Recently, a colleague and fellow ECP asked me to help her solve a problem with one of her groups. She is a psychological assistant in an intensive outpatient program for a local hospital. She noticed that in her new Distress Tolerance class patients were quite disengaged with instruction, often preferring side conversation. Relatively new to group treatments, my colleague was left confused and discouraged for future groups. I am grateful that that through my experience teaching, researching, and associating with Division 49 I was able to set her aright. In our exchange I was reminded of previous publications from Division 49 members (Brown, 2011; Burlingame & Woodland, 2013) regarding conducting psychoeducational groups (PEGs). Drawing on their writings and on personal experience thus far, here are a few simple guidelines to follow for any ECP new to PEGs.
Set the Tone
As with any therapeutic encounter, it is important to be prepared. In PEGs this means having a well-defined lesson plan. This is manifest through study and preparation of the material, as well as clearly communicating group rules and norms once the class has begun. This is especially vital in class-oriented groups in which enrollment is open-ended. One rule of thumb that has worked for me is that if there is ever a new member in the class, it’s safe to assume they don’t know the rules and norms. So, instead of assuming they will “figure it out,” make a habit of repeating the class rules, at the very least by leaving a space on the whiteboard to display them.
Another way in which the PEG therapist sets the tone is in setting up the room such that the environment promotes engagement in instruction. In my colleague’s Distress Tolerance group, the pre-established norm was for group members to be seated along three walls of a large, rectangular multi-purpose room. While this configuration allowed for all group members to see each other clearly, it also created a great deal of space between teacher and learner. This space seemed to invite side conversation, and also put a strain on members trying to see across the entire room toward the whiteboard. Some members also had to re-adjust in their chairs to properly see instruction. The solution to this problem was simple and surprisingly effective: chairs were placed in two rows of semicircles around the instructor. This moved the dead space in the room from between the teacher and learner to behind the entire class. And more importantly, side conversation was nearly eliminated.
Focus on Emotional Learning
If you were to ask group members what they learned in their last group, chances are the majority would not be able to recite the principles that were taught, much less grasp the content in the way in which the therapist intended for them. Rather, group members and class members alike retain what they are ready to learn. And in most instances, this learning is tied to an emotion. With this said, it is important that the PEG therapist not be committed to “getting through” all the lesson material. They should, rather, reward active engagement with reflection, expounding productive comments, and setting a foothold for engaging other class members. Focusing on emotional learning can also lead to the use of experiential activities, which if used properly can enhance understanding.
For example, I recently taught a PEG on ADHD. As might be expected, “telling” about things like executive function was not as effective as having them experience it. An activity we called “Sound Ball” was particularly effective. In this activity, participants were asked to make nonsense sounds while passing a ball in a circle. They were required to repeat the sound produced by the ball-thrower as they received the ball. They were then required to make up a nonsense sound as they passed the ball to someone else. For almost all patients this created a challenge in executive function, a fair share of awkward moments, and was a powerful teaching tool. Class members readily reported that experiencing difficulties mentally shifting, processing, and storing information during the activity illustrated a type for these same challenges in their daily lives.
In PEGs following up can be incredibly important. For example, using homework assignments can help clients gain clear direction about the message the PEG therapist is trying to communicate. If the PEG only constitutes one session, creating a memorable experience in which the therapist polls “takeaways” can be a useful tool. This may also be effective for the final class in a multi-session PEG. Either way, if the instructor has done their job, there was likely a small change wrought upon the patient. The proper handling of that change can help clients retain important knowledge and skills, and will enhance learning of principles to guide their own lives.
Recently I employed the “takeaway” strategy in a pain management class. I asked class members what (if anything) they would take with them after the class was over. One member expressed an excitement for instruction on mindfulness meditation, and stated that she would try mindfulness on a daily basis to help cope with her pain. Conversely, another stated that mindfulness was not for her, but that she preferred coping with a hot bath and a good book. While at first it may seem that the first class member “got it” while the other did not, both reactions to the instruction were valuable! Both class members left with greater knowledge of how to cope with their condition: one found a new tool that works, and another confirmed to herself what didn’t. As the instructor, I decided to reinforce both types of learning. This not only validated the disparate experiences, but also silently validated the varied experiences of the other members of the class.
As with any therapeutic modality, in psychoeducational groups (PEGs) rests great potential for learning. This may be didactic or “academic” learning, and can also be practical or emotional. When treated with this scope and with the proper preparation, PEGs have the potential to be transformed from the reading of slides to seeing change on and individual and group level. And perhaps most of all, they can be enriching to the instructor. As PEGs continue to gain favor in the therapeutic array, seeing them as fertile ground for therapeutic gain will transform them from classes into therapy that reflects the emotional and interpersonal learning for which group attendees will continue to yearn.
Brown, N. W. (2011). Psychoeducational groups: Process and practice. Taylor & Francis.
Burlingame, G. M., & Woodland, S. (2013). Conducting psychoeducational groups. In Koocher, G. P. Norcross, J. C., & Greene, B. A. (Eds.) Psychologists’ desk reference, 3rd ed. (pp. 380-383). New York, NY, US: Oxford University Press.
*Sean Woodland, PhD is a psychological assistant registered in the State of California, and works at Kaiser Permanente Stockton Medical Center. The opinions expressed belong to Dr. Woodland, and may not reflect those of Kaiser Permanente. For questions or concerns, Dr. Woodland may be reached by email at firstname.lastname@example.org, or by phone at 801-602-8278.
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