integrating self-help books into psychotherapy

Integrating Self-Help Books into Psychotherapy�

Linda F. Campbell

University of Georgia

�

Thomas P. Smith

University of Scranton

This article describes a systematic and integral method of incorporatingself-help books into psychotherapy as a collaborative function. We addressthe distinctions between self-help and bibliotherapy, consider bibliother-apy as adjunctive or integrative to psychotherapy, and outline the multipleuses of bibliotherapy for clinical purposes. How to apply self-help booksin psychotherapy and ways to select books are illustrated by a case exam-ple. Indications and contraindications for bibliotherapy in therapy areoutlined. © 2003 Wiley Periodicals, Inc. J Clin Psychol/In Session 59:177–186, 2003.

Keywords: self-help; self-help books; bibliotherapy; psychotherapy

Self-help materials are prolific and varied. Self-help activities can refer to reading books,watching movies, surfing the Internet, and attending groups. Self-help can be directedsolely by the person, can follow professionals’ recommendations, or can be integratedinto formal psychological treatment. In addition to its popularity with the general popu-lation, self-help is frequently recommended by psychotherapists. Practicing psycholo-gists recommend self-help books (85%), self-help groups (82%), films (46%), Web sites(34%), and autobiographies (24%) (Norcross et al., 2000, 2003).

Absent from much of the self-help literature are specific recommendations andresources for incorporating self-help into psychotherapy. In this article, we review theadvantages of integrating bibliotherapy and psychotherapy, and suggest means by whichpsychotherapists can do so in a systematic and effective manner. Bibliotherapy refers toactive use of books in psychotherapy rather than a self-help approach in which the indi-

Correspondence concerning this article should be addressed to: Linda F. Campbell, Ph.D., 402 Aderhold Hall,University of Georgia, Athens, GA 30602; e-mail: [email protected].

JCLP/In Session: Psychotherapy in Practice, Vol. 59(2), 177–186 (2003) © 2003 Wiley Periodicals, Inc.

Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.10140

vidual conducts self-directed parallel reading. Self-help and bibliotherapy, as discussedin this article, are used synonymously. The focus of the article is on the intentional use ofself-help books in psychotherapy.

Goals of Bibliotherapy

Bibliotherapy derives from the Greek words for book (biblio) and therapy (therapeia),and has been used as a therapeutic method since ancient Greece where the door to thelibrary at Thebes read “The Healing Place of the Soul” (Pardeck, 1998). The purpose ofbibliotherapy over time has been to (a) provide information, (b) generate insight, (c)stimulate discussion, (d) create awareness of others’ problems, (e) provide solutions toproblems, and (f ) troubleshoot problems after termination (Orton, 1997; Pantalon, Lubet-kin, & Fishman, 1995). These goals are desirable outcomes for psychotherapy by anymethod; however, self-help programs have historically not been viewed as legitimatepsychological treatment.

Self-help books provide phenomenological accounts of behavioral disorders in every-day terms, enhance identification and empathy, generate hope and insight, offer concreteadvice and techniques, explain treatment strategies, and summarize research findings(Norcross, 2000; Pardeck, 1998). Research suggests that the intentional nature of biblio-therapeutic reading (i.e., purposeful reading, reading and recall), relational characteris-tics (i.e., the similarity of characters to clients’experiences), and transporting characteristics(i.e., immersion and escape) are among the major benefits of bibliotherapy interventions(Cohen, 1993).

Controlled Research on Bibliotherapy

The effectiveness of bibliotherapy has been demonstrated in both single studies andmeta-analyses. Single studies have applied bibliotherapy to various disorders and treat-ments traversing the clinical universe. The results of these studies have proven promis-ing. Meta-analyses have found bibliotherapy to be effective under several differentconditions. Marrs (1995) compared bibliotherapy to therapist-administered treatmentsand found no significant differences between effect sizes, including at follow-up. Gouldand Clum’s (1993) meta-analysis of 40 self-help studies indicated that self-help booksin conjunction with therapy appear to be a more intensive integration than minimaltherapist contact conditions.

At the same time, both research and experience suggest that prescribing self-helpbooks alone frequently is not enough to promote success (Glasgow & Rosen, 1978).Bibliotherapy seems to be used best in conjunction with other therapeutic approaches(Pantalon et al., 1995). As an example of conjoint psychotherapy and bibliotherapy, spe-cifically in cognitive-behavioral treatment for depression, meta-analyses have indicatedimpressive overall efficacy for bibliotherapy. One study found an 82% improvement ofaverage bibliotherapy participants over the no-treatment participants (Scogin, Bynum,Stephens, & Calhoon, 1990).

Cognitive-behavioral therapists, in particular, find bibliotherapy to be compatiblewith formal treatment. Recent research conducted on the utility of self-help books sug-gests that they can enhance the quality of cognitive/behavioral therapy. For example,cognitive bibliotherapy offers the advantages of being readily accessible and providingbooster treatments by rereading the book, which 48% of the participants reported doing(Jamison & Scogin, 1995; Prochaska, Norcross, & DiClemente, 1995).

178 JCLP/In Session, February 2003

Decision-Making in Bibliotherapy

The clinician faces several decisions in utilizing bibliotherapy. Here, we consider threechoices: adjunctive versus integrative, nonfiction versus fiction, and clinical use versussupport/informational use.

Adjunctive Versus Integrative

Bibliotherapy within psychotherapy ranges from adjunctive to integrative. Adjunctivebibliotherapy might entail a reading recommendation as homework for further clarifica-tion, information, direction, or practice. The adjunctive format also is useful when clientsare not able to attend therapy regularly, such as the case with some elderly, geographi-cally distant, and physically disabled individuals.

The integrative approach does not imply that bibliotherapy becomes the centerpieceof therapy, but rather is applied to the client’s current concerns. The content, meaning,and recommendation for change conveyed in the book can be very helpful to the therapistin session in several ways: (a) The material can save in-session time by allowing thetherapist to review critical elements rather than engage in lengthy descriptions; (b) diverselearning modalities are accommodated through both reading (visual) and discussion (audi-tory); and (c) the therapist, through reading assignments, can more effectively extendtreatment into the client’s daily life.

Nonfiction Versus Fiction

Self-help books conventionally denote nonfiction books that offer information, decisionmaking, and problem solving. Nonfiction books often include specific processes andprocedures to accomplish treatment goals. The therapist may use nonfiction materials asteaching tools for learning new thinking or behavior and for promoting awareness.

Use of fiction in bibliotherapy is intended to promote change through the clients’identification with a book’s character (Smith & Burkhalter, 1987). The client is given theopportunity to walk in the shoes of another person.

Fictional books have not benefited from the same empirical research as have nonfic-tion resources, although both need further study. Recent studies of use of fiction, how-ever, have supported positive treatment outcomes in lowering stress (Cohen, 1993).

Clinical Use Versus Support/Informational Use

Clinical use of bibliotherapy refers to the treatment of conditions that are the focus oftherapy such as depression, anxiety, and eating disorders. These conditions may be diag-nosable disorders such major depression or panic disorder or may be life challenges suchas anger management, assertiveness, marital conflict, or adolescent problems. Clinicaluse of bibliotherapy should be more closely monitored and included in therapy sessionsin a deliberate way. The resource material is employed in the treatment plan and is anintegral part of the intervention.

Before recommending a book for clinical purposes, the psychotherapist should con-sider the fit with the client by asking questions. Does the book recommend activitiesand/or problem solutions that (a) are doable by the client, (b) have evidence of effective-ness, (c) are congruent with the treatments provided, and (d) are applicable to the client’spresenting problems? Clients’ reading about mood disorders, addiction, abuse, or schizo-phrenia can be a mirror into themselves that requires careful monitoring and processing.

Integrating Self-Help Books into Psychotherapy 179

On the other hand, a book can be used informationally. If the client has a familymember who is depressed, for example, a self-help book can be used for informationaland supportive purposes. We advise caution, however, about using resource materialclinically with someone who is not a client. This practice could result in conflict ofinterest, dual roles, and responsibility beyond what the therapist anticipated.

Self-help books can be used for informational purposes with clients as well as withfamilies, friends, and others in relationship to the client. Issues that can benefit frominformational bibliotherapy include parents dealing with teenage concerns, weight man-agement, stepfamilies, pregnancy, communication skills, and assertiveness.

Orientation to Psychotherapy and Bibliotherapy

The benefits of therapy orientation are well known. Orientation to therapy typically includesa discussion of clients’ expectations of their behavior, the therapy relationship, and ther-apist. In using bibliotherapy, the therapists should explain the role and function of bib-liotherapy in the psychotherapeutic work. Clients who do not expect to be usingbibliotherapy could have negative perceptions of being shuffled off, of the therapist notwanting to take time with them, or of feeling like they are back in school. Conversely,clients could have positive perceptions, but also transfer to the bibliotherapy assignmentthe mantel of high achievement and the need to please the therapist.

Application to Therapy

There are a number of reasons that a practitioner might incorporate bibliotherapy intopsychotherapy. Colleagues and we mailed a questionnaire to 1,500 randomly selectedmembers and fellows of the American Psychological Association’s divisions of Clinicaland Counseling Psychology (Norcross et al., 2000). Of these 1,500 members, 357 psy-chologists completed and returned the questionnaire. A total of 353 members providedusable data.

To understand how psychologists incorporate self-help books into psychotherapy, weasked psychologists to rate 10 purposes for implementing bibliotherapy into psychother-apy on a scale of 1 (never) to 5 (almost always). Table 1 presents the mean responses. Ascan be seen, the three top purposes for recommending self-help books to patients were toenlighten/increase awareness, to reinforce specific points or strategies worked on in asession, and to enhance lifestyle change. Although these numbers are somewhat encour-aging, our interpretation of these results is that “sometimes” to “almost always” leavesmuch room for improvement.

We conducted a series of analyses to examine differences between use of bibliother-apy purposes and the psychologist’s theoretical orientation. Nine of the 10 purposes evi-denced statistically significant differences due to orientation. Significant differences werefound specifically with psychodynamic psychologists’ ratings lower than the other ori-entations on 8 of these 10 purposes. Cognitive/behavioral, eclectic/integrative, and human-istic psychologists all endorsed more purposes than psychodynamic colleagues.

Matching Considerations

Systematic research has been under way regarding the matching of client variables topsychotherapy treatments. Consideration of client variables in bibliotherapy matchinghas not been similarly researched; however, some extrapolation is appropriate from find-


ings on differential effectiveness. We consider three matching variables here: stage oftherapy, stage of change, and coping style.

Selection of self-help books is important in matching the stage of therapy with therecommended readings. For example, references that explore the nature of problems,clarify conditions, and illuminate aspects of problems are recommended for early stagesof therapy. Resources that challenge incongruities, distorted cognitions, or health-impairing behaviors are appropriate for mid- to advanced stages of therapy. Books thatfeature problem solutions are very useful for actual change stages of therapy.

Those who are entering therapy at a precontemplative stage of change are unlikely tobe motivated for change early. Therefore, they are candidates for self-help books thatexplore and clarify problems and defenses. Conversely, those who are in the preparationor action stages would be candidates for books that include activities that highlight newbehaviors, list options for change, and workbook activities that focus on consequences ofchange (Norcross, 1993; Prochaska & Norcross, 1999).

Individuals with internalizing coping styles tend to successfully use bibliotherapybecause of internalized motivation and control. Individuals with externalizing copingstyles tend to work well with activities that are behaviorally oriented, such as homeworkand self-directed assignments. People who have high defensiveness and resistance (aver-sion to direction from others) also tend to do better with self-directed activities than withdirective therapists (Beutler, 1991).

Indications and Contraindications

Judgment should be exercised in matching clients with self-help books, as we haveexplained. Additional factors relating to client characteristics, treatment goals, and pro-fessional standards also should be considered.

Client Considerations

1. Assess ability of the client to attend and concentrate. Screen for level of severitymatched with clients’ symptom state (e.g., using audio tapes rather than books ifenergy level is insufficient).

Table 1Frequency of Psychologists’ Purposes in Recommending Self-Help BooksDuring Psychotherapy

Purpose M SD

Educate about diagnosis and treatment 2.82 1.14Encourage and improve motivation 2.82 1.20Empower clients to believe in them 2.99 1.28Enlighten/increase awareness 3.54 1.25Engage in more social activity 2.08 1.06Enhance lifestyle changes 3.02 1.27Maintain posttermination treatment effects 2.73 1.28Reduce the number of sessions 2.31 1.19Reinforce specific point(s) or strategies worked on in a session 3.38 1.28Provide support and knowledge for family members 2.98 1.16

Note. 1 � Never, 2 � Occasionally, 3 � Sometimes, 4 � Often, and 5 � Almost Always.


2. Consider the focus of self-help books across treatment phases. As mentionedpreviously, book recommendations are probably most effective when treatmentphase, compliance, and goals are considered. For example, a therapist may rec-ommend to a woman dealing with weight management a book (e.g., Fat Is aFeminist Issue, When Food is Love, or Fat is a Family Affair) that explores thepsychological base for the weight problem when the therapist is helping the clientexplore and understand her problem. This recommendation should be congruentwith the therapist’s conceptualization of the problem (e.g., self-concept, child-hood effects, or family thematic patterns). Later in therapy, when maintenancefactors are understood and insight has developed, the therapist may recommendbooks on actual weight loss (e.g., The LEARN Program for Weight Control, TheHunger Within: A Twelve Week Guided Journey).

3. Guard against intellectualizing of a self-help book as a diversion from the ther-apy. Some patients are quite skilled in “talking about” a subject in a way thatseems action oriented. If the patients are interesting and articulate, the diversioncan be even more difficult to detect.

4. Consider ethnic, cultural, and other demographic characteristics in the bibliother-apy selections in terms of subject, values, purpose, and message to insure con-gruence with the clients’ value system. There is no prescriptive treatment intendedhere, but rather the recommendation that therapists be knowledgeable about researchfindings and implications in regard to diversity.

5. Reading levels and preferences are particularly important for assignments tochildren.

6. Books that express the same emotional or psychological mood as the client arepreferable (Pardeck, 1998), particularly when the purpose is identification, explo-ration, or understanding. For example, for children going through the emotionalturmoil of their parents’ divorce, The Boys and Girls Book About Divorce exploreschildren’s feelings that it is normal to feel that way, and offers ideas about howthey may cope.

Therapist Considerations

Although research is lacking on this subject, several suggestions have emerged fromclinical experience.

1. The therapist may want to be relatively familiar with the recommended self-helpbook to insure that it meets the intended goals.

2. The therapist may want to insure that the book is related to the client’s problem.

3. The therapist may want to be familiar with the developmental stage of childrenfor whom a recommendation is being made (Pardeck, 1998).

4. The therapist may want to insure that the recommended activities described in thebook are doable for that particular patient.

Case Illustration

Dr. Stewart, a clinical psychologist in the cognitive-behavioral and integrative traditions,was working with the Wilsons, who presented with multiple systemic and individualconcerns. Bill (age 47) and Mary (age 45) had married two years earlier and were now astepfamily. Both were married previously. Bill had two children, Jack and Susan, who


lived with them. Mary had one son, Brian, who was married and had two young children.Bill and Mary were primarily concerned about the marital discord that had arisen in thelast six months. They were in constant tension, argued over small things, and disagreedon decision making. They were not sure what was causing it, but speculated on severalfamily circumstances.

Bill’s mother, who lived nearby, had been diagnosed with moderate dementia. Billwas one of two children, but his brother lived across the country and had not been helpfulin the care of their mother. Bill’s 17-year-old son, Jack, had had behavioral problemsthroughout school and, even though it appeared that he would graduate from high school,he continued to get into trouble for fighting, arguing with teachers, and being opposi-tional. Bill’s 15-year-old daughter, Susan, was diagnosed with bulimia a year earlier andhad cyclically improved and regressed. Bill had custody of both children and had been ata loss as to what to do. Mary’s grown son, Brian (age 27), and his wife worked, and Maryoften baby-sat the grandchildren. Brian had been struggling with chronic depression andgoing in and out of depressive cycles. Brian was not open to discussing his problem withhis mother and stepfather and did not follow a treatment plan consistently. Bill and Mary,however, felt the depressive effects through the impact on the grandchildren and in respond-ing to the unpredictability of Brian.

Bill, himself, had periodically struggled with alcohol throughout his life. He thought,in retrospect, that it was related to childhood physical abuse that he had only begun todeal with recently. Mary’s first marriage was physically and verbally abusive, from whichshe had residual symptoms of PTSD. Mary reported feeling anxious much of the time,but said this condition had been with her since she was a teenager.

Dr. Stewart’s treatment plan prioritized the marital concerns and worked with thecouple on their own relationship. From the couples’ self-report and clinical assessment,Dr. Stewart believed that the alcohol problems, the childhood abuse, previous marriages,and anxiety were negatively impacting Bill and Mary’s ability to cope with their newstepfamily. Dr. Stewart decided to use bibliotherapy conjunctively with psychotherapy inthis case. Dr. Stewart incorporated bibliotherapy by specifically describing how and whyit was being used. Just as clients have unrealistic or inaccurate expectations for therapy,so can they misunderstand the use of bibliotherapy.

Adjunctive Versus Integrative

Dr. Stewart saw an opportunity in this multifaceted case to use both. Because the maritalconcerns were primary in the treatment plan, Dr. Stewart integrated some readings onstepfamily stress, specifically how relationships within the family of origin influence themarriage. Suggestions included Why Marriages Succeed or Fail by John Gottman andIntimate Partners by Maggie Scarf. Further, Bill and Mary benefited from understandingthe unique qualities of a blended family and the impact of the blended family on thecouple. Suggestions here included Old Loyalties, New Ties by Emily Visher and JohnVisher and The Shelter of Each Other by Mary Pipher. The important themes from theseself-help books were incorporated into therapy as the couple and therapist collaborativelydetermined.

Dr. Stewart also recommended adjunctive books, some of which were discussed intherapy and which gave them initial information and understanding on other concerns.Examples of those recommendations were books on coping as an adult child of a parentwith dementia and how eating disorders affects the family for Bill. For Mary, Dr. Stewartsuggested readings on improving communication with children and understanding their


feelings (for facilitating interaction with her grandchildren) and on understanding depres-sion when someone you care for is affected.

Nonfiction Versus Fiction

Dr. Stewart decided that initially nonfiction sources would be preferable for this couplefor information gathering and understanding. Nonfiction books specifically for under-standing the Jack’s problem with anger, Brian’s experience with depression, and his moth-er’s experience with dementia may prove useful at a later time in therapy. Fiction sourcesthat provide an identification with a character would be valuable later in therapy if Bill orMary were unable to conceptualize how their problems were generated and maintained orif they were empathically unable to understand the dynamics of the problems with whichtheir children and mother were dealing.

Clinical Use Versus Support Use

Books focused on the primary therapy goals of Bill and Mary were clinical use of thebibliotherapy. In recommending books, Dr. Stewart was mindful that the recommenda-tions in the book must be doable, consistent with treatment recommendations, and appli-cable to the presenting problem. Recommendations for Bill included Wounded Boy orHeroic Men by Daniel Sonkin and for Mary The Battered Woman by Lenore Walker, andfor both of them, Allies in Healing by Laura Davis. Dr. Stewart also considered theadjunctive bibliotherapy for informational or supportive use. These gave Bill and Mary abird’s eye view into the context of the problem to be able to understand, empathize, andsupport others in the family who were living with the problems.

Matching Considerations

Dr. Stewart considered three factors in recommending books for Bill and Mary. Theirstages of therapy were the same since they began together, so Dr. Stewart used books thatfocused on exploring, understanding, and developing insight into the clients’ problemsinitially. As the therapy progressed, Bill and Mary moved into decision making and prob-lem resolution. Suitable references here included those with specific recommendations toimplement change through activities, homework, written assignments, and decision mak-ing between options.

Dr. Stewart simultaneously determined Bill and Mary’s respective stage of change.Even though they began therapy together, they were at different points in their readinessto change. Bill began his therapy in an action stage of change and thus was ready foractivities that included implementation for change such as in session rehearsal, in vivopractice, and interactive assignments. Mary was in a contemplation stage, and therefore,reading assignments and in-therapy content needed to be different from Bill’s. Bill wasable to proceed with the previously mentioned activities while Dr. Stewart worked onexploration and understanding with Mary through readings promoting character identi-fication, clarification of problems, and insight.

Finally on matching, Mary was fairly resistant to direct therapist suggestions. Dr.Stewart thus considered more self-directed assignments for Mary such as The Anxietyand Phobia Workbook, which is an activity-oriented, exploratory set of assignments (alsoadvisable since Mary was at the contemplative stage of change). Because Bill was in theaction stage and seemed to have more of an internalizing coping style, Dr. Stewart had


greater latitude in reading recommendations. Bill benefited from readings that discussedthe role of the individual in maintaining one’s problem and the impact the individual canhave in one’s own change process.

The case illustration focused on the use of self-help books, not the treatment plan.The success of the entire treatment does not depend solely on bibliotherapy; however,bibliotherapy proved useful.

Recommendations of Specific Books

As a result of research we have conducted, thousands of psychologists have rated theeffectiveness of hundreds of self-help books on 28 disorders and life challenges (Nor-cross et al., 2003). Here, we present 10 top-rated books: Healing the Incest Wound byCourtois (abuse), Driven to Distraction by Hallowell and Ratey (ADHD), A Time to Healby Cermak (addictive disorders), Stop Obsessing by Foa and Wilson (anxiety disorders),Boundaries by Cloud and Townsend (communication and people skills), When Bad ThingsHappen to Good People by Kushner (death and grieving), Dying to Be Thin by Sackerand Zimmer (eating disorders), Love is Never Enough by Beck (love and intimacy), MindOver Mood by Padesky and Greenberger (depressive disorders), and Trauma and Recov-ery by Herman (trauma/PTSD).

Summary

The use of self-help books in psychotherapy is common practice, yet it has not beentreated as a systematic and organized component of treatment planning. Research on theeffectiveness of bibliotherapy shows promising results; however, findings continue toindicate that bibliotherapy should be conducted with psychotherapy and not as the soletreatment. Bibliotherapy holds great potential to enhance and extend treatment effectsthrough reading and workbook activities.

Several factors that affect decision making in bibliotherapy were addressed: adjunc-tive versus integrative use, (b) nonfiction versus fiction use, and (c) clinical use versussupport use. Consideration of these variables can be helpful for the therapist in decidinghow to integrate bibliotherapy into the treatment plan. Also to be considered is matchingto stage of therapy, stage of change, and coping style.

The practice of using bibliotherapy as a component of treatment is in its infancy.Thus far, research indicators are positive. The next step is to further identify the how,when, where, and with whom questions.

Select References/Recommended Readings

Beutler, L.E. (1991). Predictors of differential response to cognitive, experiential, and self-directedpsychotherapeutic procedures. Journal of Consulting and Clinical Psychology, 59, 333–340.

Cohen, L.J. (1993). The therapeutic use of reading: A qualitative study. Journal of Poetry Therapy,7, 73–83.

Glasgow, R.E., & Rosen, G.M. (1978). Behavioral bibliotherapy: A review of self-help behavioraltherapy manuals. Psychological Bulletin, 85, 1–23.

Gould, R.A., & Clum, G.A. (1993). A meta-analysis of self-help treatment approaches. ClinicalPsychology Review, 13, 169–186.

Jamison, C., & Scogin, F. (1995). The outcome of cognitive bibliotherapy with depressed adults.Journal of Consulting & Clinical Psychology, 63, 644– 650.


Marrs, R.W. (1995). A meta-analysis of bibliotherapy studies. American Journal of CommunityPsychology, 23, 843–870.

Norcross, J.C. (1993). Tailoring relationship stances to client needs: An introduction. Psychother-apy, 30, 402– 423.

Norcross, J.C. (2000). Here comes the self-help revolution in mental health. Psychotherapy: Theory,Research, Practice, and Training, 37, 370–377.

Norcross, J.C., Santrock, J.W., Campbell, L.F., Smith, T.S., Sommer, R., & Zuckerman, E.L. (2003).Authoritative guide to self-help resources in mental health. New York: Guilford Press.

Orton, G.L. (1997). Strategies for counseling with children and their parents. Pacific Grove, CA:Brooks/Cole.

Pantalon, M.V., Lubetkin, B.S., & Fishman, S.T. (1995). Use and effectiveness of self-help booksin the practice of cognitive and behavioral therapy. Cognitive and Behavioral Practice, 2,213–222.

Pardeck, J.T. (1998). Using books in clinical social work practice. Binghamton, NY: The Hawthorne.

Prochaska, J.O., & Norcross, J.C. (1999). Systems of psychotherapy. Pacific Grove, CA: Brooks/Cole.

Prochaska, J.O., Norcross, J.C., & DiClemente, C.C. (1995). Changing for good. New York: Avon.

Scogin, F., Bynum, J., Stephens, G., & Calhoon, S. (1990). Efficacy of self-administered treatmentprograms: Meta-analytic review. Professional Psychology: Research and Practice, 21, 42– 47.

Smith, D., & Burkhalter, J.K. (1987). The use of bibliotherapy in clinical practice. Journal ofMental Health Counseling, 9, 184–190.


integrating self-help books into psychotherapy

Documents