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##  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                   Remolino (2000). 
* 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 true             identity. 
* 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. FUTURE DIRECTIONSThe 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. CONCLUSIONOnline 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. REFERENCESBloom, J. (1997).                 NBCC webcounseling standards. Counseling Today, 40 (5),                         6. 
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 Association. 
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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Juneau Mahan Gary is an Assistant Professor              at Kean University, Union, NJ. 
Linda Remolino hosts an online                 support group and is a School Counselor at West Orange Board of                 Education, West Orange, NJ. 
ERIC Digests are in the public domain             and may be freely reproduced and disseminated.  This publication was            funded by the U.S. Department of Education, Office of Educational               Research and Improvement, Contract No. ED-99-CO-0014. Opinions                  expressed in this report do not necessarily reflect the positions of            the U.S. Department of Education, OERI, or ERIC/CASS.                        **Title:** Online Support Groups: Nuts and Bolts, Benefits, Limitations and                Future Directions. ERIC/CASS Digest.                                         **Document Type:** Information Analyses---ERIC Information Analysis Products (IAPs) (071); Information Analyses---ERIC Digests (Selected) in Full Text (073); **Available From:** ERIC Counseling and Student Services Clearinghouse, University of               North Carolina at Greensboro, 201 Ferguson Building, P.O. Box 26171,            Greensboro, NC 27402-6171. Tel: 336-334-4114; Tel:                              800-414-9769 (Toll Free); Fax: 336-334-4116; e-mail:                            [email protected]; Web site: http://ericcass.uncg.edu.                       **Descriptors:** Counseling,  Internet,  Social Support Groups, Technology                    **Identifiers:**
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