professionals and mutual aid: becoming competent collaborators

PROFESSIONALS AND MUTUAL AID: Becoming Competent CollaboratorsAuthor(s): Andy FarquharsonSource: Canadian Social Work Review / Revue canadienne de service social, Vol. 12, No. 1(Winter/hiver 1995), pp. 36-44Published by: Canadian Association for Social Work Education (CASWE)Stable URL: http://www.jstor.org/stable/41669579 .

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PROFESSIONALS AND

MUTUAL AID

Becoming Competent Collaborators

Andy Farquharson

The HUMAN SERVICE field is preoccupied with a number of concerns in the middle of this decade, among them a need for much more collaborative and cost-effective ways of delivering services. This has contributed in part to a growing professional recognition of the important role that mutual aid groups play in the elaborate network of formal and informal systems of social support. In turn this has encouraged a number of well-intentioned professionals to become more proactive in their relationships with such groups. This development carries with it the dan- ger that too much professional enthusiasm can have some less than posi- tive consequences unless the unique nature of informal mutual aid is recognized and respected. For example, people who lack the kind of motivation and strengths required for effective participation in a self- help group may be too aggressively steered towards affiliation with a mutual aid group. Another possibility is that the professional training of group leaders may contaminate some of the effective ingredients of non-professional mutual aid: reciprocal helping can become con- strained, informal social support can be progressively displaced by

Abrégé Les professionnels des services sociaux prennent de plus en plus conscience de la vaste gamme de groupes d'entraide qui existent et certains reconnaissent leur importance. Cependant, il faut les sensibiliser davantage aux avantages de l'entraide ainsi qu'au rôle de soutien qu'ils peuvent jouer à cet égard. Ce projet visait à mettre au point un profil sur les attitudes, les connaissances et les com- pétences dont les professionnels ont besoin pour collaborer efficacement avec de tels groupes. Une liste de ressources pour les cours sur les groupes d'entraide à l'intention des professionnels a été dressée à partir de ce profil. Andy Farquharson is a professor in the School of Social Work at the University of Victoria. The project upon which this article is based was funded by National Welfare Grants , Health and Welfare Canada.

Canadian Social Work Review, Volume 12, Number 1 (Winter 1995) / Revue canadienne de service social, volume 12, numéro 1 (hiver 1995) Printed in Canada / Imprimé au Canada

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Canadian Social Work Review, Volume 12 (Winter) 37

formal problem-solving, and experiential know-how (Borkman, 1976, 1990) can become subordinated to professional knowledge.

To support effective professional collaboration with self-helpers the author became increasingly involved both in continuing professional education and in the preparation of people entering the human service professions. It was evident in the emerging literature that the elements of such effective collaboration were only understood in a preliminary way and primarily from a professional perspective. Exceptions were found in some of the more recent work by Judy Wilson (1993). It was also apparent that, together with a more member-centred analysis of the potential for collaboration, there was a need for a better range of instructional resources to support educational process that would include a more intensive critique of the assumptions built into some professional practice perspectives. It was also understood that professionals would need to hone existing new competencies and develop some fresh ones to support innovative forms of collaboration. These related needs led to the design of the project outlined here: the development of a profile of the professional competencies required for effective relationships with self-help and mutual aid groups and the creation of materials to support the acquisition of these competencies.

The project The joint venture of profiling professional abilities and creating training materials to support their development was completed in 1991 with funding from the federal government of Canada. The procedure fol- lowed during the first phase, creating the competency profile, involved an approach that drew on both the Delphi Technique (Bunning, 1979), a curriculum development approach known as DACUM (Adams, 1975), and the work of Jerrold Kemp (1985) on the instructional design process. The development of the competency profile proceeded in three stages: first, an exploration of the collaborative skills for professionals that had been detailed in published articles; secondly, a verification and amplification of these stated competencies by selected professionals collaborating with self-helpers; and, finally, a series of national consultations with members of self-help groups.

A variety of roles and activities were identified in the review of the professional literature about the relationships between self-help groups and professionals. One summary is representative of what may be found in the published material that describes the potential roles for professional collaboration with mutual aid groups:

1) making referrals; 2) providing material resources and fund-raising; 3) helping with public relations; 4) facilitating contacts with policy makers;



38 Revue canadienne de service social, volume 12 (hiver)

5) providing technical information and assistance; 6) helping design and carry out evaluative studies; 7) forming and providing guidance to new groups; and 8) serving on advisory committees. (Katz, 1987, p. 22)

In all, the literature review yielded more than 50 items of knowledge, skill, or attitude seen to influence the effective practice of professionals with self-help groups. In the next stage these competency statements were mailed across Canada to key professionals engaged in practice with self-helpers and these individuals were asked to weight the importance of these abilities and to contribute others that they saw as significant. Fifty-five additional competencies were identified through this process. In the final stage an essential contribution was made by self-helpers themselves. Seven regional consultations were held across the country from Victoria to Halifax, and more than 200 other items of knowledge, attitude, or skill were suggested by the self-help group members who participated.

The final task of this first phase of the project was to group the more than 300 desired professional competencies into perceived categories. Two judges, working at first independently, were eventually able to gather the various qualities and abilities into 25 categories, each of which was assigned a competency statement that reflected either an item of knowledge, an attitude, or a desired professional skill. These competency statements were then organized into a two-dimensional frame- work, one dimension reflecting general domains of competence and the other indicating the stages in which these various abilities might be developed during a professional's ongoing educational journey.1

Findings The 25 identified competency clusters appeared to relate to four stages of practitioner development: fundamental attributes of the beginning professional; emerging awareness of the presence and the potency of mutual aid groups; emerging collaboration with the groups, particularly in the areas of referral and information sharing; and, lastly, more sophis- ticated or interventive practice such as consultation, research, or policy development.

The first stage of this conceptual model primarily describes attitudes that one would expect to find in any capable human service professional: a respect for partnership in the healing/wellness process, flexibil- ity, recognition of the strengths and abilities of people, and a regard for confidentiality. The message about these fundamental attitudes is best captured in the words of one participant in the national consultation with self-helpers: "The ideal professional respects my dignity as a human being, treats me as a colleague, not as an authority over me, values my experience and my point of view and consults me as to anything that



Canadian Social Work Review, Volume 1 2 (Winter) 39

may affect my life." The self-help group members who were consulted expressed the view that, given time, people can either recover through mutual aid or at least achieve an improved quality of life. In this vein, they thought that human service professionals need to have less fear of situations that they cannot cure, to be more hopeful of change, and to be more willing to spend time with people who have conditions that may involve acceptance rather than recovery. Such attitudes seem so fundamental to responsible practice that these competency statements were grouped under the heading of pre-conditions to learning about practice with mutual aid groups.

It is suggested that the second stage of professional development is entered as the practitioner begins to cultivate a growing awareness of the place and the process of the mutual aid phenomenon. The competencies in this stage include not only specific knowledge about the range of groups and the benefits that tfiey can provide, but also development of respect for experiential know-how, including the ability of the professional to learn from this type of understanding (Belenky et al., 1986). Thomasina Borkman (1976) has described such experiential knowledge as "truth learned from personal experience with a phenomenon rather than truth acquired by discursive reasoning, observation or reflection on information provided by others/' In contrast, she views professional knowledge as "truth developed, applied and transmitted by an estab- lished specialized occupation . . . limited to those who . . . possess appropriate credentials." A self-help group member contacted during this study summarized the issue more succinctly: "Professionals need to believe that self-helpers can help." Professionals and self-helpers noted the need for professionals to understand the respective contributions that both parties make to the helping/coping process and to be alert to the impact that professionals can have on the dynamics of a self-help group. The group members who were consulted tended not to perceive themselves as competing with professionals but rather as exchanging a different kind of support from that offered by formal services. Repre- sentatives from both groups stressed that professionals need to preserve some humility about the efficacy of their own therapeutic strategies and to maintain respect for the unique perspective of the insider's view of a given difficulty. The ability to listen and learn from clients and patients, to hold knowledge tentatively, and to share ideas respectfully were professional attributes highly valued by these self-helpers.

The competencies included in the third stage of continuing professional development are those associated with more direct collaboration with self-help groups and potential group members. Key activities include making appropriate referrals, sharing useful information with group members, and using self-helpers as a learning resource for themselves and others.




The respondents indicated that to make effective referrals the professional must have an awareness of the full range of self-help groups that exist in the community. Given the dynamic nature of the mutual aid movement, it is difficult to remain fully in touch with all of the emerging groups; however, it is important to maintain continuing contact with information and referral services and self-help clearinghouses where these exist. In initiating a potential referral to a self-help group the professional is encouraged to support the individual in exploring a variety of groups or group chapters that relate to the particular concern and in exercising his or her own judgment in selecting a resource that appears to be suitable.

The other array of professional competencies identified as essential to collaboration with mutual aid groups pertains to the ability to share the most recent relevant scientific or professional knowledge with group members. In the regional consultations with group members it was fre- quently noted that professionals have much information that would be of value if it were shared in open and understandable ways with the groups. Self-helpers did not understand an apparent professional reluc- tance to communicate cutting-edge information about their concerns and they wanted professionals to appreciate that they were able to handle such information in an appropriate manner.

Those who contributed to this consultative process also noted that information-sharing was preferable as a two-way process and that professionals could learn much through careful attention to what their patients/ clients had to say about their experiences, their conceptions of what gave rise to these events, and their notions of the effective pathways to a sense of well-being.

The term "Advanced Practice" has been coined to describe the clus- ter of abilities associated with a more interventive role for professionals in relation to self-help groups. The assumption is that the practitioner should have developed competence in the three earlier stages of development before presuming to engage in such activities as initiating new groups, consulting on group process, managing evaluation studies, or shaping social policy in regard to mutual aid.

One of the more controversial issues in advanced professional practice with self-help groups hinges on the role of the professional in initiating new mutual aid networks. Clearly many people in the human service professions are strategically located to be aware of those who share concerns that might be addressed through mutual aid, but this raises issues of confidentiality and of group autonomy. To what extent should the practitioner be actively engaged in linking people who have revealed dif- ficulties that they share in common? What are the legal and ethical rami- fications for a professional who endorses lay helping within a self-help alliance? How can the professional play a role in the emergence of new




groups without fostering a reliance on professional leadership and professional notions of the path to wellness? Self-helpers and professionals alike felt that there was a need for constant vigilance on the part of professionals to ensure that they were not assuming duties that were within the capacity of group members. In situations where professionals could play a role in initiating a new self-help group, from the start of the process they should be planning their withdrawal from the group. Given these caveats it was recognized that there were circumstances in which professionals could play a useful part in the process of convening a new mutual aid group.

The role of the professional in consulting with groups around difficul- ties that they might experience in retaining members and sustaining productive group relationships was perceived differently by the two groups of respondents. The professionals tended to see themselves as having a variety of skills to bring to bear on the task of helping the groups to solve process problems, but the self-helpers were more cau- tious. Group members wanted people from the human service professions to share current information and to make referrals, but they were hesitant about other kinds of interventions. In sum, their comments reflected the self-help slogan that suggests that professionals should be "On tap, not on top."

The place of the professional in conducting research on mutual aid groups raises difficult issues centred on the extent to which research methodologies may intrude on the informal, confidential character of many groups. There is also the obvious problem of the outsider status of most researchers in contrast to the insider perspective (Narayan, 1989) of the self-helpers. In fact, most of the self-helpers who were consulted in the course of this project expressed little interest in participating in evaluative studies. An exception came from one self-helper who stated: "Professionals need to know more about self-help. Hopefully your project will help break down the barriers between us." Professional interest in understanding the self-help phenomenon does continue to grow and this points to the need for clearer guidelines for ethical research practice in this area. A beginning attempt to explore these ethical issues was undertaken at the International Conference on Self-Help in Canada in 1992 (Lavoie et al., 1994). In a similar vein, professionals rather than self-helpers were concerned that practitioners need to develop the capacity to shape social policies that will support and enhance self-help groups. These respondents expressed the concern that careful attention was necessary to ensure that such policies do not place an unrealistic car- ing load on the resource represented by self-help groups.




Development of instructional resources The first phase of the project was completed with the development of the overall competency profile for professionals collaborating with self- help groups, and the next task was to create and collect a range of instructional resources to support professional education about mutual aid. The goal for this phase of the project was to develop print and video resources which could be used by a workshop facilitator in conducting continuing professional education or by those teaching in professional schools. The kit materials (Cardinal 8c Farquharson, 1991) are con- tained in a three-ring binder to facilitate photocopying and there are four main sections: the competency profile and a report of the findings on which it was based, guidelines for trainers using the resource materials, a set of structured learning exercises, and 10 papers by some of the key authorities in the field.

At the outset it was recognized that there was a particular need for well-crafted experiential learning exercises which would allow learners to become actively involved in exploring knowledge, attitudes, and skills requisite for collaboration with mutual aid groups. Experiential learning in this case may be defined as the learning that "occurs when a person engages in some activity, looks back at the activity critically, abstracts some useful insight from the analysis and puts the results to work" (Pfeiffer 8c Jones, 1980). In all, 18 such structured exercises were developed, reflecting a variety of experiential learning activities: values clarifi- cation, guided imagery, role play, in-basket simulation, critical incidents, and problem-solving challenges. A model for managing experiential learning appears at the start of this section of the kit, and guidelines for the facilitator and the learners are included as part of the preamble to each exercise.

Developing the resources section of the kit entailed a further careful review of the professional literature, and 10 articles were selected for inclusion. This section also contains annotations on more than 30 additional books and articles and a complete reference list. Both the anno- tated articles and the structured learning exercises are referenced to specific competencies identified on the chart.

Two other resources are included with the kit: a booklet entitled Part- ners in Wellness (Katz, 1987) and a videocassette with four vignettes that depict some issues between professionals and self-helpers. These include an encounter between a group of bereaved parents and a helping professional, a hasty and ill-informed referral by a physician to a caregivers' support group, and two men sharing their insider's perspective on the issues involved in living with AIDS.




Conclusion Thus far more than 150 kits have been purchased at cost by individuals, professional associations, government departments, and a range of service and educational institutions. There has been no formal evaluation of the way in which the materials are being implemented, but anecdotal reports indicate that they have been widely used in continuing professional education. It would seem that people who are active and skilful workshop leaders are more likely to draw on the resource kit than those with less training experience. This may suggest a need to offer train-the- trainer sessions to build confidence in making use of the materials. It is much less clear how extensively the kit is being used within the curricula of professional schools, and this may reflect that self-help groups are still not receiving the kind of attention required in the preparation of human service practitioners.

This project represents an early step in the journey towards understanding the preferred character of competent professional collaboration with mutual aid groups. The instructional materials that are included illustrate some of the ways in which these various competencies might be achieved. As we carried out this work it became evident that there are many existing print and video resources that could be used to support this type of professional education, but they are not easy to locate or access. There is a need for a national/international inventory of such materials so that they can be used more widely and conveniently. Clearly, there are many other ways to help professionals learn about self- help (Farquharson, 1991), and the most obvious and potent resource is represented by self-helpers themselves. It would be nice to think that self-help group members would routinely be a part of any professional education about mutual aid, providing insider perspectives on a broad range of health and social issues. As professionals we will always have more to learn; self-helpers can support us on this lifelong journey if we create opportunities to learn from them. This project also demonstrates the real value of developing resource kits to support the work of those involved in continuing professional social work education, as well as for those teaching within schools of social work. Potent new educational technologies are now available to support aspects of a similar approach to other topics pertaining to continuing professional development.

NOTE 1 Copies of the full competency profile and other descriptive materials may be obtained from the author, c/o School of Social Work, University of Victoria, Box 1700, Victoria, B.C. V8W2Y2.




REFERENCES Adams, R. E. (1975). DACUM: Approach to Curriculum, Learning and Evaluation in

Occupational Training. Ottawa: Department of Regional and Economic Expansion.

Belenky, M. F., B. M. Clinchy, N. R. Goldberger, &J. M. Tarule (1986). Women's Ways of Knowing. New York: Basic Books.

Borkman, T. (1976). "Experiential Knowledge: A New Concept for the Analysis of Self-Help Groups." Social Service Review 50, 445-456.

Borkman, T. (1990). "Experiential, Professional and Lay Frames of Reference." In T. Powell, ed., Working With Self-Help , pp. 3-30. Silver Spring, Md.: National Association of Social Workers.

Bunning, R. L. (1979). "The Delphi Technique: A Projection Tool for Serious Inquiry." In J. E. Jones & J. W. Pfeiffer, eds., The Annual Handbook for Group Facilitators y pp. 174-181. Lajolla, Calif.: University Associates.

Cardinal, J., 8c A. Farquharson (1991). The Self Help Resource Kit. Victoria, B.C.: University of Victoria.

Farquharson, A. (1991). "Pathways to Perspective Transformation Among Human Service Professionals." Proceedings of Professionals' Ways of Knowing. AAACE Pre-Conference, Montreal.

Katz, A. H. (1987). Partners in Wellness: Self Help Groups and Professionals. San Francisco: California Department of Mental Health.

Kemp, J. (1985). The Instructional Design Process. New York: Harper 8c Row. Lavoie, F., A. Farquharson, & M. Kennedy (1994). Ethical Issues in Professional

and Self Help Collaboration. Ottawa: Self-Help Canada. Narayan, U. (1989). "Working Together Across Difference." In B. Compton 8c

B. Galaway, eds., Social Work Processes , pp. 317-328. Belmont, Calif.: Wads- worth.

Pfeiffer, J. W., &J. E.Jones (1980). The Annual Handbook for Group Fadlitators. La Jolla, Calif.: University Associates.

Wilson, J. ( 1993) . Breaking the Barriers Down: An Analysis of Interviews with Self Help Groups. Working Paper no. 1. Nottingham, U.K.: Self-Help Groups and Community Care.



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