Helper theory

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Helper theory or the helper therapy principle was first described by Frank Riessman (1965) in an article published in the journal Social Work. The principle suggests that when an individual (the "helper") provides assistance to another person, the helper may benefit. [1] Riessman's model has inspired subsequent research and practice by scholars, clinicians, and indigenous populations to address a variety of social and health-related issues plaguing individuals and communities around the world.

Contents

Riessman's formulation

Riessman's seminal article explored how nonprofessionals supported one another in self-help/mutual-aid support groups based on Riessman's observations of a sample of these groups, as well as his summary of the findings of research in the areas of social work, education, and leadership. This article suggested that although the "use of people with a problem to help other people who have the same problem in [a] more severe form" is "an age-old therapeutic approach," the traditional focus on outcomes for those receiving help to the exclusion of considering outcomes for those providing help is too narrow; instead, Riessman advocated for increased consideration of the experience of "the individual that needs the help less, that is, the person who is providing the assistance" because "frequently it is he who improves!" (p. 27). Although Riessman expressed doubt that individuals receiving help always benefit from the assistance provided to them, he felt more sure that individuals providing help are likely experiencing important gains; thus, according to Riessman, the helping interaction at least has the potential to be mutually beneficial for both parties involved (i.e., for both the individual giving and for the individual receiving aid), but it is not absolutely necessary for the "helpee" to benefit in order for the "helper" to enjoy the benefits of helping. In instances where true mutual benefit occurs, the helper and helpee benefit in different ways, such that the person receiving help benefits by way of receiving whatever specific form of assistance is offered to them (e.g., emotional support, information, etc.) while the person providing help benefits by the very act of providing help, regardless of the type of aid they provide. [1]

Riessman posited several different mechanisms which may facilitate the benefits experienced by an individual engaged in a helping role:

  1. gaining an improved self-image;
  2. becoming more committed to a position through the process of advocating it (i.e., "self-persuasion through persuading others");
  3. experiencing meaningful development of abilities after having been given a stake in a system and learning through teaching others;
  4. gaining access to a socially-valued role and the resultant sense of social status and importance;
  5. enjoying opportunities to affirm one's own wellness following placement in a system as a role model; and
  6. shifting one's focus from self-concerns and problems to assisting others (and thus distracting oneself from ongoing difficulties). [1]

Health care

Lepore, Buzaglo, Liberman, Golant, Greener, and Davey (2014) investigated the helper-therapy principle in a randomized control trial of a "prosocial", other-focused Internet Support Group (P-ISG) designed to elicit peer-instigated, supportive interactions online among female breast cancer survivors. [2] When compared to female breast cancer survivors who participated in a standard, self-focused Internet Support Group (S-ISG), which was not designed to explicitly provide opportunities for helping interactions to take place, analyses found that individuals in the P-ISG condition did provide more support to others yet P-ISG participants experienced a higher level of depression and anxiety following the intervention than those in S-ISG. These results fail to provide support for the helper-therapy principle which posits that "helping others is effective at promoting mental health" (p. 4085). In accounting for these results, Lepore et al. (2014) suggest that it is possible that women in the P-ISG condition felt hesitant to express their negative feelings out of fear that doing so might impact others adversely, whereas women in the S-ISG felt more able to unburden themselves of emotional pain and thus enjoyed better mental health outcomes. [2]

Arnold, Calhoun, Tedeschi, and Cann (2005) explored both the positive and negative sequelae of providing psychotherapy to clients who had experienced trauma and subsequent posttraumatic growth by conducting naturalistic interviews with a small sample of clinicians (N = 21). [3] Although all interviewees indicated experiencing some degree of negative experience as a result of engaging in trauma-focused psychotherapy (such as intrusive thoughts, negative emotional responses, negative physical responses, and doubts about clinical competence), all participants also indicated some sort of positive personal outcome occurred as a result of assisting psychotherapy clients with these types of experiences. The positive reactions experienced by clinicians engaged in trauma work included: enjoying the gratification that comes through watching others grow and triumph following difficult times; increasing recognition of one's own personal growth and development; expanding ability to connect emotionally with others; impacting one's own sense of spirituality; increased awareness of one's own good fortune in life; and increasing appreciation for the strength and resiliency of human beings. This finding suggests that the helper-therapy principle may operate in a clinical context whereby therapists (i.e., the helpers) benefit from engaging in the process of providing treatment to psychotherapy clients who have survived traumatic experiences. [3]

Pagano, Post, and Johnson (2011) reviewed recent evidence examining "helper health benefits" among populations experiencing problematic involvement with alcohol, other mental health conditions, and/or general medical problems. [4] In brief, their review suggests that when individuals with chronic health conditions (e.g., alcohol use disorder, body dysmorphic disorder with comorbid alcohol dependence, multiple sclerosis, chronic pain) help others living with the same chronic condition, the individual helper benefits (e.g., longer time-to-relapse, remission, reduced depression and other problematic symptoms, and increased self-confidence, self-esteem, and role functioning). [4]

Additionally, Post's (2005) review of the literature on altruism, happiness, and health indicates that "a strong correlation exists between the well-being, happiness, health, and longevity of people who are emotionally kind and compassionate in their charitable helping activities" (p. 73). [5] However, Post also notes that individual helpers may become overwhelmed by over-involvement in the lives of others, and that giving assistance beyond a certain variable threshold may lead to deleterious rather than beneficial outcomes for helpers. [5]

Social work

Melkman, Mor-Salwo, Mangold, Zeller, & Benbenishty (2015) used a grounded theory approach to understand 1) the motivations and experiences which led young adult "careleavers" (N = 28, aged 18–26) in Israel and Germany to assume a helper role and 2) the benefits they report enjoying as a result of helping others through volunteerism and/or human-service focused careers. [6] Participants reported that observing role models involved in helping roles, being exposed to prosocial values, and having opportunities to volunteer within the system in which they were simultaneously receiving care all contributed to later assumption of more stable and regular helping roles. These participants felt obliged to provide assistance to others, desired to provide this assistance to others, and felt sufficiently competent to carry out the tasks required of them in their helping role. These participants reported that helping others provided them with a sense of purpose in their lives, and also increased self-efficacy, social connectedness, and ability to cope with personal issues. Additionally, participants reported that assuming a helping role provided a sense of normalcy to their lives, as well as providing a sense of perspective on their own journey and outcomes. As one participant (a volunteer with a police department who was assigned to work with at-risk youth) shared with the researchers:

"The fact that I could bring a runaway girl back to her home and I made her trust me, the fact that I located a missing girl, the fact that I escorted a rape victim to hospital and I managed to give her strength and support her, these are the things that give me meaning, tell me that I'm in a much better situation than others" (p. 45). [6]

Self-help/mutual-help

Roberts, Salem, Rappaport, Toro, Luke, and Seidman (1999) found support for the helper-therapy principle among participants of GROW, a mutual-help group for individuals with serious mental illness, whereby "participants who offered help to others evidenced improvement over time in psychosocial adjustment" (p. 859). [7]

Maton (1988) reports that occupying both "helper" and "helpee" roles in a self-help/mutual-aid group (i.e., bidirectional support) was positively correlated with psychological well-being and positive perceptions regarding the benefits of group membership, and that these members with dual-roles had a greater sense of well-being and a more favorable opinion of the group than members who were helpees (i.e., recipients of assistance) only. [8]

Olson, Jason, Ferrari, and Hutcheson (2005) reviewed the existent literature on four mutual-help organizations (Alcoholics Anonymous, Oxford House, GROW, and Schizophrenics Anonymous). [9] They suggest that the processes of change framework found within the transtheoretical model of intentional behavior change (Prochaska, Diclemente, and Norcross, 1992) [10] is a useful model to conceptualize the activities of mutual-help organization members throughout their journey of mental health recovery. They explicitly link social liberation, the last of the ten processes of change articulated by the model (the others being: consciousness raising, self-reevaluation, helping relationships, self-liberation, environmental reevaluation, dramatic relief/emotional arousal, stimulus control, reinforcement management, and counterconditioning) to the helper-therapy principle, along with a related concept known as bidirectional support (Maton, 1988). [11] Per Olson et al. (2005), social liberation "involves the person in recovery focusing attention away from oneself and developing a broader recognition of social issues that contributed to the targeted problem" which encourages "recovering individuals to take more helping-related attitudes toward others who face similar problems" (p. 174). [9] In reviewing the research conducted among members of these four self-help/mutual-help organizations, they identify three different mechanisms which might underlie the therapeutic effect of mutual-help: (1) when an individual helps another, the helper's social functioning improves because the act of providing help to another allows the helper to work through their own difficulties; (2) when an individual helps another, the helper's social functioning improves because the act of providing help to another allows the helper to reinforce their own personal learning about recovery; and/or (3) when an individual helps another, the helper experiences an increase in their own sense of competence and usefulness to others and enables the helper to adopt a "strength-based roles that have not been fully exercised in other areas of life" (p. 175). [9] In reviewing the research on GROW, specifically, 67% of members of this organization sampled by Young and Williams (1987) who were asked how they most benefited from participation reported that involvement in GROW "taught [them they] could help others" (the most endorsed answer among all listed categories). [12] As suggested by a study by Maton and Salem (1995), this idea is most succinctly expressed by way of an axiom of GROW which is often recited at meetings: "If you need help, help others." [13]

A review of empirical studies investigating the effect of mutual help group participation for individuals with mental health problems by Pistrang, Barker, and Humphreys (2008) provides "limited but promising evidence that mutual help groups benefit people with three types of problems: chronic mental illness, depression/anxiety, and bereavement" (p. 110). [14]

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Therapy to improve mental health

Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group. The term can legitimately refer to any form of psychotherapy when delivered in a group format, including art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring and examining interpersonal relationships within the group.

<span class="mw-page-title-main">Self-help</span> Self-guided improvement

Self-help or self-improvement is a self-directed improvement of oneself—economically, physically, intellectually, or emotionally—often with a substantial psychological basis.

In a support group, members provide each other with various types of help, usually nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic. Members with the same issues can come together for sharing coping strategies, to feel more empowered and for a sense of community. The help may take the form of providing and evaluating relevant information, relating personal experiences, listening to and accepting others' experiences, providing sympathetic understanding and establishing social networks. A support group may also work to inform the public or engage in advocacy.

Clinical psychology is an integration of human science, behavioral science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.

<span class="mw-page-title-main">Art therapy</span> Creation of art to improve mental health

Art therapy is a distinct discipline that incorporates creative methods of expression through visual art media. Art therapy, as a creative arts therapy profession, originated in the fields of art and psychotherapy and may vary in definition. Art therapy encourages creative expression through painting, drawing, or modelling. It may work by providing a person with a safe space to express their feelings and allow them to feel more in control over their life.

Developmental disability is a diverse group of chronic conditions, comprising mental or physical impairments that arise before adulthood. Developmental disabilities cause individuals living with them many difficulties in certain areas of life, especially in "language, mobility, learning, self-help, and independent living". Developmental disabilities can be detected early on and persist throughout an individual's lifespan. Developmental disability that affects all areas of a child's development is sometimes referred to as global developmental delay.

Peer support occurs when people provide knowledge, experience, emotional, social or practical help to each other. It commonly refers to an initiative consisting of trained supporters, and can take a number of forms such as peer mentoring, reflective listening, or counseling. Peer support is also used to refer to initiatives where colleagues, members of self-help organizations and others meet, in person or online, as equals to give each other connection and support on a reciprocal basis.

Mental disorders are classified as a psychological condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological and often social functioning of the individual. Individuals diagnosed with certain mental disorders can be unable to function normally in society. Mental disorders may consist of several affective, behavioral, cognitive and perceptual components. The acknowledgement and understanding of mental health conditions has changed over time and across cultures. There are still variations in the definition, classification, and treatment of mental disorders.

<span class="mw-page-title-main">Writing therapy</span> Technique for self-guided improvement

Writing therapyis a form of expressive therapy that uses the act of writing and processing the written word for therapeutic purposes. Writing therapy posits that writing one's feelings gradually eases feelings of emotional trauma. Writing therapeutically can take place individually or in a group and can be administered in person with a therapist or remotely through mailing or the Internet.

Psychoeducation is an evidence-based therapeutic intervention for patients and their loved ones that provides information and support to better understand and cope with illness. Psychoeducation is most often associated with serious mental illness, including dementia, schizophrenia, clinical depression, anxiety disorders, eating disorders, bipolar and personality disorders. The term has also been used for programs that address physical illnesses, such as cancer.

Self-help groups for mental health are voluntary associations of people who share a common desire to overcome mental illness or otherwise increase their level of cognitive or emotional wellbeing. Despite the different approaches, many of the psychosocial processes in the groups are the same. Self-help groups have had varying relationships with mental health professionals. Due to the nature of these groups, self-help groups can help defray the costs of mental health treatment and implementation into the existing mental health system could help provide treatment to a greater number of the mentally ill population.

<span class="mw-page-title-main">Grief counseling</span> Therapy for responses to loss

Grief counseling is a form of psychotherapy that aims to help people cope with the physical, emotional, social, spiritual, and cognitive responses to loss. These experiences are commonly thought to be brought on by a loved person's death, but may more broadly be understood as shaped by any significant life-altering loss.

Prosocial behavior, or intent to benefit others, is a social behavior that "benefit[s] other people or society as a whole", "such as helping, sharing, donating, co-operating, and volunteering". Obeying the rules and conforming to socially accepted behaviors are also regarded as prosocial behaviors. These actions may be motivated by empathy and by concern about the welfare and rights of others, as well as for egoistic or practical concerns, such as one's social status or reputation, hope for direct or indirect reciprocity, or adherence to one's perceived system of fairness. It may also be motivated by altruism, though the existence of pure altruism is somewhat disputed, and some have argued that this falls into philosophical rather than psychological realm of debate. Evidence suggests that pro sociality is central to the well-being of social groups across a range of scales, including schools. Prosocial behavior in the classroom can have a significant impact on a student's motivation for learning and contributions to the classroom and larger community. In the workplace, prosocial behaviour can have a significant impact on team psychological safety, as well as positive indirect effects on employee's helping behaviors and task performance. Empathy is a strong motive in eliciting prosocial behavior, and has deep evolutionary roots.

The mainstay of management of borderline personality disorder is various forms of psychotherapy with medications being found to be of little use.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Compassion-focused therapy (CFT) is a system of psychotherapy developed by Paul Gilbert that integrates techniques from cognitive behavioral therapy with concepts from evolutionary psychology, social psychology, developmental psychology, Buddhist psychology, and neuroscience. According to Gilbert, "One of its key concerns is to use compassionate mind training to help people develop and work with experiences of inner warmth, safeness and soothing, via compassion and self-compassion."

Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. Its goal is to help trauma survivors to develop a greater sense of mind-body connection, to ease their physiological experiences of trauma, to gain a greater sense of ownership over their bodies, and to augment their overall well-being. However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research.

Bereavement groups, or grief groups, are a type of support group that bereaved individuals may access to have a space to process through or receive social support around grief. Bereavement groups are typically one of the most common services offered to bereaved individuals, encompassing both formalized group therapy settings for reducing clinical levels of grief as well as support groups that offer support, information, and exchange between those who have experienced loss.

References

  1. 1 2 3 Riessman, Frank. "The 'helper' therapy principle". Social Work. 10 (2): 27–32. ISSN   0037-8046.
  2. 1 2 Lepore, S.J.; Buzaglo, J. S.; Liberman, M. A.; Golant, M.; Greener, J. R.; Davey, A. (2014). "Comparing standard versus prosocial internet support groups for patients with breast cancer: A randomized controlled trial of the helper therapy principle". Journal of Clinical Oncology. 32 (36): 4081–4086. doi:10.1200/JCO.2014.57.0093. PMC   4265118 . PMID   25403218.
  3. 1 2 Arnold, D.; Calhoun, L. G.; Tedeschi, R.; Cann, A. (2005). "Vicarious posttraumatic growth in psychotherapy". Journal of Humanistic Psychology. 45 (2): 239–263. doi:10.1177/0022167805274729. S2CID   145618063.
  4. 1 2 Pagano, Maria E.; Post, Stephen G.; Johnson, Shannon M. (2011-01-01). "Alcoholics Anonymous-Related Helping and the Helper Therapy Principle". Alcoholism Treatment Quarterly. 29 (1): 23–34. doi:10.1080/07347324.2011.538320. PMC   3603139 . PMID   23525280.
  5. 1 2 Post, Stephen G. (2005-06-01). "Altruism, happiness, and health: it's good to be good". International Journal of Behavioral Medicine. 12 (2): 66–77. doi:10.1207/s15327558ijbm1202_4. ISSN   1070-5503. PMID   15901215. S2CID   12544814.
  6. 1 2 Melkman, Eran; Mor-Salwo, Yifat; Mangold, Katharina; Zeller, Maren; Benbenishty, Rami (July 2015). "Care leavers as helpers: Motivations for and benefits of helping others". Children and Youth Services Review. 54: 41–48. doi:10.1016/j.childyouth.2015.05.004.
  7. ↑ Roberts, L.; Salem, D; Rappaport, J; Toro, PA; Luke, DA; Seidman, E (1999). "Giving and receiving help: Interpersonal transactions in mutual-help meetings and psychosocial adjustment of members". American Journal of Community Psychology. 27 (6): 841–868. doi:10.1023/A:1022214710054. ISSN   1573-2770. PMID   10723537. S2CID   11259892.
  8. ↑ Maton, K (February 1988). "Social support, organization characteristics, psychological wellbeing and group appraisal in three self-help populations". American Journal of Community Psychology. 16 (1): 53–77. doi:10.1007/BF00906072. ISSN   1573-2770. PMID   3369383. S2CID   40655711.
  9. 1 2 3 Olson, Bradley D.; Jason, Leonard A.; Ferrari, Joseph R.; Hutcheson, Tresza D. (September 2005). "Bridging professional and mutual-help: An application of the transtheoretical model to the mutual-help organization". Applied and Preventive Psychology. 11 (3): 167–178. doi:10.1016/j.appsy.2005.06.001.
  10. ↑ Prochaska, J. O.; DiClemente, C. C.; Norcross, J. C. (1992). "In search of how people change: Applications to the addictive behaviors". American Psychologist. 47 (9): 1102–1114. doi:10.1037/0003-066x.47.9.1102. PMID   1329589.
  11. ↑ Maton, Kenneth I. (1988). "Social support, organizational characteristics, psychological well-being, and group appraisal in three self-help group populations". American Journal of Community Psychology. 16 (1): 53–77. doi:10.1007/BF00906072. ISSN   0091-0562. PMID   3369383. S2CID   40655711.
  12. ↑ Young, Jim; Williams, Christopher L (February 1, 1987). "An Evaluation of Grow, a Mutual-Help Community Mental Health Organisation". Community Health Studies. 11 (1): 38–42. doi: 10.1111/j.1753-6405.1987.tb00129.x . ISSN   1753-6405. PMID   3581779.
  13. ↑ Maton, Kenneth I.; Salem, Deborah A. (1995). "Organizational characteristics of empowering community settings: A multiple case study approach". American Journal of Community Psychology. 23 (5): 631–656. doi:10.1007/BF02506985. ISSN   0091-0562. PMID   8851343. S2CID   45290144.
  14. ↑ Pistrang, Nancy; Barker, Chris; Humphreys, Keith (2008-08-05). "Mutual Help Groups for Mental Health Problems: A Review of Effectiveness Studies". American Journal of Community Psychology. 42 (1–2): 110–121. doi: 10.1007/s10464-008-9181-0 . ISSN   0091-0562. PMID   18679792. S2CID   14963975.
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