Self-help books: An area of ethical responsibility for professional counselors

David J. Tobin
Jessica L. Bordonaro
Gannon University

Correspondence should be addressed to:

David J. Tobin, Ph.D.
Director, Community Counseling
109 University Square, Gannon University
Erie, PA 16541
tobin001@gannon.edu
814-871-7537

Abstract

Psychologists have periodically addressed concerns regarding the rapid expansion and utilization of self-help books and bibliotherapy; and have urged for greater ethical responsibility when selecting and marketing these books. Similarly, the proliferation of self-help books poses an area of ethical responsibility for professional counselors. An investigation into the psychology and counseling literature yielded guidelines for selecting and recommending self-help books and bibliotherapy. Ethical guidelines and professional responsibilities for dealing with consumers and the general public were reviewed. Counselors were cautioned to exercise careful scrutiny when evaluating self-help books.

Self-help books: An area of ethical responsibility for professional counselors

Self-help books typically offer advice on problem solving, how to change a behavior, or cope effectively. The selection of a self-help book by a mental health practitioner is referred to as bibliotherapy. Several studies revealed the recommendation of self-help books to be a common practice among psychologists (Starker, 1988a); and others have validated the use of bibliotherapy as an adjunct to psychotherapy (Black & Threlfall, 1986; Gould, Clum, & Shapiro, 1993; Kohutek, 1983; Ogles, Lambert, & Craig, 1991; Quackenbush, 1991). It is believed that millions of American readers seek out self-help books on their own. Early reviews cite evidence of a multimillion dollar publishing phenomena with as many as 2,000 new self-help books published each year (Marx, Gyorky, Royalty, & Stern, 1992). Self-help books have become an important source of information and psychological advice for millions of Americans (Santrock, Minnett, & Campbell, 1994).

The proliferation of psychological self-help books poses an area of ethical responsibility for professional counselors. Over the past several decades psychologists have periodically addressed concerns regarding the rapid expansion and utilization of self-help books and bibliotherapy. They have urged for greater responsibility in regard to endorsing, publishing, and marketing self-help books, along with greater scrutiny when selecting books for bibliotherapy. Reiterated by previous psychologists, these same concerns may hold relevance for contemporary counselors. This article further investigates the psychology and counseling literature on self-help books and provides guidelines for responsible and ethical practice.
Self-Help Books

In conjunction with the increased proliferation of self-help books, psychologists have periodically raised concern for the over-prescription and potential harm to uninformed readers (Halliday, 1991). Rosen (1981) cautioned against the over prescription of self-help books and stated that the "titles and claims that accompany these books have become incredible if not outrageous" (p. 189). He later (1987) referred to this widespread practice as the commercialization of psychotherapy and stated "these books could be written by any author who liked to write and believed in what he or she had to say" (p. 46). He added that the proliferation of untested do-it-yourself books reflected commercial considerations rather than professional standards. More alarming is the contention by Starker (1988b) who surveyed practicing psychologists on the use of self-help books and cautioned that they may "well be endorsing unproven and perhaps unhelpful procedures, thereby misleading clients" (p. 454). In response to these concerns the American Psychological Association Task Force on Self-Help Therapies (1978) recommended guidelines for the responsible marketing of these texts. Specifically, they noted that psychologists are in a position to educate consumers on the use of self-help books. They concluded that sensationalism should be avoided and the Ethical Standards of Psychologists should be adhered to in regard to the commercialism of self-help books. These concerns were also addressed by Ellis (1993) who delivered a discussion on the advantages and disadvantages of self-help therapy materials and recommended for psychologists and professional organizations to take an active role in researching materials and addressing marketing issues. It is evident that these previous psychologists responded with alarm to an expanding self-help industry.

Contemporary psychologists and researchers have also raised concerns in regard to the pervasiveness of psychological self-help literature. Dolby (2005) examined why Americans read self-help books and claimed that potential readers are enticed by "authentication employed by authors' credentials and quoted recommendations on the jacket cover" (p.8); and that writers inspire readers with persuasion rather than professional standards of research. Stanovich (2004) cautioned that the public is unaware that the publishing industry does not provide quality control over the self-help literature it promotes. Many of these books present "new therapies based on personal experience or a few case studies, rather than controlled experimental investigation" (p. 178). Self-help literature was reported to create confusion about the goals and general perception of psychology by portraying the practice of psychology as purely "recipe knowledge", defined as "the knowledge of how to use something without knowledge of the fundamental principles that govern its functioning" (p. 180). Psychological practice and research were deemed much more expansive than recipe knowledge.

Santrock, Minnett, and Campbell (1994) published The Authoritative Guide to Self-Help Books. Initially they conducted a survey of mental health practitioners and found that 86% reported that good self-help books were beneficial when used in conjunction with psychotherapy. They then conducted a survey of 500 psychologists who selected and rated over 1,000 self-help books. These ratings provide a review of the strengths and shortcomings of each book. Approximately half of these books were considered positive and half were viewed as negative. The top five books and bottom five books were listed according to a wide array of topics. Furthermore the authors offered strategies for selecting a self-help book and cautioned against the following: hot topics; phenomenal breakthroughs; advertising outlays; grandiose claims for a quick fix; and psychobabble. This guide potentially contributes to both consumers and professionals by providing information for informed choices.

Mahoney (2003) stated that self-help books perpetuate a common myth, the myth of "arrival" or illusion of a cure. This myth is both seductive and maladaptive since it encourages the "expectation of the unattainable goal of arrival, and results in feelings of frustration over not reaching the mythical destination" (p. 18). Accordingly, self-help books imply a good life filled with health and happiness, and deny pain and suffering. These concerns are similar to those expressed by Becvar (1978) who raised ethical questions regarding self-help books. Specifically, he contested a liberal view of mental illness that viewed unhappiness as an abnormal or psychiatric condition and stated it was unethical to "suggest a solution to the mental illness of being unhappy or being anxious" (p. 162).. He challenged that the utopia promised by self-help books may be "pathological in its own right", and warned against marketing experts who promote a book beyond any reasonable evidence of efficacy. Several suggestions were offered to responsible professionals: (a) be realistic when promoting workshops or books (b) professional organizations should enforce ethical codes that relate to truth in advertising and labeling (c) counselor educators should be conscious of how they portray theoretical biases and promote attitudes for responsible professional practice.

Bibliotherapy

Schrank and Engels (1981) reviewed the use of bibliotherapy as a counseling adjunct. After conducting an extensive review of the literature, they reported that bibliotherapy could be useful to counselors; however bibliotherapy was viewed as an emerging discipline that required further outcome studies in order to test replication. They stated that "counselors should be aware that positive recommendations about the value of bibliotherapy exceed available documentation of its usefulness" (p. 146). Starker (1988a) shared the view that the prescribed self-help books were generally helpful but pointed out that bibliotherapy was not well documented and further empirical investigations are warranted. Halliday (1991) conducted an empirical investigation unto a group of clinic clients and found that 43 out of 100 read self-help books, and most reported benefit from reading such books. However, he reiterated an obligation for writers to provide accurate information and cautioned that many of these books were written by non-psychologists. Rather than non-trained professionals, he stated it would be more assuring for psychologists to provide their own well written books. Floyd (2003) indicated that adjunctive bibliotherapy supplemented psychotherapy for depression in older adults. However, he found that some clients resist homework, especially when asked to read a lengthy book. Self motivation and interest in bibilotherapy were considered essential. However, only annecdoted case studies were provided to indicate effectiveness, and no statistics were provided on the number of clients who resisted bibliotherapy. Riordan and Wilson (1989) also questioned the effectiveness of bibliotherapy as a tool in treatment. After reviewing the literature they reported mixed research results, and limited well-documented studies. They viewed bibliotherapy as an adjunct and recommended further research into how it could be incorporated into treatment.

Culture

Dolby (2005) suggested self-help books maintain a stability of culture or a collective world view. Numerous authors have criticized self-help books for reinforcing unproductive gender role stereotypes (Marx, Gyorky, Royalty, & Stern, 1992). Implicated are books on parenting and child development, which comprise one of the largest categories of self-help books (Santrock et al., 1994). Adjusting to the roles and responsibilities of parenting can be challenging. When parents turn to the "experts" they are met with "promises to turn out a happier, more competent child" (p. 100). Parents often find themselves bewildered and frustrated by the vast array of choices and contradictory messages found within this literature (Pardeck, 1998).
Fleming and Tobin (2005) reviewed the professional literature on parenting and cited evidence for an emerging image of fatherhood that characterized increased involvement with child-rearing. However, they speculated that the popular literature on parenting did not recognize or support the expanded roles of fathers and perhaps "perpetuated outdated cultural expectations" (p. 18). Using the Subject Guide to Books in Print (2001) they selected a random sample of 23 popular child-rearing books, and conducted a qualitative data analysis of the passages. Out of 56,379 paragraphs contained in these books, only 2,363 (4.2%) pertained to the roles of fathers. Furthermore, fathers were not referred to in the passages that involved medical needs, health, and nutrition; and were barely mentioned in regard to daycare. Fleming and Tobin concluded that child-rearing books are "written largely for a female audience and that father's roles are peripheral and limited" (p. 20). Although these books were marketed for both parents, it was clear that these books did not acknowledge the value of the role of the fathers and did not support couples where both parents tried to contribute to the development of their child.

Ethical Responsibility

Psychologists have reiterated concerns regarding the proliferation and commercialization of self-help books. Furthermore, they recommended that the ethical standards of the profession be acknowledged and purported a responsibility to protect and educate consumers. We contend that counselors share a similar ethical responsibility when they endorse, select, or recommend self-help books. Section C of the ACA Code of Ethics pertains to Professional Responsibility and instructs counselors to engage in "open, honest, and accurate communication in dealing with the public and other professionals . . . and engage in counseling practices that are based on rigorous research methodologies" (ACA 2005, p. 9). Furthermore the ACA Code of Ethics (2005) and the Ethical Principles of Psychologists (2002) are similar in regard to designated sections on media presentations, and specify that public statements should be based on appropriate professional literature and practice, consistent with the ethical codes, and do not infer that a therapeutic relationship has been established [see ACA, section c.6.b; APA, section 5.04]. Further specifications within Section C include the need to disclose accurate information to consumers when developing products and training advertisements; and not to use undue influence when promoting products or training [see ACA, section C.3.e., C.3.f].

The ACA Code of Ethics establishes a professional responsibility for counselors when dealing with consumers or the general public. We believe these sections are pertinent in regards to the concerns generated for self-help books and that it is important for professional counselors to consider ethical guidelines when either publishing or endorsing self-help books, and prescribing bibliotherapy.

Conclusion

Based on the review of the literature, we concluded that counselors should exercise careful scrutiny when selecting or recommending a self-help book. The promise of self-help should be based on realistic expectations and reliable research. Sensationalistic claims, anecdotal case studies, recipe knowledge, and messages about cultural roles should be critically evaluated. Former researchers have cautioned against claims based on anecdotal evidence rather than empirical investigation. They called for greater control over the marketing claims attached to these books. Others reacted against the phenomena of the quick fix and recipe knowledge associated with these books. Bibliotherapy was also viewed as an effective adjunct, but further investigation was recommended, along with an awareness of limitations posed by client motivation and reading habits. Finally, popular literature was found to convey outdated cultural expectations in regard to parenting; which could prove more confusing or unproductive. This synthesis of the literature serves as a guideline for responsible professional practice.

Discussion

The proliferation of self-help books seems commonplace in our society. Psychologists have periodically reiterated concerns regarding the marketing claims associated with these books. Bibliotherapy is also viewed as a common practice in counseling and psychotherapy. Despite widespread utilization, the efficacy of this approach has not been fully validated. Further empirical investigation is recommended. Furthermore the proliferation of psychological self-help books may pose an area of ethical responsibility for professional counselors. Ethical and professional responsibility for dealing with consumers and the general public were specifically reviewed. The synthesis of the literature on self-help books also yields guidelines for selecting or recommending self-help books. Counselors are cautioned to exercise careful scrutiny when evaluating a self-help book.
A final recommendation is for counselor educators to promote information literacy as a learning outcome. Information literacy pertains to the "understanding and set of skills necessary to carry out the functions of effective information access, evaluation, and application" (Middle States Commission on Higher Education, 2002, p. 38). Attaining information literacy would enable the emerging counselor to evaluate sources of discipline specific literature throughout their graduate education and career (Tobin & Kramarik, 2005). This skill set would help professional counselors to evaluate self-help books and make responsible recommendations for bibliotherapy.

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