Continue assessing your progress
Step 2 gets you started measuring and plotting the effects of your self-help efforts. This step suggests you keep up the record keeping, so you can decide if you are making satisfactory progress, and determine what is causing the changes. It is easy to neglect the daily recording of your progress; it is routine and unexciting; it might even be discouraging. Try to sustain the record keeping by building it into your daily routine or as part of a diary, or perhaps doing it before dinner or at bedtime, and rewarding it. Measurement is not absolutely necessary but it is helpful. It is absolutely necessary if you want to truly do objective research.
Deciding if you are making progress
It may not be clear if your self-help efforts are working or not. First of all, it may take some time to start getting results. Don't give up too soon. Secondly, there may be some initial changes--getting better or getting worse--that are temporary. Don't draw hasty conclusions, these early changes may not last. Third, the change may be so gradual or the results so spotty that it is hard to tell if you are making progress, unless you measure. Don't rely entirely on your subjective judgment; too often feeling successful is wishful thinking (Sorrentino & Higgins, 1986).
Compare the results of your self-help efforts, if you have plotted your progress on a graph, with the level you were at prior to starting the project (called "baseline" data). If on 6 days out of 7 during a typical week of self-helping, you are doing better than you did before, you are probably (9 chances out of 10) making significant progress. Pat yourself on the back. That's a crude method but it's ordinarily good enough; see a statistics book for more sophisticated methods. Lastly, some periodic review of each project may be necessary forever to be sure you are maintaining your gains. For instance, over-eating tends to recur, so dieting may be a lifetime endeavor. Check your weight every week, and adjust your eating habits immediately if you gain a pound or two. Waiting until the habit is out of control and you have gained 5 pounds is a major problem.
Encourage others to check on your progress
Research is showing that "phone therapy," i.e. calling and checking on someone's self-help progress, is beneficial. Calls have proven helpful to people stopping smoking, wanting to exercise more, needing to take medication as prescribed, etc. It is a matter of emphasizing the importance of your treatment plan and your changing; it is a prompt or reminder to carry out a new behavior; it is a way of saying "I care about you."
Deciding what is causing the progress
A good self-helper learns what methods work for him or her. The fact that you are successful the first time you try a particular method does not prove the effectiveness of that method. The truth is that the change may have occurred because you expected to get better, because of some other event (e.g. talking to a friend), because the problem was going away anyway, or because of many other reasons. However, if a particular self-help method repeatedly and consistently works for you, then it becomes increasingly convincing that the method you are using, not some other event, is the cause of the improvement. You might even want to stop your self-help efforts (especially when changing behaviors and emotions) occasionally to see if the improvement stops also. Even after "proving" a method works for you, you still don't know if it is the most effective method available. You must try out other ways.
Becoming your-own-researcher requires an inquiring, questioning attitude, and a logical, systematic approach to discovering what methods produce what results. If you faithfully record your daily self-help efforts as well as the results in terms of how well you are feeling/doing, there are amazingly rich and complex insights to be gained from your data. Some excellent examples of the "daily process approach" can be seen in recent studies (Tennen et al, 2000). For instance, these researchers confirmed that the drinking of problem drinkers could be predicted by their nervousness earlier that evening; thus, confirming the "self-medication hypothesis." However, the findings got complicated if they looked at more factors: moderate and heavy drinkers drink less on stressful days if they had used active coping strategies ("I did something to try to change the situation"). They drank more on stressful days in which they had used emotion-focused strategies ("I let my feelings out today"). For most people in this group, however, avoidant coping ("I tried to pay attention to other things") during the day was not related to how much they consumed. These conclusions can only be drawn if each application of the self-help method(s) and the consequences are recorded.
In another study, Tennen and his colleagues divided patients suffering pain (fibromyalgia) into three groups: recently depressed, not depressed but depressed years ago, and never depressed. They found a history of depression was associated with more pain, more attention to the pain, more catastrophizing about the pain, and more refraining from social, work, and personal activities when in pain. This seems to confirm the "scar hypothesis"--that depression leaves scars that interfere with coping. Interestingly, these researchers came to believe that people often develop explanations of how-to-cope that just don't fit with the actual observations of what worked. That's a good arguement for recording data and carefully analyzing it.
In a third study, the same researchers tested and confirmed the "fallback hypothesis," namely, that emotion-oriented self-help methods (venting of feelings) are less likely to be used unless action-oriented strategies (trying to change things) are also being used. Only by recording both self-change actions and the outcome of those strategies can we truly understand self-help. Good research involves thinking in a sensible and careful ways, careful and frequent observations, and the use of statistics to help us (as well as researchers) draw valid conclusions. The end product--useful knowledge--is vitally important. You can do research.
STEP 8:REVISE THE TREATMENT PLAN AS NEEDED; DEAL
WITH RESISTANCE; FIND A THERAPIST
If your self-help project doesn't produce the desired results in a reasonable length of time, figure out what is wrong. Perhaps the method needs to be used in a different way, e.g. a behavioral contract may be demanding too rapid change, if so, reward changes in smaller, easier steps. Or, perhaps another method would work better, there are several to choose from in the same or different parts of the problem. Or, perhaps you have lost your motivation or the "faith" you need in yourself to change. Or, perhaps you are resisting change, there may be subtle pay offs for your unwanted behavior or emotions. Several chapters discuss the excuses we often give ourselves for not changing.
Seek professional help
If you are still unsuccessful after a couple of revisions of your treatment plan, seek help from a friend, teacher, school counselor, or mental health professional. Clinical and Counseling Ph.D. Psychologists are the best trained; Counselors, School Psychologists, and Social Workers with a M.A. are adequately trained and could probably be helpful with self-help; some ministers are trained as counselors but many are not; the family doctor is ordinarily not any more familiar with self-help than you are. Do not be embarrassed that your self-help has, thus far, failed. Instead, be proud of making an effort, including consulting with them for help with changing.
Why don't we seek help? About 20% of teenagers appear to have problems, but few seek professional help. Kuhl, Jarkon-Horlick & Morrissey (1997) found several barriers: many teens believe that their parents and friends are sufficient help; "Oh, I can handle it" or "it will work out OK" are other thoughts that block seeking help; also "I don't have time," "I don't want others to know," "people will think I'm crazy," "it will cost too much," and "the doctor will tell my parents and my school" are barriers to getting the help they need. Usually health insurance will cover the costs. The therapist will explain to you the confidentiality guaranteed by law.
How to Find a Therapist
How to find psychological help depends on many things: the nature and severity of your problem, where you live, how many and what kind of therapists are nearby, whether you are covered by insurance or not, who is recommended by your Primary Care Doctor, Insurance Co. or HMO, your financial situation, your past experience with therapists, etc. A detailed discussion about the nature of therapy and how to select a therapist is given by Dr. Bennett Pologe at aboutpsychotherapy. A very different view of "How to Choose a Competent Counselor" is given by Martha Ainsworth at Metanoia. It would be good to read both. There is also a book that gives advice about selecting the right therapist for you (Finney, 1995).
(Note: I apologize for my focus being on finding a therapist in the US. If any of you will send me information about how-to-find a therapist in other countries, I will include it here.)
As a general rule, if your psychological treatment will be paid for by insurance or if money is no problem, go see an experienced, highly recommended therapist in private practice. These therapists, usually Ph.D. clinical psychologists or very experienced registered Social Workers, are commonly listed in the Yellow Pages, but so are counselors with questionable qualifications. Thus, it is important to get recommendations from people who know the available practitioners--a School Counselor or Psychologist, a therapist at your Community Mental Health Center, an EAP counselor at work, or the psychiatrist who is prescribing your psych medications. These people's recommendations are more likely to be on target if they know a little about the nature of your problems. Sometimes, Primary Care Physicians, Ministers, and friends or relatives who have been in therapy know something about local therapists but often they do not. (A therapist who is seeing or has seen a relative or a close friend is usually not a good choice for you.)
If you are "on your own" looking for a therapist in private practice, there are a couple of ways to go. One is to use the National Register of Psychologists, which does a good job of checking each practitioner's credentials. The site is searchable so you can find psychologists by state and by types of problems treated. Another approach is to find the Psychological Association Web site in your state using a search engine or by going to the New York Psychological Association site, which has links to most other states. Many states provide a phone number to call for a free referral service based on the problem and the specialization of the therapist (all licensed).
There are many places on the Internet where you can get psychotherapy entirely online. I have three personal opinions about that: (1) if I had a choice of seeing a therapist face to face vs. writing to him/her by email or in a chat room, I believe I'd benefit more from the face to face experience, (2) while there are excellent therapists available both face to face and online, it would by my guess that there is a higher percentage of inexperienced, poorly trained, and unqualified practitioners online than in offices, and (3) since most HMOs and Insurance Companies do not, yet, pay for online professional services, the expense to you is likely to be higher than your co-pay for face to face therapy covered by insurance. Yet, for some people there are important advantages to having their therapist online. Here are a few fairly large sites which seem to select their therapists pretty carefully: HelpHorizons.com, here2listen.com, Metanoia (this offers a free checking of credentials and a listing of online providers), Online Clinics.com, and others. Be aware that there are hundreds of therapists who have their own Web site and offer therapy and advice--find them through your search engine and check their credentials yourself.
There are also a few Web sites that simply help you find a therapist (of course, the therapist usually pays for this locating service): 1-800-THERAPIST (this site provides personal assistance in matching you with a therapist and also offers some good advice about how to handle a person who is reluctant to seek therapy), Who's Who in Mental Health, Mental Health Net (under Services, click Find a Therapist or Find an online Therapist), Find-a-Psychologist.com, Find-a-Therapist, 4therapy.com, and others. After finding a therapist, you usually work out arrangements for treatment directly with the therapist.
If you don't have insurance/HMO coverage or other means of fully paying for therapy, your best bet is likely to be your Community Mental Health Center. Their charges will usually be based on your ability to pay. Get their number from the phone book. You can also find the location and phone number of your MH Center by going to The Substance Abuse and Mental Health Services Administration site. Then click on "Looking for Help," and you will get to a Directory of Service Providers and to Referral Help lines (try that). Then click on CMHS Mental Health Directory or on Mental Health Consumer Resources where you will find KEN's state by state listing. Eventually, you will get to your state and your local MH Center. In general, you will find over-worked MA-level practitioners--Social Workers and Psychologists--in state funded Mental Health Centers. Most of these helpers know what they are doing, however, so don't be bothered that they are not "doctors."
If you live near a major university or hospital with a large psychiatric service, there will be psychotherapists-in-training. They are usually well supervised, so as a patient you get the benefit of two therapists. And the cost is minimal. Likewise, in a very large metropolitan area, like New York City, Chicago, Boston, Atlanta, LA, San Francisco and so on, there are many specialized treatment centers, e.g. for phobias, Obsessive-Compulsive Disorders, Borderline Personality, Bipolar, addictions, headaches, etc., which always have interns and residents who need patients. Likewise, there are advanced training institutes, such as Psychoanalysis, Adler, Gestalt, and many others. Ask any of these institutions for a low-cost but competent therapist specializing in your kind of problem.
It is a good idea to carefully investigate your therapist before or immediately after starting to see him/her. The degrees and state licenses should ordinarily be hanging on the wall. If they aren't on the wall, ask where and when the therapist graduated and got licensed. Be sure to get his/her complete name and perhaps even the license number, then you can call the state licensing office and confirm their license (note that my biography on the title page of this book makes it easy to confirm my credentials). Ask how much experience they have had treating people with your problem. If they are in training or just starting practice, ask how much supervision or consultation they will be getting as you work together. If anything seems amiss or out of line, bring it up for discussion with them (don't pussyfoot around, YOU are the boss here; your therapist works for you). If you remain doubtful about the therapist's experience, training, or ability to help you, seek another professional's advice or just try another therapist. Select your therapist carefully, just like you would a heart surgeon.
How do you know therapy is going well? Hard question. First, sometimes it is obvious from the start that the chemistry just isn't good. Try someone else. Sometimes, it takes a while to know how well things are going to click. Good working relationships are a function of both personalities, the skills, warmth, and techniques of the therapist, the degree these two people just plain need and like each other, the amount of trust and openness the patient can develop in this situation, and so on. If the relationship lacks trust and warmth or if the patient has little faith in being helped after 3 or 4 hours, it would be wise to discuss these things bluntly so that either improvements can be made or the patient referred to another therapist. If problems do not arise until after 6 to 8 sessions or more, a concerted effort should be made to resolve the barriers--too much has been invested at that point to just walk away without trying to fix it. Like marriage, this relationship occasionally needs to be fixed. Oh, by the way, therapy sometimes gets to the point where it just continues on and on without many changes occurring. They may have become comfortable or dependent on each other; the patient may simply believe she/he "should" be in therapy. When progress stops...when all the benefits have been gained...therapy should stop.
Time is a good healer
It is not uncommon for interest in changing to wane after a few weeks. You may discover that the change you wanted doesn't seem important any longer, that the benefits are not worth the trouble, or that the new you isn't exactly what you expected. So, certain self-help projects may just fade away. This is fine so long as you can honestly assure yourself that you aren't running away from an important, upsetting problem.
Sometimes it is best to simply leave the problem alone for awhile, if the problem is tolerable. Most problems improve with time. Indeed, some problems seem to get stronger as you struggle in vain to get rid of them; then, without attention, the problem may gradually disappear. Consider putting the persistent but mild problem completely aside for six months, then re-think the problem and what to do about it. In the meantime, work on other improvements.
STEP 9:TRY TO INSURE THAT THE DESIRED BEHAVIOR
This is a small step, but it requires some conscious effort to insure that the newly gained behavior is occasionally rewarded, preferably in some naturally occurring way. Examples: the reluctant student who needs to reward himself for studying will, hopefully, soon receive intrinsic satisfaction from studying itself, such as intellectual stimulation, new interesting conversations, pride in his/her classroom and test performance, etc. Or, the person, who might at first be so uncomfortable socializing that rewards, like a good book or a night of TV, are necessary to overcome the shyness, should eventually find socializing sufficiently satisfying to maintain itself.
Step 7 mentions the importance of occasionally checking for backsliding. Like "phone therapy," another approach is to team up with a buddy who faithfully checks on your progress, is tolerant of backsliding, but urges you to re-attack the problem if it gains ground on you. Losing some valued characteristic you have gained through hard self-help efforts should be a loud warning signal. It tells you to immediately plug the dike. Mend the damage soon or face a major repair job. Chapter 4 discusses relapse prevention in detail; you have to guard against the return of bad habits. Support from others is important when we start to weaken. Keeping our failures to ourselves reduces our motivation.
Maintaining your gains or regaining them involve the same kind self-help methods that enabled you to make the gains in the first place. So, this book should be useful here too. Also, a book by Todd Davison (1998), a psychoanalyst who believes that back-sliding after therapy is inevitable unless one continues self-analysis, could be useful in this maintenance step. He emphasizes the use of meditation, journaling, and the importance of forgiveness.
Don't forget to celebrate your continued success (sometimes success is just holding your own).
STEP 10:LEARN FROM EACH SELF-HELP EXPERIMENT; USE
It is hoped that you will keep this book handy, using it frequently for ideas concerning your problem-of-the-moment. With the passage of time, as the result of your self-experimentation--trying out and evaluating self-help methods--you will acquire a great deal of unique knowledge about yourself and self-improvement methods. Make notes about your preferred methods, what problems were changed successfully, what methods failed, the techniques that were the most fun, what parts of your problems seem to be the most troublesome, what works with your spouse, the children, the boss, a colleague, etc. A diary emphasizing "growth experiences" could be both helpful and a treasure in later years.
As you gain confidence in self-help, you will depend less on advice from friends, experts, and books, like this one, and become more self-reliant. You will find yourself saying, "I needed help before, but now I can do it myself" (Janis, 1983). That's great (as long as it is true).
Share your experiences and ideas with others. Find satisfaction in helping others help themselves and in working together for your mutual benefit. One of the most therapeutic things we can do is help someone else.
The art of helping oneself, although as old as the human race, is just beginning to be guided by scientific studies. It will take thousands of researchers and tens of thousands of studies to find the better approaches for specific problems, and there will continue to be individual differences so that certain methods work better for some than for others. As science makes its slow progress and shares its findings, you will learn from those sources but remain your own expert and main source of help, a self-helper relying on yourself as a researcher and as the best storehouse of knowledge about yourself. That is a big order. Hopefully, this book, plus the personal knowledge you can add to the book, will combine together with a little help from your friends to produce a different and better life for you. Good luck.
Wouldn't it be wonderful if we lived in a world without unfair limitations, so everyone had an equal opportunity to make the best possible life for themselves? For that to happen, society and families would have to change. School and work would have to change. And, each of us would have to learn how to produce changes in ourselves when the opportunities were in front of us. All these changes take knowledge and work. You can start anytime, though; you always have yourself to work on.
After reviewing this chapter, you are ready to go to any "understanding the problem" chapter.
References cited in this chapter are listed in the Bibliography (see link on the book title page). Please note that references are on pages according to the first letter of the senior author's last name (see alphabetical links at the bottom of the main Bibliography page).