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The development of an instrument to survey experiences with and attitudes toward self-help groups

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Title:
The development of an instrument to survey experiences with and attitudes toward self-help groups
Creator:
McRee, R. Lynn, 1950-
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English
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vii, 125 leaves : ; 28 cm.

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Subjects / Keywords:
Consulting services ( jstor )
Group development ( jstor )
Medical personnel ( jstor )
Mental health ( jstor )
Mutual aid ( jstor )
Professional associations ( jstor )
Professional development ( jstor )
Professional services ( jstor )
Psychology ( jstor )
Standard deviation ( jstor )
Counselor Education thesis Ph.D
Dissertations, Academic -- Counselor Education -- UF
Mental health personnel -- Attitudes ( lcsh )
Psychometrics ( lcsh )
Self-help groups -- United States ( lcsh )
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bibliography ( marcgt )
non-fiction ( marcgt )

Notes

Thesis:
Thesis (Ph. D.)--University of Florida, 1989.
Bibliography:
Includes bibliographical references (leaves 116-124)
General Note:
Typescript.
General Note:
Vita.
Statement of Responsibility:
by R. Lynn McRee.

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University of Florida
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University of Florida
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Copyright R. Lynn McRee. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Resource Identifier:
030543163 ( ALEPH )
21268338 ( OCLC )

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THE DEVELOPMENT OF AN INSTRUMENT TO SURVEY
EXPERIENCES WITH AND ATTITUDES TOWARD SELF-HELP GROUPS BY

R. LYNN MCREE



























A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN PARTIAL
FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY

UNIVERSITY OF FLORIDA 1989















ACKNOWLEDGMENTS



I would like to thank several people to whom I am indebted for helping to make this project a reality.

First, I would like to thank my chairman, Dr. Rod McDavis, for his continued encouragement and assistance throughout a process, which lasted much longer than either of us anticipated.

Next, I would like to thank my committee members, Dr. Ellen Amatea and Dr. Bob Ziller, for their suggestions and support.

I would also like to thank my friends for their lasting belief in me, their humor, kindness, and love which helped me to persist.

I would also like to thank my in-laws, Norman and Renee Krim, for buying us a computer which made it all so much easier.

Special thanks are extended to the professionals who

served on the panel of experts and the members of AMHCA who responded to a stranger's request so diligently. Without them this study would have been impossible.

Finally, special appreciation goes to my family. I would like to thank my husband, Allan Krim, for his patience, his ii







ready willingness to assist in any way he could, his typing, and his computer skills. His love, faith, and encouragement made it possible to keep going. And thanks go to my daughters, Jessa and Leah, who inspired me to practice what I intend to preach by finishing what I had begun.










































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TABLE OF CONTENTS

Dage

ACKNOWLEDGMENTS........................................... ii

ABSTRACT ........................................................... vi

CHAPTERS

1 INTRODUCTION......................... ............. 1

Statement of the Problem .......................... 8
Need for the Study ................................ 10
Purpose of the Study................................ 13
Significance of the Study ........................ 13
Definition of Terms ............................... 16
Organization of the Study ......................... 18

2 REVIEW OF RELATED LITERATURE...................... 19

Self-Help Movement ................................ 19
Competing Explanations of Self-Help Group
Development ..................................... 26
The Power Struggle Between Self-Help and
Professionals................................... 31
Professional Collaboration with Self-Help
Groups..................................................... 38
Self-Help and Research............................ 47
Summary ................................................................ 50

3 METHODOLOGY....................................... 53

Research Questions................................. 53
Theoretical Basis ................................. 54
Item Development.................................. 55
Pilot Study ....................................... 61
Panel of Experts Item Response .................... 65
Field Test......................................... 69
Limitations of the Study......................... 71







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4 RESULTS AND DISCUSSION..........................** 73

Results of the Study ............................. 73
Sample............................................ 73
Item Analyses..........................................76
Content Validity.................................. 84
Construct Validity............................... 85
Reliability ....................................... 93
Discussion of the Results ......................... 96
Content Validity ............................... 96
Construct Validity................................ 100
Internal Reliability ........................... 101

5 CONCLUSIONS, IMPLICATIONS, SUMMARY,
AND RECOMMENDATIONS ............................ 102

Conclusions....................................... 102
Implications ...................................... 102
Summary.............................................. 105
Recommendations................................... 106

APPENDICES

A MEMBERS OF THE PANEL OF EXPERTS................... 108

B SAESHG .............................................. 110

REFERENCES.............................................. 116

BIOGRAPHICAL SKETCH..................................... 125


























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Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy



THE DEVELOPMENT OF AN INSTRUMENT TO SURVEY
EXPERIENCES WITH AND ATTITUDES TOWARD SELF-HELP GROUPS BY

R. Lynn McRee

August, 1989


Chairman: Dr. Roderick McDavis Major Department: Counselor Education

The purpose of this study was to develop an instrument, The Survey of Attitudes toward and Experiences with SelfHelp Groups (SAESHG), and to answer three research questions regarding the instrument's content validity, factor structure, and reliability.

Section I of the SAESHG was a survey of experiential

knowledge and Section II, a survey of theoretical knowledge of self-help groups. Item development was based on extensive review of the literature on self-help groups. The items were subsequently evaluated by a panel of experts possessing both experiential and theoretical knowledge of self-help groups.

One thousand members of the American Mental Health Counselors Association (AMHCA) were surveyed, and 410 vi













returned completed instruments. Three hundred and fifty one surveys with at least 50 of 53 items completed were used for the analyses. Item responses were factor analyzed and four factors were found. Generally supported from the analyses were the construct areas of purposes/activities, characteristics, and relationship to other helpers. Alpha coefficients for the four factors were .91, .64, .66, and .56 respectively. Additional refinement of the SAESHG was suggested and various studies recommended to further validate the instrument.




























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CHAPTER 1


INTRODUCTION


Therapy is an essentially human activity
which has been preempted and monopolized by
a therapy elite and sold as a commodity on
the open market (Glenn & Kunnes, 1973, p.8).




Self-help groups trace their origins to early man.

Associations in the Mesolithic period, first formed for the purposes of hunting and gathering, evolved during the Neolithic Period into agricultural villages. These associations, based upon shared ties and common interests, reached their crest in the modern urban-industrial period. Over the past two decades, a growing consumerism has lead people to take greater responsibility for their own needs. This initiative has been associated with the proliferation of mutual help groups and organizations (Silverman, 1986). Found in all parts of the world, mutual aid associations or mutual help groups, now referred to as self-help groups, have played a continuous role in social and cultural change and in the evolution of society (Anderson, 1971).

Currently, there are over 500,000 self-help groups

(Katz, 1981). These groups, with a combined membership of

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15 million people, range in size from Alcoholics Anonymous (A.A.) which has 750,000 members in over 40 countries, to local neighborhood groups which may have less than ten members. The concept of mutual aid is not limited to one culture or type of political environment. Self-help groups range from organizations of welfare mothers in Australia to hypertension clubs in Yugoslavia, to relatives of mental patients in Austria, and to consciousness raising among children in England (Katz & Bender, 1976b).

Many views concerning self-help groups have been stated in the literature. Authors consider it a social movement (Katz & Bender, 1976b; Sidel & Sidel, 1976; Toch 1965; Vattano, 1972), a spiritual movement or secular religion (Hurvitz, 1974; Mowrer & Vattano, 1976; Newmark and Newmark, 1976), a support system (Killilea, 1976), a phenomenon of the service society, (Gartner & Reissman, 1974), a subculture, or an agency of social control and resocialization. Prominent among these orientations is the view that selfhelp groups are part of the service society, particularly in the area of mental health services (President's Commission on Mental Health, 1978). Authors L'Abate and Thaxton (1981) typed self-help groups into three categories: physical, emotional, and social. Examples in these categories include the Endometriosis Association for the physical type,









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Alcoholics Anonymous for the emotional type, and Parents Without Partners for the social type.

The rise and fall of mutual aid or self-help groups is closely linked to economic and social conditions as can be seen by tracing the history of these organizations. In some form, they have continued from earliest times to the present and will, no doubt, persist as long as the imperfections of social living and social institutions endure (Katz, 1981).

Social and economic conditions have also affected the development of therapy. Therapy in the United States began in the early 19th century with physicians treating emotional problems as stemming from abnormalities in the brain and/or nervous system, or as evil "humors" circulating in the body. Some kind of curse or bad living also was considered to be a likely cause of emotional disorders. Treatment consisted mainly of containment in the familial home or imprisonment.

In the early 1800s, so-called mental patients began to be seen as human beings with something wrong with their bodies that was causing problems with their heads. This organic approach to mental illness became a new area of study. In Europe, where the asylums were overcrowded, patients were released and treated with various techniques.









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Physicians, as heads of asylums, set up diagnostic systems to govern the detainment and release of the interred masses.

In the United States, the asylum system was largely for the well-to-do. Such places had large staffs and few patients. Therapy techniques included hydrotherapy, simple talks, walks, work, fear, whirlabouts in a chair, showers, and so on. The cure rate was actually fairly good. Those unable to afford the asylums turned to clergy, family, friends, quacks, and faith healers. Following the Civil War, with the influx of immigrants who could speak little English and who were culturally different, and large numbers of poor, ill-educated people pouring into the cities, the asylums became storage bins for the socially undesirable as well as the "insane." Cure rates dropped, and treatment was mainly custodial care until psychiatry emerged.

Psychiatry became a medical specialty as an off-shoot

of neurology. By the turn of the 20th century, it had given birth to psychoanalysis with its theory of inner conflict and the associated psychodynamic approach. According to Glenn and Kunnes (1973), Freud and his colleagues strongly influenced American psychiatry which was at the top of the therapy hierarchy. Freud's theories and techniques, however, were based on the treatment of rather disturbed but somewhat functional white middle-class cases, not the psychotic, interred mixed masses. Freud's theories split









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psychiatry into two camps, the proponents of intrapsychic conflict and the more medically minded psychology of the older physical/organic school. In either case, therapy was still firmly in the hands of the medical professions (Glenn & Kunnes, 1973).

As the 20th century progressed, people other than

physicians entered the therapy profession. Soon after World War II, therapy suddenly came of age. From the viewpoint of Glenn and Kunnes (1973), psychiatrists and psychologists were hired to sell bourgeois psychology to everyone, and the government suddenly discovered the value of the idea of "mental illness." Therapy was a'comment on all', a cureall. Social workers, clinical psychologists, hospital personnel, and others claimed their own special expertise all their own. Therapists became consultants to every sector of American life. Psychologists began to develop their own "clinical" talents, and social workers did the same. In fact, each group of ancillary personnel began to develop its own ideology, its own professional history, and its own "expertise" (Glenn & Kunnes, 1973).

After 1963, newly created mental health centers, with their expanded programs featured a proliferation of jobs for therapists. Therapy became big business. For some time, it seemed that therapists, or helping professionals, could afford to simply ignore the self-help movement. A









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committee report on "Humanizing Health Care" contained a section on self-help and medical self-care outlining the nature of these activities, addressing policy implications, and suggesting needed directions for research. It was the first time that a professional organization of social scientists recognized the importance of self-help organizations both as a form of social institution and as a useful field of study (Humanizing health care, 1977).

Since the early 1970s, when helping professionals began to recognize and write about the self-help movement, several changes have occurred in the relationship between the helping professional and self-help groups. Professionals' reactions, which initially ranged from hostile to ambivalent, now seem to be more accepting, with a trend toward "symbiotic cohabitation" (Riordan & Beggs, 1987). A survey of helping professionals attitudes toward and experiences with self-help groups would provide information to substantiate or refute this suggestion of symbiotic cohabitation. The survey could also provide information as to the autonomy of the self-help movement from the professional sector. This could be gauged by assessing professionals relative involvement with self-help groups. Finally, results of the study might provide information as to the degree of acceptance by helping professionals of self-help groups as an alternative treatment method.









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If the fate of the paraprofessional movement in the human services was any indication, the attitudes of the professional community will have a great deal of influence on the self-help movement. The role of the paraprofessional was developed in the 1960s to capitalize on "natural helpers" or those people in the community who seemed to be able to very effectively establish helping relationships with their neighbors. They were hired by various agencies to do their helping under the auspices of the agency (Pearl & Riessman, 1965). Gradually, they came to be supervised by agency workers, and their work was regularized by agency rules and professional practice. Formally or informally, they were pressured to improve their education and become more professional. Their unique helping qualities became less and less valued by the agencies and by themselves. They have long since been absorbed into agencies, adopting the values and working within the organizational constraints of those agencies (Silverman, 1986). This tendency to coopt may be affected by the positive or negative attitudes and experiences that professionals have toward self-help groups. The type of attitudes that professionals have toward selfhelp groups will play a decisive role in the nature and extent of collaboration that professionals will have with self-help groups.









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Statement of the Problem

As self-help groups have grown in the last 25 years,

discontent with professional services viewed as ineffective, unaffordable, and irrelevant also has increased. Self-help groups could be seen as an alternative or adjunct to professional services. Caplan and Killilea (1976), Dumont (1974), Gartner and Reismann (1974), and Levy (1976) noted that self-help groups are increasingly recognized as important resources in meeting the mental health needs of our society. Self-help groups are recognized as resources both by people who, in large numbers, are turning to various self-help groups for support, and by helping professionals who are considering ways of utilizing self-help groups in the mental health system. Interest in self-help groups also has extended to other individuals and/or professionals concerned with incorporating such groups into their service delivery system.

Some guidelines for the utilization and/or collaboration of self-help groups were in a report of The 1978 President's Commission on Mental Health, which included several recommendations for initiatives by the federal government in community mental health. Among the initiatives particular to self-help groups were to improve the linkages between natural networks and professionals, to recognize and strengthen natural helping networks, and to









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monitor changes in American life (President's Commission on Mental Health, 1978). Specific objectives suggested were to provide directories of self-help groups to mental health centers for dissemination to the general public; develop a clearinghouse for dissemination of information on mutual help groups; sponsor conferences to "enable professionals and members of self-help groups to learn from each other; and develop curricula in all helping related undergraduate and graduate programs on the nature and function of community support systems, natural helping networks, and mutual help groups" (President's Commission on Mental Health, 1978, p.12).

The relationship between self-help groups and helping professionals is an important one which should be studied. Self-help groups not only affect the growing number of people who join them, but they also affect a widening circle of people within the community. As self-help groups become more action-oriented, they will need to broaden their support base in order to achieve their goals. It is important to understand the attitudes of people in the community, including mental health professionals, toward self-help groups to evaluate such things as the probability of the self-help group being able to achieve its goals within the community.









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To date, few studies have been conducted surveying the attitudes of various helping professionals toward self-help groups. Unfortunately, they all followed an ad hoc design in that all instruments were developed for a specific study. Each had serious methodological limitations and nothing was provided on validity or reliablity of the instrument used.





Need for the Study

Thus far, the self-help movement has been ignored by most social scientists. Some attempts have been made to study the effectiveness of self-help groups. The paucity of adequate outcome studies stems from the lack of attention and problematic issues relating to the technical complexity of the research (Lieberman & Borman, 1976). The research task can be defined as "(1) what kind of changes are produced by (2) what kinds of group methods applied to (3) what kinds of group members by (4) what kinds of group leaders under (5) what kinds of group environment conditions" (McGovern, 1983, p.468). According to Priddy (1987), the problems encountered while doing outcome research on self-help groups are due to two factors: the complexity of group phenomenon and the primitive state of theoretical development in the area of group treatment. He









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concluded that it may be an impossible task to determine the effectiveness of self-help groups using empirical methods.

At this point, there is really no aspect of the selfhelp movement which has been adequately researched. Few instruments have been developed to measure the outcomes of participation in self-help groups, the effectiveness of groups in dealing with specific problems, or the attitudes of members of self-help groups toward helping professionals. Of the few, even less have been 11 validated. The need exists for their development, however.

Killilea (1976), in a review of the literature on selfhelp groups, suggested that

What is needed are more studies looking at the actual relationship in nature between individual professions
and individual mutual help groups; referral patterns
and kinds of transactions between mutual aid organizations, individual professionals, and formal human
service institutions. (p.82)

One important area for research is how self-help groups are viewed by others (Levy, 1978) because self-help groups are having an increasingly active role in their communities. This increased activity may be due to the fact that selfhelp groups are being recognized as a means of achieving some of the goals of community mental health centers. The degree of support a self-help group receives from professionals within the community, the nature of its institutional affiliation, and the character of its community, all will affect the manner in which the group









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functions and how effectively. As community institutions and agencies become increasingly involved in sponsoring self-help groups, their attitudes will affect the growth and effectiveness of these groups (Levy, 1984).

Self-help groups are viewed by Lurie and Shulman (1983) as therapeutic and physical extenders of services. They feel self-help groups and professionals providers can be major allies in identifying needed services and marshalling consumers' active participation to work within the health care system to develop needed services.

According to Chutis (1983), the provision of services

to self-help/mutual aid groups is a natural outgrowth of the goals, objectives and activities of the consultation and education (C&E) departments of community mental health centers. Recently, C&E services have expanded to include the education and training of natural community care-givers, such as self-help groups, in an effort to better serve the mental health needs of the larger community (Snow & Swift, 1981). Results of a survey of 244 mental health centers throughout the country conducted by Hermalin and Swift (1981) indicate that the importance of involvement with self-help groups has been widely recognized. Staff in surveyed facilities reported initiating self-help groups, providing space, and making referrals as some methods of collaboration. There is a need to gather information on the










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attitudes of self-help members, community members, and helping professionals, among others, toward self-help groups.

The focus of this study was to develop an instrument

to examine helping professionals' attitudes toward self-help groups. There is a lack of adequate assessment tools to gather this needed information. These two factors, a need for information, and a need for a tool to gather the information, were addressed in this study by the development of an instrument to assess attitudes toward and experiences with self-help groups.





Purpose of the Study

The purpose of this study was to develop and validate an instrument to assess helping professionals' experiences with and attitudes toward self-help groups. Content and construct validitation procedures were used. The internal consistency of the instrument also was determined to provide some evidence as to the reliability of the instrument.





Significance of the Study

The development of an instrument to measure attitudes toward self-help groups would assist the researcher









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examining perceptions of self-help groups. The instrument provides a method of assessing the current attitudes of helping professionals toward self-help groups as well as providing the means to assess helping professionals' attitudes in the future. The instrument facilitates information gathering. It has potential uses for future research efforts. An instrument assessing the attitudes towards self-help groups also allows comparisons of different populations, after validation on those populations. The instrument can be used to develop profiles of those persons, or groups of persons, most favorable and least favorable toward self-help groups. The instrument can be a standard assessment tool which can promote generalizations across studies.

The instrument can be used to assist professionals in their consultation activities with other professionals or with self-help groups. The assessment of the consultees' attitudes can be an excellent method for professionals to begin the consultation process. The instrument also can be used with self-help groups to assist them in their consultations with professionals or in their assessment of the degree of openness of systems or organizations to their groups. Additionally, the instrument may aid professionals in determining whether to refer clients to self-help groups









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by using it to assess the attitudes of those clients for whom the professional is considering referral.

In the area of training, the instrument can be used as a preliminary assessment tool to aid in planning training activities for helping professionals. By assessing the attitudes of the trainees toward self-help groups, trainers can prepare a program to either strengthen or challenge these attitudes. Much discussion also can be generated concerning training needs. The instrument can be used to identify those professionals who have both experiential and professional knowledge of self-help groups. These individuals can be important role models in training programs for collaborating with self-groups (Borman, 1976). The instrument can be used by students in professional training programs as a self-assessment tool. By assessing the attitudes of its students, a departmental faculty can better plan further training or practicum experiences with self-help groups or determine whether such steps are necessary.

As previously discussed, the instrument was developed for multiple uses. At the same time, it was beyond the scope of this study to validate the instrument on all populations for which it might be used. For the purpose of this study, members of the American Mental Health Counselors Association (AMHCA), a diverse group of helping









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professionals, were selected as the group of professionals to use for validation purposes.





Definition of Terms

The terms listed below are defined in the following manner for the purposes of this study:

Attitude is a predisposition toward a psychological object, i.e., person, thing, concept, or idea.

Human service professionals are helping professionals in the areas of mental health, psychology, behavioral science, and medicine.

Mutual aid/mutual assistance is cooperation among groups or individuals for the purpose of support or assistance.

Mutual aid groups are voluntary groups whose purpose is to provide help and support for its members in dealing with their problems and improving their psychological functioning and effectiveness.

A Natural helping network is a group or system of

people voluntarily created and continued by themselves for the purposes of support and mutual aid.

A Self-help group is a voluntary group whose purpose is to provide help and support for its members in dealing with their problems and improving their psychological or physical









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functioning and effectiveness. The group's origin and sanction for existence rest with members of the groups themselves, rather than with some external agency or authority. The group relies on its members' efforts, skills, knowledge, and concern as the primary source of help. The group is generally composed of members who share a common core of life experiences and problems. Its structure and mode of operation are under the control of members, although they may, in turn, draw upon professional guidance and various theoretical and philosophical frameworks (Levy, 1978).

Support systems are continuing interactions with

another individual, a network, a group, or an organization that provide individuals with feedback about themselves and 17 validation of their expectations about others (Caplan, 1976).

Therapists are helping professionals in the areas of mental health, psychology, and behavioral science.

Voluntary associations are groups of individuals who

share a common need or problem and who seek to use the group as a means of dealing with that need or problem. This term can be used synonymously with self-help groups and mutual aid groups.









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Organization of the Study

The remainder of this study is organized into four chapters. A review of related literature on self-help groups and professional collaboration with self-help groups is presented in Chapter Two. The research questions, theoretical basis of the instrument, item development, pilot study, field test of the instrument, and limitations of the study are described in Chapter Three. The results of the study and a discussion of these results are presented in Chapter Four. Conclusions, implications, a summary, and recommendations for future studies are discussed in Chapter Five.

















CHAPTER 2

REVIEW OF RELATED LITERATURE

Who then can so softly bind up the wound of
another as he who has felt the same wound
himself? (Thomas Jefferson)

The review of related literature includes an overview of the self-help movement, the relationship of self-help groups and society, the power struggle between self-help and professionals, various methods of collaboration between self-help groups and professionals, research on self-help groups, and a summary.



Self-Help Movement

Self-help or mutual aid groups, broadly defined as

voluntary associations among individuals who share a common need or problem and who seek to use the group as a means of dealing with that need or problem (Durman, 1976), have early historical origins. Mutual aid groups began in the Mesolithic Period when individuals banded together to hunt and gather food. By the Neolithic Period, agricultural villages, formed on the basis of kinship ties and territorial groupings, were widespread (Anderson, 1971).




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Prince Peter Kroptkin, in a series of articles

refuting Darwinism written in the 1890's, argued that mutual aid played a role in the development of all animal species, including man. He maintained that man could survive the evolutionary process only through mutual aid and social cooperation. These two factors, mutual aid and social cooperation, were key elements in the formation and continuity of the family, tribe, village, and state (Kroptkin, 1914).

Sociologist Louis Wirth (1938) agreed with Kroptkin

that mutual aid groups developed very early in civilization and were found in most societies of the world. Wirth found no single cause for the development of self-help groups. He concluded that voluntary associations rise when primary bonds of kinship, neighborhood, family, and religion are weakened as well as thrive when the primary support system is supported (Smith & Freedman, 1972).

By the Middle Ages, mutual aid groups, originally a

means of insuring physical survival, had expanded into the work arena. Much of the mutual aid in the Middle Ages and Renaissance was exclusive in character, however, limited to members of the guild or community. Strangers, pilgrims, or other non-members of the groups had to rely on the meager resources of the church or town charity for assistance.









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With the development of the Industrial Revolution in England and its ensuing social effects came "Friendly Societies." From early prototypes of the guild system, Friendly Societies were developed by the common people of England to cope with the stresses of industrialization. Before 1800, 191 such societies were founded. Generally, they were organized around occupations, providing members with funds for illness and old age. Friendly Societies aroused greatest opposition from employers who viewed the groups as schools for politics and class warfare (Katz & Bender, 1976a).

The growth of capitalist enterprise during the latter part of the 18th Century increased the hardships of the working class. Friendly Societies became used more and more as trade unions to defend or better the members' working conditions (Cole & Wilson, 1951). Thompson (1963) estimated the total memberships of these societies as 648,000 in 1793, 704,000 in 1803, and 925,000 in 1815. In addition, many groups failed to register with the authorities due to the latter's hostility towards them. Foster (1974) wrote, "the Friendly Society was one social institution that touches the adult lives of the near majority of the working population" (p.216). Even in modern times, Friendly Societies are still evident. Beveridge (1948) found 18,000 Friendly Societies









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functioning in 1945 to provide housing and building services, workingmen's compensation and cooperative stores.

Another outgrowth of the Industrial Revolution, in addition to Friendly Societies, was formalized consumer cooperatives. These developed rapidly in England and spread to other parts of Europe and later to North America. There was a clear mutual aid component in these cooperatives but few survived because the base of group cohesion was a "cash nexus"-- a poor foundation upon which to build continuity of sentiment and human caring (Katz & Bender, 1976a).

The historical development of mutual aid groups in the U.S. closely paralleled that of the Mother Country. When colonists first came to America, it was necessary to band together for protection against nature, to assist each other to insure survival. Once a community was established, communal efforts were discarded in favor of the American tradition of rugged individualism. The wealth of virgin territory, seemingly unlimited natural resources, and the lack of state controls, made this move to individualism possible. As the American ethic of self-sufficiency developed, the needy were viewed as social outcasts-unfortunate due to their own moral failures. Any charity was provided through private agencies or individuals. This









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situation was to remain unchanged until the Great Depression.

With the growing complexity of town and rural problems, new self-help forms emerged to meet common difficulties. For example, groups of dairymen formed mutual aid associations in 1800 to insure markets for their products, and the Mormons founded irrigation cooperatives to bring water in to Utah (Katz & Bender, 1976a). The advent of the Industrial Revolution in the United States in the midnineteenth century, brought the same problems for the working class that had first become manifest in Englandgrievously long working hours, paltry pay, hazardous working conditions, forced child labor and chronic illnesses. These forces united the oppressed workers. Self-help, as a means of survival, re-emerged in the labor movement.

In the 1870s a league of consumer cooperatives called

the Sovereigns of Industry was organized. This movement was taken over by the Knights of Labor, an all-inclusive national trade union body which attained a membership of 703,000 in 1886 (Katz & Bender, 1976a). Their slogan, "An injury to one is the concern of all" (Boyer & Morais, 1975, p.89) served to unite workers from hundreds of trades around demands for an eight hour working day, a minimum wage, grievance proceedings, safer working conditions, and an end









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to child labor. The idea of strength in unity has been the foundation for self-help groups ever since.

A large part of the work force was composed of

immigrants at this time. As newcomers in a strange land, the immigrants were at the bottom of the heap, forced to take the lowest paying jobs and live in the poorest housing. Beginning around 1800, large networks for self-help and mutual aid were developed by a variety of these immigrant groups. The Greek community in Massachusetts had over 1,000 members in its Pan-Hellenic Union in 1912. The Italians, Lithuanians, Germans, Russian and Polish Jews all set up similar organization to provide services ranging from free burials to free loans societies and wayfarers lodges. As the needs of the immigrants lessened, and their assimilation increased, these organizations slowly declined.

Self-help groups were declining when the Great

Depression overwhelmed the nation. With one third of the population ill-housed, ill-fed, and ill-clothed, the government was forced to set up programs. The service concept was born. Social Security, Vocational Rehabilitation, and Maternal and Infant Care were some of the varied programs created to give service to people with specific needs.

Coupled with the Great Depression, the repeal of

prohibition in 1933 increased the numbers of alcoholics who,









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in turn, added to the growing numbers needing inexpensive but effective psychological services (Brenner, 1973). The existing systems were unable to meet the increased demand for help. New solutions were necessarily created. Many social experiments, including the development of selfhelp programs for social amelioration, were undertaken to solve the problems of the Great Depression. Seeking new and cheap methods to deal with multitudinous problems, the government created several self-help programs--Tennessee Valley Authority, Civilian Conservation Corps, Works Progress Administration and National Youth Administration. At the same time, the people turned to grassroots activities--wildcat strikes, resistance to evictions and foreclosures, and communal soup kitchens (Hurvitz, 1976).

Inclusive in the service concept was the belief that

the professional knows best and that the professional has the power in the relationship. The client, if unhappy with this arrangement or critical of the service, was labeled uncooperative or resistant (Katz, 1970b). The third surge of self-help groups which occurred following World War II was initiated by two groups in response to being labeled or neglected by professional and bureaucracies (Steinman & Traunstein, 1976). One group, parents of the mentally retarded, overcame almost insuperable odds to create schools and workshops for their children (Steinman & Traunstein,









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1976). The other group, alcoholics, whom professionals had been notably ineffective in treating, created their own treatment. Their organization, Alcoholics Anonymous (A.A.) has become the model for numerous self-help groups which followed. These include Gamblers Anonymous, Neurotics Anonymous, and Overeaters Anonymous.



Competing Explanations of Self-Help Group Development

Four viewpoints explain the development of self-help groups (Lieberman & Borman, 1976). One view is that selfhelp groups developed from unmet needs. An example to illustrate this viewpoint is the growth in Alcoholics Anonymous which was the result of inadequate responses by professionals to alcoholism. A second view is that selfhelp groups developed as an alternative to services already provided. This viewpoint has been used by Tracy and Gussow (1976) to explain their finding that self-help health related groups are increasing at the same time as professional services are increasing. They suggest selfhelp groups offer support, technical assistance, models of dealing with an illness, social activity and usefulness, and help with an adaptive problem which professionals are not providing.

A third proposed view is that self-help groups develop from the widespread feelings of alienation in our society









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(Mowrer & Vattano, 1976). Striving to meet their needs for affiliation and a sense of community, individuals turn to a group. Meeting these needs through the group becomes even more important than the aim of the groups. A fourth view, that self-help groups develop from other affiliative arrangements outside kith and kin (Tax, 1976), explains development to provide a basis for intimacy, identity, and affiliation.

Back and Taylor (1976) have suggested an additional

viewpoint to the four offered above. They viewed self-help as representing a social movement. They applied Blumer's five stages of a social movement to self-help groups. These stages: agitation, group forms which tries to cure the unrest, development of morals, development of ideology, and final achievement of goal (Blumer, 1969), are paralleled in the reports of some self-help groups. Katz and Bender (1976b) concurred that self-help groups can be viewed as a social movement. They reasoned that self-help is change directed and seeks alterations in (1) its constituency's relation to society per se, (2) dominant institutions of the society, and often in (3) the personality and behavior of the member him/herself.

From a review of the literature on self-help, Killilea (1976) concluded that mutual help organizations are not a simple phenomena or a single movement. She divided the









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literature into 20 categories of interpretation. These include the categories of support systems, product of social and political forces, phenomenon of service society, alternative care giving systems, adjunct to the professions, subculture-way of life, supplementary community, agencies of social control and resocialization process, and therapeutic method.

Even this multiplicity of interpretations may not prove adequate for each of the over 500,000 self-help groups with their 15 million members (Evans, 1979). The sweep of the concept of mutual aid itself offers wide latitude for expression in its social forms. It is not limited to one culture or type of political environment but includes such diversity as organizations of welfare mothers in Australia, hypertension clubs in Yugoslavia, relatives of mental patients in Austria, consciousness raising among children in England (First International Conference on Self-Help and Mutual Aid in Contemporary Society, 1976).

From reviewing the historical development of self-help and acknowledging the influence of social and economic factors upon that development, it becomes clear that, changes in the forms of help are shaped at least as much by the predominant social forces of the times as they are by thoroughly supported developments in the science of human behavior (Levine & Levine, 1970).









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Today, as in the past, social conditions and economic factors are prime elements contributing to the growth of self-help groups. Some of the social conditions which have shaped the need for self-help groups include industrialization with its accompanying growth of vast business and governmental structures, high cost of professional services, loss of options in life choices, decline of faith in established institutions, feelings of powerlessness and inability to control events, decline in a sense of community and identity, and erosion of the family structure (Katz & Bender, 1976b).

Sidel and Sidel (1976) referred to self-help groups as the "grass-roots" answers to such social forces as the rate and pervasiveness of technology, the complexity and size of impersonal institutions, and professionalization of services that were previously provided by non-professional individuals. Durman (1976) viewed the self-help movement as a mandate for refocusing planning efforts of the next decade from the agency to the helping network; from services which ignored existing natural resources to efforts which encourage and foster the ability of ordinary people, working together, to resolve many of life's difficulties without professional intervention.

Katz (1970a) encouraged self-help groups to continue in their militancy, renewal, and shake-up every few years to









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renew their vitality. Katz believes self-help groups can be innovative and challenging, that they can monitor professional services to ensure more and better provision of services, and fight the dead hand of bureaucracy. In agreement with Katz years prior, MacIver (1931) felt mutual aid associations have a flexibility, an initiative, a capacity for experiment, a liberation from the heavier responsibility of taking risks, which the state rarely, if ever, possesses. Associations can foster the nascent interests of the groups and encourage social and economic enterprise at the growing points of a society.

It is this freedom to experiment, this struggle with

society which Sidel and Sidel (1976) addressed. They warned that self-help groups should not be used to foster adjustment to an unjust society but should struggle to modify that society. They saw that self-help could be used to divert attention from the maldistribution of resources and power, that it could fragment communities and families from each other, that it could foster the ideology of blaming the victim, and that it could advance "medicalization" of all health-related problems. For prevention of these dangers, they suggested that the self-help movement be placed in the context of an appropriate set of broader social goals within an ideological framework (Sidel & Sidel, 1976). Finally, they encouraged self-help groups to be as









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concerned with teaching professionals how to work humanely with clients as with helping the people directly to help themselves.

Others who have recognized self-help groups as an

important resource in meeting the mental health needs of society include Caplan and Killilea (1976), Dumont (1974), Gartner and Reissman (1976), Levy (1976), and Van Til (1978). Van Til felt self-help groups appear to be a very effective but quite inexpensive way of meeting human needs. He believed that groups offer potential to society and individual organizations to greatly expand the number of people served. Levy (1976) viewed self-help groups as political and sociological phenomenon and a psychological phenomenon. Levy considered self-help groups as challenges to established institutions, as attempts to redistribute power, and as responses to certain failures in the social order.



The Power Struggle Between Self-Help and Professionals

Self-help can be viewed as an attempt to redistribute power (Levy, 1976), to place more power in the hands of the client by taking away power from the professional. To better understand the nature of this conflict, some background information on the source of power of both self-help









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groups and professionals will be examined. A comparison/ contrast between the two also will be drawn.

Robert Morris (1973) listed functions performed by publicly provided services in response to client needs. These functions (and some of the services which fulfill them) include: a) assessment and counseling (group therapy, family planning); b) environmental arrangements (half-way houses, nursing homes, homemaker services; c) training, education, and equipment (work training, nutrition, home management); d) protective and legal (protective services for adults and children, legal aid); e) liaison (information and referral, resource mobilization--social change); and f) transportation (escort service).

Two needs not met through public service, but prominent in the literature on self-help, are support and advocacy (Morris, 1973). Because self-help groups provide extended contact over a long period of time at all hours, they are better able to give support than conventional services. Because self-help groups are often founded due to the delivery system being unable to meet their needs, self-help groups are often advocates for change.

Frank Reissman (1976) concluded that the power of selfhelp comes from five basic components. First is the helpertherapy principle. This states that the person giving the help often receives more benefit in the process than the









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person they are trying to help. The second component is consumer intensity. The group is geared towards meeting the needs of the consumers (group members). The third component is the professional dimension with its emphasis on practicality and common sense. Suggestions made in the group have been tried by group members. The fourth component is that caring and spontaneity are central. Fifth is the demand that the individual can do something for himself. The five components are what make mutual aid groups empowering and thus, dealienating (Reissman, 1976).

The normative characteristic of a profession is

autonomy--the right to determine work activity on the basis of professional judgement. Autonomy, in turn, is based on two other characteristics of a profession: a store of esoteric knowledge and a service orientation or altruism (Haug & Sussman, 1969). Professional knowledge is based on knowledge developed, applied, and transmitted by an established specialized occupation. This knowledge is viewed by the professional as the private property of the provider and gives him/her the power to dominate the less privileged, propertyless client (Marieskind & Ehrenreich, 1975).

Self-help, in contrast, is based upon experiential

knowledge or truth learned from personal experience. The wisdom that results from personal experience is concrete,









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specific, and common-sensible (Borkman, 1976). The two types of knowledge are not mutually exclusive but professional knowledge is better known and a more widely accepted source of truth in the United States than experiential knowledge (Borkman, 1976). The greater acceptance and higher value of professional knowledge has led to an imbalance of power between the professional and the client.

According to Haug and Sussman (1969), clients are in revolt against delivery systems for knowledge application which has been controlled by the professional. Clients are against the encroachment of professional authority into areas unrelated to professional claimed expertise.

In addition to challenging knowledge application, the other challenge is to the professional's service orientation. Governmental response to the Great Depression of the 30's marked the initiation of the service concept. Social Security, Vocational Rehabilitation, and Mental Health programs were created to give service to people with specific needs. A basic tenet of the service concept was that the professionals knew best, that they had the power of deciding what was right for clients, and that clients were resistive or uncooperative if they did not like the services provided (Katz, 1970a). The service concept set up between the professional and the client an unbalanced power relationship.









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Haug and Sussman (1969) believed that the power of the professional depends upon the consent of the client. As clients have struggled to shift the balance of power, professionals have sought to preserve both their power and autonomy by stifling challenges. Hospitals form patient councils, poverty programs have "indigenous" community representatives, and students are placed on advisory boards. In this way, professionals give up only a little power and socialize the descendants, according to Haug and Sussman (1969). The professional self-image as a person of knowledge, compassion and of power is left, more or less, intact. Without the solution of cooperation, the struggle could result in less diffuse power, a narrowing of autonomy, and deprofessionalization of the professional.

As a means of summarizing the nature of the power struggle between self-help groups and professionals, a contrast of the two is presented. Self-help groups use group parity, are free, and held in nontherapy-oriented milieu. Professionals use authoritative therapy, charge fees and work in therapy-oriented milieu (Hurvitz, 1974). Self-help groups encourage family involvement, members are similar and identify with each other, act as role models and set examples. Members are active, judgemental, and critical. They divulge to each other and must give as well as receive support (Reissman, 1976). Professionals do not









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confront the family, do not identify with the patient, are not role models, do not set personal examples, are nonjudgemental and noncritical. They listen as the patient unilaterally divulges and those disclosures are secret. Patients expect only to receive support from the professional who does not expect it back in return, other than financial (Hurvitz, 1974).

A self-help group has been described in the following way by Reissman (1976). In a self-help group, members are not concerned with symptom substitution. They reject disruptive behavior and hold each other responsible. Peers aim to reach each other at "gut level." An emphasis is placed on faith, will power and self control.

The professional, as contrasted by Hurvitz (1974), is concerned about symptom substitution if underlying causes aren't removed. The psychotherapist accepts disruptive behavior, absolves the patient by blaming the cause. He/she doesn't aim to reach "gut level," emphasis is on etiology and insight.

With self-help groups, the members' intersocial

involvement has considerable community impact. Primary emphasis is on day-to-day victories: another day without liquor or drugs, etc. The group provides continuing support and socialization. With orthodox psychotherapy, the therapist-patient relationship has little direct community









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impact. Everyday problems are subordinated to the longrange cure. Extracurricular contact and socialization with the therapist is discouraged (Hurvitz, 1976).

Orthodox psychotherapy has a lower cumulative drop-out percentage than does self-help groups. In orthodox psychotherapy, the patient cannot achieve parity with the psychotherapist. By contrast, members of self-help groups may themselves become active therapists (Hurvitz, 1974; Reissman, 1976).

It would appear from the writings of Reissman (1976), Powell (1975), Katz and Bender (1976b) that there are real contrasts between self-help groups and professional services. Dewar (1976) has been one of the few challengers to this assessment. Dewar believed that self-help, in the health area, does not offer an alternative to professional services. He believed the services are similar, the difference is in who offers the services. Dewar felt that patients are socialized into thinking in the professional mode and that the groups apply professional solutions which are only as effective as the professionals they mimic. In their study of self-help groups in health-related areas, however, Henley (1976, p. 86), quoted the chief of cardiac surgery as saying, "the most important thing I have learned is that rehabilitation takes place in the peer group, with medical personnel in an advisory role."









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A discussion of the merits of self-help versus

professional therapy could be supported by expert opinions from both sides. The self-help movement is neither deterred by lack of research nor lack of participation by professionals. As Dumont (1974, p. 633) stated, "the redistribution of political and economic power is meaningless if the power residing in professionals is not redistributed." One method of power redistribution which might prove beneficial to both the self-help movement and professionals is collaboration.



Professional Collaboration with Self-Help Groups


...Forging the links between professional and
non-professional helpers is hard work; there are barriers of language, education and expectations.
(Fields, 1980, p. 2)

The power struggle between self-help groups and

professionals can be resolved in several ways. One way is for self-help groups and professionals to strengthen their autonomy and allow little cross-over of clients or resources. Another possibility is for professionals to recognize the unique qualities of self-help groups and seek to collaborate with them in ways which still preserve that uniqueness. Still another possibility is for helping professionals to be as actively involved as they are allowed to be in whatever manner they are allowed with self-help









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groups. Each of these possibilities has been tried and each has had varying outcomes.

Although it would appear at first glance that self-help groups are autonomous, a review of self-help groups reveals that many of them were begun by professionals. Groups in which professionals played a leading role include: Recovery, Inc., begun in 1937, by Dr. Abraham Low, a psychiatrist who wanted a continuing support group for his mental health clients; Integrity Groups, begun in 1945 by psychologist O.H. Mowrer; G.R.O.W., begun in 1957 by clergyman Father Keogh; Compassionate Friends, begun in 1969 by Reverend Stephens for parents dealing with the death of their child; Parents Anonymous, begun in 1971 by social worker Leonard Lieber; and Epilepsy Self-Help, begun in 1975 by social psychologist Lawrence Schlesinger (Lieberman, Borman, & Associates, 1979). Recovery, Inc., which has continued to grow after the death of Dr. Low, is now the largest exmental patient group with over 15,000 members in 1,000 groups (Gartner & Reissman, 1980).

Characteristics of these men or others like them who found or support self-help groups include willingness to look beyond conventional theories, acceptance of a broader definition of afflictions, interest in expanding their skills and techniques, focus on rehabilitation and aftercare, concern for neglected populations, willingness to









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alter their professional role to include collaboration and support, willingness to form a group in a variety of settings, and willingness to minimize their fees (Lieberman, Borman, & Associates, 1979).

Aside from the findings that professionals have been involved in the founding and support of many self-help groups, it has also been found that most participants utilize professional help to a greater extent than do nonmembers of self-help groups (Lieberman, Borman, & Associates, 1979). In view of these findings, it is somewhat ironic that the professional sector has neither been trained to consider mutual help groups as a referral option nor is under any pressure from peers or clients to do so. Under these circumstances, professionals remain oblivious to existing mutual help groups or come to perceive them as irrelevant to professional practice according to Gottlieb (1980). If this professional attitude does not change, if professionals do not find some common ground with the selfhelp movement, Dumont (1976) has predicted that professionals will become increasingly cloistered, selfserving, and irrelevant.

As discussed earlier, one of the ways in which

professionals have been involved with the self-help movement is through organizing a variety of self-help groups. In some instances, after the groups were founded, the profes-









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sional took a gradually decreasing leadership role. In other cases, professionals have always served only as advisors. Such is the case with the largest self-help organization, Alcoholic Anonymous (A.A.). A.A. encourages its members to cooperate with the professional community (A.A. Newsletter, 1980).

One result of this cooperation has been referrals from the professional community to A.A. One member in five has credited a physician or hospital with directing them to A.A. (Alcoholics Anonymous World Services, Inc., 1972). More than 1,400 treatment centers have A.A. groups. This peaceful co-existence may in part be due to A.A.'s suggestions to its members to abide by all agency rules, keep commitments, do not argue or criticize, and to represent A.A. well when working with professionals (A.A. World Services, Inc., 1979).

For professionals considering referring a client to a self-help group, Powell (1975) suggested that they learn about the group before making the referral; check that the clients referred are similar to the group members so that they do not feel conspicuous; discuss the similarities and differences of the group and group activities; and check that the group is accessible to their clients. Powell also suggests that professionals be supportive of the group and plan with the clients how to use the group.









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Just as professionals refer clients to self-help

groups, Tyler (1976) believed that self-help groups can link clients to the professionals. This link results from group members learning from one another how to utilize effectively professional services. Self-help groups and professionals can use each other as consultants. Powell (1979) suggests that professionals think of self-help groups as a set of potential consultants who cost little and have expertise available in area such as alcoholism, child abuse, gambling, homosexuality, and divorce.

Self-help groups have used professionals as consultants for such things as improving the effectiveness of the group and its organizational structure, planning programs, participating in board meetings, and writing statements of support for grants (Gartner & Reissman, 1980). Powell (1975) suggested that professionals can use the self-help groups as a source of information, as an alternative to therapy for the reluctant client, and in collaboration with treatment by requiring participation in the group as part of therapy.

Gartner and Reissman (1980) presented the following

ways a professional can collaborate with a self-help group: a) make referrals, b) help develop a group, c) consult with a group, d) offer suggestions or information to the group, e) staff the group, f) conduct basic research, g) plan programs for the group, and h) evaluate the group.









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Another means of collaboration aside from starting self-help groups or consulting, is for professionals to identify and connect people in similar stressful circumstances. Through connecting these people, they have the option of beginning a group or of building a support system (Gottlieb, 1980). Use of stressful life events, social indicators, and critical life transitions can aid the professional in identifying people and getting them to develop ideas through resources of collectivity.

Strengthening support systems can serve as preventive

services (Gordon, 1978). Connecting resources is one way of educating the community. By encouraging the development of networks, professionals are increasing the number of clients served. Rather than trying to reach all the clients themselves, professionals can concentrate on helping the helpers by assisting self-help members in clarifying their ideas and increasing their confidence (Patterson, 1980).

Collaboration can be seen as a mutual learning experience for the professional and the self-help group. Through consulting, leading, or researching a self-help group, professionals may increase their understanding of groups members. Such was the case with Feinburg (1970) who started a self-help group for women who had mastectomies. For selfhelp groups, they could develop close ties with professionals and conventional services during collaboration









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(Durman, 1976). Some models have already been established for collaboration. In assertiveness training, for example, professionals train lay people who become trainers returning to the professionals for additional training from time to time. With this model, a small number of professionals have an effect which radiates out to many (Gartner & Reissman, 1977).

The assertiveness training model is very similar to the peer group rap session models in which professionals train a large number of kids then take a back-up role in the ensuing meetings. Various health groups have also been established in this manner by professionals. In reference to medical problems, professionals can diagnose the illness, prescribe relevant drugs, then help patients with similar needs find each other and come together. A final model is the professional who writes a self-help book which stimulates readers to form a self-help group on the basis of the book. Books such as Parent Effectiveness Training and Transcendental Meditation are two examples (Gartner & Reissman, 1977).

While it appears there is a variety of ways for

professionals to collaborate with self-help groups, Borkman (1976) stated the collaboration is dependent on the types of professionals and their ideology and on the type of the self-help groups and its ideology. The more the profession-









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al model includes experiential knowledge (truth based on personal experience), the better professionals can work with self-help groups.

It would be difficult to argue convincingly that there are no ways in which a self-help group and a helping professional can collaborate. Some caution or care must be taken, however, in order to insure a successful collaboration. In a study of a volunteer self-help group within a service agency, Kleinman, Mantell, and Alexander (1976) warned against hasty attempts to use self-help principles in an alien agency environment. They conclude that a self-help group could not be supervised by an agency because of the conflicts of the formal agency organization with the group's informality, the power differential and the disputes over values and objectives.

Van Til (1978) believed self-help can be successfully incorporated into a formal organization if both professionals and self-help clients actively consent to its development. One necessity is that the formal organization or institution be willing to bend enough to implement self-help principles.

Other authors are concerned that if professionals

become involved with self-help groups, they may tamper with the ideology of such groups (Antze, 1976), they may make the group feel it can not help itself or that it needs a profes-









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sional (Jertson, 1975), or that the professional will take over the group or change its orientation (Henley, 1975). Along those lines, Katz (1965) saw a pattern of professionals doing something for the recipient rather than the recipient joining in the doing. Professionals are not accustomed to cooperative ventures and they lack confidence in the individual or group to do anything for themselves. Katz (1965) suggests a need for a firmer partnership between the giver and recipient of services. He views professionals as necessary resources and as specialists rather than the only prime movers for the group.

Caplan (1974) saw the role of the professional as a "support for the supporters" and to provide continuity in group sessions. Vattano (1972) also saw the professional as a catalyst and a facilitator particularly in the early stages of the group. Mowrer (1970) suggested that universities can train and supply persons competent to start self-help groups. Regardless of which manner professionals may choose to collaborate with self-help groups, the degree of collaboration will depend in large measure on the willingness of both parties to attempt to work together. An instrument to measure the attitudes toward self-help groups could aid both parties in assessing this willingness.









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Self-Help and Research

After an extensive review of the literature on self-help groups, Killilea (1976) concluded that more systematic attention, both conceptually and methodologically, should be focused on self-help groups. Caplan (1974) predicted that the self-help movement would become a major focus of systematic research during the next decade. He felt systems organized by non-professionals should be carefully studied in order to learn how to stimulate and foster supports in the population without distorting or forcing them into professional patterns. While his prediction that the movement would be a major focus of systematic research has not yet come to pass, recent studies are indicating that more professionals are becoming involved with self-help groups. How or if these groups are in turn being distorted by this involvement is an area which desperately needs to be researched, as does many aspects of the self-help movement.

Lieberman and Borman (1976) stated that the paucity of research on self-help groups is due to the following reasons: a) most social scientists ignore the movement and b) the technology to assess self-help groups is inadequate. Perhaps because the technology is inadequate, social scientists are continuing to conduct little research in the area. They do seem to be writing more articles, however.









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Dumont (1974) wrote:

By and large, the acknowledgement of the self-help
movement in professional journals is absent,
indifferent or hostile, not unlike the perceptions
of the professional in general. On the other
hand, there is an inevitability about the movement
based on a confluence of ideological and cultural
forces that suggests it is more than a passing fad
in the human services (Dumont, 1974, p. 634).

In the fourteen years since Dumont's statement, his

words have proven to be prophetic. The self-help movement has shown itself to be more than a passing fad. It has endured and grown. It has also attracted the interest and attention of large numbers of helping professionals.

The perceptions of these helping professionals toward self-help groups have been the subject of several surveys. In 1978, Levy mailed out a questionnaire to all outpatient psychiatric facilities in the United States, approximately 1,800. He sought to assess the attitudes of professionals toward the efficacy of self-help groups. He felt their attitudes would be manifested in the following ways: the extent to which the professionals utilized self-help groups through referrals, the extent to which the self-help groups were viewed as making referrals, the professionals' evaluation of the effectiveness of the self-help groups, the professionals' judgements of the importance of the potential role self-help groups might play in the mental health delivery system, and an estimate of the probability that the









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professionals' agency would try to integrate self-help groups with the agency services.

In 1981, Hermalin and Swift surveyed 244 community

mental health centers. They also asked for ways in which the centers could collaborate with self-help groups.

In 1982, Todres surveyed 308 helping professionals in

the Toronto area. His personally administered questionnaire included information on the respondent's knowledge of selfhelp groups in the area, methods of collaboration, and 20 items to assess their attitudes toward self-help groups.

In 1985, Toseland and Hacker surveyed 247 social

workers. Their mail questionnaire included information on the respondent's knowledge of self-help groups, methods of collaboration, and 19 items to assess their attitudes toward self-help groups.

All of these authors stressed the importance of selfhelp groups as a resource which helping professionals could not afford to ignore. They documented a trend of professionals' increasing involvement with self-help groups and increasing positive attitudes. Unfortunately, each study was incomplete. Each used an ad hoc design and created an instrument for each particular study. No information was given on how items were developed. No validity or reliability studies were done on the instruments









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designed. No recommendations for further refinement of the instruments were made.

The self-help movement is a phenomenon full of potential for professionals. Foundations and government funding sources are beginning to support research, training and some service grants. The Office of Child Development, part of HEW, provided a grant to Parent's Anonymous which enabled them to begin chapters in almost every state, to develop a national newsletter, and to provide training materials to members. Some form of legal recognition may be forthcoming to self-help groups, networks, and extended families for the role they play in prevention (Borman, 1976). Should funding become more available, research on the self-help movement might be more lucrative for agencies and professionals.




Summary

Self-help groups have early historical origins. They

originally formed for the purposes of hunting and gathering food. As civilizations became more developed and basic needs were consistently met, self-help groups expanded into other areas.

The prevailing social and economic conditions of the

times have greatly influenced the type and function of selfhelp groups. Back and Taylor (1976) have suggested that









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self-help represents a social movement. Other researchers have suggested that self-help groups developed from unmet needs; as an alternative to services already provided; from widespread feelings of alienation in our society; or from other affiliative arrangements outside kith and kin (Lieberman & Borman, 1976). From a review of the literature on self-help, Killilea (1976) concluded that mutual help organizations are not a simple phenomena or a single movement.

Although self-help groups may be viewed as antiprofessional, research does not verify this conclusion (Lieberman, Borman, & Associates, 1979). Many professionals have been involved with self-help groups either by beginning the groups or serving as a consultant to the group.

Self-help groups and professionals have powerful,

albeit different, helping techniques (Reissman, 1976). It is possible for both to collaborate in several ways. Each can use the other for referrals, for consultation, or as a mutual learning experience (Gartner & Reissman, 1980).

Due to technological limitations and lack of professional interest little research has been conducted on selfhelp groups (Lieberman & Borman, 1976). Questions such as how self-help groups function, what is the impact of participation on groups members, and how can self-help










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groups work with professionals, have yet to be answered (Killilea, 1976).

With over fifteen million people involved in self-help groups (Evans, 1979), the self-help movement warrants investigation. The developed instrument resulting from this study is a step towards furthering research on self-help groups by assessing helping professionals attitudes toward self-help groups.
















CHAPTER 3


METHODOLOGY

The purpose of this study was to develop and validate an instrument to assess helping professionals' experiences with and attitudes toward self-help groups. The research questions, theoretical basis of the instrument, item development, pilot study, field test of the instrument, and limitations of the study are presented in this chapter.



Research Questions



The following research questions were addressed in this study.

1. To what extent does the instrument have content validity?

2. What is the factor structure of the instrument?

3. To what extent is the instrument reliable as demonstrated by internal consistency?








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Theoretical Basis

Much of the literature regarding self-help groups is descriptive in nature. Considering the size of the selfhelp phenomenon, relatively little research has been conducted. Technological limitations with conducting this type of research as well as the lack of instruments are two factors which account for the paucity of research. Due to the lack of research, there were few guidelines to use in the development of the instrument for this study.

The primary sources of guidance were studies conducted by Levy (1978) and by Torres (1982). Levy (1978) developed an instrument to use with mental health professionals which consisted of surveying their use of referrals to or from self-help groups, their evaluation of the effectiveness of self-help groups, and their estimate of the potential role of self-help groups at their agencies. Torres (1982) developed a series of statements to assess the attitudes of helping professionals toward self-help groups. Construct areas were not identified. No rationale for these statements was given. Although both studies were informative, neither researcher conducted item analyses or validation or reliability studies.

In this study, as in Levy's and Torres', the researcher collected data on professionals' attitudes by surveying professionals' experiences with self-help groups and surveying responses to selected statements about self-help







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groups. From a review of the literature, it appeared that attitudes toward self-help groups would be based on two components: experiential knowledge and theoretical knowledge. Section I of the instrument was designed to measure the former, Section II the latter.



Item Development

The instrument, Survey of Attitudes Toward and

Experiences With Self-Help Groups (SAESHG), is divided into three parts. The first part of SAESHG consists of questions which request information on the educational levels and job titles of the respondents. This information was requested to determine whether the respondents' types of experiences with or attitudes toward self-help groups differed on the bases of their degree levels or job titles. The next part of the SAESHG, Section I, contains a list of 12 methods of collaboration with self-help groups. Respondents are instructed to evaluate the effectiveness of those methods with which they have experience. Information collected from this section was considered as part of the item analysis of the instrument. Methods of collaboration included in this section were selected through a review of the literature. Because all commonly used methods of collaboration were identified through the literature and considered to be under one domain (i.e., the domain of methods of collaboration







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with self-help groups), the panel of experts was not asked to place these items in content areas.

An extensive review of the literature on self-help

groups was conducted in order to generate items for Section II of the SAESHG, consisting of 55 statements about selfhelp groups. From this review, five content areas were identified as major categories of information on self-help groups. Using these five areas as a guide, 60 statements were generated, some phrased positively, some negatively. Upon closer scrutinty of the content areas and statements, however, it appeared that by deleting only five statements, two of the content areas could be collapsed. The three remaining areas were: purposes/activities of self-help groups, characteristics of self-help groups, and the relationship of self-help groups to other helpers. Using these three content areas, 55 statements remained. These statements, following Edward's (1957) guidelines for constructing Likert-type attitudinal scales, were designed to evoke affect or opinion rather than cognition or recall. To create uniformity of scoring, all statements which were negatively phrased were re-coded. The following items were re-coded: 5,12,15,18,19,20,23,28,32,33,36,36, and 42.

The SAESHG was reviewed in a preliminary screening

by a panel of eight experts who were selected based upon their prominence in the area of research on self-help groups and their willingness to participate in the study. All







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panel members were required to have both experiential knowledge of self-help groups as evidenced by their participation in some way with a self-help group and theoretical knowledge as evidenced by their publications about self-help groups. See Appendix A for a listing of panel members names, experience, and relevant publications. The panel was asked to evaluate whether pertinent content areas for item generation had been identified and whether comprehensive items had been generated for each content area. They also evaluated the technical quality of the SAESHG items to determine whether the wording for the items was consistent, and if the items were clear and understandable.

The panel first reviewed Section II of the SAESHG

to determine the degree to which the statements represented the domain of attitudes toward self-help groups. All panel members were sent copies of the SAESHG. The panel was asked to choose which of three content areas was most appropriate for the item, if the wording was clear, and if the item appeared appropriate for inclusion. Panel members were asked to return the completed SAESHG within 10 days of receipt in the accompanied, stamped, addressed envelope. The three content areas, processes/activities (P/A), characteristics (C), and relationship to other helpers (ROH), the column undecided/no response (U/NR) and the








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panel's responses are shown in Table 3-1. The numbers 0-8

indicate the number of panel members who chose each area.

In assessing the 55 SAESHG items in Section II, a

majority of five or more experts believed that 50 of the

items were clearly worded and 51 were appropriate. Many of


Table 3-1
Panel of Experts' Evaluations of Item Content in Section II

Item# Content Area Wording Appropriate
P/A C ROH U/NR C NC U/NR Yes No U/NR

1 0 2 5 1 4 2 2 7 1 0 2 1 3 3 1 5 0 3 7 1 0 3 5 0 2 1 8 0 0 8 0 0 4 5 1 0 2 4 2 2 6 1 1 5 0 1 5 2 6 0 2 7 1 0 6 3 3 0 2 6 1 1 8 0 0 7 3 4 0 1 6 0 2 7 1 0 8 2 1 0 5 5 1 2 6 0 2 9 3 2 0 3 5 2 1 6 1 1 10 3 0 3 2 6 2 0 6 0 2 11 1 1 4 2 7 1 0 7 0 1 12 5 1 0 2 6 0 2 6 0 2 13 5 1 0 2 5 2 1 5 1 2 14 6 0 0 2 6 2 0 5 1 2 15 0 6 0 2 4 3 1 5 1 2 16 0 0 5 3 6 2 0 6 1 1 17 3 2 0 3 5 2 1 6 0 2 18 2 2 0 4 6 1 1 6 0 2 19 1 3 0 4 7 1 0 8 0 0 20 4 2 0 2 5 2 1 5 1 2 21 0 0 6 2 6 0 2 7 0 1 22 2 2 3 1 5 1 2 5 1 2 23 0 0 6 2 8 0 0 6 1 1 24 4 2 0 2 5 2 1 7 0 1 25 0 4 0 4 5 1 2 5 1 2 26 0 4 4 0 6 1 1 5 1 2 27 4 2 0 2 7 0 1 7 0 1 28 0 3 4 1 8 0 0 7 1 0 29 2 2 0 4 4 2 2 4 1 3 30 3 2 0 3 6 1 1 4 2 2 31 0 0 6 2 8 0 0 8 0 0 32 0 0 6 2 7 0 1 7 0 1 33 1 1 4 2 7 1 0 8 0 0 34 0 0 5 2 2 5 1 3 4 1 35 4 2 0 2 6 2 0 6 2 0








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Table 3-1 continued

Item# Content Area Wording Appropriate
P/A C ROH U/NR C NC U/NR Yes No U/NR

36 0 4 1 3 6 1 1 6 1 1 37 0 0 6 2 7 1 0 6 1 1 38 0 0 6 2 6 2 0 7 0 1 39 4 2 0 2 7 0 1 7 0 1 40 0 1 5 2 4 4 0 4 3 1 41 2 1 1 4 7 0 1 6 1 1 42 1 0 5 2 7 1 0 6 1 1 43 4 1 0 3 6 0 2 5 1 2 44 2 3 0 3 6 1 1 5 1 2 45 0 0 5 3 6 1 1 5 1 2 46 2 2 0 4 5 0 3 5 0 3 47 0 0 5 3 7 0 1 7 0 1 48 0 0 5 3 6 1 1 6 1 1 49 0 0 5 3 6 1 1 5 1 2 50 0 0 5 3 5 2 1 6 1 1 51 3 1 0 4 5 1 2 5 0 3 52 2 3 0 3 6 1 1 5 1 2 53 3 2 0 3 5 1 2 5 0 3 54 1 4 0 3 6 1 1 6 0 2 55 0 0 5 3 6 0 2 5 0 3 Note. P/A = purposes/activities; C = characteristics; ROH = relationship to other helpers; U/NR = undecided/no response.


the panel members, however, commented that they did not like

the content areas and believed it was too difficult to

distinguish in which content area an item should be placed.

Specifically, many of the panel members believed it was

difficult to choose between the content areas

purposes/activities, and characteristics. Some of the panel

members marked all three areas for the same item, others

refused to choose any area.

The majority of the panel members agreed on the same

content area for 24 of the items. Thirty-one items had no

clear-cut majority of responses. If the majority opinion of







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the panel was that the item was appropriate, then the item was kept regardless of whether the panel could agree on the content area for the item. A majority was considered to be five of the eight panel members.

One panel member chose the content areas but not

whether the item was clearly worded or appropriate. Another panel member was inconsistent in responding, often omitting the content areas and only indicating if the item was appropriate or not. Six of the panel members consistently evaluated each item across all categories. Based upon the panel's evaluation, items 34 and 40 were omitted. The revised SAESHG contained 53 items in Section II. A Likerttype scale was selected as the response format for the items. It ranged from Strongly Disagree (1) to Strongly Agree (5). After the item revision was completed, the instrument was mailed back to panel members. The panel was asked to review each section and to comment on the format of the questions, wording, appropriateness, comprehensiveness of items, and ease of completion. Comments from the panel were very favorable. No revisions were required in Section I and only minor revisions were made in Section II prior to the pilot study. The panel also was requested to complete the revised SAESHG. This provided a method of assessing their experience and attitudes toward self-help groups.







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Pilot Study

The purpose of the pilot study was to determine the

suitability of the item format, the appropriateness of the items, and the ease of completion of the instrument. Since the field test involved a large mail-out, the pilot study served as a screening device for identifying problems respondents might have completing the SAESHG.

A class of graduate students in Counselor Education at Hunter College in New York City was selected for the pilot study. This class was chosen because of their similarity to the research sample and their willingness to participate in the study. Permission was obtained from the professor to ask the students to participate in the study. All ten students agreed to participate. They were given the SAESHG, asked to complete it and mail it back within two weeks. They were also asked to make any comments or write any questions they had on the instrument. All completed surveys were received during the first week.

The educational level of the students was as follows: five had Bachelor's degrees, four had Master's degrees, and one had a Specialist in Education. Three were employed as counselors, four as teachers, one as an administrator, and two in other fields. Regarding training with self-help groups, five had had college courses, one had had a seminar, one had had practical experience, and three had had no training.







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Regarding experience with self-help groups, four had experience as participants, four had experience as observers, and two had experience as leaders. Two of the students had no experience with self-help groups, six had only one type of experience, one had two types, and one had three types of experience with self-help groups.

At the time of the pilot study, the SAESHG had two parts to Section I. Items on both parts were identical. Respondents who had experience with self-help groups were requested to indicate those areas in which they had worked with self-help groups by evaluating the effectiveness of the collaboration using a Likert-type scale. Respondents who had no experience with self-help groups were requested to indicate the probability of their collaborating in the ways listed by using the same scale.

Although eight of the ten students gave at least one type of experience with self-help groups, none completed part one of Section I of the SAESHG. No one commented on why they did not complete this section. One possibility is that they did not feel sufficiently experienced to evaluate self-help groups in the manner requested in that section. Another possibility is that they were confused over whether to complete part one or part two since all the students with experience completed part two rather than part one.

Nine of the ten students completed part two of Section I. Part two of Section I requested respondents with no







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experience with self-help groups to indicate the probability of their collaborating with self-help groups in various ways by using a Likert type scale. Six of the nine indicated they would collaborate with self-help groups by making referrals to the groups and receiving referrals from the groups. Four of the nine indicated they would collaborate by providing training to a self-help group and conducting research on a self-help group. Three of the nine indicated they would probably not collaborate by conducting research on a self-help group.

While this information was useful in that it indicated a strong willingness in some specific areas to collaborate with self-help groups, it was possibly misleading since respondents with experience had completed the section for respondents without experience. Because the study was to focus on the actual experience the respondents had with self-help groups, part two of Section I was omitted from the SAESHG prior to the field test. This resulted in a shorter instrument which could be completed in less time. It also reduced confusion over which part of Section I to complete.

The mean, standard deviation, and respondent numbers

for each item in Section II is given in Table 3-2. With the exception of items 17, 20, 28, 30, 43, 46, and 48, all participants responded to each item.








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Table 3-2
Section II Results of Pilot Study

Item# Mean s.d. N

1 3.5 0.9 10 2 3.3 0.6 10 3 4.8 0.4 10 4 4.8 0.4 10 5 3.6 1.0 10 6 3.0 0.9 10 7 3.8 0.7 10 8 4.5 0.7 10 9 4.3 1.0 10 10 3.7 1.0 10 11 2.6 0.6 10 12 4.3 1.2 10 13 3.8 0.9 10 14 3.4 0.9 10 15 4.2 1.1 10 16 3.3 1.1 10 17 2.8 0.9 9 18 4.8 0.4 10 19 3.2 1.1 10 20 3.1 0.7 9 21 2.4 0.8 10 22 3.5 0.8 10 23 2.8 0.9 10 24 4.1 0.7 10 25 3.1 0.8 10 26 2.0 0.9 10 27 3.9 1. 10 28 3.1 1.4 9 29 3.5 1.4 10 30 3.3 0.9 9 31 3.7 0.4 10 32 3.2 1.2 10 33 3.1 0.7 10 34 4.3 0.9 10 35 4.0 1.2 10 36 2.5 0.8 10 37 4.2 0.6 10 38 4.2 0.9 10 39 2.6 0.9 10 40 2.4 0.7 10 41 2.6 1.0 10 42 3.8 0.9 10 43 3.2 0.4 9 44 4.4 0.5 10 45 4.2 0.6 10 46 3.1 0.9 9 47 4.5 0.5 10








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Table 3-2 Continued

Item # Mean s.d. N

48 2.7 1.3 9 49 4.0 0.6 10 50 3.9 0.7 10 51 3.2 0.9 10 52 3.9 0.5 10 53 3.9 0.7 10


The means ranged from 2.0 to 4.8. The standard

deviations ranged from .4 to 1.4. Five items, 3,4,8,18,and 47, had means greater than or equal to 4.5. These items all pertained to attributes of a self-help group except item 47 which stated that helping professionals should support selfhelp groups. Four items (21,26,36,and 40) had means less than or equal to 2.5. These items all pertained to the relationship of self-help groups to helping professionals or traditional therapy.

Panel of Experts' Item Responses

After evaluating the items and format of the

instrument, the panel of experts was requested to complete the SAESHG to provide a comparison with the pilot study and field test. Their responses also were requested to ascertain the degree of variability in their responses. Six panel members completed both sections of the SAESHG. One member did not respond to questions on educational level, training, or experience, but did complete Section II. One panel member did not return the survey.







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Of the six panel members, five had Ph.D.s and one had a D.S.W. Four were professors, one was a counselor/therapist, and one an administrator. All six had training through self-directed study and practical experience. Two members also had training through a seminar/workshop and two through assisting with research. Experience with self-help groups was divided among four members who had been participants in self-help groups, five were interested observers, five were consultants, five were researchers, two were leaders and one was an administrator of a national self-help group. Five of the members had training and experience with self-help groups in at least three different areas.

Regarding Section I, the following means of

collaboration were rated as very effective by at least three of the six panel members: using self-help groups as a source of information, forming an advocacy group or coalition with a self-help group, serving as a consultant to a self-help group, using a self-help group as consultants, and conducting research on a self-help group or phenomenon. One panel member rated using self-help groups as a source of information as a very ineffective means of collaboration. One panel member also rated receiving referrals from selfhelp groups, integrating self-help group members into committees, boards, etc., and sharing facilities with selfhelp groups as somewhat ineffective means of collaboration.








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Seven panel members completed Section II of the SAESHG.

Their responses are presented in Table 3-3.


Table 3-3
Section II Results from the Panel of Experts

Item# Mean s.d. N

1 2.4 0.7 7 2 4.1 0.6 7 3 4.8 0.3 7 4 3.8 1.0 7 5 3.5 0.7 7 6 3.5 1.1 6 7 3.4 0.5 7 8 5.0 0.0 7
9 4.0 0.6 6 10 3.2 0.9 7 11 2.1 0.8 7 12 4.7 0.5 7 13 4.1 0.6 7 14 4.2 0.5 7 15 4.1 1.0 7 16 2.8 1.5 7 17 4.2 1.0 7 18 4.5 0.7 7 19 3.8 0.6 7 20 3.0 0.8 6 21 3.5 1.3 7 22 3.3 1.4 6 23 4.7 0.5 7 24 4.7 0.5 7 25 3.4 0.5 7 26 4.7 0.7 7 27 2.5 0.5 7 28 2.8 1.1 6 29 3.0 1.3 7 30 4.0 0.9 7 31 1.4 0.7 7 32 3.0 1.0 6 33 2.8 1.0 7 34 4.5 0.5 7 35 4.4 0.7 7 36 3.5 0.9 7 37 4.2 1.4 7 38 4.2 0.7 7 39 2.2 1.5 7 40 2.6 0.8 5 41 3.8 0.4 6 42 3.6 0.9 6








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Table 3-3 Continued

Item# Mean s.d. N

43 3.6 0.5 6 44 4.5 0.8 6 45 4.2 0.7 7 46 3.7 0.9 7 47 4.0 1.3 7 48 3.6 0.9 6 49 4.4 0.5 7 50 3.7 1.2 7 51 3.3 0.7 6 52 4.1 0.7 6 53 4.0 0.6 5



The means ranged from 1.4 to 5. The standard

deviations ranged from .3 to 1.5. Nine of the items (3, 8, 12, 18, 23, 24, 27, 34, and 44) had means greater than or equal to 4.5. All the items pertained to attributes of a self-help group except item 23, self-help groups should be started by a helping professional. Three of the items (3,8,and 18) were also rated the highest by the pilot study.

Four items (1,11,31,and 39) had means less than or

equal to 2.5. None of these items were rated that low in the pilot study. All items pertained to the relationship of self-help groups with helping professionals or other agencies.

Although several items appeared to have little

variance, as evidenced by standard deviations below .50, no items were deleted at this point. Because the pilot study sample was so small and the panel of experts so experienced







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with self-help groups, it seemed premature to delete items based on those responses.



Field Test

The purpose of the field test of the SAESHG was to

answer the three research questions posed by the study: does the instrument have content validity, what is the factor structure of the instrument, and is it reliable? A diverse group of helping professionals, members of the American Mental Health Counselors Association (AMHCA), was chosen as the sample population. This group was selected because a population was needed which possessed direct experience or familiarity with self-help groups and which represented differing types of professionals likely to use self-help groups. A computerized mailing list of every 14th name on the mailing list was provided by AMHCA. A total of 1,000 names of AMHCA members was included on the mailing list.

Once permission was secured from AMHCA to survey their members, the SAESHG was mailed to the 1,000 AMHCA members randomly selected. The questionnaire method was chosen because it makes information from a large group of people more accessible. It is a method which allows objectivity in evaluating responses. It eliminates interpretive problems. It insures anonymity for the respondent, and as a result, encourages honest and valid responses (Isaac & Michael, 1971; Kerlinger, 1973).







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Included with the instrument was a letter of transmittal explaining the purpose of the study, instructions for completion, and a stamped, return-addressed envelope. A six week period immediately following the mail-out was chosen as the time frame for inclusion in the study. A total of 410 instruments were received during that period. The return rate of 41% was high enough to provide 145 more surveys than required for the data analysis used in the study. An additional 14 completed surveys were received after the cutoff date, bringing the overall return rate to 42.4%.

Content validity of the SAESHG was determined by the panel of experts chosen to review the instrument and evaluate whether the items were appropriate. A list of the panel members is found in Appendix A. The panel was asked to evaluate whether relevant content areas for item generation had been identified and whether comprehensive items had been generated for each content area. They also evaluated the technical quality of the items to determine whether the wording was appropriate, and if the items were clear and understandable. As discussed in Item Development, the panel believed most items were clear and appropriate. Refer to Table 3-1 for the evaluations.

Based on the panel's responses and suggestions, items were revised or discarded. After the item revision was completed, the instrument was mailed to panel members and they were asked to complete the instrument. The panel was







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asked to review each section and to comment on the format of the questions, wording, appropriateness, comprehensiveness of items, and difficulty completing the instrument. Based on their comments, the SAESHG was revised further.

Factor analyses were completed for both sections of

the SAESHG, Section I surveying experiential knowledge, and Section II surveying theoretical knowledge. All 410 completed instruments were hand scored and the data subsequently transferred to a computer disc. An alpha level of .05 was the criterion set for statistical significance evaluations. Principal Components factor analyses using an oblique rotation was completed using the Statistical Package for the Social Sciences. The mean and standard deviation were calculated for each item and for the total scores. Factor loadings were reviewed for the clearest seperation of factors.

The internal consistency of the instrument was

computed to provide a measure of reliability for the SAESHG. Coefficient Alpha analyses were employed to assess internal consistency.



Limitations of the Study

One limitation of this study was that the data

collected were based upon self reports which could be limited by the respondents' honesty and/or security, the accuracy of the respondents' memory, and whether the







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respondents understood the items. Another limitation was the subject selection. Only one group of helping professionals (AMHCA) was surveyed. Since this was a descriptive study, the only threat to external validity was in subject selection (Isaac & Michael,1971). Because only one helping professional group was surveyed, it may not be possible to generalize to all helping professionals. It is possible that the AMCHA members who chose not to respond had different views from those who did respond (Babbie, 1973).















CHAPTER 4


RESULTS AND DISCUSSION




Results of the Study

The purpose of this study was to develop and validate an instrument to assess helping professionals' experiences with and attitudes toward self-help groups. The three research questions in the study were (a) to what extent does the instrument have content validity, (b) what is the factor structure of the instrument and (c) to what extent is the instrument reliable? The results of the study presented in this chapter include information on the sample, content validity, construct validity, and reliability.



Sample

Instruments were mailed to 1,000 randomly selected members of AMHCA. Instruments returned during the first three weeks following the mail-out were included in the study. A total of 410 instruments were received during this period. The 41% return rate was relatively high for a mailout and yielded more than the 265 surveys necessary for the




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study. Another 14 instruments were received after the cutoff date, increasing the overall return rate to 42.4%.

It should be noted that 44 participants only completed the biographical questions and did not respond to any items in Section I, the Experience Scale, or Section II, the Attitude Scale. Apparently, after reading the directions for Section I, instructing only those participants with experience with self-help groups to complete it, these 44 respondents did not continue to Section II.

Information about the respondents who completed both

sections of the SAESHG is provided in Table 4-1. Because of the high response rate to Section II, the Attitude Scale, as shown in Table 4-3, analyses were conducted using 351 surveys. This includes the 288 surveys in which all items were completed and the 63 surveys in which at least 50 of the 53 items were completed.


Table 4-1
Demographic Characteristics of Sample

Zip Code N % of Total

Area O East Coast 40 11.4 Area 1 East Coast 46 13.1 Area 2 East Coast 36 10.3 Area 3 East Coast 51 14.5 Area 4 Mid-West 34 9.7 Area 5 Mid-West 25 7.1 Area 6 Mid-West 32 9.1 Area 7 Far West 23 6.6 Area 8 Far West 30 8.5 Area 9 Far West 31 8.8
No Area Given 3 .9








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Table 4-1 Continued

Educational Level

Bachelor 13 3.7 Master 236 67.2 EdS 13 3.7 PhD or EdD 74 21.1 Other 13 3.7 Missing 2 .6


Job Title

Counselor/Therapist 254 72.4 Teacher 12 3.4 Administrator 25 7.1 Other 29 8.3 Missing 31 8.8

Types of Experience with Self-Help Groups

No experience 26 7.4 1 type 79 22.5 2 types 125 35.6 3 types 88 25.1 4 or more types 33 9.4

Amount of Training with Self-help Groups

No Training 4 1.1 1 kind 113 32.2 2 kinds 83 23.6 3 kinds 103 29.4 4 kinds 48 13.7



The geographic distribution of participants seems to

follow the general population distribution of the United

States. The majority (49.3%) live within the East Coast

region, in postal zip code areas 0-3, including all the

Atlantic Seaboard. The Mid-West region, areas 4-6, accounts

for 25.9% of the sample. The Far West, areas 7-9, accounts

for 23.9%.







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As might be expected in a professional organization, 88.3% had graduate degrees. The majority (67.2%) had Master's degrees. Most of the participants (72.4%) listed their job title as counselor/therapist. The remaining participants were divided between administrators, teachers, other, or not given.

Only 7.4% of the participants had no experience with self-help groups. Almost one quarter of the participants (22.5%) had experienced one type of collaboration with selfhelp groups. A surprisingly large number (70.1%) had experienced two or more types of collaboration with selfhelp groups. Regarding training with self-help groups, only

1.1% had no training, 32.2% had one kind of training, and 66.7% had two types of training or more. Demographic characteristics of the AMHCA membership were unavailable for this study. It is assumed, however, that the AMHCA members in this study were representative of all AMHCA members because they were randomly selected.



Item Analyses

Item analyses were performed on the items in both

sections of the SAESHG. The means and standard deviations for items in both sections of SAESHG are shown in Table 4-2.








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Table 4-2
Means And Standard Deviations For All Items

Item Number Mean s.d. N

Section I
1 4.08 .98 302 2 3.61 1.07 265 3 4.10 .89 304 4 3.31 1.16 239 5 3.54 1.12 270 6 3.20 1.14 211 7 3.14 1.07 219 8 3.88 1.04 251 9 3.44 1.12 238 10 3.89 1.09 253 11 3.31 1.17 231 12 3.02 1.24 195
Section II
1 3.03 1.19 362 2 3.68 1.13 361 3 4.51 .82 365 4 4.39 .84 363 5 2.82 1.03 361 6 3.32 .94 360 7 3.67 .77 360 8 4.48 .81 364 9 4.11 .80 361 10 2.91 1.24 363 11 2.41 .99 362 12 4.37 .92 364 13 3.97 .96 363 14 3.56 1.06 362 15 4.35 .93 363 16 3.10 1.18 357 17 3.94 .88 355 18 4.51 .80 360 19 3.55 1.09 360 20 3.14 1.00 351 21 2.38 1.10 360 22 2.75 1.16 356 23 3.26 1.14 358 24 4.25 .84 359 25 2.66 1.02 360 26 2.14 .91 355 27 4.14 .87 359 28 3.22 .98 356 29 2.91 1.26 361 30 3.49 1.04 353 31 3.75 .93 360 32 2.30 1.17 359 33 3.16 .99 355








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Table 4-2 Continued

Item Number Mean s.d. N

Section II
34 4.15 .75 359 35 4.11 .97 358 36 2.28 1.05 356 37 4.22 .90 354 38 4.19 .72 358 39 1.84 1.10 358 40 2.14 .90 359 41 2.69 1.10 353 42 3.74 .99 361 43 3.76 .92 354 44 4.19 .75 364 45 4.10 .86 362 46 2.93 1.07 359 47 4.30 .82 361 48 2.71 1.05 354 49 3.59 .89 361 50 3.87 .72 361 51 3.27 1.03 355 52 3.64 .90 361 53 3.92 .86 354



Section I consisted of items 1 through 12, listing 12

methods of collaboration between helping professionals and

self-help groups. Respondents were asked to evaluate the

effectiveness of those methods with which they had experience by using a Likert-type scale. Possible responses

ranged from 1, very ineffective, to 5, very effective.

Table 4-2 indicates that the highest number of respondents

chose item 3, indicating experience making referrals to

self-help groups. The data in Table 4-2 also indicate that

302 respondents chose item 1, indicating they used self-help

groups as a source of information. These two areas of







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collaboration also had the highest mean (4.1) rating them the most effective method of collaborating as well.

The lowest number of responses (195) was to item 12,

conducting research on self-help groups or phenomenon. The remaining 10 items had means ranging from 3.89 to 3.02. The item means for Section I were at the high end, ranging from 3.02 to 4.10. There was considerable variability, however, in responses as demonstrated by the range of the item standard deviations from .89 to 1.24.

Section II consisted of 53 statements about selfhelp groups which respondents were asked to rate, again using a Likert-type scale. The number of responses per item ranged from a high of 365 responses to item 3, self-help groups are an important resource in meeting the mental health needs of society, to a low of 315 to item 20, self-help groups encourage members to conform to social norms. The means ranged from a high of 4.51 for item 18, self-help groups are not effective to a low of 1.85 for item 39, self-help groups should be regulated by the government for consumer protection. Variance in response to the items was indicated by the item standard deviations ranging from .72 to 1.27. The participants' response rates for Section II, the Attitude Scale, are shown in Table 4-3.







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Table 4-3 Participants' Response Rates to Attitude Scale

# of Items Omitted Frequency % Cum %

0 288 70.2 70.2 1 40 9.8 80.0 2 15 3.7 83.7 3 8 2.0 85.6 4 1 .2 85.9 5 1 .2 86.1 6 1 .2 86.3 8 1 .2 86.6 11 1 .2 86.8 13 1 .2 87.1 19 1 .2 87.3 20 1 .2 87.6 21 1 .2 87.8 24 1 .2 88.0 25 4 1.0 89.0 43 1 .2 89.3 53 44 10.7 100.0

TOTAL 410 100.0 100.0
Mean 6.58
Standard Deviation 16.58




The participants' responses to the items in Section I,

the Experience Scale, are provided in Table 4-4.


Table 4-4 Frequency and Value Distribution of Items in Section I

1. Use self-help groups as a source of information.

Value Label Value Freq Percent

Very Ineff 1 10 2.8 Somewhat Ineff 2 15 4.3 Neither 3 27 7.7 Somewhat Eff 4 126 35.9 Very Eff 5 110 31.3 No Response 9 63 17.9 Mean 4.08 Standard Deviation .99








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Table 4-4 Continued
2. Publicize self-help groups active in the area.

Value Label Value Freq Percent

Very Ineff 1 13 3.7 Somewhat Ineff 2 28 8.0 Neither 3 55 15.7 Somewhat Eff 4 108 30.8 Very Eff 5 48 13.7 No Response 9 99 28.2 Mean 3.59 Standard Deviation 1.07

3. Make referrals to self-help groups.

Value Label Value Freq Percent

Very Ineff 1 6 1.7 Somewhat Ineff 2 14 4.0 Neither 3 26 7.4 Somewhat Eff 4 140 39.9 Very Eff 5 103 29.3 No Response 9 62 17.7 Mean 4.11 Standard Deviation .90

4. Share facilities with self-help groups.

Value Label Value Freq Percent

Very Ineff 1 24 6.8 Somewhat Ineff 2 18 5.1 Neither 3 93 26.5 Somewhat Eff 4 51 14.5 Very Eff 5 44 12.5 No Response 9 121 34.5 Mean 3.32 Standard Deviation 1.18

5.Receive referrals from self-help groups.

Value Label Value Freq Percent

Very Ineff 1 21 6.0 Somewhat Ineff 2 22 6.3 Neither 3 58 16.5 Somewhat Eff 4 108 30.8 Very Eff 5 47 13.4 No Response 9 95 27.1 Mean 3.54 Standard Deviation 1.13








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Table 4-4 Continued
6. Form an advocacy group or coalition with a self-help group.

Value Label Value Freq Percent

Very Ineff 1 25 7.1 Somewhat Ineff 2 22 6.3 Neither 3 70 19.9 Somewhat Eff 4 67 19.1 Very Eff 5 22 6.3 No Response 9 145 41.3 Mean 3.19 Standard Deviation 1.15

7. Integrate self-help group members into committees,boards,etc.

Value Label Value Freq Percent

Very Ineff 1 23 6.6 Somewhat Ineff 2 28 8.0 Neither 3 75 21.4 Somewhat Eff 4 73 20.8 Very Eff 5 15 4.3 No Response 9 137 39.0 Mean 3.14 Standard Deviation 1.08

8. Serve as a consultant to a self-help group.

Value Label Value Freq Percent

Very Ineff 1 14 4.0 Somewhat Ineff 2 11 3.1 Neither 3 33 9.4 Somewhat Eff 4 113 32.2 Very Eff 5 70 19.9 No Response 9 110 31.3 Mean 3.89 Standard Deviation 1.06

9. Use a self-help group as consultants.

Value Label Value Freq Percent

Very Ineff 1 20 5.7 Somewhat Ineff 2 20 5.7 Neither 3 61 17.4 Somewhat Eff 4 93 26.5 Very Eff 5 36 10.3 No Response 9 121 34.5 Mean 3.46 Standard Deviation 1.12








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Table 4-4 Continued
10. Provide training to a self-help group.

Value Label Value Freq Percent

Very Ineff 1 17 4.8 Somewhat Ineff 2 7 2.0 Neither 3 42 12.0 Somewhat Eff 4 102 29.1 Very Eff 5 78 22.2 No Response 9 105 29.9 Mean 3.88 Standard Deviation 1.10

11. Receive training from a self-help group.

Value Label Value Freq Percent

Very Ineff 1 23 6.6 Somewhat Ineff 2 28 8.0 Neither 3 62 17.7 Somewhat Eff 4 77 21.9 Very Eff 5 34 9.7 No Response 9 127 36.2 Mean 3.32 Standard Deviation 1.18

12. Conduct research on self-help group or phenomenon.

Value Label Value Freq Percent

Very Ineff 1 36 10.3 Somewhat Ineff 2 13 3.7 Neither 3 76 21.7 Somewhat Eff 4 41 11.7 Very Eff 5 25 7.1 No Response 9 160 45.6 Mean 3.03 Standard Deviation 1.25



The methods of collaboration selected as very

effective were using self-help groups as a source of

information (item 1), making referrals to self-help groups

(item 3), and providing training to a self-help group (item

10). The methods chosen least effective were forming an

advocacy group or coalition with a self-help group (item 6)







-84


and conducting research on a self-help group or phenomenon (item 12).

The methods of collaboration which had the lowest

percentage of no response, less than 20%, indicating the most experience, were using self-help groups as a source of information (item 1), and making referrals to self-help groups (item 3). The highest percentage of no response, more than 40%, indicating areas of least experience, were forming an advocacy group or coalition with a self-help group (item 6), and conduct research on self-help group or phenomenon (item 12).



Content Validity


Although the panel of experts chosen to evaluate the items generated for the SAESHG rated the items appropriate, they had difficulty choosing which item was in which content area for Section II, the Attitude Scale with 53 items. This was especially true in discriminating between the areas of purposes/activites and characteristics. The panel could not decide between purposes/activities and characteristics for 31 items. For the content area relations to other helpers, 17 items were developed, and 15 of these were chosen for that area by the panel. Rather than discard items which the panel had agreed were appropriate for the instrument because of confusion over








-85


which content area the item should be placed in, all items were retained. After the field test, factor analyses were completed so that items could be seperated by empirical methods.



Construct Validity



Factor analyses were completed on both sections of the SAESHG using responses from the field study to determine how items loaded in both Section I and Section II. Regarding Section I, the Experience Scale, a factor analysis using principal component analysis was completed. Because items were designed for one scale, a decision was made a priori to force items to one factor. As can be see in Table 4-5, all items have a factor loading of at least .54.


Table 4-5
Principal Component Analysis of Section I, Items 1-12

Item # Factor Loading

1 .55287 2 .63918 3 .55763 4 .59291 5 .60604 6 .71064 7 .61656 8 .54512 9 .64949 10 .65004 11 .62643 12 .60665








-86


A principal component analysis using an oblique

rotation was used on Section II, the Attitude Scale. A .30

loading cut-off point was used to select items for factor

loadings. It was believed a priori that items comprised

three separate scales. The factor analysis used to explore

this possibility was a principal component analysis for a

three factor solution. The resulting factor loadings are

shown in Table 4-6.



Table 4-6
Factor Loadings: Principal Component Analysis, Oblique

Item# <.3 Factor 1 Factor 2 Factor 3

1 .33162
2 X
3 .61759 4 .59257
5 .36092
6 X
7 .55139 8 .56372 9 .41192
10 .47340 11 X
12 .67783 13 .59428 14 .34812 15 .39778 16 -.64683 17 .58893 18 .76605 19 .34280 20 X
21 .36025 .45434 22 .51548 23 .65330 24 .45699 25 .49758 26 .52298 27 .36324 28 X
29 .41990








-87


Table 4-6 Continued

Item# <.3 Factor 1 Factor 2 Factor 3

30 .36863 31 .54763 32 .38013 33 X
34 .58914 35 .36185 36 .71750 37 .30359 38 .71734 39 -.31153 40 .64729 41 X
42 .40963 .30643 43 .43255 44 .70545 45 .58375 46 X
47 .71982 48 .41441 49 .52232 50 .58460 51 .32492 .32133 52 .57143 53 .63732


Based on the loading cut-off point of .30, the

following items were not retained: 2, 6, 11, 20, 28, 33, 41,

and 46. Item 37 just met the cut-off criteria with a loading

of .30359.

A principal component analysis with a varimax rotation

also was done using a three factor solution with very

similar results. Table 4-7 provides the factor loadings for

each item.








-88


Table 4-7
Factor Loadings: Principal Component Analysis, Varimax

Item# <.3 Factor 1 Factor 2 Factor 3

1 .34789
2 X
3 .61405 4 .58552
5 .34684
6 .30386
7 .54905 8 .54354 9 .41197
10 .48618 11 X
12 .66787 13 .59926 .32267 14 .35651 15 .38670 16 -.64244 17 .59120 18 .75954 19 .33960 20 X
21 .34811 .42120 22 .52396 23 .66358 24 .45474 25 .50565
26 .50307 27 .36073 28 X
29 .42511 30 .36926 31 .54715 32 .37304 33 X
34 .59026 35 .36755 36 .70257 37 .31117 38 .71753 39 -.30012 40 .64163 41 X
42 .39612 .35337 43 .41485 44 .70278 45 .58115 46 X
47 .71455








-89


Table 4-7 Continued

Item# <.3 Factor 1 Factor 2 Factor 3 48 .42592 49 .52457
50 .58588
51 .33341 .34456 52 .57382
53 .63406



A comparison of Table 4-6 and Table 4-7 reveals that for both analyses items 2, 11, 20, 28, 33, 41, and 46 had loadings less than .3. Item 6 did load on factor 2 using the varimax rotation, but since it loaded at .30386, this item cannot be considered definitive. Comparing the loadings on Factor 1, all the items were the same for both with the exception of item 37 which loaded on the oblique rotation at .30359. Due to the low value of this loading, item 37 could be discarded. On Factor 2, the same items loaded with the exception of 6 and 13. Item 13 had a higher value on Factor 1. On Factor 3, the same items loaded with the exception of items 9 and 37, both of which had values less than .312. This comparison of Table 4-6 and Table 4-7 appears to further indicate that items 2, 11, 20, 28, 33, 41, and 46 could be omitted from the instrument since they did not load on any factor, and that the remaining 46 items are loading on the same factors, with few exceptions.

A review of the items showed that many loaded as

expected. Some of the items which did not load seemed to be








-90


related to each other. Since one explanation of the

difficulty of the panel of experts to choose between the

three hypothesized factors was that there was another factor

within one of the possible three factors, a principal

component analysis was conducted to investigate if there was

a fourth factor. Results are shown in Table 4-8.


Table 4-8 Factor Loadings: Principal Component Analysis, Varimax Rotation

Item# <.3 Factor 1 Factor 2 Factor 3 Factor 4

1 .44908 2 -.55732
3 .62001 4 .58890
5 .55298
6 .34638
7 .53849 8 .54449 9 .39592
10 .40960 .41737 11 -.39497
12 .67632 13 .61545 14 .35795 15 .39344
16 -.72561
17 .58809 18 .76679 19 .35521
20 .34403
21 .36139 .62873
22 .51187
23 .68719
24 .45528 -.36059
25 .50719 26 .53884
27 .34875
28 X
29 .42199 30 .36669 31 .56876
32 .41503
33 X
34 .59493








-91


Table 4-8 Continued

Item# <.3 Factor 1 Factor 2 Factor 3 Factor 4

35 .36798
36 .70528
37 .30085 38 .72900 39 -.30664
40 .60429
41 X
42 .40624
43 .43989
44 .70972 45 .59066
46 X
47 .71987
48 .42064
49 .53034 50 .58988
51 .34030 .35097
52 .57591 53 .64653
Eigen value 9.65123 3.15474 2.68013 2.28233 Pct of 18.2 6.0 5.1 4.3
Variance

Of the items which had not loaded previously

across three factors, items 28, 33, 41, and 46 also

failed to load across four factors. Items 2, 11, and 20,

which had also failed to load previously, now loaded on

factor 4. In addition, items 1,5,10,24,32,and 51, which

had previously loaded on other factors, now loaded on

factor 4. This completed the factor analyses on Section

II.

At this point a Scree Test was used to assist in

selecting the three or four factor solution for subsequent

reliability studies. As illustrated in Figure 1, the elbow

occurring at factor 4 indicates that the four factor

solution is the more desirable one.






Eigen Values

10

9-
8
7-

6-

5-
4-

3
2 -0



0 1 2 3 4 5 6 7 8 9 10 11 12131415161718
FACTORS FIGURE 1. SCREE TEST







-93


Factor 1 consisted of 31 items with factor loadings ranging from .30 to .76. The content of these items pertained to characteristics of self-help groups including benefits to members, strengths, and importance of self-help groups. Factor 2 consisted of 10 items with factor loadings ranging from .35 to .60. The content of these items pertained to contrasts between self-help groups and traditional therapies.

Factor 3 consisted of 4 items with factor loadings from .63 to .73. Items related to the involvement of a helping professional with a self-help group. Due to the high negative loading of item 16, it was omitted prior to the reliability analysis for this factor.

Factor 4 consisted of 9 items with factor loadings from .34 to .56. The content of these items related to comparisons between self-help and professional services, and functions of self-help groups. Items loading on this factor did not seem to be as related in content as on the other factors.

Reliability

As mentioned previously, data analyses were

completed using 351 participants, or those participants who responded to 50 or more items in Section II. Based on the factor analytic solutions, reliability studies were conducted on Section II for factors 1, 2, 3, and 4. The




Full Text

PAGE 1

THE DEVELOPMENT OF AN INSTRUMENT TO SURVEY EXPERIENCES WITH AND ATTITUDES TOWARD SELF-HELP GROUPS BY R. LYNN MCREE A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 1989

PAGE 2

ACKNOWLE DGMENTS I would like to thank several people to whom I am indebted for helping to make this project a reality. First, I would like to thank my chairman, Dr. Rod McDavis, for his continued encouragement and assistance throughout a process, which lasted much longer than either of us anticipated. Next, I would like to thank my committee members. Dr. Ellen Amatea and Dr. Bob Ziller, for their suggestions and support . I would also like to thank my friends for their lasting belief in me, their humor, kindness, and love which helped me to persist. I would also like to thank my in-laws, Norman and Renee Krim, for buying us a computer which made it all so much easier. . . ; Special thanks are extended to the professionals who served on the panel of experts and the members of AMHCA who responded to a stranger's request so diligently. Without them this study would have been impossible. Finally, special appreciation goes to my family. I would like to thank my husband, Allan Krim, for his patience, his ii

PAGE 3

ready willingness to assist in any way he could, his typing, and his computer skills. His love, faith, and encouragement made it possible to keep going. And thanks go to my daughters, Jessa and Leah, who inspired me to practice what I intend to preach by finishing what I had begun. ^,

PAGE 4

TABLE OF CONTENTS > ; ' -f page ACKNOWLEDGMENTS ii ABSTRACT vi CHAPTERS 1 INTRODUCTION 1 Statement of the Problem 8 Need for the Study 10 Purpose of the Study 13 / Significance of the Study 13 / Definition of Terms 16 / Organization of the Study 18 i I 2 REVIEW OF RELATED LITERATURE 19 Self -Help Movement 19 Competing Explanations of Self-Help Group Deve 1 opment 26 The Power Struggle Between Self-Help and Professionals 31 Professional Collaboration with Self-Help Groups 38 Self-Help and Research 47 Summary 50 3 METHODOLOGY 53 Research Questions 53 Theoretical Basis 54 Item Development 55 Pilot Study 61 Panel of Experts Item Response 65 Field Test 69 Limitations of the Study 71 iv

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1^ 4 RESULTS AND DISCUSSION 73 Results of the Study 73 Sample 73 Item Analyses 76 Content Validity 84 Construct Validity 85 Reliability 93 Discussion of the Results 96 Content Validity 96 Construct Validity 100 Internal Reliability 101 5 CONCLUSIONS, IMPLICATIONS, SUMMARY, AND RECOMMENDATIONS 102 Conclusions 102 Implications 102 Summary 105 Recommendations 106 APPENDICES A MEMBERS OF THE PANEL OF EXPERTS 108 B SAESHG 110 REFERENCES 116 BIOGRAPHICAL SKETCH 125 V

PAGE 6

Abstract of Dissertation Presented to the Graduate School of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy THE DEVELOPMENT OF AN INSTRUMENT TO SURVEY EXPERIENCES WITH AND ATTITUDES TOWARD SELF-HELP GROUPS BY R. Lynn McRee August, 1989 Chairman: Dr. Roderick McDavis Major Department: Counselor Education The purpose of this study was to develop an instrument, The Survey of Attitudes toward and Experiences with SelfHelp Groups (SAESHG) , and to answer three research questions regarding the instrument's content validity, factor structure, and reliability. Section I of the SAESHG was a survey of experiential knowledge and Section II, a survey of theoretical knowledge of self-help groups. Item development was based on extensive review of the literature on self-help groups. The items were subsequently evaluated by a panel of experts possessing both experiential and theoretical knowledge of self-help groups. One thousand members of the American Mental Health Counselors Association (AMHCA) were surveyed, and 410 vi

PAGE 7

returned completed instruments. Three hundred and fifty one surveys with at least 50 of 53 items completed were used for the analyses. Item responses were factor analyzed and four factors were found. Generally supported from the analyses were the construct areas of purposes/activities, characteristics, and relationship to other helpers. Alpha coefficients for the four factors were .91, .64, .66, and .56 respectively. Additional refinement of the SAESHG was suggested and various studies recommended to further validate the instrument. vii

PAGE 8

CHAPTER 1 INTRODUCTION Therapy is an essentially human activity which has been preempted and monopolized by a therapy elite and sold as a commodity on the open market (Glenn & Kunnes, 1973, p. 8). Self-help groups trace their origins to early man. Associations in the Mesolithic period, first formed for the purposes of hunting and gathering, evolved during the Neolithic Period into agricultural villages. These associations, based upon shared ties and common interests, reached their crest in the modern urban-industrial period. Over the past two decades, a growing consumerism has lead people to take greater responsibility for their own needs. This initiative has been associated with the proliferation of mutual help groups and organizations (Silverman, 1986) . Found in all parts of the world, mutual aid associations or mutual help groups, now referred to as self-help groups, have played a continuous role in social and cultural change and in the evolution of society (Anderson, 1971) . Currently, there are over 500,000 self-help groups (Katz, 1981) . These groups, with a combined membership of -1-

PAGE 9

-215 million people, range in size from Alcoholics Anonymous (A. A.) which has 750,000 members in over 40 countries, to local neighborhood groups which may have less than ten members. The concept of mutual aid is not limited to one culture or type of political environment. Self-help groups range from organizations of welfare mothers in Australia to hypertension clubs in Yugoslavia, to relatives of mental patients in Austria, and to consciousness raising among children in England (Katz & Bender, 1976b) . Many views concerning self-help groups have been stated in the literature. Authors consider it a social movement (Katz & Bender, 1976b; Sidel & Sidel, 1976; Toch 1965; Vattano, 1972) , a spiritual movement or secular religion (Hurvitz, 1974; Mowrer & Vattano, 1976; Newmark and Newmark, 1976), a support system (Killilea, 1976), a phenomenon of the service society, (Gartner & Reissman, 1974) , a svibculture, or an agency of social control and resocialization. Prominent among these orientations is the view that selfhelp groups are part of the service society, particularly in the area of mental health services (President's Commission on Mental Health, 1978) . Authors L' Abate and Thaxton (1981) typed self-help groups into three categories: physical, emotional, and social. Examples in these categories include the Endometriosis Association for the physical type.

PAGE 10

-3Alcoholics Anonymous for the emotional type, and Parents Without Partners for the social type. The rise and fall of mutual aid or self-help groups is closely linked to economic and social conditions as can be seen by tracing the history of these organizations. In some form, they have continued from earliest times to the present and will, no doubt, persist as long as the imperfections of social living and social institutions endure (Katz, 1981). Social and economic conditions have also affected the development of therapy. Therapy in the United States began in the early 19th century with physicians treating emotional problems as stemming from abnormalities in the brain and/or nervous system, or as evil "humors" circulating in the body. Some kind of curse or bad living also was considered to be a likely cause of emotional disorders. Treatment consisted mainly of containment in the familial home or imprisonment . In the early 1800s, so-called mental patients began to be seen as human beings with something wrong with their bodies that was causing problems with their heads. This organic approach to mental illness became a new area of study. In Europe, where the asylums were overcrowded, patients were released and treated with various techniques.

PAGE 11

-4Physicians, as heads of asylums, set up diagnostic systems to govern the detainment and release of the interred masses. In the United States, the asylum system was largely for the well-to-do. Such places had large staffs and few ' patients. Therapy techniques included hydrotherapy, simple talks, walks, work, fear, whirlabouts in a chair, showers, and so on. The cure rate was actually fairly good. Those unable to afford the asylums turned to clergy, family, friends, quacks, and faith healers. Following the Civil War, with the influx of immigrants who could speak little English and who were culturally different, and large numbers of poor, ill-educated people pouring into the cities, the asylums became storage bins for the socially undesirable as well as the "insane." Cure rates dropped, and treatment was mainly custodial care until psychiatry emerged. Psychiatry became a medical specialty as an off-shoot of neurology. By the turn of the 20th century, it had given birth to psychoanalysis with its theory of inner conflict and the associated psychodynamic approach. According to Glenn and Kunnes (1973), Freud and his colleagues strongly influenced American psychiatry which was at the top of the therapy hierarchy. Freud's theories and techniques, however, were based on the treatment of rather disturbed but somewhat functional white middle-class cases, not the psychotic, interred mixed masses. Freud's theories split

PAGE 12

-5psychiatry into two camps, the proponents of intrapsychic conflict and the more medically minded psychology of the older physical/organic school. In either case, therapy was still firmly in the hands of the medical professions (Glenn & Kunnes, 1973). As the 20th century progressed, people other than physicians entered the therapy profession. Soon after World War II, therapy suddenly came of age. From the viewpoint of Glenn and Kunnes (1973), psychiatrists and psychologists were hired to sell bourgeois psychology to everyone, and the government suddenly discovered the value of the idea of "mental illness." Therapy was a^comment on all', a cureall. Social workers, clinical psychologists, hospital personnel, and others claimed their own special expertise all their own. Therapists became consultants to every sector of American life. Psychologists began to develop their own "clinical" talents, and social workers did the same. In fact, each group of ancillary personnel began to develop its own ideology, its own professional history, and its own "expertise" (Glenn & Kunnes, 1973) . After 1963, newly created mental health centers, with their expanded programs featured a proliferation of jobs for therapists. Therapy became big business. For some time, it seemed that therapists, or helping professionals, could afford to simply ignore the self-help movement. A

PAGE 13

-6coininittee report on "Humanizing Health Care" contained a section on self-help and medical self-care outlining the nature of these activities, addressing policy implications, and suggesting needed directions for research. It was the first time that a professional organization of social scientists recognized the importance of self-help organizations both as a form of social institution and as a useful field of study (Humanizing health care, 1977) . Since the early 1970s, when helping professionals began to recognize and write about the self-help movement, several changes have occurred in the relationship between the helping professional and self-help groups. Professionals' reactions, which initially ranged from hostile to ambivalent, now seem to be more accepting, with a trend toward "symbiotic cohabitation" (Riordan & Beggs, 1987) . A survey of helping professionals attitudes toward and experiences with self-help groups would provide information to substantiate or refute this suggestion of symbiotic cohabitation. The survey could also provide information as to the autonomy of the self-help movement from the professional sector. This could be gauged by assessing professionals relative involvement with self-help groups. Finally, results of the study might provide information as to the degree of acceptance by helping professionals of self-help groups as an alternative treatment method.

PAGE 14

-7If the fate of the paraprofessional movement in the human services was any indication, the attitudes of the professional community will have a great deal of influence on the self-help movement. The role of the paraprofessional was developed in the 1960s to capitalize on "natural helpers" or those people in the community who seemed to be able to very effectively establish helping relationships with their neighbors. They were hired by various agencies to do their helping under the auspices of the agency (Pearl & Riessman, 1965) . Gradually, they came to be supervised by agency workers, and their work was regularized by agency rules and professional practice. Formally or informally, they were pressured to improve their education and become more professional. Their unique helping qualities became less and less valued by the agencies and by themselves. They have long since been absorbed into agencies, adopting the values and working within the organizational constraints of those agencies (Silverman, 1986) . This tendency to coopt may be affected by the positive or negative attitudes and experiences that professionals have toward self-help groups. The type of attitudes that professionals have toward selfhelp groups will play a decisive role in the nature and extent of collaboration that professionals will have with self-help groups. . .

PAGE 15

-8Statement of the Problem As self-help groups have grown in the last 25 years, discontent with professional services viewed as ineffective, unaf fordable, and irrelevant also has increased. Self-help ^ groups could be seen as an alternative or adjunct to professional services, Caplan and Killilea (1976), Dumont (1974), Gartner and Reismann (1974), and Levy (1976) noted that self-help groups are increasingly recognized as important resources in meeting the mental health needs of our society. Self-help groups are recognized as resources both by people who, in large numbers, are turning to various self-help groups for support, and by helping professionals who are considering ways of utilizing self-help groups in the mental health system. Interest in self-help groups also has extended to other individuals and/or professionals concerned with incorporating such groups into their service delivery system. Some guidelines for the utilization and/or collaboration of self-help groups were in a report of The 1978 President's Commission on Mental Health, which included several recommendations for initiatives by the federal government in community mental health. Among the initiatives particular to self-help groups were to improve the linkages between natural networks and professionals, to recognize and strengthen natural helping networks, and to

PAGE 16

-9monitor changes in American life (President's Commission on Mental Health, 1978) . Specific objectives suggested were to provide directories of self-help groups to mental health centers for dissemination to the general public; develop a clearinghouse for dissemination of information on mutual help groups; sponsor conferences to "enable professionals and members of self-help groups to learn from each other; and develop curricula in all helping related undergraduate and graduate programs on the nature and function of community support systems, natural helping networks, and mutual help groups" (President's Commission on Mental Health, 1978, p.l2) . The relationship between self-help groups and helping professionals is an important one which should be studied. Self-help groups not only affect the growing number of people who join them, but they also affect a widening circle of people within the community. As self-help groups become more action-oriented, they will need to broaden their support base in order to achieve their goals. It is important to understand the attitudes of people in the community, including mental health professionals, toward self-help groups to evaluate such things as the probability of the self-help group being able to achieve its goals within the community.

PAGE 17

-10To date, few studies have been conducted surveying the attitudes of various helping professionals toward self-help groups. Unfortunately, they all followed an ad hoc design in that all instruments were developed for a specific study. Each had serious methodological limitations and nothing was provided on validity or reliablity of the instrument used. Need for the Study Thus far, the self-help movement has been ignored by most social scientists. Some attempts have been made to study the effectiveness of self-help groups. The paucity of adequate outcome studies stems from the lack of attention and problematic issues relating to the technical complexity of the research (Lieberman & Borman, 1976) . The research task can be defined as "(1) what kind of changes are produced by (2) what kinds of group methods applied to (3) what kinds of group members by (4) what kinds of group leaders under (5) what kinds of group environment conditions" (McGovern, 1983, p. 468). According to Priddy (1987) , the problems encountered while doing outcome research on self-help groups are due to two factors: the complexity of group phenomenon and the primitive state of theoretical development in the area of group treatment. He

PAGE 18

-11concluded that it may be an impossible task to determine the effectiveness of self-help groups using empirical methods. At this point, there is really no aspect of the selfhelp movement which has been adequately researched. Few instruments have been developed to measure the outcomes of participation in self-help groups, the effectiveness of groups in dealing with specific problems, or the attitudes of members of self-help groups toward helping professionals. Of the few, even less have been 11 validated. The need exists for their development, however. Killilea (1976) , in a review of the literature on selfhelp groups, suggested that What is needed are more studies looking at the actual relationship in nature between individual professions and individual mutual help groups; referral patterns and kinds of transactions between mutual aid organizations, individual professionals, and formal human service institutions, (p. 82) One important area for research is how self-help groups are viewed by others (Levy, 1978) because self-help groups are having an increasingly active role in their communities. This increased activity may be due to the fact that selfhelp groups are being recognized as a means of achieving some of the goals of community mental health centers. The degree of support a self-help group receives from professionals within the community, the nature of its institutional affiliation, and the character of its community, all will affect the manner in which the group

PAGE 19

-12f unctions and how effectively. As cominunity institutions and agencies become increasingly involved in sponsoring self-help groups, their attitudes will affect the growth and effectiveness of these groups (Levy, 1984) . ? Self-help groups are viewed by Lurie and Shulman (1983) as therapeutic and physical extenders of services. They ^ », feel self-help groups and professionals providers can be major allies in identifying needed services and marshalling consumers' active participation to work within the health care system to develop needed services. According to Chutis (1983) , the provision of services to self -help/mutual aid groups is a natural outgrowth of the goals, objectives and activities of the consultation and education (C&E) departments of community mental health ~ centers. Recently, C&E services have expanded to include the education and training of natural community care-givers, such as self-help groups, in an effort to better serve the mental health needs of the larger community (Snow & Swift, 1981) . Results of a survey of 244 mental health centers throughout the country conducted by Hermalin and Swift (1981) indicate that the importance of involvement with self-help groups has been widely recognized. Staff in surveyed facilities reported initiating self-help groups, providing space, and making referrals as some methods of collaboration. There is a need to gather information on the

PAGE 20

-13attitudes of self-help members, community members, and helping professionals, among others, toward self-help groups . The focus of this study was to develop an instrument to examine helping professionals' attitudes toward self-help groups. There is a lack of adequate assessment tools to gather this needed information. These two factors, a need for information, and a need for a tool to gather the information, were addressed in this study by the development of an instrument to assess attitudes toward and experiences with self-help groups. Purpose of the Study The purpose of this study was to develop and validate an instrument to assess helping professionals' experiences with and attitudes toward self-help groups. Content and construct validitation procedures were used. The internal consistency of the instrument also was determined to provide some evidence as to the reliability of the instrument. Significance of the Study The development of an instrument to measure attitudes toward self-help groups would assist the researcher

PAGE 21

-14examining perceptions of self-help groups. The instrument provides a method of assessing the current attitudes of helping professionals toward self-help groups as well as providing the means to assess helping professionals' attitudes in the future. The instrument facilitates information gathering. It has potential uses for future research efforts. An instrument assessing the attitudes towards self-help groups also allows comparisons of different populations, after validation on those populations. The instrument can be used to develop profiles of those persons, or groups of persons, most favorable and least favorable toward self-help groups. The instrument can be a standard assessment tool which can promote generalizations across studies. The instrument can be used to assist professionals in their consultation activities with other professionals or with self-help groups. The assessment of the consultees' attitudes can be an excellent method for professionals to begin the consultation process. The instrument also can be used with self-help groups to assist them in their consultations with professionals or in their assessment of the ' ; degree of openness of systems or organizations to their groups. Additionally, the instrument may aid professionals in determining whether to refer clients to self-help groups

PAGE 22

-15by using it to assess the attitudes of those clients for whom the professional is considering referral. In the area of training, the instrument can be used as a preliminary assessment tool to aid in planning training activities for helping professionals. By assessing the attitudes of the trainees toward self-help groups, trainers can prepare a program to either strengthen or challenge these attitudes. Much discussion also can be generated concerning training needs. The instrument can be used to identify those professionals who have both experiential and professional knowledge of self-help groups. These individuals can be important role models in training programs for collaborating with self-groups (Borman, 1976) . The instrument can be used by students in professional training programs as a self-assessment tool. By assessing the attitudes of its students, a departmental faculty can better plan further training or practicum experiences with self-help groups or determine whether such steps are necessary. As previously discussed, the instrument was developed for multiple uses. At the same time, it was beyond the scope of this study to validate the instrument on all populations for which it might be used. For the purpose of this study, members of the American Mental Health Counselors Association (AMHCA) , a diverse group of helping

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-16professionals, were selected as the group of professionals to use for validation purposes. ' . s • . . Definition of Terms The terms listed below are defined in the following manner for the purposes of this study: Attitude is a predisposition toward a psychological object, i.e., person, thing, concept, or idea. Human service professionals are helping professionals in the areas of mental health, psychology, behavioral science, and medicine. Mutual aid/mutual assistance is cooperation among groups or individuals for the purpose of support or assistance. Mutual aid groups are voluntary groups whose purpose is to provide help and support for its members in dealing with their problems and improving their psychological functioning and effectiveness. A Natural helping network is a group or system of people voluntarily created and continued by themselves for the purposes of support and mutual aid. A Self-help group is a voluntary group whose purpose is to provide help and support for its members in dealing with their problems and improving their psychological or physical

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-17functioning and effectiveness. The group's origin and sanction for existence rest with members of the groups themselves, rather than with some external agency or authority. The group relies on its members' efforts, skills, knowledge, and concern as the primary source of help. The group is generally composed of members who share a common core of life experiences and problems. Its structure and mode of operation are under the control of members, although they may, in turn, draw upon professional guidance and various theoretical and philosophical frameworks (Levy, 1978) . Support systems are continuing interactions with another individual, a network, a group, or an organization that provide individuals with feedback about themselves and 17 validation of their expectations about others (Caplan, 1976) . Therapists are helping professionals in the areas of mental health, psychology, and behavioral science. Voluntary associations are groups of individuals who share a common need or problem and who seek to use the group as a means of dealing with that need or problem. This term can be used synonymously with self-help groups and mutual aid groups.

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-18Orqanization of the Study The remainder of this study is organized into four chapters. A review of related literature on self-help groups and professional collaboration with self-help groups is presented in Chapter Two. The research questions, theoretical basis of the instrument, item development, pilot study, field test of the instrument, and limitations of the study are described in Chapter Three. The results of the study and a discussion of these results are presented in Chapter Four. Conclusions, implications, a summary, and recommendations for future studies are discussed in Chapter Five.

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CHAPTER 2 REVIEW OF RELATED LITERATURE Who then can so softly bind up the wound of another as he who has felt the same wound himself? (Thomas Jefferson) The review of related literature includes an overview of the self-help movement, the relationship of self-help groups and society, the power struggle between self-help and professionals, various methods of collaboration between self-help groups and professionals, research on self-help groups, and a summary. Self -Help Movement Self-help or mutual aid groups, broadly defined as voluntary associations among individuals who share a common need or problem and who seek to use the group as a means of dealing with that need or problem (Durman, 1976) , have early historical origins. Mutual aid groups began in the Mesolithic Period when individuals banded together to hunt and gather food. By the Neolithic Period, agricultural villages, formed on the basis of kinship ties and territorial groupings, were widespread (Anderson, 1971) . -19-

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-20Prince Peter Kroptkin, in a series of articles refuting Darwinism written in the 1890 's, argued that mutual aid played a role in the development of all animal species, including man. He maintained that man could survive the evolutionary process only through mutual aid and social cooperation. These two factors, mutual aid and social cooperation, were key elements in the formation and continuity of the family, tribe, village, and state (Kroptkin, 1914). Sociologist Louis Wirth (1938) agreed with Kroptkin that mutual aid groups developed very early in civilization and were found in most societies of the world. Wirth found no single cause for the development of self-help groups. He concluded that voluntary associations rise when primary bonds of kinship, neighborhood, family, and religion are weakened as well as thrive when the primary support system is supported (Smith & Freedman, 1972) . By the Middle Ages, mutual aid groups, originally a means of insuring physical survival, had expanded into the work arena. Much of the mutual aid in the Middle Ages and Renaissance was exclusive in character, however, limited to members of the guild or community. Strangers, pilgrims, or other non-members of the groups had to rely on the meager resources of the church or town charity for assistance.

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-21With the development of the Industrial Revolution in England and its ensuing social effects came "Friendly Societies." From early prototypes of the guild system. Friendly Societies were developed by the common people of England to cope with the stresses of industrialization. Before 1800, 191 such societies were founded. Generally, they were organized around occupations, providing members with funds for illness and old age. Friendly Societies aroused greatest opposition from employers who viewed the groups as schools for politics and class warfare (Katz & Bender, 1976a) . The growth of capitalist enterprise during the latter part of the 18th Century increased the hardships of the working class. Friendly Societies became used more and more as trade unions to defend or better the members' working conditions (Cole & Wilson, 1951) . Thompson (1963) estimated the total memberships of these societies as 648,000 in 1793, 704,000 in 1803, and 925,000 in 1815. In addition, many groups failed to register with the authorities due to the latter 's hostility towards them. Foster (1974) wrote, "the Friendly Society was one social institution that touches the adult lives of the near majority of the working population" (p. 216). Even in modern times. Friendly Societies are still evident. Beveridge (1948) found 18,000 Friendly Societies

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-22functioning in 1945 to provide housing and building services, workingmen ' s compensation and cooperative stores. Another outgrowth of the Industrial Revolution, in addition to Friendly Societies, was formalized consumer cooperatives. These developed rapidly in England and spread to other parts of Europe and later to North America. There was a clear mutual aid component in these cooperatives but few survived because the base of group cohesion was a "cash nexus" — a poor foundation upon which to build continuity of sentiment and human caring (Katz & Bender, 1976a) . The historical development of mutual aid groups in the U.S. closely paralleled that of the Mother Country. When colonists first came to America, it was necessary to band together for protection against nature, to assist each other to insure survival. Once a community was established, communal efforts were discarded in favor of the American tradition of rugged individualism. The wealth of virgin territory, seemingly unlimited natural resources, and the lack of state controls, made this move to individualism possible. As the American ethic of self-sufficiency developed, the needy were viewed as social outcasts — unfortunate due to their own moral failures. Any charity was provided through private agencies or individuals. This

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-23situation was to remain unchanged until the Great Depression. With the growing complexity of town and rural problems, new self-help forms emerged to meet common difficulties. For example, groups of dairymen formed mutual aid associations in 1800 to insure markets for their products, and the Mormons founded irrigation cooperatives to bring water in to Utah (Katz & Bender, 1976a) . The advent of the Industrial Revolution in the United States in the midnineteenth century, brought the same problems for the working class that had first become manifest in Englandgrievously long working hours, paltry pay, hazardous working conditions, forced child labor and chronic illnesses. These forces united the oppressed workers. Self-help, as a means of survival, re-emerged in the labor movement. In the 1870s a league of consumer cooperatives called the Sovereigns of Industry was organized. This movement was taken over by the Knights of Labor, an all-inclusive national trade union body which attained a membership of 703,000 in 1886 (Katz & Bender, 1976a). Their slogan, "An injury to one is the concern of all" (Boyer & Morals, 1975, p. 89) served to unite workers from hundreds of trades around demands for an eight hour working day, a minimum wage, grievance proceedings, safer working conditions, and an end

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-24to child labor. The idea of strength in unity has been the foundation for self-help groups ever since. A large part of the work force was composed of immigrants at this time. As newcomers in a strange land, the immigrants were at the bottom of the heap, forced to take the lowest paying jobs and live in the poorest housing. Beginning around 1800, large networks for self-help and mutual aid were developed by a variety of these immigrant groups. The Greek community in Massachusetts had over 1,000 members in its Pan-Hellenic Union in 1912. The Italians, Lithuanians, Germans, Russian and Polish Jews all set up similar organization to provide services ranging from free burials to free loans societies and wayfarers lodges. As the needs of the immigrants lessened, and their assimilation increased, these organizations slowly declined. Self-help groups were declining when the Great Depression overwhelmed the nation. With one third of the population ill-housed, ill-fed, and ill-clothed, the government was forced to set up programs. The service concept was born. Social Security, Vocational Rehabilitation, and Maternal and Infant Care were some of the varied programs created to give service to people with specific needs. Coupled with the Great Depression, the repeal of prohibition in 1933 increased the numbers of alcoholics who.

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-25in turn, added to the growing numbers needing inexpensive but effective psychological services (Brenner, 1973) . The existing systems were unable to meet the increased demand for help. New solutions were necessarily created. Many social experiments, including the development of selfhelp programs for social amelioration, were undertaken to solve the problems of the Great Depression. Seeking new and cheap methods to deal with multitudinous problems, the government created several self-help programs — Tennessee Valley Authority, Civilian Conservation Corps, Works Progress Administration and National Youth Administration. At the same time, the people turned to grassroots activities — wildcat strikes, resistance to evictions and foreclosures, and communal soup kitchens (Hurvitz, 1976) . Inclusive in the service concept was the belief that the professional knows best and that the professional has the power in the relationship. The client, if unhappy with this arrangement or critical of the service, was labeled uncooperative or resistant (Katz, 1970b). The third surge of self-help groups which occurred following World War II was initiated by two groups in response to being labeled or neglected by professional and bureaucracies (Steinman & Traunstein, 1976) . One group, parents of the mentally retarded, overcame almost insuperable odds to create schools and workshops for their children (Steinman & Traunstein,

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-261976) . The other group, alcoholics, whom professionals had been notably ineffective in treating, created their own treatment. Their organization, Alcoholics Anonymous (A. A.) has become the model for numerous self-help groups which followed. These include Gamblers Anonymous, Neurotics Anonymous, and Overeaters Anonymous. Competing Explanations of Self -Help Group Development Four viewpoints explain the development of self-help groups (Lieberman & Borman, 1976) . One view is that selfhelp groups developed from unmet needs. An example to illustrate this viewpoint is the growth in Alcoholics Anonymous which was the result of inadequate responses by professionals to alcoholism. A second view is that selfhelp groups developed as an alternative to services already provided. This viewpoint has been used by Tracy and Gussow (1976) to explain their finding that self-help health related groups are increasing at the same time as professional services are increasing. They suggest selfhelp groups offer support, technical assistance, models of dealing with an illness, social activity and usefulness, and help with an adaptive problem which professionals are not providing. A third proposed view is that self-help groups develop from the widespread feelings of alienation in our society

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(Mowrer & Vattano, 1976) . Striving to meet their needs for affiliation and a sense of community, individuals turn to a group. Meeting these needs through the group becomes even more important than the aim of the groups. A fourth view, that self-help groups develop from other affiliative arrangements outside kith and kin (Tax, 1976) , explains development to provide a basis for intimacy, identity, and affiliation. Back and Taylor (1976) have suggested an additional viewpoint to the four offered above. They viewed self-help as representing a social movement. They applied Blumer's five stages of a social movement to self-help groups. These stages: agitation, group forms which tries to cure the unrest, development of morals, development of ideology, and final achievement of goal (Blumer, 1969) , are paralleled in the reports of some self-help groups. Katz and Bender (1976b) concurred that self-help groups can be viewed as a social movement. They reasoned that self-help is change directed and seeks alterations in (1) its constituency's relation to society per se, (2) dominant institutions of the society, and often in (3) the personality and behavior of the member him/herself. From a review of the literature on self-help, Killilea (1976) concluded that mutual help organizations are not a simple phenomena or a single movement. She divided the

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-28literature into 20 categories of interpretation. These include the categories of support systems, product of social and political forces, phenomenon of service society, alternative care giving systems, adjunct to the professions, subculture-way of life, supplementary community, agencies of social control and resocialization process, and therapeutic method. Even this multiplicity of interpretations may not prove adequate for each of the over 500,000 self-help groups with their 15 million members (Evans, 1979) . The sweep of the concept of mutual aid itself offers wide latitude for expression in its social forms. It is not limited to one culture or type of political environment but includes such diversity as organizations of welfare mothers in Australia, hypertension clubs in Yugoslavia, relatives of mental patients in Austria, consciousness raising among children in England (First International Conference on Self-Help and Mutual Aid in Contemporary Society, 1976) . From reviewing the historical development of self-help and acknowledging the influence of social and economic factors upon that development, it becomes clear that, changes in the forms of help are shaped at least as much by the predominant social forces of the times as they are by thoroughly supported developments in the science of human behavior (Levine & Levine, 1970) .

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Today, as in the past, social conditions and economic factors are prime elements contributing to the growth of self-help groups. Some of the social conditions which have shaped the need for self-help groups include industrialization with its accompanying growth of vast business and governmental structures, high cost of professional services, loss of options in life choices, decline of faith in established institutions, feelings of powerlessness and inability to control events, decline in a sense of community and identity, and erosion of the family structure (Katz & Bender, 1976b) . Sidel and Sidel (1976) referred to self-help groups as the "grass-roots" answers to such social forces as the rate and pervasiveness of technology, the complexity and size of impersonal institutions, and prof essionalization of services that were previously provided by non-professional individuals. Durman (1976) viewed the self-help movement as a mandate for refocusing planning efforts of the next decade from the agency to the helping network; from services which ignored existing natural resources to efforts which encourage and foster the ability of ordinary people, working together, to resolve many of life's difficulties without professional intervention. Katz (1970a) encouraged self-help groups to continue in their militancy, renewal, and shake-up every few years to

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-30renew their vitality. Katz believes self-help groups can be innovative and challenging, that they can monitor professional services to ensure more and better provision of services, and fight the dead hand of bureaucracy. In agreement with Katz years prior, Maclver (1931) felt mutual aid associations have a flexibility, an initiative, a capacity for experiment, a liberation from the heavier responsibility of taking risks, which the state rarely, if ever, possesses. Associations can foster the nascent interests of the groups and encourage social and economic enterprise at the growing points of a society. It is this freedom to experiment, this struggle with society which Sidel and Sidel (1976) addressed. They warned that self-help groups should not be used to foster adjustment to an unjust society but should struggle to modify that society. They saw that self-help could be used to divert attention from the maldistribution of resources and power, that it could fragment communities and families from each other, that it could foster the ideology of blaming the victim, and that it could advance "medi* » calization" of all health-related problems. For prevention of these dangers, they suggested that the self-help movement be placed in the context of an appropriate set of broader 1 social goals within an ideological framework (Sidel & Sidel, 1976) . Finally, they encouraged self-help groups to be as

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-31concerned with teaching professionals how to work humanely with clients as with helping the people directly to help themselves. ' : . , , : v i Others who have recognized self-help groups as an important resource in meeting the mental health needs of society include Caplan and Killilea (1976), Dumont (1974), Gartner and Reissman (1976), Levy (1976), and Van Til (1978) . Van Til felt self-help groups appear to be a very effective but quite inexpensive way of meeting human needs. He believed that groups offer potential to society and individual organizations to greatly expand the number of people served. Levy (1976) viewed self-help groups as political and sociological phenomenon and a psychological phenomenon. Levy considered self-help groups as challenges to established institutions, as attempts to redistribute power, and as responses to certain failures in the social order. The Power Struggle Between Self -Help and Professionals Self-help can be viewed as an attempt to redistribute power (Levy, 197 6) , to place more power in the hands of the client by taking away power from the professional. To better understand the nature of this conflict, some background information on the source of power of both self-help

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-32groups and professionals will be examined. A comparison/ contrast between the two also will be drawn. Robert Morris (1973) listed functions performed by publicly provided services in response to client needs. These functions (and some of the services which fulfill them) include: a) assessment and counseling (group therapy, family planning) ; b) environmental arrangements (half-way houses, nursing homes, homemaker services; c) training, education, and equipment (work training, nutrition, home management) ; d) protective and legal (protective services for adults and children, legal aid) ; e) liaison (information and referral, resource mobilization — social change) ; and f) transportation (escort service) . \ ^ Two needs not met through public service, but prominent in the literature on self-help, are support and advocacy (Morris, 1973) . Because self-help groups provide extended contact over a long period of time at all hours, they are better able to give support than conventional services. Because self-help groups are often founded due to the delivery system being unable to meet their needs, self-help groups are often advocates for change. Frank Reissman (1976) concluded that the power of selfhelp comes from five basic components. First is the helpertherapy principle. This states that the person giving the help often receives more benefit in the process than the

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-33person they are trying to help. The second component is consumer intensity. The group is geared towards meeting the needs of the consumers (group members) . The third component is the professional dimension with its emphasis on practicality and common sense. Suggestions made in the group have been tried by group members. The fourth component is that caring and spontaneity are central. Fifth is the demand that the individual can do something for himself. The five components are what make mutual aid groups empowering and thus, dealienating (Reissman, 1976) . The normative characteristic of a profession is autonomy — the right to determine work activity on the basis of professional judgement. Autonomy, in turn, is based on two other characteristics of a profession: a store of esoteric knowledge and a service orientation or altruism (Haug & Sussman, 1969) . Professional knowledge is based on knowledge developed, applied, and transmitted by an established specialized occupation. This knowledge is viewed by the professional as the private property of the provider and gives him/her the power to dominate the less privileged, propertyless client (Marieskind & Ehrenreich, 1975) . Self-help, in contrast, is based upon experiential knowledge or truth learned from personal experience. The wisdom that results from personal experience is concrete,

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-34specific, and common-sensible (Borkman, 1976) . The two types of knowledge are not mutually exclusive but professional knowledge is better known and a more widely accepted source of truth in the United States than experiential knowledge (Borkman, 1976) . The greater acceptance and higher value of professional knowledge has led to an imbalance of power between the professional and the client. According to Haug and Sussman (1969) , clients are in revolt against delivery systems for knowledge application which has been controlled by the professional. Clients are against the encroachment of professional authority into areas unrelated to professional claimed expertise. In addition to challenging knowledge application, the other challenge is to the professional's service orientation. Governmental response to the Great Depression of the 30 's marked the initiation of the service concept. Social Security, Vocational Rehabilitation, and Mental Health programs were created to give service to people with specific needs. A basic tenet of the service concept was , that the professionals knew best, that they had the power of deciding what was right for clients, and that clients were resistive or uncooperative if they did not like the services provided (Katz, 1970a). The service concept set up between the professional and the client an unbalanced power relationship.

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-35Haug and Sussman (1969) believed that the power of the professional depends upon the consent of the client. As clients have struggled to shift the balance of power, professionals have sought to preserve both their power and autonomy by stifling challenges. Hospitals form patient councils, poverty programs have "indigenous" community representatives, and students are placed on advisory boards. In this way, professionals give up only a little power and socialize the descendants, according to Haug and Sussman (1969) . The professional self-image as a person of knowledge, compassion and of power is left, more or less, intact. Without the solution of cooperation, the struggle could result in less diffuse power, a narrowing of autonomy, and deprof essionalization of the professional. As a means of summarizing the nature of the power struggle between self-help groups and professionals, a contrast of the two is presented. Self-help groups use group parity, are free, and held in nontherapy-oriented milieu. Professionals use authoritative therapy, charge fees and work in therapy-oriented milieu (Hurvitz, 1974). Self-help groups encourage family involvement, members are similar and identify with each other, act as role models and set examples. Members are active, judgemental, and critical. They divulge to each other and must give as well as receive support (Reissman, 1976) . Professionals do not

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-36confront the family, do not identify with the patient, are not role models, do not set personal examples, are non judgemental and noncritical. They listen as the patient unilaterally divulges and those disclosures are secret. Patients expect only to receive support from the professional who does not expect it back in return, other than financial (Hurvitz, 1974) . A self-help group has been described in the following way by Reissman (1976) . In a self-help group, members are not concerned with symptom substitution. They reject disruptive behavior and hold each other responsible. Peers aim to reach each other at "gut level." An emphasis is placed on faith, will power and self control. j ' The professional, as contrasted by Hurvitz (1974), is concerned about symptom substitution if underlying causes aren't removed. The psychotherapist accepts disruptive behavior, absolves the patient by blaming the cause. He/she doesn't aim to reach "gut level," emphasis is on etiology and insight. With self-help groups, the members' intersocial involvement has considerable community impact. Primary emphasis is on day-to-day victories: another day without liquor or drugs, etc. The group provides continuing support and socialization. With orthodox psychotherapy, the therapist-patient relationship has little direct community

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-37impact. Everyday problems are subordinated to the longrange cure. Extracurricular contact and socialization with the therapist is discouraged (Hurvitz, 1976). Orthodox psychotherapy has a lower cumulative drop-out percentage than does self-help groups. In orthodox psychotherapy, the patient cannot achieve parity with the psychotherapist. By contrast, members of self-help groups may themselves become active therapists (Hurvitz, 1974; Reissman, 197 6) . It would appear from the writings of Reissman (1976) , Powell (1975) , Katz and Bender (1976b) that there are real contrasts between self-help groups and professional services. Dewar (1976) has been one of the few challengers to this assessment. Dewar believed that self-help, in the health area, does not offer an alternative to professional services. He believed the services are similar, the difference is in who offers the services. Dewar felt that patients are socialized into thinking in the professional mode and that the groups apply professional solutions which are only as effective as the professionals they mimic. In their study of self-help groups in health-related areas, however, Henley (1976, p. 86), quoted the chief of cardiac surgery as saying, "the most important thing I have learned is that rehabilitation takes place in the peer group, with medical personnel in an advisory role."

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-38A discussion of the merits of self-help versus professional therapy could be supported by expert opinions from both sides. The self-help movement is neither deterred by lack of research nor lack of participation by professionals. As Dumont (1974, p. 633) stated, "the redistribution of political and economic power is meaningless if the power residing in professionals is not redistributed." One method of power redistribution which might prove beneficial to both the self-help movement and professionals is collaboration. Professional Collaboration with Self-Help Groups ...Forging the links between professional and non-professional helpers is hard work; there are barriers of language, education and expectations. (Fields, 1980, p. 2) The power struggle between self-help groups and professionals can be resolved in several ways. One way is for self-help groups and professionals to strengthen their autonomy and allow little cross-over of clients or , resources. Another possibility is for professionals to recognize the unique qualities of self-help groups and seek to collaborate with them in ways which still preserve that uniqueness. Still another possibility is for helping professionals to be as actively involved as they are allowed to be in whatever manner they are allowed with self-help

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-39groups. Each of these possibilities has been tried and each has had varying outcomes. Although it would appear at first glance that self-help groups are autonomous, a review of self-help groups reveals that many of them were begun by professionals. Groups in which professionals played a leading role include: Recovery, Inc., begun in 1937, by Dr. Abraham Low, a psychiatrist who wanted a continuing support group for his mental health clients; Integrity Groups, begun in 1945 by psychologist O.H. Mowrer; G.R.O.W. , begun in 1957 by clergyman Father Keogh; Compassionate Friends, begun in 1969 by Reverend Stephens for parents dealing with the death of their child; Parents Anonymous, begun in 1971 by social worker Leonard Lieber; and Epilepsy Self-Help, begun in 1975 by social psychologist Lawrence Schlesinger (Lieberman, Borman, & Associates, 1979). Recovery, Inc., which has continued to grow after the death of Dr. Low, is now the largest exmental patient group with over 15,000 members in 1,000 groups (Gartner & Reissman, 1980) . Characteristics of these men or others like them who found or support self-help groups include willingness to look beyond conventional theories, acceptance of a broader definition of afflictions, interest in expanding their skills and techniques, focus on rehabilitation and aftercare, concern for neglected populations, willingness to

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-40alter their professional role to include collaboration and support, willingness to form a group in a variety of settings, and willingness to minimize their fees (Lieberman, Borman, & Associates, 1979) . Aside from the findings that professionals have been involved in the founding and support of many self-help groups, it has also been found that most participants utilize professional help to a greater extent than do nonmembers of self-help groups (Lieberman, Borman, & Associates, 1979) . In view of these findings, it is somewhat ironic that the professional sector has neither been trained to consider mutual help groups as a referral option nor is under any pressure from peers or clients to do so. Under ^ these circumstances, professionals remain oblivious to existing mutual help groups or come to perceive them as irrelevant to professional practice according to Gottlieb (1980). If this professional attitude does not change, if professionals do not find some common ground with the selfhelp movement, Dumont (1976) has predicted that professionals will become increasingly cloistered, selfserving, and irrelevant. As discussed earlier, one of the ways in which professionals have been involved with the self-help movement is through organizing a variety of self-help groups. In some instances, after the groups were founded, the profes-

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-41sional took a gradually decreasing leadership role. In other cases, professionals have always served only as advisors. Such is the case with the largest self-help organization, Alcoholic Anonymous (A.A.). A. A. encourages its members to cooperate with the professional community (A. A. Newsletter, 1980) . One result of this cooperation has been referrals from the professional community to A. A. One member in five has credited a physician or hospital with directing them to A. A. (Alcoholics Anonymous World Services, Inc., 1972). More than 1,400 treatment centers have A. A. groups. This peaceful co-existence may in part be due to A. A. 's suggestions to its members to abide by all agency rules, keep commitments, do not argue or criticize, and to represent A. A. well when working with professionals (A. A. World Services, Inc., 1979). For professionals considering referring a client to a self-help group, Powell (1975) suggested that they learn about the group before making the referral; check that the clients referred are similar to the group members so that they do not feel conspicuous; discuss the similarities and differences of the group and group activities; and check that the group is accessible to their clients. Powell also suggests that professionals be supportive of the group and plan with the clients how to use the group.

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-42Just as professionals refer clients to self-help groups, Tyler (1976) believed that self-help groups can link clients to the professionals. This link results from group members learning from one another how to utilize effectively professional services. Self-help groups and professionals can use each other as consultants. Powell (1979) suggests that professionals think of self-help groups as a set of potential consultants who cost little and have expertise available in area such as alcoholism, child abuse, gambling, homosexuality, and divorce. Self-help groups have used professionals as consultants for such things as improving the effectiveness of the group and its organizational structure, planning programs, participating in board meetings, and writing statements of support for grants (Gartner & Reissman, 1980) . Powell (1975) suggested that professionals can use the self-help groups as a source of information, as an alternative to therapy for the reluctant client, and in collaboration with treatment by requiring participation in the group as part of therapy. Gartner and Reissman (1980) presented the following ways a professional can collaborate with a self-help group: a) make referrals, b) help develop a group, c) consult with a group, d) offer suggestions or information to the group, e) staff the group, f) conduct basic research, g) plan programs for the group, and h) evaluate the group.

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-43Another means of collaboration aside from starting self-help groups or consulting, is for professionals to identify and connect people in similar stressful circum; stances. Through connecting these people, they have the option of beginning a group or of building a support system (Gottlieb, 1980) . Use of stressful life events, social , indicators, and critical life transitions can aid the professional in identifying people and getting them to develop ideas through resources of collectivity. Strengthening support systems can serve as preventive services (Gordon, 1978) . Connecting resources is one way of educating the community. By encouraging the development of networks, professionals are increasing the number of clients served. Rather than trying to reach all the clients themselves, professionals can concentrate on helping the helpers by assisting self-help members in clarifying their ideas and increasing their confidence (Patterson, 1980) . Collaboration can be seen as a mutual learning experience for the professional and the self-help group. Through consulting, leading, or researching a self-help group, professionals may increase their understanding of groups members. Such was the case with Feinburg (1970) who started a self-help group for women who had mastectomies. For selfhelp groups, they could develop close ties with professionals and conventional services during collaboration

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-44(Durman, 1976) . Some models have already been established for collaboration. In assertiveness training, for example, professionals train lay people who become trainers returning to the professionals for additional training from time to time. With this model, a small number of professionals have an effect which radiates out to many (Gartner & Reissman, 1977) . The assertiveness training model is very similar to the peer group rap session models in which professionals train a large number of kids then take a back-up role in the ensuing meetings. Various health groups have also been established in this manner by professionals. In reference to medical problems, professionals can diagnose the illness, prescribe relevant drugs, then help patients with similar needs find each other and come together. A final model is the professional who writes a self-help book which stimulates readers to form a self-help group on the basis of the book. Books such as Parent Effectiveness Training and Transcendental Meditation are two examples (Gartner & Reissman, 1977) . While it appears there is a variety of ways for professionals to collaborate with self-help groups, Borkman (1976) stated the collaboration is dependent on the types of professionals and their ideology and on the type of the self-help groups and its ideology. The more the profession-

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-45al model includes experiential knowledge (truth based on personal experience) , the better professionals can work with self-help groups. It would be difficult to argue convincingly that there are no ways in which a self-help group and a helping professional can collaborate. Some caution or care must be taken, however, in order to insure a successful collaboration. In a study of a volunteer self-help group within a service agency, Kleinman, Mantell, and Alexander (1976) warned against hasty attempts to use self-help principles in an alien agency environment. They conclude that a self-help group could not be supervised by an agency because of the conflicts of the formal agency organization with the group's informality, the power differential and the disputes over values and objectives. Van Til (1978) believed self-help can be successfully incorporated into a formal organization if both professionals and self-help clients actively consent to its development. One necessity is that the formal organization or ' institution be willing to bend enough to implement self-help principles. Other authors are concerned that if professionals become involved with self-help groups, they may tamper with the ideology of such groups (Antze, 1976), they may make the group feel it can not help itself or that it needs a profes-

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-46sional (Jertson, 1975) , or that the professional will take over the group or change its orientation (Henley, 1975) . Along those lines, Katz (1965) saw a pattern of professionals doing something for the recipient rather than the recipient joining in the doing. Professionals are not accustomed to cooperative ventures and they lack confidence in the individual or group to do anything for themselves. Katz (1965) suggests a need for a firmer partnership between the giver and recipient of services. He views professionals as necessary resources and as specialists rather than the only prime movers for the group. Caplan (1974) saw the role of the professional as a "support for the supporters" and to provide continuity in group sessions. Vattano (1972) also saw the professional as a catalyst and a facilitator particularly in the early stages of the group. Mowrer (1970) suggested that universities can train and supply persons competent to start self-help groups. Regardless of which manner professionals may choose to collaborate with self-help groups, the degree of collaboration will depend in large measure on the willingness of both parties to attempt to work together. An instrument to measure the attitudes toward self-help groups could aid both parties in assessing this willingness.

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-47Self-Help and Research After an extensive review of the literature on self-help groups, Killilea (1976) concluded that more systematic , . attention, both conceptually and methodologically, should be focused on self-help groups. Caplan (1974) predicted that the self-help movement would become a major focus of systematic research during the next decade. He felt systems organized by non-professionals should be carefully studied in order to learn how to stimulate and foster supports in the population without distorting or forcing them into professional patterns. While his prediction that the movement would be a major focus of systematic research has not yet come to pass, recent studies are indicating that more professionals are becoming involved with self-help groups. How or if these groups are in turn being distorted by this involvement is an area which desperately needs to be researched, as does many aspects of the self-help movement. Lieberman and Borman (1976) stated that the paucity of research on self-help groups is due to the following reasons: a) most social scientists ignore the movement and b) the technology to assess self-help groups is inadeguate. Perhaps because the technology is inadequate, social scientists are continuing to conduct little research in the area. They do seem to be writing more articles, however.

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-48Dumont (1974) wrote: By and large, the acknowledgement of the self-help movement in professional journals is absent, indifferent or hostile, not unlike the perceptions of the professional in general. On the other hand, there is an inevitability about the movement based on a confluence of ideological and cultural forces that suggests it is more than a passing fad in the human services (Dumont, 1974, p. 634). In the fourteen years since Dumont 's statement, his words have proven to be prophetic. The self-help movement has shown itself to be more than a passing fad. It has endured and grown. It has also attracted the interest and attention of large numbers of helping professionals. f The perceptions of these helping professionals toward self-help groups have been the subject of several surveys. In 1978, Levy mailed out a questionnaire to all outpatient psychiatric facilities in the United States, approximately 1,800. He sought to assess the attitudes of professionals toward the efficacy of self-help groups. He felt their attitudes would be manifested in the following ways: the extent to which the professionals utilized self-help groups through referrals, the extent to which the self-help groups were viewed as making referrals, the professionals' evaluation of the effectiveness of the self-help groups, the professionals' judgements of the importance of the potential role self-help groups might play in the mental health delivery system, and an estimate of the probability that the

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-49professionals' agency would try to integrate self-help groups with the agency services. In 1981, Hermalin and Swift surveyed 244 community mental health centers. They also asked for ways in which the centers could collaborate with self-help groups. In 1982, Todres surveyed 308 helping professionals in the Toronto area. His personally administered questionnaire included information on the respondent's knowledge of selfhelp groups in the area, methods of collaboration, and 20 items to assess their attitudes toward self-help groups. In 1985, Toseland and Hacker surveyed 247 social workers. Their mail questionnaire included information on the respondent's knowledge of self-help groups, methods of collaboration, and 19 items to assess their attitudes toward self-help groups. All of these authors stressed the importance of selfhelp groups as a resource which helping professionals could not afford to ignore. They documented a trend of ' professionals' increasing involvement with self-help groups and increasing positive attitudes. Unfortunately, each study was incomplete. Each used an ad hoc design and created an instrument for each particular study. No information was given on how items were developed. No validity or reliability studies were done on the instruments

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-50designed. No recommendations for further refinement of the instruments were made. The self-help movement is a phenomenon full of potential for professionals. Foundations and government funding sources are beginning to support research, training and some service grants. The Office of Child Development, part of HEW, provided a grant to Parent's Anonymous which enabled them to begin chapters in almost every state, to develop a national newsletter, and to provide training materials to members. Some form of legal recognition may be forthcoming to self-help groups, networks, and extended families for the role they play in prevention (Borman, 1976) . Should funding become more available, research on the self-help movement might be more lucrative for agencies and professionals. Summary Self-help groups have early historical origins. They originally formed for the purposes of hunting and gathering food. As civilizations became more developed and basic needs were consistently met, self-help groups expanded into other areas. The prevailing social and economic conditions of the times have greatly influenced the type and function of selfhelp groups. Back and Taylor (1976) have suggested that

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-51self-help represents a social movement. Other researchers have suggested that self-help groups developed from unmet needs; as an alternative to services already provided; from widespread feelings of alienation in our society; or from ^ other affiliative arrangements outside kith and kin * (Lieberman & Borman, 1976) . From a review of the literature on self-help, Killilea (1976) concluded that mutual help organizations are not a simple phenomena or a single movement . Although self-help groups may be viewed as antiprofessional, research does not verify this conclusion (Lieberman, Borman, & Associates, 1979) . Many professionals have been involved with self-help groups either by beginning the groups or serving as a consultant to the group. Self-help groups and professionals have powerful, albeit different, helping techniques (Reissman, 1976) . It is possible for both to collaborate in several ways. Each can use the other for referrals, for consultation, or as a mutual learning experience (Gartner & Reissman, 1980) . Due to technological limitations and lack of professional interest little research has been conducted on selfhelp groups (Lieberman & Borman, 1976) . Questions such as how self-help groups function, what is the impact of participation on groups members, and how can self-help

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-52groups work with professionals, have yet to be answered (Killilea, 1976) . With over fifteen million people involved in self-help groups (Evans, 1979) , the self-help movement warrants investigation. The developed instrument resulting from this study is a step towards furthering research on self-help groups by assessing helping professionals attitudes toward self-help groups.

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. 1" . . I /. ' r CHAPTER 3 METHODOLOGY The purpose of this study was to develop and validate an instrument to assess helping professionals' experiences with and attitudes toward self-help groups. The research questions, theoretical basis of the instrument, item development, pilot study, field test of the instrument, and limitations of the study are presented in this chapter. Research Questions The following research questions were addressed in this study . 1. To what extent does the instrument have content validity? 2 . What is the factor structure of the instrument? 3. To what extent is the instrument reliable as demonstrated by internal consistency? -53-

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-54Theoretical Basis Much of the literature regarding self-help groups is descriptive in nature. Considering the size of the selfhelp phenomenon, relatively little research has been conducted. Technological limitations with conducting this type of research as well as the lack of instruments are two factors which account for the paucity of research. Due to the lack of research, there were few guidelines to use in the development of the instrument for this study. The primary sources of guidance were studies conducted by Levy (1978) and by Torres (1982) . Levy (1978) developed an instrument to use with mental health professionals which consisted of surveying their use of referrals to or from self-help groups, their evaluation of the effectiveness of self-help groups, and their estimate of the potential role of self-help groups at their agencies. Torres (1982) " developed a series of statements to assess the attitudes of helping professionals toward self-help groups. Construct areas were not identified. No rationale for these statements was given. Although both studies were informative, neither researcher conducted item analyses or validation or reliability studies. In this study, as in Levy's and Torres', the researcher collected data on professionals' attitudes by surveying professionals' experiences with self-help groups and surveying responses to selected statements about self-help

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-55groups. From a review of the literature, it appeared that attitudes toward self-help groups would be based on two components: experiential knowledge and theoretical knowledge. Section I of the instrument was designed to measure the former, Section II the latter. Item Development The instrument. Survey of Attitudes Toward and Experiences With Self -Help Groups (SAESHG) , is divided into three parts. The first part of SAESHG consists of questions which request information on the educational levels and job titles of the respondents. This information was requested to determine whether the respondents' types of experiences with or attitudes toward self-help groups differed on the bases of their degree levels or job titles. The next part of the SAESHG, Section I, contains a list of 12 methods of collaboration with self-help groups. Respondents are instructed to evaluate the effectiveness of those methods with which they have experience. Information collected from this section was considered as part of the item analysis of the instrument. Methods of collaboration included in this section were selected through a review of the literature. ' Because all commonly used methods of collaboration were identified through the literature and considered to be under one domain (i.e., the domain of methods of collaboration

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-56with self-help groups) , the panel of experts was not asked to place these items in content areas. An extensive review of the literature on self-help ^ f groups was conducted in order to generate items for Section II of the SAESHG, consisting of 55 statements about selfhelp groups. From this review, five content areas were identified as major categories of information on self-help groups. Using these five areas as a guide, 60 statements were generated, some phrased positively, some negatively. Upon closer scrutinty of the content areas and statements, however, it appeared that by deleting only five statements, two of the content areas could be collapsed. The three remaining areas were: purposes/activities of self-help groups, characteristics of self-help groups, and the relationship of self-help groups to other helpers. Using these three content areas, 55 statements remained. These statements, following Edward's (1957) guidelines for constructing Likert-type attitudinal scales, were designed to evoke affect or opinion rather than cognition or recall. To create uniformity of scoring, all statements which were negatively phrased were re-coded. The following items were re-coded: 5,12,15,18,19,20,23,28,32,33,36,36, and 42. The SAESHG was reviewed in a preliminary screening by a panel of eight experts who were selected based upon their prominence in the area of research on self-help groups and their willingness to participate in the study. All

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-57panel members were required to have both experiential knowledge of self-help groups as evidenced by their participation in some way with a self-help group and theoretical knowledge as evidenced by their publications about self-help groups. See Appendix A for a listing of panel members names, experience, and relevant publications. The panel was asked to evaluate whether pertinent content areas for item generation had been identified and whether comprehensive items had been generated for each content area. They also evaluated the technical quality of the SAESHG items to determine whether the wording for the items was consistent, and if the items were clear and understandable. The panel first reviewed Section II of the SAESHG to determine the degree to which the statements represented the domain of attitudes toward self-help groups. All panel members were sent copies of the SAESHG. The panel was asked to choose which of three content areas was most appropriate for the item, if the wording was clear, and if the item appeared appropriate for inclusion. Panel members were asked to return the completed SAESHG within 10 days of receipt in the accompanied, stamped, addressed envelope. The three content areas, processes/activities (P/A) , characteristics (C) , and relationship to other helpers (ROH) , the column undecided/no response (U/NR) and the

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-58panel's responses are shown in Table 3-1. The numbers 0-8 indicate the number of panel members who chose each area. In assessing the 55 SAESHG items in Section II, a majority of five or more experts believed that 50 of the items were clearly worded and 51 were appropriate. Many of Table 3-1 Panel of Experts' Evaluations of Item Content in Section II Item# Content Area Wording Appropriate f/A \^ TT /MTJ p TT /MP Vo<3 X CO TT /TJR J. n o T X p p 7 1 X n 1 X 1 X p; u n 7 X 0 3 •J 0 1 Q 0 0 Q 0 0 A 0 A "X p p 6 1 1 n A. P fi \j 0 p 7 1 X J n P 1 X X Q O n 0 7 «J 4. •* n 1 X f. n p 7 1 X 0 Q O X. n X P o n p Q o n -J c p X o X X n u o J p. D •J n u o u p t. ± J. ± J. A O •7 1 J. n u •7 / u X T X u O £, D n u "5 O n u o ^ 1 P p X C X p 14 6 0 0 2 6 2 0 5 1 2 15 0 6 0 2 4 3 1 5 1 2 16 0 0 5 3 6 2 0 6 1 1 17 3 2 0 3 5 2 1 6 0 2 18 2 2 0 4 6 1 1 6 0 2 19 1 3 0 4 7 1 0 8 0 0 20 4 2 0 2 5 2 1 5 1 2 21 0 0 6 2 6 0 2 7 0 1 22 2 2 3 1 5 1 2 5 1 2 23 0 0 6 2 8 0 0 6 1 1 24 4 2 0 2 5 2 1 7 0 1 25 0 4 0 4 5 1 2 5 1 2 26 0 4 4 0 6 1 1 5 1 2 27 4 2 0 2 7 0 1 7 0 1 28 0 3 4 1 8 0 0 7 1 0 29 2 2 0 4 4 2 2 4 1 3 30 3 2 0 3 6 1 1 4 2 2 31 0 0 6 2 8 0 0 8 0 0 32 0 0 6 2 7 0 1 7 0 1 33 1 1 4 2 7 1 0 8 0 0 34 0 0 5 2 2 5 1 3 4 1 35 4 2 0 2 6 2 0 6 2 0

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-59Table 3-1 continued Item# Content Area Wording Appropriate p/a c TT /KTT? c NP TI /NR Yes No U/1 n H 1 X •> f. 1 X 1 X 1 X 1 X J / n n f. \j 7 1 X 0 f, 1 X 1 X 0 0 e. 2 2 0 7 0 1 A •* r> 0 v/ 7 0 1 X 7 0 1 ACl •* yj n 1 X •* "X 0 4 3 1 41 1 X 1 X A 7 0 1 X 6 1 1 4? 1 n •J 7 1 X 0 g 1 X 1 X A T X n J V) n 2
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-60the panel was that the item was appropriate, then the item was kept regardless of whether the panel could agree on the content area for the item. A majority was considered to be v' ^ five of the eight panel members. One panel member chose the content areas but not whether the item was clearly worded or appropriate. Another panel member was inconsistent in responding, often omitting the content areas and only indicating if the item was appropriate or not. Six of the panel members consistently evaluated each item across all categories. Based upon the panel's evaluation, items 34 and 40 were omitted. The revised SAESHG contained 53 items in Section II. A Likerttype scale was selected as the response format for the items. It ranged from Strongly Disagree (1) to Strongly Agree (5) . After the item revision was completed, the instrument was mailed back to panel members. The panel was asked to review each section and to comment on the format of the questions, wording, appropriateness, comprehensiveness of items, and ease of completion. Comments from the panel were very favorable. No revisions were required in Section I and only minor revisions were made in Section II prior to the pilot study. The panel also was requested to complete the revised SAESHG. This provided a method of assessing their experience and attitudes toward self-help groups.

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-61Pilot Study The purpose of the pilot study was to determine the suitability of the item format, the appropriateness of the items, and the ease of completion of the instrument. Since the field test involved a large mail-out, the pilot study served as a screening device for identifying problems respondents might have completing the SAESHG. A class of graduate students in Counselor Education at Hunter College in New York City was selected for the pilot study. This class was chosen because of their similarity to the research sample and their willingness to participate in the study. Permission was obtained from the professor to ask the students to participate in the study. All ten students agreed to participate. They were given the SAESHG, asked to complete it and mail it back within two weeks. They were also asked to make any comments or write any questions they had on the instrument. All completed surveys were received during the first week. The educational level of the students was as follows: five had Bachelor's degrees, four had Master's degrees, and one had a Specialist in Education. Three were employed as counselors, four as teachers, one as an administrator, and two in other fields. Regarding training with self-help groups, five had had college courses, one had had a seminar, one had had practical experience, and three had had no training.

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-62Regarding experience with self-help groups, four had experience as participants, four had experience as observers, and two had experience as leaders. Two of the students had no experience with self-help groups, six had only one type of experience, one had two types, and one had three types of experience with self-help groups. At the time of the pilot study, the SAESHG had two parts to Section I. Items on both parts were identical. Respondents who had experience with self-help groups were requested to indicate those areas in which they had worked with self-help groups by evaluating the effectiveness of the collaboration using a Likert-type scale. Respondents who had no experience with self-help groups were requested to indicate the probability of their collaborating in the ways listed by using the same scale. Although eight of the ten students gave at least one type of experience with self-help groups, none completed part one of Section I of the SAESHG. No one commented on why they did not complete this section. One possibility is that they did not feel sufficiently experienced to evaluate self-help groups in the manner requested in that section. Another possibility is that they were confused over whether to complete part one or part two since all the students with experience completed part two rather than part one. Nine of the ten students completed part two of Section I. Part two of Section I requested respondents with no

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-63experience with self-help groups to indicate the probability of their collaborating with self-help groups in various ways by using a Likert type scale. Six of the nine indicated they would collaborate with self-help groups by making referrals to the groups and receiving referrals from the groups. Four of the nine indicated they would collaborate by providing training to a self-help group and conducting research on a self-help group. Three of the nine indicated they would probably not collaborate by conducting research on a self-help group. While this information was useful in that it indicated a strong willingness in some specific areas to collaborate with self-help groups, it was possibly misleading since respondents with experience had completed the section for respondents without experience. Because the study was to focus on the actual experience the respondents had with self-help groups, part two of Section I was omitted from the SAESHG prior to the field test. This resulted in a shorter instrument which could be completed in less time. It also • reduced confusion over which part of Section I to complete. The mean, standard deviation, and respondent numbers for each item in Section II is given in Table 3-2. With the exception of items 17, 20, 28, 30, 43, 46, and 48, all participants responded to each item.

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-64Table 3-2 Section II Results of Pilot Study Ctemf Mean s . d . N 1 3 . 5 0 . 9 10 2 3 . 3 0 . 6 10 3 4 . 8 0 . 4 10 4 4 . 8 0.4 10 5 3 . 6 1 . 0 10 6 3 . 0 0 . 9 10 7 3 . 8 0.7 10 8 4 . 5 0 . 7 10 9 4 . 3 1.0 10 10 3 . 7 1.0 10 11 2 . 6 0 . 6 10 12 4 . 3 1 . 2 10 13 3 . 8 0.9 10 14 3 . 4 0 . 9 10 15 4 . 2 1 . 1 10 16 3 . 3 1 . 1 10 17 2 . 8 0 . 9 9 18 4 . 8 0.4 10 19 3 . 2 1. 1 10 20 3 . 1 0.7 9 21 2 . 4 0 . 8 10 22 3 . 5 0.8 10 23 2.8 0.9 10 24 4 . 1 0.7 10 25 3 . 1 0.8 10 26 2 . 0 0 . 9 10 27 3 . 9 1 . 10 28 3 . 1 1.4 9 29 3 . 5 1 . 4 10 30 3 . 3 0 . 9 9 31 3 . 7 0.4 10 32 3 . 2 1.2 10 33 3 . 1 0 . 7 10 34 4 . 3 0 . 9 1 0 35 4 . 0 1 . 2 1 0 36 2 . 5 0 . 8 1 n 37 4 . 2 0 . 6 10 38 4.2 0.9 10 39 2.6 0.9 10 40 2.4 0.7 10 41 2.6 1.0 10 42 3.8 0.9 10 43 3.2 0.4 9 44 4.4 0.5 10 45 4.2 0.6 10 46 3.1 0.9 9 47 4.5 0.5 10

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-65Table 3-2 Continued Item # Mean s.d. N 48 49 50 51 52 53 2.7 4.0 3.9 3.2 3.9 3.9 1.3 0.6 0.7 0.9 0.5 0.7 9 10 10 10 10 10 The means ranged from 2.0 to 4.8. The standard deviations ranged from .4 to 1.4. Five items, 3,4,8, 18, and 47, had means greater than or equal to 4.5. These items all pertained to attributes of a self-help group except item 47 which stated that helping professionals should support selfhelp groups. Four items (21,26, 36, and 40) had means less than or equal to 2.5. These items all pertained to the relationship of self-help groups to helping professionals or traditional therapy. After evaluating the items and format of the instrument, the panel of experts was requested to complete the SAESHG to provide a comparison with the pilot study and field test. Their responses also were requested to ascertain the degree of variability in their responses. Six panel members completed both sections of the SAESHG. One member did not respond to questions on educational level, training, or experience, but did complete Section II. One panel member did not return the survey. Panel of Experts^ Item Responses

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-66Of the six panel members, five had Ph.D.s and one had a D.S.W. Four were professors, one was a counselor/therapist, and one an administrator. All six had training through self -directed study and practical experience. Two members also had training through a seminar/workshop and two through assisting with research. Experience with self-help groups was divided among four members who had been participants in self-help groups, five were interested observers, five were consultants, five were researchers, two were leaders and one was an administrator of a national self-help group. Five of the members had training and experience with self-help groups in at least three different areas. , Regarding Section I, the following means of collaboration were rated as very effective by at least three of the six panel members: using self-help groups as a source of information, forming an advocacy group or coalition with a self-help group, serving as a consultant to a self-help group, using a self-help group as consultants, and conducting research on a self-help group or phenomenon. One panel member rated using self-help groups as a source of information as a very ineffective means of collaboration. One panel member also rated receiving referrals from selfhelp groups, integrating self-help group members into committees, boards, etc., and sharing facilities with selfhelp groups as somewhat ineffective means of collaboration.

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-67Seven panel members completed Section II of the SAESHG. Their responses are presented in Table 3-3. Table 3-3 Section II Results from the Panel of Experts Item# Mean s . d. N 1 2.4 0.7 7 2 4.1 0.6 7 3 4 . 8 0. 3 7 4 3 . 8 1.0 7 5 3 . 5 0.7 7 6 3 . 5 1.1 6 7 3.4 0.5 7 8 5.0 0.0 7 9 4 . 0 0.6 6 10 3.2 0.9 7 11 2 . 1 0.8 7 12 4.7 0.5 7 13 4.1 0.6 7 14 4.2 0.5 7 15 4.1 1.0 7 16 2.8 1.5 7 17 4.2 1.0 7 18 4.5 0.7 7 19 3.8 0.6 7 20 3.0 0.8 6 21 3 . 5 1.3 7 22 3 . 3 1.4 6 23 4.7 0.5 7 24 4.7 0.5 7 25 3.4 0.5 7 26 4.7 0.7 7 27 2.5 0.5 7 28 2.8 1 . 1 6 29 3.0 1.3 : t 30 4.0 0.9 1 31 1.4 0.7 7 32 3.0 1.0 6 33 2.8 1.0 7 34 4.5 0.5 7 35 4.4 0.7 7 7 36 3.5 0.9 37 4.2 1.4 7 38 4.2 0.7 7 39 2.2 1.5 7 40 2.6 0.8 5 41 3.8 0.4 6 42 3.6 0.9 6

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-68Table 3-3 Continued Item* Mean s.d. N 43 3.6 0.5 6 44 4.5 0.8 6 45 4.2 0.7 7 46 3.7 0.9 7 47 4.0 1.3 , 7 • ' ^ j"^ 48 3.6 0.9 6 49 4.4 0.5 7 V' * ' 50 3.7 1.2 7 51 3.3 0.7 6 52 4.1 0.7 6 53 4.0 0.6 5 The means ranged from 1.4 to 5. The standard deviations ranged from .3 to 1.5. Nine of the items (3, 8, 12, 18, 23, 24, 27, 34, and 44) had means greater than or equal to 4.5. All the items pertained to attributes of a self-help group except item 23, self-help groups should be started by a helping professional. Three of the items (3, 8, and 18) were also rated the highest by the pilot study. Four items (1,11, 31, and 39) had means less than or equal to 2.5. None of these items were rated that low in the pilot study. All items pertained to the relationship of self-help groups with helping professionals or other agencies. Although several items appeared to have little variance, as evidenced by standard deviations below .50, no items were deleted at this point. Because the pilot study sample was so small and the panel of experts so experienced

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-69with self-help groups, it seemed premature to delete items based on those responses. Field Test The purpose of the field test of the SAESHG was to answer the three research questions posed by the study: does the instrument have content validity, what is the factor structure of the instrument, and is it reliable? A diverse group of helping professionals, members of the American Mental Health Counselors Association (AMHCA) , was chosen as the sample population. This group was selected because a population was needed which possessed direct experience or familiarity with self-help groups and which represented differing types of professionals likely to use self-help groups. A computerized mailing list of every 14th name on the mailing list was provided by AMHCA. A total of 1,000 names of AMHCA members was included on the mailing list. Once permission was secured from AMHCA to survey their members, the SAESHG was mailed to the 1,000 AMHCA members randomly selected. The questionnaire method was chosen because it makes information from a large group of people more accessible. It is a method which allows objectivity in evaluating responses. It eliminates interpretive problems. It insures anonymity for the respondent, and as a result, encourages honest and valid responses (Isaac & Michael, 1971; Kerlinger, 1973).

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-70Included with the instrument was a letter of transmittal explaining the purpose of the study, instructions for completion, and a stamped, return-addressed envelope. A six week period immediately following the mail-out was chosen as the time frame for inclusion in the study. A total of 410 instruments were received during that period. The return rate of 41% was high enough to provide 145 more surveys than required for the data analysis used in the study. An additional 14 completed surveys were received after the cutoff date, bringing the overall return rate to 42.4%. Content validity of the SAESHG was determined by the panel of experts chosen to review the instrument and evaluate whether the items were appropriate. A list of the panel members is found in Appendix A. The panel was asked to evaluate whether relevant content areas for item generation had been identified and whether comprehensive items had been generated for each content area. They also evaluated the technical quality of the items to determine whether the wording was appropriate, and if the items were clear and understandable. As discussed in Item Development, the panel believed most items were clear and appropriate. Refer to Table 3-1 for the evaluations. Based on the panel's responses and suggestions, items were revised or discarded. After the item revision was completed, the instrument was mailed to panel members and they were asked to complete the instrument. The panel was

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-71asked to review each section and to comment on the format of the questions, wording, appropriateness, comprehensiveness of items, and difficulty completing the instrument. Based on their comments, the SAESHG was revised further. Factor analyses were completed for both sections of the SAESHG, Section I surveying experiential knowledge, and Section II surveying theoretical knowledge. All 410 completed instruments were hand scored and the data subsequently transferred to a computer disc. An alpha level of .05 was the criterion set for statistical significance evaluations. Principal Components factor analyses using an oblique rotation was completed using the Statistical Package for the Social Sciences. The mean and standard deviation were calculated for each item and for the total scores. Factor loadings were reviewed for the clearest seperation of factors. The internal consistency of the instrument was computed to provide a measure of reliability for the SAESHG. Coefficient Alpha analyses were employed to assess internal consistency. ' 1 Limitations of the Study One limitation of this study was that the data collected were based upon self reports which could be limited by the respondents' honesty and/or security, the accuracy of the respondents' memory, and whether the

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-72respondents understood the items. Another limitation was the subject selection. Only one group of helping professionals (AMHCA) was surveyed. Since this was a descriptive study, the only threat to external validity was in subject selection (Isaac fie Michael , 1971) . Because only one helping professional group was surveyed, it may not be possible to generalize to all helping professionals. It is possible that the AMCHA members who chose not to respond had different views from those who did respond (Babbie, 1973) .

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CHAPTER 4 RESULTS AND DISCUSSION Results of the Study The purpose of this study was to develop and validate an instrument to assess helping professionals' experiences with and attitudes toward self-help groups. The three research questions in the study were (a) to what extent does the instrument have content validity, (b) what is the factor structure of the instrument and (c) to what extent is the instrument reliable? The results of the study presented in this chapter include information on the sample, content validity, construct validity, and reliability. Sample Instruments were mailed to 1,000 randomly selected members of AMHCA. Instruments returned during the first three weeks following the mail-out were included in the study. A total of 410 instruments were received during this period. The 41% return rate was relatively high for a mailout and yielded more than the 265 surveys necessary for the -73-

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-74study. Another 14 instruments were received after the cutoff date, increasing the overall return rate to 42.4%. It should be noted that 44 participants only completed the biographical questions and did not respond to any items in Section I, the Experience Scale, or Section II, the Attitude Scale. Apparently, after reading the directions for Section I, instructing only those participants with experience with self-help groups to complete it, these 44 respondents did not continue to Section II. Information about the respondents who completed both sections of the SAESHG is provided in Table 4-1. Because of the high response rate to Section II, the Attitude Scale, as shown in Table 4-3, analyses were conducted using 351 surveys. This includes the 288 surveys in which all items were completed and the 63 surveys in which at least 50 of the 53 items were completed. Table 4-1 Demographic Characteristics of Sample Zip Code N % of Total Area O East Coast 40 11.4 Area 1 East Coast 46 13.1 Area 2 East Coast 36 10.3 Area 3 East Coast 51 14.5 Area 4 Mid-West 34 9.7 Area 5 Mid-West 25 7.1 Area 6 Mid-West 32 9.1 Area 7 Far West 23 6.6 Area 8 Far West 30 8.5 Area 9 Far West 31 8.8 No Area Given 3 .9

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-75Table 4-1 Continued Educational Level Bachelor 13 3.7 Master 236 67.2 Eds 13 3.7 PhD or EdD 74 21.1 Other 13 3.7 Missing 2 .6 Job Title Counselor/Therapist 254 72.4 Teacher 12 3.4 Administrator 25 7.1 Other 29 8.3 Missing 31 8.8 Types of Experience with Self -Help Groups No experience 26 7.4 1 type 79 22.5 2 types 125 35.6 3 types 88 25.1 4 or more types 33 9.4 Amount of Training with Self-help Groups No Training 4 1.1 1 kind 113 32.2 2 kinds 83 23.6 3 kinds 103 29.4 4 kinds 48 13.7 The geographic distribution of participants seems follow the general population distribution of the United States. The majority (49.3%) live within the East Coast region, in postal zip code areas 0-3, including all the Atlantic Seaboard. The Mid-West region, areas 4-6, accounts for 25.9% of the sample. The Far West, areas 7-9, accounts for 23.9%.

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-76As might be expected in a professional organization, 88.3% had graduate degrees. The majority (67.2%) had Master's degrees. Most of the participants (72.4%) listed their job title as counselor/therapist. The remaining , participants were divided between administrators, teachers, other, or not given. > , 5 t ^ . Only 7.4% of the participants had no experience with self-help groups. Almost one quarter of the participants (22.5%) had experienced one type of collaboration with selfhelp groups. A surprisingly large number (70.1%) had experienced two or more types of collaboration with selfhelp groups. Regarding training with self-help groups, only 1.1% had no training, 32.2% had one kind of training, and 66.7% had two types of training or more. Demographic characteristics of the AMHCA membership were unavailable for this study. It is assumed, however, that the AMHCA members in this study were representative of all AMHCA members because they were randomly selected. Item Analyses Item analyses were performed on the items in both sections of the SAESHG. The means and standard deviations for items in both sections of SAESHG are shown in Table 4-2.

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-77Table 4-2 Means And Standard Deviations For All Items Item Number Mean s.d. N Section I 1 X & no H • U O QR 2 1 n7 X . u / A ID RQ T n A A J • J X X • XD Z J 7 R •J t^A 1 15 X . X^ 07(1 Z / U (i J • ^ u X . X4 Oil ^ J. J. 7 1 A O • X H X . u / O 1 Q ^ J.7 8 J • o o 1 OA X . U H 5 R 1 ^ O X 9 X • X^ "> T H ZOO 1 0 J • O 27 1 no X . U7 Z 3 J 11 O • J X 1 17 X . X / 511 Z J X 12 1 OA X . ^ 4 1 Q R X7 3 »ct 1 on T T 1 1 1 Q X . X7 2 3 fiR 1 1 X . X J 1 fi 1 J O X 3 A SI R 0 . o ^ 4 R A . O *» J O J 5 P R? 1 m X . u o J O X 6 3 . 32 . ^ •« 1 fin o o u 7 3 67 77 T fi n o o u 8 A 48 R 1 .ox T fi A 9 A n RO Ifil J O X 10 2 91 1 9 A J O J 11 ? 41 QQ J OZ 12 4 17 . 7 Z 1 fi A J 04 13 Q7 Q .70 fi 1 JO J 14 X . uo 1
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-78Table 4-2 Continued Item Number Mean s.d. N Section II J •* 4 15 .75 359 •J -J 4 11 . 97 358 T 6 2 28 1 . 05 356 «j / 4 22 . 90 354 4 1 Q 72 358 .J J/ X • o t 1 10 X • X V/ 358 4^ • X *x 90 359 ** J. ^ • 07 1 in X • ±.\J ^ ^ J 42 3.74 .99 361 43 3.76 .92 354 44 4.19 .75 364 45 4.10 .86 362 46 2.93 1.07 359 47 4.30 .82 361 48 2.71 1.05 354 49 3.59 .89 361 50 3.87 .72 361 51 3.27 1.03 355 52 3.64 .90 361 53 3.92 .86 354 Section I consisted of items 1 through 12, listing 12 methods of collaboration between helping professionals and self-help groups. Respondents were asked to evaluate the effectiveness of those methods with which they had experience by using a Likert-type scale. Possible responses ranged from 1, very ineffective, to 5, very effective. Table 4-2 indicates that the highest number of respondents chose item 3, indicating experience making referrals to self-help groups. The data in Table 4-2 also indicate that 302 respondents chose item 1, indicating they used self-help groups as a source of information. These two areas of

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-79collaboration also had the highest mean (4.1) rating them the most effective method of collaborating as well. The lowest number of responses (195) was to item 12, conducting research on self-help groups or phenomenon. The remaining 10 items had means ranging from 3.89 to 3.02. The item means for Section I were at the high end, ranging from 3.02 to 4.10. There was considerable variability, however, in responses as demonstrated by the range of the item standard deviations from .89 to 1.24. Section II consisted of 53 statements about selfhelp groups which respondents were asked to rate, again using a Likert-type scale. The number of responses per item ranged from a high of 365 responses to item 3, self-help groups are an important resource in meeting the mental health needs of society, to a low of 315 to item 20, self-help groups encourage members to conform to social norms. The means ranged from a high of 4.51 for item 18, self-help groups are not effective to a low of 1.85 for item 39, self-help groups should be regulated by the government for consumer protection. Variance in response to the items was indicated by the item standard deviations ranging from .72 to 1.27. The participants' response rates for Section II, the Attitude Scale, are shown in Table 4-3.

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-80Table 4-3 Participants' Response Rates to Attitude Scale Items Omitted Frequency % Cum % 0 288 70.2 70.2 1 40 9.8 80.0 2 15 3.7 83.7 3 8 2.0 85.6 4 1 .2 85.9 5 1 .2 86.1 6 1 .2 86.3 8 1 .2 86.6 1 1 X X i. • « o O . o 13 1 .2 87.1 19 1 .2 87.3 20 1 .2 87.6 21 1 .2 87.8 24 1 .2 88.0 25 4 1.0 89.0 43 1 .2 89.3 53 44 10.7 100.0 TOTAL 410 100.0 100.0 Mean 6.58 Standard Deviation 16.58 The participants' responses to the items in Section I, the Experience Scale, are provided in Table 4-4. Table 4-4 Frequency and Value Distribution of Items in Section I 1. Use self-help groups as a source of information. Value Label Value Freq Percent Very Ineff i lo 2.8 Somewhat Ineff 2 15 4.3 Neither 3 27 7.7 Somewhat Eff 4 126 35.9 Very Eff 5 110 31.3 No Response 9 63 17.9 Mean 4.08 Standard Deviation .99

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-81Table 4-4 Continued 2. Publicize self-help groups active in the area. Value Label Value Freq Percent Very Ineff 1 13 3.7 Somewhat Ineff 2 28 8.0 Neither 3 55 15.7 Somewhat Eff 4 108 30.8 Very Eff 5 48 13.7 No Response 9 99 28.2 Mean 3.59 Standard Deviation 1.07 3 . Make referrals to self -help groups. Value Label Value Freq Percent Very Ineff 1 6 1.7 Somewhat Ineff 2 14 4 . 0 Neither 3 26 7.4 Somewhat Eff 4 140 39.9 Very Eff 5 103 29.3 No Response 9 62 17.7 Mean 4.11 Standard Deviation .90 4. Share facilities with self-help groups. Value Label Value Freq Percent Very Ineff 1 24 6.8 Somewhat Ineff 2 18 5.1 Neither 3 93 26.5 Somewhat Eff 4 51 14.5 Very Eff 5 44 12.5 No Response 9 121 34.5 Mean 3.32 Standard Deviation 1.18 5. Receive referrals from self-help groups. Value Label Very Ineff Somewhat Ineff Neither Somewhat Eff Very Eff No Response Value 1 2 3 4 5 9 Freq 21 22 58 108 47 95 Percent 6.0 6.3 16.5 30.8 13.4 27.1 Mean 3.54 Standard Deviation 1.13

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-82Table 4-4 Continued 6. Form an advocacy group or coalition with a self-help group. Value Label Value Freq Percent Very Ineff Somewhat Ineff Neither Somewhat Eff Very Eff No Response 1 2 3 4 5 9 25 22 70 67 22 145 Mean 3.19 Standard Deviation 1.15 7, 6, 19, 19, 6. 41.3 7. Integrate self-help group members into committees, boards, etc. Value Label Value Freq Percent Very Ineff Somewhat Ineff Neither Somewhat Eff Very Eff No Response 1 2 3 4 5 9 23 28 75 73 15 137 6.6 8.0 21.4 20.8 4.3 39.0 Mean 3.14 Standard Deviation 1.08 8. Serve as a consultant to a self-help group. Value Label Value Freq Percent Very Ineff Somewhat Ineff Neither Somewhat Eff Very Eff No Response 1 2 3 4 5 9 14 11 33 113 70 110 4 3 9 32 19 31, 0 1 4 2 9 3 Mean 3.89 Standard Deviation 1.06 9. Use a self-help group as consultants. Value Label Value Freq Percent Very Ineff Somewhat Ineff Neither Somewhat Eff Very Eff No Response 1 2 3 4 5 9 20 20 61 93 36 121 5.7 5.7 17.4 26.5 10.3 34.5 Mean 3.46 Standard Deviation 1.12

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-83Table 4-4 Continued 10. Provide training to a self-help group. Value Label Value Freq Percent Very Ineff 1 17 4.8 Somewhat Ineff 2 7 2.0 Neither 3 42 12.0 Somewhat Eff 4 102 29. 1 Very Eff 5 78 22.2 No Response 9 105 29.9 Mean 3.88 Standard Deviation 1.10 11. Receive training from a self-help group . Value Label Value Freq Percent Very Ineff 1 23 6.6 Somewhat Ineff 2 28 8.0 Neither 3 62 17.7 Somewhat Eff 4 77 21.9 Very Eff 5 34 9.7 No Response 9 127 36.2 Mean 3.32 Standard Deviation 1.18 12. Conduct research on self -help group or phenomen Value Label Value Freq Percent Very Ineff 1 36 10.3 Somewhat Ineff 2 13 3.7 Neither 3 76 21.7 Somewhat Eff 4 41 11.7 Very Eff 5 25 7.1 No Response 9 160 45.6 Mean 3.03 Standard Deviation 1.25 The methods of collaboration selected as very effective were using self-help groups as a source of information (item 1) , making referrals to self-help groups (item 3), and providing training to a self-help group (item 10) . The methods chosen least effective were forming an advocacy group or coalition with a self-help group (item 6)

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-84and conducting research on a self-help group or phenomenon (item 12) . The methods of collaboration which had the lowest percentage of no response, less than 20%, indicating the most experience, were using self-help groups as a source of information (item 1), and making referrals to self-help groups (item 3) . The highest percentage of no response, more than 40%, indicating areas of least experience, were forming an advocacy group or coalition with a self-help group (item 6) , and conduct research on self-help group or phenomenon (item 12) . Content Validity Although the panel of experts chosen to evaluate the items generated for the SAESHG rated the items appropriate, they had difficulty choosing which item was in which content area for Section II, the Attitude Scale with 53 items. This was especially true in discriminating between the areas of purposes/activites and characteristics The panel could not decide between purposes/activities and characteristics for 31 items. For the content area relations to other helpers, 17 items were developed, and 15 of these were chosen for that area by the panel. Rather than discard items which the panel had agreed were appropriate for the instrument because of confusion over

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-85which content area the item should be placed in, all items were retained. After the field test, factor analyses were completed so that items could be seperated by empirical methods . Construct Validity Factor analyses were completed on both sections of the SAESHG using responses from the field study to determine how items loaded in both Section I and Section II. Regarding Section I, the Experience Scale, a factor analysis using principal component analysis was completed. Because items were designed for one scale, a decision was made a priori to force items to one factor. As can be see in Table 4-5, all items have a factor loading of at least . 54 . Table 4-5 Principal Component Analysis of Section I, Items 1-12 Item # Factor Loading 1 .55287 2 .63918 3 .55763 4 .59291 5 .60604 6 .71064 7 .61656 8 .54512 9 .64949 10 .65004 11 . 62643 12 .60665

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-86A principal component analysis using an oblique rotation was used on Section II, the Attitude Scale. A .30 loading cut-off point was used to select items for factor loadings. It was believed a priori that items comprised three separate scales. The factor analysis used to explore this possibility was a principal component analysis for a three factor solution. The resulting factor loadings are shown in Table 4-6. Table 4-6 Factor Loadings: Principal Component Analysis, Oblique Item# <.3 Factor 1 Factor 2 Factor 3 1 .33162 2 X 3 .61759 4 .59257 5 .36092 6 X 7 .55139 8 .56372 9 .41192 10 .47340 11 X 12 .67783 13 .59428 14 .34812 15 .39778 16 -.64683 17 .58893 18 .76605 19 .34280 20 X 21 .36025 .45434 22 .51548 23 .65330 24 .45699 25 .49758 26 .52298 27 .36324 28 X 29 .41990

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-87Table 4-6 Continued Itein# <. 3 Factor 1 Factor 2 Factor 30 .36863 31 .54763 32 . 38013 33 X 34 .58914 35 .36185 36 .71750 37 .30359 38 . 71734 39 -.31153 40 . 64729 41 X 42 .40963 .30643 43 .43255 44 .70545 45 .58375 46 X 47 .71982 48 .41441 49 .52232 50 .58460 51 .32492 .32133 52 .57143 53 .63732 Based on the loading cut-off point of .30, the following items were not retained: 2, 6, 11, 20, 28, 33, 41, and 46. Item 37 just met the cut-off criteria with a loading of .30359. A principal component analysis with a varimax rotation also was done using a three factor solution with very similar results. Table 4-7 provides the factor loadings for each item.

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-88Table 4-7 Factor Loadings: Principal Component Analysis, Varimax Item# < . 3 Factor 1 Factor 2 Factor 3 1 .34789 2 X 3 .61405 ' ? ' \ . . 4 .58552 5 • .34684 6 .30386 ; 7 .54905 8 .54354 9 .41197 10 .48618 11 X 12 .66787 13 .59926 .32267 14 .35651 15 .38670 16 -.64244 17 .59120 18 .75954 19 .33960 20 X 21 .34811 .42120 22 .52396 23 .66358 24 .45474 25 .50565 26 .50307 27 .36073 28 X 29 .42511 30 .36926 31 .54715 32 .37304 33 X 34 .59026 35 .36755 36 .70257 37 .31117 38 .71753 39 -.30012 40 .64163 41 X 42 .39612 .35337 43 .41485 44 .70278 45 .58115 46 X 47 .71455

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-89Table 4-7 Continued Itein# < . 3 Factor 1 Factor 2 Factor 3 48 49 50 51 52 53 .52457 .58588 .33341 .57382 .63406 .42592 .34456 A comparison of Table 4-6 and Table 4-7 reveals that for both analyses items 2, 11, 20, 28, 33, 41, and 46 had loadings less than .3. Item 6 did load on factor 2 using the varimax rotation, but since it loaded at .30386, this item cannot be considered definitive. Comparing the loadings on Factor 1, all the items were the same for ' both with the exception of item 37 which loaded on the oblique rotation at .3 0359. Due to the low value of this loading, item 37 could be discarded. On Factor 2, the same items loaded with the exception of 6 and 13. Item 13 had a higher value on Factor 1. On Factor 3, the same items loaded with the exception of items 9 and 37, both of which had values less than .312. This comparison of Table 4-6 and Table 4-7 appears to further indicate that items 2, 11, 20, 28, 33, 41, and 46 could be omitted from the instrument since they did not load on any factor, and that the remaining 46 items are loading on the same factors, with few exceptions. A review of the items showed that many loaded as expected. Some of the items which did not load seemed to be

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-90related to each other. Since one explanation of the difficulty of the panel of experts to choose between the three hypothesized factors was that there was another factor within one of the possible three factors, a principal component analysis was conducted to investigate if there was a fourth factor. Results are shown in Table 4-8. Table 4-8 Factor Loadings: Principal Component Analysis, Varimax Rotation Item# <• 3 Factor 1 Factor 2 Factor 3 Factor 1 .44908 2 . 55732 3 .62001 4 S88Q0 5 • -aJ ^ ^ ^ O 6 .34638 7 .53849 8 . 54449 9 . 39592 : 10 • *S V/ ^ U V/ 11 • 0 7 4 7 / 12 .67632 13 .61545 14 .35795 15 .39344 16 -.72561 17 .58809 18 .76679 19 .35521 20 .34403 21 .36139 .62873 22 .51187 23 .68719 24 .45528 -.36059 25 .50719 26 .53884 27 . 34875 28 X 29 .42199 30 .36669 31 .56876 32 .41503 33 X 34 .59493

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-91Table 4-8 Continued Item# <.3 Factor 1 Factor 2 Factor 3 Factor 4 35 .36798 36 .70528 37 .30085 38 .72900 39 -.30664 40 .60429 41 X 42 .40624 43 .43989 44 .70972 45 .59066 46 X 47 .71987 48 .42064 49 .53034 c o o o o . 58988 51 .34030 .35097 52 .57591 53 .64653 Eigen value 9.65123 3.15474 2.68013 2.28233 Pet of 18.2 6.0 5.1 4.3 Variance Of the items which had not loaded previously across three factors, items 28, 33, 41, and 46 also failed to load across four factors. Items 2, 11, and 20, which had also failed to load previously, now loaded on factor 4. In addition, items 1 , 5 , 10, 24 , 32 , and 51, which had previously loaded on other factors, now loaded on factor 4 . This completed the factor analyses on Section II. ' ^ At this point a Scree Test was used to assist in selecting the three or four factor solution for subsequent reliability studies. As illustrated in Figure 1, the elbow occurring at factor 4 indicates that the four factor solution is the more desirable one.

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-92-

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-93Factor 1 consisted of 31 items with factor loadings ranging from .30 to .76. The content of these items / , pertained to characteristics of self-help groups including benefits to members, strengths, and importance of self-help groups. Factor 2 consisted of 10 items with factor loadings ranging from .35 to .60. The content of these items pertained to contrasts between self-help groups and traditional therapies. Factor 3 consisted of 4 items with factor loadings from .63 to .73. Items related to the involvement of a helping professional with a self-help group. Due to the high negative loading of item 16, it was omitted prior to the reliability analysis for this factor. Factor 4 consisted of 9 items with factor loadings from .34 to .56. The content of these items related to comparisons between self-help and professional services, and functions of self-help groups. Items loading on this factor did not seem to be as related in content as on the other factors. Reliability As mentioned previously, data analyses were completed using 351 participants, or those participants who responded to 50 or more items in Section II. Based on the factor analytic solutions, reliability studies were conducted on Section II for factors 1, 2, 3, and 4. The

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-94results of these studies are presented in Tables 4-9 through 4-12. Table 4-9 Reliability Analysis for Factor One Item# Alpha if Item Deleted 3 .9016 4 .9025 7 .9033 8 .9035 9 .9055 12 .9007 13 .9008 14 .9056 15 .9058 17 .9020 18 .8994 19 .9063 24 .9045 27 .9065 29 .9061 30 .9062 31 .9020 34 .9023 35 .9062 38 .9003 42 .9056 44 .9005 45 .9021 47 .9001 49 .9029 50 .9021 51 .9057 52 .9019 53 .9009 Reliability Coefficients 29 items Alpha = .9062 Standardized Item Alpha = .9128

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-95Table 4-10 Reliability Analysis for Factor Two Itein# Alpha if Item Deleted 6 .6222 10 .6059 22 .5827 25 .5903 26 .6214 40 .5839 43 .6405 48 .6160 Reliability Coefficients 8 items Alpha = .6401 Standardized Item Alpha = .6420 Table 4-11 Reliability Analysis for Factor Three Item# Alpha if Item Deleted 21 .6296 23 .5646 36 .4827 Reliability Cofficients 3 items Alpha = .6567 Standardized Item Alpha = .6583 Table 4-12 Reliability Analysis for Factor Four Item# Alpha if Item Deleted 1 .4302 5 .4816 10 .3923 20 .5297 32 .4287 51 .4539 Reliability Coefficients 6 items Alpha = .5581 Standardized Item Alpha = .5601

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-96Based upon the results of the factor analyses and the reliability analyses conducted, as well as a review of the content of the items, several items were dropped. Items 9, 15, 24, 27, and 35 were dropped because of poor item dispersion as evidenced by means <2.0 or >4.0 and loadings of .40 or less. The content of these items also appeared to be more cognitive than affective. Additional items which were dropped were: 2, 11, 16, 28, 33, 37, 39, 41, and 46. Remaining items had loadings of .34 or greater and standard deviations >.72. The items which were retained for the final form of the SAESHG are in Table 4-13. Discussion of the Results Content Validity An exhaustive review of the literature on self-help groups was conducted before the SAESHG items were developed. Certain broad areas were identified through this literature search which seemed to encompass most of the information available about self-help groups. Specific items were developed for the SAESHG based on these broad areas. Once items for the SAESHG were developed, these items were submitted to the panel of experts for evaluation. Candidates for the panel of experts also were identified through a review of literature. Only those authors with experiential knowledge of self-help groups were asked to be members of the panel of experts.

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-97Table 4-13 Final Factors for SAESHG Factor 1 Factor Item # Loadings 3. SHGS are an important resource in meeting the mental health needs of society. .63 4 . SHGS foster support networks throughout the population. .59 7. SHGS have positive effects on family relationships. .54 8. SHGS are not a passing fad. .54 12. SHGS are more harmful than beneficial. .68 13. A SHG is a powerful change agent. .62 14. SHGS serve to educate the general publi .36 17. SHGS empower their individual member .59 18. SHGS are not effective. .77 19. SHGS do not reach those most in need of assistance. .36 29. Anyone can benefit from a SHG. .42 30. SHGS "normalize" the needs of their members. .37 31. Professionals have a great deal to learn from SHGS. .57 34. SHGS encourage members to give, not just to receive. .59 38. SHGS increase members' abilities to help themselves. .73 42. Most SHGS don't last long enough to be effective. .41 44. A SHG benefits its members. .71 45. A SHG is an excellent resource for a helping professional. .59 47. The professional helping community should support SHGS. .72 49. Participation in a SHG is a move away from reliance on helping professionals. .53 50. SHGS increase members psycho-social skills. .59 52. SHGS encourage independence. .58 53. Helping professionals should refer their clients to SHGS. .65

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-98Factor 2 Factor Item # Loadings 6. Members of SHGS benefit most by being able to help someone else. . 35 22. SHGS offer a diversity of approaches which traditional therapies lack. .51 25. Members of SHGS have natural helping expertise. .51 26. The majority of people in SHGS have tried traditional therapies and rejected them. .54 40. A SHG is preferable to traditional therapy. .60 43. SHGS increase as professional services are rejected. .44 48. SHGS are more appropriate than professional therapies for treatment of the stigmatized. .42 Factor 3 Factor Item # Loadings 21. The involvement of a helping professional with a SHG lessens the groups ability to help itself .63 23. SHGS should be started by a helping professional. .69 36. Most SHGS could benefit from a helping professionals expertise. .71 Factor 4 Factor Item # Loadings 1. SHGS are more similar to professional services than different from professional services. .45 5. People who join SHGS also need traditional therapy. .55 10. SHGS are a viable alternative to professional services . .42 20. SHGS encourage members to conform to social norms. .34 32. SHGS are not an alternative to traditional therapy. .42 51. SHGS play a significant role in the prevention of mental illness. .35 Of the 55 items for Section II, the panel of experts evaluated all but two items as appropriate for inclusion on the SAESHG. This evaluation indicated that the review of literature had been thorough, that the items had been well

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-99chosen, and that they reflected the content of the field regarding self-help groups. The panel of experts' difficulty in agreeing on the content area of the items may have been due to the globalness of the construct area. Since no guidelines had been established in earlier studies as to the nature of the domain of attitudes toward self-help groups, it was decided that the constructs could best be identified through empirical methods. According to Kerlinger (1973), content validation is • basically judgemental. Content validity is based on the soundness of the method of construction of the items and the evaluation of the items by experts. From the thorough review of the literature and the panel's agreement as to the appropriateness of the items, the SAESHG was determined to have content validity. In addition to the evaluation by the panel of experts, participants in the pilot study also were instructed to comment on the SAESHG in terms of format and content. Their comments that the SAESHG was easy to read and understand and their willingness to complete the SAESHG were taken as indicators of face validity. The participant response rate to Section II, 86.8% omitting 8 items or less, also was taken as an indicator of face validity. Although face validity is only one aspect of content validity, it is nonetheless desirable.

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-100Construct Validity Based on the literature review, several construct areas were hypothesized to be part of the domain of attitudes toward self-help groups. Because this study was a first attempt at identifying the constructs, rather global terms were used initially. The three hypothesized construct areas were purposes/activities, characteristics, and relationship to other helpers. Perhaps due to the globalness, the panel of experts had difficulty in agreeing in which construct area an item should be placed. Since the reason for the panel's difficulty was unclear, factor analyses were used to identify the construct areas. From the factor analyses, one factor was identified for Section I, and four factors were identified for Section II. The loadings on the four factors in Section II placed the items in a similar pattern to their development. Items in factors 1 and 2 had primarily been placed in the content areas processes/activities and characteristics. Items in factors 3 and 4 had primarily been grouped together under the content area relationship to other helpers. From a review of the items in Section II which loaded on factor 1, it appears that this factor is more general in scope. It also has the most combination of items from the other areas as developed and as chosen by the panel. It appears that factor 2 is composed of items which make a comparison and contrast between self-help groups and more

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-101traditional therapy. This factor could be viewed as a more specialized division of the larger factor of relationship to other helpers. Items from factors 3 and 4 also appear to be part of this larger factor, relationship to other helpers. Since these factors are part of the three hypothesized construct areas and are internally reliable, this provided evidence regarding the construct validity of the SAESHG. Internal Reliability In order to estimate the reliability of the SAESHG factors, coefficient alpha, a measure of internal consistency, was computed for each factor. For Section II, the coefficient alpha for Factor 1 was .9062, for Factor 2 it was .6401, for Factor 3 it was .6567, and for Factor 4 it was .5581. These results indicated that the instrument had internal consistency. According to Nunnally (1978) , coefficient alpha provides a good estimate of reliability in most situations, since the major source of measurement error is because of the sampling of content (p. 2 30) . The extensive review of literature, a preliminary step in item development, was the foundation on which the SAESHG was built. This foundation provided the base for items which were found to be both valid and reliable.

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CHAPTER 5 CONCLUSIONS, IMPLICATIONS, SUMMARY, AND RECOMMENDATIONS Conclusions Four conclusions were drawn based on the data presented in the study. One conclusion was that the SAESHG had content validity. A second was that the SAESHG had construct validity. The third conclusion was the SAESHG is reliable as demonstrated by internal consistency. The fourth conclusion was the SAESHG is a valid and reliable instrument for assessing helping professionals' attitudes towards self-help groups. Implications One implication of this study is that the SAESHG can assist in conducting research on self-help groups. The SAESHG provides a method of assessing helping professionals' current attitudes and their levels of experience. Should further refinement on the SAESHG provide evidence of its temporal stability, it will provide a method of assessing attitudinal change over time. By using the instrument to assess attitude change, a researcher can develop hypotheses -102-

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-103to explain present findings and to predict future direction based on current trends. Another implication of this study is that the SAESHG can be used to make comparisons across populations. After validating the instrument on other populations, comparison studies can be made. By using the instrument with a variety of populations, profiles can be developed of those persons, groups, or regions most and least favorable toward self-help groups. These findings would generate new theories or confirm existing theories about the populations attitudes and experiences with self-help groups. A third implication is that the SAESHG can be used as a quantitative measure to determine whether existing hypotheses concerning attitudes and experiences with selfhelp groups are substantiated. A fourth implication is that the SAESHG can assist helping professionals in their consultation activities with other professionals or with self-help groups. An excellent method to begin the consultation process is through assessment of the consultees current attitudes and experiences. The SAESHG provides a means of assessing consultees attitudes and experiences. The SAESHG also can be used by self-help groups as a means of evaluating potential consultants. By determining consultants' attitudes and experiences with self-help

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-104groups, the self-help group can better decide whether they wish to retain consultants. A sixth implication is that the SAESHG can be used by helping professionals to assess their clients. By giving the survey to clients, helping professionals can better determine whether or not to refer clients to self-help groups. , Another implication is that the SAESHG can be used as a preliminary assessment tool to aid in planning training activities pertaining to self-help groups. By assessing the attitudes of the trainees, trainers can prepare a program to challenge or strengthen these attitudes. Areas of experiential knowledge which are limited can be identified and appropriate opportunities created for the trainees. By using the SAESHG to identify those professionals who have both experiential knowledge and positive attitudes toward self-help groups, these professionals can be enlisted in training activities. They can serve as important role models in training programs for collaborating with self-help groups (Borman, 1976) . A final implication is that the SAESHG can be used as a self-assessment tool by students in professional training programs. Using the SAESHG as a sel f -assessment , trainees can better understand their attitudes and experiences and identify areas in which they may want more training. Consultants can use the survey as a pre and post measure to

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-105evaluate the impact of their training on trainees. A counselor education department can use the instrument with its trainees to better plan training or practicum experiences with self-help groups and/or to determine whether such steps are necessary. Summary An introduction, statement of the problem, need for the study, purpose of the study, significance of the study, definition of terms, and organization of the study was contained in Chapter One. A review of the related literature which included sections about the self-help movement, selfhelp groups and society, the power struggle between selfhelp groups and professionals, professional collaboration with self-help groups, self-help and research, and a summary was presented in Chapter Two. The research questions, theoretical basis, item development, pilot study, panel of experts item response, field test, and limitations of the study were described in Chapter Three. The results of the study and a discussion of the results was presented in Chapter Four. Based on the method of construction of the items and the evaluation of the items by the panel of experts, the SAESHG was determined to have content validity. From the literature review, the factor analyses results, and the internal reliability of the instrument, the SAESHG was determined to have construct

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-106validity. From the results of the coefficient alpha analyses, the SAESHG was determined to be reliable as demonstrated by internal consistency. Recommendations Further refinement of the SAESHG is strongly recommended. The following revisions to the instrument are suggested. First, additional demographic questions such as sex and race of respondent should be included in the first part of the SAESHG to collect further information on the population surveyed. Second, a not applicable or N/A response choice to Section I should be included. This would enable the respondent to indicate whether they had experience rather than the researcher assuming that the respondent had no experience because the item had no response. In Section I, some method to indicate the amount of experience should be included to distinguish between respondents who have years of experience versus those with minimal experience. Third, several comparison studies should be conducted. In one study, all items which did not load at the 5.0 level should be deleted from the instrument. A comparison should be done with remaining items on factors 1 and 2 and with remaining items on factors 1, 2, 3, and 4. All items with means <2.0 or >4.0 also should be omitted in a comparison study. This would result in Factor 1 retaining 8 items.

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-107Factor 2 retaining 4 items, Factor 3 with 4 items, and Factor 4 with 2 items. New items should then be created to allow more uniformity of factors. Factor 4 may need to be discarded altogether since most of the items are loading on Factor 2. Following instrument revision, it is further recommended that a test/retest be conducted with a small population to provide indications of stability. Studies should be conducted using other populations for the purpose of further validating the SAESHG. These populations could include social workers, alcohol and drug abuse counselors, correctional counselors, members of selfhelp groups, and students in various helping professional graduate training programs. Longitudinal studies should be conducted using the SAESHG with targeted populations to document attitudinal changes over time for the purpose of predicting future trends. Since the growth of self-help groups in the last 25 years, helping professionals have progressed from ignoring the phenomenon, to beginning collaboration, to perhaps enveloping the movement. Future studies are needed to assess the developing pattern.

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APPENDIX A PANEL OF EXPERTS Dr. Thomasina Borkman, George Mason University, has had training in working with self-help groups in the areas of self -directed study, practical experience, and research. She has had experience with self-help groups in the following capacities: participant, interested observer, consultant, and researcher. Her publications include: Experiential knowledge: A new concept for the analysis of self-help groups in Social Service Review . 1976, 50: 445-456; Participation patterns and benefits of membership in a selfhelp organization of stutterers in A. Katz and E. Bender (Eds.), The strength in us: Self-help groups in the modern world , New York: New Viewpoints, 1976, 81-90; Experiential knowledge in self-help groups as the basis of selective utilization of professional knowledge and services, a paper presented at Pennsylvania Sociological Society, Pittsburg, October, 1977; Mutual self-help groups: A theory of experiential inquiry. Services Analysis Branch, NIAA (Xeroxed), 1979, among others. Dr. Alan Gartner, Co-Director of the National Self-Help Clearinghouse at the City University of New York, has had training working with self-help groups through self-directed study, seminar/workshops, and practical experience. He has also been an interested observer, consultant, and researcher of self-help groups. His publications co-authored with Dr. Frank Reissman include, among others: Self-help in the human services , San Francisco: Jossey-Bass, 1977; Help: A working guide to self-help groups . New York: Franklin Watts, 1979; Professional involvement in self-help groups, SelfHelp Reporter. 3, 4-5, 1979; The Self-Help Revolution . New York: Human Services Press, Inc., 1984. Dr. Alfred Katz, University of California, has had training working with self-help groups through self -directed study, and practical experience. He has had experience with selfhelp groups as a participant, interested observer, consultant, researcher, and administrator of a national self-help group. His publications include: Self-help organizations and volunteer participation in social welfare in Social Work. 15, 52-53, 1970; Self-help groups in Western society: History and prospects. Journal of Applied Behavioral Science. 12, 265-281, 1976 and The Strength in -108-

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-109Us . New York: New Viewpoints, 1976 both co-authored with E. Bender, and Self-help and mutual aid: An emerging social movement?, American Review of Sociology . 7. 129-155, 1981. Dr. Bob Knight, has had training with self-help groups through self-directed study, practical experience, and as a research assistant in a self-help study at Indiana University. He has had experience with self-help groups as a participant, observer, consultant, researcher, and leader. His publications include: Self-help groups: The members' perspectives, American Journal of Community Psychology . 8, 53-65, 1980. Dr. Thomas Powell, University of Michigan, has had training through self-directed study, seminar/workshop, and practical experience. His experience with self-ehlp groups has been as an observer, consultant and researcher. His publications include: The use of self-help groups as supportive refernce communities, American Journal of Orthopsychiatry . 45, 756764, 1975; and Comparisons between self-help groups and professional services. Social Casework . 11 . 561-565, 1979. Dr. Richard Steinman, University of Maine, did not provide information on his experience and training with self-ehlp groups. His publication, co-authored with D. Traunstein was entitled Redefining deviance: The self-help challenge to the human services. Journal of Applied Behavioral Science . 12., 347-361, 1976. Dr. Rubin Todres, University of Toronto, has experience as a researcher with self-help groups. His publications include Professional attitudes, awareness and use of self-help groups. Prevention in Human Services . 1, 91-98, 1982. Dr. Ann Withorn, University of Massachusetts, has training with self-help groups through self -directed study and practical experience. Her experience has been as a participant, consultant, and leader. Her publications include Helping ourselves: The limits and potential of selfhelp. Social Policy . 11 . 20-28, 1980.

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APPENDIX B Survey of Attitudes Toward and Experiences With Self-Help Groups 1. What is your highest educational level? Bachelor Ph.D. or Ed.D Master Other Education Specialist (Ed.S.) 2. What is your present job title? (Check appropriate job category.) Counselor/Therapist ^Administrator Teacher Other 3. What training have you had in working with self-help groups? (Check as many as are applicable) College course (s) Practical Experience Self -directed study Other Seminar/Workshop None 4. In what capacity have you had experience with self-help groups? (Check as many as are applicable.) Next to the capacity, list the self-help group (s) . Participant Interested observer Consultant Researcher Leader Other Complete this section only if you have had some experience working with self-help groups . Listed below are several means of collaboration between helping professionals and self-help groups. Please indicate all those areas in which you have worked with a self-help group by evaluating the effectiveness of those collaborations using the following scale: 1 very ineffective 4 somewhat effective 2 somewhat ineffective 5 very effective 3 neither ineffective nor effective -110-

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-1111. Use self-help groups as a source of information 12 3 4 2. Publicize self-help groups active in the area 12 3 4 5 3. Make referrals to self-help groups 12 3 4 5 4. Share facilities with self-help groups 12 3 4 5 5. Receive referrals from self-help groups 12 3 4 5 6. Form an advocacy group or coalition with a self-help group 12 3 4 5 7. Integrate self-help group members into committees, board etc. 12 3 4 5 8. Serve as a consultant to a self-help group 12 3 4 5 9. Use a self-help group as consultants 12 3 4 5 10. Provide training to a self-help group 12 3 4 5 11. Receive training from a self-help group 12 3 4 5 12. Conduct research on self-help group or phenomenon 12 3 4 5 13. Other methods of collaboration (please specify and rate effectiveness) Listed below are several statements. Please respond to each by circling the appropriate number on the following scale: 1 totally disagree 4 somewhat agree 2 somewhat disagree 5 totally agree 3 neither disagree or agree

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-1121. Self-help groups are more similar to professional services than different from professionals services 1 2 3 4 5 2. The ideology of a self-help group alters when a professional becomes leader 12 3 4 5 3. Self-help groups are an important resource in meeting the mental health needs of society 12 3 4 5 4. Self-help groups foster support networks throughout the population 12 3 4 5 5. People who join self-help groups also need traditional therapy 12 3 4 5 6. Members of self-help groups benefit most by being able to help someone else 12 3 4 5 7. Self-help groups have positive effects on family relationships 12 3 4 5 8. Self-help groups are not a passing fad 12 3 4 5 9. Members of self-help groups benefit most from learning how others attempt to solve similar problems 12 3 4 5 10. Self-help groups are a viable alternative to professional services 12 3 4 5 11. Members of self-help groups don't want to be involved with helping professionals 12 3 4 5 12. Self-help groups are more harmful than beneficial 1 2 3 4 5 13. A self-help group is a powerful change agent 12 3 4 5 14. Self-help groups serve to educate the general public 1 2 3 4 5 15. Most people who join self-help groups are "on the fringe" of society 12 3 4 5 16. A professional can best collaborate with a self-help group by being a facilitator 12 3 4 5

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-11317. Self-help groups empower their individual members 1 2 3 4 5 18. Self-help groups are not effective 12 3 4 5 19. Self-help groups do not reach those most in need of assistance 12 3 4 5 20. Self-help groups encourage members to conform to social norms 12 3 4 5 21. The involvement of a helping professional with a selfhelp group lessens the groups' ability to help itself 1 2 3 4 5 22. Self-help groups offer a diversity of approaches which traditional therapies lack 12 3 4 5 23. Self-help groups should be started by a helping professional 12 3 4 5 24. Sharing personal experiences is a major function of a self-help group 12 3 4 5 25. Members of self-help groups have natural helping expertise 12 3 4 5 26. The majority of people in self-help groups have tried traditional therapies and rejected them 12 3 4 5 27. Sharing information is a major function of a self-help group 12 3 4 5 28. People who use self-help groups for assistance are the same as those who use professional therapists 12 3 4 5 29. Anyone can benefit from a self-help group 12 3 4 5 30. Self-help groups "normalize" the needs of their members 1 2 3 4 5 31. Professionals have a great deal to learn from self-help groups 12 3 4 5 32. Self-help groups are not an alternative to traditional therapy 12 3 4 5

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-11433. A self-help group substitutes reliance on a group for reliance on a helping professional 12 3 4 5 34. Self-help groups encourage members to give, not just to receive 12 3 4 5 35. A self-help group is more economically feasible than traditional therapy for most people 12 3 4 5 36. Most self-help groups could benefit from a helping professional's expertise 12 3 4 5 37. Helping professionals know as much as they need to know about self-help groups 12 3 4 5 38. Self-help groups increase members abilities to help themselves 12 3 4 5 39. Self-help groups should be regulated by the government for consumer protection 12 3 4 5 40. A self-help group is preferable to traditional therapy 1 2 3 4 5 41. Self-help groups are frequently involved in political activites or social advocacy 12 3 4 5 42. Most self-help groups don't last long enough to be effective 12 3 4 5 43. Self-help groups increase as professional services are rejected 12 3 4 5 44. A self-help group benefits its members 12 3 4 5 45. A self-help group is an excellent resource for a helping professional 12 3 4 5 46. Participation in a self-help group is a move away from reliance on helping professional 12 3 4 5 47. The professional helping community should support selfhelp groups 12 3 4 5 48. Self-help groups are more appropriate than professional therapies for treatment of the stigmatized 12 3 4 5

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-11549. Participation in a self-help group decreases the stress of its members 12 3 4 5 50. Self-help groups increase members' psycho-social skills 1 2 3 4 5 51. Self-help groups play a significant role in the j prevention of mental illness 12 3 4 5 ' 52. Self-help groups encourage independence 12 3 4 5 53. Helping professionals should refer their clients to self-help groups 12 3 4 5 Please make any comments about self-help groups in the space below. Thank you for completing this survey. If you would like a copy of the results, please provide your name and address below. Return this survey to: Lynn McRee Borough of Manhattan Community College 199 Chambers Street, Room S773 New York, New York, 10007

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REFERENCES About Alcoholics Anonymous. (Fall, 1980). Newsletter. Alcoholics Anonymous World Services, Inc. Alcoholics Anonymous in Treatment Centers. (1979) . Pamphlet. Alcoholics Anonymous World Services, Inc. Anderson, R.T. (1971) . Voluntary association in history. American Anthropologist . 73., 209-222. Antze, P. (1976) . The role of ideologies in peer psychotherapy organizations: Some theoretical considerations and three case studies. Journal of Applied Behavioral Science , 12, 323-346. Babbie, E. (1973) . Survey research methods . Belmont: Wadsworth Publishing Co. Back, K.W. , & Taylor, R.C. (1976). Self-help groups: Tool or symbol? Journal of Applied Behavioral Science . 12. 295-309. Beveridge, W. (1948) . Voluntary action; A report on methods of social advance . New York: Macmillan. Bird, C. (1940) . Social psychology . New York: AppletonCentury-Crofts, Inc. Blumer, H. (1969) . Social movements. In B. McLaughlin, Studies in social movements: A social psychological perspective . New York: The Free Press. Borkman, T. (1976) . Experiential knowledge: A new concept for the analysis of self-help groups. Social Service Review . 50, 445-456. Borman, L.D. (1976). Self-help and the professional. Social Policy , 1, 46-47. -116-

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-117Boyer, R. , & Morais, H. (1955). Labor untold story . New York: United Electrical, Radio, and Machine Workers of America. Brenner, M.H. (1973). Mental illness and the economy . Cambridge, MA: Harvard University Press. Brown, B. (1978) . Social and psychological correlates of help-seeking behavior among urban adults. American Journal of Community Psychology . 6, 425-439. Caplan, G. (1974) . Support systems and community mental health . New York: Behavioral Publications. Caplan, G. , & Killilea, M. (1976). Support systems and mutual help . New York: Brune & Stratton, Inc. Chutis, L. (1983). Special roles of mental health professionals in self-help group development. Prevention in Human Services . 2, 65-73. Cole, G.D., & Wilson, A.W. (1951). British working class movements, select documents 1789-1875 . London : Macmillan and Co. , Ltd. Dewar, T. (1976) . Professionalized clients as self-helpers. In Self-help and health: A report . New York: City University of New York, Queens College, New Human Service Institute. » . Drakeford, J. (1969). Farewell to the lonely crowd . Waco, TX: Ward Books Publishers. Dumont, M.P. (1974). Self-help treatment programs. American Journal of Psychiatry . 131 , 631-635. Durman, E. (1976) . The role of self-help in service provision. Journal of Applied Behavioral Science . 12, 433-443. Edwards, A.L. (1957). Techniques of attitude scale construction . New York: Appleton. Evans, G. (1979). The Familv Circle guide to self-help . New York: Ballantine Books.

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-118Feinberg, N. (1970) . A self-help group in action. Volunteer Administration . 11, 32-34. Fields, S. (1980). Mental health networks: Extending the circuits of community call. Innovations . 7, 2-3. Foster, J. (1974) . Class struggle and the Industrial Revolution; Early industrial capitalism in three English towns . New York: St. Martin's Press. Gartner, A., & Reissman, F. (1974). The service society and the consumer vanguard . New York: Harper & Row. Gartner, A., & Reissman, F. (1977). Self-help in the human services . San Francisco: Jossey-Bass. Gartner, A., & Reissman, F. (1980). Help: A working guide to self-help groups . New York: New Viewpoints. Glenn, M. & Kunnes, R. (1973) . Repression or revolution? Therapy in the United States today. New York: Harper & Row, Publishers. Goffman, E. (1963) . Stigma: Notes on the management of spoiled identity . Englewood Cliffs, NJ: Prentice-Hall. Gordon, J.S. (1978). Special study on alternative mental health services . Task panel reports to the President's Commission on Mental Health. Gottlieb, B.H. (1980) . Professional in self-help and mutual aid groups. In A. Gartner and F. Reissman, Help: A working guide to self-help groups . New York: New Viewpoints . Grosz, H.J. (1972). Recovery. Inc. . Survey . Chicago: Recovery, Inc. Gussow, A., & Tracy, G.S. (1976). The role of self-help clubs in adaptation to chronic illness and disability. Social Science and Medicine . 10, 407-414. Haug, M. , & Sussman, M. (1969). Professional autonomy and the revolt of the client. Social Problems . 17 . 153-160.

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-119Hermalin, J. & Swift, M. (1981). Study of self-help groups identifies four main topics. National Council (of Community Mental Health Centers) News . February, 4-5. Henley, A. (1975) . No questions barred. Prism . 3., 33-36. Humanizing health care (1977) . Committee report in Medical Care . 15 . 19-48. Hurvitz, N. (1974). Similarities and differences between conventional psychotherapy and peer self-help psychotherapy groups. In P.S. Roman and H.M. Trice (Eds.), The sociology of psychotherapy . New York: Aranson. Hurvitz, N. (1976) . Origins of the peer self-help psychotherapy group movement. Journal of Applied Behavioral Science . 12, 283-294. Interview with Dr. Robert Hess: Helping thyself to mental health, (1980). Innovations ^ 7, 81-21. Isaac, S. & Michael, W. (1971). Handbook in research and evaluation . San Diego: EDITS. Jertson, J. (1975). Self-help groups. Social Work . 20 . 144-145. Katz, A. (1965) . Application of self-help concepts in current social welfare. Social Work . 10, 68-74. Katz, A. (1970a) . Dynamics and future of self-help parent groups in mental retardation. Volunteer Administration . 12, 30-33. Katz, A. (1970b) . Self-help organizations and volunteer participation in social welfare. Social Work ^ 15 . 52-53. Katz, A. (1981) . Self-help and mutual aid: An emerging social movement? American Review of Sociology ^ 7, 129-155.

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-120Katz, A., & Bender, E. (1976a). Self-help groups in Western society: History and prospects. Journal of Applied Behavioral Science . 12, 265-281. Katz, A., & Bender, E. (1976b). The strength in us . New York: New Viewpoints. Kerlinger, F.N. (1973) . Foundations of behavioral research . 2nd edition. New York: Holt, Rinehart & Winston. Killilea, M. (1976) . Mutual help organizations: Interpretations in the literature. In Caplan, G. , and Killilea, M. Support systems and mutual help . New York: Bruner & Stratton. Kleinman, M.A. , Mantell, J.E., & Alexander, E.S. (1976). Collaboration and its discontents: The perils of partnership. Journal of Applied Behavioral Science . 12, 403-409. Kroptkin, P. (1914) . Mutual aid: A factor of evolution . Boston: Extending Horizons Books. L'Abate, L. & Thaxton, M.L. (1981). Differentiation of resources in mental health delivery: Implications of training. Professional Psychology . 12, 761-767. Levin, L.S., & Idler, E.L. (1981). The hidden health care system: Mediating structures and medicine . Cambridge, MA: Bal linger Publishing Co. Levine, M. , & Levine, A. (1970). A social history of the helping services: Clinic, court, school and community . New York: Appleton-Century-Crofts. Levy, L.H. (1976). Self-help groups: Types and psychological processes. Journal of Applied Behavioral Science, 12, 310-313. Levy, L.H. (1978). Self-help groups viewed by mental health professionals: A survey and comments. American Journal of Community Psychology , 6, 305-313.

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-121Leiberman, M.A., & Borman, L.D. (1976). Self-help and social research. Journal of Applied Behavioral Science . 12, 455-463. Leiberman, M.A. , & Borman, L.D., and Associates. (1979). Self-help groups for coping with crisis . San Francisco: Jossey-Bass. Lurie, A., & Shulman, L. (1983). The professional connection with self-help groups in health care settings. Social Work in Health Care . 8, 69-77. Maclver, R.M. (1931) . Society and its structure and changes . New York: Long and Smith. Marieskind, H. , & Ehrenreich, B. (1975). Toward socialist medicine: The women's health movement. Social Policy . 6, 34-42. McGovern, T.V. (1983) . Interpersonal skills training in groups. In D.R. Forsyth, An introduction to group dynamics (pp. 455-481) . Monterey, CA: Brooks/Cole. Morris, R. (1973). Welfare reform 1973: The social services dimension. Science, 181, 515-522. Mowrer, O.H. (1970). Peer groups and medication: The best therapy for laymen and professionals alike. Psychotherapy: Theory. Research and Practice . 7 , 44-54. Mowrer, O.H. & Vattano, A.J. (1976) . Integrity groups: A context for growth in honesty, responsibility and involvement. Journal of Applied Behavioral Science . 12,419-431. Newmark, J., & Newmark, S. (1976). Older persons in a planned community: Synanon. Social Policy , 7, 93-99. Nunnally, J. (1978) . Psychometric theory . New York: McGrawHill Book Company. Patterson, E. (1980) . In A. Gartner and F. Reissman, Help: A working guide to self-help groups . New York: New Viewpoints.

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-122Pearl, P. & Riessman, F. (1965). New careers for the poor . New York: Free Press. Perlman, J.E. (1976). Grassrooting the system. Social Policy . 7, 4-20. Powell, T. J. (1975). The use of self-help groups as supportive reference communities. American Journal of Orthopsychiatry . 45, 756-764. Powell, T.J. (1979) . Comparisons between self-help groups and professional services. Social Casework . 11, 561565. President's Commission on Mental Health. (1978) . Commission report . 1, Washington, D.C.: U.S. Government Printing Office. Priddy, J.M. (1987) . Outcome research on self-help groups: A humanistic perspective. Journal for Specialists in Group Work . 3, 2-9. Profile of an A. A. meeting. (1972) . Alcoholics Anonymous World Services, Inc. Reissman, F. (1965) . The helper therapy principle. Social Work, 10, 27-32. Reissman, F. (1976) . How does self-help work? Social Policy . 7, 41-45. Riordan, R. & Beggs, M. (1987) . Counselors and self-help groups. Journal of Counseling and Development . 65, 427-429. Robinson, J. P., & Shaver, P. (1976). Measures of social psychological attitudes . Ann Arbor: Institute for Social Research. Sagarin, E. (1969) Odd man in . Chicago: Quadrangle Books. Sidel, V.W. & Sidel, R. (1976). Beyond coping. Social Policy . 7, 67-69.

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-123Silverman, P.R. (1986) . The perils of borrowing: Role of the professional in mutual help groups. The Journal for Specialists in Group Work . 11 . 68-73. Smith, C, & Freedman, A. (1972). Voluntary associations; Perspectives on the literature . Cambridge, MA: Harvard University Press Snow, D. , & Swift, C. (1969) . Recommended policies and procedures for consultation and education services within community mental health systems/agencies . Washington, D.C.: U.S. Government Printing Office. Spiegel, D. (1976) . Going public and self-help. In G. Caplan and M. Killilea, Support systems and mutual help . New York: Brune & Stratton, Inc. Steinman, R. , & Traunstein, D.M. (1976). Redefining deviance: The self-help challenge to the human services. Journal of Applied Behavioral Science . 12 . 347-361. Tax, Sol. (1976). Self-help groups: Thoughts on public policy. Journal of Applied Behavioral Science . 12, 448-454. Thompson, E.P. (1963). The making of the English working class . London: Victor Gollanez, Ltd. Toch, H. (1965) . The social psychology of social movements . Indianapolis: Bobbs-Merril . Todres, R. (1982) . Professional attitudes, awareness and use of self-help groups. Prevention in Human Services . 1, 91-98. Toseland, R. & Hacker, L. (1985). Social workers' use of self-help groups as a resource for clients. Social Work, 30, 232-237. Tracy, G.S. & Gussow, Z. (1976). Self-help groups: A grass-roots response to a need for services. Journal of Applied Behavioral Science . 12, 381-396. Tyler, R.W. (1976) . Social policy and self-help groups. Journal of Applied Behavioral Science . 12, 444-448.

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V -124Van Til, J. (1978) . Revealing research: Help thyself. The Grantsmanship Center News . 1., 33-35. Vattano, A. (1972) . Power to the people: Self-help groups. Social Work . 17, 7-15. Wechler, H. (1960) . The ex-patient organization: A survey. The Journal of Social Issues . 16 . 47-53. Wirth, L. (1938) . Urbanism as a way of life. American Journal of Sociology . 44 . 1-24. Withorn, A. (1980) . Helping ourselves: The limits and potential of self-help. Social Policy . 11 . 20-28. Wittenberg, R. (1958) . Personality adjustment through social action. American Journal of Orthopsychiatry , 18, 207-221.

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BIOGRAPHICAL SKETCH R. Lynn McRee was born on July 2, 1950 in Montgomery, Alabama, the only child of Robert C. McRee and JoAnn Gottsberger. She spent her childhood in Alabama, Missouri, and Florida. Although she attended Auburn University for three years, she graduated from Florida State University in 1972 with a B.A. degree in psychology. She received her M.Ed, degree from Florida Agricultural and Mechanical University in Counselor Education in 1976. She con±>ined her counseling and organizational skills to administer several federally funded grants until the birth of her second child. Currently she is a full-time mom to her daughters Jessa and Leah. She plans to resume grant writing on a part-time basis following the completion of her Ph.D. in August, 1989. -125-

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I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. Roderick J. Davis, Chairman Professor of Counselor Education I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor o£ Philosophy. Ellen sT Amatea Associate Professor of Counselor Education I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, jjj^-seepe-ao^^^ality^ as a dissertation for the degree of Doc Rob^gt-G-r-^iller Professor of Psychology This dissertation was submitted to the Graduate Faculty of the College of Education and to the Graduate School and was accepted as partial fulfillment of the requirements for the degree of Doctor of Philosophy. Dean," College of Education August, 1989 Dean, GriCduate School


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