Psychology Psychoeducational Group Presentation Assignment

Please see the instructions and reading attached

 The Psychoeducational Group Presentation Assignment is an extension of your Psychoeducational Group Plan Assignment.  The Psychoeducational Group Plan Assignment is attached,

Create a slide presentation that articulates your written plan. The presentation should be 10-15 slides in length (excluding title and reference slides) and should be formatted in the most current APA 7 professional style. Avoid overloading the slides with text. Instead, use the speaker notes section to provide detailed explanations of what would be presented verbally during the session. Each slide should include a minimum of 150 words in the speaker notes section. Utilize appropriate graphics, charts, or other visual elements to enhance clarity and engagement. Proper credit is required for graphics not student created.

https://video.alexanderstreet.com/watch/psychoeducational-group-demonstration

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Psychoeducational Group Plan: Supporting Sexual Assault Survivors with PTSD

Abraham De La Cruz
Doctorate of Education-Community Care and Counseling-
Marriage and Family, Liberty University
EDCO 711: Advanced Group Counseling
Prof. Dr. Gregory Mears
March 23, 2025

I. Subject Synopsis

Members of psychoeducational groups can learn more about a specific issue, problem, or worry; develop their interpersonal skills and self-awareness; and improve their ability to comprehend and resolve issues that impact them (Brown, 2018). The purpose of this psychoeducational group is to assist survivors of sexual assault who are suffering from post-traumatic stress disorder (PTSD). The main goals will be to educate people on PTSD symptoms, coping mechanisms, and resilience building. Numerous evaluations have shown that sexual assault is linked to an increased risk of being diagnosed with conditions such as acute stress disorder (ASD), post-traumatic stress disorder (PTSD), and symptoms of PTSD (Stockman et al., 2023). Psychoeducational interventions have been shown to statistically significantly improve PTSD and depression in survivors and can significantly improve coping mechanisms, including trauma-focused therapy interventions like cognitive processing and exposure therapy (Heard & Walsh, 2023). To empower members, this group will apply evidence-based practices such as mindfulness, cognitive-behavioral approaches, and peer support.

According to Moring et al. (2023), giving patients psychoeducation before to starting CPT might boost their expectations, optimism, and perception of the therapy’s legitimacy—all of which are essential for the best possible outcome. This group will be set up to provide a secure and encouraging setting where members may learn how to control their symptoms and enhance their quality of life. According to Brown (2018), members may experience significant feelings of guilt, wrath, resentment, and other upsetting emotions as a result of personal shortcomings and may blame others or themselves for what occurred to them. This group is extremely significant in the counseling industry since survivors of sexual assault frequently suffer from PTSD.

II. Group Outline

A. Group Purpose:

· To give survivors of sexual assault psychoeducation on PTSD symptoms and coping techniques.

· To promote self-efficacy and emotional resilience using evidence-based practices.

· To establish a secure environment where survivors may talk about their experiences and get assistance from their peers. These groups can offer a secure setting where people can freely express unpleasant and upsetting emotions (Brown, 2018).

B. Target Audience:

· Adult survivors of sexual assault have been diagnosed with or are suffering symptoms of PTSD.

· Individuals seeking formal direction and assistance during their recovery process.

· Participants are willing to participate in psychoeducational activities and conversations.

C. Goals:

1. Improve participants’ awareness of PTSD’s effects on mental health and daily life.

2. Provide participants with appropriate coping skills for managing PTSD symptoms and enhancing emotional control.

D. Objectives:

1. At the end of the group, participants will be able to recognize three typical PTSD symptoms and psychological repercussions.

2. Participants will grasp how trauma impacts cognitive and emotional processing.

3. Participants will learn and practice at least three evidence-based coping methods to manage PTSD symptoms, such as grounding techniques, mindfulness, and cognitive restructuring. According to Heard and Walsh (2023), these techniques help to reduce PTSD symptoms and improve coping skills.

4. Participants will develop a tailored coping strategy with at least three methods for high-stress situations.

E. Group Rules:

Heard and Walsh (2023) argue that activities to build trust and group norms are essential for effective treatments.

1. Confidentiality: To create a secure and trustworthy atmosphere, all group talks are kept 

2. private.

3. Respect: Participants will acknowledge each other’s experiences, viewpoints, and limits.

4. Supportive, non-judgmental environment for healing and growth. Participation: Members are urged to participate while maintaining their comfort levels.

5. Safety: Any reports of injury to self or others will be handled following ethical and legal 

standards.

6. A major ethical concept is to do no damage; while this may seem straightforward, it is 

not, and group leaders must be cognizant of ethical standards to monitor the potential for 

harm (Brown, 2018).

F. Biblical Integration:

·
Psalm 34:18: “The Lord is close to the brokenhearted and saves those who are crushed in spirit.” This scripture stresses God’s compassion and consolation for people who are suffering.

·
Isaiah 41:10: “So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen and help you and uphold you with my righteous right hand.” This scripture reassures survivors that they are not alone in their healing journey.

· The Christian values of hope, restoration, and support will be used to promote faith-based healing and resilience.

References

Brown, N. W. (2018). Psychoeducational Groups, 4th Edition. [[VitalSource Bookshelf version]]. Retrieved from vbk://9781351689410Heard, E., & Walsh, D. (2023). Group Therapy for Survivors of Adult Sexual Assault: A Scoping Review. 
Trauma, Violence & Abuse, 
24(2), 886–898.

https://doi.org/10.1177/15248380211043828

Heard, E., & Walsh, D. (2023). Group Therapy for Survivors of Adult Sexual Assault: A Scoping Review. 
Trauma, Violence & Abuse, 
24(2), 886–898. https://doi.org/10.1177/15248380211043828

King James Bible Version. (2025). KJV Online. https://www.kingjamesbibleonline.org/

Moring, J. C., Peterson, A. L., Straud, C. L., Ortman, J., Mintz, J., Young, M. S., McGeary, C. A., McGeary, D. D., Litz, B. T., Macdonald, A., Roache, J. D., Resick, P. A., & for the STRONG STAR Consortium. (2023). The interactions between patient preferences, expectancies, and stigma contribute to posttraumatic stress disorder treatment outcomes. 
Journal of Traumatic Stress, 
36(6), 1126–1137. https://doi.org/10.1002/jts.22982

Stockman, D., Haney, L., Uzieblo, K., Littleton, H., Keygnaert, I., Lemmens, G., & Verhofstadt, L. (2023). An ecological approach to understanding the impact of sexual violence: a systematic meta-review. 
Frontiers in Psychology, 1–16. https://doi.org/10.3389/fpsyg.2023.1032408

EDCO 711

Psychoeducational Group Presentation Assignment Instructions

Overview 

The
Psychoeducational Group Presentation Assignment is an extension of your
Psychoeducational Group Plan Assignment. For this assignment, you will develop the introductory material from
Psychoeducational Group Plan Assignment of your psychoeducational group. This material will reflect a well-organized plan grounded in scholarly literature and aligned with best practices in psychoeducation.

Instructions 

Based on the
Psychoeducational Group Plan Assignment you previously developed, you will create a detailed written plan and accompanying slide presentation that outlines the content and flow for the introductory session of your psychoeducational group. Your submission should be comprehensive, including the following components:

1. Objectives for the Session
Clearly define the objectives for this introductory session. Each objective should be measurable, using Bloom’s Taxonomy and align with the overall goals of the psychoeducational group. Ensure the objectives are supported by evidence-based practices, citing relevant scholarly, peer-reviewed sources.

2. List of Planned Activities
Provide a detailed list of the activities you plan to implement during the session. Each activity should have a clear purpose and be tied to the session’s objectives. Include information on any materials or resources required to facilitate these activities. Support your choices with scholarly references where appropriate.

3. Mini-Lecture of the Topic
Develop a mini-lecture that introduces the group members to the key concepts and foundational knowledge related to the topic of your psychoeducational group. This lecture should be concise yet informative, grounded in current research, and reflective of doctoral-level critical analysis. The mini-lecture should incorporate the scholarly sources from your week one assignment. These should be peer-reviewed from within the last three years.

4. Tentative Schedule
Outline a tentative schedule for the session, indicating the time allocation for each activity, discussion, or lecture segment. The schedule should reflect careful planning to ensure the session remains engaging and focused on achieving the session’s objectives.

5. Slide Presentation
You will create a slide presentation that articulates your written plan. The presentation should be 10-15 slides in length (excluding title and reference slides) and should be formatted in the most current APA professional style. Avoid overloading the slides with text. Instead, use the speaker notes section to provide detailed explanations of what would be presented verbally during the session. Each slide should include a minimum of 150 words in the speaker notes section. Utilize appropriate graphics, charts, or other visual elements to enhance clarity and engagement. Proper credit is required for graphics not student created.

6. References
Your presentation must include a reference slide formatted in current APA professional style. The same scholarly references used in your
Psychoeducational Group Plan Assignment should be incorporated, with the option to add additional sources as needed to support your content.

Formatting and Submission Requirements

· APA Style: Ensure that both the written plan and the slide presentation adhere to APA formatting guidelines, including proper citation of sources and formatting of references.

· Scholarly Sources: Incorporate a minimum of five scholarly sources, published within the last three years. These sources should support your objectives, activities, and lecture content.

Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.

Read: Brown: Chapters 13

Leading Psychoeducational Groups for Adults

Major Topics

Examples and research for adult groups

Descriptions for categories

Adult group settings

A basic framework for creating the adult group

Major considerations for facilitating adult groups

Introduction

This chapter will focus on general guidelines for adult psychoeducational groups categorized as educational such as parenting, task or work related such as meetings and professional development, teams such as sports teams and work teams, and life transitions such as retirement and divorce. Presented are the definition and descriptions for the categories, some examples of groups for adults, general guidelines for creating and facilitating adult psychoeducational groups, differentiation concerns for the various categories, and sample plans for an educational group, a one-session task or work-related group, a work team development procedure, and a multisession life transition group. Chapter 14 addresses adult psychoeducational groups for medical and psychiatric diagnoses.

Psychoeducational groups for adults differ from groups for children and adolescents in some important ways that have implications for the group leader.

Adults are more likely to be voluntary participants as they can choose to attend many of these groups.

Adults will more often have specific objectives or learning they expect from the group, and they are more aware of these expectations.

Behavior, especially disruptive or aggressive behavior, is not usually a concern.

Adults have life experiences that add to the richness of the group.

Adults can be more task focused.

In addition, adults, in contrast to children and adolescents, tend to be more focused, have specific knowledge or skills they are seeking, value the leader’s organization and wise use of time, are eager to see progress or results, desire a personal connection to the material, and may be less flexible in their thinking and attitudes. Their beliefs, attitudes, values, and life experiences are major components for their thoughts, ideas, feelings, and responses, and will be significant and important parts of their levels of participation in the group. These are also factors that play roles in how the leader creates and develops the group’s goal, objectives, and the strategies and techniques to use. While a more directive stance can be helpful with children and adolescents, this may be less effective with adults, and the group leader may have to adopt a more collaborative and flexible stance with an adult group because of these differences. These traits can make the planning and facilitation of groups for adults much easier in some ways.

However, adults can also be more demanding and critical, impatient for results, desirous of more personalization and individualization, and very adept at resistance and defensive behavior. These traits can make the group leader’s tasks more difficult.

Examples of Groups for Adults

There are numerous examples for the effectiveness of psychoeducational groups for a variety of adult issues, concerns, and problems. Examples include the following.

Self-esteem

—(Swell, 1992; McManus et al., 1997)

Social skills—(Stein et al., 1994; Martin & Thomas, 2000)

Parenting

—(Morgan & Hensley, 1998; Vacha-Haase et al., 2000)

Stress—(Ulman, 2000; Jones, 2001)

Work-related groups—(Hall & Cockburn, 1990)

Teams

—(Sverfrup et al., 2017) classroom; (Gevers et al., 2016) industry; and (Beersma et al., 2016) military (Dutch)

Domestic violence—(Levesque et al., 2012)

Descriptions of Adult Groups

It can be helpful to provide descriptions for the variety of adult groups presented in this chapter. The categories for this discussion are educational, task or work group, teams, life transitions, and life skills.

Educational Groups

Educational groups have a primary focus of information dissemination, can be single or multisession, have a narrow focus, and are designed to prevent or solve specific problems. Leaders will make considerable use of instruction although there are numerous opportunities for activities, and for expressing feelings. Examples for educational groups include the following:

Parenting

Career development and exploration including career changes

Training groups

Classroom project groups

Study skills and test taking

Some leadership objectives for these groups are to disseminate a needed body of information, learn and practice new skills, learn how to work in groups, explore personal needs related to cognitive topics, and to increase understanding of an issue, problem, or concern. Leaders are expected to be able to plan and present material in a variety of ways so as to engage the adult learner, to present material at the learning/educational level appropriate for the target audience, to use techniques to engage participants, and to also address and attend to the affective needs of the group.Some educational groups can be a single session, such as an information session for parents of prospective college attendees, or a workshop for college professors on how to integrate culture and diversity material into their courses, or explaining a new policy to a work group in a business. Some educational groups are intended to have multiple sessions over a period of time to allow for considerable information to be disseminated, and to provide opportunities for members to integrate the material.

Guidelines for Facilitating

Discussion

s

The guidelines for activities focused on an expansion of personal feelings and reactions. Following are the guidelines for expanding cognitive content, such as that which is used in educational groups, but are also applicable to other adult groups with cognitive content such as training workshops and skills development. The following is presented on the assumption that the discussion follows a mini-lecture, presentation, video or DVD, or after participants have read some material such as in handouts.

Prepare questions in advance. The questions or statements posed help focus attention on relevant information, encourage participants to present their own ideas and opinions, promote airing of diverse perspectives, and can trigger critical thinking. It is best that these be created in advance so that the focus is kept on the most significant and important material.

Begin the discussion by asking for reactions from participants. When they are asked for their reactions, they have an opportunity to express their initial reactions free from any expectations for what these reactions should or ought to be. Their reactions can then be spontaneous and will provide some information about their perceptions and ideas.

Ask participants what was focal, meaningful, or seemed important to them as a way to trigger and focus their expressions. Exploring what seemed most significant can be useful to help participants sort out the material that they absorbed, and to provide an opportunity to make personal connections to the material. Hearing what others found significant and meaningful can also provide an additional avenue for thoughts and ideas.

Listen carefully in order to link participant’s responses. Listening and observing to what participants found to be meaningful and significant provides some material for linking among them. They can be similar in their perceptions and/or associations even though these may be phrased differently. Listening carefully also helps the group leader to discern the theme, and to identify where there may be resistance. This information can then be used to better understand the group and its needs, identify gaps in their knowledge and understanding that may need to be addressed in order to make the best use of the material, and to highlight areas of members’ sensitivity.

Give paraphrasing and reflection responses. Paraphrasing and reflective responses help participants to feel heard and understood. It can also be helpful to open it up to the group by asking if others share the opinion, thought, perspective, and the like. Refrain from exploring the speaker’s feelings at this point, as this can sidetrack the discussion. If it seems that the speaker has intense and/or important feelings about the material, topic, or his/her input, this can be acknowledged by saying something on the order of, “I can see that you have some strong feelings about this,” and move on or, if appropriate, remark that these feelings will be explored later.

Make it a habit to only correct important misinformation. Small errors in understanding can be ignored or considered as a difference in perceptions. The most important thing is to listen and encourage expressions of thoughts, ideas, feelings, perspectives, and the like. It is not helpful to question or challenge speakers in a discussion, to engage in debate with him/her, or to bring in additional material to refute what the speaker is saying. Doing so may have a chilling effect on the discussion, causing others to be reluctant to openly express their reactions. Further, challenging can redirect the discussion to the conflict rather than keeping the focus on the presented material.

Keep to the time limit and stop even when the discussion is lively and interesting. This can be hard to do when the discussion is energized and significant material is being disclosed. However, for the sake of the group’s schedule and agenda, it is very important to respect the time boundaries and to terminate the discussion in time to do a summary.

Try to involve as many participants as possible. Involving as many participants as possible promotes airing of diverse perspectives, encourages ownership of responsibility for the group’s work, and can help promote universality by hearing that others have similar thoughts and reactions. One technique that can be helpful is to ask after a speaker has made input, if there are others who have similar perspectives and the like. This would help ensure that the speaker would not feel ignored, the perspective overlooked or discounted, and could identify connections to other group members. One way to reduce the possibility of monopolizing is for the leader to state that he/she needs to hear from as many people as possible.

Summarize the major points revealed by the discussion. Bring closure to the discussion by summarizing the major points that emerged during the discussion. It can be helpful to write these down as they emerge, or to post them on a chalkboard or whiteboard, or a large newsprint pad.

Task or Work Groups

Task or work groups are usually found in business and other organizations, and are focused on training, skills development, problem solving, decision making, and other such topics related to the world of work and productivity. While there can be some overlap with the descriptions of other categories such as with education and teams, these groups function in a work environment and their group topics related to their work. Wheelan (2005) developed a list of learning and leadership objectives relative to task groups.

Relation of the skills to specific work situations

Understanding when the skills are appropriate or inappropriate to use

Observation of competent modeling of the skill(s)

Cognitive practicing of what is to be learned

Assessing practice, observation, and the like of self and of others

Giving and receiving feedback about performance

Receiving encouragement and support, especially for engaging in or trying new behaviors

Wheelan also provides a different perception for how leaders can make group interventions with task groups. While the concern, issue, or problem is generally phrased as interpersonal difficulties, it is more likely that the real difficulties lie more in a lack of work goal(s) clarity, an ambiguous role expectation, and confusing or non-existent procedures for decision making. Examples for task groups include staff development, stress management, and management and supervisory skills such as performance evaluation.

Many such task or work groups may be one or two sessions. They too are cognitively focused as are educational groups, but there can be an additional element of skills training. When skill training is a component for a task group, planning should include enough time for group members to practice the new skills with appropriate feedback.

A major constraint for many task/work groups is that they are composed of peers who have an existing relationship including some conflictual ones, and who will have to work together after the group is completed. This constraint should be taken into consideration when planning group activities as well as the constraint that there may be cliques in the group. Group leaders should take care to not have activities that will promote shaming or conflict as there may not be enough time to resolve these during group time, and that these can cause future detrimental work relationships.

Teams

Teams are formed in many settings and are composed of several individuals who have and work toward a common goal. Some teams are mainly permanent, such as a department in a business or university or a sports team, and continue to work together over a period of time. Members of permanent teams can change with members being added and released at any time. Some teams are temporary in the sense that they are formed to accomplish a specific and defined task such as is found for committees, classroom teams, task forces, and projects. Once the defined task is completed, these teams usually cease to exist.

Permanent teams with changing membership usually have a leader or a designated leader who is charged with structuring the administration of a unit such as a department. This is the person who assigns tasks, projects and the like, chairs meetings, and provides performance evaluation for team members, or has significant input into their evaluations. Although this is considered a team, this discussion will focus on just one major task of the leader, that of chairing meetings. These kinds of teams can also have the constraints of the task/work team described in the previous section of being peers, having preexisting relationships including some that are conflictual, and having cliques as a possibility.

Meetings for permanent teams can include those for special projects such as accreditation, brainstorming for new endeavors or to solve problems, strategic planning for the future, and developing or explaining new policies. There are some actions the leader can take to make meetings of any kind more meaningful and productive. These include having a purpose or goal, providing informative materials in advance of the meeting, having an agenda that is reasonable in length considering the time that is available, and providing for all members’ input. While the cognitive component is important, it is also essential that the group leader attend to members’ affective needs and to not ignore these trying to get the task finished.

Temporary teams are usually task and time bound. That is, they are created for a specific task or reason, and once that is accomplished, the team is dissolved. For example, a team can be formed in an academic course to complete a project and once that project is submitted, the team disbands. However, during the time period that the team is working, there should be a group leader who, along with group members, structures the tasks, helps to make assignments for duties and responsibilities, and holds and facilitates meetings to ensure that all team members are working, have the resources needed and the like. Leaders of temporary teams have many of the same tasks and responsibilities as do leaders of other types of groups.

Sample Format for Meetings

The following is an example for the format for meetings. It is recommended that any format used be consistent for all of the meetings of a task or work group, department, unit, task force, and other such groups.

Name of Organization (Group, Task Force, and the like)

Date of Meeting

Agenda

Opening (welcome, remarks and the like)

Responsible person

’s name

Roll call (or other form of taking attendance)

Responsible person

Approval of previous meeting minutes (distributed in advance)

Agenda (review and ask for additions)

Responsible person

ITEMS (List the items in order they will be considered and only list those that need decisions.)

Responsible person

Review or discussion items (These are items that are open for discussion, input, brainstorming and so on.)*

Responsible person

Informational items (This material does not call for a discussion.)**

Responsible person

Announcements

Summary of meeting’s decisions, needs for additional information, assignments such as a committee report, and date and time for the next meeting

Responsible person

* See the section on leading discussions presented earlier in this chapter. Set time limits for the review or discussion, for example

20 minutes

.

** Clarifying questions may be asked.

Committees, class project, or other groups and the like will also find it helpful to have a meeting template and to follow that so that the major tasks for the meeting are accomplished, discussions are focused on essentials, and so that members of these group feel productive.

Life Transitions/Life Skills

Life transitions adult groups can be focused on facilitating expected developmental tasks, or on adjusting to life changes. Leaders can expect that significant and intense emotions can be present in these groups, and that members are in the process of adjusting to ambiguous, uncertain, and sometimes distressing situations. While information is of importance, attending to the emotional needs of members is also critical. Examples of life transition topics and focus are: divorce, death, retirement, displaced homemakers, loss of employment.

Group leaders can expect that many group therapeutic factors such as universality, hope and catharsis will emerge or will need to be fostered. In many instances, existential factors will also be present such as in a grief group, or a group of professionals approaching retirement. These factors can be of immense help to group participants to help allay fears of ambiguity and uncertainty, reduce isolation, and increase social connections. Unlike some of the other adult groups that were previously described, these groups will be more like therapy groups in some respects: multisessions, use of group therapeutic factors, catharsis with the interpersonal feedback loop as described by Yalom and Lesczc (2005), less reliance on dissemination of information, and group process. These groups are planned as are other psychoeducational groups, but there is more of an interpersonal component that had to be considered by the group leader.

Life skills groups can be considered as a subset of life transitions and are usually focused on expected skills development, especially those that relate to the quality of life, adjusting to changes, and interpersonal relationships. Leaders can expect that members will have both cognitive and affective needs, and that there will be a level of skill acquisition and development that may need to be an integral part of the group. Examples of life skills topics include relationship and communication skills, leisure and recreation, healthy lifestyles to include diet, smoking cessation, and stress management.

Settings for Adult Psychoeducational Groups

Psychoeducational adult groups are held in many settings such as business and industry, colleges and universities, public and private agencies, and in hospitals and other health organizations. Since these vary widely and are numerous, this discussion is limited to a general description for these four.

Business and Industry

Businesses and industry are usually concerned with productivity and groups in these settings tend to focus on maintaining or increasing productivity through training and skills development. These groups are usually limited in their time frames, membership can be very diverse, and the focus or goals very narrow and focused. It is helpful to have a clear understanding of the business or organization’s purpose, goals, and expectations for the group before beginning to plan the group. This is in addition to determining what members think they will want to accomplish or achieve. In essence, group leaders are dealing with two different entities, the group and outside the group forces. It is helpful for the group leader to understand that this is what members are encountering, and that the group does not exist in isolation from the external forces. Many of the psychoeducational groups for agencies address medical and/or psychiatric issues, problems, and concerns, and these are presented in Chapter 14.

College Counseling Centers

College counseling centers (Kincade & Kalodner, 2004) are now very common on college and university campuses. The four major purposes for these groups are prevention, skill and awareness building, academic issues, and stress management. Kincade & Kalodner describe the college counseling groups as different from groups in other settings in the following ways:

Considerable diversity among the group members in terms of age, class rank, lifestyle, physical ability and other factors.

The closed nature of the college environment can produce dual relationships and/or multiple roles among group members and between the group leader and the members

Scheduling of meetings can be difficult because of the multiplicity of the members’ schedules.

Group members must commit to the group, and this may be a new experience for them as they may not be required to attend class, and are able to drop in campus offices without appointments.

They can have deep fears about confidentiality and privacy because of the closed nature of the campus.

There can be difficulty in recruiting group members.

Topics and conditions addressed with psychoeducational groups for college students and in college counseling centers include the following: body image and weight (Blow et al., 2010), depression (Buchanan, 2012), grief (Vickio, 2008), international students (Cheng et al., 2015), eating disorders (Tillman et al., 2015), relationship violence (Hays et al., 2015), career (Powell et al., 2014), bereavement (Battle et al., 2013), procrastination (Toker & Avci, 2015), stress (Martinovich, 2015), adjustment (Harris et al., 2003), ADHD (Allison & Antshel, 2015; Kercood et al., 2015), first generation college attendees (Williams & Ferrari, 2015), test anxiety (Rajiah & Saravanan, 2014), academic dishonesty (Oh & Nussli, 2014), interpersonal (Hiclurmaz & Oz, 2016), and learning disabilities (Milsom et al., 2004).

It is essential that leaders of psychoeducational groups in college counseling centers have the appropriate training prior to facilitating psychoeducational groups to better understand how to balance the cognitive and affective components. It is also recommended that these groups be organized around a common theme, have a strong didactic teaching component, personalization of information, focus on behavioral skills acquisition, and be tailored to fit the specific college environment.

Public and Private Agencies

Agencies such as outpatient facilities, clinics, community agencies, mental health settings, HMOs, and the like provide a wide variety of adult groups. Common topics and foci for these groups include the following:

Stress management

Coping skills

Medication

Parenting skills

Relationship and communication skills

Grief and loss

Career exploration

Self-esteem

Physical and psychological health

The thrust for these groups are education, mutual support, practice socialization skills, and to express feelings (Clifford, 2004).

Hospitals and Health Organizations

Psychoeducational groups can also be a part of inpatient treatment in agencies such as the Veterans Administration hospitals. Greene et al. (2004) describe these groups as topic oriented, task focused, and health promoting. Topics are oriented to increasing understanding and proficiency at establishing meaningful social relationships and other affiliations, becoming productive in work-related activities, and integrating constructive leisure activities. Task foci are on helping to learn to manage stress and other physical and psychological conditions such as a dual diagnosis and discharge planning. Promoting health includes topics such as weight management, smoking cessation, and stress management. These groups tend to be multisession groups over a long period of time, and are an integral part of the treatment plan, which necessitates working with other professionals.

A Basic Framework for Adult Groups

The basic framework for adult psychoeducational groups includes many of the same factors as do groups for children and adolescents. However, these factors may differ for many of the adult groups, and leaders may need to consider these when planning their particular group(s). The factors that can differ in significant ways are information gathering, the time frame, and facilitating strategies.

Information Gathering

Perhaps one of the most important tasks for the leader of adult groups is to gather information about the target audience’s characteristics. This data can be essential in deciding on the priorities and relative importance for each topic or activity for the group. For example, a group of adult females will differ in significant ways from a group of adult males; and there can be other significant variables such as the following:

Educational level

Occupation(s)

Cultural and diversity factors

Socioeconomic status

Previous training and knowledge of topic

The setting for the group

Other possible sensitive areas, such as political party preference

These factors are important in determining what material to present, how it can be best presented, strategies to use to encourage involvement and participation, identifying potential sources for conflict and/or resistance, and how developmental concerns may impact group members and the group. While group leaders cannot anticipate all potential sources for difficulties, knowing and preparing for some can be facilitated with the essential information gathered. Pay particular attention to the following:

Appropriate language such as terms and concepts are used and are suitable for the educational and/or occupation of group members.

Print materials are at an appropriate level of reading.

Ensure that cultural norms are not violated as this can unintentionally fuel resistance.

Adjustments are made in the language used in material and activities for diversity factors so that they are appropriate for the target audience, such as for an all male or all female group.

The level of the presentation is neither too elementary nor too advanced.

Strategies are selected that are focused on essentials and the connections to the goal and purpose for the group are easily discernable.

Try to reduce or eliminate professional jargon, and select terms and concepts that can be easily understood by a general audience. Group leaders do not want to have to spend your time defining terms and explaining concepts, especially when these are needed to understand the remainder of the material since some in the group may need time to absorb the new information before applying it.

The group leader can make certain assumptions about the reading levels for group members based on their educational level, and/or occupation. A good rule of thumb to use for print material is to gear it toward the level of reading required by a newspaper unless there is reason to believe that members need more simplified reading material.

It is relatively easy to avoid violating cultural norms when these are known in advance, and extremely easy to violate them when they are not known.

Knowing something about the various cultural backgrounds of the group members in advance of starting the group can help prevent violations that offend, and can cause resistance that remains unexpressed or hidden. At a minimum, try to obtain information about the racial/ethnic/geographic region makeup of the group members.

Be sure to pay attention to diversity factors, as these can necessitate adjustments in your presentations. For example, suppose there is a heavy reliance on using visual material for presentations, and there is one or more visually impaired individuals in the group. The visually impaired group member(s) can become frustrated at not being able to participate because they cannot read or see the presentation.

Gear the presentation to a level that will maintain the interest of all group members regardless of their educational level, and work to ensure that it is neither too elementary nor too advanced. When presentations are too elementary group members can feel that the leader is talking down to them and not respecting their abilities. When presentations are too advanced, members can be turned off and not listen because they don’t understand what is being presented, and it has no personal relevance for them.

The final point addresses one of the most important factors for adult groups, that is, to have strategies that focus on essentials, and that these be directly related to the goal and purpose. Group members should not have to guess about the relevance of the material to the goal, or for them personally.

Time Frame

The time frame can also be of importance for adult groups. For example, many task groups have a single session, while inpatient psychoeducational groups can have multiple sessions over a relatively long time period. Single session groups can be challenging because the adults are demanding and hopeful that their needs will be met, but can also be skeptical that anything of importance can be accomplished in a single session. Thus, planning, scheduling, and sequencing of activities is critical. Multisession groups, such as those described in Chapter 14, have their own challenges when working with adults. It is suggested that, although material can be sequential with one session building on acquisition in the previous session, each session be somewhat self-contained so that members can capitalize on whatever information and learning is present in every session as attendance can be spotty.

Facilitating the Group

Facilitating strategies address both the cognitive and affective aspects. Group leaders may want to review the material in the chapters on instruction and activities that present these strategies for planning what strategies to use in the group. The modes for presenting information, ensuring active participation, personalizing the experiences, and other such aspects for the adult group can be critical, and those chapters describe the various modes that are available and useful.

The chapter on group skills can be helpful in understanding what will be facilitative during the group sessions. The leader’s relating attributes are essential in establishing safety and trust in the group to promote disclosure and reduce resistance, and their communication skills are essential in helping members to feel valued and of importance. Having these as the basis for what is done and said will help assist to effectively facilitate the group regardless of its topic, goal, or purpose.

Guidelines for Adult Groups

The advantages for adult groups mentioned earlier also carry some expectations for leaders. In order to meet these needs and expectations, leaders must be organized, plan well, and involve participants in setting goals.

Group composition and group size are of less concern than for children and adolescent groups. Helpers are useful for adult groups when group size rises above 20, however. It is generally most effective to divide a large group into small groups for discussion, exercises, and to promote interaction and involvement.

Length, duration, and number of sessions also are of less concern with groups for adults. Timing should be determined around availability of participants and the topic covered. Groups that have a topic of adequate interest for adults will attract and keep participants for a number of sessions over weeks and months.

Setting Goals and Objectives

Spend some time in the beginning of the group clarifying participants’ goals, objectives, and expectations so that plans can be made to accommodate as many as possible. One way is to have participants write their goals, objectives, and expectations on paper, then break into small groups, compile the lists on newsprint, post them on the wall, discuss them, and come to some agreement on the most important ones for the group. A variation would be to divide into groups; brainstorm goals, objectives, and expectations; prioritize and write them on newsprint; post them on the wall; and discuss.

Group leaders may accurately anticipate the major goals, objectives, and expectations, but the primary outcome for any activity is to promote involvement and commitment. Getting participants involved and excited encourages participation and promotes learning.

Environmental Concerns

Because adult group sessions tend to be held over a longer time span, attention should be given to the comfort of participants. Adequate space for moving around and stretching is helpful, as is comfortable seating. Temperature control, a quiet atmosphere, adequate air exchange, and close availability of bathrooms also contribute to comfort.

Freedom from intrusion is as important for adults as it is for children and adolescents. Disruptions tend to focus attention away from the topic and interrupt input and interaction.

Leader Tasks

Following is a short list of questions to explore when planning an adult group:

What are the primary outcomes expected?

What are the participants to know or be able to do as a as a result of the group?

Who are the participants? Group leaders will need to know group members’ ages, educational levels, and employment.

How many participants will comprise the group? Is the group to be homogeneous or heterogeneous around gender, age, or other characteristics?

How much time is needed or is available for group sessions? Be explicit about the number of hours the group will last—for example, say three hours rather than half a day, which could be either three or four hours. If there are several sessions planned, will there be a consistent time for the group to meet?

What facilities will be used? Will the group be held at an organization’s facilities, at rented facilities such as a hotel, or in some other place?

What are the funding concerns? Will there be sufficient funds to cover helpers’ stipends, cost of materials, copying, renting movies or equipment, and refreshments?

An Example Plan

Table 13.1 shows a sample plan for a one-day psychoeducational group on time management formulated for a workplace setting with about 35 middle management participants who already know each other. The participants will be divided into five subgroups of seven members each for the exercises. There will be both small group and large group discussions.

Handout

s are prepared in advance.

Table 13.1 Sample Plan—Time Management Group

Activity

Time Needed

Materials

Introductions and overview (adjustments made to schedule if needed)

20 minutes; large group

Handouts on purpose, schedule

Generating a list of time management concerns and problems

30 minutes; small group meets first, then large group discussion

Newsprint, felt markers, masking tape

Mini-lecture: “Daily Planning” and discussion

20 minutes

BREAK

10 minutes

Exercise: My Work Plan, energy and work day/time, Usual day/time

35 minutes

My work plan forms: best day and time, usual day and time

LUNCH

60 minutes

Exercise: “Categories of Time Use” and discussion

40 minutes

Handout

Mini-lecture: “Time Wasters and Management Functions”

20 minutes

Handout

BREAK

10 minutes

Exercise: Tools for managing time wasters

45 minutes

Form, newsprint, masking tape

Summary and discussion

20 minutes

Evaluation

15 minutes

Evaluation forms

Read: Brown: Chapters 1

4

Psychoeducational Groups for Illnesses and Other Conditions

Major Topics

Planning and forming the group

Members’ factors, such as emotional intensity

Members’ attitudes and behaviors

Guidelines for a single session

Multisession psychoeducational groups for illnesses and conditions

Introduction

Brown (2005) compiled the literature from 1990 to 2005 for research on psychoeducational groups’ efficacy for people with medical illnesses and emotional disturbances. Since that time, other studies were reported on illnesses and conditions. Table 14.1 presents a listing of example studies on psychoeducational groups for the medically ill, and Table 14.2 presents the examples for emotional disturbances.

Many therapies now include a component for psychoeducational groups where participants receive information specific for the condition that is under treatment along with the other treatment modalities. This approach is used in both outpatient and inpatient settings. These groups are characterized by having a specific focus and theme, an emphasis on information relative to the goal, narrowly defined goals, homogeneity of group members, being time specific or time bound, and opportunities to consult with other professionals treating the same person on a more regular basis.

Table 14.1 Examples of Studies on Psychoeducational Groups for Medical Illnesses and Conditions

Cancer

Dowlatabadi et al. (2016); Kasparian et al. (2016); Mahendran et al. (2017)

Caregivers of people with medical illnesses

Barbosa et al. (2016); Liljeroos et al. (2017)

Cardiac

Kao et al. (2016)

Bariatric surgery

Beaulac and Sandre (2015)

Table 14.2 Sample Studies on Psychoeducational Groups for Emotional Disturbances

Schizophrenia

Haller et al. (2009)

Affective disorder

Garcia-Campavo et al. (2010)

Anxiety

Eilenberg et al. (2016)

Drug addiction

Forghani and Ghanbari (2016)

Dementia

Cheston and Ivanecka (2016)

Trauma

/PTSD

Karatzias et al. (2016); Sripada et al. (2016)

Bipolar disorder

Zyto et al. (2016)

Eating disorders

Schag et al. (2015)

Borderline personality disorder

Kramer et al. (2016)

Psychiatric disorder

Bersani et al. (2017); Nikolitch et al. (2016); Magliano et al. (2016)

Depression

Aagaard et al. (2017); Bros et al. (2016); Raya et al. (2015); Kumar and Gupta (2015)

Characteristics for Groups for Illnesses and Other Conditions

The major general characteristics for this discussion are a specific focus and theme, emotional intensity, similarities among group members, homogeneity of condition, time bound, and as part of treatment programs. There can be some other differences that will factor into planning the group, but these are the overall considerations.

Specific Focus and Theme

One basic characteristic that can have an impact on the group and the leader is the remedial focus for the group, even when the group is categorized as prevention, such as relapse prevention. Participants have a condition, problem, or concern that is negatively affecting their lives. This condition can be physical, emotional, relational, or any combination of these. It is important to remember that what affects one part of a person’s life generally has implications for other parts of his or her life. This interaction is one reason why planning groups for a target population with a common concern cannot be entirely pro forma, in that you cannot readily predict the needs of a particular group or for a particular group member. However, there can be some certainty for the target group, as they will have some commonalities, which can be very helpful for the group leader.

The remedial nature of the group is one commonality that is important. It is considerably harder to overcome a deficit, weakness, ignorance, or the like, than it is to learn something new, such as prevention strategies. In addition, for many of these therapy-associated psychoeducational groups, leaders are also dealing with members whose basic condition will not change—for example, alcoholism—no matter what the treatment. The group leader must maintain an awareness of the hopelessness for changing the condition and not hold out false hope of overcoming or eliminating it.

The condition also should not be ignored because of its hopeless nature. Although the tendency may be to want to move beyond what cannot be fixed and focus on what can be done, care should be taken not to move too fast. Group members need to know that the leader understands much about their condition and its impact before they can trust that what the leader is trying to do will be beneficial for them. Leaders need to remember that group members’ goals may differ from leaders’ goals, but members’ goals will determine their behavior and the success or failure of the group.

Emotional Intensity

Another characteristic may be the emotional intensity of members and the defense mechanisms used to mask this intensity. Members will differ in their emotions and in their intensity, and each will use a variety of defense mechanisms to try and manage them. However, the group leader should expect that members will have many of the following:

Anger—“Why me?”

Resentment—“It isn’t fair.”

Despair—“I’ll never get better.”

Fear—“I’ll be abandoned and/or destroyed.”

Envy—“Others are not more worthy than I am.”

Rage—“I’ll make someone pay (suffer) for this.”

Dread—“I won’t be able to cope.”

Shame—“I am so flawed and I cannot do anything about it.”

Humiliation—“I can’t look out for myself. I have to be dependent (ask for and take help from others).”

Alienated—“No one can understand what I’m going through.”

Isolated—“No one will be able to tolerate being around me.”

Anxiety—“Can I survive?”

The difficulty for the leader is that these feelings may not be openly expressed, acknowledged, or even in members’ awareness. The feelings may be masked, hidden, denied, repressed, and/or expressed in indirect ways. The trust and safety the leader can develop is dependent on an understanding of members’ feelings and how they are expressed in indirect ways, or are being denied and repressed.

Similarities Among Members

The paradox for members of these psychoeducational groups is that they have similar conditions, issues, concerns, and experiences, but all these can also differ in significant ways. Members may tend to focus on these differences, which will prevent the group from becoming cohesive. Groups become cohesive around similarities and dissolve or fail to become cohesive around differences. Thus, in order to build universality and promote cohesiveness, the leader must seek out and highlight similarities among members.

Leaders need to be aware that similarities are not always evident and observable. Some are subtle and must be teased out from the information that members share. This is where the skill of linking can be important, as the leader can perceive the similarities for two or more members and can speak about them to the group. While members tend to perceive visible similarities, such as age, race, and gender, leaders can become experienced at perceiving deeper and more meaningful similarities, such as values and family of origin experiences.

Differences are important to members, as each wants to be perceived as a unique individual, and leaders must be careful not to forget these individual differences in the effort to highlight similarities. It can be very threatening to some members when the leader does not appear to perceive their differences from other members. However, other members may prefer that the leader view them as similar to other members, as being different means exclusion from the group.

Humiliation—“I can’t look out for myself. I have to be dependent (ask for and take help from others).”
Alienated—“No one can understand what I’m going through.”
Isolated—“No one will be able to tolerate being around me.”
Anxiety—“Can I survive?”
The difficulty for the leader is that these feelings may not be openly expressed, acknowledged, or even in members’ awareness. The feelings may be masked, hidden, denied, repressed, and/or expressed in indirect ways. The trust and safety the leader can develop is dependent on an understanding of members’ feelings and how they are expressed in indirect ways, or are being denied and repressed.

Similarities Among Members
The paradox for members of these psychoeducational groups is that they have similar conditions, issues, concerns, and experiences, but all these can also differ in significant ways. Members may tend to focus on these differences, which will prevent the group from becoming cohesive. Groups become cohesive around similarities and dissolve or fail to become cohesive around differences. Thus, in order to build universality and promote cohesiveness, the leader must seek out and highlight similarities among members.

Leaders need to be aware that similarities are not always evident and observable. Some are subtle and must be teased out from the information that members share. This is where the skill of linking can be important, as the leader can perceive the similarities for two or more members and can speak about them to the group. While members tend to perceive visible similarities, such as age, race, and gender, leaders can become experienced at perceiving deeper and more meaningful similarities, such as values and family of origin experiences.

Differences are important to members, as each wants to be perceived as a unique individual, and leaders must be careful not to forget these individual differences in the effort to highlight similarities. It can be very threatening to some members when the leader does not appear to perceive their differences from other members. However, other members may prefer that the leader view them as similar to other members, as being different means exclusion from the group.

The most obvious similarity is the common problem, issue, concern, or condition that brought members to the group, and this is a good starting point to emphasize similarities. Leaders should not take for granted that members know the rationale for the group. Stating the rationale can emphasize that members are similar in important ways.

Homogeneity

Many therapeutic groups will be homogeneous around one or more of the following: age, gender, educational level, and other demographics. This homogeneity can be both a strength and a weakness. Members can feel safe when it is evident that they are like other group members. They can have more certainty, assurance, and understanding of other group members. Leaders will find that they do not have to work as hard to show members their similarities. Research tends to show that members in homogeneous groups will have positive feelings about the group quicker than members of heterogeneous groups (Yalom, 1995).

On the other hand, heterogeneous groups tend to have a wider range of resources because members differ. Members can get a variety of perspectives, experiences, and feedback that is not available when members are homogeneous. This is enriching to the group process, and members can increase their self-understanding and understanding of others when this variety is available.

Time Bound

These groups are usually time bound whether conducted in an inpatient or outpatient setting, and usually a part of the treatment process. They can range from a single group session to several sessions that are still conducted within a relatively short time span.

Therefore, it becomes critical for the group leader to understand and plan for the possibility of an open group, and/or single sessions, and to adopt a perspective that accommodates the ambiguity and uncertainty of attendance, membership, and other such factors.

Yalom (1985) gives guidance for a single session framework with a concentration on limited and reasonable goals for what can be accomplished. Pollack (1990) extended this to define a framework having the following steps and components:

Five minutes preparation for members for the group

Group members create an agenda for the session

Discussion among members and with the leader

Summary and closure

Klose and Tinius (1992) propose the use of activities such as art, poetry, self-help exercises, discussion of irrational beliefs, and/or identification of self-defeating behaviors as a possible focus for the single session. A single session self-contained model is presented later in the chapter.

Part of Treatment Programs

Many therapeutic psychoeducational groups are likely to be a part of treatment programs for both inpatient and outpatient groups. Treatment programs usually include a variety of modalities, such as medication, individual therapy, group therapy, art therapy, family therapy, and so forth. Even when the condition is medical, such as cancer and heart attacks, there are several treatment modalities involved, and these professionals may be an integral part or have roles in planning the psychoeducational group. The group leader may need to consult with the other professionals and get their input on the following:

How other treatments may have an effect on members and what these effects are

What information is essential or critical for members to have

Characteristics of group members that may be important for the group’s functioning

Expectations for the leader for case management, reporting, and so on

Consulting with other professionals involved in treatment of group members helps to foster a team approach to providing valuable information for planning and conducting the group.

Planning and Forming the Group

The process for planning a therapeutic psychoeducational group is almost the same as the planning for other categories. There are a few differences, and these are important:

The possible direct involvement of other treatment professionals

The effects of other therapies and/or medication on members

Reporting responsibilities for the leader

Outside-group socialization

Physical, psychological, and emotional states of members

Effects of the condition on members’ functioning

While most of these can be present for one or more members of other types of groups, they differ in that any one or all of them can exist for every member of a therapeutic psychoeducational group. Thus, leaders should plan the group assuming that all members will have a common effect, state, or reaction—for example, to medication, a situation, and so on—around the particular condition that defines the group. There will be individual differences, of course, but leaders need to plan for an overall possibility.

Other Treatment Professionals

It can be very helpful to know and understand what therapies and services are being provided by other professionals, not so much the content for particular members, which may be confidential, but knowing what areas are being explored. For example, if impulse control is the focus for individual therapy for many group members, the psychoeducational group could have a session on a related topic.

Understanding the purpose, process, and effects of other therapies can help provide a more integrated experience for members of the psychoeducational group. The leader can consult, expand, enhance, compensate, and enrich other therapies through the group experience, but this is unlikely to occur if the psychoeducational group is isolated from members’ other therapeutic treatments.

Reporting Responsibilities

The usual constraints for reporting confidential material may not apply to the therapy psychoeducational group, and the group leader must determine the extent to which they do apply. Group leaders have certain reporting responsibilities that should be communicated to group members at the first session. The treatment program, agency, or hospital and/or the lead professional for the treatment team may require reporting of

Attendance

Extent of participation

Major personal issues discussed

Violations of the facilities’ rules and regulations

Disclosures of illegal acts

Suspicions of child abuse and child neglect

Drug and alcohol use

Violent acts in the group

Sexual assault or rape

Harassment

Stalking behavior

Threats against staff

These are simply examples for what can be mandated reporting. It is only fair that members understand the limits on what can be kept confidential and what has to be reported.

Reporting responsibilities also include case notes where the group leader has to submit regular reports for each group member and/or for the group session. The facility will usually have a format and guidelines for this reporting. An additional concern can be the legal implications for written case notes. Each state can differ in the legal requirements, and group leaders should determine what the legal requirements are for their states.

Leaders should be aware that personal notes can be subpoenaed in some states, and these may not remain confidential. A good guideline for case and personal notes is to not write anything you do not wish the client or an open court to read.

Outside-Group Socializing

Members who socialize outside the group run the risk of becoming a clique and of revealing confidential material. These are two undesirable outcomes, but it may be impossible to prevent outside-group socializing. For example, members from inpatient treatment may live together in the facility and have other shared activities. It would not be reasonable to expect that there would be no outside-group socializing under these circumstances.

The best that a group leader may be able to do is remind members not to discuss group material outside the group, and when socializing or other interactions do take place outside the group, the interaction should be brought back to the group—for example, if two or three members meet for lunch, this would be reported in the next session. Outside-group socializing can foment distrust when it seems secretive, which is why it is important for members to openly acknowledge it.

Members’ State

Each member’s physical, psychological, and emotional states are dynamic and can even change by the moment. It is important for the group leader to know in advance the current and/or expected states for each member—for example, members who had recent heart attacks may be expected to have some level of depression; members who are taking tranquilizers may be lethargic; men arrested for spouse abuse may be hypersensitive and angry. These states will have an impact on the process and progress for the group.

Members’ states can also impact how much material can be learned and what instructional strategies to use. It does no good to present information if the audience cannot take it in and remember it. It is not helpful to lecture to sleeping or zoned-out members. Choosing an activity or exercise that could produce acting-out behavior, either verbally or physically, is not advisable. These are some of the reasons why a group leader would want to get as much information as possible in advance about expected effects of the condition and treatment in general, and specifically for members attending the group.

Effects of Medication

Although the effects of medication are associated with the previous section, this factor is listed separately to highlight its importance. Medication can affect members’ ability to pay attention, nonverbal behaviors, and concentration. Some effects can be subtle and others can have a major impact. The group leader should learn the expected effects for any usual medication provided for the treatment of a specific condition, as it can have implications for behavior in the group.

It can also be important to understand food and drug interactions, especially if the group allows food and drink during sessions. Food and drink are not recommended, but some group leaders do permit them. The interaction of food and medications is often overlooked. Group leaders should not provide anything that could produce an adverse reaction with known medications. It may be too much to expect leaders to know about other medications and food interactions, as these can be varied. But knowing this for the specific treatment medications for the particular condition could be helpful.

Effects of the Condition

Understanding how members are affected by the condition is essential when planning therapy psychoeducational groups. This understanding includes a literature review to get as much comprehensive information as possible. It is probably not wise to totally rely on your experience, even when it is extensive. It is also not advisable to think that you know the effects because you, too, experienced the condition. New information is constantly emerging and can be helpful in guiding selection of material to present, instructional strategies, and other planning. When group leaders rely heavily on their personal experiences for guidance, they run the risk of omitting relevant material and using only anecdotal evidence that may not be fully understood. There are some similarities among people with the same experiences, but there can be significant differences—for example, gender or age could produce different effects.

Attention should be given to as many areas of functioning as possible. It is not sufficient to just know some physical effects; it is much more helpful to also know the psychological, emotional, and relational effects, since they can play a major role in members’ needs, extent and kind of involvement in the group, ability to attend to and learn the material, developing relations in the group, interactions among members, and other group dynamics.

Members’ Attitudes and Behaviors That Can Affect the Group

Members of therapy-related psychoeducational groups may have some characteristics, behaviors, and attitudes that will impact the leader and the group’s functioning in important ways:

Self-absorbed behaviors and attitudes

Less reaching out and connecting to others

Easily triggered defenses

Intense fears of contamination, loss of control, incompetence, and shame

Displaced hostility

Depressed state, resignation, and giving up

These characteristics, behaviors, and attitudes can make it more difficult for the leader to form a therapeutic alliance and can negatively impact the amount of information that members can incorporate, learn, and retain. The leader who is aware of these potential characteristics, behaviors, and attitudes is better able to address them, cope when they emerge, and be more secure in his or her ability to manage them in a constructive way.

Self-Absorption

The nature of the condition and the client’s personal level of development can interact to produce more self-absorbed behaviors and attitudes. Even members who have an age-appropriate level of developed narcissism may regress to an earlier level when faced with the condition that brought them to treatment—for example, people faced with a life-threatening condition, such as a heart attack or cancer, could regress to a more dependent state and become more self-absorbed. This self-absorption can

Make it more difficult for members to be interested in the group and other members

Prevent emergence of therapeutic factors such as altruism

Impair, or make difficult, constructive interactions among members and with the leader

Produce more acting-out behavior

Increase resistance

Block the ability and willingness to learn new material

These issues can be significant forces in the group, and there will not be much the leader can do to effectively address them. It takes time to build a therapeutic relationship, and the psychoeducational group usually does not last long enough to address these intense and important items. There are other reasons why the leader has few options, but it is important that leaders neither blame themselves for not being effective nor blame members for being self-absorbed.

What are some self-absorbed behaviors and attitudes?

Wanting to be considered as unique and special

Attention-seeking behaviors

Admiration-seeking behaviors

Lack of empathy

Entitlement attitude

Grandiosity, arrogance, and contemptuous attitude

Everything seen and related to in terms of self

Self-absorption is differentiated from self-care by its intensity and frequency. In addition, the self-absorbed person has a cluster of these behaviors and attitudes, not just one or two of them. A self-care focus is expected and understandable for adults, just as self-absorption is for children. This is known as age-appropriate narcissism. However, the self-absorption of children and adolescents is not expected to be manifested in adult behavior and attitudes.

Reaching Out and Connecting

Group interactions and relationships are important indices of the quality of the group’s process. Process is defined as the here-and-now interactions among group members and with the leader. Although the primary focus for psychoeducational groups is on presenting and learning information, it is also important to attend to the emotional and relational components. Indeed, the feelings that group members bring to the group, past and present associations for these, and how these feelings are expressed and received can play major roles in the effectiveness of the group and the positive impact on group members.

Interactions among group members that are genuine, respectful of differences, caring, and constructive are enriching to the group and to members. Positive interactions promote self-learning, self-reflection, and self-understanding while reducing defensiveness, resistance, isolation, and alienation. Thus, it can be vitally important for the group leader to conduct the group in ways that foster interactions among members. Group members can be valuable resources for each other, and group leaders should plan to capitalize on these.

Easily Triggered Defenses

Members of therapeutic psychoeducational groups can be emotionally fragile, and their defenses can be easily triggered. They are confronted with

Loss of control, or an inability to control major parts of their lives

Powerlessness

Helplessness

A realization of their mortality

Dependence, whereas before there was some or considerable independence

Shame, embarrassment, or humiliation

Fear of the unknown

Ambiguity and uncertainty

These are both internal and external assaults on the self, and the usual response is to defend against them. Leaders must realize that members may be constantly on edge and alert for potential attacks from either direction. Some members may be so well defended that they never let down their guard.

Leaders should recognize the defense and leave it alone. There is not enough time to build the necessary therapeutic relationship that will enable members to feel safe, trust each other, or trust the leader sufficiently to lower or explore the defense. It is there to protect the member, and leaders are well advised to leave it in place. The most a leader can hope for is that there will be some moderation of defenses for some members.

Intense Fears

It is not unusual for group members to have intense fears that

They will catch something from other members that will make them worse.

The sessions will be constructed so as to make them lose control of their emotions or their resistance to self-disclosure, or the leader will push them to lose control.

Other members and the leader will perceive them as incompetent, or their incompetence will be revealed.

They will be shamed.

These fears are intensified because members can feel emotionally fragile and worried that they will not be able to maintain their defenses.

Leaders cannot relieve these intense fears. The more they try to show members that they are needlessly worrying, the more anxious they may become. Expecting members to trust the leader because he/she is a trustworthy person is an exercise in futility. It is not about the leader; it is about them. The best a leader can do is be him/herself, make empathic responses, block other members’ aggression, and foster expression of feelings. It takes time to build trust, and the leader’s understanding of their fears, conditions, and emotions helps to develop trust. Many members will not be able to reduce or eliminate their intense fears because of other long-standing deep-seated issues.

Displaced Hostility

Fears, anxiety, other emotional states, transference, and unfinished business can play roles in how members handle the anger and hostility related to their condition and to other aspects of their lives. How other treatment professionals interact and relate with them, insurance and HMO policies and procedures, the treatment facility, and other external forces also contribute to displaced hostility. Leaders must remain aware that the hostility directed at them or at other members may be the outcome of that member’s external and internal experiencing, not the current experience of the people who are present.

It can be very disconcerting when members are hostile, attack the leader, remain detached, and/or cannot be satisfied with anything or anyone. After all, the leader considers him/herself as cordial, warm, caring, and trustworthy. The leader is trying to be helpful, and that should be obvious and accepted in the spirit with which it is given. Although some leaders may be expecting hostile behavior, they can still be unprepared for when it occurs. Although these challenges are expected in the second stage of group development, there are times when it is present from the first moment of the beginning of the group.

The leader’s initial response may be to try harder to please, or to become defensive, or to go on the offensive. It is usually helpful to reflect on whether the hostile behavior and attitudes are being displaced on the leader and/or other members. This realization can do much to allow the leader to stop trying so hard to please, since this cannot be done; to be less defensive or not defensive at all, since he/she is not in the wrong; and to not go on the offensive. As a matter of fact, it is never acceptable for you as the leader to go on the offensive.

Once a group leader realizes that he/she is encountering displaced hostility, constructive steps can be taken with the following caveats:

It is not the leader’s responsibility to make the group member feel better.

Outside the group concerns are being displaced on the leader, but the leader cannot or does not know what these are for that member.

There can be a difference between what that member is experiencing in the group and what the leader is experiencing.

The leader cannot force insight or learning.

The most constructive step is for the leader to not take the hostility as a personal attack or failure. It is also helpful to stick to what was planned and at the same time be empathic and understanding of members’ conditions, concerns, and fears. Modeling how to contain and manage anxiety, refusing to retaliate, and continuing to show caring, warmth, and acceptance can help members learn other ways to respond to hostility. Most displaced hostility will be eliminated by these actions and attitudes.

Depressed State, Resignation, and Giving Up

Some members may be resigned to what they know or think is their fate. They do not have hope, and without hope there is no reason to work to reduce or eliminate their suffering, or to try to connect to others. There are many levels or variations of this state ranging from mild to severe. If there is a severe depressed state, the member should immediately be referred for a mental status assessment. If the member is already on medication and under treatment for depression, you need not refer.

We are not really sure what causes it, but the presence of a depressed group member can dampen the group’s mood and interfere with learning. The depressed person does not intend this and is usually helpless to do anything about how he or she feels. It may be important for the leader to block any behaviors that tell or suggest that the depressed person “look on the bright side,” attack the person for being down or feeling hopeless, or seek to exclude the depressed person.

There may be outside concerns that contribute to this depressed state, such as family and financial concerns. Group leaders cannot be expected to address or solve these. However, it can be useful to allow expression of these concerns and to show your understanding of their impact on the group member. If you feel uncomfortable or alarmed about a member who seems resigned, depressed, hopeless, or makes statements about “giving up,” you have a responsibility to check out his or her suicidal ideation. Directly ask if the person is considering suicide or has made plans to commit suicide. If either answer is yes, you have an ethical obligation to report this to your supervisor or to whomever your site has designated as leader of the treatment team.

A Single Session Model

There are numerous constraints when only a single group session can be held. There are usually no opportunities for screening or pre-group orientation. Members are likely to have significant emotional intensity because of the illness, condition, loss of function, life changes, and the like. There is insufficient time available for

Allowing issues and concerns to unfold

Establishing trust and safety that encourages self-exploration and self-disclosure

Teaching members to accept group process commentary

Encouraging and fostering the emergence of many therapeutic factors

Experiencing movement through group stages

Therapeutic use of many group dynamics

However, in spite of these significant constraints, there remain numerous important goals that can be accomplished in a single session; feeling expression, information dissemination, providing social support and interactions, some therapeutic factors can emerge such as hope, and relationship building can be introduced. The following model describes components that can structure and facilitate single sessions that can be constructive and helpful. The components are leader preparation, goals and or purposes and objectives, and content.

Leader Preparation

Leader preparation includes a realistic perspective and attitudes, an understanding of the illness or condition and its accompanying impact and implications, core relating attributes, group facilitation skills, organizing and planning competencies, and time management skills.

It is critical for the leader to be realistic about what can be reasonably and effectively accomplished in a single session for group members who may have considerable emotional intensity because of the illness or condition. The leader’s attitude and perception will be conveyed to group members both verbally and nonverbally, and they may also sense the leader’s nonconscious and/or unconscious feelings. Conveying confidence in members’ abilities and competencies to understand and cope with their circumstances could be a critical component for their healing and should not be minimized.

It is also important that the group leader have a firm and accurate knowledge and understanding of the illness or condition. Minimum knowledge includes symptoms and manifestations for these, treatment and treatment options, usual medications and their side effects, progression of the illness or condition, and expectations for recovery, remission and the like. It is neither necessary nor essential that group leaders have personal experience with the illness or condition that is the focus for the group. It is helpful for group leaders of these groups to educate themselves as much as possible so as to know what members are encountering, can sort out what facts to present, can know where other sources of information can be located as references for group members when they leave the group, and this knowledge and understanding can increase your credibility with members.

The importance of the level and extent of development of the leader’s core relating attributes cannot be overly emphasized. With only one session group leaders have to establish a therapeutic relationship, and get some measure of trust and safety established in the group. Therefore, how the leader presents him/herself becomes even more important since group members do not have time to get to know the leader.

Group facilitation skills are equally important because of the short time frame. Encouraging members to interact, listening, the leader’s emotional presence, empathic responding and repairing empathic failure, linking, blocking, and fostering the emergence of therapeutic factors are needed and contribute significantly to the maximum benefits that can be obtained from just a single session.

Organizing and planning the session will take considerable skill and expertise. Group leaders can have much to do even when you pare it down to basic essentials. Preplanning goals, objectives and strategies will give you confidence, and that in turn, will be communicated to group members. Basic essentials are introductions and agenda setting, general rules for the session, and confidentiality; members’ immediate needs for knowledge, and feelings they bring to the session, having a mini-lecture or other means of disseminating information, allowance of sufficient time for expression of feelings, summary, closure, and referral sources for additional information and/or counseling.

Time management skills during the session can also be critical as there is not sufficient time to allow material to unfold, or to explore many possible paths that could be instructive and productive for each group member. The focus and emphasis has to stay on the group as a whole so that each member takes away something that could be personally useful. It is helpful to write the proposed schedule in advance as a guide.

Don’t think of this as rigid, or that it has to be followed no matter what happens or is needed, but perceive it as the game plan. An example of a schedule for a 90-minute group of 8 to 10 adults is as follows:

Welcome and introductions—10 minutes

Collaborative agenda setting, rules, confidentiality—15 minutes

An exercise (e.g., focused on feelings related to the topic)—20 minutes

Mini-lecture and discussion—25 minutes

Closing exercise and summary—20 minutes

Managing time during the session can be a challenge at times because leaders usually do not know much of anything about group members in advance of the session. They do not have information most of the time about members’ likely participation behavior, such as talking or being silent, their extent of openness to feeling expression or disclosure, areas of sensitivity and the like. So, the time estimated for session activities has to be flexible to adjust to the group members. The important thing is that there is a plan, an estimate of the time needed for each component, and that the group leader follows the plan to the extent possible with adjustments for the unanticipated, and the unexpected.

Goals/Purpose

The self-contained single session psychoeducational group has to have a specific goal or purpose that is narrowly defined. From this goal or purpose, objectives are developed and strategies and content selected. Although the goal may be narrow and specific, it can have two components, cognitive and affective. The cognitive goal is about information and the affective goal incorporates feeling expression, therapeutic factors, relationship building among members, and identification of members’ support systems.

The cognitive goal focuses on knowledge, learning, and understanding of relevant facts about the illness or condition, its progression, treatment options, and recovery expectations. Group leaders will find it helpful to consult with other professionals to determine what information is of priority importance and which group members will find most helpful, and what other sources of information will be available to members after the group is over. You cannot expect to provide all of the information in the group even if this was a multisession group experience. The cognitive goals for the session should focus on the minimum because of time constraints and members’ factors such as emotional intensity, and plan to use other means to give members more information such as brochures, reading lists, Internet sources, and so on. Group leaders may find that members cannot take in a lot of information during the session, and having something to refer to at a later time is very helpful. When the cognitive goal is developed, group leaders should stay mindful of what members are likely to absorb and use, and not try to present too much material.

The affective component addresses feeling expression, relationship building, fostering the emergence of therapeutic factors, and helping members recognize or establish a social support system. It may be that the affective component assumes more prominence than does the cognitive component, and group leaders need to be prepared to handle what emerges as most important for a particular group as this can vary even when the groups are focused around the same topic.

Content

The specific content relates to the illness or condition, and its components with care taken to ensure that the material fits the target audience. The material in the chapter on planning provides an extensive discussion on selection and presenting, and the chapter on exercises provides material and suggestions for activities. The leader has extensive preparation to accomplish all of this for a single session group.

Selection of content should encompass the following:

Provide one or more strategies or ideas the members can implement immediately

Suggest strategies that can be implemented on a longer-term basis

Try to have one or more suggestions for symptom relief that does not involve medication

Disseminate the amount of information that group members can absorb and use

Limit the presented information in the session to members’ abilities to understand and retain it

When there is only a single session, or the multisession group has self-contained sessions for that possibility, guidance for members can be crucial, and other professionals may need to be consulted. The primary idea is that members will take away something that is useful, comforting, and/or thought provoking from this single session.

Searching the literature can also be helpful. There can be studies that point to information and coping strategies that others have found to be of value and effectiveness, and can stimulate your creative thinking.

It is also important to limit the information presented in the session and to prepare handouts in advance. These handouts can be a list of references and/or credible web resources, additional reading material, community resources available for additional help and/or counseling, and other such material.

Group Facilitation Considerations

There are five considerations when facilitating a single session therapeutic psychoeducational group: expression of feelings, relationship building, therapeutic factors, the content to be disseminated, and members’ social support system.

Expression of Feelings

Group members can bring significant and important feelings into the session, and it is critical to have some means that allows for expression of feelings. In addition, the group may be the only place where members can speak their feelings for many reasons such as a reluctance to burden family or friends, or not having anyone available to hear these, or not realizing just how intense their feelings really are. Suggestions for how to provide for feeling expression are provided in the section on content, and in the chapters on activities and group facilitation skills.

Relationship Building

Relationship building among group members and with the leader permits a freer exchange of thoughts, ideas, and feelings; promotes self-disclosure; and encourages the emergence of therapeutic factors. Relationship building fosters trust and safety for group members, but the time constraints will have a limiting effect on this. However, it can be important for the group leader to prepare to accommodate some relationship building among members that focuses on characteristics, values, and experiences other than the shared illness or condition.

Therapeutic Factors

Fostering the emergence of therapeutic factors could be the most helpful part of the single session group. Therapeutic factors most likely to be needed and can be fostered are universality, hope, altruism, guidance, and existential factors. Universality reduces feelings of isolation and alienation, shows connections to others, and helps reduce feelings of being flawed, strange and/or weird. Hope is really essential for group members to persevere in the face of adversity. Some members may feel hopeless and helpless, and providing even a glimmer of hope can be encouraging. Care should be taken to not hold out unrealistic hope for a miracle cure, but to focus on the kind of hope that capitalizes on members’ strengths, strategies they can take to cope with the adverse situation, and other guidance to show how they can help themselves.

Altruism can be fostered in the group where members freely five of themselves to each other. This is not advice giving, or telling people what they should or ought to do. Giving of yourself to others means identifying their strengths, particularly those that they seem to be ignoring or do not recognize, providing encouragement and support, and in listening and empathizing. Group leaders and members can be altruistic. The therapeutic factor of guidance is provided through the cognitive component, and is an integral part of a psychoeducational group. Existential factors appear in all groups, but remain unrecognized and invisible in many groups (Yalom & Lesczc, 2005). However, in a group focused on illnesses and emotional disturbances, existential factors may be more visible and prominent. Members will and do speak openly about

Death and dying

Meaning and purpose for their lives

Pain and suffering

The unfairness of their situation and of the universe

Freedom and will

The task of the group leader is to explore these and their importance for group members. Final answers are not possible as these issues continue to emerge throughout life, do not have final answers but could be answered for their current situation, and each person must find the answers for him/herself. These issues should not be ignored or minimized as event he exploration of them can provide comfort and solace.

Social Support System

There are numerous studies that point to the efficacy of having a social support system (Jewell, et al. 2009; Gonyea et al., 2006; Edelman et al., 2000; Veltro et al., 2006; Donker et al., 2009). Therefore, it can be helpful to members of the single session group to raise this topic, and to have them reflect on their support system, and its availability. Some members may not have a support system, and the session can help them think of ways they could establish or reestablish one. Social support systems can be comprised of family, friends, neighbors, clergy, clubs, civic and social organizations, and/or others in the community. These systems can reduce loneliness and isolation, provide listeners, and have opportunities for altruistic acts for group members.

Sample Plan for a Multisession Group

The multisession psychoeducational group focused on an illness or other condition has several advantages over the single session group. Dissemination of information is increased and can be sequential, more time is available to establish trust and safety, movement through most or all of group stages can be experienced, there is more time and space for feeling expressions and exploration, the process can unfold, and the leader can adjust material for members’ needs between sessions. Even with all of these positive advantages, the multisession group is encouraged to consider each session as being self-contained like the single session group so that factors like attendance and premature termination do not limit any member from obtaining the maximum benefit from the group.

Following is an outline for an eight-session group for adults. The group is focused on controlling allergy symptoms that worsen asthma. Each session is one hour, has an introduction and agenda setting, information dissemination, an exercise or other activity, and summarization and closure as a framework.

Session 1—Beginning

Introductions and overview (collaborative goals setting for the session, rules, and discussion about confidentiality)

Exercise—Who am I? (a drawing activity to include their support system)

Mini-lecture—“The relation of allergies to asthma symptoms”

Discussion

Summary and closure (a short closing exercise where members identify one piece of new information or understanding.)

Session 2—Personal Impact of Allergies

Unfinished business from the previous session and/or identification of items of personal concern

Agenda setting for session 2

Exercise (feelings about illness/condition)

Mini-lecture—“Extent of concern/problem, and steps for containing and/or improving”

Discussion
Summary and closure

Session 3—Avoiding Allergens

Unfinished business/urgent and important concerns

, agenda setting for session 3

Mini-lecture—“Avoid allergens: air, food, contact”

Discussion

Activity—Members will list all avoidance strategies they currently use and the impact on their lives, and list all that they need to implement

Summary and closure

Session 4—Getting the most from a visit to the doctor

Unfinished business/urgent and important concerns

Check-in on accomplishments from activity in previous session

Mini-lecture—“Medications, inhalers, and desensitization shots: benefits and constraints”

Exercise—Role play a doctor visit

Summary and closure

Session 5—Take charge of your environment

Unfinished business/urgent and important concerns

Mini-lecture—Changing your environment: cleaning, materials (e.g., carpet, pets, meals)

Action plan development exercise—forming an action plan to better manage symptoms

Summary and closure

Session 6—Emotions and emotional regulation

Check-in on action plan steps, constraints, and accomplishments

Mini-lecture—The associations of emotions and symptoms

Discussion

Exercise—Personal distress tolerance strategies

Summary and closure

Session 7—Non-drug symptoms management

Check-in and updates on actions plans, distress tolerance strategies

Mini-lecture—Non-drug strategies: exercise, diet, sleep, and mood adjustment Discussion

Exercise—Emotional regulation and control: expression, containing, and managing

Summary and closure

Session 8—Taking control

The session will focus on accomplishments, knowledge gained, feelings about condition and managing symptoms, and value of the group

Exercise—Closure

Discussion/Reflection Questions

Develop an outline for a group of adolescents that focuses on managing diabetes.

Develop an outline for a group of young adults who are overeaters.

Develop an outline for a group of children who have a parent who is seriously ill with a chronic disease (your selection).

Read: Brown: Chapters 1

5

Psychoeducational

Self-Help and Support Groups

,

Manualized Groups

Major Topics

Definition and descriptions for support groups

Designing and conducting a psychoeducational support group

Manualized groups: advantages and disadvantages

Virtual/cyber groups: description, ethical concerns

Introduction

There are three primary topics for this chapter; leader-led psychoeducational self-help and support groups, manualized psychoeducational groups, and virtual/cyber psychoeducational groups. While there are peer and leaderless self-help and support groups, the emphasis here is on those groups that have trained group leaders. Presented here is the information that is central for these groups, and guidelines for the group leader who may or may not have a personal involvement with the issue, condition, or problem that is central for the particular self-help or support group. These groups are most likely to be open groups where new members are added and some decide to terminate, attendance is voluntary and may be erratic, and the decisions about joining are made by the group member him/herself. Other possible complications for these group leaders are an inability to definitively plan the group to have a beginning and ending date, or to decide on the maximum number of group members, to plan beginning and ending activities and strategies, to always know when a new member will appear or when a member decides to terminate, or many other procedures and processes that describe other psychoeducational groups. Material in this chapter not only informs prospective leaders about structural and facilitating factors, but information is presented to aid group leaders to cope with the ambiguity and uncertainty that surrounds these groups.

Manualized groups are those formed to address a narrowly defined issue, problem, or concern, such as anger management, and have a formal guide and plan developed for each session with predetermined objectives, strategies, and activities. The guide or manual is usually developed from studies and provides the basis for evidence-based practice to address the topic. The group leader has minimal planning to do to create group sessions although other tasks, as described in Chapter 2, are still in effect.

Many manualized groups’ material was developed using CBT principles and practices, and it is thought that validity is compromised when there are deviations from what is presented in the manual, for example, not including some topics or having insufficient session time for completion of the described work. Some of these groups can also rely on having members do homework, which can be problematic and a possible deviation when the homework is not completed. Presented are the advantages and disadvantages for manualized groups.

The final main topic for this chapter is virtual or Internet psychoeducational groups. Group members do not meet face to face, the group leader is at a remote location or there may not be a designated group leader, and many of the group leaders’ facilitation tasks and strategies may not be feasible. There is also the added complication of technology, including adequate access, reliability and dependability, technical support services, and other such concerns. In addition, there can be ethical concerns and considerations. Nevertheless, the number and extent of virtual/cyber groups are increasing and there is the potential for these groups to be of considerable help to a larger number of people.

Self-Help and Support Groups

Support groups are often thought of as self-help groups, but they differ in some important ways: leadership, focus, goals and objectives, and structure. Support groups generally have a leader who is trained in leading groups as well as having knowledge about the condition or circumstance that is being addressed. Self-help groups quite often do not have a formally trained leader. Many self-help groups use a rotating peer leader instead of a consistent group leader.

The focus for support groups also differs from that for self-help groups. Support groups have a primary focus on educating members about the condition or circumstance, whereas self-help groups’ primary purposes are mutual assistance and support. This difference is not as clear-cut as other differences, as both self-help and support groups focus on education and on mutual assistance and support but have them as different priorities. Understanding the primary focus for the group keeps the group on track for accomplishing its goal.

The goals and objectives can also differ in important ways. Support groups’ goals and objectives are more specific and short-term than those of self-help groups. The educational component drives the objectives and strategies for support groups, whereas self-help groups tend to stay focused on mutual assistance and are more peer facilitated. The major differences between the two can be found in the structure for the groups. Many support groups are time bound, in that there are a specific number of sessions. Self-help groups tend to not have a specific number of sessions and can continue for many years. Many support groups described in the literature are closed, and new members are not added. Self-help groups, for the most part, are open groups with members leaving and new members constantly added. Another structural difference is the curriculum for support groups can be formal, written, and followed. This structure makes the group more like an academic course. Self-help groups tend to either not have a curriculum or to develop one in response to members’ needs specific for that group. It can be confusing to try to distinguish between support and self-help groups, as there are numerous similarities.

Similarities between support and self-help groups include paying attention to emotions, providing a source of social support, imparting information and guidance, emphasizing similarities among members, and having an underlying theme that provides evidence of commonalities among members. Both kinds of groups recognize that the emotional content is very important, even when the primary focus is on providing information. Considerable attention is given to helping members sort through conflicting feelings and expressing them, providing a venue for catharsis, and giving encouragement and support for difficult feelings.

Social support has been found to be beneficial for people’s feelings of hope, well-being, and efficacy. The quality of interpersonal relations and social support does much to assist people in coping with disease and conditions, and both groups recognize its importance. This is one reason why these groups tend to be homogeneous around the disease or condition.

Both types of groups provide information and guidance. This is one of the therapeutic factors that members find helpful in all types of groups, and support and self-help groups have it as a major focus.

Members maintain their uniqueness while searching for similarities. The emphasis is on similarities around a common concern. As in any group, situations and individuals differ, but similarities tend to be more easily discernible in self-help groups, and members begin to look for these similarities from the first session.

It seems to be therapeutic for members to actively interact with other members who have benefited from being in the group and dealing with the problem or concern. Seeing others who have been in similar circumstances and hearing how they coped or dealt with the situation promotes hope and provides encouragement.

Universality is a therapeutic factor and appears to be strong in support and self-help groups. There is a conscious search for common underlying themes to unite members. A kind of “we are all in this together” attitude reduces isolation and helps form supportive connections.

Support and self-help groups allow members to try new behaviors and skills, encourage them, cheer them if they are successful, and support them if they are not. This support encourages members to continue trying, modifying, and changing until they are successful. Members learn that goal setting and achievement is an ongoing process and that failure is not the worst thing that can happen—giving up is.

Description of Psychoeducational Support Groups

Psychoeducational support groups are defined as having

A strong and formal educational component

A trained group leader

A specific number of sessions

The tendency to be a closed rather than an open group

A unifying theme and purpose

Structure and direction

The main goals for psychoeducational support groups are the following:

To provide information and guidance about the disease, condition, or circumstance

To empower and encourage members to obtain control over and improve the quality of their lives and relationships, and self-acceptance

To provide an emotional support system that decreases alienation and isolation, moderates despair, and increases hopefulness and personal responsibility

To help members derive a greater sense of joy and satisfaction from life as it is, with all of its barriers, constraints, setbacks, and disappointments

To practice and learn new ways of behaving and relating

A major responsibility for the leader is to learn about the disease, condition, or circumstance, or to locate other professionals who can provide members with needed information. A review of the literature is essential, and it is suggested that group leaders get in the habit of searching the literature for available information.

Leaders must decide how they will impart this information as well, and should follow guidelines provided in Chapter 2. Leaders need to know enough about the condition to facilitate groups even when the in-depth knowledge comes from an outsider who will probably attend only one or two meetings.

Guidelines for Formal Learning

The primary guidelines for psychoeducational support groups are to emphasize education and therapeutic alternatives, teach members how to relieve anxiety and stress, identify needed lifestyle changes, teach behavioral steps to achieve these changes, and provide emotional support. Teaching is a major component for formal learning.

Emphasize Education

Members probably do not have sufficient and accurate information about their conditions. They may not have encountered the circumstance before and have no idea what behaviors or feelings to expect. If they are dealing with an acute or chronic illness, they may have little knowledge about the etiological factors, expected treatment, or potential outcomes. If the group members are family members of someone who is ill, they need this information in order to best care for and react to the illness. The leader should obtain reading materials and a list of questions about the condition; talk with a professional about optimum treatment, as well as about what the individual can do to help him/herself; and/or secure the services of someone to teach a session on these topics.

Anxiety and stress often contribute to the condition, illness, or circumstance. Stress reduces immunity, thereby giving rise to infections; can increase blood pressure and constriction of the arteries; and increases muscle tension, leading to pain, such as lower back pain and headaches. Relaxation moderates reactions to stress, reduces anxiety, and allows the individual to feel more in in control. The sample psychoeducational self-help program in this chapter focuses on stress reduction.

Teaching members the benefits of life changes, such as diet, exercise, work habits, and use of leisure, is another task for the leader. Understanding the effects of their present lifestyle and setting reasonable goals for changes can improve their attitudes as well as their physical health. A leader needs to be knowledgeable in these areas.

Emotional Expression

Support groups are developed around a problem, condition, or concern: Something is awry or wrong. Whatever the situation, intense feelings usually are aroused. These feelings can be openly expressed and dealt with in self-help groups. Facilitating expression of feelings is a primary goal for these groups.

There are conditions, characteristics, and events that contribute to increased potential for stress when we are faced with a life condition over which we have little or no control. These risk factors range from manageable to unmanageable, and differ in their extent and intensity—that is, one person may be able to tolerate more of a particular factor than others, or some may be prone to responding to even a slight presence of a factor where others can accept and deal with more of the same factor.

The factors associated with increased potential for uncomfortable stress are categorized as existential/spiritual, work related, stress management, negative stress management behaviors, personal characteristics, and uncontrollable events. Examples of existential/spiritual stress include lack of purpose in one’s life, unclear and/or unattainable goals, conflicting values, and confused beliefs. Examples for work-related stress are boring tasks, conflict with coworkers and/or the boss, external pressures to do more, ambiguous or uncertain environment, responsibility without the necessary authority, inadequate resources to get the job done, feeling unappreciated or devalued, confusing lines of authority, multiple bosses, and rigidity versus flexibility attitudes. Another source for stress is inadequate stress management skills such as refusals to change or seek new ways to cope, neglecting emotional support systems, and poor health habits. There are also negative stress management behaviors that bring their own set of additional problems such as alcohol abuse, drug abuse, overeating, under-eating, frequent temper tantrums, overspending on unneeded material goods and services, and other such actions. Then, there are personal characteristics that can produce and add to existing stress such as a need for perfection, a pessimistic outlook, suppressing or denying or repressing emotional expression, and feeling overly responsible for others who are able to care for themselves. An overlooked and potentially major source of stress is taxes, accidents, death, severe and chronic illnesses, and weather destructiveness such as hurricanes.

Background for Psychoeducational Support Groups

A review of literature revealed a considerable number of articles on studies that were labeled specifically as psychoeducational support groups. These studies were on a wide variety of conditions and circumstances that were conducted for children, adolescents, and adults. For purposes of discussion, these studies are categorized as support groups for medical conditions, caretakers, families, psychiatric conditions, life transitions, and trauma.

It is not unreasonable to conclude that the value of psychoeducation is perceived for many conditions and circumstances. A brief description of the literature follows, and readers are encouraged to read the full text, especially for those conditions of interest either personally or professionally.

Medical Conditions

Many local daily newspapers provide a listing of available support groups in their regions, and many of these are focused on medical conditions. In addition, many physicians’ offices and hospitals have literature and announcements about support groups they sponsor. There seems to be a recognition that psychoeducational support groups can make a difference in the recovery and treatment of medical conditions whether they are acute and short-term, such as surgery for cancer, or chronic and long-term, such as Parkinson’s disease.

Roberts et al. (1997) worked with young adults who were diagnosed with cancer. The psychoeducational support group component was designed to help members accept and adjust to the diagnosis. Topics such as fertility, finances, health and well-being, and relationships were addressed.

Karp et al. (1999) conducted a study with women who had a high genetic risk for breast cancer and were considering the possibility of prophylactic mastectomy. This was a pilot study to determine the usefulness of a psychoeducational support group with this population. The authors concluded that such groups are cost-effective and beneficial when used with individual counseling.

Payne et al. (1997) studied the effectiveness of a modified thematic counseling model for patients successfully treated for soft tissue sarcoma. The results showed that members’ feelings of isolation, anger, depression, and anxiety significantly decreased, and self-confidence increased.

Caretakers

This category of psychoeducational support groups is focused on the people who must provide extensive and long-term everyday living assistance for another person who is not expected to recover full function or to significantly improve. It is now recognized that there are many physical, emotional, and psychological impacts on caregivers, and that few people understand the demands that their caregiving exerts on their well-being, or how to cope with the many uncomfortable feelings that can emerge.

Bultz et al. (2000) conducted a pilot study on the effects of a brief psychoeducational support group for partners of women who had early-stage breast cancer. Assessment at pre-, post-, and three-month follow-up showed that the intervention helped both the patient and the partner; there was less mood disturbance for both and greater support and relationship satisfaction.

Cummings et al. (1999) present a model for caretakers of people who have early-stage Alzheimer’s. The model was developed from a study on the effectiveness of a psychoeducational support group for this audience. Posttest measures showed that the group intervention could assist caregivers to be better prepared for the emotional and physical effects of the caregiving role.

Families

Although caregivers are usually family members, a separate category is described for families, since the psychoeducational groups described here are for the family members of someone who does not need the extensive care provided by caregivers. Some are groups to help family members understand the condition, treatment options, impact of the condition on functioning and relationships, supportive strategies that family members can provide, and the process for recovery. Other groups are conducted to improve the quality of family life and to help family members learn new coping skills.

Lefley (2001) describes the psychoeducational support groups conducted by the University of Miami–Jackson Memorial Medical Center for families of people who have severe psychiatric illnesses and are also criminal offenders. Members are referred by the hospital, other mental health facilities, or private psychiatrists.

Morgan and Hensley (1998) conducted a study to determine the efficacy of a psychoeducational support group for helping working mothers manage their roles. The group was designed to reduce stress, provide social support, and achieve different cognitions about self.

Arledge (1997) studied the effectiveness of a psychoeducational support group intervention for young children of alcoholics. These children were ages 6 to 12 with a parent who attended a private alcohol and drug treatment center. Follow-up results showed that the intervention to provide education and support was effective, and that these results continued to have a positive effect on the children’s lives.

Psychiatric Conditions

Psychoeducational support groups are provided for a wide range of diagnosed psychiatric conditions for the person, caregivers, and/or family members. These groups are usually designed to provide information about the condition, treatment, and how to cope with expected behaviors. Evidence is increasing that these psychoeducational support groups can make a significant difference in stress levels, coping, functioning, and relapse prevention.

Misri et al. (2000) conducted an experimental study on the effectiveness of a psychoeducational support group and a control group for women suffering from postpartum depression and their partners. Results showed that members of the support group had a significant decrease in depressive symptoms and other conditions.

In their analysis of an integrated therapy program for schizophrenic patients that included a psychoeducational group, Vallina-Fernandez and colleagues (2001) found a significant difference between the experimental group and the control group on clinical status, stress level, family functioning, coping styles, and problem-solving skills. The improvement of the experimental group members persisted through the nine-month follow-up period.

Life Conditions and Transitions

This category of psychoeducational support groups incorporates a wide range of topics for all ages. Topics such as grandparents raising grandchildren, dating violence prevention for teens, gay men, menopausal women, and multiracial children are in the following review.

The theme for some groups is prevention and preparation for life’s tasks, while for other groups the theme is remedial, to learn how to cope with one’s condition as it exists. This category is very broad in terms of topics and audiences.

Caluza (2000) described the 12-session curriculum used for psychoeducational support groups for multiracial adolescents, and the qualitative study used to derive the themes for the curriculum. Themes include ethnic identity, physical appearance, family, socialization and marginalization experiences, historical context, and contact with other multiracial groups.

Diegel (1999) conducted a qualitative study on the efficacy of a dating violence prevention psychoeducational support group on a sample of high school female students. Eight core themes were derived: healing wounds, belonging, trust, holistic involvement, education, increased awareness, empowerment, and appreciation.

Trauma

This last category begins a bridge to counseling or therapy, as trauma victims may often receive these more in-depth services. However, there are also psychoeducational support groups for victims and family members. These groups provide an educational component to give information about potential physical, psychological, and emotional effects; and to guide members in understanding how to cope with their reactions. These support groups can reduce isolation and alienation that can result from being a trauma victim. Interpersonal relationships can be impaired, and both victims and their families can be educated and supported about challenges and changes that will result in certain behaviors and relationships.

Zamanian and Adams (1997) described a 16-week group for sexually abused boys that incorporated the eight goals of the Specialized Treatment and Rehabilitation Service program developed by the community health department of Merced County, California. The program uses exercises, artwork and role-play, and discussion of the topic of the week.

Mara and Winton (1990) described a parent support group for parents who had a sexually abused child. Topics presented and discussed were child sexuality, normal child development, stress management, managing difficult feelings such as guilt, behavior modification, and problem solving. An evaluation by the authors found that there was a decrease in the associated children’s dysfunctional behaviors.

Designing Psychoeducational Support Groups

There are a few general guidelines for designing psychoeducational support groups for all target audiences regardless of age, gender, condition, disease, or circumstance. The guidelines presented here are divided into two categories: factors for planning and factors for facilitation.

Factors for Planning

These factors include the following:

Understanding major background factors of the target audience

Sensitivity to the participants’ emotional states

The role of fear

The impact of a sense of personal inadequacy and failure

Loss and grief issues

Dealing with feelings of powerlessness and loss of control

Major background factors are demographics, such as age, gender, educational level, and occupation. These factors play major roles in decisions about content, instructional strategies, and other activities—for example, group leaders will want to gear the content to the lowest reading level of participants, since some materials will require reading. Presenting material that is too advanced or too elementary can alienate the audience. Background factors can play a part in deciding the sequence for material, illustrations, and examples, terminology, and many other instructional strategies. If members are to learn, apply, and retain the material, the leader has to present the material in the most effective way. Knowing your audience helps.

The emotional state of members is important, because anxiety, shame, embarrassment, and other emotions can interfere with learning and participation. Members may feel stigmatized, socially alienated, and angry that they are singled out to carry the burden of the disease, condition, or circumstance. The leader’s sensitivity to members’ emotional states can play a major role in establishing safety and trust, facilitating learning, and members’ willingness to self-disclose.

Fear can play a role in the quantity and quality of members’ participation. Members can bring fears to the group about any or all of the following:

Potential and possible personal death

An inability to care for self and having to rely on others

Financial concerns

Loss of function

Deterioration of the quality of life

The negative impact on relationships

The fears may not be openly disclosed, but that does not lessen their impact on group members. These fears are in addition to the following common fears about group experiences that many members bring to the group:

Being excluded or rejected by other members and/or the group leader

Losing control

Getting worse by being in contact with sick or emotionally disturbed people

Being attacked

Catching other members’ emotions

Losing individuality

Lacking of sufficient boundaries for the group

There are many fears, and all members will have some level of most of these fears, even if they do not speak of them. Leaders need to be aware that the fears exist and take steps to address them.

Some group members will perceive their disease, condition, or circumstance as a personal failure or inadequacy on their part. This is an irrational reaction that is buried in the unconscious, incorporated from messages received in childhood from parents, religious teachings, or the cultureSome group members will perceive their disease, condition, or circumstance as a personal failure or inadequacy on their part. This is an irrational reaction that is buried in the unconscious, incorporated from messages received in childhood from parents, religious teachings, or the culture and/or a part of their self-perception that they should have prevented this from happening.

This perception can be a belief for children, parents, and immature adults who have not developed to the point where they clearly understand their boundaries and acceptance that there are forces beyond their control. These people believe that they can and should control what happens to them. Group leaders will have to choose their words carefully to prevent any hint of blame or criticism of members for the disease, condition, or circumstance. The art of group leadership is especially important in addressing this concern.

Loss and grief will be large issues in support groups, as all members will be facing them on some level. There can be, among many others,

Loss of innocence

Deterioration of function

Reduction in quality of life

Actual loss of a physical part of the person

Loss of some quality or trait for the person

A realization of impending doom and/or death

Loss of meaningful connections to others

A sense of vulnerability, as safety has been compromised

A realization of helplessness and powerlessness to help or to save oneself

These feelings can be intense for members, and much of their emotional reactions can be traced to dealing with grief and loss.

The overwhelming feelings of powerlessness and loss of control have to be addressed before members can move on and start to take action. This depressive state can be real depression or it can be a realistic appraisal of group members’ inability to return to a previous state, to change themselves or what happened to them, and to significantly impact their future around whatever brought them to the group.

Group leaders need to expect that the depressive state will manifest itself in different ways, such as increased activity and acting out, apathy, or an inability to connect to others. It could be helpful to bring these feelings out at some point and make them visible for everyone—that is, the leader could say that some people might feel powerless and a lack of control when faced with the situations of group members, and the leader could open the floor for members who want to connect or verbalize such feelings. Just do not ignore them.

Factors for Facilitation

Leaders can take pains to promote certain factors. They are facilitative for both individual members and for the group as a whole. These factors can work toReduce guilt and shame feelings

Increase connectedness to others

Provide a reality check

Mobilize helpful but unrecognized strengths

Help members recognize stress and its impact

Show and guide members in planning for the future

Teach members a self-care focus rather than being self-absorbed

These factors are incorporated in the helpful group factors described in Chapter 4.

Members can have considerable feelings of shame and guilt for needing care, not being perfect or healthy, using family resources, and so forth. Never underestimate the importance and impact of these feelings, since they do affect behavior, reactions, and even healing.

Although the primary focus for psychoeducational support groups is education, the emotional state of members plays an important role. It is helpful when group leaders remain aware of the possibility that members have guilt and shame feelings, recognize the indirect ways these can be expressed, help members identify commonalities and feelings, and work to reduce the negative impact these feelings can have.

The importance of interpersonal connections in assisting people to heal, get better, remain hopeful, and effectively cope cannot be overestimated. For example, a longitudinal study of more than 7,000 people over nine years found that the “common denominator that most often led to good health and long life [was] the amount of social support a person enjoys”(Blai, 1989, p. 261). The report goes on to note that people who had strong ties to other people were better able to stay well.

The psychoeducational support group can be one source for making meaningful connections and can help members recognize and/or build other sources of support. This is accomplished when group leaders identify commonalities, promote interactions among group members, give constructive feedback, and model and foster altruism.

Group members are helpful in providing each other with a reality check. Although members are concerned with their personal situation, they are also able to see what other members are discounting, overlooking, or minimizing. The reason for the support group can be overwhelming for some members, which can make it difficult for them to see unrecognized and unused resources, understand what outside resources are available, and focus on hopeful factors. Other group members can be more realistic about someone else and provide a needed reality check.

Mobilizing unrecognized strengths of members can do much to instill hope. This would be a realistic hope, not a fantasy, that all will be well. When people are in a crisis, pain, or lack sufficient information, they tend to focus more on deficits than strengths. Psychoeducational support groups are a rich source for helping members to identify their strengths.

Capitalizing on strengths is more effective and satisfying than trying to remediate deficiencies. Further, many members’ perceived deficiencies are a part of what brings them to the group, and little can be done to remedy these deficits. Members can be taught to focus on what they can do or be, not what is lost or not possible under the current circumstances.

Most everyone accepts that stress exists and that it can have a negative impact on physical, emotional, psychological, and relational functioning. Indeed, some physical conditions that bring members to psychoeducational groups have a strong stress-related component. Conditions such as hypertension, asthma, substance abuse, and heart conditions are some examples. The group can be a place where members allow themselves to become aware of the impact that stress is having on them, learn ways to reduce and cope with stress, and practice relaxation techniques. Staying in a state of tension does not aid recovery, nor does it help in everyday living and relating.

On the other hand, there are constructive ways to handle stress, and some members may have mastered that process. Not only can the leader recognize this as a personal strength for those members but the members can be models to help fellow group members learn new ways of coping with stress.

Many, if not most, members in psychoeducational support groups will be stuck in the disease, condition, or circumstance, and will find it difficult to visualize their futures. The group can be an excellent resource to introduce short- and long-term planning. Members can learn more about the limitations of what brought them to the group and how to overcome or compensate for these constraints.

Members can also gain hope, optimism, and determination that can be valuable in recovery, compensating, and/or making life decisions. There is considerable evidence that these mental states play an important role in the quality of life, physical and psychological health, and connectedness to self and others.

Reducing self-absorption and promoting a self-care focus may need more time and effort than what a psychoeducational group can provide. It is not realistic to think that the group will bring about a deep characterological change for the member who is very self-absorbed. However, all members can become more aware of how their self-absorbed behaviors and attitudes can negatively affect their relationships through interactions among group members and through feedback from members and the leader.

Although they may seem similar, self-care is vastly different from self-absorption, and group leaders are encouraged to read the literature on self-psychology and narcissism to gain a fuller understanding of self-absorption. Self-care requires an understanding of psychological boundaries, the limits for taking responsibility for the care of others, and an ability to reach out to others when needed. In other words, others are not exploited, there is a realization that others are separate and distinct and they exist for themselves, or others are not manipulated and controlled.

Manualized Groups

Manualized groups generally use a manual or curriculum designed and published by outside sources. Many manuals are the result of research about interventions for a particular issue, problem or concern. For example, there are manuals for CBT treatments for various conditions.

Advantages

The advantages for using manuals instead of developing the plan treatment include the following:

The strategies and techniques are based on research findings for a particular issue, condition, or problem. This makes it easier for the group leader to prepare for a group and to be able to support their strategies and techniques as being evidence based. This can be particularly important for agencies and other settings that use insurance reimbursements.

The manual provides a sequence for sessions and learning. The sessions are organized to provide the necessary sequence for presenting the cognitive material and use principles of instruction and learning as a basis for what is presented.

May have curriculum/session plans that specify objectives and strategies with a sequence for presenting these. These plans make it easier for the group leader to understand the relative importance of the various topics that are to be presented, and the objectives and strategies are integrated with the purpose and goal for the group.

Some have pre-prepared PowerPoint or other media. The ancillary materials that accompany some manuals make it easier for the group leader to prepare for the group as relevant information is provided as well as the presentation method. However, group leaders do need to be familiar with what is being presented, as they will have to answer questions and lead discussions.

Evaluation forms are a part of the manual. As noted in Chapter 3, evaluation is an important part of the group planning. The methods and forms for evaluation of the group and of the materials are generally provided with the manual or are easily accessible on a website, ensuring that the group leader can assess the group without having to develop a procedure or process.

Manualized treatment is usually focused on narrow goals and expectations. This narrow focus aids in helping to be successful as these are specific, usually behavioral in nature, and are capable of being observed and assessed. They are not vague or subject to personal interpretations.

Some manuals will have activities or forms to use, and or to use has homework for group members. Group leaders will not have to seek out or create activities or forms as these have been designed for the specific topic that defines the group. Even when the group leader may feel that there are better activities and the like, it compromises the validity of the manualized group to not use the designated activities and forms. Having members do homework can be problematical, as was discussed in Chapters 2 and 3.

The knowledge to be disseminated is included. This can be immensely helpful to group leaders, as they do not need to seek out relevant information. However, there is a drawback in that there can be updated material that is different, contradictory, or even more enhancing that was produced after the manual was developed. Group leaders of manualized groups are encouraged to continue to do a literature search for updated findings prior to implementing the group.

Using manuals can reduce the leader’s anxiety about the ambiguity and uncertainty for planning, organizing, directing, and presenting group sessions. It can be comforting to group leaders, especially beginning group leaders and those who have not had enough training, to have to facilitate a manualized group. As noted in previous points, much of the organizing and production of group materials accompany the manual, meaning that there can be less time needed to prepare for the group (Brownlee et al., 2017).

Disadvantages

However, there are some constraints to using these manuals.

In order to be most effective, the manual must be followed as presented. Minor modifications to address member characteristics, such as reading ability, can be made, but major deviations will invalidate the results.

Many of the art, science, and blended KASST model factors are omitted from many manuals especially those related to group facilitation tasks and skills.

There is little attention given to the use of group dynamics, stages of group development, fostering the emergence of therapeutic group factors, and managing difficult group member behaviors.

Many do not provide and understanding of group process or use of group process commentary.

The use of cultural and diversity sensitivity may not described.

Group member factors such as managing and containing intense emotions, member to member interactions, and the like are not addressed.

Enhancing Manualized Groups

The success of manualized group sessions depends on the group leader’s knowledge and group facilitation skills. The same leader tasks discussed in previous chapters continue to be of importance for these groups as well. While the sessions and much of the content are preplanned and structured, the group still requires the group leader’s attention to forming the therapeutic relationship, establishing trust and safety, fostering the emergence of group therapeutic factors such as universality and hope, attending to group dynamics and group therapeutic process, providing encouragement and support, identifying and repairing empathic failures and, other group facilitation art and skills factors described in the KASST model in Chapter 1. In addition, the group leader may need to make some minor adjustment to how cognitive material can best be presented based on the needs and characteristics of the particular group members. Manuals provide the structure and frame for the sessions, but the group leader has to fit those to the group.

There are some specific leader actions that can enhance the manualized group experience just as they do other types of groups. Eight are described as follows:

Attend to the therapeutic alliance. This continues to be essential even though there may be a greater emphasis on content and learning.

Ensure that each member responds every session. Monitor group members’ participation as active participation promotes greater learning.

Highlight therapeutic factors that appear, such as universality, hope, and altruism.

Identify and repair empathic failures. This is a major responsibility for the group leader in all types of groups and may be of more important in these groups where the relationship between group members is not emphasized.

The leader must take care to model empathic responding. This is both encouraging and supportive of group members, and teaches them an effective communication skill.

Assess members’ progress periodically by asking them about their perceptions of their progress. This promotes shaping of behavior as it notes small progressions.

Have a ritualized beginning and ending for the sessions. Begin and end session intentionally and consistently. Try to not just stop because time has run out.

Use stress reduction techniques such as progressive relaxation, meditation, or breathing. This can help reduce members’ tensions thus promoting more active involvement especially with personally sensitive material.

Block storytelling and monopolizing as these consume a lot of time in a session, and may not allow for every member to have input in a session.

There are many opportunities for group leaders to implement the art factors of group facilitation with these very structured and organized groups. Presented are some suggestions to help trigger group leader’s creative ideas for how they can enhance manualized groups.

Virtual/Cyber Psychoeducational Support Groups

The use of virtual/cyber psychoeducational support groups seems to be increasing, and is expected to further increase in the future. These are support groups formed around a particular condition, issue, or problem where members do not hold face to face sessions but use another process and modality to connect and share thoughts, information, and feelings. This type of support group is referred to in the professional literature as virtual communities, electronic support groups, peer-to-peer communities, cyber, online self-help group, and Internet/asynchronous online groups. This presentation will use the term virtual/cyber groups.

Some general characteristics of these groups are as follows:

The group meets online and members must have Internet access.

Meetings are asynchronous using message boards for posting information, questions and answers, and the like.

The group has a group leader/moderator who manages the postings for the message board especially the cognitive content for teaching and informing.

Boundaries are fluid such as the number of participants, how and when to join, termination process and procedures; and there can be lurkers.

There are definite advantages to these support groups. There are no formal meeting days and times so that group members can attend when their schedules permit, services can be extended to a larger number of people who may need them, especially members that are home bound, they seem to show positive benefits for medical and psychiatric conditions, needed information is provided and accessible and they have the potential to reduce isolation and loneliness for people in areas where there may be no other resources.

There are also disadvantages, and these tend to be primarily in the affective component for psychoeducational groups. Disadvantages include the inability to establish a therapeutic relationship, inconsistent and erratic attendance and postings, the intensity of members’ negative emotions cannot be monitored nor can their capacity to manage these be assessed, the contributions of group process cannot be used, there can be a large drop-out rate, and there is a lack of privacy.

Eysenbach et al. (2004) conducted a review and analysis of studies on the effects of electronic peer-to-peer self-help and support groups on health and social outcomes. They found that many of these groups that were studied had leaders or moderators and were not peer-to-peer groups; they used structured psychoeducational interventions and/or provided access to therapeutic relationships with health professionals. The results were mixed with some studies showing significant improvement and other studies showing no improvement. The authors noted that there was insufficient evidence to confirm or to deny the possible negative effects of these groups such as verbal inhibition or aggression, hoaxes and spam, encouragement of suicide, and the lack of privacy.

Other studies on a variety of cyber/virtual groups include

Hsiung (2004)—effectiveness; (2007)—suicide

Voorhes et al. (2013)—depression

Poole et al. (2015)—bipolar disorder

Watson et al. (2016)—eating disorders

Osei et al. (2013)—prostate cancer

Grey et al. (2013)—youth with Type 1 diabetes

Carlbring (2015)—university students with SAD

Hsiung (2004) provided a list of ethical concerns that were endorsed by the International Society for Mental Health Online. Leaders/moderators of online psychoeducational groups will want to pay attention to the following ethical standards.

Informed Consent—to include a description of the process, the leader’s credentials, the risks and benefits for participation, the safeguards that will be used, and alternatives that are available.

Operating procedures—to include leader competence, legal requirement, the structure of services, how and when the group will be evaluated, multiple treatment providers, confidentiality, records, and existing guidelines.

Emergencies—and how these are managed such as the procedures and backup that are in place.

Group leaders must take care to follow their profession’s ethical code for facilitating or moderating these groups especially since the leader and group members may be in many different states.

With the increasing use of the Internet and other electronic messaging devices, more people can receive the benefits of psychoeducational groups. However, training programs do not usually include sufficient information to guide group leaders on the most effective and efficient ways to present these groups in this format. Holmes and Kozlowsk (2015) present a reasoned case for the inclusion of such training in counselor preparation programs, and this training is needed for all mental health professionals’ preparation programs.

Discussion/Reflection Questions

Design an exercise for adolescents that focuses on one or more existential issues.

Modify one of the exercises presented in the book for use in a support group for adults that are caretakers of someone with a serious illness.

Describe how you would develop a support group for children who have an ill parent or sibling.