paying attention, lost in space–Pairing—side talk–Dependence—expecting you to have all the answers

•Remember, the group’s work can take a lot of different forms:–Clarification of issue–Analysis–Providing experience–Suggestions–Ways to solve problems–Establishing relationships–Listening and comforting (humor sometimes)–Doing administrative tasks

PRACTICAL TIPS (continued)

• Gladly accept positive comments or corrections from the group. This is the group’s job. If a particular correction appears not to be positive, do not confront; rather say we can consider that in the future (or discuss now if appropriate).• It is best not to directly challenge fallacious thinking, but rather, ask probing questions of “how will that work,” “who

will help,” “what will be the outcome,” etc.• Avoid “rabbit trails.” An individual may tempt you with a topic that there is no way to resolve. Focus on what can be a

helpful area. One example, don’t get into what some other group has done to cause the problem but focus on remedies. (the government, fundamentalists, Hari Krishna) Other examples are too much discussion about medicines or underlying causes of seasonal mood swings.• Try to make group members comfortable with your gentle direction. Do not criticize or make an example of them when

they are off base. Be gentle while discouraging side talk or pairing.• Consider working with a silent co-facilitator (another pair of eyes to follow the group’s reactions).

You can never be perfect—don’t worry about the things that could have been done better. Just rehearse in your mind what else you can do better for the next time and say to yourself:

Woulda’, shoulda’, coulda’Is not constructive.

Let my lessons from the pastHelp me avoid repeating history.

25

Some More IdeasFrom Sean “Paul”

I am a performer by training, in other words, from a preteen I was trained to be on stage at a piano or other musical instrument. Iʼm 55, and since 17, Iʼve been teaching piano and musical composition. I find facilitating to be a little like these things: Iʼm speaking up while others are listening; Iʼm keeping track of the time and trying to get all the “pieces” (musical pieces or topics) in before 8; I help others take turns. Very much like piano performance and teaching.

I believe and constantly remind myself that this is their group, Iʼm just basically a time keeper and someone who keeps track of who had their hand up first. I donʼt “fix”

anyone nor am I responsible to “fix” the group. Others with me in the group are just that: “with me.” Silence is not just okay it is good; silence is like breathing - needed. If someone in the group is irritating they are in the right place - I try to not judge them or the groupʼs response to them but consider healthy directions. I am not a therapist. I am not a therapist. I am not... you get the idea. I aim positive thoughts to each person in the room. St Benedict believed that the youngest person should always be heard; for me that means that anyone can come up with surprising wisdom - just listen.

If two people will “team facilitate” make sure they sit together the whole time and coordinate how the clipboard is filled out. If after break people have moved around,

do the introductions again with a fresh clipboard page.Understand most people want you to do well and wish you well in the group. Breath. Count backwards from 10 to 1. Slow down, if you are going too fast. For your first few times read all the group rules yourself, that way people there will know you are the facilitator if they havenʼt seen you much that way.Try not to be the last one to share about the topic. Try not to share at all if plenty of group members are sharing.To Do: Look around a lot to see if anyone has raised their hand. Allow others to help you if you have missed a hand up. Announce the order of who is to share/go next in

sharing, that way they know they are in the queue to share and not left out or have not had their hand seen. If someone has their hand up make a sign, or a nod to them so they can relax and know they have been acknowledged (and they can put their hand down!).

Donʼt worry about silence: this is their group and not yours. Having too many topics is okay, just remind them as time goes on that “we have a lot of topics left to get to” and the group will understand. If there are too few topics it is

good to have about 5 topics to throw out there but I remember: this is the groupʼs group, Iʼm just basically a time keeper. If there arenʼt a lot of topics left, when there is a break, tell members beforehand that there is time for more topics. Ask a few members during break for topic ideas.

It is their group, you can relax; it’s not your group. Try to finish by 8 and have a break (the break is good for facilitators! too!).

26