The Phases of Helping in Group Work

Phases of Helping

The concept of the phases of helping indicates there is a preferred sequence of worker activity so as to help the group become a mutual aid system and achieve group purpose (Gitterman, 2004; Glassman and Kates, 1990; Kurland and Salmon, 1998; Schwartz, 1961, 1976, 1977). The phases occur over the course of the group’s life cycle and include: preparation, beginning, work and ending phases (Schwartz, 1961; Gitterman, 2004). This framework has relevance for conceptualizing the sequencing of worker activity in each group session as well (Birnbaum and Cicchetti, 2000; Birnbaum, Mason and Cicchetti, 2002; Shalinsky, 1983; Shulman, 2005b).


The Preparation Phase

The preparation phase attends to ‘tuning in’, pre-group planning, and work with the prospective members (Gitterman, 2004; Kurland and Salmon, 1998; Schwartz, 1961; Shulman, 2006). Tuning-in helps the worker anticipate members’ needs and feelings and develop preliminary empathy (Schwartz, 1961; Shulman, 1999, 2006). The worker also tunes-in to one’s own feelings, attitudes and thoughts about the ensuing group encounter (Shulman, 1999, 2006). A framework for pre-group planning proposes that the worker consider such interrelated factors as group purpose, composition, structure, size, content, and the environmental context of the group (Kurland and Salmon, 1998; Northen and Kurland, 2001). Group workers, in addition to preparing the new group member, need to work with other staff members to gain sanction for their group and to facilitate referrals (Shulman, 1999, 2005b). Member outreach and preparation provides an opportunity to identify the goodness of fit between the group purpose and the prospective member’s needs and address feelings of ambivalence or reluctance about attending the group (Shulman, 1999, 2005b).



The Beginning Phase

The beginning phase has as its central assignment a collaborative approach to developing an initial contract for work (Henry, 1992; Schwartz, 1961, 1971a; Shulman, 1999, 2006). According to Schwartz (1971), “The contract, openly reflecting both stakes, provides a frame of reference for the work that follows, and for understanding when the work is in process, when it is being evaded, and when it is finished” (p.8) The work of the beginning stage is understood as group building. Phillips (1957) explains the role of the worker in group building indicating that the worker should focus her attention at “understanding and using the worker’s activity in a process that enables each group member to find and take part in the whole, in relationship with other members” (p.142).
Several developmental frameworks postulate that member ambivalence about both the work and connecting with one another is normative (Bennis and Shepherd, 1956; Kurland and Salmon, 1998; Schiller, 1995; Shulman, 2006). Shulman (2006) incorporated ideas from Bion’s group-as-a-whole approach, in particular his observation that members approach emotionally threatening material with a ‘fight’ or ‘flight’ response further explicating the understanding of ambivalence. In response to this the worker engages in purposeful group building so as to cultivate a climate of safety and trust which in turn contributes to establishing a culture for work (Schiller, 1995; Shulman, 2006).


The Work Phase

In the work phase the group’s energy is directed to “the main body of problems and to the major tasks of the helping process” (Schwartz, 1977, p.1335). The worker considers when to intervene with the group as a whole, the interactional process and the individual member (Shulman, 1999, 2006; Toseland and Rivas, 2005). Central worker tasks include the maintenance of the group as a mutual aid system and actualizing group purpose (Schwartz, 1977). The tasks of this phase according to Schwartz (1977) include: the search for common ground; detecting and challenging obstacles to task accomplishment; worker contribution of ideas, facts and values; the sharing of the worker’s vision, that is “his feelings about the process, and his faith in the clients’ strengths and capacities”; and defining the boundaries of the “situation in which the small group is set” (Schwartz, 1977, p. 1335).
How the work is conceptualized is in large part informed by the population, the nature of the group and the purpose for which the group was formed (Shulman, 2006). The nature of the therapeutic work for people with SUDS is conceptualized as a developmental process with early treatment tasks focused on establishing abstinence, deepening motivation and eroding denial (Flores, 1997; SAMHSA, 2005a). The nature of treatment for people with SUDS will be discussed further in a subsequent section.


The Ending Phase

The ending phase presents the group members the opportunity to consolidate gains, explore feelings and thoughts about endings, review and evaluate their work and make plans for the future (Gitterman, 2004; Schwartz, 1961; Shulman, 1999). Variations on endings occur when the worker leaves the group and when members leave a group that is ongoing (Shulman, 1999).

The Role of The Worker in Mutual Aid Based Group Work

The scope of this discussion is to identify the role of the worker in the mutual aid based social work group. Of note, as with the discussion of ‘member’ the use of the title ‘worker’ is of philosophical importance and can be contrasted with ‘leader’, as leadership is thought to emerge amongst the membership (Trecker, 1948). The understanding of the role of the ‘worker’ is that she/he too is a member, albeit with special skills and the responsibility to ‘work the process’ (Newstetter, 1935; Lang, 2004; Trecker, 1948). The worker seeks to build the group through purposeful worker activity (Coyle, 1937; Hartford, 1976; Trecker, 1948), cultivate indigenous leadership (Konopka, 1983) and support the group’s autonomy (Middleman and Wood, 1990b). Successful group building requires the worker to engage the individual member with the group, help the group identify and accept common goals, and enable the group to develop their within-group relationships (Coyle, 1937; Murphy, 1959; Newstetter, 1935; Phillips, 1957).
The primary role of the worker in a mutual aid based approach to practice is that of mediator, wherein the worker helps mediate the individual/group engagement (Schwartz, 1961; Gitterman, 2004). As Schwartz (1961) indicated, the worker “acts to help others act” (p. 19). Schwartz (1976) viewed mediation as the primary worker function. Mediation, he suggested, was meant to “create not harmony but interaction, based on a sense of strength, feeling and purpose” (Schwartz, 1976, p. 184). Eventually, Schwartz (1986) would come to think of his client as the process of social interaction itself.
Through purposeful worker activity the strength of members can be harnessed and the potent dynamics of mutual aid unleashed (Steinberg, 2004). The mediation function suggests the following worker tasks: identifying members’ common ground; cultivating mutual aid; and identifying and working through obstacles (Gitterman, 2004; Schwartz, 1961; Shulman, 1999, 2006). As Schwartz (1976) indicated an important worker task was “helping people not only help themselves but to help each other as well” (p. 196).
Schwartz (1994) recognized that the worker is also a representative of the agency and needs to present the purpose of the group in light of agency function. Where there could be tension between the agency and the group, Schwartz envisioned the worker role as mediating the connection between these systems as well(Gitterman, 2004; Schwartz, 1994).

Guiding Values

Consonant with the social group work tradition, a mutual aid based group work approach draws upon democratic and humanistic values (Coyle, 1937; Getzel, 1978; Gitterman, 2004; Glassman and Kates, 1990; Konopka, 1978; Northen, 2004; Northen and Kurland, 2001; Schwartz, 1961; Shulman, 2006; Steinberg, 2004; Trecker, 1948; Tropp, 1976). Northen and Kurland (2001) identify the value system informing group work practice with “the ultimate value of social work” which they suggest is “that human beings have opportunities to realize their potential for living in ways that are both personally satisfying and socially desirable” (p.15). The perspective espoused by several social work group work experts is that people are responsible for one another and that mutual interdependence is preferable to individualism (Falck, 1989; Getzel, 1978; Glassman and Kates, 1990; Northen and Kurland, 2001; Schwartz, 1961; Shulman, 2006; Steinberg, 2004).
Humanism is “built on particular values that cast people in society as responsible for and to one another” (Glassman and Kates, 1990, p.13). Democratic norms of group participation promote cooperation and “fluid distribution of position, power and resources” (Glassman and Kates, 1990, p. 14). These values guide practice, inform worker role and use of self, and the understanding of membership in a social work group.
Humanistic values are manifested in the social work group when the worker and members demonstrate caring, cooperation, mutual aid, inclusivity, and respect for differences, according to Glassman and Kates (1990). Glassman and Kates (1990) underscore the role of humanistic values as they inform social work practice with groups and highlight the perspective that people have inherent worth; have a right to belong; have a right to be heard; and have a right to question and challenge the professionals with which they work.

Factors that Influence Mutual Aid Processes

The degree, type and quality of mutual aid processses depend upon several factors including group type; purpose; group composition; communication patterns utilized; size of the group; stage of development; worker ideology and skill; and member attributes (Garvin et al, 2004; Lieberman et al, 1973; Schwartz, 1961; Shulman, 2005a, 2006). These factors will be addressed in more detail in later posts. Furthermore, different types of processes available through peer interaction may have greater significance depending on the needs of the members (Rugel, 1991). The worker can tune in to the needs of the members to get a sense for which processes will be meaningful and productive for the group and the members in it. The central point here though is as is shown in encounter group research: “change does not revolve around the solitary sun of the leader; the evidence is strong that psychosocial relations in the group play an exceedingly important role in the process of change” (Lieberman et al, 1973, p. 428).
For our purposes here I would highlight the role of the worker and his/her ideology of help as it impacts the emergence of mutual aid processes. While writing about group psychotherapy research that used the Yalom Therapeutic Factor construct, Lieberman has made several salient observations. Lieberman (1983), in his analysis of change mechanisms made the point that the therapist’ beliefs, value systems, and ideology of help “bear great weight on the clients’ belief about what it was that helped them” (p.199). Lieberman (1983) posited that the beliefs of the therapist “must, to some extent, be accepted by the client” (p.199). For example, Lieberman (1983) suggested, the likelihood that insights will occur “is enhanced if the therapist generates the information required to explore this area” (p.199). Lieberman (1983) posits that therapists emphasize events and processes that are “under their control” (p.194). Accordingly, insight, feedback, and the expression of and experience of strong affect were often elements stressed in therapy and encounter groups (Lieberman, 1983)). These items were “subject to specific leader interventions, in contrast, for example to altruism” (Lieberman, 1983, p.194). This belief has caused Lieberman (1983) to posit that this act of influence “clouds and makes it empirically difficult to examine phenomenological information in a change-induction study and distinguish it from the inculcation of a specified belief system that is not necessarily a true reflection of the client’s experience” (p.200). This is an important consideration when one resorts to empirical evidence to determine which interventions should be utilized.
In a mutual aid based approach to group work practice the worker engages in, as Schwartz (1976) indicated, “helping people not only help themselves but to help each other as well” (p. 196). The worker is encouraged to "think group" which refers to a mindset that calls for the worker to consider the group as a whole as a primary lens through which to consider his/her actions in service of fostering the group's ability to become an effective mutual aid system (Middlemand and Wood, 1990). This idea has resonance with the ‘two client perspective’ which calls for the worker to consider the group-as-a-whole as one client, the individual members as the second client, and charges the worker with facilitating the connection between the two (Schwartz, 1961; Trecker, 1948).

Mutual Aid Processes: Specific Processes

This post builds upon the previous post by explicating specific mutual aid processes that potentially occur amongst and between group members. The mutual aid processes identified and discussed here primarily stem from the discussions on mutual aid provided by Shulman (2006) and Northen & Kurland (2001). You may want to read the preceding post prior to this one if you haven't done so already or look to the right column for the Group Work Theory Links to read all theoretical posts sequentially.

Sharing Data or Acquiring Needed Knowledge

Sharing data can be understood as occurring when members share useful, relevant information (Hartford, 1976; Parad et al, 1976; Shulman, 1999, 2005a; Steinberg, 2004; Wasserman and Danforth, 1988). Northen and Kurland (2001) add that “the group is a safe place to acquire needed knowledge” (p.26). This process makes use of members’ experiential knowledge, wisdom and beliefs (Parad et al, 1976; Shulman, 2005a). For example, in crisis debriefing groups members might be encouraged to share coping strategies (Parad et al, 1976). In recovery oriented groups members might share strategies for protecting sobriety.

The Dialectic Process

The dialectic process occurs when members express differing perspectives about the topic under discussion (Shulman, 1999, 2005a; Steinberg, 2004; Wasserman and Danforth, 1988). Members might propose opposing or seemingly opposing points of view which can be discussed and debated. The dialectic process that unfolds allows for discussion of the pros and cons of the multiple perspectives regarding any topic. This group activity has resonance with the principles of motivational interviewing (Miller & Rollnick, 1991). Wasserman and Danforth (1988) suggest “it is critical that these differences be revealed in the group, where people can think about them and discuss the pros and cons, and where their own affirmations and doubts about a topic can be challenged” (p.139).


Discussing Taboo Topics

Discussing ‘taboo’ topics refers to the discussion of subject matter that is typically regarded as more revealing than polite conversation (Schwartz, 1961; Shulman, 1999, 2005a; Steinberg, 2004; Wasserman and Danforth, 1988). The range of taboo topics might include direct communication about the worker’s use of their authority to issues of sexuality, drug use, and experiences that have induced feelings of shame or guilt (Shulman, 2005a; Steinberg, 2004; Wasserman and Danforth, 1988). This process has been likened to the TF, catharsis (Northen and Kurland, 2001; Shulman, 2005a; Wasserman and Danforth, 1988).


The All in the Same Boat Phenomenon or Universality

The ‘all in the same boat phenomenon’ is resonant with the TF, universality (Anderson, 1985; Northen and Kurland, 2001; Shulman, 1999, 2005a; Yalom, 1995). Northen and Kurland (2001) posit that “the realization that similar feelings and difficulties are common among the members lessens the sense of being unique and alone” (p.25). This discovery is thought to enhance both self esteem and mutual esteem (Northen and Kurland, 2001).


Developing a Universal Perspective

Developing a universal perspective is described as a special type of the ‘all in the same boat phenomenon’ (Shulman, 1992, 1999, 2005a). The process has been likened to ‘consciousness-raising’ (Shulman, 1992, 1999, 2005a). This process suggests that as members identify commonalities they will begin to note the role of societal forces that contribute to a more textured understanding of their problem, rather than simply viewing their difficulties as the result of personal deficits (Breton, 2004; Shulman, 1992, 1999, 2005a). This process is presented as especially resonant with the needs of people who are vulnerable and/or oppressed (Shulman, 1992, 1999, 2005a). In addition to consciousness-raising, this process is conceptually similar to the concept of ‘critical consciousness’ as described by Freire (1970).

Mutual Support

Mutual support is identified with both the supportive, accepting culture of the group as well as member to member supportive interaction (Gitterman, 1989; Hartford, 1976; Northen, 1951; Northen and Kurland, 2001; Shulman, 1986, 1999, 2005a; Tropp, 1976; Wasserman and Danforth, 1988). The effective communication of support requires both sympathy and empathy and is expressed verbally, non-verbally and through physical gestures like hugging (Shulman, 2005; Steinberg, 2004). This process is viewed as buffering against distress caused by personal difficulties (Caplan, 1974; Gottlieb, 1983; Gitterman and Shulman, 2005; Gottlieb, 1983; Northen and Kurland, 2001; Shulman, 1999; Steinberg, 2004). As Shulman (1986) has pointed out, “carrying a burden is often easier if others express their understanding” (p.55). Shulman’s (1986) belief is supported by social support research that has demonstrated the buffering and protective effects associated with social support (Gottlieb, 1983). For example, research on the effects of support groups for breast cancer survivors and cardiac arrest patients reveal significant mental and physical health benefits including fewer hospitalizations, longer life span and improved psychosocial functioning (Gottlieb, 1983).
The manner in which support is helpful is explained by Northen and Kurland (2001) who note that the supportive, accepting climate “reduces anxiety and facilitates self expression and willingness to try out new ideas and behaviors” (p.25). Resonant with the TF ‘altruism’, Shulman (1986) opined that “the giving of empathic support is often helpful to the one who gives as the one who receives” (p.55).

Mutual Demand, Group Control and Reality Testing

Mutual demand, in addition to support, is believed to be required for growth and change (Gitterman and Shulman, 2005; Northen and Kurland, 2001; Shulman, 1986, 1999, 2005a). The skillful leader will cultivate a group climate that has an appropriate balance of challenge and support (Gitterman and Shulman, 2005). The challenging climate leads to an internalized sense of accountability to the group and yields member to member challenge and confrontation (Gitterman and Shulman, 2005; Northen and Kurland, 2001; Shulman, 1999; Steinberg, 2004). Northen and Kurland (2001) suggest the expectations of the group, that is the group control, “serves as a means toward the goal of appropriate self control” (p.26). This contributes to strengthening a ‘culture for work’ (Shulman, 1999). Members, as opposed to the worker, are believed to be both more adept at identifying behavior or attitudes that warrant confrontation (Gitterman and Shulman, 2005; Shulman, 1999). Likewise, it is posited that members are more likely to make better use of the confrontation emanating from a peer as opposed to a worker (Gitterman and Shulman, 2005; Shulman, 1999). Northen and Kurland (2001) in discussing their concept of reality testing note that ‘feedback from peers is often more candid and explicit than are responses offered by the worker” (p.26).


Mutual Support and Demand, Quality of Relationship

The combined effect of mutual support and mutual demand, Shulman (1986) suggested, is similar to the following items in Yalom’s ‘interpersonal learning’ construct: “learning how I come across to others”; “other members honestly telling me what they think of me”; “feeling more trustful of groups and other people”; and “learning about the way I related to the other group members” (Yalom, 1975, p. 79 as referenced in Shulman, 1986, p.142). Northen and Kurland (2001) echo this perspective by noting that the when the quality of relationships contains a “blend of support and challenge”…it provides…”a corrective emotional experience” (p.25).

Individual Problem Solving

Individual problem solving has long been recognized as an important activity in social work groups (Hartford, 1976; Schwartz, 1961; Northen, 1976; Somers, 1976; Shulman, 1999, 2005a; Steinberg, 2004). The social group work approach to problem solving typically draws upon the framework proposed by Dewey (1910) and invites full participation of the group members (Kurland and Salmon, 1992). The belief amongst social group workers is that when one member helps another they are helping themselves (Gitterman and Shulman, 2005; Shulman, 1999; Steinberg, 2004; Wasserman and Danforth, 1988).
Shulman (1999) offers the example of a group member complaining about the ‘strained relationship between herself and her mother’ (p.309). As the problem is explored and reframed other members began to “make associations to a similar concern” (p.310). As solutions were generated by the group other members could see that these solutions could apply to their concern as well. Shulman (1999) observes that “this is one of the important ways in which giving help in a mutual aid group is a form of self-help” (p.310). Shulman (1999) explains the point by noting that “it is always easier to see the problem in someone else’s relationships than in your own” (p. 310).

Rehearsal and Skill Acquisition

Rehearsal can be understood as the intentional practicing of new skills and ideas in the context of a supportive forum, the group (Shulman, 1999; Steinberg, 2004; Wasserman and Danforth, 1988). Northen and Kurland (2001) note that the group provides the opportunity for acquisition of new skills as well. Steinberg (2004) suggests that rehearsal can be operationalized overtly as in the use of a role play but can also be understood as an aspect of simply participating in the group. Steinberg (2004) proposes that the group can be “a place to freely experiment with new ways of being and doing” (p.118).


The Strength in Numbers Phenomenon

The strength in numbers phenomenon (Shulman, 1999, 2005a) has also been identified as ‘the strength in us’ (Breton, 2004), perhaps a harkening to the book of the same name about mutual aid-self help by Katz and Bender (1976). Shulman (1986) explained that members “often feel powerless to deal with large institutions and agencies, helping professionals (even the group leader), and apparently overwhelming tasks” (p.58). Consequently, “sometimes it is easier to do things as a group than it would be as an individual” (Shulman, 1999, p. 312). In my own group practice this phenemenon occurred when members accompanied one member to a 12 Step meeting who had been having difficulty returning to A.A.



The proceses offered by Northen and Kurland (2001) not explicitly identified in the preceding discussion include cohesiveness, altruism and development of hope, which can be understood in much the same way as explained Yalom's discussion of Therapeutic Factors. While written with regard to interactive group psychotherapy I suspect these processes occur in social work groups.


Cohesiveness

Cohesion exists in reciprocal relationship to other TFs in that it promotes their emergence and is strengthened by them (Crouch, Bloch, and Wanlass, 1994). Group cohesiveness is understood by Yalom as analogous to relationship in the dyadic therapeutic relationship and includes both the group experience of “esprit de corps” as well as the individual members’ “attraction to the group” (Yalom, 1995, p.48). Yalom (1995) proposes the following statements as indicative of group cohesion: “belonging to and being accepted by a group”; “continued close contact with other people”; “revealing embarrassing things about myself and still being accepted by the group”; “feeling alone no longer”; and “belonging to a group of people who understood and accepted me” (p. 74).


Altruism

Altruism operates when the group member offers “support, reassurance, suggestions, or comments to help other group members; shares similar problems with the purpose of helping other members; feels a sense of being needed and helpful; can forget self in favor of another group member; and recognizes the desire to do something for another group member” (Crouch, Bloch and Wanlass, 1994, p. 285). Yalom (1995) adds that discovering that you can be of help to another person has the potential to “boost self-esteem” (p.12). The category is described by Yalom (1995) as including the following statements: “helping others has given me more self-respect”; “putting others’ needs ahead of mine”; “forgetting myself and thinking of helping others”; “giving part of myself to others”; and “helping others and being important in their lives” (p. 74).


Instillation of Hope

Instillation of hope is “crucial in psychotherapy” according to Yalom (1995, p. 4). The instillation of hope occurs through group member action and interaction, as well as therapist intervention (Yalom, 1995). Crouch, Bloch and Wanlass (1994) suggest that “hope operates when the patient simply notes that improvement does occur” (p. 286). In Yalom’s survey instrument the instillation of hope is operationalized in the following statements: “seeing others getting better was inspiring to me”; “knowing others had solved problems similar to mine”; “seeing that group members improved encouraged me”; and “knowing that the group had helped others with problems like mine encouraged me” (Yalom, 1995, p.78).

Mutual Aid Processes: Introduction

The concept of mutual aid in the worker-led social work group is understood as an exchange of help wherein the member is both the provider as well as the recipient of help in service of achieving common group and individual goals (Borkman, 1999; Gitterman, 2006; Lieberman, 1983; Northen & Kurland, 2001; Schwartz, 1961; Shulman, 2006; Steinberg, 2004; Toseland & Siporin, 1986). The concept is premised on the belief that members have strengths, opinions, perspectives, information, and experiences that can be drawn upon to provide help to others in the group (Shulman, 2006). Additionally members have the capacity to share emotions and respond empathically and supportively to one another. Related to this is the belief that some types of mutual aid processes, for example, confrontation, are better received when it comes from peers rather than a worker (Shulman, 2006) and that helping others helps the helper, a concept referred to as the "helper-therapy principle" (Reissman, 1965) for which there is empirical support (Roberts et al, 1999). According to the findings of research conducted by Roberts et al (1999), providing help potentially leads to increased feelings of “competence, equality, social usefulness, independence, and social value” (p.843). Mutual aid activities that occur amongst and between group members are posited to stimulate affective, cognitive, and behavioral processes that as Northen and Kurland (2001) explain can be understood as “dynamic forces”, “therapeutic factors” and “change mechanisms” (p.24). Furthermore, Reissman (1965) writing about the helper-therapy principle but equally apropos of mutual aid processes notes the impact on the group as a whole: “not only are individual group members aided in the group, but the group as a whole may be greatly strengthened in manifold ways as it continually offers assistance to individual group members” (p.32).
From the field of social work, building upon the work of Schwartz (1961), Shulman (2006) since 1979 has presented an elaboration of mutual aid processes that is typically associated with the Mutual Aid Model of social work with groups. Building upon the research of Bloch, Crouch and Reibstein; Rohrbaugh and Bertels; Yalom; Corsini and Rosenberg; and Shulman, Northen and Kurland (2001), also from the field of social work, presented “the dynamic forces of mutual aid” (p.26). Their discussion tethers mutual aid processes to the concepts "therapeutic factors" and "change mechanisms", terms commonly used to describe the helpful processes of group therapy.
Schwartz (1961, 1971, 1976, 1977) had proposed that the social work group engage in problem solving; employ authentic, affect- laden communication; accommodate expressions of difference and conflict; and discuss ‘taboo’ topics. Shulman (1979, 1986, 1992, 1999, 2006) advanced a conceptual framework of mutual aid processes comprised of the following 10 types of processes: sharing data; the dialectic process; entering taboo areas; the ‘all in the same boat’ phenomenon; developing a universal perspective; mutual support; mutual demand; individual problem solving; rehearsal; and the strength in numbers phenomenon. Northen and Kurland (2001) presented “the dynamic forces of mutual aid” (p.26). Their elaboration includes the following processes/dynamics: mutual support; cohesiveness; quality of relationships; universality; a sense of hope; altruism; acquisition of knowledge and skills; catharsis; reality testing; and group control (Northen and Kurland, 2001, p.25/26).
Members enter the social work group with intrapsychic obstacles to establishing mutual aid. This fact informs the role of worker, whose function it is to foster mutual aid and help the group identify and work through these obstacles. Conversely, the worker can truncate the emergence of mutual aid if he/she is not fully invested in harnessing the strengths of the members. One final thought to keep in mind as well is that the types of and degree of mutual aid processes that emerge are influenced by a variety of factors, including group type; purpose; stage of development; and needs and capacity of the members.
In conclusion, the role of mutual aid processes in the social work group is illuminated by Gitterman (2006), a contemporary expert on mutual aid based group work from the field of social work. Gitterman (2006) contends that “mutual aid is the major rationale for the provision of group services” (p.93). Gitterman (2006) elaborates on mutual aid in the social work group noting that, “as members become involved with one another, they develop helping relationships and become invested in each other and in participating in the group” (p.93). The mutual aid processes that unfold help group members “to experience their concerns and life issues as universal”, “to reduce isolation and stigma”, “to offer and receive help from each other”, and “to learn from each other’s views, suggestions and challenges” (Gitterman, 2006, p.93).

The Concept of Mutual Aid

Mutual aid theory was first elaborated by Kropotkin (1903), one of the most important evolutionary theorists and socio-biologists of his time, as an evolutionary theory to expand upon that proposed by Darwin which underscored the role of struggle and competition encapsulated in the notion of ‘natural selection’ amongst species, an idea often understood as ‘the survival of the fittest’. Kropotkin (1903) argued that mutual aid as exemplified in efforts at cooperation in the face of common environmental threats was a significant factor in the survival of species. Upon being influenced by a lecture entitled “On the Law of Mutual Aid” delivered at the Russian Congress of Naturalists in January, 1880, by noted zoologist, Professor Kessler, and through his own observations of a number of species that placed communal needs before individual needs rather than engaging in competition for survival, Kropotkin formulated the theory of mutual aid (Kropotkin, 1903). Kropotkin underscored the role of mutual aid with this observation: “…wherever I saw animal life in abundance…on the lakes…in the colonies of rodents…in the migrations of birds…in a migration of fallow dear…I saw Mutual Aid and Mutual Support carried on to an extent which passed before my eyes, I saw in it a feature of greatest importance for the maintenance of life, the preservation of each species, and its further evolution” (p.ii).
The role of mutual aid in human society was observed by Kropotkin (1903) as well. Kropotkin (1903) observed: “the mutual aid tendency in man has so remote an origin, and is so deeply interwoven with all the past evolution of the human race, that it has been maintained by mankind up to the present time, notwithstanding all vicissitudes of history (p.145). He noted the role of mutual aid in primitive societies as well as his then contemporary society. He found himself “struck with the immense part which mutual aid and mutual support principles play even now-a-days in human life” (Kropotkin, 1903, p.148). Principles of mutual aid are operating in spontaneous neighborliness; utopian cooperatives; trade unions; labor unions; and the settlement house movement (Katz and Bender, 1976; Lee and Swenson, 2005).
The concept of mutual aid bears resemblance to that of social support (Lee and Swenson, 2005). Social support is thought to buffer or cushion the individual from potentially harmful or physiological conditions (Caplan, 1974). Social support can include professional helping offered by an individual worker; this however, represents a departure from the concept of mutual aid as treatment technology. The bi-directional nature of mutual aid is more clearly illuminated when the concept of social support from peers is paired with the helper-therapy principle (Lee & Swenson, 2005; Reissman, 1965). This principle hypothesizes that helping others helps the helper (Reissman, 1965), a hypothesis supported by empirical findings (Roberts et al, 1999). Furthermore, Reissman (1965) suggests that the principle impacts the group as a whole: “not only are individual group members aided in the group, but the group as a whole may be greatly strengthened in manifold ways as it continually offers assistance to individual group members” (p.32). This concept is resonant with the concept of altruism, identified by Yalom (1995) as a therapeutic factor available through group therapy.
Mutual aid theory continues to influence sociobiology (M. Glassman, 2000); is often used as an explanatory framework for understanding self-help/mutual aid groups (Borkman, 1999; Katz & Bender, 1976); and informed the Mutual Aid Model of group work practice originated by William Schwartz (Gitterman, 2004; Schwartz, 1961).
Mutual aid in the worker-led treatment group is understood as an exchange of help wherein the member is both the recipient as well as the provider of help in service of achieving group and individual goals (Borkman, 1999; Gitterman, 2006; Lieberman, 1983; Northen & Kurland, 2001; Schwartz, 1961; Shulman, 2006; Steinberg, 2004; Toseland & Siporin, 1986). Mutual aid activities are posited to stimulate affective, cognitive, and behavioral processes that as Northen and Kurland (2001) explain can be understood as “dynamic forces”, “therapeutic factors” and “change mechanisms” (p.24).

The Concept of Membership

While the language is not consistent in the social work literature, in general the understanding is that the group worker employing a mutual aid based approach works with ‘members’ of groups rather than ‘clients’ as well as the group itself (Konopka, 1978; Trecker, 1948; Shulman, 1999; Steinberg, 2004). The concept of membership versus client is not insignificant nor simply a matter of semantics (Falck, 1989). As Konopka (1978) pointed out, “the concept of member instead of client indicates a democratization of the helping process, an acceptance of the legitimacy of indigenous leadership and the concept of mutual aid as a goal” (p.128). Members are viewed as active, “self-realizing” and “energy producing” rather than passive recipients of treatment (Schwartz, 1977, p.1331). In this approach the strengths of members are recognized (Schwartz, 1977).
A mutual aid based approach to group work has implications for understanding not only the role of the member but the nature of the ideal relationship between and amongst members as well. Members are viewed as interdependent (Northen and Kurland, 2001) with responsibilities to and for one another (Falck, 1989; Glassman and Kates, 1990; Northen and Kurland, 2001). Falck (1989) makes the point that implicit in the notion of member is the “principle of connectedness” (p.24), that we are all a part of a larger whole. Falck (1989) observes that “nobody exists aside from others; no social interaction is possible without others” (p.24/25).
This perspective within the context of the group experience subjugates the notion of self-determination to that of social self-determination (Falck, 1989). Illustrating the point, Falck (1989) notes that there is a difference in asking “what do you want to talk about?” than “what shall we discuss?” (p. 29). This framework has implications for the role of the worker whose responsibility includes mediating the reciprocal relationship to be found between the group and member and the members with one another.

What do you think? Are the people in your group patients, clients or members? What do the people in your group think about themselves? What does it mean to be a patient? A client? A member? Are there pitfalls in only thinking of the people in your groups as members? What is it like when all of your colleagues refer to these people as patients and you think of them as members? Please share your perspective.

The Evolution of Social Group Work/Social Work with Groups

The Mutual Aid Model and the role of mutual aid in group work can be best understood within a historical context. While mutual aid is an aspect of group approaches developed in other professional disciplines, the concept of mutual aid as a feature of group work has been given primacy within social group work/social work with groups’ approaches. While Schwartz introduced the appellation ‘mutual aid’ to the social work profession, and through the Mutual Aid Model, brought greater clarity about how to stimulate mutual aid processes, the idea of mutual aid has been thematic throughout the evolution of social group work/social work with groups. While all social work with groups models do not place equal primacy on establishing the group as a mutual aid system, in general, where appropriate, in many models the worker is encouraged to cultivate mutual aid (AASWG, 2006; Garvin et al, 2004; Gitterman, 2006; Middleman and Wood, 1990a).
So as to better understand the rationale for stimulating mutual aid in group work, the history and evolution of social group work/social work with groups is addressed below. Within this discussion the various theoretical, philosophical, sociocultural and political forces that influenced the development of group work theories, in particular the Mutual Aid Model, will be identified.


The Early Years: Seminal Contributions

Social group work and group psychotherapy have primarily developed along parallel paths. Where the roots of contemporary group psychotherapy are often traced to the group education classes of tuberculosis patients conducted by Joseph Pratt in 1906, the exact birth of social group work can not be easily identified (Kaiser, 1958; Schleidlinger, 2000; Wilson, 1976). Social group work approaches are rooted in the group activities of various social agencies that arose in the latter part of the 19th century and the early years of the 20th century. Social upheaval and new found demands as a result of post Civil War industrialization, migration and immigration left many with numerous concrete and psychosocial needs (Brown, 1991; Kaiser, 1958; Middleman, 1968; Reid, 1991; Schwartz, 1977; Wilson, 1976). Some of these needs were met through group work endeavors found in settlement houses, religious and charity organizations (Middleman, 1968; Wilson, 1976). Additionally group work could be found in the progressive education movement (Dewey, 1910), the play and recreation movement (Boyd, 1935), informal education, camping and youth service organizations invested in ‘character building’ (Alissi, 1980; Schwartz, 1977; Williamson, 1929; Wilson, 1976).
As Clara Kaiser (1958) has indicated there have been numerous philosophical and theoretical influences on the development of social group work. Chief amongst these influences are the ethics of Judeo-Christian religions; the settlement house movement’s charitable and humanitarian efforts; theories eminent in progressive education, especially those of Dewey (1910); sociological theories about the nature of the relationship between man and society, i.e. Mead (1934); the democratic ethic articulated by early social philosophers; the psychoanalytic theories of Rank and Freud; the practice wisdom, theory building, educational and research efforts of early social group workers (Alissi, 1980; Kaiser, 1958; Wilson, 1976). Early theoretical, research and practice efforts of Grace Coyle (1930, 1935, 1937, 1947, 1948), Wilber Newstetter (1935), and Neva Boyd (1935) paved the way for the advancement and development of social group work.
Grace Coyle presented an early theoretical framework for social group work articulating the need for a democratic value base (Coyle, 1935), identifying the role of the worker as a group builder (Coyle, 1937) and noting the benefits of ‘esprit de corps’ or group morale (Coyle, 1930). As the editor of several small group research compendiums Hare (1976) would later point out, “many of her insights about group process were ahead of her time” (p.388).
Social group work debuted at the National Conference for Social Work in 1935. At this conference, Newstetter (1935) introduced the concept of social group work and identified group work as a field, process and set of techniques. He described group work as an “educational process” concerned with “the development and social adjustment of an individual through voluntary group association” and “the use of this association as a means of furthering other socially desirable ends” (p.291). As with other early perspectives Newstetter (1935) noted that the worker’s task involved cultivating social interaction, “a ‘we’ feeling…a bond” (p.292). Noting that all work with groups is not group work, Newstetter (1935) advanced the perspective that the worker needed to cultivate the “group work process” (p.296).

The Mid-Thirties to the 1950s: a period of growth and Expansion

The period of time between the 1930s and the 1950s was one of growth and expansion for social group work (Alissi, 1980; Wilson, 1976). The economic despair of and varied psychosocial needs resultant of the Great Depression paved the way for greater affiliation between the social work profession and the field of group work (Alissi, 1980; Konopka, 1983; Wilson, 1976). The psychological needs of returning war veterans who served in World War II resulted in the more frequent application of social group work in psychiatric treatment (Konopka, 1983). It was during this period of time that the field of social group work would appear at the National Conference for Social Work; establish academic courses and research institutions; form a professional organization, The American Association of Social Work with Groups (AAGW); and establish the journal, The Group. The first textbooks would appear as well, written by Harleigh Trecker (1948) and Wilson and Ryland (1949).
The 1950s would usher in even greater affiliation of group work with the profession of social work (Alissi, 1980; Andrews, 2001). The merger of the AAGW with six other organizations to form the National Association of Social Work (NASW) in 1955 solidified the identification and integration of social group work with the social work profession (Alissi, 1980; Andrews, 2001). The impact of the merger was reflected in efforts at definitional shifts regarding group work. In 1956 the NASW formed a group work section which issued a new definition that contrasted in focus with that proposed by the AAGW. The new definition dismissed the idea of group work with normal growth and adjustment and instead saw group work as a “service to a group where the primary purpose is to help members improve social adjustment, and the secondary purpose is to help the group achieve objectives approved by society…the definition assumes that the members have adjustment problems” (Alissi, 1980, p. 24). Less than one fifth of the group work section agreed with this definition at the time (Alissi, 1980). The ensuing tensions regarding the defining parameters of social group work lead to a reconceptualization that included recognition that there existed different models to be used for different purposes (Hartford, 1964; Papell and Rothman, 1966).




Toward greater theoretical conceptualization
The attention given to the interaction between the function of the worker and the cultivation of group process would be of central focus in theory building efforts during this time period. Cohen (1944/1952) advanced the following perspective: “Group work, as we understand it, begins with a conscious effort to work the process. The group worker…stimulates and guides the group so that it will function in a democratic way rather than arbitrary way” (p.197). For Coyle (1944/1952) group work implied that “some leader is aware of the group inter-action and discerns social inter-actions of the group as well as the program activities which the group is doing (that is process and content)” (p.201).
The philosophical and operational conceptualization of both social group work and the role of the group worker were further addressed by the American Association of Group Workers. The draft of the association’s definition of group work in 1948 identified group work as “a method by which the group worker enables various types of groups to function in such a way that both group interaction and program activities contribute to the growth of the individual, and the achievement of desirable social goals” (originally mimeographed and printed in Sullivan, 1952, p.420).
Grace Coyle lead a committee charged with developing the “Definition of the Function of the Group Worker” which concluded that the group worker bears responsibility for promoting both group interaction and program activities that contribute both to individual growth and advances the achievement of socially desirable goals (originally mimeographed and published in Sullivan, 1952). A primary task of the worker was to influence the group process, which in large part included member to member interaction in service of achieving group goals. Wilson and Ryland (1949) promoted the following perspective about the role of the worker, “it is through the professional use of this relationship that the members and the group as a whole are helped to achieve their personal and corporate purposes. The success of the social group work method depends upon the worker’s wisdom and discretion in developing the interpersonal relationships within the group and with other groups” (p.85)
In 1956 the Council on Social Work Education undertook a three year study to examine the curriculum in the education of social workers (Murphy, 1959). This study included examination of group work curricula to identify the essential characteristics of social group work being taught to students (Murphy, 1959). The project included review of curricula of ten schools of social work and from this was derived “a set of descriptive propositions” regarding social group work (Murphy, 1959, p. 37).
The propositions reflected beliefs primarily about the nature of group interaction, the role of group process, and the tasks of the worker (Murphy, 1959). The following propositions were made by the curricula review committee: members bring to the group experiences and patterns of behavior “first learned in the primary family group”; “the development of group characteristics in a given group can be examined, understood, and evaluated”; group work is simultaneously concerned with both content and process; worker efforts at helping members function optimally in the group has the benefit of helping them function optimally in “other social situations”; the worker deals with “multiple interactions of group members”; problem solving in the group considers “multiple points of view”; the worker helps “members use relationships with others more constructively” (p.37-39).
With regard to theory building, a significant contribution to group work later reflected in Schwartz’ (1961) model was the concept of ‘engagement’ proposed by Phillips (1957). Phillips (1957) noted the interaction between the worker and group process and suggested that it was amongst the worker’s primary functions to engage the individual member with the group process, help the group identify and accept common goals, and enable the group to develop their within group relationships.
In sum, the history of social group work to this point reflected the following practice principles: allegiance to democratic principles; primacy was placed on the role of member to member interactions; members were viewed as possessing inherent strengths and competencies; and the function of the worker was viewed as “working” the process (Trecker, 1948) or “engaging” the group members (Phillips, 1957). In Schwartz’ (1959/1994) own review of the history of social group work while he appreciated the gains made he acknowledged what he felt was the lack of adequately developed practice theory. He noted that “a theory of method must be formalized, transmissible, and amenable to interpenetration to those in whose service it is pledged. Without a theoretical foundation for method, we have knowledge and cannot use it, or we have goals without a sense of how they can be reached” (Schwartz, 1959/1994, p.217-218).



The 1960s to the present: Further Development of Practice Theories

The 1960s and the 1970s saw the expansion of the social welfare state; the Vietnam War; the emergence of the war on poverty; the Women’s Rights Movement; the Black Power Movement; and the Lesbian and Gay Rights Movement (Balgopal and Vassil, 1983; Somers, 1976). The above social, intellectual and cultural factors influenced the social work profession including social group work (Balgopal and Vassil, 1983; Somers, 1976). With such a wide range of social and therapeutic needs there seemed to be an even greater appreciation of group work (Balgopal and Vassil, 1983; Hartford, 1964; Somers, 1976).
Having expanded into differing practice settings, the purposes and goals of group work had been more broadly described at this juncture than in previous decades. While consensus would not be found in accepting any one theory of practice or approach, it is best said that social group work comprised differing approaches with differing goals. In 1964 the Committee on Practice of the Group Work Section would agree that group work was applicable for the following purposes: corrective/treatment; prevention; normal social growth and development; personal enhancement; and citizenship indoctrination (Hartford, 1964). Hartford (1964) advanced the perspective that the “group is the means for providing social group work service” (p.69) as opposed to simply the context. The facilitation of interpersonal relationships amongst members was regarded as a central work task (Hartford, 1964).
Group work scholars made great strides in developing practice theories. The work of Vinter and Schwartz and their respective associates would dominate the group work scene for much of this decade and the next (Galinsky and Schopler, 1974). In Vinter’s approach (1967) the treatment group is thought of as a small social system “whose influences can be planfully guided to modify client behavior” (p.4). In this approach the worker takes a central position in providing treatment, interventions are planned, group process is highly structured, and great emphasis is given to outcome evaluation and research (Vinter, 1967; Garvin, 1987; Galinsky and Schopler, 1974).
Schwartz (1961) proposed his vision of the small group as an enterprise in mutual aid. In what would become regarded as the ‘mainstream of social work practice with small groups’ (Lang, 1979) the cultivation of mutual aid would be viewed as a central worker task over and above the purpose for which the group was formed (Hartford, 1976; Papell and Rothman, 1980).
In 1965 Bernstein and colleagues introduced another social group work practice theory (Bernstein, 1978; Lowy, 1978; Garland, Kolodney and Jones, 1978). The centerpiece of the edited collection was a developmental stage model, known as the Boston Model, which presented a framework for understanding how groups navigate degrees of emotional closeness over time (Bernstein, 1978; Garland, Kolodney and Jones, 1978). In 1966 Papell and Rothman (1966) presented a typology of social group work that included the social goals model (in the tradition of Coyle), the remedial model (as developed by Vinter) and the reciprocal model (as articulated by Schwartz). In 1968 Middleman (1968) made a seminal contribution in articulating an approach to group work practice that utilized non-verbal activities. In 1976 Roberts and Northen presented a collection of ten group work practice theories (Roberts and Northen, 1976) further illustrating the diversity of approaches to group practice.
As theory building proliferated there was a simultaneous effort to distill the essential elements of social group work. In 1980 Papell and Rothman suggested the essential characteristics of the mainstream model were “common goals, mutual aid, and non-synthetic experiences” (1980, p.7). Also Middleman and Wood (1990a) identified the common characteristics of various approaches to social work with groups.



From Social Group Work to Social Work with Groups

In a 1990 discussion of ‘social work practice with groups’ that illuminated the relationship of ‘social group work’ to ‘social work with groups’, Middleman and Wood suggested that, “First of all, to qualify as social work with groups, worker attention must focus on helping members to become a system of mutual aid” (1990a, p. 10).
For Middleman and Wood (1990a) the evolution in conceptualization of practice from social group work to social work with groups recognized earlier tensions about the definitional scope of social group work which was not thought of as including group therapy. Earlier Tropp (1977b) had pointed out, “there are many kinds of social work with groups, of which one is social group work” (p.74). Social group work aims to “help people in the enhancement of their functioning...in consonance with the society around them”, according to Tropp (1977b, p. 74). Tropp (1977b) suggested that one difference between social group work and group therapy is that in group therapy “the individuals have similar goals but usually do not have a common goal” (p.14).
Middleman and Wood (1990a) acknowledged the continued expansion of the range of group services that social workers were providing, noting that “therapy can be the content of social work with groups” (italics mine, p. 10). According to Middleman and Wood (1990a) the four essential elements of social work with groups include: worker attention to helping the group develop as a mutual aid system, viewing the group process as a powerful force for individual change, cultivating group autonomy, and helping members experience their ‘groupness’ upon termination.
Within the framework proposed by Middleman and Wood mutual aid and group autonomy are posed as definitional parameters of social work with groups. At the same time, the view advanced by Middleman and Wood is not espoused by all social workers. For example, Garvin et al (2004) provide a less constraining definition of social work with groups noting they have a “broad view of this domain of social work” and view social work practice with groups as “encompassing any and all types of groups in which social workers participate” (p.1). With regard to the quality of interaction in the group, Garvin et al (2004) suggest that “whenever appropriate to the purpose of the group, this quality includes the principle of mutual aid, which sees members as helping one another” (italics mine, p.2).



Contemporary Group Work

Contemporary group work practice continues to be informed by the work of early pioneers and the vanguards of the 1960s and 1970s. In addition to the Mutual Aid Model of social work with groups, the Cognitive-Behavioral Group Work Model is recognized as influential on contemporary group work practice (Rose, 2004). The approach suggested by Rose (1989, 2004) integrates cognitive and behavioral interventions with small group strategies. While primacy is not placed on establishing the group as a mutual aid system in quite the same way as with the Mutual Aid Model, Rose (2004) suggests the worker promote group discussion and member interaction. Furthermore, drawing upon Yalom’s Therapeutic Factor construct Rose (2004) points out the benefits of universality, altruism, and group cohesion as well as mutual reinforcement, factors which are conceptually resonant with mutual aid.
Contemporary social workers continue to build upon group work theory. For example, Schiller (1995) has proposed a model of practice that builds upon developmental stage theory and integrates Feminist theory. The Relational Model considers the developmental needs of women, places primacy on cultivating safety and views power and control issues as less important to the group’s growth as compared to other approaches (Schiller, 1995). Schiller (2002) suggests that this model has application to group work with oppressed and vulnerable populations as well. Another example of theory building can be seen in group approaches that integrate technology mediated communication (Meier, 2004).



Contemporary Challenges

The late seventies saw the reemergence of a professional journal, Social Work with Groups in 1978. Additionally, in 1978 social group workers formed a committee to host a symposium in honor of Grace Coyle which paved the way for an annual conference in subsequent years (Northen and Kurland, 2001). The conference planning committee was transformed into the membership driven organization, the Association for the Advancement for Social Work with Groups, now an international organization (AASWG, 2006).
Despite the proliferation of professional activity there has been deep lamentation for the state of both group work education and practice since the late 1960s onward (Birnbaum and Auerbach, 1994; Birnbaum and Wayne, 2000; Goodman, 2006; Hartford, 1978; Kurland and Salmon, 1992; Middleman, 1978; Tropp, 1977b; Steinberg, 1992, 1993, 1997, 2004; Strozier, 1997). While it has been observed that work with groups has been happening with great frequency, it is often not group work grounded in theory, the values of the profession, and/or evidence (Middleman, 1978; Steinberg, 1992). The concern has been traced most prominently to the Council on Social Work Education’s policy shift leading to an approach to education that calls for a generalist foundation so as to promote integrative practice (Northen and Kurland, 2001).
The concern about practice was forcefully stated by Tropp in 1968 at the 95th Annual Forum National Conference on Social Welfare in California (Tropp, 1977b). Tropp (1977b) stated his worry: “throughout social work today, groups are found adrift, at sea, with very little sense of direction, weak motivation or engaging in games of cooperative talk…to accommodate the worker, but signifying very little” (p.78). Tropp (1977b) saw this problem as stemming from a philosophy that promoted generalization instead of specialization. In 1966 Tropp cautioned that “the newest wave of the future in social work is the movement toward a unitary method of practice” (Tropp, 1977b, p.47).
Northen and Kurland (2001) explain the profession’s stance toward integrative practice: “The rationale for the integration of modalities is the view that social work practice is an entity made of several approaches…calling for work with an individual…family…small group…or with organizations in the community” (p.13). Consequently, social workers should be able to draw upon the specific skills needed to work effectively with each particular system (Northen and Kurland, 2001).
The problem, however, is that many schools of social work fail to adequately prepare graduating students to work effectively with groups (Birnbaum and Auerbach, 1994; Birnbaum and Wayne, 2000). In 1963 seventy six percent of MSW programs offered a group work concentration; in 1981 the percentage dropped to 22%; and in 1992 only 7% of MSW programs offered a group work concentration (Birnbaum and Auerbach, 1994). According to research conducted by Birnbaum and Auerbach in 1991 only 19% of schools require that students take a specific group work course, leaving most students to obtain their knowledge from the generalist foundation courses (Birnbaum and Auerbach, 1994). Survey research of faculty teaching generalist practice courses, however, indicates that meaningful group work concepts are not being taught sufficiently (Birnbaum and Wayne, 2000).
The erosion of group work education has resulted in practice that bears little resemblance to the professional standards for effective group work practice, as evidenced by research conducted by Steinberg (1992). Steinberg’s (1992) research comparing differences in approach to practice of those with more than two semesters of group work specific education and those with less indicated that group workers who had taken at least three group work courses were more likely to view their work from the two-client perspective; actively cultivate mutual aid and group autonomy; and view conflict as a normative aspect of group development.
Consequently, in the absence of substantial exposure to group practice theory, workers are left to draw upon strategies most appropriate for work with individuals (Hartford, 1978; Kurland and Salmon, 1992; Middleman, 1978; Steinberg, 1992, 1993). This approach to practice typically looks like work with an individual in a group setting (Hartford, 1978; Middleman, 1978; Steinberg, 1992, 1993). As a result of this approach members are typically recipients of the worker’s help; and do not engage in reciprocal relationship with one another (Steinberg, 2004). Group work is likely to become sterile; uninspired; devoid of mutual aid; and arguably ineffective (Freeman, 1987; Steinberg, 1992, 2004).
The concern has not gone unacknowledged by the CSWE and the Association for the Advancement of Social Work with Groups. In 1995 the two organizations partnered to develop publications designed to address the educational gaps (Shulman, 1998). Toward that end Kurland and Salmon (1998) published the first of this series entitled “Teaching a Methods Course in Social Work with Groups” written with the neophyte group work instructor in mind. A major goal of the teaching approach described is to facilitate students’ appreciation of what is uniquely group work “…especially, the essential power of mutual aid” (Kurland and Salmon, 1998, p.147).
Ironically perhaps, Schwartz (1977) was a proponent of an integrative approach to social work education. “It becomes clearer that the interactionist impetus is essentially integrative”, suggested Schwartz (1977, p. 1337). In theory there may be great benefit to such an educational approach, but as the evidence indicates, many social workers are inadequately prepared to work with groups effectively (Birnbaum and Auerbach, 1994; Birnbaum and Wayne, 2000; Steinberg, 1992, 1993). More research of both practice and education needs to be conducted to fully understand the impact of generalist education on group work practice (Kurland and Salmon, 2006; Northen and Kurland, 2001; Steinberg, 1992).

The Mutual Aid Model of Group Work

The Mutual Aid Model of group work practice (Gitterman, 2004) has its roots in the practice theory proposed by William Schwartz (1961) which was introduced in the article, “The Social Worker in the Group”. Schwartz (1961) envisioned the group as an “enterprise in mutual aid, an alliance of individuals who need each other in varying degrees, to work on certain common problems” (p.266). Schwartz elaborated: “the fact is that this is a helping system in which clients need each other as well as the worker. This need to use each other, to create not one but many helping relationships, is a vital ingredient of the group process and constitutes a need over and above the specific tasks for which the group was formed” (1961, p. 266).
Schwartz (1976) regarded this approach as resonant with the demands of a variety of group types including, natural and formed; therapeutic and task; open and closed; and voluntary and mandatory. Both the Mutual Aid Model and the concept of mutual aid have endured and continue to inform social work practice with groups (Gitterman, 2004).
Schwartz (1961) premised his approach to practice on ideas expressed by Kropotkin (1903), Dewey (1910), Mead (1934) and Simmel (1955) that illuminated the nature of the relationship between the individual and society. The model was premised on the proposition that there exists a reciprocal, symbiotic relationship between the individual and society, a dynamic encapsulated in the small group (Schwartz, 1961). This type of mutualistic symbiosis was expressed by Schwartz (1971) as the “need to use each other” to work on resolving common problems (p.7).
Schwartz (1977) contrasted this model with approaches that failed to collaboratively work with groups. More importantly he rejected the medical model wherein the worker “decides what is wrong”, “labels it” and prescribes the treatment (Schwartz, 1977, p.1331). This was not to say that the worker avoids using prior professionally obtained knowledge but rather the worker uses this knowledge to deepen “preliminary empathy” (Schwartz, 1977, p.1334). A similar perspective was advanced by Tropp (1977b) who suggested that the worker should employ a phenomenological approach and attend to “current group and individual behavior rather than on prior personality diagnosis” (p.96).
A concept common amongst social group work approaches has been the ‘two-client’ perspective which views both the individual and the group as the two clients engaged with the worker (Trecker, 1948; Schwartz, 1977; Steinberg, 2004). For Schwartz (1977) this dualism was resolved by observing that they both are inextricably linked, engaged in reciprocal relationship. Both the individual and the group “needs the other for its own life and growth” argued Schwartz (1961, p. 153). From this stance flowed Schwartz’ beliefs about the mediating role of the worker, a role he argued belonged to the social work profession at large (Schwarz, 1961, 1971, 1977).
Schwartz (1961) viewed the group as an organic whole and identified “the group organism as a complex of moving, interdependent human beings” (p.18). Expanding on this perspective he identified four main features of the group: the group is a “collective, in which people face and interact with each other; people need each other; the purpose of the group is oriented by needing to work on common problems or tasks; and the work of the group is embedded in the function of the agency” (Schwartz, 1976, p. 185).
Schwartz (1971) proposed that the tasks of the worker and the members of the group are interdependent but different, an idea he expressed as “parallel process” (Schwartz, 1971, p.10). The members of the group are charged with both helping themselves and each other (Schwartz, 1971, 1976). The nature of the help could be understood as deriving from the exchange of members’ personal views and experience as well as the expression of feeling (Schwartz, 1977).


Evolution of the Mutual Aid Model

The model proposed by Schwartz followed a historical, theoretical path along the mainstream of social group work (Papell and Rothman, 1980; Tropp, 1977a). According to Tropp (1977a) “the mainstream was more deeply explored by William Schwartz, who further elaborated the concepts of group function and worker involvement, while adding the dimensions of the mutual aid phenomenon and the contractual relation between worker and group” (p.1322).
Schwartz (1961, 1964) initially thought of this approach as an organic systems model (as he viewed the group as an organic whole) later to refer to it as the mediating model and then the interactionist model (Schwartz, 1977). The model initially proposed by Schwartz has been further developed most notably by Lawrence Shulman and Alex Gitterman, who have since referred to this model as the Mutual Aid Model (Gitterman, 2004, 2005; Shulman, 1979, 1992, 1999, 2005b; and Steinberg, 1997, 2004).
The change in nomenclature reflects shifting focus on the various facets of the model with attention to its philosophical underpinnings (reciprocal); to the focus on worker function and activity (mediating); to the emphasis on member interaction (interactional); and with the current appellation, the Mutual Aid Model, to the quality and nature of the interaction of the members (Gitterman, 2004; Middleman and Wood, 1990a; and Steinberg, 1997). Recently Shulman (2005a) introduced the alternate appellation “Mutual Aid Group Treatment” (MAGT) to contrast worker lead treatment groups with mutual aid self help groups (MASH).
Subsequent to presentation of this practice theory, Schwartz elaborated on this model in the following articles and/or chapters” “Toward a Strategy of Group Work Practice (1961); “Small Group Science and Group Work Practice” (1964); “Analysis of Papers Presented on Working Definitions of Group Work Practice” (1964); “On The Use of Groups In Social Work Practice” (1971a); “Social Group Work: The Interactionist Approach (1977); and “Between Client and System: The Mediating Function” (1976). Finally, an unfinished text believed to be written from the period of 1968 to 1972, entitled “Social Work with Groups: The Search for a Method”, was published in a collection of Schwartz’ work in 1994 by Toby Berman-Rossi called “Social Work: The Collected Writings of William Schwartz”.
Noting the importance of this model, Papell and Rothman (1966) identified the model’s primary contribution to social group work practice theory: “its outstanding contribution” is as “the construct of a mutual aid system with professional interventions” (p. 130). For Papell and Rothman, the conceptual strength of the model lay in the observation that “what had been vaguely referred to in the past as ‘helping members help themselves’ has acquired a higher level of theoretical statement. It is now possible to consider the attributes and culture of a specialized system and to transmit the skills necessary to support its realization. This is probably the single most important contribution that group work method can make to the social work profession at large (italics mine, 1966, p. 130). Sharpening Papell and Rothman’s observation, Schwartz (1976) would note that the worker invested in cultivating mutual aid had “the additional task of not only helping people help themselves, but to help each other as well” (p. 194).
Mutual aid would come to be regarded as a hallowed concept in the practice of social group work (Tropp, 1977b). Hartford (1976) noted that the cultivation of mutual aid had become central to generic group work practice. Echoing this observation, Papell and Rothman (1980) noted that “the conception of the group as a mutual aid system had become a universal one in all of group work practice” and had become a feature of the ‘mainstream’ of practice (1980, p. 9).