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By Martin Slater

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A stress-coping model predicts that the effect of life events on help-seeking is mediated by increased subjective distress. , 1982) but these studies do not consider the distressed individuals who do not appear in clinic samples. , 1981) but not in others (Norcross & Prochaska, in press); however, the retrospective design is particularly insensitive for detecting any such effects that may exist. , Greenley & Mechanic, 1976) are suspect in this regard because attitudes about psychotherapy are strongly influenced by participation in a therapeutic relationship (see Beutler, 1981).

Several prospective studies over 2year to lO-year periods (Berkman & Syme, 1979; Blazer, 1982; House, Robbins, & Metzner, 1982) have found social support measures to predict lower rates of all-causes mortality, and have shown that this effect holds with control for pre-existing risk factors and health behavior patterns. A related issue is what aspects of social support may serve to buffer the potentially adverse impact of negative life events. Here, results depend on the type of support measure used.

One point, often obscured in the meta-analyses, is the substantial degree of positive change that occurs in the control (untreated) groups (Luborsky, Singer, & Luborsky, 1975). , 1985). The other point is evidence showing that entry into formal therapy is accompanied by an increase in informal help-seeking as well (Cross, Sheehan, & Khan, 1980). This finding has profound implications for psychotherapy outcome research, for if professional help-seeking has the general consequence of stimulating an increase in informal help-seeking, then it is difficult to know how to attribute the observed therapy outcome effects to formal versus informal help.

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