ERIC Identifier: ED446330 Publication Date: 2000-07-00
Author: Gary, Juneau M. - Remolino, Linda Source: ERIC
Clearinghouse on Counseling and Student Services Greensboro NC.
Online Support Groups: Nuts and Bolts, Benefits, Limitations
and Future Directions. ERIC/CASS Digest.
Traditionally, people discuss emotionally distressing issues with someone
they know, with someone in a similar situation, with a mental health
professional or do not discuss the issue at all. Computer technology is now
altering the traditional ways people handle stress. More people participate in
online support groups on such thematic topics as alcoholism, eating disorders
and depression which provide privacy from the comfort of home.
Online support groups can range from serving as one therapeutic component of
a comprehensive mental health treatment plan to serving as the sole support
system. They attract a broad variety of members who may previously have avoided
peers and their traditional support system. Satisfied members report feeling
validation and support while dissatisfied members express frustration caused by
technology problems and by the absence of visual, auditory and interpersonal
cues (Galinsky, Schopler & Abell, 1996).
NUTS AND BOLTS OF ONLINE SUPPORT GROUPS
* Access. Online
support groups can be accessed through use of a computer and modem in
conjunction with an Internet service provider (ISP) such as America Online
(AOL). Once connected through an ISP, online support groups may also be reached
through Internet portals (e.g., Yahoo) or through specialized websites (e.g.,
www.onlinepsych.com or www.stresscenter.com).
* Format. Online support groups can function in real time (i.e., synchronous
group) and through newsgroups (i.e., asynchronous groups):
* Synchronous Groups. Groups are interactive. Members correspond anonymously
using text-based communication in real time. These groups use contrived screen
names (i.e., pseudonyms), meet at a scheduled time to encourage consistent
participation and convene for one hour on average. Limited expressions of
emotions are conveyed symbolically by emoticons as illustrated in Gary and
* Asynchronous Groups. Members post messages and questions twenty-four hours
in newsgroups to a specific member or to the general membership. This format
allows members to send and retrieve messages at their convenience and regardless
of their time zone.
* Group Leader. Groups are led by hosts who may be a mixture of mental health
professionals and non-professionals, depending on the site. Hosts function as
resource persons rather than online counselors. They use human relations skills
to assist members in expressing feelings, disseminate information and make
referrals to helplines, self-help resources, traditional support/self-help
groups, local counseling centers, crisis centers, and hospice centers. They also
recommend links to other online support groups, mental health web sites and
fee-based cyber mental health services. An excerpt from a typical online support
group session for loss issues can be found in Gary and Remolino (2000).
STRENGTHS OF ONLINE SUPPORT GROUPS
* Increased Access to
Support. Online support groups reduce the sense of isolation for those who
reside in underserved or remote locations, are housebound, need additional
support between traditional support groups or counseling sessions, or seek
anonymity. Internet access at a library, after-school program or community
center enables a person with limited financial resources to participate as an
equal member without financial resources becoming a barrier.
* Adjunct to Counseling. Online support groups can function as an effective
therapeutic adjunct to counseling services for members who require more support
than counseling offers and/or more frequent support than counseling provides. A
member can join several free online support groups between counseling sessions
and seek support without experiencing additional expenses.
* Therapeutic Factors. Members of online support groups benefit from Yalom's
(1995) seven therapeutic factors. Through a combination of therapeutic factors,
the potential for growth, change and social experimentation contribute to the
group's cohesion and perceived helpfulness. For example, the factor of
"universality" unites people as they share similar thoughts, feelings, fears
and/or reactions with their cyber community. Others struggle too, and this is
not always evident to people in distress.
* Specialized Online Support Groups. Specialized groups can connect people
who need someone with whom they can communicate honestly and openly without
regard to geographic boundaries. Groups dedicated to specific topics, age groups
or gender groups can be formed.
* Privacy. Groups give members the privacy to seek support and information
about behavior that might be perceived as a stigma and thereby become a barrier
to seeking counseling and/or information. However, to ensure privacy, a member
should minimize participation in an online support group at an employer's
computer, during the lunch hour for example, because the employer may be legally
entitled to monitor transmissions and computer activity (Hughes, 2000).
LIMITATIONS OF ONLINE SUPPORT GROUPS
* Differing Stages of
Group Development. Groups are open continuously to new membership. In addition
to new members joining an established group, other online members may log on or
log off at any time during a session. Such fluctuations in membership make it
difficult for online groups to engage in the typical group phases of warm-up,
action and closure or to maintain the working stage of group development for
extended periods. This limitation reduces the efficacy of online support groups
as a sole support source for some members.
* Limited Feedback. The lack of face-to-face contact obscures vocal
intonations and verbal and non-verbal cues, including body language and
expressions of emotion. Limited feedback may require changes in a member's
habitual patterns of interaction and thinking in order to overcome this
limitation. Dissatisfied members typically cite limited feedback as a
disincentive to participate (Galinsky et al., 1996).
* Crisis Management. The successful resolution of an emotional crisis in
cyberspace is challenging. Limited feedback and the lack of identifying
information complicate the assessment and referral process.
* Anonymity Breaches. Steps are taken to maintain the anonymity of each
member and the confidentiality of group dialogue. For example, the host
discourages the exchange of identifying information and personal communication
between members. However, anonymity can be breached. Members must consider the
risk of a breach in anonymity before joining.
* Host Competency. Requirements for hosts vary among websites, portals and
ISPs. Hosts should state their professional qualifications (or indicate none) at
the beginning of each session, or during orientation, while not divulging their
* Quality Control. The quality of online support groups is inconsistent. Each
sets its own standards and procedures. The new user should try several groups in
search of the best fit.
* Members with Limited Language Skills. Members with an expressive or
receptive learning disability or with language limitations (such as English as a
second language) may be frustrated by the rapid pace and multiple dialogues, and
consequently, may be frustrated by text-based communication. Furthermore,
members may be challenged in communicating feelings and thoughts clearly to
others. In a text-only format with limited interpersonal feedback, communicative
misunderstandings are common for all members and this could be exacerbated for
the member with limited language skills. We recommend software programs that
convert spoken words to text and vice versa.
* Ethical and Legal Concerns. The hosting of and participation in online
support groups raises some ethical and legal questions that currently remain
unanswered. Currently, it is unclear if the online support group is considered a
cyberspace mental health service. However, several mental health professional
organizations and licensing boards have begun to grapple with cyberspace ethical
and legal issues (Bloom, 1997).
* Hoax Perpetuations. People with unscrupulous motives can deceive an online
support group. Hoaxes tend to occur because members are anonymous or lack an
emotional commitment to the cybercommunity.
The quality and speed of computers and
Internet technology steadily improves. For example, Internet software such as "OnLive Traveler", "The Palance" (The Palance, Inc., 1998) or "e-mail Voice
Link" use microphones and speakers to communicate. With the addition of a video
camera connected to the audio equipment, Video Teleconferencing (VTC) enables
members to maintain visual and audio contact. Technological advances can make
online support groups somewhat comparable to face-to-face support groups while
avoiding the inconveniences associated with gathering at a specific location.
However, some of the benefits of privacy and anonymity that members currently
enjoy and find unique about online support would be compromised to various
degrees. Finally, "Internet time" is a relatively new global concept of time
that should facilitate the scheduling of online support groups across time zones
(Lockridge, 1999). It transcends time zones and makes the time of day the same
across all time zones.
Online support groups provide an alternative
vehicle of support for people in distress by linking people with similar issues.
They have the potential to improve the access and delivery of support to a wide
range of people, including some who would not seek face-to-face support at all.
Finally, they reduce the sense of isolation caused by geographic or
physical/medical constraints and increase feelings of validation. However, they
are not appropriate for everyone.
Galinsky, M., Schopler, J., & Abell, M. (1996). Connecting group members
through telephone and computer groups. Social Work with Groups, 19 (3-4), 21-39.
Gary, J. & Remolino, L. (2000). Coping with loss and grief through
on-line support groups. In J. Bloom & G. Walz (Eds.), Cybercounseling and
cyberlearning: Strategies and resources for the millennium (pp. 95-115).
Alexandria, VA: American Counseling Association.
Hughes, R. (2000). Cybercounseling and regulations: Quagmire or quest? In J.
Bloom & G. Walz (Eds.), Cybercounseling and cyberlearning: Strategies and
resources for the millennium (pp. 321-338). Alexandria, VA: American Counseling
Lockridge, R. (Correspondent). (1999, February 27). Internet time: Will the
"beat" go on? Science and Technology Week. Atlanta, GA: CNN.
The Palance (Version 3.4.2) [Computer software]. (1998). Cupertino, CA:
Electric Communities Co.
Yalom, I. (1995). The theory and practice of group psychotherapy (fourth
ed.). New York: Basic Books.
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