Psychoeducational Groups

Process and Practice

Nina W. Brown

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351689410
• Edition: 4
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

With this 4th edition, Psychoeducational Groups remains the only comprehensive, user-friendly guide to planning, implementing, facilitating, and evaluating psychoeducational groups. The 4th edition expands the discussions about group leaders' knowledge base, self-development, and techniques; best practices for group facilitation; and effective uses for group therapeutic factors. Substantial new material includes templates, scripts, and sample forms; suggestions for leader interventions for group and individual issues and difficulties; a social media policy; and the effectiveness of manualized and cyber/virtual groups.

Part I

Structuring

1

Psychoeducational Groups

Overview and Model

Major Topics

• Advantages and disadvantages of psychoeducational groups
• Psychoeducational groups defined, described, and categorized
• Myths and misunderstandings about psychoeducational groups
• The KASST psychoeducational group leadership development model

Introduction

Psychoeducational groups offer an opportunity for group members to become informed about a particular concern, issue, or problem; to grow in self-understanding and in interpersonal relationships; and to become more effective in understanding and solving problems that affect them. These groups offer a balance of cognitive and affective material with both assuming equal importance, and what is presented here is intended to guide psychoeducational group leaders to provide a rich and balanced group experience so that group members will derive considerable learning, growth, and understanding no matter what the primary focus for the group.

To underscore the potential uses for psychoeducational groups, a partial listing of examples for the variety of applications shows that these groups are used for many conditions, issues, and concerns across the ages and life span. DSM conditions include eating disorders, schizophrenia (Pitschel et al., 2009; Bechdolf et al., 2010), bipolar disorder (Pearson & Burlingame, 2013), social phobia (Bonsaken et al., 2013; Bonsaksen et al., 2013), and depression (Michalak et al., 2016; Scope et al., 2017). Abuse and trauma include sexual abuse (Karatzias et al., 2016), military trauma (Cox et al., 2014), and domestic violence (Levesque et al., 2012). Examples for audiences include children (MacPherson et al., 2016), military (Cox et al., 2014), older adults (Krishna et al., 2013), inpatient (Lothstein, 2014), international (Brouzos et al., 2015), and adolescents (Nkyi, 2015).

Examples for psychoeducational groups for medical conditions include cancer (Bechdolf et al., 2010; Cheng et al., 2015; Dieng et al., 2017; Kwiatkowski et al., 2016; Mahendran et al., 2017; Shannonhouse et al., 2014; Sherman et al., 2010; Watson et al., 2016), inflammatory bowel disease (Reusch et al., 2016), heart/stroke, diabetes (Pibernik-Okanovic et al., 2015), multiple sclerosis, (Bassi et al., 2016). Additional applications and guidelines for their use are presented in Section 4 of the book.

Central to the success of psychoeducational groups are the leader’s self-understanding, expertise, and skills. In addition, group facilitation requires that the leader have the capability to be an observer and understand the individual group members and the group as a whole so as to effectively guide the group and to facilitate interventions. This is the focus and emphases for the presentations in the following chapters. Group leaders will be most helpful to the group and its members when they can tune in to and use group process to further the growth and functioning of the group. For individual group members, group leaders can provide group process commentary, and use the resources of the group to help individual group members progress, grow, and become more effective. In some instances, these will also promote healing for some group members.

Advantages

There are many advantages for psychoeducational groups, including specific time boundaries and duration, a safe environment, dissemination of information, promotion of connectedness, alleviation of blame and/or stigma, correction of misinformation, learning strategies to better cope and manage, discussion of difficult topics, and so on. The expansion of the number and kind of psychoeducational groups in the past few years supports the perceptions of their efficacy.

There are usually specific time boundaries ranging from a one-hour one-session group to groups with multiple sessions over a several month period. However, these groups do have a specific beginning and ending date, and are usually considered as brief in comparison to psychotherapy groups.

These groups can provide a safe environment where uncomfortable and distressing feelings can be expressed openly. Some group members may not want to express these with family for fear of causing them more distress, and some members can need coaching to express these. The group becomes a safe place for talking about feelings, thoughts, and ideas that cannot be expressed in other settings.

Dissemination of information is as important for psychoeducational groups as it is for other groups, and the value of accurate and relevant information should not be underestimated. Since many of these groups are formed around specific conditions, illnesses, and disturbances where the leader may not have sufficient knowledge and expertise, it can be helpful to bring in outside experts and/or have consultants that do have the knowledge and expertise.

Reduction of feelings of isolation and/or alienation can be very important for the physical and psychological well-being of group members, and psychoeducational groups can help promote feelings of connectedness. Caring, concern, genuineness, and warmth are core conditions that promote feelings of acceptance, positive regard, and respect. These states can be very supportive to members who are experiencing trying times and situations.

An important psychological component for these groups and their members is alleviation of blame and/or stigma. Members can blame themselves or others for what happened to them, and have considerable shame, anger, resentment, and other such distressing emotions because of personal failings, such as smoking, fate, the unfairness of the universe or a deity, failure to get an accurate diagnosis or correct treatment, and other people. In addition, some illnesses, diseases, and conditions can be perceived as a stigma that produces shame for the group member. Also, there are some cultures that consider certain illnesses and the like as shameful. Group leaders must stay aware of the possibilities of blame and stigma, and be prepared to deal with these as they arise in the group.

In spite of the large number of resources, written information, and experts available, group members can come to the group with misinformation, and the group can be an excellent setting for correcting misinformation and ignorance about policies, procedures, medication, the antecedents for the condition, and so on, and for expected outcomes, processes, and other associated states. Interactions in the group can cause some of these to become visible, others emerge as members think about their situations, and some common ones may be known in advance so that the group leader can plan to address these as part of the dissemination of information.

The group is a place where members can be taught and can learn coping strategies to better manage the condition or other states, increase the quality of members’ lives, and to feel less victimized because of the empowering nature of coping. Chapter 6 presents information that can be helpful for teaching coping strategies.

Some members may not have anywhere outside of the group where difficult topics can be openly discussed. Topics such as the terminal outlook for the condition or other states; anger at self and others; resentment, envy, and jealousy that others are not also suffering; fear of the uncertain and the unknown; and other such distressing topics can be discussed, and feelings expressed and shared in the group where they will be carefully and respectfully considered, acknowledged, and accepted as valid concerns, their universality revealed, and catharsis promoted.

Disadvantages

There are also some disadvantages for psychoeducational groups. However, the advantages outweigh the disadvantages. Examples for disadvantages include time constraints, determining the root cause, leaders lack specific information, connections and cohesion may not have time to develop, and the lack of screening for many groups.

Time constraints do not permit exploration of many relevant and important topics, nor can additional problems, issues, or concerns that emerge during group sessions be explored. It takes time for trust and safety to develop to the point where many group members can feel confident enough to reveal important and significant personal material, and the duration of some groups will preclude this from happening.

The root causes for some conditions, disturbances, and/or disorders cannot be easily discovered, as this is a long uncovering process. This is the work that is best undertaken in psychotherapy, but glimpses can be seen in some psychoeducational groups although time does not permit exploration of these. In addition, some may be related to unresolved family of origin issues and time constraints work against uncovering and understanding them.

The leader can lack in-depth knowledge about the group’s primary concern, such as a chronic illness, and the information may not be easily obtained or learned. Further, group leaders will have to be able to address all sorts of conditions, issues, and concerns that members bring to group that can be a result of their illness or disturbance, or other such matters. Psychoeducational group leaders must know the process and procedures for the group as well as the specific information relative to any particular group.

Members can be so caught up in their individual misery that connections and cohesion do not have time to develop or emerge. Group members are interested in their personal issues and how these can be addressed and it takes time for them to develop trust and safety, to start to form meaningful connections with other group members and with the leader, and to start to reach out to give and receive helpful feedback. Some psychoeducational groups are too short-term for some of this to take place.

The lack or inability to screen group members can lead to inappropriate placement of some group members resulting in the possibility that neither they nor other group members will be able to gain the maximum from the group experience. Many psychoeducational groups are formed because potential members have the same condition, disorder, disturbance, and/or concern, but the potential members’ commitment, motivation, and other positive group member attributes are not taken into concern when forming the group. This can result in having one or more members in a particular group that are not appropriate for that group at that time, which in turn, can present difficulties for the group and for the group leader.

Myths and Misunderstandings

There are some commonly held myths and misunderstandings about psychoeducational groups and these can interfere with effective understanding and group facilitation.

1. Groups should be formed around a common problem, concern, and/or issue.
   Some psychoeducational groups are formed this way, and some are not. Even when formed around a common problem, each member’s problem will differ in important ways.
2. There is a right way and a wrong way to facilitate groups.
   There are effective facilitative strategies, and some that are less effective than are others. Each group leader has a unique style and facilitates in a different way, and there are numerous facilitation strategies that can be effective. Think in terms of effectiveness/ineffectiveness instead of right or wrong.
3. The group leader directs the group in what to do and what to discuss, and this is how the group’s agenda is formed.
   The group leader can plan, organize, and guide the group. The group may appear to agree with the directing when this is used, but will often find a way to meet its own agenda. Collaborative goal setting and faith in the group to make its needs known result in the best group outcomes.
4. Only therapy/counseling groups are “real” groups.
   All groups are “real” wherever they may be. It is helpful when the group has a purpose and goals; members are committed and participate; members are willing to express thoughts, feelings, and ideas in the group; and members are willing to risk.
5. Specific and effective interventions can be taught and learned.
   It is difficult and almost impossible to teach and learn specific and effective interventions that will apply to every group situation all of the time. Each group is different, and each group leader is different. Further, groups are much too complex for specific interventions to be proposed with any assurance these will fit. Group leaders will have to rely on their general knowledge about groups and how they function, their level of self-development, and apply these to the group situations they encounter.
6. Knowing what to do and say at all times are the group leader’s responsibilities.
   Even experienced group leaders will find that they are confused and can flounder at times. No one can know what to do at all times. Group members can also be of help in responding in the group.
7. Group leaders should be so confident that they do not experience anxiety, uncertainty, or confusion.
   Group leaders will experience all of these emotions, as will group members. The difference is that the leader should be better able to manage and contain these emotions.

Activity: How many of these were your beliefs or thoughts about psychoeducational groups?

Group Leaders’ Expertise

Creating and leading psychoeducational groups demands a considerable amount of expertise and knowledge. A variety of groups fall into the category of psychoeducational, the conditions addressed are vast and emotionally sensitive, and there is a wide range of intended audiences. Leaders of these groups have to be extensively prepared with information, skills, and a deep understanding of the group topics and the intended audience. Leaders are not just presenters of information, they are also facilitators who are responsible for guiding group members’ personal learning, fostering interactions among group members, providing opportunities for emotional expression in a safe place, showing group memb...