Chapter One

Introduction to Self-Help
in Mental Health

You have probably heard about or read one or more of the following self-help books:

Feeling Good by David Burns
What Color Is Your Parachute? by Robert Bolles
Dianetics by L. Ron Hubbard
Infants and Mothers by T. Berry Brazelton
The Courage to Heal by Ellen Bass and Laura Davis
Ageless Body, Timeless Mind by Deepak Chopra
The Dance of Anger by Harriet Lerner
When Bad Things Happen to Good People by Harold Kushner
Reclaiming the Inner Child by Jeremiah Adams
Your Perfect Right by Robert Alberti and Michael Emmons
The Silent Passage by Gail Sheehy
Men Are from Mars, Women Are from Venus by John Gray
Listening to Prozac by Peter D. Kramer
Winning through Intimidation by Robert Ringer
You Just Don't Understand by Deborah Tannen
Don't Sweat the Small Stuff ... and It's All Small Stuff by Richard Carlson
How to Win Friends and Influence People by Dale Carnegie
The Power of Positive Thinking by Norman Vincent Peale
The Battered Woman by Lenore Walker
Emotional Intelligence by Daniel Goleman
Dr. Atkins' New Diet Revolution by Robert C. Atkins
The 7 Habits of Highly Effective People by Steven Covey

You have probably also seen several of the following movies on family relationships and mental health topics:

The Color Purple
The Prince of Tides
Cat on a Hot Tin Roof
Days of Wine and Roses
The War of the Roses
As Good as It Gets
9 1/2 Weeks
Good Will Hunting
Ordinary People
What about Bob?
Rain Man
When Harry Met Sally
Field of Dreams
Shine
Dead Poets Society
The Piano

    Each of these books has been at or near the top of national best-seller lists, and each of the movies has been seen by millions of people. Are they good self-help books and movies? That is, do they provide accurate information? Do they help individuals cope effectively with problems? The consensus of mental health experts in the United States is that one-third of these self-help books and movies are not effective self-help resources; even though they were best-sellers and top-grossing films, most mental health experts view them negatively. The other two-thirds of the books and movies on this list are excellent self-help materials. In this book, we tell which are the good ones, which are the bad ones, and why.

SELF-HELP RESOURCES

Self-help materials have become an indispensable source of psychological advice for millions of Americans. Whether we want to improve our marital lives, control our anger, gain self-fulfillment, overcome depression, become better parents, lose weight, solve sexual problems, cope with stress, recover from addictions, or tackle another problem, there is a self-help book.

    Our preoccupation with self-improvement is nothing new; it's been around since the Bible. Although not exactly known as a self-help book author, Benjamin Franklin dispensed self-improvement advice in Poor Richard's Almanac: "Early to bed, early to rise, makes a man healthy, wealthy, and wise." In the 19th century, homemakers read Married Lady's Companion for help in managing their houses and families. In the 1930s, Dale Carnegie's How to Win Friends and Influence People made him the aspiring businessman's guru. And the 1950s brought us Maxwell Malty's Psychocybernetics and dozens of marriage manuals.

    Interest in understanding the human psyche and how to improve it heated up in the 1960s and 1970s and was accompanied by a glut of self-help books. I'm OK, You're OK and Your Erroneous Zones were read by millions of Americans and made fortunes for their authors. They turned out to be only the tip of the iceberg.

    The advent of popular films, the information revolution, and the ascendancy of the Internet have given rise to a dizzying diversity of self-help resources. Millions routinely go to the movies, surf the net, and attend self-help groups for edification and assistance. This book is designed to guide you through this morass of self-help information—and misinformation—by providing quality ratings and brief descriptions of five types of self-help materials: self-help books, autobiographies, movies, Internet sites, and self-help/support groups.

1. Self-Help Books

The self-help book market has yielded an overwhelming, bewildering array of choices. Self-help books appear at the rate of about 2,000 a year (Rosen, 1993), and they routinely occupy prominent places on best-seller lists. Books are written on every conceivable topic, as the following list of titles vividly demonstrates:

Dance Naked in Your Living Room
How to Juggle Women Without Getting Killed or Going Broke
I Lost 600 Pounds: I Can Sure Help You Lose 30
Change Your Underwear, Change Your Life
Dated Jekyll, Married Hyde
Boldly Live as You Have Never Lived Before: Life Lessons from Star Trek
The Fairy Godmother's Guide to Dating and Mating
Celestial 911—Call with Your Right Brain for Answers
Don't Bite the Apple 'til You Check for Worms

    The soaring volume of self-help books makes the question of quality—which one will work?—increasingly urgent. More than 95% of self-help books are published without any research documenting their effectiveness (Rosen, 1987, 1993). We hope that they will work, but we do not have any systematic evidence to indicate that they do.

    So how do people select self-help books? Until this book—the Authoritative Guide to Self-Help Resources in Mental Health—people have largely relied on the opinions of friends, their minister, their doctor, their therapist, guest authors on talk shows, a salesperson at a bookstore, or the promotional information on the book's cover. But even personal contact with professionals, such as physicians and psychologists, provides limited information about which book to purchase. Self-help books have been published at such an astonishing pace that even the well-intentioned professional has difficulty keeping up with them. The professional may be well-informed about books in one or two areas, such as depression or anxiety, but may know little about books in other areas, such as eating disorders, women's issues, relaxation, and parenting.

    Some self-help books have been written by professionals who have masterful insights about who we are, what we are about, and how we can improve our lives. Others, to put it mildly, leave a lot to be desired. As a concerned psychologist lamented, "Many self-help books are not worth the paper they are printed on." With literally thousands of books on the market, we wanted to know what the leading psychologists in the United States think are the best and the worst self-help books.

    After all, restaurant critics inform us which restaurants are superb and which ones to avoid; automobile guides educate us about the gems and the lemons; and consumer magazines dispense advice on which refrigerators, computers, televisions, and VCRs to buy. Considering the immense number of self-help books, a guide to them based on professional judgments by mental health experts is badly needed. This book is that guide.

    The good news from research is that self-help programs can be quite effective. Several reviews of the literature have determined that the effectiveness of self-help program substantially exceeds that of no treatment (Kurtzweil, Scogin, & Rosen, 1996; Scogin, Bynum, Stephens, & Calhoon, 1990). For example, in one analysis of the effectiveness of 40 self-help studies, effect sizes for self-help were nearly as large as for therapist-assisted treatments (Gould & Clum, 1993). Fears, depression, headaches, and sleep disturbances were especially amenable to self-help approaches.

    Similarly, bibliotherapy—a fancy way of saying using self-help books—has been shown to be valuable for many, but not all, adults. In one thorough review (Marrs, 1995), bibliotherapy was as effective as therapist-administered treatments. Comparable findings have been reported for the effectiveness of self-help books with specific disorders, such as sexual dysfunctions (van Lankveld, 1998), depression (Cuijpers, 1997), anxiety disorders (Weekes, 1996), alcohol problems (Watson & Sher, 1998), and geriatric depression (Scogin, Hamblin, & Beutler, 1987; Scogin, 1998).

    Self-help books come in many guises. In this book, we do not evaluate books that are primarily religious in nature or medical in content. Books that focus on physical health and disease, be it AIDS, cancer, or heart disease, were not included. Our target is self-help books on mental health topics.

    In Study 1, we asked mental health professionals to rate more than 350 self-help books. We chose these books by examining the shelves of major national bookstore chains, by perusing the wares of large Internet book dealers (Amazon.com, bn.com), by discussing self-help books with psychologists, by consulting the best-seller lists, and by reading numerous books and articles about self-help books. In Study 2 and Study 3, mental health professionals rated an additional 250 self-help books—a few that were missed in Study 1, but mostly books that were published after Study 1 was completed.

2. Autobiographies

Autobiographies provide an inside view of people facing life's problems, drawing on the human capacity for self-description and self analysis. In this way, memoirs complement research and case studies performed from the outside looking in. Written in the person's own words, an autobiography emphasizes issues that the writer, as distinct from a therapist or researcher, considers important. It describes a disorder in its family and environmental context. Such books are interesting to read as narratives with a strong story line.

    Autobiographical authors and their credentials vary tremendously. Some authors are celebrities, already the subject of public interest; others are writers, poets, and artists capable of portraying their inner worlds in words, songs, and drawings. Many accounts are written by ordinary people whose first contact with publishing is writing about their disorder. Some earlier accounts have become classics in mental health education; other books by Kay Jamison (An Unquiet Mind), William Styron (Darkness Visible), and Mark Vonnegut (The Eden Express) are likely to become future classics. Several autobiographies have been made into major films, bringing them to a wide public audience. The books have been used in training mental health professionals and as part of therapy for mental health consumers.

    Autobiographies cover virtually all diagnostic categories. There have also been at least 100 published bibliographies and book-length anthologies of first-person accounts of mental disorder (Sommer, Clifford, & Norcross, 1998).

    The autobiographies listed and evaluated in this book were selected specifically for their availability. Our earlier research articles on autobiographies contained many historical accounts, often very difficult to obtain. In this resource, we looked for first-person accounts still in print that covered mental health problems and life challenges. We visited bookstores and checked electronic booksellers to make sure that the book was still available. The date listed is that of the most recent edition, often in paperback. Even so, it is likely that some books will no longer be available by the time this book is published. However, it is likely that an out-of-print title can be obtained on the used book market.

    An autobiographical account presents a personal view of the disorder and its treatment. When an author says that a mood disorder was relieved by Prozac or blames a family member or therapist for some transgression, this represents the person's view of the situation. Most of the books listed were written by the person with the disorder, but occasionally there is a book by a family member, which provides another perspective on the disorder and the treatment.

    The self-help industry is virtually unregulated. The people with the most influence on which autobiographies are published and marketed are the publishers, the owners of large bookstore chains, and a hodgepodge of authors with a vast range of credentials, knowledge, and competencies. We hope our studies and this book help put a corrective influence in the hands of informed, experienced mental health professionals whose competencies are superior to those of the merchandisers.

3. Movies

Watching popular movies toward therapeutic ends—call it videotherapy—extends reading self-help books and autobiographies. They have similar aims, but movies typically differ from books in using fiction, rather than nonfiction, and in using the film medium, rather than print.

    Films are a powerful and pervasive part of our culture. The widespread availability of movie theaters, VCRs, and videotapes allows most Americans ready access to movies. Gallup polls indicate that watching movies at home and in theaters are amongst adults' favorite pastimes (along with reading, watching television, and participating in family activities). Domestic box office revenues top, according to Variety, a staggering $12 billion for the 100 top-performing movies. And movies frequently touch us emotionally more than book. Psychologist Ken Gergen (1991) opines that the movies have become one of the most influential rhetorical devices in the world; "Films can catapult us rapidly and effectively into states of fear, anger, sadness, romance, lust, and aesthetic ecstasy—often within the same two-hour period. It is undoubtedly true that for many people film relationships provide the most emotionally wrenching experiences of the average week" (pp. 56-57).

    Movies possess a number of advantages over books and computers. Films are fun to watch, require only a small investment of time, appeal to more people than reading, and are already part of many clients' usual routines (Hesley & Hesley, 1998). Instead of spending days or weeks reading books, people get the thrust in a few hours. As a result, clients may be more compliant with recommendations for movies, which are more accessible, fun, and familiar.

    We are not the first to recommend specific movies to enhance self-help, but we may well be the most systematic. Several mental health professionals have penned fine compilations of popular movies to use in understanding psychopathology (Wedding & Boyd, 1999), to use in psychotherapy (Hesley & Hesley, 1998), to help with life's problems (Solomon, 1995), and to illustrate how psychiatry is depicted in the American cinema (Gabbard & Gabbard, 1999). But all of their books essentially present one or two individual opinions. By contrast, in this book we present the consensus of hundreds of mental health experts.

    In preparation for Study 5, we compiled a large list of healing films by reviewing movie books (including those listed above), tracking the top-grossing films from the past decade, and throwing in some of our personal favorites. We also used the excellent Internet Movie Database (http://www.imdb.com) and Amazon.com to search for reviews. We then conducted a small pilot study of 25 colleagues to identify movies that a sizable proportion had actually seen. The result was a list of popular, commercially available films that have played in theaters or, in a few cases, only on television. These were then evaluated by hundreds of psychologists.

    The movies portray healing stories. The best of them typically increase awareness about a disorder or treatment; As Good as It Gets comes immediately to mind for its accurate and humorous depiction of obsessive-compulsive disorder (OCD). The best also show flawed, yet effective role models struggling realistically with problems and ultimately resolving them; two cases in point are The Color Purple about overcoming childhood abuse and On Golden Pond about accepting the ravages of aging and healing family rifts. The favorably rated movies typically generate hope and inspiration and perhaps give a new perspective on ourselves and our relationships.

    As with all of the self-help resources in this book, using movies requires certain warnings and preparation. Viewers are asked to suspend belief and to enter a fantasy world, but not to overidentify or overgeneralize from a single cinematic episode. The young and the squeamish should be directed away from stark, frightening portrayals. People suffering from debilitating psychiatric disorders should be forewarned of possible negative consequences of dramatic films, and those who recently suffered from trauma depicted in films should be careful not to be retraumatized by the experience.

4. Internet Resources

The Internet has opened a whole new world for people seeking information and advice. There are online sites for every aspect of human life and type of psychological suffering. Researchers estimate that half of all Internet users have already sought health care information there.

    But which sites and which information should be trusted? Internet sites are unregulated, and their quality varies extensively. Early studies suggest that the quality of mental health sites is not impressive; almost half were judged to be inadequate in terms of accuracy and practicality of information (DiBlassio et al., 1999). Gleaning trustworthy information on the Internet is like taking a 2-year-old on a walk: The toddler picks up a few pretty pebbles, but also lots of garbage and dirt (Skow, 1999) Professionals may know when a beguiling irrelevancy can be dismissed with a click of the mouse, but the average person rarely does. And any single search engine indexes no more than 16% of the public web, according to a recent study published in Nature (Lawrence & Giles, 1999).

    For this book, Dr. Edward Zuckerman visited approximately 3,000 Internet sites that seemed to be related to the topics covered in this book and might provide assistance to people struggling with mental health problems and life challenges. He chose the 500 or so listed sites on the belief that they would assist people—with or without psychotherapy—by fulfilling two major functions. First, these Internet sites would support the person or client with evidence that they are not alone, that others have overcome similar difficulties, and that much is known about their conditions. Second, the online resources would provide education for patients or parents concerning symptoms and diagnoses, the logic and methods of treatment, and other aspects of treatment.

    In using these Internet resources, psychotherapists will have to explore ways to incorporate the materials. Some could be assigned as homework to save time, increase accuracy and completeness of education, enhance adherence and motivation, decrease dropouts and resistance, and provide instruction in the self-administration of some techniques. Online materials could empower people and raise their self-confidence, encourage socializing, enhance lifestyle changes, maintain changes after treatment, reduce the number of sessions, reinforce points or strategies of a session, and the like. A mental health professional should always read the materials because their contents may frighten rather than educate some clients, may conflict with a particular treatment plan, or may have changed.

    You should assume that all materials on the net are copyrighted. If you find them of value, someone worked hard to make them valuable, and that Person deserves your respect. Generally, for multiple copies, educational uses, or commercial distribution, you must get permission from the copyright holder. Therefore, obtain permission to use any of these materials with your patients unless they are specifically indicated as available for reprinting. You must include the copyright holder's information when you reproduce any materials.

    There are literally thousands of chat rooms, bulletin boards, and other forms of support for clients to participate in. Many sites offer materials that are simply readings, much like a handout or pamphlet. Many of the better ones are in the form of FAQs (frequently asked questions and their answers). A few sites offer questionnaires that are scored and interpreted online. There are almost no interactive therapeutic activities available.

    In selecting sites, we included those that provide people with information, explanations, and introductions to treatments beyond what the clinician could easily supply and that would not compete with or distract the client from the processes of therapy. The material had to be current; we estimate that more than 90% of the sites listed here were written in the last 3 years. All sites were visited as the book was being published and were working at that time. However, the Internet is a famously fluid place, so you might want to visit a site before recommending it.

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