I believe with fervor that having survivor-led mad group therapy available to the public can greatly reduce the suffering that people who experience “psychosis,” or what I prefer to call special message crisis, go through. Over the last nine years I have been leading mad-focused groups in multi-cultural settings mostly in, but sometimes outside, the system. I have found not only that they can be run safely, but that they can have the power to transform lives. However, I do feel motivated to assert that when it comes to kicking people out of group to maintain group equilibrium and safety that I believe there are five steps leaders need to be prepared to make first.
First, I believe that leaders need to accept the way people show up, prepared to intuit all varieties of presentations or manifestations. Perhaps group members may feel like they are being confused by others in the group via illusions that function as ideas of reference, or even controlled by them. They may code up their language for protection. They may treat the leader as if the leader can hear the same voices that they hear, or as they know the leaders' reincarnated soul. They may not believe that the leader has experienced what they have (and indeed they may be right.) Some may dominate the discussion or purposely try to take over the group. Because all of this can be challenging to safety I have learned that it helps when the leader is intuitively prepared for any and everything. I myself have prepared myself for these challenges by trying to better define what “psychosis” is. I have reconstructed a definition that can sync up a wide variety of what has historically been defined as conditions. And I try to be forever curious as there are always new things to learn. Indeed, if the leader is not prepared to intuit and 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 to the group.
Second, I believe that leaders need to work to 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 and I advocate for a spirit of risk-taking / sharing by acknowledging that people in “psychosis” or special message crisis may be so used to dangerous or disturbing experiences that guarantee 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 without too many problems. In other words, treating the “set of symptoms” as a neglected culture that is subjugated works. Moreover, I have found educating the group about the reconstructed definition of “psychosis,” or messages crisis, has set the group focused on the things they have in common with each other, particularly in the early stages of group development. Strongly supporting alienated individuals also helps train the group to be more tolerant and can avoid many problems that come up. This can go a long way in discouraging the group from expecting a “trouble maker” to get kicked out.
Third, because there is a high degree of diversity in the mad community, I believe the leader needs to be extremely sensitive to all forms of culture, particularly relating to relevant issues of subjugation. Remaining open to all people who show up without cultural bias is particularly important to when a person shows up in a difficult manner. Knowing how the behavior fits into cultural issues can be key to addressing it. Race, class, gender, sexual orientation, age, religion, education, legal justice, substance abuse, immigration, gang affiliation, disability, regional conflicts, employment history, social adeptness and many other social factors or potential for cultural conflicts. It is wrong, I believe, to exclude someone because they are bothered by these kinds of social factors. Although they may not all show up immediately, a leader needs to be prepared to accept, learn and support everyone. Again, a person who is not accepted on the basis of something that the leader is ignorant about or is not curious to explore, may do harm.
Fourth, I believe that leaders need to be prepared to make time to meet with individuals outside of group to learn more about why they might be trying to hurt the group. If they are doing this intentionally, they may in fact be expressing a need to connect with you. Perhaps, they are experiencing messages that are extremely misunderstood or there is a cultural issue with you that they need to talk with you about. I have learned that getting to know peoples' messages in deeper ways can really help in managing problems that might otherwise come up in group. But when the group is truly becoming unsafe for participants, which is rare, special meetings need to be called for and the leader needs to work on better understanding the problems that come up in group and clear up the cultural issues. Perhaps, an outside the group meeting might involve two individuals at times when there is conflicts. On the one occasion I neglected to do this in a pro-bono group, I lost a lot of group members.
Fifth, finally, if taking the time for a meeting or two does not improve the behavior, the leader can attempt to make a targeted-and-specific, cultural-sensitive behavior contract to protect the group. In my opinion, this is best utilized in real emergency circumstances and needs to be devoid of the leader's cultural biases to the best of their ability. This is also something that requires the participant's participation in which the problem can be identified and an agreed upon solution can be proposed. At the very least the contract needs to be something the participant can buy into. When the participant takes the power to get involved, consequences can involve sitting some groups out, or being referred to individual therapist if they are unable to make a change in behavior. I'd suggest that if the participant takes steps outside the group to improve themselves the leader can be in communication with them, pining for their return.
It is true that many people who suffer from “psychosis” or message crisis also have complex histories and trauma and other co-occurring problems (like addiction and nuero-diversity.) I do believe that these kinds of complex issues which challenge safety can be addressed within a group process. I have seen them addressed even by survivors who visit programs rather than work in them.