Life's work: So your husband's an alcoholic and your best friend's down on her luck - why do you care? Emma Cook on the psychology of helping
Is there such a thing as true altruism? Are some people simply more generous-hearted than others, more innately inspired to help and console the needy? Or are their ceaseless efforts to give out motivated more by their own unmet needs than a selfless desire to solve people's problems?

Ten years ago, there was nothing Jane wouldn't do for her husband Peter, a businessman. Back then she would have described herself as the perfect helper; the ultimate caring person. Peter was an alcoholic and Jane spent her marriage trying to solve the problem of his addiction. "It stemmed from this great need to be needed', she says simply. "I thought, I can put this man right, make his world a better place. I wanted to make things better for him, as if to say, 'let me do this for you and you'll see what a great person I am'." I realise now that it was a complete lack of self- esteem. I thought if I married someone who needed me, he wouldn't leave me.'

Emotionally exhausted by years of "protecting" Peter - putting him to bed each night; lying to his customers when he left work early; handling his business when he was unable to - Jane finally joined Al-Anon, a self- help group for relatives and friends of alcoholics. The first lesson she learnt was that "helping" Peter actually perpetuated the problem. "They told me to leave him alone so I stepped back and started to live my own life; within three months Peter had stopped drinking."

Neil Crawford, a psychotherapist and senior consultant at the Tavistock Centre is not surprised: "Caring for another may seem altruistic but it can be selfish. You have to ask one simple question: is the care offered string-free or not? If not, then that begs the question, what motivates their concern for the other?

For Jane, helping was a way of retaining power. "I only felt safe if I was in total control and my need to control was drastic," she says. In a balanced relationship, says Crawford, care is given depending on who needs it; it should come naturally for both partners to put aside their own concerns temporarily. But being cast as the carer in a personal relationship is worlds apart from the desire to "help" as part of a job. Most therapists would agree that there's always a personal motive for wishing to solve other people's problems and aid their well-being. Some reasons may be less admirable than others but this doesn't matter as long as the trainee counsellor or therapist knows why.

Maggie McKenzie, a psychotherapist and director of the therapy centre Spectrum in London, explains, "It's an absolute key to being a therapist. It's one of the first questions we ask trainees. If someone says, 'I want to help people', it often means the they're quite controlling - they really want to tell people what to do. This emerges through training and if it's an idea they cling onto then they don't hang around."

Crawford also believes self-awareness is essential. "You can only connect with other people if you can draw on your own experiences. It's never as straightforward as saying, 'I want to help people.' It begs too many questions. You need to be able to ask yourself why. The people who can start thinking about the complexity of their emotions are the ones who make good therapists; those that have the capacity for humility."

Penny, 42, has been an analyst for five years and believes, as a good Freudian would, that some of her motives for helping others are rooted firmly in her past. "I'm an eldest child and I think that a lot of eldest children are carers - it's a natural position for them. Often they've looked after younger siblings and they feel responsible." She's also aware that when her twin brothers were born she felt excluded from the limelight. "I did lose some of the attention and I realised after my training that part of me felt counselling was a vicarious way of getting the care I wish I could have had."

Another reason for choosing this line of work can be the gratifying sense of contrast; helping people more depressed than yourself can put your own problems into perspective. As Penny says, "It implies that if you're helping them then you're strong. It's a case of feeling, 'I'm OK if you're not OK.' And it can be reassuring - like saying, 'If I'm on this end I can't be that bad'."

In the same way that Jane retained "drastic" control in her relationship as a carer, therapists and counsellors also have to be aware that "care" can equal power. "It is a fairly unequal relationship," says Penny. "You are in a powerful position and it's naive not to recognise that." And also to recognise if there's something in your own personality that may, on some level, be drawn to that.

Of course there are many admirable motivations for choosing a caring role; often people wish to use their listening skills and powers of empathy or, very commonly, they've been helped through a trauma themselves and feel so appreciative they want to put something back.

Dr James Thompson, a senior psychology lecturer at the University College London Medical School who has studied altruism, believes it has strong links with empathy. "It's a very important aspect. You've got to have the capacity to understand what someone's going through. If you can't it's less likely you'll be helpful."

He also says that benevolence may rely on a genetic motivation. "The genes may have a better chance of survival in a helpful environment. It's a group survival technique along the lines, 'If I help you now maybe you'll tell me about other dangers later on'." Even this implies that the most giving among us require, even if it's for our own survival, some sort of payback or reward.

Yet Debbie Jones, 31, who works through a health authority caring for a brain-damaged patient in the community, feels her motivations are less clear cut. "I don't do it to get something back. I just find it interesting working with Patrick. He's not verbal and speaks mostly through movement. It's at a subtle level and I enjoy trying to understand the way he communicates." She certainly doesn't view herself as a "do-gooder". "It's not about being needed. He only needs me in as much as I'm there - it could be anyone. You often meet people, especially if they're religious, who feel they should be doing this sort of work, almost in a self-righteous way. I hate that attitude. They're the ones who shouldn't be involved."

In a culture where we're constantly being told about the collective decline of altruism, those left to do a lot of the helping are often viewed with suspicion. Either that or we tend to invest society's carers with super- human qualities and strengths. In this context, Debbie's attitude seems extremely well-balanced, "I'm realistic about myself. Whatever I find enjoyment and stimulation in I'll continue doing. If it becomes something I feel I should be doing then I'll move on."