From there, they reflect on how their social environment influences their identity and sense of self worth. They consider the view that self-worth is shaped by contextual, rather than individual, factors. This introduces the notion of looking outward, instead of inward, for a way to prevent or resolve demoralization and depression. For many of the SHOP participants it was empowering to stop blaming themselves for feelings of low morale and uselessness.

In SHOP women create their own definition of social health. From there, they move on to learn or hone skills which enable them to feel and act like valuable and effective participants in their social world. Throughout the sessions the personal social network is emphasized. Early in the program women create a map of their own network. Later in the program each participant evaluates her network to identify any gaps or deficiencies. The women are then encouraged to set social goals to strengthen their networks and to increase their participation in rewarding roles.

Some of the women's comments reflect their response to the knowledge and skills component of SHOP. One woman said, "What I have learned coming to SHOP is that I can think". In relation to the network mapping exercise the women commented as follows: "just looking at this map makes me realize I've got some building to do"; "I've realized I'm relying too much on my daughter for support" and, "I need more community involvement". Almost all of the women reported that setting social goals, or any goals, for themselves was a new and difficult experience. The consensus was that in their lives planning for themselves had been contingent on the needs of others.

Many of the women did not come to SHOP For their own well being but because they were bored and looking for an interesting activity to structure their time. Several women emphasized that they appreciated " SHOP's learning activities as challenging but something they could handle. One woman noted that she felt very aware of her lack of knowledge from not having been as much of a reader as the others. However, she reported feeling comfortable in the group and attendee all but one session.

The learning activities in SHOP build on the women's life experiences. Through reflection on their own experiences participants reframe their view of themselves from 'the one to be blamed' to 'the one who has endured, often through trying and hostile life circumstances'. One woman wrote that SHOP was helpful because "it encouraged or forced me to think and remember positive events and some successes in my life which rarely if EVER think of as important at all." Another woman commented, "you know, I learn so much from listening to these other women. I feel like I was shut out from the world for so many years due to illness." In the problem-solving session women work together to identify problems and create strategies for resolving them. After this session one woman observed "I wish I had known this before."