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PSYCHOLOGICAL SCIENCE

General Article

WHO (OR WHAT) CAN


DO PSYCHOTHERAPY:
The Status and Challenge of
Nonprofessional Therapies
By Andrew Christensen and Neil S. Jacobson
Research suggests thai paraprofesstonal therapists usually pro- practical, and methodological implications for research
duce effects that are greater than effects for control conditions on psychotherapy At the theoretical level, this literature
and comparable to those for professional therapist treatment addresses fundamental questions about the necessary in-
Other nonprofessional psychological treatments, such as self- gredients for therapeutic change For example, is a rela-
admimstered materials and self-help groups, have also demon-
tionship necessary or sufficient for therapeutic change''
strated positive effects Because of the promise of these non-
professional treatments, their potential for low-cost service At a practical level, this literature suggests a cost-
delivery, and the important theoretical questions that studies effective expansion of mental health service delivery
comparing them can answer, psychotherapy outcome research while promoting role changes for professional therapists
should shift away from comparisons of different professional from direct service providers to program developers, di-
therapies and instead compare nonprofessional therapies with rectors, trainers, and supervisors At a methodological
professional therapy level, this research suggests treatment-aptitude studies
that can delineate specific client charactenstics that pre-
Recently, a number of important publications have dict benefit from professional versus nonprofessional
summarized the vast literature on psychotherapy re- treatments
search In 1989, the Amencan Psychiatnc Association In this article, we give a bnef overview of this research
(APA) published its massive work on the treatment of on nonprofessional psychological treatments Then we
psychiatnc disorders (APA, 1989) Consisting of 263 articulate the implications and make recommendations
chapters and more than 3,000 pages, this four-volume set for future psychotherapy research
descnbes the psychosocial and biological treatments for
most psychiatnc disorders In 1990, the Annual Review
of Psychology included articles on individual psychother- HOW EFFECTIVE ARE
apy (Goldfned, Greenberg, & Marmar, 1990), psycho- PARAPROFESSIONAL THERAPISTS''
therapy for children and adolescents (Kazdin, 1990),
counseling interventions (Gelso & Fassinger, 1990), and In 1979, Durlak reviewed 42 studies that compared
social and community interventions (Heller, 1990) professional and paraprofessional therapists Expen-
Considered as a whole, these works provide extensive enced psychologists, psychiatnsts, and social workers
coverage of the research on psychological interventions typically constituted the professional therapists m these
However, they focus almost exclusively on psychologi- studies, and adults without postbaccalaureate, cbnical
cal interventions that are delivered by professional ther- training in professional mental health programs consti-
apists They give bttle or no attention to paraprofessional tuted the paraprofessional therapists Most of these stud-
treatments, self-administered treatments, or treatment ies found no differences in effectiveness between profes-
through mutual-support groups Yet a substantial litera- sional and paraprofessional therapists Only one study
ture in psychology and psychiatry supports the effective- demonstrated the supenonty of professionals over para-
ness of paraprofessional treatments and, to a lesser ex- professionals A second study was inconclusive How-
tent, self-admimstered treatments and treatment via ever, in 12 studies, paraprofessionals actually outper-
mutual-support groups formed professionals Durlak concluded "In terms of
We bebeve this literature has important theoretical. measurable outcome, professionals may not possess de-
monstrably supenor cbmcal skills when compared with
Address correspondence to Andrew Christensen, Department of par^rofessionals Moreover, professional mental health
Psychotogy, University of Califorma, Los Angeles, CA 90024 education, training, and expenence do not appear to be

Copyright O 1994 Amencan Psychological Society VOL 5, NO 1, JANUARY 1994


PSYCHOLOGICAL SCIENCE

Andrew Christensen and Neil S Jacobson

necessary prerequisites for an effecUve helping person" ten code such factors as therapist expenence and relate
(p 80) these factors to outcome Across 47S studies of psycho-
Nietzel and Fisher (1981) cnticized Duiiak's review, therapy outcome. Smith, Glass, and Miller (1980) found
arguing m part that (a) he included studies that lacked no relationship (r = 00) between years of therapist ex-
sufficient mtemal vahdity to allow interpretation of re- penence and therapy outcome In a later meta-analysis of
sults and (b) he used mappropnate or inconsistent defi- 143 studies, Shapiro and Shapu-o (1982) also found no
nitions of professional and paraprofessionai therapists relationship between the two Finally, a meta-analysis of
Hattie, Sharpley, and Rogers (1984) tned to evaluate 108 well-designed psychotherapy studies with children
these criticisms empirically by conducting a meta- and adolescents (Weisz, Weiss, Alicke, & Klotz, 1987)
analysis of 39 of the 42 studies that Durlak reviewed (3 found no overall difference in effectiveness between pro-
studies had to be excluded for vanous reasons) along fessional therapists, graduate-student therapists, and
with a separate analysis of 4 recent studies not included paraprofessionai therapists
in Durlak's review Yet, instead of disconfirming These meta-analyses of psychothei^y research sug-
Durlak's findings, this improved analysis strengthened gest a substantial effect of psychotherapy compared with
the case for his conclusions Hattte et al (1984) found control conditions Effect sizes range from 68 to 93 Yet
that the studies which were most sound from a method- none of the seven reviews descnbed found evidence that
ological standpoint favored the paraprofessionai thera- professional training or therapist expenence enhanced
pists They concluded that "clients who seek help from outcome The later reviews often begin with a cnticism of
paraprofessionals are more likely to achieve resolution of previous reviews and then try to improve on the meth-
their problem than those who consult professionals" (p odology Yet, whatever refinements are made, whatever
534) studies are included or excluded, the results show either
Next to find fault with the existing summanes of this no differences between professionals and paraprofession-
literature were Berman and Norton (1985), who selected als or, surpnsingly, differences that favor paraprofes-
the 32 studies examined by Hattie et al (1984) that Ber- sionals
man and Norton deemed most methodologically appro- These are provocative findings for the psychotherapy
pnate and then conducted their own meta-analysis, using community As do other professionals, we assume that
somewhat different, and more appropnate, statistical the effects of professional training and expenence are
procedures Yet even this new and improved analysis substantial Years of study and training should dramati-
supported Durlak's conclusions Berman and Norton cally alter a person's ability to conduct professional
were unable to find any significant differences between work In most professions, it would be ludicrous to com-
professional and paraprofessional therapists across any pare a trained and an untrained person It is hard to imag-
of the four most common categones of patient complaint ine a study companng trained and untrained surgeons, or
in this research (social adjustment, phobia, psychosis, trained and untrained electncians for that matter Dead
and obesity), across five forms of treatment (behavioral, patients in the first instance or dead trainees m the sec-
cognitive-behavioral, humanistic, cnsis intervention, and ond could be the unfortunate outcome Not only should
undifferentiated counseling), or across different outcome we expect significantly better outcomes for profession-
measures ally trained therapists relative to nonprofessional thera-
An independent review by Stem and Lambert (1984) pists, but the effect sizes should be substantial, and the
reported a meta-analysis on studies companng therapists differences clinically as well as statistically significant
ith different levels of traimng, but included studies com- But perhaps there are some factors, even artifacts,
panng inexpenenced with expenenced therapists as well that limit the relevance of this research for the practice of
as studies companng professional with paraprofessional psychotherapy and thus affect the conclusions to be
therapists Stein and Lambert selected studies addressing drawn from it Our scrutiny of this literature suggests five
"real climcal problems using such treatment approaches possible qualifications
as psychodynamic, client-centered therapy, and behav- First, one cannot prove a null hypothesis of no differ-
ioral methods" (p 130) Across the 24 studies in their ences between professionals and paraprofessionals or be-
analysis, they found no evidence that expenenced ther- tween expenenced and inexpenenced clinicians It is
apists created better outcomes than inexpenenced ther- possible that with a larger N and greater statistical power,
apists a difference would be apparent However, given the con-
Findings from these reviews are buttressed by the siderable research that has been done and the large effect
broader meta-analyses that have examined psychother- size we would expect from training, the burden of proof
apy outcome studies in general, not just those companng IS clearly upon people who would assert that professional
professional and paraprofessional therapists These stud- training enhances the effectiveness of therapy
ies address the overall effects of psychotherapy, but of- Second, many studies compared mildly to moderately

VOL 5, NO I, JANUARY 1994


PSYCHOLOGICAL SCIENCE

Psychotherapy

expenenced therapists with inexpenenced or paraprofes- (1987) found that professional therapists did better than
sional therapists, rather than companng very expen- paraprofessional therapists with children who had prob-
enced therapists with inexpenenced ones Typically, the lems of overcontrol (internalizing problems)
professional therapists have had some training or expe- Despite these caveats, up to now the evidence strongly
nence, but not a vast amount (e g , less than 5 years) But suggests that under many if not most conditions, para-
if there is a substantial benefit to be gained by profes- professionals or professionals with limited expenence
sional training or increased clinical expenence, one perform as well as or better than professionally trained
would expect it to show up in compansons between para- psychotherapists Professional training and cbnical expe-
professional therapists and moderately expenenced pro- nence may not add to the efficacy of psychotherapy
fessional therapists Furthermore, there are studies m
this literature that examined very expenenced therapists
For example, the effectiveness of analytically onented CAN SELF-HELP MATERIALS BE EFFECTIVE
and expenentially onented therapists who had an average THERAPEUTIC AGENTS''
of 23 years of expenence was compared with that of lib-
eral arts college professors (not in psychology) who had Estimates suggest that more than 2,000 self-help books
no clinical expenence or training but who were selected are published in this country annually (Doheny, 1988)
for their reputations as being warm, trustworthy, and in- These books cover all manner of human problems, in-
terested in students (Strupp & Hadley, 1979) Disturbed cluding psychiatnc difficulties such as anxiety and de-
college students were randomly assigned to these two pression Surveys by Starker (1988) indicate that most
groups of therapists The two groups of students showed practicing psychologists prescribe self-help books to
no differences m outcome at the end of treatment, al- their chents and find these books helpful
though both groups were supenor to a control group A number of studies have examined the effectiveness
Third, this body of literature, while substantial, has of self-administered treatments such as self-help books
hardly examined the relative effectiveness of paraprofes- and audiotapes when used alone or with minimal thera-
sional and professional treatments across the full scope of pist contact Recently, Scogin, Bynum, Stephens, and
psychiatnc disorders and professional treatments How- Caihoon (1990) conducted a meta-analysis on 40 of these
ever, a number of different treatments and disorders have studies that compared self-administered treatment with a
been examined It seems unlikely that the unexamined control condition such as no treatment or therapist-
treatments and disorders differ from the examined ones administered treatment The studies in this review ad-
in ways that would affect the generality of these results dressed five general problem areas (a) habit control,
Fourth, paraprofessionals in these studies were often such as smoking, alcohol, and weight control problems,
selected, trained, and supervised in methods developed (b) depression and anxiety, (c) phobias, (d) skiU training,
by professionals (Weisz et al , 1987) Therefore, the lack such as parent training and study skills, and (e) an
of differences between the two groups does not mean that "other" category that included sleep, sex, and memory
professional therapists are dispensable They may be an problems The results indicated that self-administered
essential part of many paraprofessionai programs Of treatments were more effective than no treatment, and
course, m some studies, such as the one involving college the differences between self-admimstered and therapist-
professors, paraprofessionai therapists proceeded auton- administered treatments were nonsignificant The au-
omously, with little or no training or supervision by pro- thors were careful to note that many of the studies dealt
fessionals ith rather circumscnbed problems that may lend them-
Finally, the most important question is not the horse- selves to education and information-based interventions,
race companson of who is most effective, but the more and one should not immediately conclude that self-
complicated question of under what conditions profes- admimstered treatments are uniformly as effective as
sional therapy is the treatment of choice and under what therapist-administered treatments
conditions paraprofessional therapy is the treatment of Gould and Clum (1993) examined a different but over-
choice Some of the literature reviewed has addressed lapping set of 40 self-help treatment studies that used
this question For example, Berman and Norton (1985) no-treatment, wait-list, or placebo controls as compan-
found that professionals were slightly better when work- sons This meta-analysis found overall effect sizes com-
ing with bnefer treatments and older patients, whereas parable to those for the psychotherapy literature, further-
paraprofessionals were slightly better when working in more, an exanunation of 12 studies that compared self-
longer treatments and with younger patients However, help and therapist conditions revealed no differences
the professionals tended to be older than the paraprofes- between the two Based on their analyses of problem
sionals in the studies Berman and Norton reviewed In types, Gould and Clum concluded that self-help treat-
reviewing child and adolescent treatments, Weisz et al ments were more effective with skills deficits and diag-

VOL 5, NO 1, JANUARY 1994


PSYCHOLOGICAL SCfENCE

Andrew Chnstensen and Ned S. Jac(^>son

nostic problems such as fears and depression than with vanety of dependent measures but did not differ fixHn
habit problems, such as smoking, dnnking, and overeat- each other
ing The literature on self-admimstered treatments is not as
An important, recent study compared professional extensive as that on paraprofessional and inexpenenced
therapists with a combination of self-admimstered mate- psychotherapists Furthermore, self-help treatments
nals and paraprofessionai counselors to treat depression have often been applied to circumscnbed problems, such
(Beutler et al , 1991) This study included an attempt to as addictive behaviors and habit control However, for
predict what patients would respond best to what treat- the domains investigated, the current evidence suggests
ments Sixty-three patients diagnosed with major depres- that self-administered treatments achieve outcomes com-
sive disorder were randomly assigned to (a) group cog- parable to those of therapist-adnumstered treatments
nitive therapy, (b) focused, expressive psychotherapy (a
form of group expenential psychotherapy), or (c) sup-
portive, self-directed therapy that gave clients a sug- CAN SELF-HELP, MUTUAL-SUPPORT GROUPS BE
gested reading list of 10 popular self-help books and pro- EFFECTIVE THERAPEUTIC AGENTS^
vided weekly, supportive telephone contacts The Some estimates suggest that there are 750,000 self-help
cogmtive and expressive therapies were administered by and mutual-help groups in the United States, with about
Ph D psychologists with 5 or more years of expenence 15 million members (APA, 1989) Other estimates are
The supportive, self-directed psychotherapy was admin- more conservative, suggesting a prevalence of about 7
istered by advanced graduate students At posttreatment million adults in self-help groups in 1990 (Jacobs & Good-
and 3-month follow-up, there were no differences be- man, 1989) However, all estimates predict increased in-
tween conditions on independent psychiatnc evaluations volvement by Amencans in self-help groups for the fore-
or on self-report symptom measures More important seeable future
than gross outcome results across the three groups, how- Research on self-help group activities is at "an embry-
ever, were the results on differential response to treat- onic stage" (APA, 1989, p 2606) Some research has
ment As predicted, the supportive, self-directed therapy examined the outcome of self-help groups without com-
was more effective than the authontarian treatments pansons to other treatment or control conditions For
(cognitive therapy and focused, expressive psychother- example, Lieberman (1986) summarized research on the
apy) with high-resistant (defensive) patients, while the sobnety state of members of Alcoholics Anonymous
ithontative treatments were more effective than sup- Gnmsmo, Helgesen, and Borchgrevink (1981) reported
portive, self-directed therapy with low-resistant patients on the outcome of more than 10,000 members of Norwe-
Also as predicted, supportive, self-directed therapy was gian self-help groups for weight reduction Other re-
more effective than cognitive therapy for internalizing search has compared the outcome of self-help groups
patients, while cognitive therapy was more effective than with nonrandomized control or companson conditions
supportive, self-directed therapy for externalizing pa- For example, Lieberman (1986) summanzed his studies
tients Counter to prediction, focused, expressive psy- companng participants in THEOS, a self-help group for
chotherapy was not differentially effective across levels widows and widowers, with people who chose not to
of patient internalization and externalization participate in THEOS and those who sought psychother-
Future self-admimstered treatment programs are likely apy Galanter (1988) compared the outcome for partici-
to involve video and computer technology as well as au- pants in Recovery, Inc , a self-help program for people
dio recordings and reading matenals To date, comput- with psychiatnc problems, with the outcome for commu-
enzed treatments have been used successfully for obesity nity control subjects Of most value are research studies
(Burnett, Taylor, & Agras, 1985), phobias (Ghosh, that compare self-help conditions with randomized con-
Marks, & Carr, 1988), and depression (Selmi, Klein, trol and companson conditions For example, Jason and
Greist, Sorrell, & Erdman, 1990) For example, in the associates (1987) examined whether self-help discussion
study by Selmi et al , 36 volunteer patients who met re- groups developed at the worksite aided a smoking cessa-
search diagnostic cntena for depressive disorder were tion program Levitz and Stunkard (1974) compared sub-
randomly assigned to one of three conditions therapist- jects who were randomly assigned to several different
administered cognitive-behavioral therapy, computer- treatment programs, one of which was TOPS (Take Off
administered cognitive-behavioral therapy, and a Pounds Sensibly), a nationwide self-help organization for
waiting-list control The therapist-adnumstered and com- the obese With the exception of this last study, all these
puter-admimstered cognitive-behavioral conditions fol- investigations have indicated positive outcomes for par-
lowed a similar format and content agenda After treat- ticipants in self-help groups
ment and a 2-month follow-up, both treatment groups Because of the limited number of investigations of self-
improved significantly more than control subjects on a help groups, and because many of the studies have meth-

VOL 5, NO 1, JANUARY 1994 11


PSYCHOLOGICAL SCIENCE

Psychotherapy

odological problems, no general conclusions about the cans are seeking answers to their psychological problems
effects of self-help groups are possible at this point How- through self-admimstered bibliotherapy Even in formal
ever, the promising results of the existing investigations therapy, people may be exposed to self-help matenals,
mdicate further study of self-help treatment groups is because therapists often prescnbe such readings as an
warranted adjunct to therapy (Starker, 1988) From 7 to 15 million
Amencans are seeking help for their difficulties t h r o u ^
self-help groups (APA, 1989, Jacobs & Goodman, 1989)
RESEARCH IMPLICATIONS Such widespread use of all these alternate forms of psy-
We believe that more research money and energy chological interventiona use that now far exceeds pro-
should be directed away from current psychotherapy re- fessional treatmentdeserves greater empincal atten-
search designs, which emphasize compansons between tion
professionally administered psychotherapies, and toward Fourth, compansons of these alternative treatments
designs that investigate nonprofessional therapies and with professionally administered treatments can reveal
compare them with professional therapies The promis- theoretically as well as practically important information
ing empincal evidence on nonprofessional therapies en- Comparisons of self-administered with therapist-
courages additional research, but there are six other com- administered treatment when both treatments involve the
pelling reasons for our recommendation same procedures show whether a human relationship is
First, the need for mental health services cannot con- necessary for positive change Compansons of profes-
ceivably be met by professional therapists Current esti- sionals with paraprofessionals following identical treat-
mates suggest that only one in five people with diagnos- ment procedures tell whether the special cbnical skills of
able mental disorders gets treatment (Castro, 1993) a professional therapist are necessary to create change
Recent epidemiological surveys mdicate that about 30% These two kinds of compansons indicate the extent to
of the U S population will qualify for one or more diag- which the treatment procedures themselves produce
noses of mental illness dunng their lifetimes (Regier et change versus the extent to which the treatment proce-
al , 1988) If medical and psychotherapy approaches are dures must be conducted in a special interpersonal envi-
the pnmary means of treating these disorders, then a ronment In contrast, compansons of professional treat-
large portion of them will continue to go untreated ment with self-help groups show whether the emotional
Second, current cutbacks in third-party payments for support and knowledge of laypersons is sufficient to bnng
psychotherapy will continue as managed health care be- about change without the benefit of professional thera-
comes the dominant theme in medical care for the fore- peutic expertise Because these compansons question
seeable future Additionally, about 37 million Amencans, the relative contnbutions of technical procedures and
a substantial proportion of the population, have no insur- personal relationships, they address central theoretical
ance coverage at all (Toufexis, 1990) The fact that a questions about psychotherapy
cost-effective treatment may produce effects commensu- Fifth, research on nonprofessional therapies can ex-
rate with those produced by more expensive treatments pand psychotherapy's theoretical base by increasing the
IS an extremely important practical finding given this fi- range of potentially therapeutic pnnciples examined For
nancial climate Even if these alternate treatment ap- example, advocates of self-help, mutual-support groups
proaches were not uniformly more effective than or as discuss the "helper therapy" pnnciple, according to
effective as professionally administered approaches, they which people who help other people are themselves
might still have widespread use and applicability These helped (APA, 1989), as when recovenng alcoholics may
alternative formats might be useful adjuncts to profes- maintain their own sobnety by assisting other alcohobcs
sionally admimstered approaches Or they might be use- Research on professional therapies would not target such
ful for people with mild versions of a problem or disorder a potential change mechanism because of its urelevance
Third, people are already utilizing these alternative to professional therapy More generally, personal change
treatment formats in great numbers Most people with that does not rely on experts may create a sense of per-
psychological problems do not contact formal mental sonal autonomy or p>ersonal empowerment that is not
health professionals (Cowen, 1982) If they seek profes- obtained in professional therapy but has implications for
sional help at all, they are more hkely to consult their the maintenance of the change Again, only by investi-
physicians or their clergy than they are to consult psy- gating nonprofessional therapies can this question be ex-
chotherapists Because physicians and clergy receive iined
some limited training in mental health disorders and Sixth, comparisons of professional treatment with
counsehng, they can be considered paraprofessionals these alternative formats can provide more theoreticaUy
when It comes to psychotherapy The widespread popu- and practically significant information than is typically
lanty of self-help books suggests that millions of Amen- obtained from the cuiTently common design of companng

12 VOL 5, NO 1, JANUARY 1994


PSYCHOLOGICAL SQENCE

Andrew Chnstensen and Ned S Jacobson

two professional treatments The most common findmg give psychology away The second body <rf research de-
from compansons of two active professional treatments mands It
IS that each is better than no treatment but the two are not
different fTom one another (Beutler et al , 1991, Kazdin &
REFERENCES
Bass, 1989, SUles, Shapiro, & Elliot, 1986) There is often
no theoretical information denved from these findings American Psychiatric Auociatioo (I99) Tnalmenls of psychiatric Msorders
because two very different treatments produce identical Washington, DC Author
Berman J S . & Norton, N C (1983) Does pixifessional tnunmc make a therapist
effects, yet it is unclear why Furthermore, there is little man etcxxve'> Ptychologtcal BulUtm 98 401-406
practical information denved from such a companson be- Beutler L E , Engle, D , Mohr D , DaMnip, R J , Bergan, J , Meredith, K , &
Merry, W (1991) Predictors of differential response to cofmtive, experi-
cause the two treatments are approximately equally cost- ential and self^lirected psychotherapeutic procedures Journat (^Cotuuii-
efTective In contrast, compansons between professional mg and Clinical Psychology 59, 33^340
Bumett, K F Taylor, C B , & Agras, W S (I98S) AmbuUtory computer-
and nonprofessional treatments may answer theoretical assisted therapy for obesity A new ftontier for behavior therapy Journal <^
questions such as those already noted Furthermore, a Consulting and Clinical Psychology. 5 698.-703
Castro, J (1993 May 31) What pnce mental heahh") Time, pp 59-ttt
findmg of "no difference" suggests a cost-effective treat- Cowen E L (1982) Help is where you find it Four informal helping groups
ment approach Amencan Psychologist 37 385-.395
Doheny K (1988, October 2) Selfhelp Los Angeles Times, p VII
We believe the greatest theoretical and practical ben- Durlak, J (1979) ComparaUve effectiveness of paraprofessioiuU and profettMoal
efit will come from studies that examine not just the over- helpers Psychological Bulletin 86 80-92
Galan(er,M (1988) Zealous self-help groups as a4|uncts to psychiatnc treatment
all outcome of professional versus nonprofessional ther- A study of Recovery Inc Amencan Journal of Psychuary. Hi 1248-1253
apies, but also the charactenstics that predict which Gelso C J , & Fassinger R E (1990) Counseling psychotogy Theory and re-
search on interventions Annual Review of Psychology 41 355-3^
client will denve greater benefit from which therapy Ghosh A , Marks, I M St. Can A C (1988) Then^Mst contact and outcome of
Treatment-by-aptitude studies that prospectively investi- self-exposure treatment for phobias A controlled study British Journal of
Psychiatry 152 234-238
gate differential client response to different treatments Goldfned M R , Greenberg, L S A Mannar, C (1990) Individual psychother-
will be most beneficial The Beutler et al (1991) study is apy Process and outcome Annual Review of Psychology. 41, 659-tgS
Gould R A , & Clum G A (1993) A meta-analysis of self-help treatment ap-
an excellent example Another example is Project proaches Chnical Psychology Review IS 169-186
MATCH, a large, ongoing, multisite study of alcoholism Gnmsmo, A Helgesen G & Borchgrevink, C (1981) Short-tenn and loi-term
effects of lay groups on weight reduction Bntish Medical Journal 283.
that IS companng (a) an Alcoholics Anonymous-type in- 1093-1095
tervention, (b) a motivational enhancement intervention Hattie J A Sharpley C F &Ro^rs H J (1984) CompanUiveeffecUveoesiof
professional and pantprofessional helpers Psychological Bulletin, 95, 534-
designed to stimulate self-change and involving limited 541
professional contact, and (c) a professionally delivered Heller K (1990) Social and commumty Annual Review ofPsychol-
cogmtive-behavioral therapy The project is investigating Jacobs, M K , & Goodman, G (1989) Psychology and self-help groups Predic-
client charactenstics that predict differential perfor- tions on a partnership Amencan Psychologist 44 536-545
Jason.LA Gnider C L Martino,S ,FUy, B R , Wamecke,R ,*Thomas,N
mance in these three therapies (Project MATCH Re- (1987) Work site group meetings and the effecUveness of a televised smok-
search Group, m press) ing cessation intervenUon Amencan Journal of Community Psychology,
15 57-72
In 1%9, George Miller expressed his dream of giving Kazdm, A E (1990) Psychotherapy for children and adolescents Annual Review
psychology away He wrote "Our responsibility is less of Psychology 41 21-54
Kazdm A E & Bass, D (1989) Power to detect differences between altemaUve
to assume the role of experts and try to apply psychology treatments in comparaUve psychotherapy outcome research Journal of
ourselves than to give it away to the people who really Consulting and Climcal Psychology 57 I3S-I47
Leviu, L S & Stunkaid A J (1974) A therapeuUc coaliuon for obesity Be-
need it" (p 1071) Later in the same article, he contin- havior modification and patient self-help Amencan Journal of Psychiatry
ued " I can imagine nothing we could do that would be 131 423-427
Liebennan,MA (1986) Self-help groups and psychiatry InAJ Frances&RE
more relevant to human welfare, and nothing that could Hales (Eds ), Amencan Psychiatnc Association annual review (Vol 5, pp
pose a greater challenge to the next generation of psy- 744-759) Washington, DC Amencan PsychutrK Press
chologists, than to discover how best to give psychology r G A (1969) Psychology as a means of promoUng human welfare Amer-
ican Psychologist 24 106^1075
away" (p 1074)
The research summanzed in this article suggests that 565
the psychology that is given away (or at least sold much Project MATCH Research Group (m press) Prefect MATCH Rauonale lad
less expensively) through paraprofessional, self- methods for a multi-site cimical trial matching alcohohsm patienU to treat-
ment Alcoholism Clinical and Expenmental Research
admimstered, and mutual-support group treatment may Regier, D A , Boyd, J H Burke, J D , Rae, D S , Myers, J K , Kramer, M ,
be as effective for some problems as the professional Robms C N , George, L K Kamo, M , A Locke, B Z (1988) One month
prevalence of mental disorders m the U S Archives of General Psychology,
psychology that is sold A second body of research sum- 45 977^986
manzmg the current prevalence of psychological disor- in F Bynum, J Stephens, G & Calhoon, S (1990) Efficacy of self-
administered treatment programs Meta-analytic review Professional Psy-
der and the available resources to provide treatment sug- chology Research and Practice 21 42-47
gests that if psychology is not given away, most people in Selmi, P M , Klein, M H , Greist, J H , SorreU, S P , A Eidman, H P (1990)
Computer-administered cogmtive-behavmal therapy for depressioa Amer-
need will not get it, because they cannot afford it The ican Journal cf Psychiatry, I47U), 51-56
first body of research encourages us in our efforts to Shapiro, D A , & Shapiro, D (1982) Meta-analysis of comparative therapy out-

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Psychotherapy

comeiUidies A icpbcatioa lod refioemeol Fiychohgical BuUeim, 92 581- Stdes, W B , Shapiro. D A . ft EUKM. T (1986) "Are all psychotberapies equiv-
fiO4 alenf ' Amtncan Psychohgut. 41. 163-180
Smith. M L . GUu, G V , ft MiUer, T I (19W) The benefits of psychotherapy Stnipp. H H . ft Hadley. S W (1979) Specific vs nonspecific (actors m psycho-
BahimoK Johns Hopkins University Press therapy A controlled study of outcome Archives cf General Psychiatry 36.
Starker S (1M8) Self-help treatment books The rest of the story 1I25-II36
Ptychotogm. 43 S99-00 Toufexis. A (1990. May 7) A caO forradicalsui^cry rune, p SO
Stem, D M , A Umbert. M J (19M) On the relationship between therapist e; Wetsz. J R . Weiss. B . Alicke. M D . ft Klotz. M L (1987) Effecbveness of
penencc and psychotherapy outcome Omcal Psychology Review 4 12' psychotherapy with children and adolescents A meta-analysis for chm-
142 cians Journal ofConsultuig and CUmcai Psychology. 55. 542-549

Forthcoming Papers
Feature Reviews
461 Factor-Analyzed Data Sets What They Tell Us and
Don't Tell Us About Human Intelligence
Robert J Sternberg

Cognitive Abilities
Nathan Brody

General Article
Has Psychology a Future*>
Eleanor J Gibson

Research Articles
Modeling Probabilistic Categonzation Data Exemplar
Memory and Connectionist Nets
Jerome L Myers. Jtll H Lohmeier. and Arnold D Well

Military Aggression and Risk Predicted by Explanatory Style


Jason M Satterfield and Martin E P Seiigman

Research Reports
Graph-Theoretic Confirmation of Restructuring Dunng Insight
Francis T Durso. Cornelia B Rea, and Tom Dayton

High-Fidelity Perceptual Long-Term Memory


Svein Magnussen and Stem Dyrnes

Reconfirmation of the Short-term Storage Concept


Nelson Cowan. Noelle L Wood, and Dawn N Borne

Commentary
Can MulUple-Choice Reading Tests Be Constnict-Valid'' A Reply
to Katz, Lautenschlager, Blackburn, and Hams
Roy Freedle and Irene Kostin

VOL 5, NO 1, JANUARY 14

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