C.A.I.R. Self-help Groups
James O. Henman, Ph.D.
This article describes a new model of self-help groups presented at the CPA Annual Convention in San Diego. Psychologists are facing an increasing conflict between the long term therapeutic needs of clients and the realities of managed health care limitations. In response to this conflict there has been a growing attention to the development of brief treatment models and utilizing community resources outside of the therapy setting.
There has been a proliferation of Twelve-Step self-help groups addressing problems ranging from sexual addiction to eating disorders, with each group designed to deal with a specific problem area. Although C.A.I.R. (Changing Attitudes In Recovery) self-help groups are formed in the Twelve-Step tradition of people helping people, the organizing principle for the meetings is different. The common bond that draws members together is a commitment to growth and development of healthy self-esteem. The definition of self-esteem used in the groups has been adopted from the California Task Force to Promote Self-esteem and Personal and Social Responsibility: "Appreciating my own worth and importance and having the character to be accountable for myself and to act responsibly toward others" (California Task Force, 1990, p. 1). The process of healing self-esteem is termed recovery.
C.A.I.R. groups welcome everyone, regardless of the problems that lead to the desire for change. These problems may include chemical dependency, eating disorders, codependency, anxiety problems, depression, low self-esteem, relationship difficulties, etc. The groups have been designed to provide a safe place to practice the attitudes and tools necessary for recovery. This unique blend of diverse backgrounds with a shared focus on changing self-esteem, allows members to work together in a supportive "family" of people committed to learning and practicing a "New Program" way of life. This growing process takes place in an atmosphere of "no-fault learning." C.A.I.R. self-help group meetings follow the format presented in Changing Attitudes In Recovery - A Handbook On Esteem (Henman, 1990), and are designed to supplement brief cognitive psychotherapy and other Twelve-Step programs.
C.A.I.R. groups are based on eight fundamental principles which form New Program. These fundamental principles include: "1. Being non-judgmental, open, and accurate; 2. Believing that we are all Fallible Human Beings; 3. Understanding that we react to life through our perceptual filters rather than directly to "reality"; 4. Acknowledging and accepting the Reality of the Present; 5. Believing in Mutual Respect and Valuing; 6. Nurturing a healthy parenting relationship with the "wounded inner child"; 7. Nurturing a growing relationship with a Loving Higher Power; and 8. Maintaining a continuing commitment to recovery, both our own and others'" (Henman, 1990, p. 84).
There is no cost for attending C.A.I.R. meetings. The group meetings are designed to last an hour and a half. The first hour is held in a large group format for a more structured learning process. Selected paragraphs from the Handbook are read aloud to help focus and stimulate discussion on important issues in recovery and the change process. The Handbook gives general principles and tools, the members contribute the personal examples. In the last half hour the members break into small groups to informally discuss issues related to their growth into recovery. An introduction from the Handbook is read aloud at the beginning of each meeting to define the goals and expectations of the group. Mutual respect and safety are strongly emphasized, with all members sharing in the responsibility to insure this atmosphere. The Handbook contains a "Recovery Tool Box" full of cognitive and behavioral tools to help the members constructively address issues shared in the meetings.
New members are given the following one page "welcome" from the steering committee at their first meeting:
"We are glad that you are here. It is nice for us to have company on the journey. We understand that you may feel uncomfortable, because we have all felt the same way. We are all traveling on this Recovery Path together (however imperfectly), but in the group atmosphere of "NO-FAULT LEARNING", we are free to accept ourselves and others "in transit". Please feel free to share your experiences or just listen -- it is O.K. not to talk. If your usual way of dealing with being nervous is to become silent and "invisible", we encourage you to share that as a starting point. If you often hide behind words, allow yourself to quietly listen, even to the silences, to begin to learn what you are feeling.
The C.A.I.R. Handbook has a full description of the C.A.I.R. group process (pages 80-85), but we felt it would be helpful to have this sheet for new members that emphasizes some of the important guidelines of C.A.I.R. We try to create an atmosphere within the C.A.I.R. groups of safety to support healthy esteem, in ourselves and with our "family" of C.A.I.R. We can brainstorm and share tools and principles to help in the growing process. We don't have to walk alone!
No one, however well intentioned, is allowed to breech that safety by asking directed questions, giving advice, making judgmental or comparative statements, or any other form of communication that violates the principles of New Program. We are all free to move along at our own pace. Mutual Respect is shown through the acceptance of each of us where we are on the Recovery Path (page 110). We will support the New Program Adult in each of us.
It is helpful to use 'I' statements that relate our own personal experiences. We do not use "You" statements such as, "Your problem is . . .", and "You need to . . .". If a group member shares a feeling that you identify with, a personal example of how a similar situation was or was not processed in your own experience is the way C.A.I.R.. works. This means of sharing allows us to check our "masks" at the door, knowing we will be safe and not have to fear being "put on the spot" or judged. No member has the right to consistently endanger the feelings of safety. We are all equally responsible for sharing in a respectful way with the group these feelings of unsafety (pages 1-3).
C.A.I.R. groups are about caring and sharing. The more you come to meetings, the easier it is to allow yourself to be open to New Program. We surprise ourselves by our ability to share things that we have found impossible to share with family or friends in the past. C.A.I.R. groups become like a family that can share good times and bad times with the security of being accepted where we are on our Journey at the time. We practice New Program together and celebrate our growth. Again, WELCOME!! We look forward to you being a member of our C.A.I.R. family."
The theories underlying the Handbook are based on Cognitive-Perceptual Reconstruction (Henman, 1987; Henman & Henman, 1990), an integrative psychotherapy designed to work with Adult Children of Dysfunction. The Handbook utilizes these tools and principles in a self-help context.
The first meeting of a C.A.I.R. group was held in Modesto, CA. in the Spring of 1990. A steering committee of recovering individuals from a variety of problem backgrounds helped to develop the group process for C.A.I.R. meetings and gave feedback on material in the Handbook. This steering committee formed the core for the first C.A.I.R. meeting. When attendance began to run consistently above 30 members, the steering committee found a second meeting site on another day. There are now meetings held in Modesto on every night of the week. There are currently also groups in Ceres, Merced, Roseville, Sacramento, San Diego, Sonora, Stockton, and Turlock. Specific instructions for forming new C.A.I.R. groups are given in the Handbook. A complimentary "Chairperson's C.A.I.R. Binder" is available for new groups. For more information on meetings and the Handbook, contact Psychological Associates Press.