Self-Help

Karen Horney's publication of Self-Analysis in 1942 led to a new genre in psychological literature: self-help books. These are books that give advice about solving psychological problems without the need to visit or pay for a therapist. In 1969 psychologist George Miller, who urged fellow psychologists to "give psychology away" in his 1969 American Psychological Association presidential address. By the 1970s there was a full-fledged self-help movement underway in America.

What did Forest find to be typical promises of self-help books?

A 1978 task force of the American Psychological Association (APA) appeared to embrace the trend, suggesting that "psychologists were in a unique position to contribute to the self-help movement." Forest (1988) found 232 paperbacks published between 1970 and 1983 which made some kind of "explicit promise" to help people with behavioral, emotional, and social problems. Over 40 became nationwide bestsellers. Most described their approaches with words like "(a) new, unique, and revolutionary; (b) proven and effective, and (c) easy to learn and use." The book covers advertised cure rates "ranging from helping thousands to helping everybody." Today, the internet is full of self-help sites for people with psychological problems; I list the best I can find on my own web site (http://www.psywww.com/resource/selfhelp.htm).

Is there evidence to back up the extraordinary claims made on the jackets of self-help books? Apparently not! Rosen (1987) cited over 100 studies or case reports evaluating the self-help programs of the 1970s. The results showed that, on the whole, the programs were not terribly effective. Here are some typical examples from Rosen:

What did Rosen find to be typical results of using self-help therapies? What was the "main problem"?

Of six couples assigned a do-it-yourself treatment for premature ejaculation, a common sexual problem in males (discussed in Chapter 16) not one successfully completed the program.

Five mothers attempted to use the Azrin and Foxx method for toilet training in a single day in a do-it-yourself group, but only one succeeded. By contrast, four out of five mothers succeeded when the same program was directed by a therapist.

In a typical study of self-administered desensitization, all reported some fear reduction, but only half completed the program.

The main problem with self-help approaches is failure to complete the program. A therapy technique may be backed by scientific research showing that it works in a clinic. However, in a clinic people are pressured to follow a program systematically from start to finish. When left on their own, most people will not complete a disciplined program of self-change.

How does the possibility of a free college education illustrate the problem with self-help books?

To understand the problem with self-help therapies, contemplate the amount of money people spend on a college education. In truth, anybody could get a college education free by reading textbooks available in any campus library. Professors would be glad to point out important books, and most coursework consists of reading books anyway. But how many people have the motivation and discipline to pursue a complete course of study independently?

Some people do have the motivation to complete a course of study independently. For example, Eric Hoffer—the philosopher who wrote the book The True Believer—was blind as a youth, and after his vision was restored in adulthood, he educated himself by reading library books. However, most people seem to need the social pressure of a contract to motivate them to stick with a difficult task. Enrolling as a college student somehow makes it possible to engage in a disciplined activity (studying books) that most students could do on their own-but never would.

The same thing is true in therapy. There is no reason people cannot help themselves by applying scientifically proven techniques in a systematic way. However, in the real world, few people have the motivation to do this. Things are different if they see a therapist. People seem to need a contract-like commitment to motivate them to complete a complex, demanding program. Perhaps this is why behavior contracting is treated as a therapy technique in itself. It targets the weak link in self-help, which is the commitment to see a program through to a successful conclusion.

Self-help and seeing a therapist are not incompatible activities. Starker (1988) found that nearly nine out of ten psychotherapists in the Seattle area prescribed self-help books to their clients, on such topics as parenting and personal growth. About half the therapists reported that self-help books seemed to produce noticeable positive results.


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Copyright © 2007 Russ Dewey