Bibliotherapy (therapy administered via a book) has been used to treat or aid in treating a wide range of problems, including depression, panic, sexual dysfunction, self-harming behaviors, and (as an adjunct) in the treatment of childhood aggression. The Internet is also increasingly serving as a source of self-help information.

Bibliotherapy and other types of self-help have several very positive features. Books like Treating Mental Disorders: A Guide to What Works, by Peter Nathan, Jack Gorman, and Neil Salkind (Oxford University Press, 1999) and websites like those of the Anxiety Disorders Association of America and the Obsessive Compulsive Foundation can play a valuable role in informing consumers about their disorders and effective treatments for them. Armed with this information, consumers can actively seek out practitioners who provide evidence-based therapies, and they can ask assertive and intelligent questions when they interview potential providers. The use of bibliotherapy is consistent with CBT, which emphasizes teaching clients skills to understand and change behaviors in order to solve problems. Skills can be taught in a systematic and time-efficient way via written materials. Readers can use exercises in a book to learn and practice new skills, and they can review the book whenever they need to. Bibliotherapy and the Internet are cheap and widely available.

Empirical studies show that bibliotherapy can be helpful. For example, Forest Scogin and colleagues (Jamison & Scogin, JCCP, 1995 and Scogin et al., JCCP 1999) showed that mildly and moderately depressed elderly adults benefited (when compared to a waiting list control group) from spending one month reading David Burns' "Feeling Good: The New Mood Therapy" (William Morrow, 1999) and doing some of the exercises in the book. Gains were maintained six months later.

Nevertheless, any helpful intervention can be unhelpful or even harmful when misused. Gerald Rosen (American Psychologist, 1987) reviewed studies showing that self-help interventions to treat premature ejaculation and to assist mothers in toilet training their children were less effective than therapist-directed treatment. In addition, the study of toilet training produced some evidence suggesting that bibliotherapy was linked to an increase in problem behaviors in the children whose mothers used it. In addition, Rosen pointed out that bibliotherapy presentations of even empirically-based therapies tend to make exaggerated claims for success.

At the Center we make extensive use of books as an adjunct to the treatment we provide, and we find them extremely important and useful. We also find them to be quite helpful in training therapists. At the same time, we have learned to be alert for counter-therapeutic uses of books and the Internet among our depressed and anxious clients. Sometimes reading books or collecting information on the Internet can serve an avoidance function for individuals who fear social interactions or leaving the home. I once treated a young woman who, when she encountered an overwhelming situation, escaped from the situation as soon as she could and went home to complete a Thought Record about it! Until we sorted out that she was using cognitive restructuring as part of a way of avoiding frightening situations, she did not make progress in therapy. Sometimes individuals with health anxiety conduct extensive and repeated Internet searches for health information in an attempt to alleviate their health anxiety. This behavior can be PART of the clinical problem, not a solution to it, analogous to the checking behaviors of the client who has obsessive-compulsive disorder and feels compelled to repeatedly ask all the members of her family whether she has said or done anything to offend. It can be difficult to sort out when internet-searching for health information is helpful and when it is harmful. When the behavior is driven by an irrational fear (e.g., "I can't do anything else until I find out whether this symptom indicates that I have a terrible illness"), it is likely to be maladaptive. Another clue to the maladaptive nature of this behavior is that it takes up huge amounts of time and replaces other, more adaptive behaviors.

Thus, bibliotherapy can be both helpful and harmful. We find its helpful effects to outweigh the harmful ones in our clients, but of course we use bibliotherapy as an adjunct to treatment; we don't see the individuals who are using bibliotherapy alone, with no therapist assistance. However, even in our clients, careful monitoring of progress and a clear formulation of the case are needed to determine whether bibliotherapy and other types of self-help are facilitating or undermining a particular client's progress.