Atlas›Domain V · Systemic, relational, group & community›Guide 124
Guide V-124

GROW

Con Keogh1957Sydney, Australia
A 39 · L 54 · M 719 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: GROW as its national bodies currently describe it in public materials (Grow Australia: intro leaflet 2020, 2021 Timeline, Dave Mc's history paper, an award application of c. 2016–17, member stories, Get Growing brochure 2022, Program Training Channel 2026; Grow Ireland; Grow New Zealand), with news reporting of the 2026 program-book update (Region Canberra). Research descriptions come from Finn, Bishop & Sparrow (2009), Lakeman et al. (2010), Corrigan et al. (2002, abstract; Con Keogh was a co-author) and Young (1992, thesis abstract). The founding history and the rename date are confirmed by Grow Australia's own timeline and history; Grow's own publications confirm that the Middle Routine, the Four Stabilising Questions, the Basic Convictions and the Three Determinations exist, but their content is not public. The Blue Book (The Program of Growth to Maturity, sold in New Zealand as The Grow Journey) and the Group Method card are member literature without public copies, so their wording and the full order of meeting parts remain [uncertain].

What it is. GROW is a peer-led mutual-help fellowship for people with mental health problems and other life difficulties. It is not a therapy that a clinician delivers. The guide below is written for a clinician who refers clients to GROW, works alongside it, or adapts its principles. A priest, Con Keogh, was hospitalised after a breakdown in 1954. In 1956 he and others went to Alcoholics Anonymous meetings. There they met people whose problems were mental illness rather than alcohol, and they decided to form their own group. They called it Recovery, to put the emphasis on the goal rather than the problem. It first met on 26 April 1957 in a church hall in Hurstville, Sydney, with about thirteen people present [source: Grow Australia 2021 Timeline; Grow award application c. 2016–17; Dave Mc, A brief history]. Keogh called himself a co-founder, not the founder [source: Dave Mc history]. Rename: Grow's own timeline and history paper both give 1975 as the year Recovery 'officially' changed its name to GROW. Grow's award application says 'early 1970s', and the timeline records that the movement had already spread to Hawaii under the name GROW in the early 1970s [source: Grow 2021 Timeline; Dave Mc history; Grow award application]. Lakeman et al. (2010) give 1972. This guide follows 1975 for the official Australian rename. The year the name GROW was first used remains [uncertain]. Other dates from Grow's timeline: first group in a prison (Long Bay Gaol) 1963, New Zealand 1965, Ireland 1967, first mainland USA groups in the late 1970s [source: Grow 2021 Timeline]. Wikipedia (secondary) adds that GROW took in will-training methods from Recovery International [source: Wikipedia, citing Kurtz & Chambon 1987]. GROW now runs in Australia, New Zealand, Ireland and elsewhere. It meets in community halls, hospital wards, prisons, schools and online [source: Lakeman et al. 2010; Grow Australia podcasts].

How change happens (as GROW and its researchers describe it). Members wrote down, over decades, what helped them. This became a lay 'Program': a set of 12 Steps plus readings, which researchers describe as a layperson's cognitive-behavioural therapy [source: Finn et al. 2009; Lakeman et al. 2010]. Each week a member brings one problem. The group helps link it to one part of the Program and one practical task. The member reports back the next week [source: grow.ie Program page]. Corrigan et al. (2002; Keogh co-authored) analysed GROW's written program and 22 member testimonies. The two processes they found most central were being reasonable and 'decentralizing' from self by taking part in community. The testimonies also stressed accepting one's personal value [source: Corrigan et al. 2002, abstract]. Young's (1992) evaluation describes GROW groups as cohesive and firmly led, with a climate that encourages growth and change while avoiding the expression of negative feelings and confrontation [source: Young 1992, thesis abstract]. Several other things drive change in this account:

  • Belonging and friendship.
  • Hope from hearing others' recovery.
  • Helping others (the 'helper therapy' principle).
  • Moving from passive attendance to active roles and leadership, which researchers call 'platforms of growth'. Over time members stop seeing themselves as 'problem people' and start seeing themselves as learners and helpers [source: Finn et al. 2009].

The Program treats growth as lifelong: a member works towards maturity through daily habits [source: grow.ie FAQ; grow.org.nz Growth & Recovery].

2. Framework

GROW has no treatment phases, fixed session count or discharge point. [source: grow.ie FAQ; Grow Australia intro 2020] It is open-ended membership, with progression described in the following ways.

Format of a meeting.

  • Meetings are weekly, face to face or online (Australia's online groups are called eGrow).
  • They last about 2 hours.
  • Peers lead them, using a set structure called the Group Method. A 'method card' serves as the agenda.
  • Group size: Australia gives 3–10 members, New Zealand 5–9, and Finn et al. 3–15. In Ireland a meeting needs at least 3 people.
  • Membership is free, needs no referral or diagnosis, and members may stay anonymous.
  • Face-to-face meetings end with tea and socialising [source: Grow Australia intro 2020; grow.ie FAQ and Program page; Healthpoint NZ; Finn et al. 2009].

Parts of the meeting. Meetings follow a set 'Group Method' that specifies how group time is allotted [source: Finn et al. 2009, citing GROW 1982]. Only two points of order are confirmed: everyone recites the Commitment at the start, and a personal testimony comes in the opening part, after which time goes to members' problems and progress [source: Grow award application; Finn et al. 2009]. The sources name the parts below, but none gives the full sequence. The order shown after the first three items is not verified [uncertain]:

  • The Grow Commitment, said together at the start by everyone present. Grow's own description says it includes respecting group confidentiality [source: Grow award application; Program Training Channel].
  • An agreement on confidentiality.
  • Personal testimony, in the opening part of the meeting [source: Finn et al. 2009].
  • Progress reports on last week's practical tasks.
  • Problem solving on members' problems.
  • A discussion of Program readings. In early meetings this was the discussion of the 'Declaration' attached to each Step, which grew into today's 'Middle Routine' [source: Dave Mc history, re-checked]. What the Middle Routine contains now is not public [uncertain].
  • 'Adult education' on rebuilding lives.
  • A section on group problems.
  • Setting each member's practical task for the week. Finn et al. add that each member is asked to phone one other member during the week.
  • One or two prayers, with non-religious alternatives available.

[source: Grow award application c. 2016–17; Grow Program Training Channel; grow.ie FAQ; Dave Mc history; Healthpoint NZ, both GROW listings, which say 'one or two prayers are recited in the weekly Group Method'; Finn et al. 2009]

How a member progresses.

  • Starting out. Australia advises attending at least three meetings before judging whether GROW suits you. Ireland advises newcomers to listen for the first few meetings and says they may bring a friend or relative once or twice [source: Grow Australia intro 2020; grow.ie FAQ].
  • Member levels. Members are described as Beginning, Progressing or Seasoned Growers, according to time in the group and stage of recovery. The Blue Book is reportedly divided into sections that match these three levels [source: grow.ie FAQ; Wikipedia]. No formal criteria for moving between levels are published [uncertain].
  • Steps. Step 1, admitting that life has gone off track and help is needed, comes first. Steps 2–12 'can be studied in any order' [source: grow.org.nz]. Progress is not linear [source: grow.ie Program page].
  • Leadership path. Members can take on rising responsibility, a path researchers call 'platforms of growth'. This includes rotating chair, welcoming newcomers and becoming organiser or recorder. Beyond the group there are leaders' meetings, Organisers & Recorders (O&R) meetings and committees. Training ranges from leadership weekends to an accredited five-part distance course with a mentor (Ireland, Dublin City University) [source: Finn et al. 2009; Lakeman et al. 2010; Program Training Channel].

Clinician-side framework [synthesis]. None of this comes from GROW sources.

  • (a) Assess fit and refer.
  • (b) Prepare the client and plan the first three meetings.
  • (c) Run therapy and GROW side by side. Link each GROW practical task to therapy goals.
  • (d) As the client takes up roles and builds a GROW network, therapy contact can be reduced. GROW then continues as a long-term community support.
  • Move from one stage to the next on observable signs: the client attends regularly, gives progress reports, has at least one contact between meetings, and takes on a role.

3. Guiding principles

These principles come from GROW's own publications and from researchers. Where GROW publishes only the name of a principle, only the name is given here and its content is [uncertain].

  • Personal Value [source: Program Training Channel, 'Early Grow Foundational Principles 1–5'; Dave Mc history, which lists it among early principles 'still evident in the Program today']. Practical meaning: every member is treated as valuable whatever their diagnosis or history. Feeling valued is a named part of recovery [source: Finn et al. 2009], and accepting one's personal value was a key theme in members' written testimonies [source: Corrigan et al. 2002, abstract].
  • Self Activation [source: Program Training Channel]. Practical meaning: the member does the work of recovery through weekly tasks; the group does not fix them.
  • Mutual Help [source: Program Training Channel; Finn et al. 2009]. Practical meaning: helping others counts as part of one's own recovery, so newcomers are steered towards helping roles early. Corrigan et al. found 'decentralizing from self' by taking part in community to be one of the two most central recovery processes in GROW's materials and testimonies [source: Corrigan et al. 2002, abstract].
  • Ordinariness [source: Program Training Channel, title only; content uncertain]. Practical meaning (inferred): leaders are ordinary members, not experts or professionals. This fits GROW's 'psychology of mental health' built from the experience of ordinary people [source: Lakeman et al. 2010], and 'self-esteem through ordinariness' was one of the changes committed members described in an Illinois dissertation on GROW [source: Kennedy 1995, abstract].
  • Friendship [source: Program Training Channel; Finn et al. 2009]. Practical meaning: friendship, phone contact and socials between meetings are part of the method, not optional extras.
  • Peer leadership with structure [source: grow.ie; Program Training Channel]. Practical meaning: there are no professional facilitators. The Group Method keeps time and focus. Leaders aim for fidelity to the method without rigidity.
  • One person, one problem, one part of the Program, one practical task [source: grow.ie Program page]. Practical meaning: each member works on one concrete step at a time.
  • Reason over feelings [source: grow.org.nz Step 8; Lakeman et al. 2010 Table 1; Dave Mc history, re-checked]. Practical meaning: members practise telling facts from feelings and acting on reason. Step 8 is about learning to think by reason rather than by feelings and imagination. Its early Declaration asked members to stop voicing ideas that, on sound advice, they had come to regard as probably delusions or obsessions. 'Be reasonable' was one of the two most central recovery processes in Corrigan et al.'s analysis of GROW's program [source: Corrigan et al. 2002, abstract].
  • Will-training and persistence [source: grow.org.nz Steps 6 and 9]. Practical meaning: do what is right even when you do not feel like it, until it becomes habit, and keep going through hard times.
  • Care of the body [source: grow.org.nz Step 7; Dave Mc history]. Practical meaning: diet, exercise and rest are part of the Program. Changing one small habit is encouraged.
  • Responsible place in society, and carrying the message [source: grow.org.nz Steps 10 and 12]. Practical meaning: recovery is lived out in roles, relationships and in helping others in need. Dave Mc's history gives a final principle: "Each person's recovery aids the transformation of the world."
  • Five pillars: Understanding, Acceptance, Confidence, Control, Love [source: grow.ie Program page]. Practical meaning: lenses for looking at, and changing, one's thinking, behaviour and relationships.
  • Spiritual but non-religious [source: Grow Australia intro 2020; grow.org.nz Step 3; Healthpoint NZ]. Practical meaning: Step 3 refers to a greater power, which members may understand as God, love and goodness, or nature. Meetings include prayers, but GROW is not tied to any church. Since 2026 a secular edition of the program book speaks of a 'Higher Self' instead of God [source: Region Canberra 2026].
  • Medication and diagnosis belong with the doctor [source: grow.ie FAQ]. Practical meaning: GROW supports medical treatment and does not interfere with medication. Talk of diagnosis, treatment and psychiatric jargon is strongly discouraged in meetings.
  • Confidentiality with limits [source: grow.ie FAQ]. Practical meaning: members agree to confidentiality at each meeting. It does not hold where there is a threat of harm to self or others, a minor at risk of abuse, or serious crime.
  • Readiness to change [source: grow.ie FAQ; Grow Australia intro 2020]. Practical meaning: GROW suits people who accept they need help and are willing to change how they think and relate. It will not work for someone who cannot yet see a need for help.
  • Experiential knowledge is refined collectively [source: Dave Mc history]. Practical meaning: from the start GROW separated 'helping meetings' (working on problems) from 'leaders' meetings', which reflect on what helped and write it up as leadership papers and Program literature.
  • Other named parts of the Program. Dave Mc's history lists the Four Stabilising Questions, Personal Value, First Keys for Understanding Feelings, Basic Convictions and Three Determinations as early principles from the leaders' meetings that are 'still evident in the Program today' [source: Dave Mc history, re-checked]. A member's account published by Grow Australia, taken from Growing to Recovery: Readings for Mental Health Vol 2, confirms the Four Stabilising Questions are in current use. It describes them as a tool for crises and high-stress moments that helps a member step back from their thoughts and feelings. The same account names the Four Qualities and a 7th Principle, 'Constant improvement': situations can be improved through good habits of thinking and acting and through cooperation with help, even amid disorder and limitations [source: Grow Australia, 'How has Grow been the answer to my recovery journey?']. No open source gives the wording of the questions, convictions, determinations or qualities; it is in the Blue Book [uncertain]. Do not teach them from memory; ask the client or a local GROW group for the Blue Book.

4. Intervention inventory

This inventory has two parts.

  • Part A describes GROW's own practices as GROW publishes them. Peers run these inside the fellowship; the therapist does not run them. A clinician needs to know them in order to prepare a client and to use GROW alongside treatment.
  • Part B gives the clinician's own procedures for referring to GROW and working with it. Part B is [synthesis] unless a source is tagged.

In both parts, all example wording is my own and labelled (illustrative).

Part A — GROW practices (peer-run)

A1. The Grow Commitment and confidentiality agreement

  • Purpose / when: Opens every meeting, face to face and online, and is said by everyone present. It sets the tone of the meeting and reminds members what it means to belong [source: Program Training Channel, 'The Grow Commitment']. Grow's own description says the Commitment includes respecting group confidentiality [source: Grow award application c. 2016–17]. Members agree to respect what is shared, within stated limits (risk of harm to self or others, a minor at risk of abuse, serious crime) [source: grow.ie FAQ].
  • Steps: At the start of the meeting the group recites the Commitment together, then confirms the confidentiality agreement. The wording is GROW's own and is not reproduced here [uncertain]. In 2026 Grow Australia reported an expanded version of the Commitment [source: Grow podcast Ep. 18].
  • Clinician use / example language: "At the start, everyone says a short commitment together and agrees to keep what's said in the room. The exceptions are about serious risk — the same as with me." (illustrative)
  • Watch for: Clients with trauma or religious injury may react to reciting a shared text or a prayer. Prepare them: it is fine to stay silent.

A2. Personal testimony

  • Purpose / when: Early in the meeting a member tells the story of how they came to GROW and how it has helped [source: Finn et al. 2009; Grow Australia intro 2020]. Testimony is also given outside the group, at hospital orientations, seminars and training events [source: Finn et al. 2009]. Grow Australia's podcast notes that a run of regular progress reports adds up, over time, to a testimony of recovery [source: Program Training Channel, 'Progress Reports'].
  • Steps (as described): A member volunteers or is invited to tell their story. Sharing is optional, and a member does it when ready [source: grow.ie Program page]. GROW's guidance on the length and shape of a testimony is not public [uncertain].
  • Clinician use / example language: "You'll probably hear someone tell their story early in the meeting. Notice where it overlaps with yours. You don't have to tell yours for a long time." (illustrative)
  • Watch for: A client comparing themselves unfavourably with others. A testimony is also a sign of progress: a client who offers one has moved from passive to active membership [source: Finn et al. 2009].

A3. Progress reports

  • Purpose / when: Each member reports on the practical task they set last week. The group recognises change, holds the member accountable and affirms them. The aim is to move from short-term coping towards long-term growth by tracking small steps [source: Program Training Channel, 'Progress Reports'; Lakeman et al. 2010].
  • Steps (as described): The member says what they tried, what happened, and which part of the Program helped. They then take on a task for the next week [source: grow.ie Program page]. The exact order and timing within the meeting are not published [uncertain].
  • Clinician use / example language: "Bring me the task you reported on this week. Let's look at what it tells us about our work here." (illustrative)
  • Watch for: Repeated 'no progress' reports. These can lead to shame and dropout (see Section 5).

A4. Practical problem solving (coping versus growth problems)

  • Purpose / when: At each meeting, any member can bring a problem. GROW names two kinds:
    • A coping problem is a struggle with the basic realities of life.
    • A growth problem is one whose solution moves the member forward, such as a career or study. [source: grow.ie Program page]
  • Steps (as described):
    • (1) The member presents one problem.
    • (2) Other members respond with lived experience and relevant Program content [source: Finn et al. 2009].
    • (3) The group and the member identify the area to work on.
    • (4) A practical task is set (A5).
    • Leaders keep the discussion on task and quickly check 'irrelevant talk' (see A8) [source: Program Training Channel].
  • Example language for clinicians preparing a client: "Try bringing one small, concrete problem — for example, getting out of bed before ten — not the whole story of the depression." (illustrative)
  • Watch for: Groups reframe crises more positively and offer a 'holding process' with feedback [source: Finn et al. 2009]. Check that the client experiences this as support, not as being pushed.

A5. Practical tasks

  • Purpose / when: These are GROW's core behavioural mechanism: one concrete action to do before the next meeting [source: grow.ie Program page; Lakeman et al. 2010].
  • Examples from sources:
    • Taking a bus with another member to a meeting.
    • Phoning one other group member during the week; Finn et al. report every member is asked to do this at the end of each meeting. [source: Finn et al. 2009]
  • Steps: The group helps set the task. The member works on it during the week and reports back (A3). The Program book offers affirmations for when a task cannot be completed [source: grow.ie Program page].
  • Clinician use: Treat the GROW task as a homework partner to therapy tasks; do not let the two compete. Check the size of the task. A task that is too big is a common reason for a failed week [synthesis].
  • Example language: "What task did the group help you set? How does it fit with what we planned?" (illustrative)

A6. The Program: Blue Book readings, Middle Routine and adult education

  • Purpose / when: The Program is the members' accumulated experience in written form, and the reference text for meetings. The main volume is the Blue Book, The Program of Growth to Maturity. Grow's timeline dates its first version to 1959 [source: Grow 2021 Timeline]. Grow New Zealand now sells it as The Grow Journey ('aka Blue Book'), a pocket-sized book that is usually the first one members are encouraged to buy; members are encouraged to memorise parts of it [source: Grow NZ shop listing; Grow Australia intro 2020]. It is reportedly around 94 pages and divided into Beginning, Progressing and Seasoned Grower sections [source: Wikipedia, citing Grow 1983; secondary, uncertain: secondary, unverified]. Grow NZ also sells Growing to Maturity, Steps to Recovery, Readings for Mental Health Vol 1 and Soul Survivors Vol 2. The Green Book, Growing to Recovery, is Readings for Mental Health Vol 2 [source: Grow NZ shop listing; Grow Australia member story].
  • Other GROW titles:
    • Brown Book: Readings for Mental Health (Keogh 1975).
    • Green Book: Growing to Recovery (2022).
    • A revised program book (2026). Grow published A Program for Personal Growth, an updated version of the Blue Book, in a faith-based and a secular edition; the secular edition does not use the word 'God' and refers to a 'Higher Self'. A Grow program worker described it as the first major update to the 12 Steps in 15 years. Grow's podcasts describe expanded guidance on healthy relationships and codependency. [source: Region Canberra, 23 Apr 2026; Grow podcast Ep. 16, Ep. 23; Wikipedia]
  • History of the Middle Routine: In early meetings, members discussed a 'Declaration' attached to each Step: an expanded explanation of that Step. That discussion became today's Middle Routine [source: Dave Mc history, re-checked]. Grow's timeline dates the first written version of the 12 Steps, the 'Amplification of the 12 Steps', to 1958. Dave Mc's history says the Amplification came about a year after the Steps were first written down. It served as the meeting's 'Program Focus' for reading and discussion, and amplifications were first published as Program Commentary in 1960 [source: Grow 2021 Timeline; Dave Mc history]. New Zealand meetings include 'adult education about rebuilding lives' [source: Healthpoint NZ].
  • Steps: The current content and order of the Middle Routine are not public [uncertain]. Do not describe it to clients in detail; let the group introduce it.
  • Clinician use: Ask the client which reading or 'part of the Program' they used this week. Then link it to your own model: for example, GROW's facts-versus-feelings work maps onto cognitive restructuring [synthesis].

A7. Working the 12 Steps (and the stages of decline)

  • Purpose / when: The 12 Steps of Personal Growth and Recovery are the Program's framework [source: grow.org.nz; grow.ie]. Paraphrased:
    • 1: admit that life has gone off track and that you need help, owning your part.
    • 2: commit to getting well and cooperate with help.
    • 3: trust a greater power, however you understand it.
    • 4: take an honest inventory of strengths and weaknesses and accept yourself.
    • 5: take a moral inventory and let go of guilt.
    • 6: stay with it through hard times.
    • 7: look after your body.
    • 8: think by reason rather than by feelings or imagination.
    • 9: train your will to do what is right.
    • 10: take a responsible, caring place in society.
    • 11: keep growing towards maturity.
    • 12: carry the message to others. [source: grow.org.nz; Lakeman et al. 2010 Table 1; Dave Mc history]
  • History of the wording: Step 1 was reworded to 'maladjusted' after prisoners asked for wording that covered people who had done wrong, not only people who were ill [source: Dave Mc history]. A parallel set of twelve stages of decline holds that emotional illness begins with self-centredness [source: Wikipedia, citing Grow literature; uncertain: secondary, unverified].
  • Steps: Members work at their own pace. Step 1 comes first; Steps 2–12 may be taken in any order [source: grow.org.nz].
  • Clinician use / example language: "Which step are you working on? What would doing it look like this week?" (illustrative)
  • Watch for: Steps 4–5 (inventory and guilt) can stir up shame, trauma memories or scrupulosity. Offer to work on them in therapy [synthesis]. The 'self-centredness' account of decline can also feel blaming to some clients. Discuss it [synthesis].

A8. Group problems and checking irrelevant talk

  • Purpose / when: The meeting has a section on group problems. Examples given are late starts, breaches of confidentiality, and venue or membership concerns. Problems are tackled at group level first. Unresolved ones go to the regional Organisers & Recorders meeting, which can set practical tasks and arrange support from a program worker [source: Program Training Channel, 'Tackling Group Problems'; 'O&R Meeting Part 1']. Leaders are also trained to spot 'irrelevant talk', to understand why it happens and how it disrupts problem solving, and to bring the group back on track with care [source: Program Training Channel, 'Irrelevant Talk'].
  • Clinician relevance: If a client reports a confidentiality breach or conflict in the group, encourage them to raise it through this route first [synthesis].

A9. Friendship network between meetings

  • Purpose / when: Friendship is a founding principle. Members keep up phone contact between meetings, attend organised socials and the after-meeting cuppa, and go to training days [source: Finn et al. 2009; Healthpoint NZ].
  • Clinician use: Ask the client about their GROW contacts as a measure of social network growth [synthesis]. Example: "Who did you ring this week, and who rang you?" (illustrative)
  • Watch for: Socially anxious clients may avoid the phone task. Rehearse it with them in session [synthesis].

A10. Community weekends, residential training weekends and residential programs

  • Purpose / when:
    • Community weekends build friendship and reduce isolation [source: Grow podcast Ep. 21].
    • Residential training weekends are a key setting for social skills, and members can build up their time there gradually [source: Finn et al. 2009].
    • GROW has run residential programmes, beginning in Cairns in 1976. A residential drug rehabilitation programme followed in NSW in 1979, and a rehabilitation expansion in northern NSW was reported in 2026 [source: Dave Mc history; Grow podcast Ep. 21].
  • Clinician use: Before a weekend, review the client's sleep, medication, crisis plan and any trigger points around shared living [synthesis]. Admission criteria for the residential programmes are not described here; ask the provider [uncertain].

A11. Leadership roles and leadership development

  • Purpose / when: Taking on roles is a central mechanism of change: 'learning by doing' and 'platforms of growth' [source: Finn et al. 2009]. Roles include:
    • Rotating chair.
    • Welcoming newcomers.
    • Organiser, who sets up the weekly meeting, welcomes members, keeps the group on task and may chair.
    • Recorder.
    • Committee member. [source: Finn et al. 2009; Lakeman et al. 2010]
  • Regional and training structures:
    • Organisers and Recorders meet regionally. Their meeting includes organiser testimony, reports every two months, approval of new groups, practical tasks for group problems, and preparation for leadership meetings [source: Program Training Channel, O&R Parts 1–2].
    • Leaders' meetings reflect on what helped and write it up as Leadership Papers [source: Dave Mc history; Grow podcast Ep. 20].
    • Training includes organiser and recorder training weekends [source: Grow podcast Ep. 23, 25]. A 1991 talk by Keogh on '8 Characteristics of leadership' is held by Grow Australia [source: Program Training Channel, title only; content uncertain]. In Ireland there is a five-part distance course, accredited by Dublin City University, with a mentor for each participant [source: Lakeman et al. 2010].
  • Clinician use: Support the client in taking a role when they are stable enough. In therapy, work on the skills the role needs (assertiveness, keeping time, coping with a member in distress) [synthesis].
  • Watch for: Taking on a role too early and burning out, or tying self-worth to the role [synthesis].

A12. Outreach formats: hospital orientations, Welcome to GROW, prisons, schools, online, short courses

  • What exists:
    • Hospital orientations, where members visit wards; these rely on good relationships with staff.
    • 'Welcome to GROW' orientation sessions for newcomers.
    • Prison groups and groups for people leaving prison.
    • Get Growing, a ten-week peer mental wellbeing program for young people aged 11 to 17, run within schools and other organisations by trained Youth Program Workers; topics include resilience, feelings, friendship, problem solving, safety, personal value, strengths, goals, stress and dealing with a crisis [source: Get Growing brochure 2022].
    • eGrow and online groups, including Zoom groups that are open internationally.
    • A Growing Resilience short course. [source: Grow podcasts Ep. 17, 19, 22; Dave Mc history; Healthpoint NZ; Program Training Channel, 'Online Grow groups']
  • Clinician use: Inpatient and forensic clinicians can invite GROW's orientation team to the ward, so patients meet members before discharge [synthesis, built on the published orientation role]. The content of the orientations and of Growing Resilience is not public [uncertain].

Part B — Clinician procedures for referring to and working alongside GROW

These are my own procedures [synthesis], built on GROW's published conditions. Tagged items cite a source.

B1. Assessing fit

  • Purpose / when: Before suggesting GROW, check whether it suits this client now.
  • Steps:
    • (1) Check what GROW says it suits. Its target group is wide: people with experience of mental health problems, and also people facing bereavement or family problems [source: grow.ie FAQ]. GROW NZ lists depression, anxiety, bipolar disorder, schizophrenia, suicidal thoughts, PTSD, addictive behaviours and psychosis [source: Healthpoint NZ].
    • (2) Check readiness. Does the client accept they need help, and are they willing to change habits? GROW states it will not work without this [source: grow.ie FAQ].
    • (3) Check practical fit. Is there a group nearby or online, at a time the client can attend? Is the language right (NZ meetings are in English) and is the client an adult? Youth formats exist in some countries [source: Healthpoint NZ; Dave Mc history].
    • (4) Check attitudes to the spiritual element. Step 3 refers to a greater power and meetings include one or two prayers, although non-religious alternatives exist [source: Healthpoint NZ; grow.org.nz].
    • (5) Check current state. Is the client stable enough to sit in a group for 2 hours? A client in acute risk or acute psychosis needs clinical stabilisation first. GROW can come alongside that work, not replace it.
  • Example language: "There's a free peer group called GROW. People there have been through mental health problems themselves, and they work on one practical step each week. Would you want something like that alongside our sessions?" (illustrative)
  • Watch for: A client hearing the referral as being 'handed off'. Make clear that therapy continues.

B2. Preparing the client for the first meetings

  • Purpose / when: Once the client agrees. The aim is to reduce early dropout.
  • Steps:
    • (1) Find a group with the client: through the national website or phone line, or for Ireland through the Area Coordinator [source: grow.ie Program page; Grow Australia intro 2020].
    • (2) Explain the format: about 2 hours, a small group, a commitment and possibly prayers at the start, people's stories and progress reports, and then problem solving.
    • (3) Tell the client it is fine to only listen at first [source: grow.ie FAQ]. They may bring a friend or relative to the first one or two meetings [source: grow.ie FAQ]. Agree on trying three meetings before deciding [source: Grow Australia intro 2020].
    • (4) Agree on what to keep private. Talk of diagnosis and medication is discouraged in the group anyway [source: grow.ie FAQ].
    • (5) Rehearse a one-sentence introduction, and an exit line in case it becomes overwhelming.
    • (6) Book a session soon after the first meeting to debrief.
  • Example language: "You don't need to say anything at the first meeting. If you want to talk, 'I'm new, I've been struggling with low mood, and I'm here to listen' is enough." (illustrative)
  • Watch for: Anticipatory avoidance. Treat going to the first meeting as a graded task.

B3. Debriefing and linking GROW work to therapy

  • Purpose / when: In each session while the client attends GROW.
  • Steps:
    • (1) Ask for the client's own progress report: their task, what happened, and the part of the Program they used.
    • (2) Map it onto the therapy formulation. For example:
      • Facts versus feelings (Step 8) → thought records.
      • Will-training (Step 9) → behavioural activation.
      • Body care (Step 7) → routine and sleep.
    • (3) Agree on the size of the next GROW task with the client, so it neither competes with therapy homework nor duplicates it.
    • (4) Track the client's network: their phone contacts and socials.
  • Example language: "So the group helped you set 'ring Sam on Wednesday', and you did it. What did you notice beforehand, and what did you notice afterwards?" (illustrative)
  • How to know it's working: Signs include:
    • Regular attendance.
    • Progress reports with completed tasks.
    • At least one contact between meetings.
    • The client starting to help others or offering a testimony. These match the change process described by Finn et al. 2009.

B4. Coordinating medication and clinical care

  • Purpose / when: Throughout. GROW supports medical treatment and leaves medication to the member and their doctor [source: grow.ie FAQ].
  • Steps:
    • (1) Tell clients that medication decisions stay with their prescriber.
    • (2) If group feedback conflicts with clinical advice, explore it openly. Finn et al. describe a member who was discouraged by her psychiatrist from returning to study; her group supported her through a hard six months [source: Finn et al. 2009]. Peer views can be a valid challenge to clinical caution.
    • (3) Keep the client's crisis and safety plan up to date. It should name GROW friends only if the client chooses.
  • Example language: "If someone at GROW suggests a change to your medication, bring it here or to your doctor. You stay in charge of that decision." (illustrative)

B5. Observing a group or building a referral relationship

  • Purpose / when: When a service wants to refer regularly.
  • Steps:
    • (1) Contact the national or regional office.
    • (2) Ask whether the local group accepts community observers. Grow Australia has a role for community observers, with etiquette and proposed guidelines [source: Grow podcast Ep. 17]. The guidelines themselves are not public [uncertain].
    • (3) Offer the ward or clinic as a venue for a GROW orientation [source: Grow podcast Ep. 22].
    • (4) Never attend as a professional without the group's agreement.
  • Watch for: Professional presence changes peer dynamics. Respect that the group is peer-run and member-controlled [source: Finn et al. 2009; Mutual Support review 2015].

B6. Supporting a client who takes a leadership role

  • Purpose / when: When the client is invited to chair, organise or record.
  • Steps:
    • (1) Look at the gains (confidence, purpose) and the risks (overload, relapse triggers).
    • (2) Rehearse the skills the role needs, such as bringing someone back to topic kindly or handling a member in distress.
    • (3) Agree on early warning signs and a plan for stepping back from the role.
    • (4) Encourage the client to use GROW's own leadership training and O&R support [source: Program Training Channel; Lakeman et al. 2010].
  • Example language: "Being organiser sounds meaningful to you. What would tell us it's become too much, and who in GROW would you hand over to?" (illustrative)

B7. Adapting GROW principles in clinician-run groups

  • Purpose / when: In services without a local GROW group.
  • Steps:
    • (1) Do not call the group GROW or use GROW literature without the organisation's agreement.
    • (2) Use generic features drawn from the published model: a fixed agenda; one problem and one concrete weekly task per member; progress reports; members helping each other; rotating roles; contact between meetings.
    • (3) Partner with GROW to seed a real peer-led group where possible. Peer support tends to lose its integrity when formal services run it [source: Mutual Support review 2015].
  • Watch for: Drifting into therapist-centred facilitation, which defeats the mutual-help mechanism.

5. Handling problems

GROW's own published problem-handling covers group-level issues: late starts, confidentiality breaches, venue or membership concerns, and irrelevant talk. Its route is to deal with these in the group first, then escalate to the Organisers & Recorders meeting and program worker [source: Program Training Channel]. It also covers crises, which the group meets with support and reframing [source: Finn et al. 2009]. One finding bears on several problems below: Young's (1992) evaluation found GROW groups cohesive, firmly led and resistant to change, with a climate that avoids expressing negative feelings and confrontation [source: Young 1992, thesis abstract]. A client who needs room to voice anger or distress may find this restrictive; agree where that work happens, usually in therapy [synthesis]. Everything else below is my own guidance for the referring clinician [synthesis].

  • Client won't go, or stops after one meeting. Ask what happened: a mismatch with the group, social anxiety, the spiritual element, or feeling different from the others. GROW advises trying at least three meetings [source: Grow Australia intro 2020]. Options [synthesis]:
    • Agree three meetings as a graded task.
    • Suggest a different group or an online group.
    • Let the client bring a friend [source: grow.ie FAQ].
    • Debrief after each meeting.
  • Stuck: repeated 'no progress' reports. Help the client make the GROW task smaller and more concrete. Look at what got in the way: avoidance, low mood, practical barriers. Show them that GROW's Program anticipates tasks that cannot be done [source: grow.ie Program page]. Normalise that progress is not linear [source: grow.ie] [synthesis].
  • Resistance to the 12-Step or spiritual framing. Explain that GROW is not tied to any religion and offers alternatives to 'God' [source: Grow Australia intro 2020; grow.org.nz]. Agree that the client can stay silent during prayers. If the language of self-centredness or moral inventory feels blaming, process that in therapy. Where it still does not fit, consider another mutual-help option [synthesis].
  • Overwhelm in the meeting (hearing others' stories, trauma reminders, panic).
    • Prepare an exit line and grounding skills beforehand. Agree that leaving early is acceptable. Finn et al. describe a member with depression who at first left meetings quickly, then gradually became more involved [source: Finn et al. 2009].
    • Debrief the next day if you can [synthesis].
  • Risk or crisis disclosed in the group. The group's confidentiality does not cover risk of harm to self or others [source: grow.ie FAQ]. Keep the client's own safety plan and crisis contacts current (for example 988 in the US, Samaritans 116 123 in the UK and Ireland, or the local crisis line). Clarify that GROW peers are not a crisis service. Agree whether the client wants GROW friends named as supports. Follow standard risk assessment and safety planning; this includes lethal-means counselling about safe storage or removal where relevant [synthesis].
  • Group advice contradicts clinical advice (especially on medication). GROW states that it does not interfere with medication and that diagnosis talk is discouraged [source: grow.ie FAQ]. If a member does advise on medication, help the client take it to the prescriber [synthesis]. Treat peer challenge to clinical caution, for example around work or study, as information worth weighing, not insubordination [source: Finn et al. 2009, case example; synthesis].
  • Conflict with a member or a confidentiality breach. Encourage the client to raise it through the group-problems process or with the organiser. If it is unresolved, the regional O&R or program worker can help [source: Program Training Channel]. If there is exploitation, harassment or a risk to a minor, the clinician's ordinary safeguarding duties apply [synthesis].
  • Over-involvement or dependency on the group, or on one member. Watch for:
    • The client's whole social life collapsing into GROW.
    • Burnout from leadership roles.
    • An unequal 'helper' relationship. Respond by widening the client's network and pacing their roles (B6) [synthesis]. GROW's published materials do not address dependency [uncertain].
  • Rupture with the therapist over the referral. If the client feels 'passed on', acknowledge it. Restate that therapy continues, and ask what they need from each setting [synthesis].
  • Clients for whom GROW may not fit now. These include:
    • Clients in acute psychosis, mania or high suicide risk, until stabilised.
    • Clients who cannot yet see a need for help [source: grow.ie FAQ].
    • Clients in coercive relationships, where joining a group could raise risk.
    • Minors outside youth or school formats. [synthesis except where tagged]
  • No local group. Options:
    • Online or Zoom groups, which are open across New Zealand and overseas [source: Healthpoint NZ].
    • eGrow in Australia [source: Grow Australia intro 2020].
    • Starting a group with GROW's support; the O&R meeting approves new groups [source: Program Training Channel].
    • A clinician-run adaptation (B7) [synthesis].

Sources

Sources:

Further pages:

Further research on GROW without open full text, not used here: Roberts (1989), the Illinois dissertation from Rappaport's GROW research programme; Rappaport et al. (1985); Keith Humphreys' GROW studies.

Books cited:

  • GROW (1983), The Program of Growth to Maturity (the Blue Book).
  • Keogh, C. B. (1975), Readings for Mental Health.
  • Keogh, C. B. (1979), Grow Comes of Age.
  • Grow Australia (2022), Growing to Recovery.
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