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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 his 1969 American Psychological Assoc­iation presidential address, psychologist George Miller pointed out that psychologists had practical solutions to common behavioral problems, but the public was largely unaware these solutions existed.

Miller urged fellow psychologists to "give psychology away." Many psychologists were happy to publish their views and advice in books and magazines. 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 self-help books 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 from "helping thousands" to "helping everybody." When the world wide web came along in 1994, self-help sites proliferated there.

Is there evidence to back up the extra­ordinary claims made on the jackets of self-help books? Not always! 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 very effective. Here are some typical examples from Rosen:

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 participants reported some fear reduction, but only half completed the program.

The main problem with self-help approaches is failure to complete the program. In a formal therapy setting, people are pressured to follow through on a program systematically from start to finish. When left on their own, people are likely to give an idea a try but not complete a disciplined program of self-change.

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

To understand the problem with self-help therapies, contemplate the amount of money people spend on a college education. Anybody could get the equivalent of a college education free by reading textbooks available in online or in a campus library.

Professors gladly 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 it. Eric Hoffer–the philosopher who wrote the book The True Believer–was blind as a youth. After his vision was restored in adulthood, he educated himself by reading library books.

Perhaps that is the exception that proves the rule. His early blindness left Hoffer eager to spend time reading great philosophical literature. Most people have neither the early depriv­ation nor the drive to compensate by voraciously consuming literature in adulthood.

Most students seem to need the equivalent of a contract to motivate them to stick with college-level learning. Enrolling as a college student somehow makes it possible to engage in disciplined activity (studying books) that most students could do on their own...but never would.

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

The same thing is true in therapy. People can read the best-reviewed self-help books and help themselves. However, in the real world, few people have the motivation to do this.

People seem to benefit from a contract-like commitment to motivate them. That is why behavior contracting works as a therapy technique. 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 in combination with therapy.

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References:

Forest, J. J. (1988). Self-help books. American Psychologist, 43, 599.

Rosen, G. M. (1987). Self-help treatment books and the commercialization of psychotherapy. American Psychol­ogist, 41, 46-51.

Starker, S. (1988). Self-help treatment books: The rest of the story. American Psychologist, 43, 599-600.


Write to Dr. Dewey at psywww@gmail.com.


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