Forty-two studies comparing the effectiveness of professional and paraprofessional helpers are reviewed with respect to outcome and adequacy of design. Although studies have been limited to examining helpers functioning in narrowly denned clinical roles with specific client populations, findings have been consistent and provocative. Paraprofessionals achieve clinical outcomes equal to or significantly better than those obtained by professionals. In terms of measurable outcome, professionals may not possess demonstrably superior clinical skills when compared with paraprofessionals. Moreover, professional mental health education, training, and experience do not appear to be necessary prerequisites for an effective helping person. The strongest support for paraprofessionals has come from programs directed at the modification of college students' and adults' specific target problems and, to a lesser extent, from group and individual therapy programs for non-middle-class adults. Unfortunately, there is little information on the factors that account for paraprofessionals' effectiveness. Future studies need to define, isolate, and evaluate the primary treatment ingredients of paraprofessional helping programs in an attempt to determine the nature of the paraprofessional's therapeutic influence.Evaluations of research involving paraprofessional therapists have been highly positive. Reviewers concentrating on the use of college students (Gruver, 1971), community volunteers (Siegel, 1973, and parents (Berkowitz & Graziano, 1972;Johnson & Katz, 1973;O'Dell, 1974) or discussing paraprofessional therapy outcome research in general (Karlsruher, 1974) have agreed that relatively untrained workers can make a significant service contribution within the mental health field. Conspicuously ignored, however, has been the research comparing the relative effectiveness of paraprofessionals and professionals. This article attempts to review and evaluate this comparative research with respect to outcome and adequacy of design.A broad range of helping roles is considered.
Studies selected for review include individualThe author wishes to thank Daryl "Kim" Hamblin for his help in the rating task described in this report.