Community Mental Health Journal, Vol. 41, No. 6, December 2005 (! 2005)
DOI: 10.1007/s10597-005-6429-0
Some Recovery Processes in
Mutual-Help Groups for Persons with
Mental Illness; II: Qualitative Analysis
of Participant Interviews
Patrick W. Corrigan, Psy.D.
Natalie Slopen, A.M.
Gabriela Gracia
Sean Phelan
Cornelius B. Keogh
Lorraine Keck
ABSTRACT: Previous research suggests that consumer operated services facilitate
recovery from serious mental illness. In part I of this series, we analyzed the content of
the GROW program, one example of a consumer operated service, and identified
several processes that Growers believe assists in recovery. In this paper, we review the
qualitative interviews of 57 Growers to determine what actual participants in GROW
acknowledge are important processes for recovery. We also used the interviews to
identify the elements of recovery according to these Growers. Growers identified selfreliance, industriousness, and self-esteem as key ingredients of recovery. Recovery was
distinguished into a process—an ongoing life experience—versus an outcome, a feeling
of being cured or having overcome the disorder. The most prominent element of GROW
Patrick W. Corrigan, Psy.D., Natalie Slopen, A.M., Gabriela Gracia, Sean Phelan are affiliated
with University of Chicago Center for Psychiatric Rehabilitation.
Cornelius B. Keogh, Lorraine Keck are affiliated with International GROW Movement.
Address correspondence to Patrick Corrigan, Evanston Northwestern Healthcare Center for
Psychiatric Rehabilitation, 1033 University Place, Evanston, IL 60201, USA; e-mail: [email protected].
This paper was made possible by grant No. SM 52363 from the U.S. Department of Health and
Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental
Health Services.
721
! 2005 Springer Science+Business Media, Inc.
722
Community Mental Health Journal
that facilitated recovery was the support of peers. Gaining a sense of personal value
was also fostered by GROW and believed to be important for recovery. The paper ends
with a discussion of the implications of these findings for the ongoing development of
consumer operated services and their impact on recovery.
KEY WORDS: recovery; rehabilitation; qualitative research.
The President’s New Freedom Commission recognized recovery as an
essential focus of service programs for persons with serious mental illness
(Hogan, 2003; New Freedom Commission on Mental Health, 2003). Services that promote recovery and include the person with disabilities in all
facets of intervention are likely to yield greater successes in accomplishing vocational and independent living goals (Corrigan, Faber, Rashid, & Leary, 1999; Rogers, Chamberlin, Ellison, & Crean, 1997). A
variety of strategies may foster recovery including Fairweather’s lodge
(Fairweather, 1969), psychosocial clubhouses (Beard, Propst, & Malamud, 1982), assertive community treatment (Mueser, Bond, Drake, &
Resnick, 1998; Stein & Test, 1980), supported employment (Bond, Drake,
& Becker, 1998), and consumer-operated programs. One prominent
example of consumer-operated programs is the focus of this study: a
mutual-help program called GROW. In Part I of this series (Corrigan
et al., 2002), we examined GROW’s program materials and testimonies to
determine consensually recurring themes. In this paper, interviews from
active participants in the GROW program are examined to cross-validate
these themes.
Consumer-operated programs are groups of ordinary people with
similar problems that come together in places they own and control,
places where they learn from each other without need of counselors
(Chamberlin, Rogers, & Ellison, 1996; Davidson et al., 1999; Lieberman
& Snowden, 1994; Meissen & Warren, 1994; Solomon & Draine, 2001).
Examination of the history of consumer-operated programs shows them
to have been developed by persons with serious mental illness.
Consumer-operated programs are not just another form of clinical
treatment (Davidson et al., 1999; Luke, Roberts, & Rappaport, 1994).
Clinical treatment reflects a medical model: persons seek out services
to resolve symptoms and replace deficits (Corrigan & Penn, 1997).
There is a hierarchy between ‘‘healer’’ and person in clinical settings;
professional healers are often perceived to have some special power
that they use to help patients resolve their problems. The relationship
between healer and patient is expected to end, if only temporarily,
when symptoms remit.
Patrick W. Corrigan, Psy.D., et al.
723
Consumer-operated programs have been likened more to communities with life-long histories (Maton, Leventhal, Madara, & Julien,
1989). Consumer-operated programs provide a caring and sharing
community, where the person can find the necessary understanding
and recognition that society at large is not able to give. Consumeroperated services place an extraordinary value on peer support, hope
and recovery (Van Tosh & Del Vecchio, 2000). Roles in consumeroperated programs are not defined hierarchically; members are peers
benefiting from interactions with equals. There are no limits placed on
the amount of time a person can be involved in a program. Depending
on personal needs, some members come and go from consumer-operated programs while others may stay connected for years, in part
because many will have assumed leadership responsibilities within the
organization in order to give back help to others in need (Luke et al.,
1994).
GROW has more than 40 years of experience providing a highly
developed mutual-help program to people with the most severe mental
disorders. GROW is an educational/mental health organization run by
its members and based on group meetings that use a highly structured
group method—a written program of recovery and growth to maturity—and a caring and sharing community. GROW began in the 1950’s
in Australia when, after discharge from psychiatric hospitals, a few of
the founding members briefly attended Alcoholics Anonymous (AA).
Although they were not alcoholics, they found in AA the kind of
friendly, nonprofessional support for which they yearned. They
splintered from these groups to start a 12-step mutual help program for
persons with mental illness. GROW now counts more than 800 groups
worldwide.
The first generation of outcome research on GROW and similar
mutual-help programs has been encouraging. Survey studies have
shown that participants in these kinds of programs report high satisfaction as well as improved self-concept and well-being (Carpinello,
Knight, & Jatulis, 1992; Chamberlin, Rogers, & Elison, 1996; Mowbray
& Tan, 1992). Some studies have shown reduced level of psychiatric
symptoms after mutual-help (Galanter, 1988) while others failed to find
this difference (Kaufman, Schulberg, & Schooler, 1994; Raiff, 1982,
1984). However, several studies showed a significant relationship
between using mutual-help and decreased hospitalization (Galanter,
1988; Kennedy, 1989; Kurtz, 1988; Rappaport, 1993). Research also
suggests that persons who are participating in mutual-help programs
have larger support networks (Carpinello, Knight, & Janis, 1991;
724
Community Mental Health Journal
Rappaport et al., 1985) and enhanced self-esteem (Markowitz, DeMasi,
& Carpinello, 1996).
An important goal of this area of research is to identify the processes that might account for recovery. Note that we purposefully
refer to recovery processes rather than therapeutic processes
throughout the paper. Members of mutual-help organizations like
GROW believe this is an important distinction. ‘‘Therapeutic’’ refers
to the efforts of professionals seeking to help patients overcome a
disease process. ‘‘Recovery’’ is the goal of mutual help; namely to
facilitate innate healing resources so people can overcome their
problems.
Previous articles have discussed several processes that may be
potent in consumer operated services (Chamberlin et al., 1996;
Davidson et al., 1999; Kingree & Ruback, 1994; McFadden, Seidman,
& Rappaport, 1992; Young & Williams, 1988). Prominent among
these is extended social support that comes from peers, social comparisons in this supportive setting, diminished self-stigma, and
improved interpersonal skills. Unfortunately, much of the research in
this area has been piecemeal and lacked any overarching approach
for identifying key processes. In this series of papers, we selected
qualitative strategies that combine emergent and grounded theoretical analyses to examine processes (Denzin & Lincoln, 2000; Miles &
Huberman, 1994). Wolcott (1992) identified three sources of information as the foundation of qualitative research: (1) written
documents that reflect the philosophy and principles of the to-bestudied group (i.e., GROW); (2) verbal interviews with current and
past members of the group, and (3) structured observations of the
group’s activities. Multiple sources of information about a single
group help to triangulate results thereby providing a more reliable
and valid set of data.
In Part I of this series, analyses of GROW’s Program of Growth to
Maturity and written testimonies yielded 13 reliable recovery processes.
Prominent among these was being reasonable and decentralizing from
self. In this paper, we sought to describe recovery based on interviews
with Growers; this is an important effort in its own right because it provides a consumer-based definition of the lived experience of recovery. We
then asked Growers what it was about GROW that helped to facilitate
recovery. The purpose of these questions was to cross-validate the processes that emerged from the qualitative analysis of program materials
and testimonies. Moreover, findings from these interviews might suggest
additional processes in GROW that promote recovery.
Patrick W. Corrigan, Psy.D., et al.
725
METHODS
Fifty-seven people who were active participants in GROW were recruited to participate in 2-hour interviews. Participants, on average, reported they had been involved
in GROW for 6.1 years with the range of participation between 3 months and
20 years. They were informed that the overall goals of the interview included
learning: ‘‘more about how participation in GROW might affect people’s lives,’’ ‘‘which
part of GROW’s organization people find to be the most helpful,’’ and ‘‘your experiences with and perspectives on mental illness.’’ Interviews were fully audio-taped and
verbatim transcripts were subsequently produced. Answers to four sets of questions
were examined to address the goals of this study.
! ‘‘We want to know how GROW may help people’s personal problems. What kinds of
problems do people talk about in GROW?’’
! ‘‘We’ve been talking about doing well in GROW. How about the idea of recovery?
What does recovery mean to you?’’ These two sets of questions were meant to
uncover GROWer perceptions on life problems and on what recovery means to
them.
! ‘‘What specific parts of GROW would you say contribute most to people doing well
in this way?’’
! ‘‘In what ways, would you say, GROW helps people recover?’’
These questions examined how GROW helps people deal with their personal
problems and how it facilitates recovery.
Qualitative Analysis
The analysis proceeded in two steps. First, trained raters examined the responses to
these questions from 12 randomly selected interviews. Pairs of raters independently
divided the responses to each question into clusters representing separate ideas;
agreement in chunking information into clusters almost approached 100%. Verbatim
responses were then transcribed onto individual cards with each card representing a
separate category. Two senior members of the research team then consensually
sorted the cards into categories that represented common answers to the four
questions guiding the study. Two other raters independently sorted the cards into
these categories to cross-validate the categories consensually determined by the
senior researchers. Kappas representing reliability of these two independent raters
were mostly high (ranging from 0.289 to 1.00; mean of kappas is .772). Raters sorted
cards into the categories defined by the senior research members between 20.0 and
100.0% (mean = 68.8%) of the time depending on the question. Table 1 summarizes
these categories and corresponding statistics.
In Step 2 of the analysis, the categories in Table 1 were used to code the remaining
45 interviews. Two independent raters coded GROWer responses to answers to the four
questions. Categories in Table 1 were used as codes. In addition, answers to questions
about how GROW helps people do well or facilitates recovery were also coded in terms
of results of our qualitative analysis of GROW program materials (reported in Corrigan
et al., 2002)
726
Community Mental Health Journal
RESULTS
Table 1 represents the categories of responses to the four questions
that emerged from analyzing the interviews of the 12 randomly selected Growers. Kappas and percent agreements representing the
reliability of rates in this task were mostly sufficient; in cases where
kappas or percent agreements were low, those responses were omitted
from subsequent analyses in the study. As shown in Table 1, the 12
interviews yielded 72 unique information clusters (transcribed onto
cards and hence called cards hereafter) in response to the question
about the kinds of problems Growers discuss. All but 8 of these cards
were reliably sorted into 10 response categories. Most common among
these were difficulties in family relationships, other interpersonal
relationships, cognitive symptoms like obsessions and delusions, and
affect-related symptoms like anxiety and depression. Eighty-three
cards were generated in response to question two on the idea of
recovery. All but 7 were coded into 8 categories; one of these—coping
with and accepting symptoms—had poor kappas and percent agreements and, therefore, was removed from further consideration.
Recovery was most often equated with self-reliance framed as being
industrious which, in turn, coincided with regaining self-esteem.
‘‘Recovery means that people will be able to be on their own, make better
choices. . . being able to see that there’s a whole life out there, that there’s
purpose, that they can set goals, that they can do things with their life
that they never believed possible before’’ (#709). Other common responses to the question of what is recovery included reducing the need
for treatment and being cured of illness by returning to the normal life
the person had once enjoyed.
Fourty-one cards represented responses to the question what about
GROW contributed to people doing well. All but two were sorted into
seven categories. The most prominent response to doing well was the
support of others. Finally, 28 cards generated 5 categories in response to
the question regarding what about GROW helps people recovery. One of
these categories—learning to cope—had low reliability scores and was
omitted. GROW’s caring and sharing community was most often cited as
an example of a recovery facilitator.
We then used the response categories that emerged from the 12
interviews summarized in Table 1 to code the responses of the
remaining 45 interviewees. Results from this effort are summarized in
Table 2. As in Tables 1 and 2 lists the four questions guiding this
qualitative study along with the number of separate interviewees who
Definition
N of
cards
Kappa
%
agreement
Employment
Activities of daily living
Achieving major life goals
Suicide
General health problems
Treatment
Psychiatric symptoms, affect
Other interpersonal
relationships
Psychiatric symptoms,
cognition
Family relationships
The breadth of interpersonal
difficulties with parents, siblings,
children and other relatives
Interpersonal difficulties with
people who are not family
Symptoms related to the form
and content of thought processes;
e.g., obsessions and delusions
Symptoms related to emotional
processes; e.g., anxiety and
depression
Special concern about harming self
Problems with physical health
The negative consequences of
psychiatric medication and therapy
Not having a job or problems at work
Basic activities related to hygiene, diet
Goals related to independent
living and income
4
5
4
2
5
6
8
9
12
9
1
0.748
1
1
0.819
0.647
0.842
0.768
0.9
1
1
0.625
1
1
0.714
0.5
0.75
0.666
0.846
1
Q1: We want to know how GROW may help people’s personal problems. What kinds of problems do
people talk about in GROW? (N = 72. n = 8)
Category
The Categories of Responses to the Four Questions that Emerged from the Card Sort
TABLE 1
Patrick W. Corrigan, Psy.D., et al.
727
Definition
N of
cards
Kappa
%
agreement
Never recover
Improved relationships
Recovery as process
Coping with symptoms,
Accepting symptoms
Cured of illness,
Returning to
where you started
Reduction of treatment
Self-reliance, Being
industrious, Regaining
self-esteem
Being able to help one’s self; Able to
get a job and accomplish other goals
of independent living; Feeling proud
about self and optimistic about life
No longer needing medication
or therapists
No longer experiencing psychiatric
symptoms or disabilities; Feeling like
a previous stage of ‘‘normal
life’’ is regained
Develop skills to control symptoms;
Not being overwhelmed when
symptoms recur
Interacting better with other people
Rather than being an absolute,
recovery is a step by step process
Believing that one never fully recovers
2
5
7
13
13
11
25
0.556
0.738
0.583
0.374
0.551
0.950
0.658
0.4
0.6
0.444
0.294
0.428
0.916
0.657
Q2 : We’ve been talking about doing well in GROW. How about the idea of recovery? What does recovery mean to
you? (N=83. n=7)
Category
(Continued)
TABLE 1
728
Community Mental Health Journal
The support from interpersonal
relationships
The generic program and meetings of GROW
Important elements of GROW as the 12 steps
and the basic fundamentals of human living
Reading the blue book
Admit one’s inadequacies and strengths
Confidence in one’s future
Set goals that yield a sense of accomplishment
and well-being
3
4
7
3
2
7
13
Important elements of GROW as the 12 steps
and the basic fundamentals of human living
Learning alternatives to problems
Benefiting from a connection with a higher
authority
Using one’s helpers optimally
Benefiting from the sharing and caring of
others
1
11
5
1
6
1
0.611
0.289
1
0.617
1
0.843
0.894
0.787
0.642
0.753
0.816
1
0.615
0.20
1
0.5
0.5
0.75
1
0.666
0.5
0.666
0.71
Each cell in the table that lists one of the four questions has two values in parentheses; (N = the total number of cards in the card sort for that
question, and n = the number of cards that were consensually not sorted into categories). Under each question are the consensually identified
categories and definitions for each category. The N of cards for that category, kappa representing the independent card sort of two raters, and %
agreement (the ratio of cards coded similarly by senior researchers and raters over total possible cards per category) is also included.
Cooperating with help
Community
Learning to cope
Spirituality
Program philosophy
Q4: In what ways, would you say, GROW helps people recover? (N = 28 n = 3)
Program literature
Self-acceptance
Hope and power
Healthy decision
making
The organization
Program philosophy
Other people
Q3: What specific parts of GROW would you say contribute most to people doing well in this way? (N = 41
n = 2)
Patrick W. Corrigan, Psy.D., et al.
729
730
Community Mental Health Journal
provided relevant answers to the question. Two independent raters
then sorted interview responses into categories. Kappas representing
inter-rater reliability were sufficient and ranged from 0.71 to 0.77.
Table 2 then lists the number of individual interviewees who gave responses consistent with each category.
What kind of problems do people talk about in GROW?
Most common were interpersonal in nature, both with family members and those not in one’s family. ‘‘People really have difficulties with
relationships, whether it’s with another adult, or whether it’s with
family, or with friends, there just seems to be a lot of relationship
problems’’ (#709). Also fairly frequently reported were concerns with
affect related symptoms like anxiety and depression. ‘‘I would say the
most common were depression and anxiety’’ (#602). ‘‘They’re in a rut
and they don’t see any way out.’’ (#802). Relatively less frequent were
concerns about suicide or about the negative consequences of treatment.
What does recovery mean to Growers?
Similar to the findings in Table 1, self-reliance and corresponding ideas
of industriousness and self-esteem were most frequently endorsed as
characteristic of recovery. Also, reduction of treatment, cured of illness,
and improved relationship were all reported fairly frequently. Almost
no participants endorsed the idea that individuals with mental illness
never recover.
How does GROW help people recover?
Once again, support from other people was most frequently reported.
‘‘...the support and friendship that’s offered there, and also people see
examples of people who have recovered, who have started in another
place and gotten to a different place’’ (#609). Both program literature
and the formal GROW organization were also cited as important for
recovery. ‘‘Going to meetings and saying the sayings out of the blue book
can help people recover’’ (#408); ‘‘we’re learning utilization of the program in our daily living, so we’re learning how to live, how to be well,
rather than all those negative maladjustment’s that we have’’ (#501).
We coded responses to question 4—what parts of GROW contribute to a
person doing well?—in terms of the corresponding categories outlined
Patrick W. Corrigan, Psy.D., et al.
731
TABLE 2
Frequency Count of Growers in Remaining 45 Interviews Who
Mentioned Category as Answer to Each of the Four Questions
Category
frequency count
Q1: We want to know how GROW may help people’s personal problems.
What kinds of problems do people talk about in GROW? (N=42; j=0.77)
Family relationships
Other interpersonal relationships
Psychiatric symptoms; cognition
Psychiatric symptoms; affect
Suicide
General health problems
Treatment
Employment
Activities of daily living
Achieving major life goals
18
18
7
14
3
7
3
7
6
9
Q2: We’ve been talking about doing well in GROW. How about the idea
of recovery? What does recovery mean to you? (N=42; ?=0.77)
Self-reliance; being industrious; regaining self-esteem
Reduction of treatment
Cured of illness; returning to where one started
Improved relationships
Recovery as process
Never recover
33
16
15
14
13
1
Q3: In what ways, would you say, GROW helps people recover? N=37;
j=0.75)
Other people
The organization
Program philosophy
Program literature
Self-acceptance
Hope and power
Healthy decision making
20
10
8
13
4
8
4
732
Community Mental Health Journal
TABLE 2
(Continued)
Category
frequency count
Q4: What specific parts of GROW would you say contribute most to
people doing well in this way? (N=42; j=0.70)
Program philosophy
Spirituality
Cooperating with help
Community
20
2
33
0
Categories from Corrigan, Calabrese et al. (2002)
Be reasonable
Decentralize
Surrender to God
Grow to maturity
Challenge to action
Become hopeful
Settle for disorder
Be ordinary
Help others
Gain personal value
Use GROW
Gain insight
Accept help
1
2
1
0
3
0
0
3
5
21
1
0
0
Categories were drawn from Table 1. In addition, categories for Question include the recoveryfacilitating processes discovered in our earlier qualitative analysis of the GROW program material
(Corrigan et al., 2002). Each Cell in the table that lists one of the four questions has two values in
parentheses; (N = the total number of interviews in which responses were made to this question,
and? representing inter-rater reliability for assignment of responses to categories.
in Table 1 plus the GROW processes that were uncovered in our earlier
study on program literature (Corrigan et al., 2002). In terms of
response categories listed in Table 1, cooperating with help was cited
by more than three quarters of the sample. ...it’s through the caring and
the sharing and it’s through the education that is teaching the person
how they can control their feelings and their behavior and how they can
improve themselves, how their lives can improve by seeing other people
Patrick W. Corrigan, Psy.D., et al.
733
in the group improve over a period of time encourages them...’’ (#802).
The GROW philosophy as laid out in its literature like the Blue Book
was also cited frequently. Only one of the categories that emerged from
the qualitative analysis of GROW materials in our earlier study was
cited often by interviewees: gain personal value. Personal value again,
is one of them. When a person realizes that they are valuable, they often
will take better care of themselves, they often when they realize that
they’re a connecting link they will socialize. I think personal value is
very important to Growers.’’ (#603).
DISCUSSION
The purpose of this qualitative study was to hear directly from people
who participate in consumer operated services what they understand
their problems to be and what recovery is? Moreover, we sought to
understand how consumer operated services like GROW helped
someone to deal with their problems and achieve recovery. Results
showed a clear consensus on these issues. In terms of what Growers see
problems to be: they identified relationships as being a central concern.
They wanted to be able to live more comfortably and intimately with
both family members and others. Growers also identified some psychiatric symptoms of concern. These included affect-related symptoms
such as depression and anxiety as well as cognitive symptoms like
obsessions and delusions. Less common, but nevertheless identified by
a significant subset of Growers, were concerns about achieving life
goals in terms of independent living and employment.
Responses to the question of what is recovery were a bit broader than
those related to life problems. Clearly, Growers identified self-reliance
as central to the definition of recovery. Regardless of symptoms or
disabilities, Growers see themselves as recovered when they are able to
be industrious and not be dependent on others. There seemed to be a
split on the journey related to self-reliance. Some Growers saw recovery
as a cure where symptoms were remitted completely and treatment
was no longer needed. Others viewed it as a process, rather than an
absolute, a step-by-step movement towards achieving ones life goals.
Several elements of GROW seem to foster recovery. Most prominent
among these were other Growers, people with whom one can learn from
and give to. The caring and sharing community of GROW was
repeatedly cited as the single process that facilitates recovery. The
program philosophy as outlined in GROW literature like the Blue Book
734
Community Mental Health Journal
was also acknowledged as important for recovery. Cooperating with
help was identified as essential for overcoming one’s problems. Growers
believe the traditional mental health systems made up of psychiatrists
and other mental health providers mostly provides an invaluable
service which, when adhered to fully, can advance the person’s recovery
goals significantly.
Findings from these interviews, when compared with our earlier
study on GROW materials, suggest that people with serious mental
illness believe the concept of recovery is meaningful. They also report
that participation in consumer operated services helps people achieve
some of their recovery goals. Qualitative research has its limitations
however. Future research using a quantitative design is needed to
validate these findings. With this information stakeholders will achieve
a better understanding of what comprises recovery and how consumer
operated services, in particular, facilitates its development.
REFERENCES
Beard, J. H., Propst, R. N., & Malamud, T. J. (1982). The Fountain House model of psychiatric
rehabilitation. Psychosocial Rehabilitation Journal, 5(1), 47–53.
Bond, G. R., Drake, R. E., & Becker, D. R. (1998). The role of social functioning in vocational
rehabilitation, Kim Tornvall: Mueser.
Carpinello, S. E., Knight, E. L., & Janis, L. (1991). A qualitative study of the perceptions of the
meaning of self-help, self-help group processes and outcomes, Albany, NY: New York State
Office of Mental Health.
Carpinello, S., Knight, E., & Jatulis, L. (1992). A study of the meaning of self-help, self help group
processes and outcomes. Proceedings: 1992 NASMHPD Research Conference (pp. 37–44)
Alexandria, VA.
Chamberlin, J., Rogers, E., & Ellison, M. L. (1996). Self-help programs: A description of their
characteristics and their members. Psychiatric Rehabilitation Journal, 19(3), 33–42.
Corrigan, P. W., Calabrese, J. D., Diwan, S. E., Keogh, C. B., Keck, L., & Mussey, C. (2002). Some
recovery processes in mutual-help groups for persons with mental illness; I: Qualitative
analysis of program materials and testimonies. Community Mental Health Journal, 38(4),
287–301.
Corrigan, P. W., Faber, D., Rashid, F., & Leary, M. (1999). The construct validity of empowerment
among consumers of mental health services. Schizophrenia Research, 38(1), 77–84.
Corrigan, P. W., & Penn, D. (1997). Disease and discrimination: Two paradigms that describe
severe mental illness. Journal of Mental Health (UK), 6(4), 355–366.
Davidson, L., Chinman, M., Kloos, B., Weingarten, R., Stayner, D., & Tebes, J. K. (1999). Peer
support among individuals with severe mental illness: A review of the evidence. Clinical
Psychology-Science & Practice, 6(2), 165–187.
Denzin N. K. & Lincoln Y. S. (Ed.). (2000). Handbook of qualitative research, Thousand Oaks, CA:
Sage Publications.
Fairweather, G. W. (1969). Community life for the mentally ill: An alternative to institutional care,
Chicago: Aldine Publishing Co.
Galanter, M. (1988). Zealous self-help groups as adjuncts to psychiatric treatment: A study of
Recovery, Inc. American Journal of Psychiatry, 145(10), 1248–1253.
Hogan, M. F. (2003). New Freedom Commission Report: The President’s New Freedom Commission:
Recommendations to transform mental health care in America. Psychiatric Services, 54, 1467–1474.
Patrick W. Corrigan, Psy.D., et al.
735
Kaufman, C. L., Schulberg, H. C., & Schooler, N. R. (1994). Self-help group parcipation among
people with severe mental illness. In F. Lavoie, T. Borkman, & B. Gidron (Eds.) (pp. 315–
331).
Kennedy, M. (1989). Psychiatric hospitalisation of growers. Paper presented at the Second Biennial Conference of Community Research and Action, East Lansing, MI.
Kingree, J., & Ruback, R. (1994). Understanding self-help groups. In T. J. Powell (Ed.), Understanding the self-help organization: Frameworks and findings (Vol. viii, pp. 272–292).
Kurtz, L. F. (1988). Mutual aid for affective disorders: The Manic Depressive and Depressive
Association. American Journal of Orthopsychiatry, 58(1), 152–155.
Lieberman, M. A., & Snowden, L. R. (1994). Problems in assessing prevalence and membership
characteristics of self-help group participants. In T. J. Powell (Ed.), Understanding the selfhelp organization: Frameworks and findings. Sage Publications: Thousand Oaks, CA.
Luke, D. A., Roberts, L., & Rappaport, J. (1994). Individual, group context, and individual-group
fit predictors of self-help group attendance. In T. J. Powell (Ed.), Understanding the self-help
organization: Frameworks and findings (pp. 88–114). Sage Publications, Thousand Oaks, CA.
Markowitz, F., DeMasi, M., & Carpinello, S. (1996). The role of self-help in the recovery process.
Paper presented at the 6th Annual National Conference on State Mental Health Agency
Services Research and Program Evaluation. Arlington, VA.
Maton, K. I., Leventhal, G. S., Madara, E. J., & Julien, M. (1989). Factors affecting the birth and
death of mutual-help groups: The role of national affiliation, professional involvement, and
member focal problem. American Journal of Community Psychology, 17(5), 643–671.
McFadden, L., Seidman, E., & Rappaport, J. (1992). A comparison of espoused theories of self- and
mutual help: Implications for mental health professionals. Professional Psychology – Research
& Practice, 23(6), 515–520.
Meissen, G. J., & Warren, M. L. (1994). The self-help clearinghouse: A new development in action
research for community psychology. Journal of Applied Behavioral Science, 29, 446–463.
Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook,
Thousand Oaks, CA: Sage Publications Inc.
Mowbray, C. T., & Tan, C. (1992). Evaluation of an Innovative Consumer-Run Service Model: The
Drop in Center. Innovation & Research, 1(2), 19–24.
Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for
severe mental illness: A review of research on case management. Schizophrenia Bulletin,
24(1), 37–74.
New Freedom Commission on Mental Health. Achieving the promise: Transforming mental health
care in America. Final report. (DHHS pub no SMA-03–3832) (2003). Rockville, Md: Department of Health and Human Services.
Raiff, N. R. (1982). Self-help participation and quality of life: A study of the staff of Recovery, Inc..
Prevention in Human Services, 1(3), 79–89.
Raiff, N. R. (1984). Some Health Related Outcomes of Self-Help Participation. In A. Gartner.
F. Riessman (Ed.), The self-help revolution. Human Sciences Press, New York.
Rappaport, J. (1993). Narrative studies, personal stories, and identity transformation in the
mutual help context. Journal of Applied Behavioral Science, 29(2), 239–256.
Rappaport, J., Seidman, E., Toro, P. A., McFadden, L. S., Reischl, T. M., Roberts, L. J., Salem, D.
A., Stein, C. H., & Zimmerman, M. A. (1985). Collaborative Research with a mutual help
organization. Social Policy, Winter, 12–24.
Rogers, E. S., Chamberlin, J., Ellison, M., & Crean, T. (1997). A consumer-constructed scale to
measure empowerment. Psychiatric Services, 48(8), 1042–1047.
Solomon, P., & Draine, J. (2001). The state of knowledge of the effectiveness of consumer provided
services. Psychiatric Rehabilitation Journal, 25, 20–27.
Stein, L. I., & Test, M. A. (1980). Alternative to mental hospital treatment: I. Conceptual model,
treatment program, and clinical evaluation. Archives of General Psychiatry, 37(4), 392–397.
Van Tosh, L., & Del Vecchio, P. (2000). Consumer-operated self-help programs: A technical report,
Rockville, MD: U.S. Center for Mental Health Services.
Wolcott, H. F. (1992). Posturing in qualitative inquiry. In the handbook of qualitative research in
education. Orlando, FL: Academic Press.
Young, J., & Williams, C. L. (1988). Whom do mutual-help groups help? A typology of members.
Hospital & Community Psychiatry, 39(11), 1178–1182.