10+1 GUIDELINES FOR EFFECTIVE PSYCHOEDUCATIONAL GROUPS

David Barry, Psychoeducational Groups

Guiding Principle:

“What participants learn is far more important that what the facilitator says or does”.

Focusing on learner outcomes is the guiding principle in designing, developing and facilitating psychoeducational groups. When focusing on learner outcomes is in the forefront of all activities the intent of the psychoeducational groups is much more likely to be achieved. This guiding principle places emphases on how to help participants learn.

Now, focusing attention on helping participants learn appears to be an obvious part of instruction. However, psychoeducational group developers often become trapped into spending more time on developing content-based lesson plans than really thinking about how the participants will achieve the desired learning outcome. Developers can also be trapped into using “fun” exercises or using other instructional strategies that are d not necessarily focus on helping the participants achieve the desired outcomes.

Focusing on learner outcome needs to also be in the forefront of all activities when conducting psychoeducational groups. When focusing on learner outcomes is the guideline for conducting the sessions then there is greater emphasis on the learner more than just presenting information. For more information on this distinction refer to the presentation on “Facilitating Learning in Psychoeducational Groups.”

In rest of this article presents important guidelines for ensuring the success of your psychoeducational groups. It is the guiding principle of having learner outcomes at the forefront of all activities that needs to give direction to the guidelines discussed below.

Guidelines for Effective Psychoeducational Groups

1] Gain Clear Administrative Support.

2] Align the psychoeducational group programs with the mission and treatment goals of the organization.

3] Develop group psychoeducation courses with clear goals and opportunities for self-assessment.

4] Secure a positive learning environment.

5] Design psychoeducational group courses that maximize learner involvement.

6] Utilize principles of group development in the design of the Psychoeducational Group Courses.

7] Maximize the potential for learning using by structuring instructional activities and exercises.

8] Build in realistic time frames for group psychoeducational courses.

9] Balance structure with flexibility in facilitating the psychoeducational groups.

10] Celebrate the successes and learn from the mistakes.

1] Gain Clear Administrative Support:

Gaining clear administrative support is a must for Psychoeducational Group facilitators and program administrators. This administrative support is important for two reasons:

Psychoeducational group providers often compete for resources with other service providers. Having administrative support will help Psychoeducational group providers secure necessary resources.

Participants often view the value and benefits of a program based on the status of that program. Programs that have of administrative sport have a perceived higher value. The status of the program will have participants view the program as important and enhance its potential benefit.

Gaining administrative support is not to be taken for granted. Program providers must work for this support. A few keys to gaining support are to deliver the programs promised, provide timely and accurate program evaluation information to administrators and to get input from administrators on ways to improve the program.

No matter how well a psychoeducational programs is operating, lack of administrative support will leave it short when resources are tight and have the value of the program questioned by participants and other service providers.

2] Align the psychoeducational group programs with the mission and treatment goals of the organization.

Having a clear link between the psychoeducational group courses and the treatment goals of the organization is a must. It can be easy to develop psychoeducational groups that are “fun” or “keep people busy”. There are also many pre-packaged group programs that can be easy to run. However the group psychoeducational programs that are offered need to be part of the overall treatment mission of the organization. One method to measure this fit between the treatment mission of the organization and group psychoeducation courses is compare how well the group goals match the individual treatment goals of the participants’ service plans.

For some psychoeducational groups there might be two distinct types of group goals. Content Goals: One type of group goal, Content Goals, focus on the intended learning

outcome of the course. For example “participants will be able to demonstrate symptom management skills that will reduce stress” or “participants will develop a relapse prevention plan”.

Process Goals: Another type of goal, Process Goals, describes how participants are able to focus on a task, interact with others or become involved in a program. For some individuals rudimentary pro-social skills like “being able to interact with others for 45 minutes with becoming disruptive” can be an important outcome. For individuals who are unable to manage their time or complete a task, being able to “attend 8 sessions on time, without prompting and complete all learning tasks” can be an important treatment outcome.

Skill

Affective

Cognitive

3] Develop group psychoeducation courses with clear goals and opportunities for self-assessment.

When participants have a clear understanding of what they are to learn and a method to measure their success they are much more likely to succeed. Clear goals help participants keep focused. Clear goals also help participants evaluate their progress.

Psychoeducational group goals need to be written in behavioral terms and describe the intended outcome of the group The behavioral terms are expressed using action verbs like demonstrate, develop, show or apply.

There are three domains for learning. The Cognitive Domain will have goals describing what information participants are able learn. The Affective Domain has goals describing the values or attitudes that are focus of the instruction. And, the skill domain describes what specific types of behaviors the participant is expected to demonstrate at the end of the psychoeducational group course.

In many situations psychoeducational courses can have all three of these learning domains as part of their goals. For example for a participant to learn a new skill they must value or recognize the importance of the skill [Affective Domain]. Often learning a new skill involves understanding some basic information or a set of general principles [Cognitive Domain]. And finally the participant needs to demonstrate the skill [Skill Domain].

In a very specific example for a course on Assertiveness Training participants need to believe that they can assert themselves and that this assertiveness will help them better their lives. The participants will also need to know when it is important to be assertive and when it is less important. Finally, the participants will need to be able to demonstrate assertive behaviors that fit the situation.

These learning domains are important in planning and delivering psychoeducational group courses because they help the facilitators recognize the importance of having participants: accept the importance of what is being taught,

understand some basic principles demonstrate the skill or ability to apply the concepts being taught.

Self-assessment can occur periodically during a course or by having practice sessions [assignments] between sessions that help build participant confidence and reinforce learning. A variety of techniques can be used for these learning reviews. The learning reviews can be formal written assessments, role plays, inter-group competition exercises and instructional strategies. The goal of self-assessment is to help the participant master the new skill rather than assigning a pass-fail type of grade. During the assessment it is important for the participant to understand what parts of the new skill they have mastered and what they need to do to master the whole skill. The primary focus of the assessment activity is to facilitate learning. A second outcome of this assessment may be on how to increase the effectiveness of the specific lesson or course.

The real learning begins when the participants begin to talk more than the facilitator..

4] Secure a positive learning environment.

The more participants can focus on the message the more likely they will be able to learn. An environment free of distractions will help learners focus. Ideally the physical space will have a place to have posters or other materials related to the topics being taught. Facilitators need space to keep learning materials. And, participants need to associate the space with an opportunity to learn.

The physical space needs to have enough room for participants to move around or change the seating arrangements of the classes as needed. Sometimes when a session seems to be going nowhere a simple activity like changing the seating arrangements, going from a classroom, row by row seating to a semi-circle can renew interest. The facilitator should be familiar with the space and able to maximize the room so all participants can clearly see the material being presented and the facilitator can observe and maintain eye contact with all participants. A positive learning environment also provides a sense of security so when participants need to do a demonstration or take a risk they feel they and the group will not be interrupted. Participants need to feel safe in practicing new skills or discussing personal issues.

5] Design psychoeducational group courses that maximize learner involvement.

Most people learn best by doing. Learner involvement also helps keep participants interested in the course. In general the facilitator should be talking less than 20% of the group time.

There are many books and manuals that have examples of group exercises, simulations and games. Part of the Psychoeducational Groups website “Lessons” also has examples of interactive exercises.

In addition to pre-packaged exercises there are several easy techniques to promote learner involvement. Surveys about learner interest and opinions, quick quizzes followed by a discussion of the quiz, rank ordering lists are simple methods to keep learners involved.

Another simple method to keep participants involved is to have them discuss a specific topic in dyads or sub-groups and then report out to the entire class. The dyads and sub-groups provide participants opportunities to share their idea, responses with a few people and get feedback from them before sharing the ideas with the larger group. This small group discussion prior to the larger group review can be a powerful tool in helping more withdrawn members become part of the group.

Assigning psychoeducational group participants group roles can be another way to increase their involvement and sense of ownership of the group. For example tasks like time keeper, handing out information to group members, listing out group member responses and reviewing group guidelines to new members can all increase member involvement. Even those members not performing one of the above tasks often have a sense of vicarious participation watching their fellow group members.

Form follows function in the use of instructional activities.

6] Utilize principles of group development in the design of the Psychoeducational Group Courses.

Psychoeducational groups experience many of the same dynamics as other traditional groups. The group courses will go through stages of development, have the same competition for leadership roles and potential for developing cohesion as more traditional groups. In the design of group psychoeducational courses it is important to develop the individual session plans that incorporate or at lease take into account these group dynamics.

In the beginning of almost al groups the members look for direction and structure from the facilitator. As the group progresses members are more willing and want more shared leadership in the group. Gradually assigning roles and rotating those roles will help members assume this shared leadership. There can also me numerous opportunities to have the group members make decisions about how the psychoeducational group sessions progress.

Incorporating group exercises that correspond to the stage of group development is another method of integrating group dynamics into the course design. For example in the beginning of a course members may not be very wiling to take chances or become involved in exercises where then need to share personal information. As members feel a greater sense of trust and cohesion they feel more comfortable in trying new behaviors in the group and in talking about their experiences.

The presentation on “Promoting Group Development” discusses these dynamics in more detail.

7] Maximize the potential for learning using by structuring instructional activities and exercises.

Presenting, facilitating and processing an instructional activity all require good advanced planning, a high level of interpersonal skill and some luck.

First the course developer needs to be sure the exercises fit the intended learning outcomes, the stage of group development and the level of functioning of the group members. There are hundreds of fun exercises

that a facilitator can use in planning a psychoeducational group. But the exercise needs to meet the group goals. Most often this will require modifying a specific exercise or the facilitator developing his/her own exercise.

All materials need to be immediately available at the time the exercise is introduced to the group. Nothing will diminish the potential of an exercise more than having members wait for needed materials. Instructions for the exercise should be given at least twice and when possible written down. When possible the facilitator needs to demonstrate the tasks first before the group proceeds with the activity.

Introducing “prompt questions” before an activity will help learners focus on the purpose of the activity and when processing the activity the prompt questions can be used again to review the exercise. The use of prompt questions is very important when using more passive learning activities like watching a short videotape or observing a role-play. For these more passive activities it is recommended to go no longer than 10-15 minutes before a group discussion period. Even for longer videotapes or extended role-plays a “stop and go” method can be used to process sections of the activity.

A formed group will not go forward without addressing a major conflict or important issue. That conflict or issue will be part of the group life until it is addressed.

Instructional activities are one of the best methods for maximizing learning but the use of the activity needs to be well planned and facilitated to benefit the participants.

8] Build in realistic time frames for group psychoeducational courses.

Psychoeducational group courses should be developed based on the level of functioning and anticipated length of stay of the group participants. Ideally group courses will go between 8-12 sessions. Research has shown that it often takes that many sessions before the message of the course becomes adapted by the participants. However some participants are enrolled in a program for les than two weeks and others for more than two years. Participants in an inpatient psychiatric setting might not have the same capacity for concentration or ability to abstract as participants in an outpatient clinic.

Psychoeducational group courses need to be developed to incorporate these differences. For clinic settings with higher functioning participants being enrolled for longer periods of time longer 1-2 hour sessions are not uncommon. Individual courses may become parts of a larger ”curriculum”. For example a 12 session course on Relapse Prevention may become part of a large curriculum focusing on Overcoming Mental Illness and Substance Abuse. On an acute in-patient unit the courses need have fewer sessions 4-8 and a shorter time per session. For example a 6 session course on Returning Home to Friends and Family might be presented 2-3 times per week for 30-45 minutes per session.

Developing courses based on participant characteristics and length of stay in the program will help the facilitators tailor the message of the program and give participants the opportunity gain the maximum benefit from the course.

9] Balance structure with flexibility in facilitating the psychoeducational groups.

Group psychoeducational programs are structured sessions with specific learner outcomes identified for each session. Ideally sessions are developed so the information from one session is built upon and used in the subsequent sessions. Learning activities are tailored to specific groups with specific intended outcomes.

Group psychoeducational programs take place within a broader context of either a treatment setting or larger community. People coming into the sessions may be experiencing additional issues that to them seem more important at the time. Specific session topics or exercises may have more impact on members that anticipated. There are an uncountable number of factors that can impact on group participants and influence their behavior in a psychoeducational group.

Facilitators need to balance the intended purpose of their groups with participant needs. A group activity that is planned to take one session might take two. A tragic incident involving a group member might be the main concern of the group. A conflict between group members might inhibit other group members for participating in a session.

A psychoeducational group plan is a plan and should be followed as much as possible, but if participants are not ready to learn because of other factors then the facilitator needs to adjust and modify before the group is ready to proceed.

10] Celebrate the successes and learn from the mistakes.

One of the benefits of group psychoeducational programs is that participants get a chance to successfully complete a treatment. Participants can evaluate their mastery of the material presented in the class and get positive recognition for finishing a program. For longer classes, participants may be given an award or certificate or even have a special session at the end of a course to formally recognize completion of the program. For many individuals there is the intrinsic satisfaction of moving from one level of a program to the next level.

Developers and facilitators of psychoeducational groups also have the challenge of continuing to update and keep the information they present fresh and current. Participants should have the opportunity to formally evaluate the programs they participate in. Facilitators also need to evaluate the programs they facilitate and share their successes with other facilitators and discuss how to improve they programs they conduct. Part of the final session of a class should also be dedicated to learner feedback.

Conclusions:

Psychoeducational Groups can be very effective in helping individuals learn how to more effectively manage their lives. There are some fundamental principles such as integrating the classes into the overall treatment operations of the larger organization, keeping the participants involved and active, and critically evaluating the courses that will help make the psychoeducational groups even more successful.