Five Considerations that Help Keep Groups that focus on “Psychosis” Inclusive:

I believe with fervor that having survivor-led group therapy that redefines “psychosis” is missing in the system. Over the last nine years I have been leading what I call special message groups in multicultural settings. I have found not only that such groups can be run safely, but that they have the power to transform lives. However, I do have to admit that when it comes to kicking people out of group to maintain group equilibrium and safety that I believe there are a few things to consider first.

First, I believe that a group leader needs to be prepared for the fact that mad people show up in very different ways. Group facilitators need to be familiar with and recognize a wide variety of presentations or manifestations. Perhaps group members may feel like they are being mocked by others in the group via illusionary ideas of reference, or even controlled by them. They may code up their language for protection. They may treat the facilitator as if the facilitator can hear the same voices they hear. They may not believe in spite of stories shared that the facilitator has experienced what they have. I myself have prepared myself for these challenges by attempting to better define what “psychosis” is. I have reconstructed a definition that can sync up a wide variety of what have historically been defined as conditions. I believe if the leader is not prepared to accept all presentations, people will not feel safe talking about their experiences. I believe that intolerance for people who show up in a different or what is perceived as a difficult manner can be extremely hurtful.

Second, I believe the facilitator can take measures to help train the group to be brave and tolerant of each other. I frame coming together with the specific purpose of sharing untold stories to be an oft neglected privilege that has unfortunately been denied because the “they” experts say it is not safe. I am always willing to start out with my own story. I advocate for a spirit of risk taking by acknowledging that people in the group may be so used to dangerous or distressing experiences that guaranteeing safety would be a disservice. I also might point out that despite what “they” say, this is a practice that has been an effective movement in different countries and that I have done for a long time. In my mind, these kinds of comments are treating the “set of symptoms” as a neglected culture that is subjugated. Moreover, keeping the group focused on the things they have in common with each other in the earlier stages of group development can help. Also strongly supporting alienated individuals also helps train the group to be more tolerant and can avoid many problems that come up in a group discouraging them from expecting a trouble maker from getting kicked out.
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