Brief Articles

How Groups Can Make a Difference for Hispanic Immigrant Children

Elaine Clanton Harpine, Ph.D.
Elaine Clanton Harpine, Ph.D.

How Groups Can Make a Difference for Hispanic Immigrant Children

Elaine Clanton Harpine, Ph.D., Thomas Reid, Ph.D., William D. Harpine, Ph.D., Adam Pazda, Ph.D., Shana Ingram, B.A. & B.S., and Collytte Cederstrom

The Latina/Latino ethnic group has the lowest educational scores of any large ethnic/racial group in the United States (Mroczkowski & Sánchez, 2015).  According to the Nation’s Report Card, only 26% of Hispanic 4th graders scored as proficient in reading (National Center for Education Statistics (NCES, 2014).  Hispanic kindergarteners also score lower than other racial groups on reading readiness; 42% were listed in the lowest group (Gándara & Contreras, 2010).  The need to improve reading programs for Hispanic children, especially Hispanic immigrant children, becomes obvious.  Groups have been identified as being more effective than one-on-one tutoring (National Reading Panel, 2000).  Prevention groups have also been shown to be effective in academic settings (Kulic, Horne, & Dagley, 2004).  The question is:  Would a group-centered prevention approach for teaching reading be a better approach for meeting the needs of Hispanic immigrant children struggling to learn to read in English?  


The cause of reading failure for Hispanic immigrant children is the same as it is for all children:  lack of phonemic awareness (Keller & Just, 2009; Lyon, 2002).  Phonemic awareness is defined as being able to hear, understand, and make use of letter sounds or phonemes (Shaywitz & Shaywitz, 2007).  As Shaywitz (2003) stated, anyone learning to read must be able to decode (break down) words into letter sounds and then encode (reassemble) the sounds back into words.  Lack of training in phonemic awareness becomes a major concern for schools, since according to the Nation’s Report Card, 74% of Hispanic children are not able to read at grade level by 4th grade (NCES, 2014).  Yet, U. S. census findings show that 22% of all children under the age of 18 are Hispanic and 11% of those children are foreign-born (Fry & Passel, 2009).  

Purpose of the Study

Do Hispanic immigrant students need a different teaching approach than other students in the classroom?  Not really, but research has supported claims that the classroom teaching method is a major cause of reading failure (Foorman et al., 2003; Torgesen et al., 2001).   Neuroimaging research has also provided evidence that children who have failed in learning to read using typical whole language, “look-say,” Reading Recovery, or word list memorization methods can be taught to read when the teaching methods are structured to meet the actual needs of the children (Keller & Just, 2009; Meyler et al., 2008).  Learning to read is one of the most critical developmental steps for any child (Fleming et al., 2004) because it is not only related to development across the life span, but also to mental well-being (Maugban, Rowe, Loeber, & Stouthamer-Loeber, 2003).  

Hispanic immigrant children need to learn how to speak, read, write, and work with the English language (Coll & Marks, 2012; Gándara & Contreras, 2010).  This becomes important in school because Hispanic immigrant children need to be accepted by their peers, to display academic accomplishment, and to develop a positive self-identity in their new culture while maintaining a sense of pride in their family culture (Suarez-Orozco & Suarez-Orozco, 2001).  

About the Intervention Being Tested:  Camp Sharigan

We tested the group-centered approach with Hispanic immigrant children to determine whether the group-centered approach would work with students who were failing in reading at school.  We used the ready-to-use group-centered program packet, Camp Sharigan, designed for first through third grade students (Clanton Harpine, 2016).  

Camp Sharigan is a one-week, group-centered prevention program that emphasizes both learning (reading) and counseling (social skills).  This group-centered week-long intervention’s primary goal is to teach children skills (both cognitive and non-cognitive) that will improve reading ability and thereby improve mental wellness and quality of life.  Camp Sharigan emphasizes phonemic awareness, word decoding skills, oral reading, listening and attention skills, writing, encoding skills (spelling), reading fluency, and reading comprehension.  

Learning.  To teach phonemic awareness, the intervention uses vowel clustering (Clanton Harpine, 2011), a method that teaches children to break words down into letter sounds or phonemes.  Vowel clustering teaches children to break words down into sounds and then put those sounds back together as a word.

Previous Research.  We chose this program as our teaching method because it had been tested previously with Hispanic immigrant children.  In a previous study, first through third grade children from a Mexican-descent, inner-city immigrant neighborhood were randomly selected to participate in a test of two different teaching methods.  The group-centered set participated in the week-long, 10-hr Camp Sharigan program, while the other students participated in a 10-hr structured one-on-one tutoring intervention.  

The group-centered students outscored the children who participated in the one-on-one tutoring program.  One year later, during follow-up testing, the Camp Sharigan group was still showing significant improvement over the one-on-one tutoring group just from the one-week intervention (Clanton Harpine & Reid, 2009).   

Multiple Case Study:  Single-Subject Design

The Group Intervention

Although previous group research supported the effectiveness of the group-centered approach, we wanted to examine the impact that a group program like this could have on an individual student, especially students who were failing in school.  The goal was to discover a new effective group-centered teaching method for helping Hispanic, immigrant children improve their reading skills so that they could succeed in the classroom.  


We chose first graders from a one-on-one tutoring group because we wanted to examine teaching methods without the added burden and stress of multiple years of failure. We know that repeated academic failure compounds the social-emotional and learning problems of students, especially Hispanic immigrant students striving to learn English as a second language (Castro-Olivo et al., 2011).  

We chose 3 children. All of the participants (3 males) were starting first grade when randomly selected for the one-on-one tutoring group and just prior to starting second grade when they participated in the group-centered Camp Sharigan program.  The three students chosen were from the same neighborhood, and attended the same school, participated in the same English as a Second Language instructional program at school, and attended the same after-school program.  

Study Design:  Single-Case Experimental Design

We used single-case graphic analysis to chart each student’s progress.  Macgowan and Wong (2014) suggest that repeated measures should be taken on a single subject or small group of subjects under treatment and no-treatement (baseline) conditions.  Macgowan and Wong (2014) also state that the subject serves as its own control and that single-case design is a valuable research design for applied study with groups.  Kazdin (1) supports the value of studying group participants individually and states that interventions must be tested in real-world settings to prove practical application.

The Howard Street (Morris 2005) assessment procedures were administered to all three participants because the test reported high reliability and validity (predictive validity of .70 and an internal reliability of .85) (Morris, Tyner, & Perney, 2000).  All tests were age-appropriate.  Assessment scores reflected the number missed (Morris, 2005).  

All three children selected for this study were pre- and post-tested at grade level in spelling, oral reading, and sight words.  All three children received the same Howard Street pre-, mid-, and post-test instruments. All three children received pre- and post-tests the summer before first grade.  The three students were then give the same test at mid-point testing.  The summer before second grade, the three students were pre-tested directly before Camp Sharigan and post-tested again immediately after the Camp Sharigan program.  Words on the assessments were not targeted during the one-on-one tutoring or Camp Sharigan program.  

Assessment was scored on the number missed in an untimed test (Morris, 1999).  Self-corrections were not counted as words missed.  Substitutions, omissions, and insertions all counted as words missed.  

Results of the Test

The results show moderate but consistent improvement in reading and sight word recognition after participating in the 10-hr group-centered Camp Sharigan program (see Figures 1 and 2).  The baseline data incorporated each student’s first grade year in school and one full year of one-on-one tutoring before they entered the Camp Sharigan program.  Longitudinal follow-up testing was not possible with this group because of the transient nature of the population.  Improvement is indicated by reduction in number missed at post-testing. The decrease in missed reading words from the first pre-test (M = 12.67, SD = 2.52) to the last post-test (M = 6, SD = 4.58) demonstrates the program’s effectiveness, as does the decrease in missed sight words from the first pre-test (M = 10.33, SD = 0.58) to the last posttest (M = 5.67, SD = 0.58). 

For example, Student #1.  This student, when first tested before first grade, could only read two words in English from the sight word list for pre-kindergarten: “cat” and “go” and could not read words from the oral passage or pre-primer story.  After a year in first grade and with a full year of one-on-one tutoring during first grade, Student #1 was still barely reading at the pre-primer level (below kindergarten).  The student did show some improvement with sight words, but not oral passages.  He memorized a list of words but could not recognize those words when he encountered them again in a story.  After one week with the group-centered Camp Sharigan vowel clustering teaching method, the student was showing improvement with both sight words and in reading oral passages.  Although he was still below grade level and struggling, a mere 10-hour group program showed more benefit for this student than an entire year in first grade with one-on-one tutoring.  

Student #2 made very slow but gradual improvement throughout the first-grade year in school, even with one-on-one tutoring.  By the middle of first grade (6-month post-test), the student was only able to read two new words.  At the end of first grade, the student could only read four new words.  After Camp Sharigan, the student could read 8 new words.  The student demonstrated as much improvement after a 10-hr program as throughout the entire first year of classroom instruction.  Again, vowel clustering and a group-centered teaching method helped this student improve.  

Student #3 demonstrated a similar outcome.  He could not read at all during the first pre-test when he was tested before first grade.  He missed every word on the sight word list and every word on the oral passage at the pre-primer level (below kindergarten).  At the 6-month point in first grade, using Morris assessment, Student #3 was actually doing worse than when he was first tested before school.  He had given up hope.  At the end of first grade, he could only read four new words from the sight word list.  His oral passage score at the end of first grade remained the same as his original pre-test before first grade; he could not read the pre-primer story—not one word.  After the Camp Sharigan intervention, he not only read the pre-primer level story, but moved up in reading oral passages and even made progress in sight words.  The change in teaching method made success possible.  As Kazdin (1982) states, if individual analysis research can show that change occurred immediately after an intervention, then a strong case can be made that the intervention is working (see Figures 1 and 2). 


The group-centered approach helps to meet the needs of struggling Hispanic immigrant students in reading:  (1) vowel clustering offers a new, effective approach for teaching phonemic awareness, (2) group-centered interventions offer a new approach for teaching reading and social skills in a positive cohesive group atmosphere, and (3) hands-on workstations with step-by-step directions offer a new approach to teach reading comprehension and strengthen intrinsic motivation.  

What Made the Group-Centered Approach Effective?

Camp Sharigan, a one-week, 10 hr, group-centered reading program, emphasized improving phonemic awareness, interpersonal skills and rebuilding self-efficacy (belief that the child could read), using group cohesion, vowel clustering, and intrinsic motivation (Ryan & Deci, 2000) in an environment of hands-on reading-based activities in accordance with Bandura’s (1997) self-efficacy theory.  The children did not receive prizes or award; the program worked entirely with intrinsic hands-on motivators and group-centered interventions.  

What Are the Advantages of a Group-Centered Approach?

The Group-Centered Teaching Approach Individualizes Instruction. Sometimes student problems are misidentified in school.  By using six different teaching methods, the needs of the student can often be clarified.  This was true with Student #2.  What at first seemed like stubborn refusal to cooperate was a lack of phonemic awareness.  The student had never been taught to focus on letter sounds.  Instead, the child relied on memorization.  When the student encountered a word that the student did not know, the student stalled and seemed uncooperative.  After the student was taught vowel clustering, the student was willing to attempt new words.  The Snake Pit workstation provided a perfect work place for sounding out words.  This new skill was reinforced at the Rainbow Bridge workstation where the student practiced reading a vowel clustered story.  By the end of the week-long 10-hour group-centered Camp Sharigan program, Student #2 was showing improvement.  Groups really can make a difference.

The Group-Centered Approach Combines Learning and Counseling. The importance of combining learning and counseling into the same program along with the therapeutic power of cohesive group interaction became especially evident on the last day of the program.  Thursday evening, a horrendous thunderstorm struck the city and flooding.  When we opened the doors, all but three children were standing on the sidewalk waiting to enter.  The three not attending had a fever and upper respiratory infection from being out in the rain all night.  The children wanted to finish their pop-up books and to present their puppet play.  The pop-up book was a challenging project that required the children to read and follow directions to assemble their book and to write a story in English before the book could be taken home.  Children who started the week with no desire to read worked hard all week and were excited and motivated to read their finished pop-up book stories.

How Does This Report Help Group Psychologists?

This intervention report provides a new method for working with Hispanic immigrant children.  If Hispanic children in the United States do not learn to read in English, the stigmatization of failure can mark them throughout their lives (Ruiz et al., 2011; Toppelberg, Medrano, Peña Morgens, & Nieto-Castañon , 2002).  If reading scores improve, especially in the early elementary years (Lyon, 2002), then we can increase school completion rates and reduce stress as well as aggressive and dysfunctional behavior (Pressley et al., 2007; Zea et al., 2003).  

The group-centered approach is one innovative technique showing promise.  This study is but a first step.  Replication is needed.  Yet, Moerbeek and Wong (2008) emphasize that selecting a small test group for analysis can be just as effective as a large sample with individual analysis.  

As this study also demonstrates, some children will need more than a mere 10 hr group program.  Group prevention can also be used for year-long classroom and after-school programs (Clanton Harpine, 2013).  Group prevention can make the difference between success and failure for a child (Brigman & Webb, 2007).


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Clanton Harpine, E.  (2013).  After-school prevention programs for at-risk students:  Promoting engagement and academic success.  New York:  Springer.  

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Coll, C. G., & Marks, A. K.  (2012).  The immigrant paradox in children and adolescents:  Is becoming American a developmental risk?  Washington DC:  American Psychological Association.

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Brief Articles

Prevention Corner: Preventing Stigma and Suicide Through Mental Health Awareness

Shana Ingram, BA
Shana Ingram, BA

Prevention Corner: Preventing Stigma and Suicide Through Mental Health Awareness

While fall can be a very exciting time of year for kids going back to school, freshmen just starting college, and gatherings with loved ones for the numerous holidays throughout the season, it inevitably brings about change, sometimes life-altering change, which can be very unsettling for many individuals. For some, this time of year means returning to an environment where personal safety is a concern due to bullying, or becoming familiarized with a new environment away from home proves challenging, or perhaps making it through the holiday season with or without loved ones becomes more difficult than expected. Regardless of the different types of obstacles people encounter during this season, many people will also experience the unwelcome feelings of anxiety, depression, and despair as a result of these struggles. While not everyone who experiences these feelings will ultimately seek mental health services for a variety of reasons, unfortunately, these feelings, especially when left untreated, will result in suicidal ideation and attempts for many individuals. Some of the risk factors associated with suicidal ideation and attempts include stressful life events, history of substance use, history of mental illness, and stigma surrounding mental illness and help-seeking behaviors (Centers for Disease Control and Prevention [CDC], 2017). Despite the many treatment routes individuals can choose to alleviate the thoughts and feelings associated with suicide, if people feel stigmatized for seeking mental health services, treatment will likely be avoided, or discontinued, and issues may continue to worsen until it is too late. One way to diminish the harmful and deadly effects of stigma surrounding mental health issues is to better educate the public by engaging in more open discussions about mental health, and also by challenging media interpretations of individuals suffering from mental illness (Corrigan, 2004). There are many successful organizations working around the world to fight mental health stigma, particularly the National Alliance on Mental Illness (NAMI) in the United States (Rüsch, Angermeyer, & Corrigan, 2005). NAMI provides a wide range of services relating to mental health, including educational classes and support groups for individuals with mental health needs and for families of individuals with mental illness, as well as presentations focusing on promoting mental health awareness (NAMI, 2017). Recent research has noted the positive impact this organization has had on mental health advocacy efforts (Fitzpatrick, 2017).

While efforts to promote mental health awareness and decrease the stigma associated with mental health issues, including suicide, is important for everyone across all age groups, prevention efforts are particularly important for individuals between the ages of 15 and 34 since suicide rates are one of the leading causes of death during this time (CDC, 2015). This is understandable since this wide range of time encompasses extensive changes, such as the social and emotional changes related to adolescent development and the onset of mental health issues (Kessler, Berglund, Demler, Jin, & Merikangas, 2005). In the following issue of this column, I will invite individuals who have experience working in prevention efforts targeting areas associated with stigma and suicide with individuals in this age range, such as school climate and bullying, to share their experiences.

If you or someone you know is experiencing thoughts of suicide, please contact the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255).


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Corrigan, P. (2004). How stigma interferes with mental health care. American Psychologist, 59(7), 614-625.

Fitzpatrick, J. J. (2017). Psychiatric mental health nurses and family caregivers: Creating synergy. Archives of Psychiatric Nursing, 31(5), 431.

Kessler, R. C., Berglund, P., Demler, O., Jin, R., & Merikangas, K. R. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593-602.

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Brief Articles

Prevention Corner: Reading Orienteering Club

Shana Ingram, BA
Shana Ingram, BA

Prevention Corner: Reading Orienteering Club

As of 2015, 64% of fourth grade and 66% of eighth grade students were still reading below national proficiency standards (National Center for Education Statistics, 2015).  These numbers are troubling since illiteracy has been linked to lower socioeconomic status and poor health (Dugdale & Clark, 2008).  The importance of learning how to read cannot be understated, and, as such, it is vital that prevention programs target reading skills in childhood.  One program that aims to help children overcome difficulties with reading, as well as difficulties with interpersonal relationships, is the Reading Orienteering Club (ROC) founded by Dr. Clanton Harpine.  This program combines teaching and counseling in order to maximize academic benefits in an approach known as group-centered prevention (Clanton Harpine, 2015).  This format for a reading prevention group is incredibly important for two reasons.  First, combining academic and therapeutic interventions in prevention programs has been linked to a higher likelihood of obtaining academic success (Baskin, Slaten, Sorenson, Glover-Russell, & Merson, 2010), and, second, research has shown that teaching in groups, especially in small groups, leads to better results than other forms of teaching instruction (National Reading Panel, 2000).  Although this program originated in Ohio, it has found a home in Aiken, South Carolina, and, under the careful direction of Dr. Clanton Harpine, has experienced great success in improving children’s reading abilities and interpersonal skills for many years.  Even though Dr. Clanton Harpine is retiring this year, the ROC will continue under the guidance of Collytte Cederstrom, a former intern whom I worked with at the clinic while I was an undergraduate, as well as three additional team members, Sara Puckett, Matt Haslinger, and Ashley Conklin, and a rotation of church, community, and student volunteers.  Dr. Clanton Harpine was kind enough to share her thoughts on building and continuing a sustainable student-run reading prevention program, as well as the important effects of these programs for students and the larger community.  

While the ROC has typically depended on student volunteers from local undergraduate courses in order to operate fully, this proved challenging at times due to the high number of children in the program, the fluctuating number of volunteers, and the small number of permanent team members working in the clinic.  This past year, Dr. Clanton Harpine sought to enlarge her team of permanent members in order to provide more stability to the program, and, did so successfully.  The ROC now has four permanent team members and each member is in charge of their own room within the clinic with the children rotating throughout the workstations in each room.  Having this consistent, larger student presence in the clinic has not only provided a stronger base for the program, but will also continue to provide more opportunities for students and community members to gain experience working in a prevention group setting.  In addition to these permanent team members, the clinic will still rely on student volunteers, as well as community volunteers, and a rotation of church volunteers.  Community involvement has always played a role in the success of the ROC, but it seems the remarkable improvement shown by students in the program these past few years has garnered even more community and financial support, which will be vital in continuing this program.  

Although group prevention programs for academic purposes are often overlooked in favor of individual tutoring, for the 2016-2017 academic year, the ROC had two students move up four grade levels, three students move up three grade levels, and five students move up two grade levels.  In addition to the success the program has had in improving students’ reading abilities, this program, as well as others like it, also provide an area for job growth, specifically for students graduating with bachelor’s degrees in psychology who do not wish to, or are unable to, attend graduate school (Clanton Harpine, 2016).  Overall, group prevention programs represent a field that will not only benefit the participants in the programs, but also the communities they are a part of by providing more opportunities for support and job expansion.    


Baskin, T. W., Slaten, C. D., Sorenson, C., Glover-Russell, J., & Merson, D. N. (2010). Does youth psychotherapy improve academically related outcomes?: A meta-analysis. Journal of Counseling Psychology, 57, 290-296.

Clanton Harpine, E. (2015). Group-Centered Prevention in Mental Health: Theory, Training, and Practice. New York: Springer.

Clanton Harpine, E. (2016). Prevention Corner: Why can’t I get a job with a four year degree in psychology. The Group Psychologist, 26(2).

Dugdale, G., & Clark, C. (2008). Literacy changes lives: An advocacy resource. London, UK: National Literacy Trust.

National Center for Education Statistics. (2015). The Nation’s Report Card: Reading 2011 (NCES 2015-457). Washington, D.C.: Institute of Education Sciences, U.S. Department of Education.

National Reading Panel. (2000). Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction (NIH Publication No. 00-4754).


Brief Articles

Running Psychoeducational Groups: Ideas for Early Career Psychologists

Sean Woodland, Ph.D.
Sean Woodland, Ph.D.

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.

Following Up

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, or by phone at 801-602-8278.

Brief Articles

Explaining Therapeutic Change in Residential Wilderness Therapy Groups

Lee Gillis, PhD
Lee Gillis, Ph.D.
Keith Russell, Ph.D.
Keith Russell, Ph.D.

Residential wilderness therapy or adventure therapy is “the prescriptive use of adventure experiences provided by mental health professionals, often conducted in natural settings that kinesthetically engage clients on cognitive, affective, and behavioral levels.” (Gass, Gillis & Russell, 2012 p.1).  The term adventure therapy is used in the literature interchangeably with “wilderness therapy” (Russell, 2001) and “outdoor behavioral healthcare (OBH)” (Russell & Hendee, 2000).  All these terms refer to treatment that takes place with small groups often in outdoor settings utilizing either short (1-5 days) forays into nature or extended expeditions (14-60 days) where participants are immersed in a wilderness setting. White’s (2015) history of the field points to an evolutionary tree for adventure therapy whose DNA includes therapeutic summer camps, Boy Scouts, Outward Bound, and even The Church of Jesus Christ of Latter-day Saints.  The recorded history of this therapeutic intervention dates back to 1861.

How does Outdoor Behavioral Healthcare look in practice?

Therapeutic outdoor experiences typically occur in small groups (4-8 clients). Most of the groups are “open” with clients entering and leaving as they go through intake or discharge; it is rare these days to have a cohort of clients who go through a whole program together.  Thus, the group climate can be in constant flux and how congruent a member’s perceptions are with the rest of the group has been found to have implications for treatment progress. At least that is the premise put forth in the Gillis, Kivlighan, & Russell (2016) manuscript in volume 53 of Psychotherapy.

Theoretically, the OBH group therapy that takes place has the members’ shared experience(s) of paddling, hiking, rock climbing, etc. on which to reflect and give feedback to one another.  Individuals set therapeutic intentions prior to an outing and project when they may have opportunities to engage in that intention.  For example, prior to a recent river crossing, one group member, based on his past history with the group, wanted to step up and take the lead with his peers as he had been sitting back and letting others take charge in previous activities.  He projected that once they arrive at the river would be his first opportunity to step forward.  Conversely, another group member stated his therapeutic intention was to stay quiet and listen to others as he had previously blurted out what he was thinking with little regard for what other group members wanted to do.  In each case the group members offered suggestions to clarify the intentions and question how they might see it realized.  The intentions are written down in the group room and then used as the basis for feedback in the group session following the experience.

Many of us who embrace this particular experiential approach find a strong foundation in principles of Gestalt Therapy, Psychodrama, and Carl Rogers’ Person Centered groups while grounding ourselves in evidence based cognitive behavioral approaches to treatment.  The conscious and intentional use of metaphor (Bacon, 1983; Gass, 1991), influenced by Milton Erickson’s work, is also prominent among many adventure therapists.  For example, the river crossing mentioned above provides numerous therapeutic metaphors to discuss in a group session whether they be being mindful of how one steps forward in life when the footing is unsteady or simply the challenges of getting from one place to another (one side of the river to the other).

Making sense of the adventure therapy group climate black box

The metaphor of a “black box” (Ashby, 1956) is often used when trying to make inferences about how change takes place within a program when examining only inputs (pretests) and outputs (posttests). Positive pre to post treatment changes in client progress as measured by the Outcome Questionnaire 45.2 (OQ 45.2) (Lambert & Finch, 1999) and Youth Outcome Questionnaire 2.0 SR (YOQ 2.0 SR) (Bulingame, et al 1996) during adventure therapy experiences for adolescents and young adults has been well documented (c.f., Bettmann et al., 2016, Gillis, et al. 2016, Norton et al, 2014). Meta-analyses have consistently demonstrated moderate (d = 0.45) effect sizes for adventure therapy (c.f., Bowen, Neill & Crisp, 2016; Cason & Gillis, 1994).

Russell, Gillis, & Heppner (2016) recently found that changes in the non-reactive factor of trait mindfulness (Baer, et al., 2008) helped explain OQ 45.2 change in young adults being treated for substance use disorder in an OBH program despite the program studied not having formal mindfulness training.  The authors posited adventure therapy as a mindfulness-based experience (MBE) especially when involved in reflecting on their excursions into the wilderness with explicitly stated therapeutic goals to achieve while out on trail.

The global changes in the non-reactive mindfulness factor among clients does not examine how engagement in the group experience influences outcome.  That was the purpose of the Gillis et al. (2016) manuscript in volume 53 of Psychotherapy. We examined how other member and person context moderate the relationship between group members’ perceptions of engagement and their treatment outcome using the actor partner interdependence model (APIM).

When the other group members generally see the group climate as engaged, higher general perceptions of engagement for the member are related to fewer depression and anxiety symptoms, clarity of social roles and interpersonal relationships.

When the other group members generally see the climate as not engaged, higher general perceptions of engagement for the member are related to more problems.

When the group member generally sees the climate as engaged, higher member biweekly perceptions of engagement related to fewer problems during that 2-week period.

When the member generally sees the climate as not engaged, higher biweekly perceptions of engagement for the member are unrelated to changes in problems.

Summary and Conclusions

In essence, this research is highlighting the role that congruence in member, group, and leader perceptions play in effectuating treatment outcome. When these perceptions become misaligned, individual client well-being can be affected, which in turn could create a cascading effect, leading to isolation and withdrawal from the group, thus affecting overall group engagement.  Monitoring these perceptions of engagement in conjunction with progress monitoring is warranted.  Practical implications for group therapists are to routinely monitor how group members view the group climate.

In this article we used the five item engagement subscale of MacKenzie’s (1983) Group Climate Questionnaire. We have recently switched to the Group Questionnaire available at in an attempt to examine how the three factor structure (positive bonding, positive working, and negative relationship) might provide more information to both therapist and to group members when used in progress monitoring. We will continue to examine the effects that bonding and working relationships has on treatment outcome both in the moment and during the weeks prior to group and community meetings because of our preliminary findings.

Finally, as authors, we are deeply indebted to Dr. Dennis Kivlighan for the APIM analysis and mentorship with the statistics!


Ashby, W. R. (1956). An introduction to cybernetics. An introduction to cybernetics. London: Chapman & Hall Ltd

Bacon, S. B. (1983). The conscious use of metaphor in Outward Bound. Denver, CO: Colorado Outward Bound School

Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., Walsh, E., Duggan, D., & Williams, J. M. G. (2008). Construct validity of the Five Facet Mindfulness Questionnaire in meditating and no meditating samples. Assessment, 15(3), 329-342.

Bettmann, J. E., Gillis, H. L., Speelman, E. A., Parry, K. J., & Case, J. M. (2016). A meta-analysis of wilderness therapy outcomes for private pay clients. Journal of Child and Family Studies, 1-15.

Bowen, D. J., Neill, J. T., & Crisp, S. J. (2016). Wilderness adventure therapy effects on the mental health of youth participants. Evaluation and Program Planning, 58, 49-49.

Burlingame, G. M., Wells, M. G., Hoag, M. J., Hope, C. A., Nebeker, R. S., Konkel, K., McCollam, P., & Reisenger, C.W. (1996). Manual for youth outcome questionnaire (Y-OQ). Stevenson, MD: American Professional Credentialing Services.

Cason, D. & Gillis, H.L. (1994). A meta-analysis of outdoor adventure programming with adolescents. Journal of Experiential Education17(1), 40-47.

Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, practice, & research. NY: Routledge Publishing Company

Gass, M. A. (1991). Enhancing metaphor development in adventure therapy programs. Journal of Experiential Education14(2), 6-13.

Gillis Jr, H. L., Speelman, E., Linville, N., Bailey, E., Kalle, A., Oglesbee, N.,Sandlin, J., Thompson, L., & Jensen, J. (2016). Meta-analysis of treatment outcomes measured by the Y-OQ and Y-OQ-SR comparing wilderness and non-wilderness treatment programs. Child & Youth Care Forum, 45, 851-863

Gillis, H. L. (L.), Jr., Kivlighan, D. M., Jr., & Russell, K. C. (2016). Between-client and within-client engagement and outcome in a residential wilderness treatment group: An actor partner interdependence analysis. Psychotherapy, 53(4), 413-423.

Lambert, M. J., & Finch, A. E. (1999). The Outcome Questionnaire. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (2nd ed.) (pp. 831-869). Mahwah, NJ: Lawrence Erlbaum Associates.

MacKenzie, K. R. (1983). The clinical application of a group climate measure. In R. R. Dies & K. R. MacKenzie (Eds.), Advances in group psychotherapy: Integrating research and practice (pp. 159–170). Madison, CT: International Universities Press.

Norton, C. L., Tucker, A., Russell, K. C., Bettmann, J. E., Gass, M. A., Gillis, H. L., & Behrens, E. (2014). Adventure therapy with youth. Journal of Experiential Education37(1), 46-59.

Russell, Keith C. (2001). What is wilderness therapy? Journal of Experiential Education, 24(2) 70-79.

Russell, K. C., Gillis, H. L., & Heppner, W. (2016). An examination of mindfulness-based experiences through adventure in substance use disorder treatment for young adult males: A pilot study. Mindfulness, 7(2), 320-328.

Russell, K. C., & Hendee, J. C. (2000). Outdoor behavioral healthcare: Definitions, common practice, expected outcomes, and a nationwide survey of programs. Idaho Forest, Wildlife, and Range Experiment Station.

White, W. (2015). Stories from the field: A history of wilderness therapy.  Wilderness Publishers.

*This article was first published in The Society for the Advancement of Psychotherapy February 26, 2017.  Gillis, H. L., & Russell, K. C. (2017, February). Explaining therapeutic change in residential wilderness therapy groups. [Web article]. Retrieved from:

Brief Articles

Prevention Corner: Everyone Learns Differently

Elaine Clanton Harpine, Ph.D.
Elaine Clanton Harpine, Ph.D.

With the onset of a new school year, many parents are worried about their children’s progress in school.  The problem of reading failure is of particular concern.  Research has shown that prevention groups can be very effective in helping children overcome reading problems (Berking et al., 2008).  What kind of help can we as group psychologist offer to parents and teachers?


Dear Prevention Corner:  I saw the article in the newspaper this week that talked about your reading program. You did not talk about dyslexia. The school says that my son has dyslexia.  They sent me to a private tutor.  Which is better– group or tutor?  The tutor says that I am wrong because I have not told my son that he has dyslexia.  Should I tell him? 



 Dear Confused:

There are many different philosophies on whether a child should be told or not told that they have a learning disability.  There have been instances where children were diagnosed with dyslexia and have used such a diagnosis as an excuse for not being able to read.  As one student said to me one day: “You know I can’t read; I’m dyslexic.”  On the other hand, another student said, “Wow, that’s how I feel.  Now that I know that we’re all having the same problem, I’m going to learn to read.”  In my group-centered prevention program, I neither identify or label children. I believe that labels stigmatize.  Instead of saying the child has a learning disability, I say that everyone learns differently; therefore, we have learning differences.  In my opinion, whether you tell or do not tell your child is up to you.

As to your second question, which is better:  group or tutor.  I believe that prevention groups offer a major advantage over tutoring and research supports this opinion.  In my own research, children who participated in my group-centered prevention program outscored children who received one-on-one tutoring (Clanton Harpine & Reid, 2009).  Prevention groups offer many benefits that cannot be obtained through one-on-one tutoring.  Groups create a healing atmosphere, allow children to interact and work with others, and make it easier for the child to transfer what they learned back to the classroom.  In my group-centered program, Camp Sharigan, that was described in the newspaper article that you mentioned, I use six different methods for teaching reading and incorporate 11 different therapeutic factors into the group.  By combining learning and counseling together, I am able to provide a much stronger program.  Other researchers have also found this to be true (Baskin et al. 2010; Jones et al. 2015).

In my after-school Reading Orienteering Club, I use the same learning and counseling group concept.  Every child starts by learning the lower case alphabet and then begins to expand their phonemic awareness through vowel clustering.  Neuroimaging studies of the brain have shown that dyslexia results from differences in how the brain functions, particularly the posterior left hemisphere.  This is not a deformity or structural problem.  It simply means that through functional brain imaging (fMRI), researchers have been able to detect that children diagnosed with dyslexia use a different part of the brain.  This in no way means that children diagnosed with dyslexia are less intelligent.  One particular student that I worked with was extremely intelligent in science, history, and math.  Yet, the student could not read at the beginning (pre-primer) kindergarten level.  The student was in third grade, and I’m grateful to say that when he left my program at the end of the year, the student was reading beginning chapter books.

If your child has dyslexia, you want to find a program that will help your child visually identify letter shapes– the lines and curves of both capitals and lowercase letters.  We read primarily with a lowercase alphabet.  Yet, when we teach the alphabet in school, we teach capitals and lower case letters side-by-side.  One of the first big problems that I find with children who come into my program is that they may know their capitals but they do not know their lower case alphabet letters.

The second thing that a child who has been diagnosed with dyslexia needs is phonemic awareness– being able to translate letter symbols into phonemes or sounds.  This is a major step for all children.  There are many children who are labeled as being dyslexic, but in actuality, their problem is that they have never been taught phonemes or letter sounds.  Children must be able to translate written letters into sounds before they can learn to read.  Simply memorizing a word list does not teach phonemes or letter sounds.  Not all children learn the same way which is why I use six different teaching methods in my group program, but each teaching method that I use starts with phonemic awareness—translating letter symbols into sounds.

The third critical aspect in the program for a student diagnosed with dyslexia is that the student must understand the meaning of words.  Without understanding the meaning of words, there cannot be comprehension.

Reading fluency is also another major concern of children who have been diagnosed with dyslexia.  I use puppet plays and reading for a puppet to help children improve their fluency.  Reading out loud is the most effective way to help children improve reading fluency; stop watches and timing students while they read is harmful, especially for dyslexic readers.

Finally, to return to your question:  Which is better—group or tutor?  A prevention group can offer your child advantages and motivation that a one-on-one tutoring situation cannot provide.  It is the combination of being an accepted member of the group and working with others in a positive, supportive environment.  I believe that groups achieve their most success when they combine learning and counseling together in one single program.  I also believe that hands-on programs offer lots of opportunities for all students but especially students diagnosed with dyslexia.

Good luck to you and your child, and I hope that I’ve answered your questions.

For others who might wish to join this discussion, please send your comments and group prevention concerns to Elaine Clanton Harpine at


baskin, t. w., Slaten, C. D., Sorenson, C., Glover-Russell, J., & Merson, D. N.  (2010).  Does youth psychotherapy improve academically related outcomes?:  A meta-analysis. Journal of Counseling Psychology, 57, 290-296.  doi:  10.1037/a0019652

Berking, M., Orth, U., Wupperman, P., Meier, L. L., & Caspar, F.  (2008).  Prospective effects of emotion-regulation skills on emotional adjustment.  Journal of Counseling Psychology, 55, 485-494.  doi:  10.1037/a0013589

Jones, D. E., Greenberg, M., & Crowley, M.  (2015).  Early social-emotional functioning and public health:  The relationship between kindergarten social competence in future wellness.  American Journal of Public Health,105, 2283-2290.  doi:  10.2105/AJPH.2015.302630

Brief Articles

Group Specialty Council: Promoting Group Psychology and Psychotherapy

Promoting Group Psychology and Psychotherapy

Nina Brown, Ed.D., LPC, NCC, FAGPA
Nina Brown, Ed.D., LPC, NCC, FAGPA
Eleanor F. Counselman, Ed.D., ABPP, CGP, LFAGPA
Eleanor F. Counselman, Ed.D., ABPP, CGP, LFAGPA

The Group Specialty Council, with members from Division 49, the American Board of Group Psychology (ABGP), the International Board for Certification of Group Psychotherapists, and the American Group Psychotherapy Association (AGPA) is hard at work preparing a new petition to have group psychology and psychotherapy approved as an APA specialty.

As part of the petition we must show four model programs that demonstrate group specialty training. Finding such programs has been a challenge and has awakened us to the need to have group psychotherapy training better publicized.  Group training programs are not well publicized or visible so that prospective students, the general public, and regulating bodies such as CRSPPP, can easily determine that such training programs are available in a doctoral program, or an internship, or a post-doctoral residency.

There are over 200 APA accredited doctoral and internship programs in the United States, all of which are supposed to have education and training program information on their websites, but our review of these websites did not reveal any group psychology and group psychotherapy training programs.  The absence of visible programs is a major hindrance for the current petition to gain recognition for group as a specialty in training programs.

It is important and essential that members of The Society who are faculty at university APA accredited doctoral and internship programs in clinical, counseling and school psychology work to get their group education and training programs more visible on the website and other public materials, and to get their programs to formally designate group as an emphasis, or track or concentration and to publicize this. Sometimes this is just a matter of updating an existing website. Or it might mean creating a link to new material.

We are confident that there are numerous educational and training opportunities in group psychology and group psychotherapy.  Josh Gross, the director of the Florida State University’ College Counseling Center surveyed  College Counseling Training Directors, 42 responded  and found ten that had possible group training opportunities and requirements that could be designated as a program, or an emphasis, or a track, or a concentration but had not been designated so or recognized as such in their public materials.

We need your assistance in bringing more visibility to the group psychology and group psychotherapy doctoral and internship training programs, emphases, concentrations, or tracks. We believe there will be increased demand for group therapy in the future, as it is an evidenced-based treatment for many disorders  (see the AGPA Practice Resources website) that is efficient and cost effective. However, psychologists who do not have adequate group therapy training are being asked to lead groups, and this is not good for the profession, much less the patients. Specialty status and promotion of training opportunities will help support group therapy and the training sites that offer it.

Brief Articles

University/College Therapeutic Diabetes Support Group Therapy

Kathleen Lehmann, MA
Kathleen Lehmann, MA


This paper serves as a proposal for a therapeutic support group for those with type 1, type 2, and gestational diabetes in university/college environment. While a great deal is known about the medical implications of diabetes, those living with the conditions find very few opportunities in which they are able to gain psychological support to help come to terms and cope with the condition. This paper outlines a professional therapeutic diabetes support group, in which professionals would come together to learn more about diabetes and increase compliance and accountability. Over the span of the group, members will learn details about diabetes, learn ways to cope with and fight stigma, and also build rapport and develop a community from which they can obtain support in the future. The aim of the group is to have members end up with a better understanding of diabetes and develop ways to help maintain a healthier lifestyle physically and psychologically.

Keywords: diabetes, type 1, type 2, gestational diabetes, group therapy, therapeutic support group, diabetes stigma, university

University/College Therapeutic Diabetes Support Group Therapy

Diabetes is a medical condition in which your body has issues that cause blood glucose (sugar) levels to rise higher than normal (American Diabetes Association, 2015). There are two main types of diabetes: Type 1 and Type 2. In type 1 diabetes, the body, more specifically the pancreas, does not produce insulin. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. Type 2 diabetes is the most common form of diabetes. With type 2, the body does not use insulin properly, referred to as insulin resistance. At first, the pancreas makes extra insulin to make up for it. Over time it is not able to keep up and cannot make enough insulin to keep the blood glucose at normal levels (American Diabetes Association, 2015). In addition to problems with insulin regulation, diabetes can cause complications with high blood pressure that can raise the risk for heart attack, stroke, eye problems, and kidney disease if left untreated (American Diabetes Association, 2015).

Purpose of Group

The prevalence of type 1 and type 2 diabetes has been increasing worldwide in the last few decades (Unnikrishnan, Bhatia, E., Bhatia, V., Bhadada, Sahay, Kannan, & Sanjeevi, 2008). Diabetes is a growing challenge for health care systems worldwide. Recent estimates have predicted that more than 300 million people will have the condition by the year 2025 (Gomersall, Madill, & Summers, 2011; King, Aubert, & Herman, 1998; Zimmet, Alberti, & Shaw, 2001). These numbers are shocking, and preventions and interventions for diabetes are crucial now more than ever. While the medical field is doing what it can to aid developing these interventions and preventions, assistance from the experts in psychology would help to bolster the effort even more.

While it is known that there is currently a diabetes epidemic, little attention is given to the ever growing young adult population diagnosed with diabetes (Wolpert & Anderson, 2001). Young adults with diabetes face unique challenges as they transition to self-care, and yet they fail to fit into neither pediatric nor adult medicine to help address these challenges. Because of this, they tend to be a forgotten group within the university/college population and counseling centers. University/college counseling centers, according to Gallagher (2014), typically include groups for students struggling with, anxiety disorders, crises requiring immediate response, psychiatric medication issues, clinical depression, learning disabilities, sexual assault on campus, self-injury issues, (e.g. cutting to relieve anxiety), and problems related to earlier sexual abuse.

However, there is a paucity of diabetes support groups in these counseling centers. When they are present, utilization and participation of these groups are low. Many young adults are affected by serious disorders, such as epilepsy, diabetes, or autism, and support for these groups of people on college campuses falls short. People in general tend to close their eyes and are blind to these groups. Research has shown us that these disorders, specifically diabetes, come with a number of negative implications, such as depression, anxiety, and poor self-esteem (Schabert, Browne, Mosely, & Speight, 2013). However, the research is limited in that it does nothing to provide these groups of people with the psychological support they need when dealing with diabetes. For all of these reasons, the need is greater now more than ever for a support group that targets under serviced groups.

The diabetes epidemic is much more of an issue than the public realizes (Schabert et al., 2013). While the above facts give examples of how the medical field acknowledges the severity of the disease, the ways in which the field of psychology and counseling helps to support people with diabetes are few. There is a huge stigma and misconception around diabetes (Schabert et al., 2013). People with diabetes know all too well the reality of living in a world where they are labeled and judged because they have a medical condition. Many people with diabetes experience constant worry, and many consistently face feelings of self-blame, fear, disgust, and feeling the need to fit into societal norms and avoid their disease. They also fear being judged, rejected, and discriminated against due to their condition (Schabert et al., 2013). This concept may give indication as to why compliance and accountability are huge issues with diabetes. People with the diagnosis may be in denial about their condition, where admitting that they have diabetes would mean admitting that there is something wrong with them (more than a medical condition). Because of this, they may be more likely to be noncompliant with their diabetes self-care and have little accountability over the decisions they make. The stigma has been found to cause serious issues with a person’s psychological well-being (Schabert et al., 2013). There is a great shame in people with diabetes; that somehow it is their fault that they have this medical condition. For that reason, therapeutic diabetes support groups need to be established to help people realize that they are not alone in their disease and that it is not a character fault.

The young adult period marks a critical point in a person’s life, where lifelong routines of self-care are set (Wolpert & Anderson, 2001). This presents a window of opportunity to intervene and influence habits that will help maintain good health later in life. For that reason, this paper proposes that we target this young adult group during college and as they start settling into their careers. In addition, the incidence of diabetes is so high and steadily increasing and more people are left with having to come to terms and deal with the ramifications of this condition. A therapeutic diabetes support group would aim at making the transition easier on people new to the diagnosis, as well as allowing people who have lived with the condition for many years to have much needed support. The overall purpose of the group would be two-fold: help with the medical aspects of the condition, such as education on what diabetes is, information about blood glucose/testing, and dietary/exercise information, as well as provide support and accountability to help increase compliance. The focus will be to not only provide emotional and psychological support to those with diabetes, but to help normalize the concept of diabetes and to try to help end the stigma as well.

Type of Group

The therapeutic diabetes support group plans to focus on psychoeducation, skill development, and support for emerging adults with diabetes. Research has found that self-management is the most used approach to diabetes control (Gomersall, Madill, & Summers, 2011). In this self-management approach, patients are awarded the responsibility for managing their illness, for example adopting new diets and regular exercise. To control diabetes, individuals must oversee daily behavior and long-held habits that often have to be changed (Gomersall, Madill, & Summers, 2011). Understandably, this leaves room for the client to curb or even ignore compliance to these guidelines. It has been found that for people with diabetes, adhering to these programs of self-care is often problematic (Nagelkerk, Reick, & Meengs, 2006). In addition to compliance in general, a number of other barriers have been cited to cause problems. The most frequently reported barriers were lack of knowledge of a specific diet plan, lack of understanding of the plan of care, helplessness and frustration from a lack of glycemic control, and continued disease progression despite adherence to the guidelines (Nagelkerk, Reick, & Meengs, 2006). In light of these findings, a support group that focuses on the development of skills needed for diabetic maintenance, as well as psychoeducation on the disease in general, will be the most effective approach in working with this population. The therapeutic support group will focus on developing a collaborative relationship between the facilitator and group members, maintaining a positive attitude that prompts proactive learning, and having a support person who provides encouragement and promotes accountability.

Screening Criteria  

Screening criteria for the therapeutic diabetes support group will be simple but rigid. Members must have a diagnosis of type 1, type 2, or gestational diabetes. The main caveat with this group is that it will aim to be a professional diabetes group. Professionals are people with the standards of education and training that prepare members of the profession with the particular knowledge and skills necessary to perform the role of that profession. For that reason, members should be working graduate level students or professionals in emerging adulthood. Making the group a professional association works to ensure stricter compliance, accountability, attendance, and higher group rapport. The group will have a rolling admissions, and members will be able to pick up where they need. Members can be selected through a referral program or through their job place/college campus.

In addition, each member must have a blood glucose meter or a continuous blood glucose monitoring system readily available. They must have access to a computer and/or smartphone for tracking of blood sugar levels. There will be a strict attendance policy due to the fact that compliance and accountability are key components of the group. Missing a session will result in termination from the group (extenuating circumstances will be evaluated on a case by case basis). Members must agree to these conditions and sign a contract at the beginning of the initial session. Finally, research has suggested that “stage of change” may be a good predictor of attendance at diabetes prevention and intervention sessions and have implications for intervention design and assessment (Helitzer, Peterson, Sanders, & Thompson, 2007). Because of this, the group should include only people in at least the preparation stage of change. The stage of change model explains that there are five stages a person goes through when they are making a behavior. The stages include pre contemplation, contemplation, preparation, action, and maintanence (Prochaska & DiClemente, 1983). The success of the group will be based heavily on each member’s willingness to change and devotion to the rules and regulations of the group. An evaluation by the member’s therapist, doctor, and/or an interview with the group facilitators as to what stage of change the client is believed to be in will be necessary for admittance into the group. This will help ensure a higher chance that the members will attend the sessions and therefore have higher chance for success with compliance.

Role of Group Leaders and Facilitation Issues

The biggest facilitation issue will be the compliance and attendance of the group members. Because of this, the attendance policy will be very strict and groups will run weekly. The group should include a small, even number of people – preferably around six. There will be two group leaders. One should have diagnosis of diabetes themselves, and the other should be a person without diabetes who can act as a neutral, non-invested party. At least one should be therapist as well. The role of the group leaders will be to facilitate group discussions, answer questions, hold group members accountable, and provide support.

Methods and Techniques

Each session will begin with the group leaders checking in with all of the members and discussing any issues that arose from the previous week. Every session will focus on a specific topic surrounding diabetes maintenance. The group will be highly collaborative in nature, and each session topic for the following weeks will be picked by the group in the first session. Topics may include things like diets and exercise, psychoeducation on diabetes, how to maintain accountability and compliance, blood glucose meter training, and tracking of blood glucose levels. When appropriate, the group leaders will arrange a guest speaker to come into the session to discuss that week’s topic. This may include help from a dietician, for example, where every group member will be given their own personalized diet plan to follow.

In addition, medical specialists in the field of diabetes will come to educate the group on what diabetes actually is and the science behind what is going on in the body. A session will be devoted to the discussion of the psychological and emotional impacts of diabetes and how to cope with them. A nurse practitioner will attend one session to administer initial blood glucose readings (to serve as a baseline for comparison after the group has ended) and demonstrate proper use of blood glucose meters, as well as appropriate times to test blood glucose throughout the day (typically 1-2 hours after meal times). A personal trainer will attend one group to educate the members about the importance of physical activity and will help each member develop personalized exercise routines. Finally, a guest speaker will come teach the group how to track their levels in a smartphone/computer app. The members will then be able to bring their results to session every week for analysis and discussion. This will also serve as data throughout the length of the group.

Accountability will be the main component of this group. Within the group itself, everyone will be paired up with another individual. In addition to the accountability to the entire group, each member will form a therapeutic alliance with their own personal partner to further facilitate compliance. Weekly check-ins with the therapeutic partner (in addition to the actual group meeting) will be necessary. Further, members should utilize their therapeutic partners on an as needed basis throughout the week for added support. Every group member will also be given the group leaders’ contact information as a last source of support. The group leader will focus on one member every week to stay accountable to and will check in with this person daily.

Duration of Group and Expected Outcomes

Depending on the number of topics selected by the group in the first session, the group will run anywhere from 8-12 weeks. Sessions will be on a weekly basis on the assigned day and time. They will be held in the evening or on weekends to accommodate the members. After the group has ended, it is hypothesized that compliance and accountability towards their diabetes maintenance (adherence to diet, exercise, blood glucose monitoring, etc.) will increase. In addition, the members’ levels of depression, anxiety, and stress involving their diagnosis are hypothesized to decrease. Overall health and well-being (as reported in self-report form and in regards to weight loss, stamina, and overall better sense of self) is expected to increase. Finally, it is hypothesized that there will be a decrease in the overall average blood glucose levels.

Process of Evaluation

Evaluation will take place in the form of self-report, scales, and data collected throughout the span of the group. At the end of the group, the members will submit journal entries detailing their progress and how they feel the group has helped them. Depression, anxiety, and stress will be measured using pre and post scores from the Beck Depression Inventory, the Holmes-Rahe Stress Inventory, and the Health Anxiety Inventory. In addition, the data collected from each member’s smartphone/computer app will be analyzed to review the overall progress of each member and the group as a whole. The more precise blood draw taken by the nurse practitioner to measure blood glucose levels pre and post group will be used in addition to the data collected personally by the members to ensure that their true progress is calculated, and to counteract any deception by the members on their personal recording of levels. Finally, attendance and a self-report of the number of compliance days (diet, exercise, check-ins with partner, etc.) will be recorded as a final measure to check for compliance and accountability.


The aim of the therapeutic diabetes support group is to end with a better understanding of diabetes and how to best maintain a healthy lifestyle, both physically and psychologically, as well as to increase compliance and accountability. Through psychoeducation and a better medical understanding, the group members should be able to combat the stigma against them in better ways. Hopefully, they will be able to spread strength, knowledge, understanding, and positivity to help end the stigma altogether. By using a model of professionals with diabetes, the hope is that there will be more compliance and accountability. These concepts are extremely important in the initial stages as the group in general as it is just starting out. As the number of cases of diabetes continues to increase, creating a group that will help this population is critical. The proposed group will help people to come to terms with their diagnosis, get the emotional and psychological support they need, and ultimately end the stigma.


American Diabetes Association. (2015). Retrieved from

Gomersall, T., Madill, A., & Summers, L. M. (2011). A metasynthesis of the self-management of type 2 diabetes. Qualitative Health Research, 21(6), 853-871.doi:10.1177/104973231 1402096

Gallagher, R.P. (2014) The national survey of college counseling centers. Retrieved from

Helitzer, D. L., Peterson, A. B., Sanders, M., & Thompson, J. (2007). Relationship of stages of change to attendance in a diabetes prevention program. American Journal Of Health Promotion, 21(6), 517-520.

King, H., Aubert, R., & Herman, W. (1998). Global burden of diabetes, 1995-2025. Prevalence, numerical estimates and projections. Diabetes Care 21(9), 1414-1431. doi:10.2337/ diacare.21.9.1414

Nagelkerk, J., Reick, K., & Meengs, L. (2006). Perceived barriers and effective strategies to diabetes self-management. Journal Of Advanced Nursing, 54(2), 151-158. doi:10.1111/ j.1365-2648.2006.03799.x

Prochaska, J. and DiClemente, C. (1983) Stages and processes of self-change in smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology, 5, 390–395.

Schabert, J., Browne, J. L., Mosely, K., & Speight, J. (2013). Social stigma in diabetes: A framework to understand a growing problem for an increasing epidemic. The Patient: Patient Centered Outcomes Research, 6(1), 1-10. doi: 10.1007/s4027-012-0001-0

Unnikrishnan, A. G., Bhatia, E., Bhatia, V., Bhadada, S. K., Sahay, R. K., Kannan, A., & …Sanjeevi, C. B. (2008). Type 1 diabetes versus type 2 diabetes with onset in persons younger than 20 years of age. Annals Of The New York Academy Of Sciences, 1150239-244. doi:10.1196/annals.1447.056

Zimmet, P., Alberti, K. G., & Shaw, J. (2001). Global and societal implications of the diabetes epidemic. Nature, 414, 782-787.doi:10.1038/414782a


Brief Articles

Prevention Corner: Why Can’t I get a Job with a Four Year Degree in Psychology

Elaine Harpine, PhD
Elaine Clanton Harpine, Ph.D.

Prevention Corner

Why Can’t I Get a Job with a Four-Year Degree in Psychology?

As you have probably noticed in the Monitor on Psychology, in both the February and June 2016 issues, discussions over employment opportunities with a four-year psychology degree have intensified. In the February 2016 issue of the Monitor on Psychology, the APA Center for Workforce Studies stated that 38.2% of college students who graduate with a four-year degree in psychology take jobs that are “not related” to psychology. Career counselors often suggest that four-year psychology majors look for jobs as a business manager, in labor relations, as a library assistant, probation officer, in sales, real estate, insurance, marketing, case management, and in social services. In June, the Monitor reported that “sales” was the most common job for four-year bachelor degree graduates. As one student stated, “not exactly what I expected when I majored in psychology.”

The sad fact is that it doesn’t have to be this way. We are losing many outstanding students in psychology because financially they need to be able to qualify for a good paying career oriented job upon graduation with a four-year degree.

Just the other day, I was confronted on campus by a student who had worked at my community-based clinic for at-risk children. “I’m changing my major,” she said, “I won’t be able to work for you this year. My parents insist that I get a degree that will get me a job. I can’t go to grad school. I have to pay off student loans.” I naturally tried to persuade the student to stay in psychology, but in the end, I couldn’t argue that a four-year degree in psychology really only prepared you to go on to graduate school. Even the Bureau of Labor Statistics states that most four-year psychology majors do not end up working in psychology related fields. This dilemma is the background for our editorial question today.

Editorial Question Posed:

Dear Prevention Corner: 

I’m a graduate student, and I attended your symposium at the 2015 APA convention in Toronto on effective training methods. I really liked what everyone said about prevention programs. Why are schools not offering training in prevention groups? This would have been perfect for me. Is it possible to get a four-year degree in prevention? Does your university offer a program?



Dear Excited:

I’m always happy to hear from students who are excited about prevention. I’m glad you enjoyed the symposium. Unfortunately, I must report that NO, the university where I presently work does not offer a four-year degree program in prevention. I also must admit that at present I do not know of a university offering a complete 4-year degree, specialization, or 4-year training emphasis in prevention groups. This is a problem that has been discussed extensively for years. Some universities offer prevention mixed in with other subjects, but few if any offer complete training programs in group prevention. Yet the need is astronomical: medical prevention groups (cancer, diabetes, heart attack), school-based prevention, violence and anger prevention groups, bully prevention, and health prevention groups (obesity, stress). The list could go on and on. In 2013, the Report of Healthy Development reported that there is a definite need for prevention groups and a definite need for effective training programs in prevention. In 2014, an APA task force stated that prevention group training programs at present are not effective and that most of the people presently conducting prevention group programs are poorly trained or not trained at all. So, what do we do?

Many of these prevention groups, such as diabetes or heart attack prevention, do not necessarily need a licensed therapist. What they need is a trained psychologist who specializes in organizing and conducting effective prevention group programs.

Such a job would be perfect for bachelor degree graduates. Such a program would also fill the needs of many communities.

We could expand our psychology student population if we offered a four-year degree in prevention groups. We could fill a desperate need and increase psychology’s outreach into the community, schools, and medical- health related world by expanding our curriculum choices and adding a four-year specialization in prevention groups. A four-year bachelor’s degree in group prevention would allow students like yourself the option of working in psychology rather than settling for a sales job after completing your degree.

The need is widespread. At present approximately 26% of all adults experience some form of mental health disorder, but very few actually seek help because of the stigma attached to therapy (Vogel et al. 2011).   Prevention would not take away from or replace therapy. There will always be a need for therapy, but by expanding psychology’s prevention outreach, we could increase mental health services to those who refuse to seek therapy. Most prevention is conducted in groups; therefore, training in group prevention techniques is essential. Research also shows that approximately 50% of such mental disorders in adults originated or began before the age of 14 (Pirog & Good, 2013). There is a desperate need to reach people at an early age, especially since early prevention has been documented to eliminate or significantly reduce many mental health concerns (Kazak et al., 2010). Prevention groups could fill this need, especially through community and school-based settings.

We have the need. We have the ability to fill the need. We have psychology students, like yourself, interested in a four-year group prevention degree. So, why do we not have such a program?

Change is slow, but let’s dream for just a minute and outline what such a specialization could entail. We’ll highlight 13 possible classes that might be offered in a four-year specialization in prevention groups.

All students in psychology need a general overview course. Some have suggested that students looking at a four-year prevention degree might benefit the most from an introductory course on how psychology is applied to everyday life. There are already many excellent textbooks on the market and many schools even offer an introductory course in applied psychology. Developmental psychology would also be essential, especially a course that covered development across the lifespan. Social psychology, already offered by many schools, would need to emphasize interaction between individuals and within groups.

  1. Introductory course in psychology applied to everyday life
  2. Developmental psychology or life span development
  3. Social psychology and the development of perceptions

At the point where traditional psychology majors turn to research methods and statistics, four-year psychology students in prevention groups need training in applied techniques and interventions. One of the major weaknesses in group psychology, regardless whether you are working in group prevention or group therapy, is the lack of training that we offer in understanding the intricacies of group process. Many people falsely believe that working with individuals in a group setting is the same as individual single-client therapy. This is not true. To work effectively with a group, all psychologists must be trained in group process. One semester when I was teaching group psychotherapy, I took my graduate students to observe an outpatient group therapy session where the licensed group therapist proceeded to go around the circle of clients talking and working with each client individually while others merely sat and waited their turn. That is not group therapy. In prevention, we have self-proclaimed experts going out and conducting “prevention groups” where children sit on the floor in gymnasiums and merely listen to a lecture. That is not a prevention group. We desperately need effective training programs in group prevention.   The American Psychological Association (2014) avowed that existing prevention group training programs are not effective. Groups can offer a strong healing or corrective influence, but the healing power of a group is only unleashed when group process is used correctly.

Well designed and properly implemented prevention groups have been shown through evidence-based research to be effective. The key is a well-designed and effectively implemented prevention program. This is why effective training programs are essential. Research shows that how a program is used, even an evidence-based program, is the determining factor between success or failure (Pettigrew et al. 2013). Therefore, psychology majors must be taught how to conduct prevention groups effectively. Let’s look at a definition of what group prevention is and perhaps that will help to clarify the complexity of a prevention group.

Prevention groups utilize group process to the fullest extent: interaction, cohesion, group process and change. The purpose of prevention groups is to enhance members’ strengths and competencies, while providing members with knowledge and skills to avoid harmful situations or mental health problems. Prevention groups occur as a stand-alone intervention or as a key part of a comprehensive prevention program. Prevention encompasses both wellness and risk reduction. Preventive groups may focus on the reduction in the occurrence of new cases of a problem, the duration and severity of incipient problems, or they may promote strengths and optimal human functioning. Prevention groups encompass many formats. They may function within a small group format or work with a classroom of thirty or forty. Prevention may also be community-wide with multiple group settings. Prevention groups use various group approaches. Psychoeducational groups are popular and, while some prevention psychologists work within a traditional counseling group, others use a group-centered intervention approach. Two key ingredients for all prevention groups are that they be directed toward averting problems and promoting positive mental health and well-being and that they highlight and harness group processes (Conyne and Clanton Harpine 2010, p. 194).

So, as you can see organizing a prevention group involves more than just gathering a group of people together. You cannot learn to be an effective prevention group leader in a one-hour workshop. If prevention is to be effective, the group organizer must understand the intricacies of group process, interaction, and group cohesion. These intricacies must be taught. Community psychology offers courses to students working in the community and organizing community-based programs. This is why a four-year bachelor degree program would be perfect. Most community psychology programs stress prevention, but few if any, community psychology programs teach group process, how to initiate interaction in a group, or how to achieve group cohesion. You may be able to find psychology courses that talk about groups or discuss using groups, but we have very few courses which actually teach group process. Yet, understanding group process is essential for anyone working with groups.

Therefore, our next selection of courses for a four-year specialization in prevention groups would include courses in group process and prevention. Prevention group workers also need to touch on neuropsychology or the knowledge of how the brain works. A four-year student would not need the depth or research knowledge that a student going on to graduate school would, but prevention group specialists do need background knowledge in neuropsychology.

  1. Group process
  2. Group problems and how to handle difficult group situations
  3. Group prevention techniques
  4. Neuropsychology or knowledge of the brain and how it works

At this point, some readers may be saying: We have workshops, training programs, and evidence-based programs. What else do we need? A single workshop or training program is not enough. We need more in-depth training.

There are three approaches being used presently in group prevention: psychoeducational groups, traditional counseling groups, and group-centered prevention groups. A prevention group specialization would need to teach each of these approaches to group prevention. Again, textbooks are already available.

Research has shown that therapy is more effective when learning or an educational component is incorporated alongside therapy interventions (Baskin et al., 2010). The same is true with prevention groups. From a 20-year longitudinal study, Jones, Greenberg, and Crowley (2015) provide support for this concept of combining learning and counseling. They call it “combining cognitive and non-cognitive skills-training. The cognitive skills are the educational component. The non-cognitive skills include social emotional skills, behavior, personal control, self-regulation, persistence with a task, interpersonal skills or ability to relate to others, and group interaction skills. If you refer back to our definition of a prevention group, each of these skills must be incorporated in a prevention group training program. This level of understanding and training cannot be successfully taught in a single workshop or training session.

Group leaders cannot learn how to work with others effectively in a group setting without professional training (Erchul, 2013). Prevention groups need to offer skills training, especially interpersonal and group skills. Prevention group programs must also offer both a combination of knowledge and skills if such a program is to be effective (Long & Maynard, 2014). Knowledge incorporates the subject or what is being taught (diabetes or heart attack prevention), skills training involves application or how to use such knowledge in everyday life. Before group leaders can teach others, they too must receive skill-based training. One of the primary causes of prevention group failure is poor implementation and the way in which skills and knowledge were taught by the group leader (Coles et al., 2015).

Evidence-based programs sound fantastic, but in practice, they have not always been successful (McHugh & Barlow, 2010). Research has shown that many evidence-based programs result in ineffective practice because the program was not implemented as designed or was used incorrectly (Erchul, 2013). What many group leaders do not understand is that any time you change or only use bits and pieces of an evidence-based program; you have changed the program and thereby changed or reduced the effectiveness of the program (Rotheram-Borus et. al, 2012). Therefore, we need to provide training for group leaders using evidence-based prevention group programs.   Knowing how to implement or use a prevention group program, regardless whether it is an evidence-based program or not, is essential if we are ever to have effective prevention programs and must be included in any four-year degree program.

Students must also be taught how to identify an effective prevention group program as well as learn how to design and develop effective prevention group programs. Evaluation techniques must be taught.

  1. The principles of an effective prevention group
  2. Program evaluation

We also need to teach students how to design effective prevention group programs. Robert Conyne offers an excellent book for psychoeducational style programs (Conyne, 2010, 2013). I offer three books for group-centered prevention programs (Clanton Harpine 2008, 2011, 2013a). Textbooks are available. All that is missing is a 4-year undergraduate course of study in prevention groups.

  1. Designing and conducting an effective group prevention program
  2. Introduction to group counseling
  3. Group-centered prevention: Combining counseling and learning in one prevention group program
  4. Supervised internships working with actual prevention groups

Research states that courses incorporating service-learning result in higher test scores and more knowledgeable application of textbook and course content (Postlethwait 2012). Some universities are now even requiring service-learning courses or as much as 30-hours of service learning during a semester. Supervised internships working with some prevention groups should be a very vital component of any four-year degree.

We have organizations, hospitals, community groups, and schools crying out for trained personnel to organize and conduct prevention group programs. We have students seeking a four-year degree in psychology that will enable them to qualify for employment upon graduation. So, why do we refuse to offer college-level training programs in group prevention?

Students, like yourself, need to step forward and demand a four-year degree program in prevention groups. Faculty need to step forward and make it happen.

If you would like to join this discussion, let us hear from you. We welcome your participation. We invite psychologists, counselors, prevention programmers, graduate students, teachers, administrators, parents, and other mental health practitioners working with groups to network together, share ideas, problems, and become more involved. Please send comments, questions, and group prevention concerns to Elaine Clanton Harpine at


American Psychological Association. (2014). Guidelines for prevention in psychology. American Psychologist, 69, 285-296.   doi: 10.1037/a0034569

Baskin, T. W., Slaten, C. D., Sorenson, C., Glover-Russell, J., & Merson, D. N. (2010). Does youth psychotherapy improve academically related outcomes?: A meta-analysis. Journal of Counseling Psychology, 57, 290-296. doi: 10.1037/a0019652

Clanton Harpine, E. (2008). Group interventions in schools: Promoting mental health for at-risk children and youth. New York: Springer.

Clanton Harpine, E. (2011). Group-Centered Prevention Programs for At-Risk Students. New York: Springer.

Clanton Harpine, E. (2013). After-school prevention programs for at-risk students: Promoting engagement and academic success. New York: Springer.

Clanton Harpine, E. (2015). Group-Centered Prevention in Mental Health: Theory, Training, and Practice. New York: Springer.

Coles, E. K., Owens, J. S., Serrano, V. J., Slavec, J., & Evans, S. W. (2015). From consultation to student outcomes: The role of teacher knowledge, skills, and beliefs in increasing integrity and classroom management strategies. School Mental Health, 7, 34-48.   doi: 10.1007/s12310-015-9143-2

Conyne, R. K. (2010). Prevention program development and evaluation: An incident reduction, culturally relevant approach. Thousand Oaks, CA: Sage.

Conyne, R. K., & Clanton Harpine, E. (2010). Prevention groups: The shape of things to come. Group Dynamics: Theory, Research, and Practice, 14, 193-198. doi:10.1037/a0020446

Erchul, W. P. (2013). Treatment integrity enhancement via performance feedback conceptualization as an exercise social influence. Journal of Educational and Psychological Consultation, 23, 300-306.

Jones, D. E., Greenberg, M., & Crowley, M. (2015). Early social-emotional functioning and public health: The relationship between kindergarten social competence in future wellness. American Journal of Public Health, 105, 2283-2290. doi: 10.2105/AJPH.2015.302630

Kazak, A. E. (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63, 146-159. doi: 10.1037/0003-066X.63.3.146

Long, A. C. J., & Maynard, B. R. (2014). Treatment integrity as an adult behavior change: A review of models. In L. M. H. Sanetti and T. R. Kratochwill (Eds.), Treatment integrity: A foundation for evidence-based practice and applied psychology (pp. 57-78). Washington, D. C.: American Psychological Association.

Pettigrew, J., Miller-Day, M., Shin, Y. J., Hecht, M. L., Krieger, J. L., & Graham, J. W. (2013). Describing teacher-student interactions: a qualitative assessment of teacher implementation of the 7th grade keepin’ it REAL substance use intervention. American Journal of Community Psychology, 51, 43-56.   doi: 10.1007/s10464-012-9539-1

McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American Psychologist, 65, 73-84. doi: 10.1037/a0018121

Pirog, M. A. & Good, E. M. (2013). Public policy and mental health: Avenues for Prevention. Thousand Oaks, CA: Sage Publications.

Postlethwait, A. (2012). Service learning in an undergraduate social work research course. Journal of Teaching Social Work, 32, 243-256.   doi: 10.1080108841233.2012.687343

Vogel, D. L., Heimerdinger-Edwards, S. R., Hammer, J. H., & Hubbard, A. (2011). “Boys don’t cry”: Examination of the links between enforcement of masculine norms, self-stigma, and help-seeking attitudes for men from diverse backgrounds. Journal of Counseling Psychology, 58, 368-382. doi: 10.1037/a0023688

Brief Articles

Prevention Corner

Elaine Clanton Harpine, Ph.D.
Elaine Clanton Harpine, Ph.D.

Should Students be Retained or Socially Promoted When They are Failing Academically?

Elaine Clanton Harpine, Ph. D.

School questions seem to dominate our list of concerns once again. Parents, teachers, and school psychologists seem to be seeking answers to the age old question: should students be retained in the same grade for another year when they have failing grades? We actually received several letters asking if retention is psychologically safe. Our question is from a school psychologist who is grappling with this very question.

Editorial Question Posed

Dear Prevention Corner: 

I’m a school psychologist assigned the task of deciding whether children should be retained or socially promoted. Teachers make a recommendation based on student grades. After testing, I must recommend which students should be retained or socially promoted. I just read an article that said 78% of dropouts were once retained a grade in school and that 90% of students retained more than once drop out of school. Is this true?

I’m Confused


Dear Confused:

You are not the only one. The question of retention has been argued for over 40 years. Since 1975, research and statistical analysis has shown that neither grade retention (repeating a grade) nor social promotion (simply moving on to the next grade) has been effective as a method for improving academic achievement. Jimerson’s landmark study in 2001 contains one of the best overall discussions. I’ve listed the citation in the reference section. Although grade retention is still widely practiced in schools, retention is actually listed as the single most dominant predictor of whether a student will drop out of school (Thomas, 2013). You did not list the title of the article that you had read, but the statistics match commonly accepted predictions. Retention has a “scarring effect” (Andrew, 2014). Retention is a stigmatizing negative event that infuses with development across the life span—from early elementary school to college and even into adulthood (Andrew, 2014; Jimerson & Kaufman, 2003). So yes, retention is something that we as psychologists should be concerned about. It is not simply an educational problem. Students list retention as one of the most stressful events of their life (Anderson et al, 2005). The stress and stigmatization of retention and failure can even pave the way for other mental health problems and also lead to behavioral problems. Furthermore, research shows that retention is not effective. It does not help students correct their academic problems (Thomas, 2013).

Retention has not worked. Social promotion also does not work. The National Center on Response to Intervention (2010) suggests three strategies that have proven to work with students who are failing: (1) early intervention (do not wait until the child is failing), (2) customizing learning to individual student needs, and (3) focus on reading. They go on to say that the most prominent academic problem leading to failure and retention is reading failure (NCRI, 2010; Lyon, 2002). Jimerson’s research (2003) concurs with the National Center’s three suggestions and also states that improving reading skills should be listed as one of the most important variables needed for academic success.

The Monitor on Psychology this month (March, 2016) reported that reading proficiency scores for public school children have dropped. We should also be alarmed that for the past 25 years, nationwide testing has shown that over half the children and teens across the nation cannot read at grade level by 4th or 8th grade. The Nation’s Report Card for 2015 stated that only 36% of 4th graders and 34% of 8th graders across the nation can read proficiently at grade level. When we tie reading failure to retention and to dropping out of school before graduation, we truly have a serious problem.

As we have stated in this column many times before, reading failure can also lead to depression and other mental health concerns (Herman et al., 2008). Reading failure becomes a psychological problem because of the stigmatization, mental health concerns, and developmental damage caused by such failure across the life span. Reading failure in not just an educational problem; it is a psychological problem as well.

You are very wise to seek alternatives to retention. A six-year-old student was assigned to my reading clinic at the beginning of first grade as an early preventive intervention. He lived in a low socioeconomic neighborhood, single-parent home, and seemed to be having trouble adjusting to school. By the end of his first grade year, the student was reading at the third grade level and demonstrating exemplary behavior– very cooperative, very hard-working. When he returned to school at the beginning of the nest year (He should have been entering 2nd grade.), the parent was informed that the student had been retained in first grade because of his attendance record. The school had a policy of retaining all students who missed more than a certain number of days. Obviously, this was a schoolwide policy and an attempt to reduce truancy. Unfortunately, no one checked to see why the student had been absent. The student had asthma. Even with extensive absences, including at my program, the student was able to finish first grade reading at the third grade level. Math wasn’t a problem either. The student was returned to my reading clinic while repeating first-grade because of behavior problems. In talking with the student, he said, “Need something to do. Only have ‘baby books.’ Little kids think I’m funny when I get in trouble.”

Retention can and does cause psychological “scarring.” So, what is the alternative?

Homework does not help students improve academically (Cooper, 2006). After-school programs have proven to not be effective, especially homework based programs or programs that simply repeat teaching methods used in the classroom (Sheldon et al., 2010; Shernoff, 2010). Merely incorporating social and emotional learning principles is also not effective (Kaufman et al., 2014). Some educators have even gone so far as to say that failure is based on the socio-economic neighborhood in which the child lives (Plucker & Esping, 2014). I disagree.

This fall, from September to December, we had four students move up an entire grade level in reading at my reading clinic. Three of these students were from low socio-economic neighborhoods. Two were African American and one student in the group was Hispanic. This is not a one-time occurrence. Previously, we had six students move up two entire grade levels during nine months in the program. All six students were from low socio-economic neighborhoods: one Caucasian and five African Americans. Two of the students lived in a housing project neighborhood. As G. Reid Lyon said back in 1998, ineffective teaching methods are the primary cause of reading failure. No, I did not say teachers. I said teaching methods—the method that we are using to teach children to read. Whole language and old style phonics rules have both proven not to work (National Reading Panel, 2000).

Are there methods that work? Yes. In 2009, Keller and Just proved that at-risk readers can be taught to read through their neuroimaging studies. Shaywitz (2003) put forth an entire program for teaching dyslexic children. Shaywitz (2003) says that the key to teaching reading to any child is that you must teach the child to break the word down into letters sounds or phonemes. Then, teach the child to put the sounds back together as a word. I teach a similar method called vowel clustering (Clanton Harpine, 2011; 2013).

So yes, methods are available that have been proven to work. Why do we not use them in the schools? That is an excellent question. I’ll leave that question for another time. For now, I hope that you will refer to some of the references that I have listed for you. I hope that some of the programs can help you to look beyond retention and social promotion. Look to the source of the problem—reading failure.

If you would like to join this discussion, let us hear from you. We welcome your participation. We invite psychologists, counselors, prevention programmers, graduate students, teachers, administrators, parents, and other mental health practitioners working with groups to network together, share ideas, problems, and become more involved. Please send comments, questions, and group prevention concerns to Elaine Clanton Harpine at


Anderson, G. E., Jimerson, S. R., & Whipple, A. D. (2005). ‘Students’ ratings of stressful experiences at home and school: Loss of a parent and grade retention as superlative stressors, Journal of Applied School Psychology, 21(1), 1-20.

Andrew, M. (2014). The scarring effects of primary-grade retention? A study of cumulative advantage in the educational career. Social Forces, 93, 653-685.   doi: 10.1093/sf/sou074

Clanton Harpine, E. (2011). Group-Centered Prevention Programs for At-Risk Students. New York: Springer.

Clanton Harpine, E. (2013). After-school prevention programs for at-risk students: Promoting engagement and academic success. New York: Springer.

Herman, K. C., Lambert, S. F., Reinke, W. M., & Ialongo, N. S. (2008). Low academic competence in first grade as a risk factor for depressive cognitions and symptoms in middle school. Journal of Counseling Psychology, 55, 400-410.

Jimerson, S. R. (2001). Meta-analysis of grade retention research: Implications for practice in the 21st century. School Psychology Review, 30, 420-437.

Jimerson, S. R., & Kaufman, A. M. (2003). Reading, writing, and retention: A primer on grade retention research. Reading Teacher 56, 622-635.

Keller, T., A., & Just, M. A. (2009). Altering cortical connectivity: Remediation-induced           changes in the white matter of poor readers. Neuron 64, 624-631.

Lyon, G. R. (April 28, 1998). Overview of reading and literacy initiatives. Testimony before the Committee on Labor and Human Resources, Senate Dirkson Building. Retrieved November 27, 2006, from

Lyon, G. R. (2002). Reading development, reading difficulties, and reading instruction educational and public health issues. Journal of School Psychology, 40, 3-6.

National Assessment of Educational Progress. (2013). Nation’s Report Card: Reading 2013. Retrieved from report card/pdf/main2013/2010458.pdf

National Center on Response to Intervention. (March 2010). Essential components of RTI: A closer look at response to intervention.   Washington, DC: US Department of Education, office of Special Education Programs

National Reading Panel, (2000). Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction (NIH Publication No. 00-4754). Washington, DC: National Institute for Literacy.

Plucker, J., & Esping, A. (2014). Intelligence 101. New York: Springer.

Shaywitz, S. (2003). Overcoming Dyslexia: A new and complete science-based program for reading problems at any level. New York: Knopf.

Thomas, A. (Ed.) (2013). Retention is not the answer! Metairie, LA: Center for Development and Learning.