Sot. Sci. Med. Vol. 29, No. 2, pp. 263-264, 1989 Pergamon Press pk. Printed in Great Britain

Self-Help Organizations & Profesaiond Practice, by THOMAS J. POWELL. National Association of Social Workers, Maryland, U.S.A.

The rapid expansion of self-help group approaches to coping with problems has resulted in increasingly common situations where self-help and professional forms of helping parallel each other. Thomas Powell’s Self-Help Organiz- urions and Professional Pracrice provides a carefully devel- oped introduction and overview of the present state of knowledge in the United States on the interface of these two approaches to caring. A major strength of Powell’s work is his exploration of the complementary aspects of self-help and professional care while still recognizing the differences, disagreements and conflicts that sometimes have character- ized their interaction. A discussion of social science theories and concepts that help to explain the explosive growth of self-help groups and a useful typology of self-help organiz- ations add meaningful dimensions to provide a timely contribution to the self-help literature.

The book is broken down into five parts. The first part consists of two introductory chapters providing an overview of the significance of the self-help model of care, issues in the interface of self-help and professional care, and empiri- cal findings from evaluation studies of the effectiveness of self-help groups.

In the discussion of definitional issues, Powell points to serious misconceptions regarding self-help organizations which at times appear to be purposefully perpetuated. Self-help is not a solitary ‘pulling up’, but rather a growth and strengthening process involving social interactions and the mobilization of community resources. Secondly, sup- porting self-help groups and organizations does not mean being against professional services. In fact, the opposite may be the case. Self-help organizations appear to stimulate the growth of professional programs. Finally, self-help organiz- ations do not consider personal deficiencies as the root causes of human problems. They often work simultaneously on individual help and social change. Self-help groups are differentiated from other forms of lay care. For example, it is pointed out that self-care is self-help only when it involves other people in the mutual exchange of care. (Focusing on self-care, the statement would read that self-help is self-care only when giving and receiving help is directed toward the improvement of the health, insight or functioning of the individual coping with a specific problem.)

The results of evaluation studies of self-help groups are generally positive. It appears that beneficial effects are especially strong with active participation involving out- reach activities. Process studies have generated information about the basic social and psychological dynamics operating in the functioning of self-help groups. Methodological issues relevant for the design of future studies are identified.

Part two of the book is especially useful for researchers in that social science theories which help to explain the self- help phenomena are outlined. These theoretical frameworks can facilitate the systematic refinement and elaboration of empirical research on self-help groups. Organizational theory provides a framework for understanding the inter- play in self-help organizations between stability and change which can be useful when assuming new roles and functions in changing a lifestyle. The theory of reference groups shows how individuals come to adapt a new culture based on a perceived similarity with a group’s values and goals. Social network theory illustrates how expanded resources and

BOOK REVIEW

opportunities for effective coping become available through new mutually supportive relationships. Finally, social leam- ing theory provides a model for understanding how new behaviors and alterations in cognition are acquired and reinforce each other. The theoretical perspectives provide not only models for analyzing the beneficial effects of self- help group processes, but also for identifying the potential disfunctions of self-help organizations.

Professional services, informal helping systems and self- help organizations are differentiated as forms of helping in part three of the book. The basic properties of the three systems of providing care are described along with a discussion of how dominant values differ in each system.

The typology of self-help organizations developed in part four is particularly useful for practitioners and for policy/ program development. The classification is built on the purpose of the group, the people served and the problem- solving approach. Based on these criteria, five types of self-help organizations are described. Habit disrurbunce organizations are directed toward compulsive behavioral problems, e.g. compulsive use of alcohol and tobacco or other drugs, food, gambling, etc. General purpose orguniz- orions focus more on methods rather than goals in that members generally are working on a range of specific problems. L.i$esr$e orgunizarions are concerned with sub- groups of the population such as old people, single parents, gays, individuals who have been adopted, people of unusual size or any other group subject to injustice or isolation because of some departure from dominant norms. They provide both supportive social interaction and campaigns against injustice. Significanr other organizations function for parents, spouses, or other persons close to or responsible for people who suffer a primary burden, such as spouses or children of alcoholics, compulsive gamblers, etc. The fifth type, physical handicap organizarions, represent nearly every major chronic disease or condition.

The five types of self-help organizations are compared along the dimensions of: goals, technology of helping, career pattern, normalization potential, public image and relation- ship to professionals. The discussion of ‘technology’ or dominant problem solving approach focuses on the theories outlined in part two assessing the extent to which particular types of self-help organizations may adhere more closely to one than the others, thus tying together analytic frameworks with comparative descriptions of different forms of self-help groups.

The final part of the book concentrates entirely on relationships between professionals and self-help organiz- ations. Differences and disagreements are explained along with the range of closeness or distance in collaboration with professionals of the five different types of self-help groups. The potential of positive collaboration for enhancing the effectiveness of caring systems is a unifying theme.

While this book provides an overview of aspects of the self-help phenomena which is relevant for all persons inter- ested in the subject, its specific focus on developments in the United States sets some limits to its usefulness for profes- sionals and practitioners in Europe where developments related to self-help groups have taken different directions. For example, the type of lobbying described with regard to major self-help organizations in the U.S.A. is negligible in Europe. Additionally, the book is largely based on northern America literature, including only limited European refer- ences. Still, these differences do not distract from the basic relevance and usefulness of the discussions concerned with the interface of the professional and self-help models of

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caring, the theoretical frameworks and the typology of to the academic literature would be helpful. espectally more self-help groups. pragmatic discussion rn the last chapter about how self-help

Some researchers may prefer more analytic discussion of groups and professionals can collaborate. Generally. how- relevant research in the four theoretical areas. Some prac- ever. the book provides a valuable overview of the field for titioners may prefer less attention to these subjects. All all its various actors, readers probably would prefer less repetition on some points. Finally, more focus on practical experience relative KATHRYN DEAF: