Professional Psychology: Research and Practice1992, Vol.23, No. 6, 515-520

Copyright 1992 by the American Psychological Association, Inc.0735-7028/92/$3.00

A Comparison of Espoused Theories of Self- and Mutual Help:Implications for Mental Health Professionals

Lisa McFaddenUniversity of Illinois at Urbana-Champaign

Edward SeidmanNew York University

Julian RappaportUniversity of Illinois at Urbana-Champaign

Nonprofessional helping organizations, known as self- or mutual-help groups, are viewed as homo-geneous, varying primarily in the problem addressed. However, there is great diversity in theirmethods, even among groups addressing similar problems, which has important implications forreferring clinicians. Results of this study, which is a content analysis of the literature of 2 interna-tionally known organizations for the mentally ill, suggest nonprofessional helping organizationsare not homogeneous. Techniques of self-help based on authority, as opposed to mutual-help basedon interpersonal and spiritual growth, characterize some of the differences. Groups also differ inproblems addressed and help strategies offered. This study discusses the implications of thesedifferences for mental health professionals.

In recent decades numerous nonprofessional, peer-run help-ing groups have organized for members to assist each other incoping with, confronting, or eradicating a common psychologi-cal or medical problem (Department of Health and HumanServices Public Health Service, 1988; Gartner & Riessman,1984; Katz & Bender, 1990; Powell, 1990). At present, nonpro-fessional groups, often generically referred to as "self-helpgroups," exist for almost every known health or mental healthdisorder. Jacobs and Goodman (1989) have denned self-helpgroups as those that "have a common problem, meet for thepurpose of exchanging psychological support, charge minimalor no fees, and [are] essentially member-governed, even if themembers use professional consultation" (p. 536). Many groupsare local (ijs., unaffiliated with any national organization).Others, such as Alcoholics Anonymous, are part of a state, na-tional, or even international organization. Using a variety ofempirical sources, Jacobs and Goodman (1989) have estimated

LISA MCFADDEN, MA, is currently completing a PhD in clinical psy-chology at the University of Illinois Urbana-Champaign and has beenteaching psychology at Ithaca College in Ithaca, New York.EDWARD SEIDMAN, PnD, is professor of psychology at New York Uni-versity and past president of the Division of Community Psychology ofthe American Psychological Association.JULIAN RAPPAPORT, PHD, is professor of psychology at the Universityof Illinois Urbana-Champaign and editor of the American Journal ofCommunity Psychology.THIS RESEARCH WAS SUPPORTED in part by a grant from the NationalInstitute of Mental Health (MH37390) to Julian Rappaport and Ed-ward Seidman.WE GRATEFULLY ACKNOWLEDGE the assistance of the undergraduatecoders, Alberto Segre for his technical assistance, and three anony-mous reviewers for their comments on a draft of this article.CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed toLisa McFadden, Department of Psychology, Ithaca College, Ithaca,New York 14850.

that the number of people currently in a self-help group rivalsthe number of psychotherapy clients, and they predict that notonly will such groups continue to flourish in the foreseeablefuture, but they increasingly will be seen as legitimate and eco-nomical.

Because they are all primarily nonprofessional, these groupsare frequently referred to as a homogeneous entity. Levy (1984)observed that nonprofessional groups vary on a number of di-mensions, including their structure, manner of conductingmeetings, the quality of their social interaction, and their lon-gevity (see also, Maton, Leventhal, Madera, & Julien, 1989).Similarly, Killilea (1976) recognized the diversity of thesegroups in her request for research that would classify themalong several pertinent parameters, including degree of cogni-tive or affective emphasis. To further illustrate the diversityamong these groups, Levy (1984) noted that even within thesame national organization there is significant variability in themanner in which local meetings are conducted.

Luke, Rappaport, and Seidman (1991), using observer-re-corded behavioral observations, found that within the sameorganization a variety of group process differences could befound across individual groups. In addition to differing in anumber of obvious ways, such as type of problems addressed oruse of a standard program for the conduct of meetings, theyalso appear to differ on more subtle dimensions. Often theterms self-help and mutual help are used interchangeably todescribe them, although it is possible to distinguish clear dif-ferences. In self-help, emphasis is placed on the members' ownability to use an expert's or program's advice that is offered in aneasily accessible format (analogous to "do-it-yourself" pro-grams). In mutual help, emphasis is placed on shared interper-sonal support and interaction among members.

Significant heterogeneity among these nonprofessionalgroups could have important implications for clinicians. Jacobsand Goodman (1989) predict that professionals will have

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516 L. McFADDEN, E. SEIDMAN, AND J. RAPPAPORT

greater involvement with such groups. Referring clients, bothwhile still in professional care and as a form of aftercare, is oneof the important ways mental health professionals can assisttheir clientele (Department of Health and Human ServicesPublic Health Service, 1988). Indeed, it is likely that increasingnumbers of clients will ask mental health professionals to assistthem in finding an appropriate group. Particularly for long-term mental patients, membership in a peer-run group canserve to provide some of the daily life supports that profes-sionals do not have the time to offer (Salem, Seidman, & Rap-paport, 1988). Given the heterogeneity, choosing an appro-priate group for referral may require knowing more than thetype of problem a group addresses or the target population theyseek to attract. If differences among groups with similar em-phases are significant, clinicians may also want to understandthese differences to ensure a good match between clients' prob-lems and groups' goals, as well as a match between the profes-sional care and the group's methods. Although group heteroge-neity generally has been observed (Levy, 1984), there has beenlittle empirical study focused on comparing the methods ofvarious organizations. Thus, the significance of the observeddifferences remains unclear. This question is salient for clini-cians and is the focus of the present study.

Antze (1979) noted that a group's espoused theories (i.e., whatthey believe about their afflictions and the means by whichthey help) can be gleaned from a group's literature. This rela-tively easily accessed information is one method by which pro-fessionals can become better informed. Both Levy (1984) andKillilea (1976) have recommended textual analysis, compara-ble to that used in the analysis of literary criticism, to analyzewhat the group purports to be their emphases and goals. Ex-tending their suggestions, a comparative textual analysis wouldenable the direct comparison of the emphases and goals of twoor more nonprofessional groups. As a means to illustrate howmental patient groups run by nonprofessional peers can beunderstood through their written material, the literature of twowell-known organizations, GROW and Recovery, Inc., were se-lected as examples of the many groups that have the commongoal of helping people who have a history of psychiatric hospi-talization for serious mental illness.

GROW was founded in Australia in 1957 by a group of re-covering former mental hospital patients, among them a priestwho became the organization's leader. The organization nowhas over 500 groups worldwide and an extensive written litera-ture designed to help members cope with daily problems.Beyond its literature, written by the members themselves, it hastwo other program components: (a) weekly group meetingswith a structured format and (b) what GROW refers to as the"sharing and caring community" (Rappaport et al., 1985).

Recovery, Inc., was founded in 1938 by the late AbrahamLow, a psychiatrist. The program is published in a widely dis-tributed text, Mental Health Through Will Training (Low, 1971).The organization reports some 800 groups worldwide (Barter &Berning, 1991). Recovery members meet weekly in a structuredgroup format in which trained leaders provide the program'sresponses to members' problems. These trained leaders are typ-ically members who have been in the program for a long timeand have made significant progress. To discourage digressionfrom the prescribed program, participant contact between

meetings is restricted to one 10-min telephone call (for furtherdetails, see Weschler, 1960).

To examine and compare the espoused theories of GROWand Recovery, their respective literatures were content analyzedon six dimensions. The first three dimensions were chosen be-cause of their obvious interest for clinicians wanting to ensure agood fit between the type of mental health problems addressedin the group and the client's difficulties. These dimensions in-clude (a) type of problems discussed, (b) whether spirituality isan integral part of the program, and (c) whether the group fo-cuses solely on problems or whether growth issues are also dis-cussed. The next two dimensions are of interest to clinicianswho refer clients to groups as an adjunct to treatment and wantto determine whether different organizations are compatiblewith their own therapy techniques. These dimensions include(d) type of help given and (e) whether help is given in an authori-tative or nonauthoritative manner. The final dimension, (f) me-morizability, is an attempt to capture the ease with which theorganization's advice is likely to be recalled by members. An apriori scanning of the literature indicated that some portion ofit was written in an easy-to-remember form. Content analysisenabled an accurate assessment of this facet of the program.

Method

GROW and Recovery, Inc., Literature

The content of the two primary texts of GROW (The Program ofGrowth to Maturity, GROW, 1982, and Readings for Mental Health,Keogh, 1975) and the text for Recovery, Inc. (Mental Health ThroughWill Training, Low, 1971) were analyzed. These books, which are in-tended to be read by all members, contain the groups' philosophiesand methodologies. In each book problems related to mental illnessare described and suggestions of how to overcome these problems aremade.

GROW's The Program of Growth to Maturity is a pocket-sized pam-phlet of readings; the length of each varies from a single line to a fewshort paragraphs. This book, with a total of 84 excerpts and numerousone-line phrases, serves as a handy reference to the GROW philosophyduring meetings and outside the group context. Many members at-tempt to memorize these short passages as a means of integrating theGROW philosophy into their lives and coping with daily life stresses.For example, the following excerpt, entitled "The Overall Key to Men-tal Health" is designed to help members keep a balanced perspective:"Settle for disorder in lesser things for the sake of order in greaterthings; and therefore be content to be discontent in many things"(GROW 1982, p. 9). A second example is "Keep your temper. If you'rein the right, you can afford to keep it. If you're in the wrong, you can'tafford to lose it" (GROW 1982, p. 45).

GROW's Readings for Mental Health (Keogh, 1975) contains 60short pieces organized according to the program's "12 steps of personalgrowth." The 12 steps are similar to those of the Alcoholics Anony-mous program. For each step there are five readings of three to fourpages in length that are designed to help the GROW member reflect onimportant issues of that step. For example, group members working onthe second step, "cooperating with help," are provided a reading thatdescribes commonly adopted resistance attitudes that the client usesto sabotage a professional's help or to place barriers between the clientand the helpgiver. Some of these attitudes include being silent or talk-ing too much, admitting to needing help but saying "you're not the oneto help me," saying "I don't care," twisting the meaning of helpers'advice, or giving a clever display of arguments. Those working on the

THEORIES OF SELF- AND MUTUAL HELP 517

sixth step, "we endured until cured" are provided with a reading onwhy it takes time to recover. The following excerpt of this readingcaptures its general meaning: "All great changes in us take time. Thegreater the change, the longer it takes. Since we got sick over a longperiod, we cannot expect the reverse process to be instantaneous"(Keogh, 1975, p. 103).

Recovery, Inc.'s Mental Health Through Will Training is divided intofour parts: (a) panel discussions with extensive quotations, (b) paneldiscussions with abbreviated quotations, (c) the principle methods ofsabotage, and (d) group psychotherapy interviews. There are a total of61 excerpts, three to four pages in length, in which problem behaviorsare addressed through the Recovery philosophy.

After each of the panel discussions, which are scripts of group meet-ings, Dr. Low provides readers with his analysis of the problem andhow the problem should have been handled. For example, in one of thepanel discussions the group leader announces the topic of "indecisive-ness." A group member describes an occasion when she was shoppingfor her daughter and had difficulty deciding between two pairs ofsocks. She describes her symptoms and how the symptoms subsidedwhen her daughter resolved the problem by deciding for her. Othergroup members also present their examples of being indecisive. InLow's comments he notes that the woman cheated herself by allowingher daughter to decide for her. He discusses how easy it is for patients toallow others to assume their responsibility, but how relinquishing re-sponsibility robs the person of self-esteem.

The second part of the Recovery text focuses on behaviors patientsuse to sabotage their mental health. Some of the topics discussed inthis section include those that result from ignoring or discreditinginitial improvement, disparaging the competence or method of thephysician, challenging the physician's diagnosis, failing to recognizeemotionalism and sentimentalism, and failing to exercise self-disci-pline (Low, 1971). The following excerpt from one of these readingsillustrates failure to exercise self-discipline: "The patient says he suf-fers from fatigue. The fact is, however, that he thinks his muscles areexhausted and fears or neglects to use them for the purposes of walkingor working. 'Fatigue' then thwarts proper muscular behavior" (Low,1971, p. 304).

Coding System

The coding unit is denned as a single, complete excerpt that is struc-turally apparent and meaningful. This coding unit occurs naturallyand contains a single message or lesson for the reader. Smaller codingunits (e.g., sentences or words) would have been artificial and meaning-less when presented to coders out of context.

Each excerpt was categorized separately on six dimensions: type ofproblems discussed, type of help given, problem versus growth focus,whether help was given in an authoritative versus nonauthoritativemanner, memorizability of excerpt, and whether reference was madeto some aspect of spirituality. The categories for each dimension wererationally generated. Specifically, type of problem and helping re-sponse categories were delineated on the basis of the content of thethree texts and the problem and helping categories commonly dis-cussed in the psychological literature. These general categories repre-sent the major domains that might reasonably be expected to be ad-dressed in psychiatric self- and mutual-help groups.

The problem categories include affective, behavioral, interpersonal,cognitive, sexual, general mental health or illness discussion, generalprofessional mental health system discussions, the program itself, andspirituality. These categories are supplemented by a list of rationallygenerated subcategories. For example, depression, anxiety, anger, guilt,mania, anhedonia, and unhappiness are some of the subcategorieslisted under the general category of affective problems. The helping-re-sponses categories include affective, interpersonal, cognitive, and be-

havioral strategies, as well as reassurance, recommendation of profes-sional help, and appeal to spiritual help or the group program.

A third dimension on which excerpts were categorized is whether aproblem or growth focus was taken. A problem focus is defined as adiscussion of a specific problem, whereas a growth focus is representedby a discussion of enhancement issues, for example, a reading on howto be a good friend. Authoritative versus nonauthoritative manner, thefourth coding task, is defined by the manner in which the help isoffered. An authoritative excerpt conveys the feeling of an expert talk-ing to a layperson. Nonauthoritative help, in contrast, conveys equalityor focuses on the issue.

The last two dimensions, amount of spiritual or religious referenceand memorizability of an excerpt, were dichotomously coded (yes, no).Examples of a spiritual reference were listed to help coders decidewhether the excerpt contained such a reference. Similarly, features ofan easy-to-remember excerpt were delineated. The procedures for do-ing each of the six coding tasks as well as the list of categories, subcate-gories, their definitions, and extensive examples, are described in thecoding manual.1

Coding Procedures

Coders. The coders were 10 undergraduates unfamiliar withGROW and Recovery literature. They were each assigned to one of twogroups (A and B); each group was trained to do three of the six codingtasks. Group A coded excerpts with respect to type of problem, prob-lem versus growth enhancement, and religious reference. Group Bcoded the excerpts according to helping response, authoritative versusnonauthoritative helping style, and memorizability of the excerpt. Therationale for training different coders to do specific tasks was to maxi-mize independence of ratings.

Training. After studying the manual, the coders met with LisaMcFadden to review the procedures and practice the coding tasks.Coders were then tested on the definitions of the categories. Once theydemonstrated familiarity and comprehension of the categories, thecoders categorized practice excerpts. Excerpts from earlier editions ofthe GROW and Recovery literature, as well as the literature of similargroups, were used as practice material. For each task, an excerpt wasplaced into one mutually exclusive category. Coders' individual catego-rizations were compared with the established criterion, and instruc-tive feedback was provided. The Kappa statistic, K, was used to deter-mine coder-criterion reliabilities (Cohen, 1960). During this trainingphase, all coders were required to reach K = .70 on each categorizationtask.

After demonstrating familiarity and reliability with the coding sys-tem, each coder categorized four sets of excerpts from the most recenteditions of the texts. These training excerpts were selected with a strati-fied sampling procedure. Each set comprised a mixture of GROW andRecovery excerpts. The purpose of this training phase was to ensurethat the system worked on the actual excerpts. Each excerpt was catego-rized by five coders on each of the six categorization tasks. To deter-mine reliability, each excerpt needed to be represented by only onecode for each task. A consensus categorization was established when atleast three of five coders agreed on the categorization of each excerpton a particular task. When agreement was not reached by three of thefive coders, the excerpt was considered uncodable for that particulartask and was excluded from analysis. To determine the reliability of theconsensus categorization, it was compared with Lisa McFadden's crite-rion judgment. Values of K ranged from .66 to 1.00, with a medianof .87.

Coding. Coders read and categorized the GROW and Recovery lit-

1 The coding manual is available from Lisa McFadden on request.

518 L. McFADDEN, E. SEIDMAN, AND J. RAPPAPORT

erature.2 Again, a consensus categorization was obtained for each ex-cerpt on each task. Almost all excerpts were codable for memorizabil-ity, spiritual reference, and authoritative versus nonauthoritative help-ing. Approximately one fifth of the excerpts for type of problem andhelping response were uncodable, but there was no significant differ-ence in the percentage uncodable by organization. Problem versusgrowth focus were codable for approximately 90% of the GROW ex-cerpts, whereas 100% of Recovery excerpts were codable.

The subsample of excerpts categorized immediately following train-ing were categorized again during the course of categorizing all of thematerial. A comparison of the two categorizations of the same ex-cerpts provides an index of coder drift. These test-retest reliabilities (p.range = .64 to 1.00, Mdn = .90) indicate that coders continued to reli-ably use the categorization scheme.

Results

For each of the six dimensions, the categorizations of GROWand Recovery excerpts were compared. This comparison wasaccomplished using the G-square statistic, G2, which is the log-linear equivalent of chi-square and is used with the analysis ofcategorical data (Feinberg, 1980). Like chi-square, G-squareprovides an overall index of the difference between two distri-butions and also orders the categories in terms of their contri-bution to an overall significant difference.

For the type of problems presented, the overall distributionof the GROW and Recovery literature, presented in Table 1,differed significantly, G2(8, N = 165) = 118.2, p < 01. Recoverydiffers dramatically from GROW with an almost exclusive em-phasis on affective problems, such as depression and anxiety,and secondarily on professional-client mental health issues,such as use of medication. In contrast, the types of problemsdiscussed in the GROW literature are more widely distributed,with high proportions being categorized as mental health/ill-ness, interpersonal, and spiritually oriented problems. Both or-ganizations have a similar and substantial emphasis on cogni-tive problems, such as psychotic thoughts, obsessions, and inde-cisiveness.

The distribution of helping responses between GROW andRecovery, presented in Table 2, also differed significantly, G2(8,N= 158)= 74.39,p<.01. Both organizations emphasize cogni-tive coping techniques, and Recovery does so almost to theexclusion of everything else, with some attention to behaviorchange. In addition to cognitive coping strategies, GROW wasdistinguished by a higher proportion of excerpts categorized asadvocating the use of the GROW program, spirituality, andinterpersonal sources of help. A substantial proportion of theGROW excerpts offered no specific help strategy.

The results for problem versus growth focus again show asignificant difference between the GROW and Recovery distri-butions, G2(2, N = 181) = 39.52, p < .01. The Recovery litera-ture is almost exclusively focused on presentations of problem-atic situations (98%). GROW distinguishes itself from Recoveryby having 25% of its excerpts focused on encouraging individ-uals to strive to their fullest potential, without reference to anyspecific problem.

With regard to authoritative versus nonauthoritative helpingstyle, the results indicate that in approximately half of the Re-covery excerpts, help was judged to be given in an authoritativemanner, whereas in over 96% of GROW excerpts, help was

Table 1Theme Categories (%) for GROW and Recovery, Inc., Literature

Themes GROW Recovery

AffectiveMental health/IllnessInterpersonalSpiritualityProfessional mental healthProgramBehavioralCognitiveSexual

9.624.321.716.5

1.74.33.5

16.51.7

60.02.04.00.0

14.00.00.0

20.00.0

Note. Categories are listed in order of their overall contribution to G2.

judged to be given in a nonauthoritative manner, G2(4, N =187) = 141.2, p < .01. A large proportion of the Recovery ex-cerpts judged to be authoritative were those in which Dr. Lowdirectly addresses the reader. Spirituality is an important di-mension of the GROW literature. Of the GROW excerpts,42.7% contained spiritual references, whereas no such refer-ences were made in the Recovery literature, G2(l, N = 203) =80.25, p<.01.

The results indicate that 23.2% of the GROW literature con-tains short, easily memorized excerpts that members canquickly call on to help them during difficult daily interactions.The Recovery literature does not contain such short excerptsbut is written in short-story form, G2(l, N= 203) = 35.22, p <.01.

Discussion

In the context of this study, GROW and Recovery representtwo examples of well-established nonprofessional helping orga-nizations for persons with a history of serious mental illness,often including psychiatric hospitalization. Both organizationsare well known for the availability of their peer-led groups. Ifnot informed, the professional community might assume thatthese two organizations are quite similar, given their commongoal of helping the same types of people. As observed by Levy(1984), and empirically confirmed in this study, even two seem-ingly similar groups may have very different emphases andgoals. These results illustrate that nonprofessional peer helpinggroups are not homogeneous entities. These two organizations,both focused on people with a history of serious emotionaldifficulties, were found to differ on all six dimensions of inter-est. Descriptively, the results indicate that Recovery, as repre-

2 GROW and Recovery excerpts were presented in sequential orderrather than randomly. Given this procedure, order effects could poten-tially explain the obtained differences. Coders may have unintention-ally used Recovery excerpts as a reference point to make categoriza-tions rather than using the criteria listed in the manual. To test thisalternative explanation, the subsample of excerpts rated immediatelyfollowing training, which were presented in a quasi-counterbalancedorder and thus not subject to order effects, were compared with theratings of the entire sample on each task. These comparisons revealedthat order effects did not influence categorizations of Recovery mate-rial (G2 ranged from . 13 to .90, all ns).

THEORIES OF SELF- AND MUTUAL HELP 519

Table 2Helping Response Categories (%) in GROWand Recovery, Inc., Literature

Helping responses GROW Recovery

SpiritualityProgramInterpersonal changeBehavior changeAffective changeCognitive changeProfessional helpReassuranceNo help given

12.010.29.33.72.8

40.00.00.0

21.3

0.00.00.0

12.06.0

78.00.00.04.0

Note. Categories are listed in order of their overall contribution to (72.

sented in its literature, focuses on helping people with affective-related problems through the use of cognitive-change tech-niques. The idea of a psychiatrist or mental health professionalas the expert is reinforced, and spirituality or religion is not apart of the program. These emphases are closely aligned withtraditional psychotherapeutic approaches in which problemsare conceptualized and a focused range of coping techniquesare prescribed by an expert. Given that Recovery was foundedby a psychiatrist, it is not surprising to find close alignmentwith traditional therapeutic approaches.

GROW in contrast, addresses a wider range of problems,including issues related to personal enhancement. Similarly, itadvocates a wide range of methods of coping, including appeal-ing to spirituality. The help given is delivered in an issue-fo-cused, nonauthoritarian manner rather than by appeal to theauthority of a professional as expert. GROW's grassroots his-tory perhaps explains its somewhat broader, less traditionaltherapeutic focus.

Recovery and GROW differ as nonprofessional help organi-zations, not only in terms of the specific themes describedabove but also in terms of their interpretations of the process ofhelp. Recovery appears to be a self-help program in the sense ofindividuals learning to practice what is prescribed to them bythe psychiatrist who founded the organization (a top-downmodel of self-help). Their literature has put professional helptechniques into layperson terms and a tightly structured pro-gram that can be "safely" used by nonprofessionals. GROW, incontrast, is a mutual-help program in the sense of people help-ing each other by sharing common experiences (Borkman,1990). Two examples illustrate these differences. First, GROWemphasizes the importance of friendship among its members,whereas Recovery strictly limits interpersonal interaction be-tween members to one 10-min telephone call each week. Therationale for limiting contact is that members need to adhere tothe program because informal contacts might lead to digres-sion from the structured program. Second, the Recovery groupmethod is very structured, and individual input into the groupprocess is limited. At meetings members carefully recite theRecovery literature. Although references are made to the litera-ture in GROW's problem-solving process, individuals are alsoencouraged to use their own experiences as sources of help.

Knowledge of these differences may be helpful to clinicians,

who are increasingly likely to be called on to advise both theirclients and the general public concerning contact with suchgroups. These results regarding the diverse goals and emphasesof the group cannot, however, provide a "cookbook" formula ofhow to enhance compatibility between client, group, and men-tal health professional. Rather, this information illustrates themore general point of a need to obtain information about suchnonprofessional organizations, at least in terms of types ofproblems addressed and the range of helping behaviors used,before making referrals. Concretely, the fact that Recovery em-phasizes affective-related problems and uses primarily cogni-tive-change techniques does not necessarily mean that all de-pressed people should be be referred to Recovery. Neither doesit imply that cognitively oriented clinicians should refer all theirclients who might benefit from self-help to this organization.Rather, the clinician would need to consider all the client'sneeds in terms of the information he or she has gathered regard-ing the appropriate organizations. For example, clients who re-quire more authoritative structure may be more appropriatelyreferred to Recovery. The needs of other clients, such as sociallyisolated individuals who need to build a supportive social net-work, may be better met by GROW Similarly, the GROW orga-nization may be more appropriate for people who feel comfort-able with a spiritual as opposed to more exclusively cognitiveorientation, whereas Recovery may make more sense for clientswho already have a supportive social network.

In addition, if the clinician is still working with the client, heor she might want to consider the compatibility of his or herown helping techniques with that of the group. Thus, thesefindings do not imply specific recommendations regarding re-ferrals as much as they highlight the need for mental healthprofessionals to become aware of nonprofessional group hetero-geneity. This study also illustrates some dimensions that profes-sionals might want to consider in evaluating groups (i.e., typesof problems addressed and types of help given). However, theremay be other dimensions that are personally relevant to individ-ual clinicians.

The heterogeneity in emphases and goals found in this studyis probably not limited to these two organizations. Rather thanblindly referring on the basis of the problem addressed by thenonprofessional group, or on the basis of general reputation,clinicians might want to make an effort to get to know localgroups. One effective way to do so would be to carefully readthe local groups' literature. Visiting these groups and talking totheir leaders and members can also be an invaluable source ofinformation. Given the likelihood of continued growth and useof such organizations, professionals may want to consider gath-ering such information to be a part of their continuing educa-tion. It may even be advisable to invite self- and mutual-helpgroup leaders to conduct workshops and information ex-changes with professional agencies and groups.

The results of this study also have implications for themembers of nonprofessional groups. Given their diversity, suchorganizations might be encouraged by local mental health asso-ciations to disseminate information about their own emphasesand goals to local clinicians, either by mailing out their litera-ture or by presenting their program at professional meetings.These organizations are typically not in the business of adver-tising; rather, their central purpose is reaching others in need of

520 L. McFADDEN, E. SEIDMAN, AND J. RAPPAPORT

their help. To this end, disseminating information about theirgroup would be helpful.

In summary, nonprofessional helping groups are not homoge-neous entities whose emphases can be readily understood sim-ply by noting the type of problem addressed. As seen in thisstudy, even organizations that help individuals who have a his-tory of previous hospitalization may have very different em-phases that should be taken into account by professionals whowish to make sensible use of the services oifered by suchgroups.

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Received December 6,1990Revision received May 11,1992

Accepted May 11,1992 •

Acknowledgment of Ad Hoc Reviewers, 1992

Albert A. AgrestiPhilip AshJanet W BordenM. Michele BurnetteJoan C. ChrislerKathleen ChwaliszLynn Huff CollinsSherilyn L. CormierChristine A. CourtoisRobyn M. DawesTimothy T. EatonMichael F. EnrightJoseph C. GeorgeGordon C. Nagayama HallDavid HammerBarbara S. HeldEdward J. HicklingPam HighlenRobert Hirschman

Sheilagh HodginsRobert R. HutzellRichard E. JensenSeth C. KalichmanKarl KuhnertSharon LambGary J. LautenschlagerSandra S. LeeIrene W LeighMargaretha S. LucasAl R. MahrerJoseph T. McCannStephen C. McConnellBenedict T. McWhirterEllen Hawley McWhirterLynette MenefeeJoanne NicholsonLois B. OberlanderAkira Otani

Vicky PharesDon Pope-DavisAvie J. Rainwater, HILouise RiscallaEsther RothblumMary F. RuzickaDaniel SandersLawrence SchneiderLynn SingerDan SombergHoward Carlton StevensonGarnett S. StokesTimothy C. ThomasonDerek TruscottGeorgiana Shick TryonLeon D. VandeCreekC. Edward Watkins, Jr.Martha M. WoodsLuis H. Zayas