GOAL (Giving Obsessive-compulsive Another Lifestyle) support groups started in Philadelphia in 1981 when Jonathan Grayson and Gayle Frankel started the first support group for OCD in the country. From that time on, the GOAL approach has been a way has been a powerful way for individuals suffering from OCD to help themselves. Below are some question/answers about GOAL support groups.

1. What is a GOAL support group?

Think of GOAL as a support group plus. That is, like all support groups, members find the comfort and support from one another that sharing a similar problem brings. However, there are times when unstructured support groups, deteriorate into destructive complaint groups (or as one of our members calls them a “pity party”), in which members spend their time together comparing symptoms and medication side effects. GOAL goes beyond providing support and gives members a way to help one another.

2. What are the features of a GOAL support group that makes it effective with OCD?

Meetings are broken into three parts: 1) the Question, 2) GOAL planning, and 3) socializing. These three parts are all necessary and each fulfills a very important function for every member.

First there is the Question. Before the meeting, the leaders pick a topic to discuss; hopefully one that is of interest to everyone (e.g., how do you cope with uncertainty and how does that affect your OCD?). Remember, one purpose of a support group is to share ideas and thoughts about a common problem and maybe even come away with new ways of looking at your problem. Without a question, meetings tend to ramble and can easily become monopolized by a single individual’s issues or again, simply comparing symptoms and medication side effects. The Question provides members a stimulus for examining their situation from a different angle, which helps them focus their ideas, thoughts and feelings about different aspects of OCD and its effects upon their lives – or in other words, a good question helps everyone learn from one another and grow. Of course, this depends upon the question; sometimes we will come up with great questions and other times not. We save the good ones and over time have developed a pool to draw from.

Second is GOAL Planning, the heart of the meeting, this is what keeps our meetings a place of hope and progress. Quite simply, members break into small groups, and is each lead by a more experienced member and everyone chooses behavioral GOALs to work on between meetings. Usually they will be some form of exposure or response prevention. In this way the focus of the group is always positive as it reflects our belief that everyone can help themselves and others to move forward.

Finally, there is informal socializing. The heart and power of a group resides in the friendship and trust people develop towards one another. These kind of relationships depend upon the sharing that best occurs without a structure beyond providing a place to meet. Fighting OCD is hard work and having friends who can help is the defining feature of what makes a support group work.

3. What makes the GOAL group therapeutic as opposed to a mutual support meeting?

The GOAL concept is very flexible. Providing support to one another is more than just than words – providing support can be helping individuals help one another. The idea of people empowering one another in a support group is not original with us. In AA meetings, the support is not simply people getting together and saying they have a biological problem and their only hope is depending upon a higher power. They also encourage members to take very active steps and make life changes (e.g., taking responsibility for what each individual can control by supporting positive non-drinking behaviors and confronting one another when they engage at risk behaviors). Similarly, GOAL encourages members to do the same with their OCD. On the other hand, the GOAL approach can be adapted to a variety of formats and could be incorporated into a programmatic group therapy program or into the obsessive-compulsives anonymous format. GOAL is about empowering individuals and enabling them to take some control over their OCD.

4. Isn’t the concept of a GOAL sort of intimidating for someone with OCD?

The first rule of choosing a GOAL is picking something you are willing to do, because we want the individual to be successful. It doesn’t matter how small the GOAL is, because anything achieved is a start. If someone doesn’t want to choose a GOAL at our meeting, that is fine. For such individuals, we believe that over time they will change, because they will see others coming to the meeting and making changes and seeing improvement in their lives. You ask why would anyone voluntarily submit to this and the answer is the desire to overcome OCD and the hope the comes with seeing the success of others who do take GOALs.

5. What are the main objectives of a GOAL group?

The group’s primary stated purpose is to help sufferers to gain some control over their OCD through the use of self chosen behavioral GOALs. There are three groups of sufferers we try to support:

a. To help to prepare people for exposure and response prevention (E&RP) who are too afraid to immediately commit to treatment. For these sufferers, the meeting is a gentle introduction to E&RP that allows them to see that they can both cope and make progress.

b. To support those in the middle of individual E&RP treatment. For these sufferers the group encourages and supports the individual’s efforts to persevere.

c. To support relapse prevention. Finally, for those who have overcome their OCD, the group’s focus on relapse prevention and GOALs makes it harder for the individual to pretend slips can be ignored, which could result in a small slip becoming are major relapse.

6. How does the group help with relapse prevention?

OCD is both a learned and biological problem. With regard to the learned aspects, we know that for any long term behavior that a person tries to change, slips will occur. After all, how many people do you know, who have gone on a diet, stopped drinking, stopped smoking, started exercising and so on and have never slipped. In addition, there are biological components in OCD and in some people these can rise and fall over time, making them more or less susceptible to relapse. The gist of what we are saying is that slipping is inevitable. And if this meant being overwhelmed by OCD again and becoming dysfunctional, that fact would be overwhelming. But let me make this very clear, we are not saying that. Again think of a dieter who has lost 100 pounds and then gains 2 pounds. Do they want to do all that dieting for a mere, unnoticeable 2 pounds? 5 pounds? 50 pounds? The problem is not in the slipping, but in how far you let it go. Do you “get back on the wagon” when “illegal” handwashing is 5 minutes extra a day or 5 hours? The good news is that either way, 5 minutes or 5 hours, you can recover again. Your behavior, like the example with dieting, just determines how hard you will have to work.

The GOAL support group can be used as a way to monitor yourself and make sure that you keep to your maintenance program and that if you slip, it puts some pressure upon you to not lie to yourself.

7. Should families be excluded from GOAL meetings?

Family involvement can be a very important part of recovery and, obviously people could choose to run a GOAL group with family and friends present. One of our rules in choosing a GOAL is the individual chooses something they are willing to do – not something to try, but something they will do. And if they choose nothing, they are not overly pressured. In allowing a potentially coercive family to be present, the meetings could lead to greater discord at home. We are also concerned that this may discourage sufferers from returning to the meeting. At our center, we have occasionally run a separate meeting for families and friends, depending on interest. We are not currently running a family support group. Please contact us if you are interested in this resource and if we have enough interest we may consider re-starting the family group.

8. Who runs the GOAL meetings and how are they organized?

Our meetings are therapist assisted. This means that I and some of my staff volunteer our time to be present at every meeting, but we don’t run the meeting. We leave that to our more experienced members and just jump in when the need arises. I think this is the ideal, sufferers running the meeting with a professional available. But there are times this won’t be possible. If a professional is starting a GOAL support group, it will take some time for members to be experienced enough to take over. On the other hand, we realize that there are many areas where there are no professionals experienced with OCD available and we hope that the manual we wrote for the OC Foundation would enable sufferers to run their own meetings.

GOAL is really a system of recommendations of how to run a support group and to keep it positive. With that in mind, it is almost irrelevant whether it is therapist run, assisted or run without a therapist. We actually call ours therapist assisted, because although my staff and I attend meetings and help out, the actual meeting is run by our more experienced members.

Group Observation

Occasionally we receive requests from students interested in observing the GOAL group to satisfy a course requirement. To protect confidentiality and provide the most supportive environment for group members the group is not accepting student observers at this time. Thank you for understanding.