Updating the Helper Therapy Principle
Recovery rates for alcoholism doubled for those helping other alcoholics.
Posted September 3, 2008
The therapeutic benefits of helping others have long been recognized by everyday people. This concept was first formalized in a highly cited and often reprinted article by Frank Riessman that appeared in 1965 in Social Work. Riessman defined the "helper therapy" principle on the basis of his observations of various self-help groups, where helping others is deemed absolutely essential to helping oneself. These are grassroots groups that nowadays involve tens of millions of Americans. As the saying goes, "if you help someone up the hill, you get closer yourself." Riessman observed that the act of helping another heals the helper more than the person helped. In the early 1970s, the "helper therapy" principle was noted in a few premier psychiatry journals as professional researchers found that helping others was beneficial in a variety of contexts, including among teens doing tutoring for younger children (Rogeness & Badner, 1973).
Whether the group is focused on weight loss, smoking cessation, substance abuse, alcoholism, mental illness and recovery, or countless other needs, a defining feature of the group is that people are deeply engaged in helping one another, and are in part motivated by an explicit interest in their own healing. These groups adhere to the view that people who have experienced a problem can help each other in ways that professionals cannot - i.e., with greater empathy and more self-disclosure.
The members of these groups are replacing negative emotional states with the positive state called "the helper's high," a pleasurable and euphoric emotional sensation of energy and warmth. The "helper's high" was first carefully described by Allen Luks (1988). Luks, in a survey of thousands of volunteers across the United States, found that people who helped other people consistently reported better health than peers in their age group, and many stated that this health improvement began when they started to volunteer. Helpers report a distinct physical sensation associated with helping; about half report that they experienced a "high" feeling, 43 percent felt stronger and more energetic, 28 percent felt warm, 22 percent felt calmer and less depressed, 21 percent experienced greater feelings of self-worth, and 13 percent experienced fewer aches and pains.
Indeed, many state offices of mental health, including that of New York State, emphasize the role of helping others through involvement in self-help groups, recommending this activity for persons recovering from depression and schizophrenia (New York State, 2006). This kind of state initiative is reminiscent of the famous "moral treatment" era in the American asylums of the 1820s and 30s, where persons with melancholy and other ailments were treated with compassion and also, whenever possible, directly engaged in prosocial activities (Clouette & Deslandes, 1997).
My favorite example of how helping others can be incorporated in mental health recovery is the Magnolia Clubhouse community in University Circle, Cleveland. It is based on the ICCD (International Center for Clubhouse Development) Model begun by Fountain House in 1948, in New York City. There are now about 200 ICCD Clubhouses all over the U.S., and close to that number abroad. They offer training, certification, and research conferences on the ICCD model. In Cleveland, Magnolia Clubhouse is a training site for students in psychology and psychiatry, and is loosely associated with Case Western Reserve University. Members of the Clubhouse (18 years an over) typically have significant histories of mental illness, live in the area (usually in small apartments or occasionally with family), and are referred to the Clubhouse by health professions. When they come by the Clubhouse (a large converted red brick mansion), usually in the morning or at midday, they decide on what helping activities they will engage in. As Lori D'Angelo, Ph.D., Director of Magnolia Clubhouse, responded to a question we posed about the members' helping others, "I think that people tend to be more stable and happy if they feel like they are benefiting people more than themselves, or outside themselves. It helps them feel connected to a larger picture, and I would think that of human beings in general." Members are not assigned duties, but choose the kind of helping they want to do, and to the extent they wish. Some prepare meals, serve in the snack shop, help with hospitality, write letters, handle finances, do day-to-day cleaning, outside groundskeeping, snow ploughing and the like. ICCD is a self-help program that is reminiscent of the moral treatment era. Clubhouse members, of which there are a couple of hundred at any given point in time, are treated with immense compassion by the staff and by volunteers from the community (www.magnoliaclubhouse.org).
The oldest and largest self-help group in the United States is, of course, Alcoholics Anonymous (Alcoholics Anonymous, 1952). Researchers at Brown University Medical School (Pagano, et. al., 2004) examined the relationship between helping other alcoholics to recover (the famous 12th step) and relapse in the year following treatment. The data were derived from a prospective study called Project MATCH, which examined different treatment options for alcoholics and evaluated their efficacy in preventing relapse. Two measures of helping other alcoholics in Alcoholics Anonymous (being a sponsor and having completed the 12th step) were isolated from the data, and proportional hazards regressions were used to separate these variables from the number of AA meetings attended during the period. The authors found that "those who were helping were significantly less likely to relapse in the year following treatment." Among those who helped other alcoholics (8 percent of the study population), 40 percent avoided taking a drink in the year following treatment; only 22 percent of those not helping had the same outcome.
These finding around AA are especially significant because AA is a prototype organization, with offshoot organizations such as Al-Anon (for spouses of AA members), Alateen (for their children), and Narcotics Anonymous. It is widely estimated that close to 350 anonymous 12-step self-help programs exist in United States, including Overeaters Anonymous, and they help people with innumerable forms of suffering. Thus, many millions of Americans know about the 12th step through a self-help organization, but too few realize its importance to them. The pattern of one person helping another with the same problem was so central to Bill W., founder of AA, that he summed up the entire 12 steps in terms of surrender to a higher power and service to others (Bill W., 1988). Bill W. died in 1971, prominent in Life's list of the 100 greatest Americans of the 20th century as the originator of the entire self-help movement in America and worldwide (Life, "Life's 100 Most Important Americans of the 20th Century, No. 13:12, Fall 1990).
Altruistic activities are associated with better care of the self. Adolescent generativity (as present in the lives of a subset of adolescents decades ago) predicted reports of feeling satisfied with life, being peaceful and happy, having good mental health, and not being depressed as older adult. The researchers indicate that one important mechanism involved is adolescent prosocial competence, which results in a lifetime of sound judgments, choices and habits. The generative adolescents tended not to be smokers or excessive drinkers (Wink & Dillon, 2007).
So then what kind of creatures are we? The association between a kind, generous way of life and health-prolongevity can be interpreted in the light of evolutionary psychology. While it is not appropriate here to make a full case for evolutionary altruism, it can be asserted that group selection theory predicts a powerfully adaptive connection between widely diffuse altruism within groups and group survival (Sober & Wilson, 1998). Members of a successful group would likely be innately oriented to other-regarding behaviors. Anthropologists point out that early egalitarian societies practiced institutionalized or "ecological altruism," where helping others was a social norm , and not an act of volunteerism. There appears to be a fundamental human drive toward other-regarding actions. When this drive is inhibited, the human being does not thrive. Evolution suggests that human nature evolved emotionally and behaviorally in a manner that confers health benefits to benevolent love and helping behaviors. We seem to prosper under the canopy of positive emotions.
Ralph Waldo Emerson, in his famous essay on the topic of compensation, wrote, "It is one of the most beautiful compensations of this life that no man can sincerely try to help another without helping himself...." The 16th-century Hindu poet Tulsidas, as translated by Mohandas K. Gandhi, wrote, "This and this alone is true religion - to serve others. This is sin above all other sin - to harm others. In service to others is happiness. In selfishness is misery and pain." The 9th-century sage Shantideva wrote, "All the joy the world contains has come through wishing the happiness of others."
Alcoholics Anonymous (1952). Twelve Steps and Twelve Traditions. New York: Alcoholics Anonymous World Services.
Bill, W. (1988). The Language of the heart. New York: Cornwall Press.
Clouette, B., & Deslandes, P. (1997). The Hartford retreat for the insane: An early example of the use of "moral treatment" in America. Connecticut Medicine: The Journal of the Connecticut State Medical Society, 61(9), 521-527.
Luks, A. (1988, October). "Helper's high: Volunteering makes people feel good, physically and emotionally." Psychology Today, 22(10), 34-42.
New York State (2006). Self-help and peer support. Retrieved from www.omh.state.ny.us/omhweb/ebp/adult_selfhelp.htm
Pagano, M. E., Friend, K. B., Tonigan, J. S., & Stout, R. L. (2004). Helping other alcoholics in Alcoholics Anonymous and drinking outcomes: Findings from Project MATCH. Journal of Studies on Alcohol, 65 (6), 766-773.
Riessman, F. (1965). The ‘helper' therapy principle. Social Work, 10 (2), 27-32.
Rodin, J., & Langer, E. (1976). The effect of choice and enhanced personal responsibility for the aged: A field experiment in an institutional setting. Journal of Personality and Social Psychology, 34 (2), 191-198.
Rogeness, G.A., & Badner, R.A. (1973). Teenage helper: A role in community mental health. American Journal of Psychiatry, 130, 933-936.
Sober, E. &Wilson, D.S. (1998). Unto others: The evolution of unselfish behavior. Cambridge, MA: Harvard University Press.
Wink, P. & Dillon, M. (2007). Do generative adolescents become healthy older adults? In S.G. Post (Ed.), Altruism and health: Perspectives from empirical research (pp. 43-54). Oxford University Press.