PEER SUPPORT GROUP AS COLLECTIVE CARE
Vol 8 #2
Caroline Giroux, MD, FRCPC
Associate Clinical Professor, Psychiatrist, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]
Over the past months, our current world has been witnessing changes, complexity and levels of uncertainty of unprecedented magnitude. Becoming conscious of and naming the societal trauma that is befalling us will necessitate collective healing, just like in the aftermath of major global crises, disasters and war. One term that really spoke to me recently, as people were reminding all of us healthcare professionals and the society as a whole to engage in self-care, is the term “collective care”.
During our recently monthly zoom call, among the Trauma Recovery Centers (programs developed in certain American cities to assist survivors of violent crimes), it became clear that we needed to support each other as we continue to do our work with our wounded patients.
In California, just like in various places on the globe, we had to switch gears rapidly to adapt to shelter in place orders, putting home visits on hold and changing in-person visits to phone or video visits. Unfortunately, this experience has demonstrated once again that domestic violence and child abuse escalate during such crises, and since even at baseline we, healthcare providers working with survivors of trauma, are usually at risk of secondary traumatization, we can easily imagine the additional strain experienced by healers as they might watch, somewhat helplessly, the repercussions of confinement and physical distancing on our vulnerable populations. Various other concerns were also shared among TRC staff that day. As a result, the founders of the first Trauma Recovery Center at the University of California in San Francisco offered to schedule a weekly call in order to provide TRC staff from various cities and states an opportunity to address salient concerns, provide peer support and boost our resilience in these challenging times and beyond.
During our first support session, our lead introduced the topic as “collective care”. It made so much sense to me: collective care, or self-care within interconnectedness, for collective healing. Check-ins, sharing tips, naming one thing to be thankful for and reading inspiration quotes had become gradually integrated in my approach to groups, whether it is the peer support group for a specialty in our institution working in the frontlines and likely to suffer from direct trauma during this healthcare crisis, or the trauma survivors psychoeducational group I am already leading at our clinic since 2018. But this additional context of intersecting self-care from different sources consolidated and expanded my philosophy of care.
Participants from the latter group voiced many times how meaningful the bonding with others has been for them. They look forward to such a session even if it has been switched to virtual format from now. While on vacation, and because of this unusual situation, I decided to continue to offer the group therapy remotely. In times of adversity, it is essential to connect with others to process difficult emotions, to express and receive compassion, and to challenge dysfunctional beliefs stemming from irrational fear by expanding the perspective. This can constitute the foundation for growth and healing within a therapeutic frame. And for me, remaining available provides a sense of meaning that can buffer helplessness feelings.
Mindfulness meditation (or full presence or attention without judgment) as self-care has benefits that have been extensively studied. Namely, meditation can activate the parasympathetic nervous system, which is restorative as opposed to the sympathetic nervous system (the so-called “fight or flight” nervous system, essential for survival, but when overly and chronically activated, it can be deleterious for the general health and create complications). From a neuroplasticity standpoint, mindfulness practices can reshape certain brain structures and increase grey matter in brain regions that handle attention, compassion, empathy . It also improves immune function  and general wellbeing.
Doing this in group has additional benefits. By seeing or being aware of others doing an activity, mirror-neurons get activated; seeing experienced meditators being able to sit still and breathe peacefully can be relaxing in itself and inspiring. It can also improve motivation and accountability. To illustrate that meditation as a group could have more impact, Tim Desmond wrote: “Thich Nhat Hanh would also warn his students against trying to practice mindfulness without the support of a community. He said “it’s like a raindrop landing on the top of a mountain and hoping to make it all the way to the ocean by itself. However, if it can go as part of a river, reaching its destination becomes possible. If we can find people who share our aspirations, our collective energy becomes a river carrying us in the direction we want to go”. 
Before the pandemic hit, a tragedy at work prompted me to organize a healing circle for psychiatry residents and staff who just wanted to sit together and meditate before sharing. I was inspired by the quote above and could experience the power of just being together, somewhat co-suffering and co-healing.
Being in group is also an opportunity to practice kindness by saying encouraging words, by learning to interact respectfully with others (for instance, by being mindful of how much sharing one does to make sure everyone has a turn to speak). Traditional hierarchies in our health care systems are also abolished. It is especially meaningful and almost a form of resistance; we extend a hand to all in need, regardless of gender, age, race, religion or socio-economic status. There is no longer the “us-them” paradigm, everyone has something valuable to share, and everyone can humbly receive help, including the facilitators who might feel deeply inspired and energized after such interactions. Ending the group with a closing mindfulness practice and an inspirational quote can also create a habit of finding and repeating positive mantras to continue to inject compassion and positive energy into this world.
This can be accomplished via phone conference or video sessions. Until we can meet in person again, I hope this will maintain the circle of compassion (both towards self and others) alive and active. It helps to free us from various forms of oppression and also assists in restoration of social justice by giving everyone a place around the table or a seat in the room, all facing each other. I sure look forward to the weekly collective care these days for reciprocity, co-nurturing, deep interconnectedness and collective healing.
- Hanson R. Buddha’s Brain: The Practical Neuroscience of Happiness, Love and Wisdom. New Harbinger Publications, Inc. 2009.
- Desmond, T. How to Stay Human in a F*cked up World. Harper One. 2019.