Atlas›Domain V · Systemic, relational, group & community›Guide 108
Guide V-108

Neurotics Anonymous

Grover Boydston1964Washington, D.C., USA
A 36 · L 52 · M 1219 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: Neurotics Anonymous (N/A, also NAIL, for Neurotics Anonymous International Liaison) as founded in the USA in 1964 by Grover Boydston ("Grover B.") and as it runs today mainly in Latin America: in Mexico as the civil association Neuróticos Anónimos, A.C., with a General Services Office (Oficina de Servicios Generales) and the website neuroticos-anonimos.org.mx; in Brazil as Neuróticos Anônimos. Source basis: the sources confirm the founder, the 1964 US founding, the Mexican association, its service office and website, its group count and its own description of its role (from press interviews with the office's manager), and Brazil's arrival date (from a member interview). No official N/A text (website or book) is used here, so step wording, slogans and meeting script rest on secondary and ethnographic accounts [uncertain]. Two offshoots are not followed here: Emotions Anonymous (EA), which split off in Minnesota and incorporated separately in 1971, and an unrelated London charity of the same name. [source: Wikipedia, Neurotics Anonymous; EA history page; Vanguardia 2018; Crónica 2018; Folha de Boa Vista 2018] [uncertain: no official N/A text]

What it is. N/A is a peer-run twelve-step mutual-aid fellowship for people who see themselves as having "mental and emotional illness". It is not a therapy, and a clinician does not run it. This guide is for a psychotherapist who refers clients to N/A, works alongside it, or draws on its principles. Boydston was a recovering alcoholic in AA who also had psychology training. He adapted AA's Twelve Steps and Twelve Traditions with AA World Services' permission. The main change was to Step One, where "alcohol" became "our emotions". Early meetings read AA's books aloud and said "neurotic" in place of "alcoholic". [source: Wikipedia; Vice 2015; Fragoso Reyes thesis]

How change is thought to happen (the fellowship's own account).

  • Members accept that they are powerless over their emotions. The Brazilian wording is "impotentes perante nossas emoções" (powerless over our emotions) [source: Soares 2021].
  • They turn to a Higher Power as each understands it.
  • They take a moral inventory and confess it.
  • They practise emotional self-control one day at a time.
  • They share their experience with peers who identify with them.

Ethnographers add their own readings. Shared testimony reduces shame and isolation [source: Soares 2021; Rosa & Sandri 2013]. Members experience religious experience as nearly inseparable from recovery [source: Roehe 2004, abstract].

Founding details, checked. Place: the evidence points to Washington, D.C. Wikipedia gives 3 February 1964 in Washington, D.C. It cites Boydston's own 1974 history of the fellowship and Sagarin (1969), and N/A's early books were published by NAIL in Washington, D.C. A Brazilian member interview also gives 1964 in the USA, without naming a city. The only source for Miami, Florida, is one 1990s UNAM thesis, which cites nothing for it. Treat Miami as an error unless an official source says otherwise. Background: AA co-founder Bill W. wrote in 1956 that he hoped a Neurotics Anonymous would one day be formed. Spread: N/A reached Brazil in April 1969, starting in São Paulo [source: Folha de Boa Vista 2018]. A Mexican thesis dates the first German meeting to 5 August 1967 in Hagen-Boele and lists groups in Canada, England, Finland, Denmark, Israel, Uruguay and India [source: Sainz Lara, UNAM thesis]. Mexico: the arrival date is still unresolved. Vice puts it about ten years after 1964, and Fragoso Reyes says 1977. No official Mexican source gives the date, so the safest statement is "mid-1970s" [uncertain]. Size: Vice reported 869 Mexican groups in 2015. The association's manager reported more than 800 in 2018, about 70% of attendees women. Groups also exist in Argentina, Nicaragua, Portugal and the USA. Mexico's association holds national conventions; the third was in Mexico City in November 2018. [source: Wikipedia; Vice 2015; Fragoso Reyes; Vanguardia 2018; Crónica 2018; UNAM Global 2018; Diario de Yucatán 2018]

Naming hazard. N/A abbreviates itself "N/A" or "NAIL". Latin American groups write "N.A.", which is easy to confuse with Narcotics Anonymous. Always check which fellowship a client means. [source: Wikipedia; Fragoso Reyes]

2. Framework

N/A has no clinical phases, session counts or graduation criteria. Members attend open-endedly and decide for themselves when they are better. Many keep attending after that. [source: Vice 2015] The structure below combines what the fellowship does, as reported in the sources, with a clinician's referral pathway that is marked [synthesis].

A. The member's path (as reported)

  1. Self-identification. Newcomers are given a booklet with a 26-item yes/no self-test about emotional difficulties: mood swings, fears, compulsions, sleep and somatic complaints, feeling disliked, and so on. Answering yes to more than ten items is read as a sign that the person should accept powerlessness over their emotions. Membership rests on recognising oneself as "neurotic". The group's own definition of a neurotic is anyone whose emotions interfere with their behaviour "de qualquer forma e em qualquer grau" (in any way and to any degree). No clinical definition of neurosis is used. [source: Fragoso Reyes; Vice 2015; Soares 2021 fn. 6; Wikipedia] The test is published by the fellowship; its items are not reproduced here.
  2. Attendance.
    • Length: sessions run about 90 minutes in Mexico [source: Vice 2015] and about two hours in Porto Alegre [source: Roehe, as cited in Rosa & Sandri 2013].
    • Setting: members sit in a circle. A coordinator, usually a senior member, leads the meeting, and the role rotates. No professional is present.
    • Sharing: each testimony may run up to about 10 minutes without interruption. Members speak from a "tribuna" (podium) about how they feel now and how they were before joining. Dialogue and side comments are not allowed.
    • Opening and close: speakers introduce themselves along the lines of "I'm X and I'm neurotic". Money is collected at the end of the meeting.
    • Schedules: some groups meet twice a week. In Boydston's 1974 survey, members attended about six meetings a month and had belonged for 2.37 years on average. [source: Rosa & Sandri 2013; Fragoso Reyes; Wikipedia]
  3. Step work. Members work the adapted Twelve Steps in order and gradually, as suggestions. Steps 4 and 5 (moral inventory and confession) are central. [source: Fragoso Reyes]
  4. Sponsorship and service. Members who are doing better become padrinos (sponsors) to newcomers. Members also do service: cleaning, making coffee, giving talks, and keeping the group open. [source: Vice 2015]
  5. Online alternative. In Brazil, a fellowship-run forum called "Caminho Novo" was active from 2009 to early 2020 for members with no local group. [source: Soares 2021]

B. Clinician pathway [synthesis]

StageGoalTypical timeMove on when
1. Assess fitDecide whether peer twelve-step support suits this client's problem, beliefs and riskPart of one sessionClient is interested, risk is manageable, no contraindication
2. PrepareExplain the format and the language, and test expectations1 sessionClient can say what will happen and has chosen a meeting
3. Trial attendanceClient attends several meetings before judging2–6 weeksClient has been to at least 3 meetings, ideally at more than one group
4. IntegrateUse meeting and step experiences in therapy; coordinate with the sponsor only with consentOngoingClient uses N/A as one support among several
5. ReviewCheck benefit, harm, dependence and fit every few monthsEvery 2–3 monthsContinue, adjust (other group or fellowship), or stop

3. Guiding principles

Principles of the fellowship (as reported). A clinician needs to understand these to refer well.

  • Self-diagnosis, not professional diagnosis. A person is a member if they recognise their own emotional problem and want to recover. Practical meaning: clients may arrive having labelled themselves "neurotic". Explore what the label means to them. [source: Soares 2021; Wikipedia]
  • Powerlessness over emotions. This is the adapted Step One. Practical meaning: expect acceptance-based language that sits uneasily with skills-based therapy. Bridge the two rather than argue. [source: Wikipedia; Soares 2021]
  • "Being" a neurotic, not "having" a neurosis. Members frame it this way to keep responsibility with the person. Practical meaning: this can motivate change or feed self-blame, so check which it does for your client. [source: Fragoso Reyes]
  • Emotions override reason, and the sufferer causes the illness. Practical meaning: watch for clients who read trauma or biological illness as personal fault. [source: Fragoso Reyes]
  • Higher Power as understood. Belief in anything specific is not formally required, but the program is built around God. Researchers describe it as therapeutic Judaeo-Christian principles, with religious experience treated as almost required for "cure". Practical meaning: assess spiritual fit before referring. [source: Fragoso Reyes; Roehe 2004 abstract; Rosa & Sandri 2013]
  • Peers only: listening, not advising. The fellowship has no professionals. In the words of Vice's sources, members "no dan consejos" (give no advice) and "sólo escuchan" (only listen). Sponsors do advise, however. Practical meaning: tell clients that sponsor advice is peer opinion, not clinical guidance. [source: Vice 2015]
  • Trusted servants, group autonomy, anonymity, attraction rather than promotion, self-support (adapted Traditions). In principle no professionals are hired, and no outside money is accepted. Practical meaning: you cannot "refer into" N/A formally or receive reports. Contact runs only through the client. [source: Fragoso Reyes; Vice 2015]
  • One day at a time. A Brazilian motto runs "Só por hoje evitarei o descontrole emocional" (just for today I will avoid losing emotional control). Practical meaning: clinicians can link to it as a daily-commitment frame. [source: Soares 2021; Rosa & Sandri 2013]
  • Identification through shared experience. Practical meaning: the active ingredient members report is "I am not alone" and less shame. Ask about it explicitly. [source: Soares 2021; Rosa & Sandri 2013; Wikipedia]
  • Members judge their own recovery. Practical meaning: when to stop attending is the client's call. Review it, but do not prescribe it. [source: Vice 2015]

Clinician stance [synthesis]

  • Adjunct, not substitute. N/A runs alongside assessment-led treatment and does not replace it.
  • Client autonomy over the referral. Offer N/A as an option, never a condition of treatment.
  • Clinical framing stays with you. The fellowship's lay theory of "mental and emotional illness" is not a diagnosis. Keep your own formulation and discuss differences openly.
  • Safety first. Risk assessment, medication decisions and trauma processing remain clinical tasks.
  • Respect for the fellowship's boundaries. Do not try to run, attend as a professional, or reshape N/A meetings. Meet the fellowship through public information events and the client's report.

4. Intervention inventory

Part A covers the fellowship's own tools as the sources report them. Members do these things; the therapist does not run them. Each entry ends with how a clinician can support it. Part B covers clinician procedures for working with N/A, all of which are [synthesis]. N/A's own books are named here but not drawn on: Neurotics Anonymous (1968), The Laws of Mental and Emotional Illness (1970), The Etiology of Mental and Emotional Illness and Health (1978), and the Brazilian Passos e tradições a caminho da sanidade (2010). Details that would come from those books are therefore [uncertain]. [source: Wikipedia; Rosa & Sandri 2013 ref. 9]

Part A: Fellowship tools (as reported)

A1. Self-assessment questionnaire

  • Purpose / when: The newcomer's entry point. The person decides for themselves whether N/A is for them. [source: Fragoso Reyes; Vice 2015]
  • Steps (as reported):
    1. The newcomer receives the booklet.
    2. They answer 26 yes/no questions about emotional and somatic difficulties.
    3. If they answer yes to more than ten, the fellowship reads this as a reason to accept powerlessness over their emotions and to join. The questionnaire is fellowship literature; do not copy it.
  • Clinician support [synthesis]:
    1. Ask the client to bring their results.
    2. Treat the results as a description of problems, not a diagnosis.
    3. Compare them with your own assessment, and note anything the test misses: psychosis, bipolar features, trauma, substance use, suicidality.
  • Example language (illustrative): "The N/A questionnaire picked up a lot of what you're struggling with. Let's look at it next to what we've found here, because a few things need more than a self-help group."
  • Watch for: Clients who conclude that their problem is only a character matter, or who use a high score to give up on clinical care.

A2. Attending meetings and sharing a testimony ("tribuna")

  • Purpose / when: The core practice. Members end isolation and reduce shame by hearing others and by speaking. [source: Fragoso Reyes; Rosa & Sandri 2013; Soares 2021]
  • Steps (as reported):
    1. Members sit in a circle, and a senior member coordinates.
    2. Members volunteer to speak from the tribuna, starting with first name plus "neurotic".
    3. The speaker describes current feelings and life before N/A, for up to about 10 minutes.
    4. Others listen without interrupting, commenting or giving advice.
    5. A voluntary collection is taken at the end. Meetings last about 90 to 120 minutes. Visitors may attend some sessions.
  • Clinician support [synthesis]:
    1. Rehearse a first share in session if the client wants to speak.
    2. Agree in advance what the client will not disclose yet, such as trauma details, other people's identities, or legal matters.
    3. Debrief after the first two or three meetings.
  • Example language (illustrative): "You don't have to speak at the first meeting. If you want to, what's one thing you'd be comfortable saying out loud to a room of strangers?"
  • Watch for: Relief and reduced shame are good signs. Shame spikes after over-disclosure, or distress from hearing others' stories, call for a plan.

A3. Self-identification as "neurotic"

  • Purpose / when: The fellowship's way of naming the problem and taking responsibility for it. Members are taught that one is neurotic rather than has a neurosis. [source: Fragoso Reyes]
  • Steps (as reported): Members use the label when introducing themselves at each meeting.
  • Clinician support [synthesis]: Explore the label openly. Some clients find it freeing. For others it adds to stigma, which researchers flagged early (Sagarin, via Wikipedia) and which members themselves report (Fragoso Reyes).
  • Example language (illustrative): "When you say 'I'm neurotic' at the meeting, how does that sit with you afterwards? Lighter, or heavier?"
  • Watch for: Labelling that becomes global self-condemnation.

A4. The adapted Twelve Steps: Steps 1–3 (surrender)

  • Purpose / when: Accept that emotional control has failed, trust a Higher Power, and decide to hand over one's will. [source: Fragoso Reyes; Soares 2021; Wikipedia]
  • Steps (as reported):
    1. Admit powerlessness over one's emotions and that life has become unmanageable.
    2. Come to believe that a greater power can restore sanity. No specific belief is required.
    3. Decide to entrust one's will and life to God as one understands God. The steps are presented as suggestions, absorbed gradually. N/A's step text is adapted from AA's and is not reproduced here.
  • Clinician support [synthesis]:
    1. Help the client separate "I can't white-knuckle my emotions" (often useful) from "I can't do anything" (unhelpful).
    2. Link acceptance to compatible therapy concepts, such as acceptance in ACT and DBT, without merging the two frameworks.
  • Example language (illustrative): "Admitting you can't force your feelings to stop isn't the same as having no choices about what you do next. Which part of Step One feels true for you?"
  • Watch for: Learned helplessness, or rejecting medication or skills as "self-will". Non-religious clients may feel alienated; one thesis records an author calling agnostics and atheists "desorientados" (disoriented) [source: Fragoso Reyes].

A5. Steps 4–5: moral inventory and confession

  • Purpose / when: Review one's defects and admit them to God, oneself and another person, to end isolation and to belong. [source: Fragoso Reyes]
  • Steps (as reported):
    1. Write a detailed inventory of defects. The Mexican thesis describes framing these by the seven deadly sins and by misdirected instincts (sexual, security, social), starting with the most obvious ones.
    2. Confess the inventory to another person, usually the sponsor.
    3. Some Mexican groups that use AA's program for non-alcoholics ("grupos de 4º y 5º paso") run seven preparation meetings before a private inventory and confession. Those are separate groups, not confirmed as N/A practice. [source: Pérez Serrano 2013] [uncertain for N/A]
  • Clinician support [synthesis]:
    1. Before the client starts Step 4, screen for trauma, abuse, self-harm and current legal risk.
    2. Help the client tell harm done to them apart from their own "defects".
    3. Agree what goes to the sponsor and what stays in therapy.
    4. Plan aftercare for the days around the Step 5 confession.
  • Example language (illustrative): "An inventory can open up old injuries. Shall we look at it together first, so things that happened to you don't end up listed as your faults?"
  • Watch for: Re-traumatisation, guilt spirals, disclosures of risk to or from others, and unsafe confession settings.

A6. Steps 6–12

  • Purpose / when: Become willing to have defects removed, make amends, keep up self-review, pray or meditate, and carry the message to others. [source: Fragoso Reyes, Step 6 only]
  • Steps: The cited sources do not give N/A's wording or practice for Steps 7 to 12 [uncertain]. The Mexican association describes its programme as Twelve Steps of recovery based on AA's and focused on emotional problems [source: La Razón 2022], so the later steps probably follow AA's sequence: asking for defects to be removed, listing and making amends, ongoing inventory, prayer and meditation, and carrying the message. That sequence is inference, not N/A text [synthesis]. Ask the client or the sponsor to explain how their group works these steps.
  • Clinician support [synthesis]: For amends, assess safety before any contact with an abuser, an ex-partner under a protective order, or someone the client could harm. For carrying the message, watch for clients who rescue others while neglecting their own care.
  • Example language (illustrative): "Before you make that amends, let's think through what you hope for and what you'd do if it goes badly."
  • Watch for: Unsafe amends, and over-responsibility.

A7. Sponsorship (padrino / padrinho)

  • Purpose / when: One-to-one guidance from a member further along in recovery. [source: Vice 2015]
  • Steps (as reported): Members who are doing better offer advice and support to newcomers. Note that this sits alongside a group rule of "no advice" in meetings.
  • Clinician support [synthesis]:
    1. Help the client choose a sponsor: same-gender or otherwise safe, stable, and respectful of therapy and medication.
    2. Agree with the client how to handle sponsor advice that conflicts with the treatment plan.
    3. With written consent, you may speak with the sponsor, but only about practical coordination.
  • Example language (illustrative): "Your sponsor's experience is valuable. If they ever suggest something about your medication or therapy, bring it here first so we can decide together."
  • Watch for: A sponsor acting as therapist, discouraging medication, or crossing boundaries (financial, romantic, controlling).

A8. Service

  • Purpose / when: Give back and build belonging: cleaning, making coffee, giving talks, opening the room. Keeping a group open takes 2 to 3 committed members. Trusted servants do not govern. [source: Vice 2015; Fragoso Reyes]
  • Clinician support [synthesis]: Use service as behavioural activation and a mastery experience. Check that it does not displace rest or obligations.
  • Example language (illustrative): "What does it do for your mood on the days you make the coffee?"
  • Watch for: Over-commitment, and taking service roles while acutely unwell.

A9. Telephone contact and crisis lines

  • Purpose / when: Between meetings, distressed members phone other members, who listen and encourage them to come to a group. In Mexico, N/A volunteers staff a government-funded crisis hotline. The Mexican association's manager estimated in 2018 that about 20% of attendees have attempted suicide, and others have had suicidal thoughts or made plans. Expect high suicide risk in this population. [source: Vice 2015; Wikipedia; Vanguardia 2018; Crónica 2018]
  • Clinician support [synthesis]: Include N/A phone contacts in the client's safety plan as social support. They are never the sole crisis plan: list professional crisis services and emergency numbers too.
  • Example language (illustrative): "Let's put your N/A contacts on your plan for hard evenings, and next to them the crisis line for when it's more than they can hold."
  • Watch for: Suicidal crises handled only by peers.

A10. Daily-living slogans: "Just for today"

  • Purpose / when: A daily commitment to avoid losing emotional control, and to live one day at a time. [source: Soares 2021; Rosa & Sandri 2013]
  • Steps: Members renew the commitment each morning and come back to it when emotions surge. Other slogans and readings from N/A's literature are not covered here [uncertain].
  • Clinician support [synthesis]: Pair the slogan with a concrete coping step, such as a skill or a pause routine, so that "avoid losing control" does not become suppression.
  • Example language (illustrative): "'Just for today' is a good anchor. What would you actually do today when the anger rises?"
  • Watch for: Emotional suppression, and shame after an outburst.

A11. Literature reading

  • Purpose / when: Members read the fellowship's books. Early groups read AA's books with "neurotic" in place of "alcoholic". Latin American groups also use local writings. [source: Wikipedia]
  • Clinician support [synthesis]: Ask the client what they are reading and what it says about medication, psychiatry and the causes of illness. Discuss any passages that clash with the treatment plan.
  • Watch for: Literature-based beliefs that illness is purely moral or spiritual.

A12. Online forum (Brazil)

  • Purpose / when: Sharing for members with no local group. The "Caminho Novo" forum allowed posting or quiet reading at any hour, 2009 to 2020. [source: Soares 2021] Whether it or a successor runs now is [uncertain]. In Mexico, the association's groups kept meeting daily during the COVID-19 pandemic and also held online sessions. [source: La Razón 2022]
  • Clinician support [synthesis]: For isolated clients, check any current online N/A or EA meeting is real and active. Review privacy settings with the client.
  • Watch for: Late-night posting during crises without a response.

A13. Public information meetings

  • Purpose / when: N/A holds public information meetings ("juntas públicas de información") to explain itself. [source: Fragoso Reyes]
  • Clinician support [synthesis]: Attending one is the appropriate way for a clinician to learn about a local group, rather than attending a closed meeting.

Part B: Clinician procedures [synthesis]

B1. Assessing fit for referral

  • Purpose / when: Before you suggest N/A. It may suit clients with chronic anxiety, low mood, anger, jealousy, fear or loneliness who want peer support, especially where professional care is scarce or costly. The sources name these as common reasons for attending. N/A presents itself as a complement to professional care, not a replacement: the Mexican office suggests seeing a specialist, joining a group, or both, and a Brazilian member stresses that N/A "is not therapy" (paraphrased). [source: Vice 2015; Fragoso Reyes; Vanguardia 2018; Folha de Boa Vista 2018]
  • Steps:
    1. Clarify the client's diagnosis and risk.
    2. Ask about spiritual and religious beliefs, and how comfortable they are with God language.
    3. Ask about past group experiences.
    4. Check practical access: whether there is a local group (mostly in Latin America), and language.
    5. Weigh the alternatives (B3).
    6. Agree a trial.
  • Relative contraindications: active psychosis or mania; acute suicidality without a clinical plan; recent trauma where group disclosure could destabilise; strong aversion to religious framing; social anxiety so severe that a supported exposure step is needed first.
  • Example language (illustrative): "There's a peer group called Neurotics Anonymous. It's run by people with emotional difficulties, using a twelve-step, spiritually based approach. Does that sound like something you'd want to try alongside our work?"
  • Watch for: A referral the client hears as "you're too much for me". Make clear therapy continues.

B2. Preparing the client

  • Purpose / when: Before the first meeting. Reduces drop-out and surprises.
  • Steps:
    1. Describe what to expect, from the sources: circle seating; a lay coordinator; uninterrupted shares of up to about 10 minutes; "I'm X and I'm neurotic" introductions; God and Higher Power language; a voluntary collection; no professionals; no advice-giving in the meeting.
    2. Suggest trying three or more meetings, and more than one group if possible.
    3. Agree what to share and what to hold back.
    4. Plan how the client will get home and look after themselves afterwards.
  • Example language (illustrative): "Groups vary a lot. Give it at least three meetings, ideally two different groups, before deciding."
  • Watch for: Anticipatory anxiety. Treat the first visit as an exposure task, with consent and a plan for leaving early.

B3. Distinguishing N/A from similar groups

  • Purpose / when: When clients search for meetings. Several groups are easy to confuse:
    • Narcotics Anonymous, for drug addiction, also abbreviated NA.
    • Emotions Anonymous (EA). It split from N/A, has its own literature, and runs in-person, remote and email meetings in many countries. EA's only requirement for membership is "a desire to become well emotionally". By EA's own account, its first group met in St. Paul, Minnesota, in April 1966 under the name Neurotics Anonymous; after unresolved differences with N/A's main offices, the Minnesota groups dissociated, took the name Emotions Anonymous with AA's permission to use its Steps and Traditions, and incorporated in 1971. [source: EA history page]
    • Mexican "grupos de 4º y 5º paso" and "24 horas" groups. These use AA's program for non-alcoholics and are separate organisations. [source: Pérez Serrano 2013]
    • The London Neurotics Anonymous charity (late 1960s). It charged a fee and opened meetings with topical discussion. [source: Wikipedia] [uncertain: secondary, unverified]
  • Steps: Check the group's name, its literature and its membership requirement with the client.
  • Watch for: A client attending a drug-recovery meeting by mistake, or a high-intensity group they did not choose.

B4. Integrating N/A into therapy

  • Purpose / when: Ongoing. Turns meeting experiences into therapeutic material.
  • Steps:
    1. Give a few minutes of each session to a brief N/A check-in: attendance, what was heard, what was shared, and current step.
    2. Link insights to the formulation.
    3. Translate fellowship ideas into skills. For example, "just for today" becomes a daily plan, and the inventory becomes a cognitive or values review.
    4. Respect the fellowship's frame while keeping your own.
  • Example language (illustrative): "What did you hear this week that stuck with you? How does it connect to the pattern we've been working on?"
  • Watch for: Two competing explanatory models. Name differences openly rather than letting the client feel caught between them.

B5. Medication and treatment continuity check

  • Purpose / when: At referral and at every review. The sources do not say N/A opposes medication. One member's line that there is no "píldora mágica" (magic pill) is about personal effort. [source: Fragoso Reyes; Vice 2015] Peer advice can still vary.
  • Steps: Ask directly whether anyone at the group has commented on the client's medication or therapy. Agree that changes are discussed with the prescriber first.
  • Example language (illustrative): "Has anyone at N/A said anything about your medication? Whatever you hear, let's make any changes with your doctor, not on our own."
  • Watch for: Stopping medication abruptly.

B6. Reviewing benefit and ending

  • Purpose / when: Every 2 to 3 months.
  • Steps: Review the following:
    • frequency of attendance
    • perceived benefit (less shame, more connection, more emotional control)
    • any harms: self-blame, pressure, boundary problems
    • dependence, for example being unable to function without daily meetings
    • how the group fits with the client's goals Then decide together: continue, change group or fellowship (for example EA, or Al-Anon if a partner's drinking is the main issue), or stop. Remember that members judge their own recovery. [source: Vice 2015]
  • Example language (illustrative): "Looking back over the last few months, what has N/A given you, and has it cost you anything?"
  • Watch for: Staying out of guilt or obligation rather than benefit.

5. Handling problems

The sources say little about how to handle problems. All responses below are [synthesis] unless a source is cited for the problem itself.

Stuck or not engaging

  • Feels the group doesn't "get" them, or can't identify with others. Try another group, because groups vary. Consider EA or a diagnosis-specific peer group. Explore which differences the client notices, as this can be useful material.
  • Spirituality barrier (the program is built around God [source: Fragoso Reyes; Roehe 2004]). Explain "Higher Power as you understand it". If that is still unacceptable, refer to a secular peer support group instead. Never push.
  • Large groups leave little time to share [source: Rosa & Sandri 2013]. Suggest smaller meetings, sponsor contact, or service roles.
  • Rigid format, and members resistant to change [source: Rosa & Sandri 2013]. Normalise this as part of the fellowship's culture. Work on flexible skills in therapy, where they belong.

Resistance and non-adherence

  • Won't go after agreeing to. Explore what stops them: shame about the label, fear of speaking, or practical barriers. Use a graded approach: read about the group, attend an online meeting, attend in person and only listen.
  • Goes irregularly. That is the client's choice. Review benefit rather than pressing attendance.

Overwhelm and risk

  • Distress after hearing others' testimonies, or after over-disclosing. Debrief, plan containment, and agree disclosure limits (B2).
  • Step 4/5 inventory reopens trauma or triggers guilt spirals. Slow the step work, process the material in therapy first, and reframe what was done to the client as not their "defect" (A5).
  • Suicidal crisis. The fellowship's own office estimates that about one in five attendees has attempted suicide [source: Vanguardia 2018], so screen every client you refer. Peer phone contact is support, not a crisis plan [source: Vice 2015 on phone support]. Follow your standard risk assessment and safety planning, and include professional crisis contacts.

Modality-specific difficulties

  • Self-blame from "the sufferer is the cause" and "being" neurotic [source: Fragoso Reyes]. Researchers also read N/A as framing social suffering as personal failure [source: Soares 2021]. Work on a balanced formulation: responsibility for what one does next, not blame for having the illness.
  • Stigma from the "neurotic" label [source: Sagarin via Wikipedia; Fragoso Reyes]. Explore the label's meaning. The client may simply not use it outside the group.
  • Emphasis on controlling emotions turns into suppression. Researchers link N/A's motto to a push for greater self-control [source: Soares 2021]. Teach emotional awareness and regulation as alternatives to suppression.
  • Sponsor advice conflicts with the treatment plan, given that sponsors do advise [source: Vice 2015]. Use the agreed plan (A7). If needed, and with consent, coordinate with the sponsor. Help the client set limits.
  • "Progressive, fatal and incurable" illness beliefs. This wording is recorded in a related Mexican 4th/5th-step group, not confirmed for N/A [source: Pérez Serrano 2013; uncertain for N/A]. Offer a hopeful, evidence-based view of recovery without attacking the fellowship.
  • Feeling subordinate to senior members, or other hierarchy problems. Reported in a related group [source: Pérez Serrano 2013]. Coach assertiveness. The client may leave or change groups.
  • Partner's drinking is the real issue. Mexican groups are mostly women, and many attend because of a husband's alcoholism [source: Wikipedia]. Assess for domestic violence and consider Al-Anon or couples or family work.
  • Client wants to drop therapy because "N/A is enough". Respect autonomy, review risk and the clinical picture, and agree a step-down with a door left open.

Ruptures with the therapist

  • The client feels you dismiss the fellowship, or feels you "handed them off". Name the rupture, acknowledge what N/A gives them, and restate that you are offering both, not one instead of the other.
  • Contact with fellowship members. N/A hires no professionals and keeps anonymity [source: Fragoso Reyes, Traditions]. Never contact a group or sponsor without the client's written consent. Do not disclose clinical information to the group.

Problems the sources do not address [synthesis]

  • Boundary violations by members: exploitation, romantic pursuit of newcomers. Help the client recognise them, change group, and report through the group's service structure or to the police where a crime is involved.
  • Mandated attendance. N/A is voluntary, and the fellowship's own principles rest on self-identification. Do not make attendance a condition of treatment.
  • Minors. No N/A youth meetings are documented in the sources. One Brazilian group describes itself as open to all ages, but that is a single group's statement [source: Folha de Boa Vista 2018] [uncertain]. Do not refer a minor without checking that the specific group accepts them and is safe.

Sources

Pages used

Books and literature cited [uncertain]

  • Neurotics Anonymous International Liaison (1968). Neurotics Anonymous.
  • Neurotics Anonymous International Liaison (1970). The Laws of Mental and Emotional Illness.
  • Neurotics Anonymous International Liaison (1978). The Etiology of Mental and Emotional Illness and Health.
  • Neuróticos Anônimos/Enabra (2010). Passos e tradições a caminho da sanidade.
  • Boydston, G. (1974). A history and status report of Neurotics Anonymous. Ed.M. thesis, Barry University.
  • Sagarin, E. (1969). Odd Man In. Quadrangle Books.

Further pages used

Not used: the official Mexican site neuroticos-anonimos.org.mx, the US site neuroticosanonimos.us, N/A's books, and the full text of Roehe 2004. The adapted Steps 7–12, slogans other than "just for today", the official meeting script, and the year N/A reached Mexico therefore remain [uncertain].

← Previous · V-107Emotions AnonymousNext · V-109 →Schizophrenics Anonymous