One of the most outspoken critics of psychotherapy is psychiatrist Thomas Szasz. His views are an unlikely source for a defense of psychotherapy, but its defense, oddly enough, can be found there.
Szasz argues that psychology has been influenced by the disease model that dominates medicine. Medicine bases its conception of treatment on the fact that there are diseases (orinjuries) that can be helped by means of drugs or surgery. Illnesses and injuries aretreatable conditions. Treatment is applied from outside by the physician, and the condition, when the treatment is effective, improves.
But psychiatry goes a step too far when it claims that people who become emotionally helpless, hopeless, lonely, or agitated are actuallysick. Szasz claims that they are not sick; they are helpless, hopeless, lonely, or agitated. These are not "illnesses" but, rather, some of the tragic conditions of life. They areproblems of living. For Szasz—and for therapists like Viktor Frankl and Alfred Adler—psychological problems resemble "moral problems" much more than they do "physical diseases." They involve discouragement, loss of morale, loss of moral courage. They arestates of demoralization.
Now, demoralization is not atreatable condition—not, certainly, in the medical sense. You cannot apply treatment from without and expect that the patient will get better. The situation is much more complex than this. The patient—let's shift at this point to calling him or her theclient—is much more actively involved in the process of psychotherapy than is apatientin medicine. A woman who contracts pneumonia can be cured with antibiotics while she lies in bed watching television or sleeping. But an emotionally troubled woman—who has had a succession of unhappy marriages, who has lost job after job, whose personality is offensive to others, who has a low sense of self-worth, and who has lost a sense of meaning and direction in life—cannot be cured while she lies in bed and is treated with appropriate medication. "Effective treatment" just isn't possible; too much is up to the client herself.
Basically, this is why studies of the effectiveness of psychotherapy have generally led to discouraging results. Most psychological conditions (there are exceptions, as we will see) are not, at least at present,treatable in the medical sense. To combat them requires of the client a great deal of his or her own effort and even exertion. They require self-discipline, moral courage, faith in oneself—all the things emotional distress tends to undermine. No approach to psychotherapy can itself be medically effective in treating conditions like these. Somehow, the client must reach a point where he can lift himself by the bootstraps. He can beencouragedby the therapist, he can bereasoned with, he can bemanipulated in strategic therapeutic ways, the therapist can exhort him to be rational, but the focus always comes back to the client. Is he or she motivated to learn how to change? Is he or she an "effective learner"—that is, a "good student"?
The hundreds of attempts to evaluate the effectiveness of approaches to psychotherapy have, incredibly, left out this essential reference to the clients themselves: What kind of people are they? What encouragesthem? What can act as a source for their motivation, for the strength they have lost?
Ironically, the answer to these questions also lies unwittingly in the hands of psychotherapy's harshest critics.
The worst blow to fall on the shoulders of psychotherapists was dealt by placebo studies. Experiments were designed that wouldconvincea group of emotionally troubled clients that taking a pink pill (in reality, a sugar-filled placebo) would reduce their symptoms. In fact, their symptoms were, in general, reduced, and often by as much as treatment in formal psychotherapy. This fact has been interpreted by most therapists to mean that psychotherapy must therefore have been ineffective. If a pink and useless pill could equal the effects of therapy, then therapy was equally useless.
But this involved a huge oversight and a mistake in logic. The therapydidwork,as didthe placebo. But why?
The placebo effect has become increasingly interesting to psychological as well as medical researchers. Apparently, a client's or patient's strongbeliefin the therapeutic value of a process sometimes has a measurable influence on his future health. The way belief can act in this way is not necessarily mysterious or mystical. If we are prepared to see emotional difficulties in terms of demoralization, then belief in therapeutic effectiveness is the most clear-cut counterbalancing force. Strong belief of this kind may be enough—ifthe client really wishes to change andifthe therapist and the approach to therapy together can inspire the client's confidence in his own ability to regain control of his life—to help the client begin to lift himself by the bootstraps. Just what the necessary ingredients are to make this possible is not yet definitely known. Some approaches to therapy, however, seem to be more successful than others in inspiring confidence in clients with certain personality traits and with certain goals or problems. The best evidence for this comes from clients themselves, whose evaluationsof their own experiences in therapy we will look at in a moment.
The second blow that fell on psychotherapy came from the spontaneous remission critics. Again, studies demonstrated certain facts:
* How long it takes for spontaneous remission to occur depends greatly on what sorts of emotional difficulties clients have. People with depressive or anxiety reactions tend, for example, to have spontaneous remissions faster than persons with obsessive-compulsive or hypochondriacal symptoms.
* The percentages of clients who do experience spontaneous remissions are related to the period of time a study uses as a basis. (The follow-up periods of different studies vary a great deal, from months to many years. As one researcher commented, "It is doubtful whether life can guarantee five years of stability to any person."[12])
[12] Eisenbud, quoted in H. H. Mosak, "Problems in the Definition and Measurement of Success in Psychotherapy," in Werner Wolff and Joseph A. Precker, eds.,Success in Psychotherapy(New York: Grime & Stratton, 1952), p. 13.
* Spontaneous remissions frequently happen to clients whose lives improve because of fortunate events, such as an improved position at work, successful marriages and personal relationships, and periods during which pressing problems become fewer and life more stable.
Given these facts, spontaneous remission critics argued that, since many troubled individuals will get better anyway,without psychotherapy, we cannot know that psychotherapy caused any beneficial effects.
Again, poor logic. It is like saying that since certain bone fractures will eventually heal themselves in correct alignment, without being set in a cast, we cannot know for these cases that a cast had any beneficial effects. Well, for many people, a suitable psychotherapy serves much the same function as a cast does for a broken bone: it supports, lessens vulnerability, reduces pain, and makes life a little more comfortable until natural healing can take place. Again, whom do we ask to determine whether this is the case? We must ask the person with the fractured arm whether the cast made him or her more comfortable.
HOW PSYCHOTHERAPY CAN BE INJURIOUS TO YOUR HEALTH
Is there substantial evidence that psychotherapists sometimes harm, as well as benefit, their clients? I think that there definitely is and that this has been fairly well demonstrated.[13]
[13] Albert Ellis, "Must Most Psychotherapists Remain as Incompetent as They Now Are?," in J. Hariman, ed.,Does Psychotherapy Really Help People?, p. 240.
Even love can harm, and psychotherapy is no exception. Ellis identifies some of the main ways psychotherapists can make clients worse:[14]
[14]Ibid., pp. 24-36.
* Therapists may encourage clients to be dependent on them. Directly or indirectly a therapist can convey to a client, "You cannot get along without me," "You will probably need to spend at least two more years in therapy," etc.
* Therapists may overemphasize the significance of the client's past experience to the point that they persuade the client to feel unjustifiably weighed down and controlled by past events and circumstances.
* Therapists may become so hooked on the importance of modeling positive personal qualities (warmth, positive regard, congruence, empathy) for a client that they will not provide any active-directive leadership during a time when the client is floundering and needs strong recommendations.
* Therapists may place too much importance on the role of insight. The search for insight can be never-ending. It is useful only to some clients; for others, insight is irrelevant to helping them change.
* Many therapists feel that therapy gives clients a chance to vent their feelings. But catharsis by itself is not enough to replace destructive patterns of behavior and thinking with constructive ones.
* Therapists may rely excessively on distracting the client from issues that trouble him; e.g., relaxation training, meditation, or therapeutic exercise can help clients break out of a cycle of self-preoccupation. Self-absorptionperpetuates emotional suffering; distractions can therefore be invaluable. But if a client's underlying self-defeating attitudes are not confronted, distraction alone will not be enough to bring about lasting change.
* Therapists may rely too heavily on getting clients to "think positively." Positive thinking can undermine a client's already shaky confidence if he fails to achieve the goals that positive thinking led him to expect.
These are undeniable shortcomings of therapy. They can reduce the effectiveness of therapy, or negate its constructive effects, or even cause clients to accept the therapist's belief that their condition is worse than they thought and so persuade them to feel, and to be, even more troubled.
It is important to be aware of these signs of what Ellis rightly calls incompetence in therapists. It is also important to realize that psychotherapy is not unique in having to deal with professional incompetence. Physicians can and do fall victim to many of the same excesses: needlessly alarming patients, misdiagnosing their conditions, and sometimes treating them in ways that lead to a general worsening of their health. Iatrogenesis exists in medicine as well as in psychotherapy.
Until the day when the world is a perfect place, we simply have to takecaveat emptorto heart—let the buyer beware. A Ph.D. in clinical psychology, certification in marriage and family counseling, or an M.D. with specialization in psychiatry unfortunately does not guarantee against human fallibility and lack of wisdom.
WHEN PSYCHOTHERAPY IS SUCCESSFUL
It might be argued, then, that the worth of psychotherapy to the consumer (the client) does not depend on its being superior to a placebo. Whether it is or is not superior is a theoretical question of interest to theoreticians; in judging the practical worth of psychotherapy, what matters is consumer satisfaction. Judged by the latter criterion, psychotherapy is indeed worthwhile.[15]
[15] Edward Erwin, "Is Psychotherapy More Effective Than a Placebo?," in J. Hariman, ed.,Does Psychotherapy Really Help People?, p. 48.
There is a world of difference between popularity and effectiveness. Is psychotherapy only popular and simply ineffective?
All approaches to therapy have a built-in expectation that positive change will result. This belief implicitly is communicated to clients, and it can provide them with a sense of hope that replaces the helpless and demoralized state that has motivated them to seek therapy.
This happens in several ways. For example, paying attention to a person increases his morale and self-esteem. This is called theHawthorne effect. "Anyone who has been in therapy can appreciate the gratification that comes from having a competent professional give undivided attention for an hour."[16] Also, the expectation on the part of a therapist that positive results will follow itself can influence a client's attitudes and his belief that he will get better, that emotional suffering will lessen and end.
[16] James O. Prochaska,Systems of Psychotherapy: A Transtheoretical Analysis(Homewood, IL: The Dorsey Press, 1979), p. 5.
The strength of a client'sbeliefthat hecanchange, that hecanimprove, is the major single force in psychotherapy. The client has to feel that his belief iswarranted. Many factors play a role here: the client's education level and the respect he may feel toward the therapist's training and experience; the intangibles of therapy—the therapist's integrity, authenticity or convincingness, the client's sense that he is understood, that the therapist cares, that the therapist himself has learned how to cope with living and can communicate this, etc. Psychotherapy can be successful when this sense ofpromiseis present in therapy sessions.
CLIENTS LOOK BACK
I know myself better than any doctor can.Ovid
If most emotional difficulties are not illnesses at all but problems of living, and if problems of living cannot be treated medically, then the hundreds of evaluative studies of therapeutic effectiveness have been looking for something that simply is not there: an objective standard against which to judge therapeuticsuccess. It makes very little sense to speak of standards in connection with problems of living that come about from demoralization. The only standard we can reasonably appeal to is the subjective judgment of clients themselves, who have experienced periods in therapy.
[Therapy] is a purely individual affair and can be measured only in terms of its meaning to the person, child, or adult, of its value, not for happiness, not for virtue, not for social adjustment but for growth and development in terms of a purely individual norm.[17]
[17] J. Taft,The Dynamics of Therapy in a Controlled Relationship(New York: Macmillan, 1933), quoted in H. H. Mosak, "Problems in the Definition and Measurement of Success in Psychotherapy," in Wolff and Precker, eds.,Success in Psychotherapy, p. 7.
A few representative and specific evaluations of their experiences in psychotherapy by former clients follow. They are included here not as proof of the effectiveness of psychotherapy, because to search for objective proof in this area is a mistake, but rather as illustrations of different ways people believe themselves to have been helped:[18]
[18] Most evaluative studies of psychotherapy have attempted in some way to take into account the judgment of clients. One study in particular, however, has made clients' evaluations of their experiences in therapy its main focus, in fact, for a book-length treatment. That is Hans H. Strupp, Ronald E. Fox, and Ken Lessler,Patients View Their Psychotherapy(Baltimore: Johns Hopkins Press, 1969). Some of the patient evaluations included here are based on transcripts from the Strupp-Fox-Lessler study; they have been paraphrased and condensed for use here.
After being in therapy, I have learned to accept myself more easily and believe that many of the people whose opinions about me matter to me also accept me for what I am. I have come to realize that what I have in my life, in the way of my marriage, my children, my work is what I have decided to settle with. It is easier and more satisfying for me to do this than always to be fighting the present and straining for things I haven't got.
I still have problems with my own self-confidence. I accept some volunteer work at my church, in spite of these feelings of self-doubt, believing that I really am mentally capable and feeling that I can, in time, and with patience, overcome my feelings of inadequacy.
I now love my daughter without qualifications. I have much less hostility toward my mother. I'm much less afraid now to feel unpleasant emotions and feel less guilt than I did. I'm not afraid to stand up for myself and say what I feel.
I feel more patient now with myself and with others. I lose my temper much less often. I enjoy life much more, feel more content and happy over small things. I'm much more aware now of the feelings of others.
I didn't like being around people. Now I actually can enjoy their company. Even parties do not make me nervous like they used to. I am less inclined to condemn others when they are not like me, and I find myself offering suggestions and advice less frequently.
The greatest change that therapy has brought me has been to help me get my confidence again. I have gone through periods of grief three times since I left therapy, when members of my family have died. I do not feel I could have maintained a sense of balance during these times if I had not had the experience of therapy. I feel I am better able to trust my judgment now and can cope with living more effectively.
I feel better about myself, though I do often still feel a sense of guilt. My problems [having to do with a strong father who has condemned the client because of her style of living and has cut off relations with her] are still with me, but I feel that I have learned to face life more squarely and head-on without so much fear. I'm sure that therapy was the most important part of this change.
I feel much more able to relate to my fussy and neurotic parents. Their dark moods and bitterness don't plunge me into the dumps like they used to. Now, when I do get depressed, instead of just wanting to give up, I ask myself what it is that has depressed me, and often I can reason my way out of the negative state I'm in. I can cope with responsibilities much better now. I have fewer doubts now about my abilities.
I feel more inner calm and can cope with daily problems more easily. I have learned that it doesn't pay for me to be a perfectionist about everything. I still admire my desire for perfection in some things that are really important to me, but I no longer fuss with doing a perfect job, for example, patching the trash can.
I've accepted myself as a homosexual, and am happy at work, and feel productive. I am less anxious in relationships with others now. Although I still feel negative judgment from my family, I no longer have suicidal thoughts. I realize that I should live in a way that is true to myself and that others may differ, but I'm OK myself.
I sometimes will give myself a treat, something I never used to do. I will buy myself something that maybe is a little bit frivolous, but I think of this as my own therapy. I feel better about myself and deny myself less. I was almost a stoical nun before. Now I care more about myself. I used to think that spending money to have my hair done was silly and a waste of money. Now I think that if it makes me feel good about myself, and I want to treat myself to it, why not?
I used to analyze everything to the point that I didn't enjoy much and was always asking myself, like the bumper-sticker, am I having fun yet? Now, I just let some things be. It doesn't pay for me to question everything all the time. Now, when I don't like a person, I just accept this. I don't feel guilty because I couldn't see their better side, and I don't feel hostile just because for me the person isn't more likable.
WHAT MAKES PSYCHOTHERAPY SUCCESSFUL
It is not so much the teacher who teaches butthe student who learns.
Whether or not the client gets value for fee paid to a psychotherapist depends largely on the client.Don Diespecker inDoes Psychotherapy Really Help People?
Psychotherapy is much more like education than it is like medicine. In education, certain students—no more or less intelligent than others—will nevertheless be more successful. They have well-known characteristics: they are interested in what the experience of education can offer them, and they work hard and regularly.
Very much the same thing holds true in psychotherapy: some clients simply get more from therapy than others. Why? In part it has to do with how well matched a client and the approach of thetherapist are. In part it is the amount of confidence the client comes to feel toward the therapist as a person. Beyond these, the qualities of a successful client are very similar to those of a successful student.
Specifically, clients who have successful experiences in therapy tend to share these characteristics:
* While in therapy, they are motivated to change: They feel considerable internal pressure to do something to resolve their problems. They come to feel a sense of initiative and determination. They come to believe in the process of therapy and feel it can be of help to them.
* They are self-disciplined. They keep appointments regularly, they attempt to implement the therapist's recommendations, and they are less incapacitated by their difficulties than other clients with similar problems.
* They have a level of emotional maturity that is high enough to withstand some of the painful feelings or frustrations they encounter in therapy.
* Frequently they come toenjoytherapy.
Obviously, a great deal does depend on the therapist. And yet, while a good student can learn much in spite of a poor teacher, a poor student learns little from an excellent teacher. Successful therapy depends primarily on the client.
Other factors can affect your ability to succeed in therapy, but these are factors over which you have no control:
* whether you have the emotional support and sympathy of an understanding and tolerant spouse or family
* whether you have had a long history of emotional problems in connection with work and interpersonal relations (deeply ingrained habits are harder to break)
* whether precipitating factors brought about your present difficulties or they just appeared "out of the blue"
* how long you have had your present problem
* what the problem is: whether it is purely emotional or it has affected your capacity to think coherently and realistically
* whether there have been fortunate or unfortunate events in your life before and during therapy
What the future holds in store for you after therapy relies greatly on many of these same factors and on many of the personality qualities that helped you, or hindered you, as a client in therapy (see Chapter 21).
SO, DOES PSYCHOTHERAPY WORK?
Yes, for certain clients and under certain circumstances. The main changes that psychotherapies aim for are either to eliminate destructive habits of thought, attitude, or behavior or to establish new, constructive habits. Neither one can be accomplished by means of a medically effective treatment that is applied to the patient until a cure occurs.
A few emotional problems fall under the heading of true psychiatric disorders and result from physical causes. They include, for example, epilepsy, drug addiction, and Alzheimer's disease. But these conditions are in the minority; most emotional "disorders" have not been traced to underlying organic causes. There are several currently competing hypotheses relating to possible biochemical bases of schizophrenia, mania, depression, and anxiety disorders. As time goes by and medical research progresses, more emotional conditions will very likely be tied to underlying physical problems.
Until that time, however, they remainmedicallyincurable conditions. At present, the possibility of overcoming them depends heavily on clients themselves, their ability to find an approach to therapy that is appropriate for their personality and their goals or problems, and their good fortune in locating a therapist who is able to help them to summon the faith, energy, determination, and courage necessary to overcome their sense of demoralization.
21LIFE AFTER THERAPY
Theoretically, psychotherapy is never-ending, since emotional growth can go on as long as one lives.Lewis R. Wolberg,The Technique of Psychotherapy
It can be difficult to know when to terminate therapy: difficult for you, the client, and sometimes also difficult for the therapist. Some periods in therapy do not lead to a successful outcome. You may become dissatisfied with the process of therapy or with the therapist. Or, the therapist may become disappointed in your willingness to work and to change. An impasse may be reached where it seems no progress can be made. When this happens, it can be hard to know when to draw a line, to say: "We've tried, but we have to face the fact that we're not getting anywhere." But sometimes this has to be said, and then you may decide to look elsewhere for help.
On the other hand, when your therapy has been successful and has led to clear, constructive results, it may also be difficult to know when to stop. To most clients, what tends to be most important isrelief from symptoms. When this is achieved, you may be tempted to terminate. But relief from troubling symptoms is not always a sign that problems have been resolved.Frequently, relief from distress comes about because ofproblem avoidance. You may have structured your life in a way that circumvents, rather than faces, the things that trouble you. There are times when this is indeed the best solution. However, the tendency is for clients to associate relief with effective therapy, and often this is not the case.
The therapist, on the other hand, may have certain personal values that he wishes to satisfy before ending therapy with you: he may favor, for example, qualities of assertiveness and ambitiousness (or qualities of submissiveness and compliance), want you to develop these traits, and feel reluctant to end therapy until you have done this.
In general, the decision to terminate therapy should be made with a number of objectives in mind:
* Have your troubling symptoms disappeared or at least been reduced to a level that is tolerable?
* Have you improved your understanding of yourself so that you feel a healthy measure of self-acceptance?
* Do you now have a greater tolerance to frustration?
* Have you developed realistic life goals?
* Are you able to function relatively well in social groups?
* Are you better able to enjoy life and work?
These goals need always to betempered; they all involve comparative judgments that should take into account where you started and what you have accomplished. There is no perfection here, only degrees of adjustment, compromise, and a willingness to accept yourself as a mixture of human weaknesses and strengths.
... [W]e have to content ourselves with the modest objective of freedom from disturbing symptoms, the capacity to function reasonably well, and to experience a modicum of happiness in living.[1]
[1] Lewis R. Wolberg,The Technique of Psychotherapy, vol. 2, p. 747.
FACING RELAPSES
Some therapists believe that therapy cannot be called successful until you have had a relapse and have been able to getthrough it on your own. Shadows of old habits linger on. They are especially likely to resurface during periods of insecurity, disappointment, and frustration. They represent a part of you—perhaps a part you would just as soon were not there, but a part of you, nonetheless, that you cannot expect to eradicate completely.
You are much better prepared to face the challenges of the future, of events that cannot be anticipated, and of uncertainties that cannot be avoided, if you do not demand a total change in yourself to the point that old reactions never recur. You are better prepared if you realize that it is likely some will return for brief visits during periods of particular stress. If and when this happens, you can render these visits less distressing and less able to throw you by using the understanding you have gained from therapy.
You are apt to get a flurry of anxiety and a return of symptoms from time to time. Don't be upset or intimidated by this. The best way to handle yourself is first to realize that your relapse is self-limited. It will eventually come to a halt. Nothing terrible will happen to you. Second, ask yourself what has been going on. Try to figure out what created your upset, what aroused your tension. Relate this to the general patterns that you have been pursuing.... Old habits hold on, but they will eventually get less and less provoking.[2]
[2] Wolberg,The Technique of Psychotherapy, vol. 2, p. 754.
HOW TO CARRY ON
Therapy is a temporary crutch or a cast in which to heal, a comfort, a source for renewed faith in yourself, and an experience of learning. It cannot solve all the problems of future living, for these pose new challenges that require of us all that we readjust our goals and expectations, become more resilient and less easily troubled or broken. (The flexible bamboo is more likely to survive a storm than the mighty oak.)
Reducing an individual's rigidity is an objective of all psychotherapies. Becoming less rigid allows you to accommodate to changes and to tolerate external stress more easily. Decreased rigidity helps you adjust to new demands placed on you by your surroundings.
But there is another side to living successfully, and that is, first, the ability to recognize situations and circumstances that cause you excessive stress and, second, the willingness to leave them before it is too late. We tend to placeallof the responsibility for adjustment to stress on ourselves, on our inner strengths. But often this is unnecessary, unreasonable, and even self-destructive. Often it is thesituationthat is not desirable or tolerable, not a "weakness" in ourselves in being unable to cope with it. It can sometimes take more strength and courage to break free from a pattern of frustration and unhappiness than to remain on, slowly wearing down your resources and growing older fast.
Much of successful living after therapy is a matter ofprevention: of being aware when you begin to tax yourself more than you need to, when your body and mind begin to tell you that you are developing new habits of anxiety or depression or are starting to reinforce old ones. At these times, take stock of what you are doing, of how your daily living may be in conflict with your values and attitudes. Prevention here means being willing to change an undesirable situation, not just enduring it while trying to change its consequencesin you.
This is largely a matter of knowing and respecting yourself, ofnotrequiring yourself to accept conditions that you feel will lead you to grief. Therapy may help you tolerate stress more easily, but this is one-sided if you do not also learn to protect yourself from stress that is excessive. (Even bamboos can be broken.)
Therapy is an opportunity for you to learn how to cope better with the problems of living. You learn that you can face the demands of life successfully in these ways:
* through belief in yourself and through strength of will
* by diminishing your preoccupation with yourself and developing interests outside yourself
* by understanding your reactions and accepting them rather than fighting yourself
* by living in the present
* by taking yourself less seriously, by developing a sense of humor and perspective
Having learned these things, you then simply do the best you can within the limitations of life.
PART IVAPPENDIXES
[N.B. Since the first edition of this book, the majority of the groups and organizations listed in the following appendix may be readily contacted by e-mail. For current e-mail addresses, Google the names of any organizations you wish to contact.]
APPENDIX A:Agencies and OrganizationsThat Can Help(United States and Canada)
PART I: UNITED STATES
SELF-HELP ORGANIZATIONS
For General Information
Self-help groups exist for many different kinds of problems. They are listed in many communities by local branches of the Self-Help Clearinghouse. If a branch is not listed in your telephone directory and you would like a listing of self-help groups in your area, contact:
National Self-Help Clearinghouse25 W. 43rd St.New York, NY 10036(212) 840-1259
A fact sheet on self-help groups prepared by the National Institute of Mental Health is available at no charge from:
Consumer Information CenterDepartment 609KPueblo, CO 81009
Also, you may wish to contact:
National Self-Help Resource Center1729-31 Connecticut Ave., NWWashington, DC 20009(202) 387-0194
For a detailed guide to self-help groups, consultHELP: A Working Guide to Self-Help Groups, by Alan Gartner and Frank Riessman (New York: New Viewpoints/Vision Books, 1980).
For Specific Problems
For alcoholics:Alcoholics Anonymous World ServicesPO Box 459, Grand Central StationNew York, NY 10163(212) 686-1100
For families of alcoholics:Al-Anon Family Group Headquarters1 Park Ave.New York, NY 10016(212) 683-1771
For individuals with emotional problems:Emotions Anonymous International1595 Selby Ave.St. Paul, MN 55104(612) 647-9712
Neurotics Anonymous3636 16th St., NWWashington, DC 20005(202) 628-4379
For individuals who have been treated for emotionalor mental difficulties:Recovery, Inc.802 N. Dearborn St.Chicago, IL 60603(312) 337-5661
National Alliance for the Mentally Ill1901 N. Fort Myer Dr.Ste. 500Arlington, VA 22209(703) 524-7600
Autism:National Society for Autistic ChildrenInformation & Referral Service1234 Massachusetts Ave., NWWashington, DC 20005(202) 783-0125
Epilepsy:Epilepsy Foundation of America4351 Garden City Dr.Landover, MD 20785(301) 459-3700
Learning disorders:Council for Exceptional Children1920 Association Dr.Reston, VA 22091(703) 620-3660
For families who have children with behavior problems:Families AnonymousPO Box 528Van Nuys, CA 91426(818) 989-7841
For single parents with children:Parents Without Partners International7910 Woodmont Ave.Washington, DC 20014(301) 654-8850
For parents of abused children:Parents Anonymous7120 Franklin Ave.Los Angeles, CA 90046(213) 876-9642
For pathological gamblers:Gamblers AnonymousPO Box 17173Los Angeles, CA 90017(213) 386-8789
For families of pathological gamblers:Gam-AnonPO Box 4549Downey, CA 90241(213) 469-2751
For individuals with phobias:TERRAP1010 Doyle St.Menlo Park, CA 94025(415) 329-1233
For obesity:Overeaters Anonymous2190 W. 190th St.Torrance, CA 90504(213) 320-7941
Weight Watchers International800 Community Dr.Manhasset, NY 11030(516) 627-9200
For narcotics addicts:Narcotics Anonymous8061 Vineland Ave.Sun Valley, CA 91352(213) 768-6203
National Association on Drug Abuse Problems160 N. FranklinHempstead, NY 11550(516) 481-0220
PROFESSIONAL ASSOCIATIONS
American Academy of Psychoanalysis30 E. 40th St.New York, NY 10016(212) 679-4105
American Association for Marriage and Family Therapy1717 K St., NWSuite 407Washington, DC 20006(202) 429-1825
American Association of Sex Educators, Counselorsand Therapists11 Dupont Circle, NWSuite 220Washington, DC 20036(202) 462-1171
American Psychiatric Association1400 K St., NWWashington, DC 20005(202) 682-6000
American Psychological Association1200 17th St., NWWashington, DC 20036(202) 955-7686
Association for Advancement of Behavioral Therapy15 W. 36th St.New York, NY 10011(212) 279-7970
National Association of Social Workers7981 Eastern Ave.Silver Spring, MD 20907(301) 565-0333
PART II: CANADA
SELF-HELP ORGANIZATIONS
For General Information
The Centre for Service to the Public publishes the annualIndex to Federal Programs & Services, which contains descriptions of more than 1,100 programs and services administered by federal departments, agencies, and Crown Corporations. The Centre also operates the Canada Service Bureaus throughout Canada, which provide telephone referral services for individuals interested in locating federal agencies and programs. Contact:
Centre for Service to the Public365 Laurier Ave., W.Ottawa, ON KlA 0S5(613) 993-6342
Also, you may wish to contact:
Department of National Health and WelfareSocial Service Programs BranchNational Welfare Grants Program, 7th fl.Brooke Claxton BuildingTunney's PastureOttawa, ON K1A 1B5(613) 990-9563
Canadian Mental Health Association2160 Yonge St.Toronto, ON M4S 2Z3(416) 484-7750
For information about community services, contact:
Voluntary ActionDepartment of Secretary of State15 Eddy St., HullOttawa, ON K1A OM5(819) 994-2255
For Specific Problems
For alcoholics:Alcoholics AnonymousIntergroup Office272 Eglinton Ave., W.Toronto, ON M4R 1B2(416) 487-5591
ADDICS (Alcohol & Drug DependencyInformation & Counselling Services)818 Portage Ave., #209Winnipeg, MB R3G 0N4(204) 775-1233
For individuals who are mentally or physically disabled:Disabled Peoples' International (DPI)207-294 Portage Ave.Winnipeg, MB R3C 1K2(204) 942-3604
For individuals who have been treated for emotionalor mental difficulties:Mental Patients Association2146 Yew St.Vancouver, BC V6K 3G7(604) 738-5177
Autism:Autism Society CanadaBox 472, Sta. AScarborough, ON M1K 5C3(416) 444-8528
Epilepsy:Epilepsy Ontario2160 Yonge St., 1st fl.Toronto, ON M4S 2A9(416) 489-2825
Learning disorders:Canadian Association for Childrenand Adults with Learning Disabilities323 Chapel St.Ottawa, ON K1N 7Z2(613) 238-5721
For families who have children with emotional andbehavior problems:Ontario Association of Children's Mental Health Centres40 St. Clair Ave., E., #309Toronto, ON M4T 1M9(416) 921-2109
For single parents with children:One Parent Families Association of Canada2279 Yonge St., #17Toronto, ON M4P 2C7(416) 487-7976
For narcotics addicts:ADDICS (Alcohol & Drug DependencyInformation & Counseling Services)818 Portage Ave., #209Winnipeg, MB R3G 0N4(204) 775-1233
PROFESSIONAL ASSOCIATIONS
Canadian Psychiatric Association225 Lisgar St., #103Ottawa, ON K2P 0C6(613) 234-2815
Canadian Psychoanalytic Society7000 Côte des Neiges Rd.Montreal, QC H3S 2C1(514) 738-6105
Canadian Psychological Association558 King Edward Ave.Ottawa, ON K1N 7N6(613) 238-4409
Council of Provincial Associations of Psychology558 King Edward Ave.Ottawa, ON K1N 7N6(613) 238-4409
Ontario Psychological Association1407 Yonge St., #402Toronto, ON M4T 1Y7(416) 961-5552
Ontario Association for Marriage and Family Therapy271 Russell Hill Rd.Toronto, ON M4V 2T5(416) 968-7779
Canadian Association of Social Workers55 Parkdale Ave., #3l6Ottawa, ON K1Y 1E5(613) 728-1865
Corporation Professionnelle des Travailleurs Sociaux du Quebec5757 Decelles Ave., Ch. 335Montreal, QC H3S 2C3(514) 731-2749
Canadian Guidance & Counseling AssociationFaculty of EducationUniversity of Ottawa651 Cumberland St., Rm. 427Ottawa, ON K1N 6N5(613) 234-2572
APPENDIX B:Suggestions forFurther Reading
GENERAL INFORMATION
Greenberg, Bette.How to Find Out in Psychiatry: A Guide to Sources of Mental Health Information. New York: Pergamon Press, 1978.
Powell, Barbara J.A Layman's Guide to Mental Health Problems and Treatments. Springfield, IL: Charles C. Thomas, 1981.
Russell, Bertrand.The Conquest of Happiness. New York: Bantam, 1968 (first published in 1930). [One of the most psychologically perceptive attempts to identify the basic ingredients for a happy life, by a philosopher who made original contributions to whatever subjects he touched.]
Strupp, Hans H.Patients View Their Psychotherapy. Baltimore: Johns Hopkins Press, 1969. [Evaluations by patients of their experiences in psychotherapy.]
———.Psychotherapists in Action. New York: Grune & Stratton, 1960. [Focuses on what the therapist actually does in the therapy relationship.]
Watson, Robert I., Jr.Psychotherapies: A Comparative Casebook. New York: Holt, Reinhart and Winston, 1977. [A collectionof cases treated by means of different approaches to psychotherapy.]
Wheelis, Allen.How People Change. New York: Harper & Row, 1973. [An insightful book about the process of therapy.]
A. PSYCHOANALYSIS (CHAPTER 9)
Brenner, Charles.An Elementary Textbook of Psychoanalysis. New York: International Universities Press, 1973. [A world-famous introduction to analysis that has now been translated into nine languages.]
Hall, Calvin.A Primer of Freudian Psychology. New York: New American Library, 1954. [Perhaps the clearest and most concise summary of psychoanalytic concepts.]
Jones, Ernest.The Life and Work of Sigmund Freud. New York: Basic Books, 1953-57. 3 volumes. [A biography of Freud that describes his personal development and summarizes his main contributions.]
B. CLIENT-CENTERED THERAPY (CHAPTER 10)
Rogers, Carl Ronsom.Client-Centered Therapy. Boston: Houghton Mifflin, 1951. [A good introduction to Rogers's approach to therapy. It was his first major exposition of his theory.]
———.On Becoming a Person: A Therapist's View of Psychotherapy. Boston: Houghton Mifflin, 1961. [Perhaps Rogers's best-known book. It gives a very personal view of his approach.]
C. GESTALT THERAPY (CHAPTER 10)
Pagan, J., and I. L. Sheperd, eds.Gestalt Therapy Now. Palo Alto: Science and Behavior Books, 1970. New York: Harper and Row, 1971. [A collection of articles on Gestalt theory, technique, and applications by well-known Gestalt therapists.]
Perls, Frederick S.Gestalt Therapy Verbatim. Moab, UT: Real People Press, 1965. [Probably the most widely read of Perls's books illustrating the Gestalt approach.]
D. TRANSACTIONAL ANALYSIS (CHAPTER 10)
Berne, Eric.Games People Play. New York: Grove Press, 1964. [A simply written summary of the main concepts of TA: ego states, transactions, games, etc.]
———.What Do You Say After You Say Hello?New York: Grove Press, 1972. [Published after Berne's death, this is an outline of his approach to therapy, focusing on his notion of life scripts.]
E. RATIONAL-EMOTIVE THERAPY (CHAPTER 10)
Ellis, Albert.Humanistic Psychotherapy: The Rational-Emotive Approach. New York: McGraw-Hill, 1973. [A clear statement of the way people can choose to make, or not make, themselves emotionally disturbed.]
———, and Robert A. Harper.A New Guide to Rational Living. Englewood Cliffs, NJ: Prentice Hall, 1975. [One of the best-known self-help books dealing with rational-emotive therapy.]
F. EXISTENTIAL-HUMANISTIC THERAPY (CHAPTER 10)
Arbuckle, D.Counseling and Psychotherapy: An Existential-Humanistic View. Boston: Allyn & Bacon, 1975. [A good introduction to this approach to therapy.]
Binswanger, Ludwig.Being-in-the-World: Selected Papers of Ludwig Binswanger. New York: Basic Books, 1963. [A less readable book that nevertheless gives the reader a sense of how existentialism has been applied to psychotherapy.]
May, Rollo, Ernst Angel, and Henri Ellenberger, eds.Existence. New York: Basic Books, 1958. [A collection of essays dealing with basic topics of existential-humanistic psychotherapy.]
G. LOGOTHERAPY (CHAPTER 11)
Frankl, Victor.Man's Search for Meaning: An Introduction to Logotherapy. New York: Washington Square Press, 1959. [A clear and gripping description of the development of logotherapy as a result of concentration camp suffering.]
———.The Doctor and the Soul. New York: Knopf, 1963. [A further description of logotherapy.]
H. REALITY THERAPY (CHAPTER 11)
Glasser, William.Reality Therapy. New York: Harper and Row, 1965. [Glasser describes his view that, because of loneliness and feelings of inadequacy, people tend to refuse to take responsibility for fulfilling their needs for love and worth.]
See also Glasser's book,Positive Addiction, listed under "T. Therapeutic Exercise."
I. ADLERIAN THERAPY (CHAPTER 11)
Adler, Alfred.Problems of Neurosis: A Book of Case-Histories. New York: Harper Torchbooks, 1964 (first published in 1929). [These are case examples illustrating Adler's theory of neurotic development. The book contains an introduction by H. L. Ansbacher that summarizes basic Adlerian theory.]
———.Social Interest: A Challenge to Mankind. New York: Capricorn Books, 1964 (first published in 1929). [This is the last exposition given by Adler of his thought. It is a good and simply written summary of Adlerian psychology.]
J. BIOENERGETICS (CHAPTER 11)
Keleman, S.Sexuality, Self and Survival. San Francisco: Lodestar Press, 1971.
Lowen, Alexander.The Betrayal of the Body. New York: Collier, 1967.
K. PRIMAL THERAPY (CHAPTER 11)
Janov, Arthur.The Anatomy of Mental Illness: The Scientific Basis of Primal Therapy. New York: G. P. Putnam, 1971.
———.Primal Scream. New York: Dell, 1971.
L. IMPLOSIVE THERAPY (CHAPTER 11)
Stampfl, Thomas G., and D. Levis.Implosive Therapy: Theory and Technique. Morristown, NJ: General Learning Press, 1973.
M. DIRECT DECISION THERAPY (CHAPTER 11)
Greenwald, Harold.Decision Therapy. New York: Peter H. Wyden, 1973.
———, and Elizabeth Rich.The Happy Person. New York: Stein and Day, 1984. [A very readable summary of direct decision therapy.]
N. COUNTER-CONDITIONING (CHAPTER 12)
O. BEHAVIOR MODIFICATION (CHAPTER 12)
P. COGNITIVE APPROACHES TO BEHAVIOR CHANGE (CHAPTER 12)
Alberti, R. E., and M. L. Emmons.Stand Up, Speak Out, Talk Back. New York: Pocket Books, 1975. [On assertiveness training.]
Burns, David.Feeling Good: The New Mood Therapy. New York: Signet, 1980. [A good self-help account of the general cognitive approach to behavior change.]
Kanfer, F. H., and A. P. Goldstein, eds.Helping People Change. New York: Pergamon Press, 1975. [This large book discusses operant, cognitive change, and self-control methods. The emphasis is on how these techniques of behavior change are used in a clinical setting.]
Wolpe, Joseph.The Practice of Behavior Therapy. New York: Pergamon Press, 1973. [One of the major contributors to behavioral psychotherapy describes the use of techniques to encourage behavior change.]
Q. GROUP THERAPY (CHAPTER 13)
Grotjahn, Martin, Frank M. Kline, and Claude T. H. Friedman, eds.Handbook of Group Therapy. New York: Van Nostrand, 1983.
Helmering, Doris W.Group Therapy: Who Needs It?Millbrae, CA: Celestial Arts, 1976. [A good informal summary of group therapy.]
R. MARRIAGE THERAPY (CHAPTER 14)
S. FAMILY THERAPY (CHAPTER 14)
Fay, Allen.Making Things Better by Making Them Worse. New York: Hawthorne Books, 1978. [A variety of applications of therapeutic paradoxical strategies in marriage communication, as well as in connection with the treatment of anxiety, depression, fears, etc.]
Foley, Vincent D.An Introduction to Family Therapy. New York: Grune & Stratton, 1974.
Haley, Jay, ed.Changing Families: A Family Therapy Reader. New York: Grune & Stratton, 1971.
Watzlawick, Paul, John Weakland, and Richard Fisch.Change: Principles of Problem Formation and Problem Resolution. New York: Norton, 1974. [A readable and entertaining description of the tendency of family and marriage systems to resist change and a good explanation of the use of paradoxical strategies to encourage constructive change.]
T. THERAPEUTIC EXERCISE (CHAPTER 15)
Fixx, James F.The Complete Book of Running. New York: Random House, 1977. [See Chapter 2, "What Happens to Your Mind."]
Glasser, William.Positive Addiction. New York: Harper and Row, 1976. [Glasser proposes that some activities such as running and meditation are positive addictions; their practice can help a person grow emotionally stronger.]
Glover, Bob, and Jack Shepherd.The Runner's Handbook. New York: Viking Press, 1977. [See Chapter 15, "Stress and Tension," and Chapter 16, "Running Inside Your Head."]
Kostrubala, Thaddeus.The Joy of Running. Philadelphia: J. B. Lippincott, 1976. [See Chapters 6, 7, and 8 on "Psychological Effects," "Theory," and "Running and Therapy."]
U. BIOFEEDBACK (CHAPTER 15)
Brown, B. B.Stress and the Art of Biofeedback. New York: Harper and Row, 1977. [Reviews the effectiveness of biofeedback.]
Weiss, Anne E.Biofeedback: Fact or Fad?New York: Franklin Watts, 1984. [A clear, informal presentation of biofeedback.]
V. RELAXATION TRAINING (CHAPTER 15)
Benson, Herbert.The Relaxation Response. New York: Morrow, 1975.
Jacobson, E.Progressive Relaxation. Chicago: University of Chicago Press, 1930. [One of the first studies to examine systematic muscle relaxation.]
W. HYPNOSIS (CHAPTER 15)
Erickson, Milton, Ernest L. Rossi, and Sheila I. Rossi.Hypnotic Realities: The Induction of Clinical Hypnosis and Forms of Indirect Suggestion. New York: Irvington Publishers, 1976.
Wallace, Benjamin.Applied Hypnosis: An Overview. Chicago: Nelson-Hall, 1979. [A general description of hypnosis.]
Wolberg, Lewis R.Hypnosis: Is It for You?New York: Harcourt Brace Jovanovich, 1972. [A good, general description of hypnosis and its use in the context of psychotherapy.]
X. MEDITATION (CHAPTER 15)
Carrington, Patricia.Freedom in Meditation. Garden City, NY: Anchor Press, 1977. [By a clinical psychologist who uses meditation with her patients, a practical and comprehensive discussion of meditation and its connection with the human problems that bring people to psychotherapy.]
Glasser, William.Positive Addiction. New York: Harper and Row, 1976. [See Chapter 6, "Meditation."]
LeShan, Lawrence.How to Meditate: A Guide to Self-Discovery. Boston: Little, Brown & Co., 1974. [An intelligent and modest practical approach to meditation.]
Y. DRUG THERAPY (CHAPTER 16)
Leavitt, Fred.Drugs and Behavior. New York: Wiley, 1982.
Physician's Desk Reference to Pharmaceutical Specialties and Biologicals. New Jersey: Medical Economics, Inc. [Published annually with quarterly supplements. Gives detailed information about drugs, side effects, potential risks, etc.]
Swonger, Alvin K., and Larry L. Constantine.Drugs and Therapy: A Psychotherapist's Handbook of Psychotropic Drugs. Boston: Little, Brown & Co., 1976.
Z. DIET THERAPY (CHAPTER 16)
Fredericks, Carlton.Psycho-Nutrition. New York: Grosset & Dunlap, 1976.
Watson, George.Nutrition and Your Mind: The Psychochemical Response. New York: Harper and Row, 1972.
ON LEGAL ISSUES IN PSYCHOTHERAPY (CHAPTER 19)
Cohen, Ronald Jay.Legal Guidebook in Mental Health. New York: Free Press, 1982.
Gutheil, Thomas G., and Paul S. Appelbaum.Clinical Handbook of Psychiatry and the Law. New York: McGraw-Hill, 1982.
Hofling, Charles K., ed.Law and Ethics in the Practice of Psychiatry. New York: Brunner/Mazel, 1981.
ON THE EFFECTIVENESS OF PSYCHOTHERAPY (CHAPTER 20)
Eysenck, Hans J. "The Battle over Therapeutic Effectiveness," in Jusuf Hariman, ed.,Does Psychotherapy Really Help People?Springfield, IL: Charles C. Thomas, 1984, pp. 52-61.
———.The Effects of Psychotherapy. New York: Inter-Science Press, 1966.
Hariman, Jusuf, ed.Does Psychotherapy Really Help People?Springfield, IL: Charles C. Thomas, 1984. [A collection of evaluative articles about psychotherapy.]
———.The Therapeutic Efficacy of the Major Psychotherapeutic Techniques. Springfield, IL: Charles C. Thomas, 1982. [A collection of papers about the therapeutic effectiveness of a variety of approaches to psychotherapy.]
Rachman, S., and G. T. Wilson.The Effects of Psychological Therapy. Oxford: Pergamon Press, 1980.
Wolff, Werner, ed.Success in Psychotherapy. New York: Grune & Stratton, 1952.
INDEX