Remembering the 1978 and 1990 Task Forces onSelf-Help Therapies: A Response to Gerald Rosen

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Mark Floyd

University of Nevada, Las Vegas

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Nancy L. McKendree-Smith

University of Alabama, Birmingham

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Forrest R. Scogin

University of Alabama

Gerald M. Rosen has reminded us of the contributions of two task forcesthat addressed self-help therapies. The problems with self-administeredtreatments that were discussed in the recent Journal of Clinical Psychol-ogy special section (Volume 59, Number 3) also were discussed by thesetask forces. One of the primary problems is the lack of quality control and,in particular, the fact that self-help books without empirical support canbe marketed to the public. There is not sufficient data available to reachconclusions regarding the overall impact of self-help books. Additionalresearch and empirical support are needed for self-administered treat-ments; however, requiring such research support prior to publication wouldbe holding self-help books to a higher standard than is currently requiredfor psychologists (and other therapists) providing services. Our belief isthat self-administered treatment is at least benign and potentially helpfulto most consumers. © 2003 Wiley Periodicals, Inc. J Clin Psychol 60:115–117, 2004.

Keywords: self-help; self-administered; therapy; bibliotherapy

In his comments to the special section on self-administered treatments printed in Volume59, Number 3, of the Journal of Clinical Psychology, Gerald M. Rosen highlights the view-points of two task forces formed to address the subject (Rosen, 2004). It is unfortunate this

Correspondence concerning this article should be addressed to: Mark Floyd, Psychology Department, Univer-sity of Nevada, Las Vegas, Box 455030, Las Vegas, NV 89154–5030; e-mail: mfloyd@ccmail.nevada.edu.

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 60(1), 115–117 (2004) © 2004 Wiley Periodicals, Inc.

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.10231

material was not included in the articles in the special section (Scogin, 2003), and we ap-preciate his calling our attention to this.

In his comments, Rosen pointed out that the lack of empirical support for self-administered treatments and the lack of any regulatory (quality control) mechanismshave been concerns for a long time. If anything, these problems have probably worsenedsince the time of the task forces. The number of books has seemed to increase astronom-ically, and it is unlikely the rate of efficacy studies has kept up; thus, we have even moreself-help books on the market with proportionally less research support. We certainlyagree that this situation has the potential for harming the public and needs to be addressed.

As scientists, we are uncomfortable with the proliferation of “treatments” that haveno scientifically demonstrated efficacy. The available efficacy data on self-help bookswere collected in clinical trials, and such studies involved procedures that are quite dif-ferent from the procedures bookstore customers follow in selecting and reading a self-help book. Thus, we cannot make conclusions about the outcome for bookstore customersusing self-help books.

This situation is not much different from the efficacy–effectiveness debate on therapist-delivered treatments. There is scant research available on the effectiveness of psycho-therapy, as delivered by all the varieties of psychotherapists. There is efficacy researchsupporting various manualized treatments, but few practitioners closely follow treatmentmanuals, thus reducing the applicability of the research for the treatment. Licensing boardsinsure that practitioners meet some basic criteria and continue to practice within ethicalguidelines, but one can be a poor therapist and not be in violation of ethical standards.The free market system determines who remains in business as a psychotherapist, yet thesuccess of a psychotherapist can be as much determined by marketing and referral basesas it is by therapy skills. The Consumer Reports (1995) effectiveness study showed gen-erally positive outcomes for therapy, yet Seligman (1995) raised enough methodologicalissues to question the certainty of the study’s conclusions. Thus, even in therapist-delivered psychological interventions, we have the same quality-control problem: Prac-tice far exceeds the research support.

When a consumer buys a self-help book, there are at least three possible outcomes:(a) The consumer follows the suggestions in the book and improves; (b) the consumerfollows the suggestions in the book and has a negative outcome, meaning that the con-sumer is actually harmed by the book; or (c) the consumer is not affected at all, attribut-able possibly to either the consumer’s lack of effort or to factors associated with the book.Rosen (1993) focused on the second possible outcome, based upon his research thatshowed how making a very logical change to an established treatment led to less favor-able results. Furthermore, Rosen pointed out that even if the consumer is neither helpednor hindered (Outcome c), the book’s author, or more often the publisher, is guilty ofduping the consumer into spending money for a product that fails to deliver as promised.

Our opinion is that although many self-help books may not lead to lasting improve-ment (though some do), they are only rarely harmful. We would speculate that the vastmajority of the public reads a book and then files it away on the shelf without experienc-ing much lasting psychological impact, positive or negative. Our study of negative out-comes (Scogin et al., 1996) showed that Feeling Good was effective for most participantsand for those who did not improve, it was still benign. There were very few who actuallydeteriorated during the course of self-treatment, and at rates comparable to randomizedclinical trails of psychotherapy, and it is very possible that they would have deterioratedeven more if they had not been reading the book. However, these data were from efficacystudies, and conclusions about effectiveness is an extrapolation that could be inaccurate.

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Overall, we have a positive view of self-help books and self-administered treat-ments. To the extent that one believes there is a potential for harm, the more justified arethe preventive measures. We agree with Rosen (1993) that authors and publishers shouldrefrain from littering book jackets with promises that are not supported by research. Amore difficult question is whether self-help books should be regulated based upon empir-ical support? Should self-help books be subjected to similar criteria as psychoactivemedications and not be marketed to the public without successful clinical trials? Forthose who fear the worst about the effects of self-help books, the answer would be that weshould move towards this to the extent possible. Glasgow and Rosen (1979) suggestedthat self-help books contain a statement about research support for the treatment, includ-ing details on sample size, outcome, reading level, outcome predictors, and cost. Theserecommendations would help the consumer select a book based upon information otherthan the claims on the book jacket. Certainly, we would encourage self-help book authorsto voluntarily follow these recommendations. Our opinion is that taking the next step torequire such empirical support is not justified.

References

Glasgow, R.E., & Rosen, G.M. (1979). Self-help behavior therapy manuals: Recent developmentsand clinical usage. Clinical Behavior Therapy Review, 1, 1–20. Reprinted in C.M. Franks(Ed.), New developments in behavior therapy. New York: Haworth Press, 1984.

Mental health: Does therapy help? (1995, November). Consumer Reports, 60, 734–739.

Rosen, G.M. (1993). Self-help or hype?: Comments on Psychology’s failure to advance self-care.Professional Psychology: Research and Practice, 24, 340–345.

Rosen, G.M. (2004). Remembering the 1978 and 1990 task forces on self-help therapies. Journal ofClinical Psychology, 60, 111–113.

Scogin, F.R. (Ed.). (2003). The status of self-administered treatments [Special Section]. Journal ofClinical Psychology, 59, 247–349.

Scogin, F., Floyd, M., Jamison, C., Ackerson, J., Landreville, P., & Bissonette, L. (1996). Negativeoutcomes: What is the evidence on self-administered treatments? Journal of Consulting andClinical Psychology, 64, 1086–1089.

Seligman, M.E.P. (1995). The effectiveness of psychotherapy: The Consumer Reports study. Amer-ican Psychologist, 50, 965–974.

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