I recently joined an HIV-positive support group at my case manager's urging -- she felt I could get additional support from the group -- and that is the sole reason I am a member. This is my third week and I don't want to go back since I feel so completely different from the rest of the group. I'm a single African-American man in my early twenties, a high school graduate but unemployed right now. Since I am not working right now, I dress in pullover shirts and jeans. The rest of the members are mostly older white guys who come to the group after work in their suits and ties. In terms of physical appearance alone, I feel like a square peg trying to fit in a round hole.
Aside from that I just don't feel I can get into what the other members are all about. When I talk in group, I just let it all out -- I say it like it is. Everyone else is usually very quiet, but when they do talk they seem to be full of shame and uneasiness. So I ask you -- what is the point? How can they support me if they can't even support themselves? I talked about my feelings with the group leader, who feels I can contribute much to the group and wants me to keep attending. What can I gain from going, aside from making my case manager and this group leader happy?
A Response to This Case Study
You have raised a number of very good points for leaving the group and I feel you should have been given more direction by your case manager and group leader other than just encouragement. First off, I would redirect you back to your case manager to ask her for more details on what positive gains you may be able to expect from attending this particular support group. I would also want more details as to the educational qualifications of your group leader and how this group was pre-selected and developed.
You always have a choice in these matters. If you are only attending to make your case manager happy, that is a rather poor reason to remain. One should at the very least be able to enter any group process with some degree of hope and motivation to gain insights into their emotional issues and concerns. Your current situation seems to call for some kind of intervention with people who are employed and leading structured lives with HIV. However, I would have hoped that your case manager and your group leader would have given you some idea what to expect about the population of the group. People always do better when they know what to expect, and having more information about the racial makeup, age, and employment status of the members would have an impact on your level of comfort. Let's start with your issues of discomfort about staying with this particular group and what I see as good reasons to either stay or to terminate. The bottom line here is that you should feel you have the power to choose.
When people first enter any kind of group experience, they will search out others with whom they identify and feel a sense of sameness. "Do I belong and fit in?" would be a natural and normal question that would be anyone's uppermost thought at the start of any group situation. We are all looking for a sense of peace and acceptance, which is the least one could ask for from attending a support group. The basic fact that you are a young man of color and that the rest of group is all "older white men" would make a difference. If the group was reversed in color and age and you were an older white man entering the group, the same would most likely be true also. In addition, the fact that you are unemployed and may have fewer years of formal education than the other members would also on the surface create differences.
At a Crossroads
So right now in your third week, you are at a crossroads! Do you stay and "fight" this thing out and make it work? Or do you leave take "flight" and call it quits and move on, hopefully to a better support group that would be more productive? With every interaction we face one to one, or when entering a group, those two choices are always present -- fight or flight, stay or leave?
Of course, on one hand you could leave the group just based on the race issue and no one would blame you. It would be more balanced if there were more men of color in your group. Still, the basic group criteria for membership is that members are male and have HIV, not that they are of a particular race, age or employment status. You have stated "it's not a racial thing," but being unemployed while the rest of group is employed could present a difference in terms of issues and concerns. Clearly there are differences between you and the other group members in dress code and manner, and it will take time to feel a sense of together and support for these men whom at this point seem so different. This kind of relationship will take time, as it would in any other group situation.
I assume you are seeking employment and this group may provide the encouragement and support in these areas. Does the group leader conduct the group sessions and the topics of conversations towards issues and concerns that affect you? When you leave the group do you feel that in any way you have benefited from your participation? Do you benefit from the other members' input? Asking yourself these questions may help you come to a well thought-out conclusion to stay or to leave this group.
You sound very open and giving of yourself when placed in the group. That is a welcome quality for any interaction! The fact that you are more open in your feelings would provide the other group members a great role model for being less internally focused. Psychologically speaking, there are a number of research studies that indicate that men of color are more able to release feelings whereas men of European origins are more internalized and less able to discuss their feeling as openly. Of course this is speaking in very general terms and is not always the rule, but it may apply to your group situation.
Over the long term, this group may help you to become more tolerant of others who you see as different from yourself and thus reject quickly and without any insight. People are people, and I would ask you to be more patient and give these group members the time to open up more. It will take a number of group sessions to develop a sense that you are a member who belongs and that you have more in common with this group of men than you currently feel. In addition, many of these men -- for reasons of their own -- may also feel that they do not fit in, and hopefully they will also become more comfortable in time. The gain can be great and may give you the support you need regarding your HIV status and the encouragement you need to seek employment and independent housing.
Some Final Suggestions
Discuss the group make-up with your case manager and explain that the dynamic is not as productive as it would be for you if there were more men of color. In addition, request the reasons why she recommended this particular group as appropriate for you. Tell her your reasons for wanting to terminate and ask her what she feels are good reasons for staying. If your sole reason for going is due to her encouragement, and not to any motivation on your part, than you should consider termination. This is a waste of time for you and for your group.
Set up an interview with your group leader and request the following information from him: How the group was pre-selected? Is it a closed group, that is can any new members be admitted, such as other men of color? Explain to him your discomfort and ask him how he would feel if as an older white man going to a group where everyone was much younger in age, unemployed, and of color? Your level of discomfort does need to be acknowledged and if you are not satisfied with his answers as the group leader, then consider termination.
Ask yourself what you hoped to gain by attending this support group. What are the issues and concerns you are seeking to address in this support group? Do you have any hope for the group process within this group? What do you need in this group to make you feel welcomed and supported? Use this experience as positive gain. If you do terminate, you now have a clear idea in what you are looking for in a support group and what doesn't work for you.
If you feel you haven't given the group a real chance based on two session, then please consider staying and giving it a shot. Don't be too quick to reject the group because they appear to be so different -- give them a chance just as you would want to be given a chance in any group situation. Remember you always have the choice to stay or go.
|J. Buzz von Ornsteiner, Ph.D. is a psychologist and behavioral consultant in New York City and writes the "Psychologically Speaking" column.|