Psychoeducation

Psychoeducation combines psychotherapy with education to help participants deal with a targeted problem in their life. It has been implemented in a variety of settings, ranging from mental health clinics to occupational training. Psychoeducation focuses on providing valuable information to clients, and helping them improve awareness, skills, and communication related to the target problem. Therapists serve as “facilitators” by setting the intervention goals and modifying the presentation of information to meet clients’ needs. Psychoeducation can be used with diverse cultural and ethnic groups, and can be adapted to a number of presentation formats. Empirical evidence has shown that psychoeducation is an effective intervention that improves clients’ lives by increasing knowledge, developing skills, and improving relationships.

This entry describes psychoeducation—what it is, how it differs from other modes of therapy, its basic principles and treatment components, how it is conducted, and its mechanisms of action. The entry discusses the development of psychoeducation and provides examples of the diverse settings in which this type of treatment can be used. In addition, it discusses the role of therapist as facilitator and addresses cultural concerns in psychoeducation, and concludes with a summary of the evidence supporting the use of psychoeducation.

What Is Psychoeducation?

Development of Psychoeducation

The development of psychoeducation is related to the passage and implementation of the Community Mental Health Act of 1963, which resulted in deinstitutionalization. This act was developed to provide a more normalized way of living for individuals experiencing psychological disturbances who could be maintained on medications and treated through services in their community. Although the act was well intended, a majority of the community-based treatment was provided by overworked and understaffed community facilities. This resulted in poor or no treatment for many individuals. Deinstitutionalization failed in meeting its lofty goals and essentially abandoned those it was designed to help. This dilemma stimulated efforts to educate families on how to best care for relatives experiencing mental health difficulties. Psychoeducation was developed to fill the gap resulting from the negative effects of deinstitutionalization.

Another factor that promoted the development of psychoeducation was the shift in zeitgeist from a belief that mental illness was a result of family factors (i.e., “family blaming”) to alternative explanations of psychopathology. This in turn led to more family-focused treatments such as psychoeducation.

Definition of Psychoeducation

Psychoeducation is a form of therapeutic intervention that combines psychotherapy and education. It can be used with individuals, families, and groups, and implemented on its own or as a supplemental treatment to other ongoing interventions (e.g., medication management and family therapy).

Psychoeducation works by increasing knowledge and improving skills. When administered in a group format, it also provides social support. Psychoeducation applies therapeutic interventions from other theoretical models (e.g., cognitive-behavioral therapy [CBT], systems approaches, client-centered therapy) and combines them with specific information relevant to the presenting concern of the client (e.g., symptoms of a particular disorder, navigating the education or mental health system, medication side effects, healthy eating or sleeping habits).

Settings That Employ Psychoeducation

Psychoeducation can be provided in a variety of settings, including hospitals, jails, the military, schools, businesses, career centers, mental health centers, and even over the Internet using chat room/ discussion groups or individual contact. The treatment focus varies according to the setting and client’s presenting concern. For example, psychoeducation could be used when working with the family of a child having a medical illness that affects the child’s social, emotional, educational, and family functioning; when working with a husband and wife seeking marital counseling or parenting skills; or when assisting an employee to meet specific job demands.

Psychoeducation can be provided in individual, family, or group formats. Each has its distinct advantages and disadvantages. An individual format allows more time to devote to topic areas most relevant to the client, and it provides increased flexibility in covering material. A drawback is the client is not exposed to individuals with the same concerns and is therefore less likely to have an “I’m not the only one” experience. Furthermore, the client is not exposed to a social group that facilitates social learning, the development of new relations, or exposure to alternative points of view and experiences.

Family psychoeducation allows the client to address concerns affecting the family unit, and it provides increased opportunities for members to learn the same skills and assist each other with practicing and applying them. Working with the family allows members to support each other, facilitate ongoing skill practice outside of sessions, and foster consistency of the skill. A major disadvantage is the lack of opportunity to meet other families experiencing the same difficulties.

Group approaches provide opportunities for social learning, development of an additional support system, networking, and reinforcement for positive change. However, group approaches have less flexibility in scheduling, they lack the ability to focus exclusively on any one client’s needs, and some clients are uneasy sharing personal information in a group setting. All of the modalities of psychoeducation discussed here are effective.

Specific types of psychoeducational groups include educational/task groups, educational/guidance groups, training/work groups, training/relations groups, and training/social skills groups. Educational/task groups emphasize a client’s understanding of a particular topic (e.g., civic organizations or task forces). In contrast, educational/guidance groups help clients cope with life situations such as divorce. Training/work groups are developed by employers to provide information that will assist employees to meet work demands (e.g., supervising difficult workers). Training/relations groups focus on the development of communication and interpersonal skills. Finally, training/social skills groups work to increase social skills using education, self-exploration, didactic work, and practice. These interventions can also be provided in an individual format.

Components of Psychoeducation

Psychoeducation consists of sharing information with the client that is relevant to the specific area of concern (e.g., the presenting problem) in addition to applying the tenets of various therapeutic modalities. For instance, a therapist might use behavioral and cognitive approaches to help a client develop alternative responses to events and to address the client’s cognitive distortions related to these events. The therapist would also present topic-relevant information to increase the client’s understanding of cognitive distortions, and use skill-building techniques (e.g., communication and problem-solving skills) to increase the client’s ability to successfully apply the information.

Format and Duration

In individual or family psychotherapy, the therapist and client develop client-specific activities. Psychoeducation uses a “fixed but flexible” model. Treatment begins by focusing on a specific topic (e.g., improving a family and child’s management of mood disorders or improving an employee’s success in a job situation). Session content is prearranged; the “course outline” is typically shared with the client at the first session. However, new topics the client presents can be integrated into the prepared session content.

Session content can be presented verbally through discussion, presentation, and/or demonstration; through role playing; by video; or by invited guest presenters or lecturers. Information is typically provided in more than one medium. For example, if the therapist verbally describes and processes information with the client, written materials that elaborate on or summarize the topics and information might also be provided. This provides exposure via a variety of modalities, enhancing the likelihood the client will integrate and recall the information. Practicing new techniques via role-plays allows the therapist to process with the client any foreseen obstacles to completing the between-session project. Reviewing the project at the next session is paramount.

Session length and treatment duration typically are established at treatment onset. For example, a college student wishing to improve study skills might attend one 2-hour session. In contrast, an employee might attend five 1-hour sessions on managing stress in the workplace. Some psychoeducational treatments allow one or more “flex” sessions to be used as needed to address specific concerns of the client.

Group Settings

Psychoeducation can be provided in individual or group settings with minor adjustment to the materials. Most important, materials must be developmentally appropriate, topics must be relevant, and session length must be sufficient for the number of participants. Basic information can be presented simultaneously to individuals who differ in their understanding and experience of the topic. This approach mimics Lev Vygotsky’s zone of proximal development, whereby the client’s ability to use the information presented is facilitated by the client’s prior experiences and problem-solving skills, under appropriate guidance of a competent therapist or capable peers.

In a group setting, information can be presented to all clients simultaneously. The therapist can then individually tailor the amount of additional information that is needed for each client. When conducting psychoeducation in a group format, the therapist should be familiar with the process of group interventions as well as each client’s presenting concerns that may affect the group process.

Treatment Goals

Treatment goals, like the treatment itself, are predetermined. Goals can be general or specific. For instance, a general goal might be to improve overall family functioning by addressing interaction and communication style. A specific goal might be to decrease the frequency of a negative work event. In group formats, the general goal may be similar for each client, but specific goals are idiosyncratic.

Cultural Concerns

Skilled culturally sensitive therapists are aware of specific cultural concerns that may influence clients’ willingness to seek psychoeducational services, their level of participation, and whom they might wish to bring to sessions as part of their family. Additionally, therapists are aware of issues pertinent to various cultural and ethnic groups. Although this topic cannot be fully addressed herein, some examples of issues to consider are described below.

When providing psychoeducation to Native Americans, it is important to recognize that healers and community leaders are important and therefore may be brought to sessions or might assist in helping the client with the intervention. Asian Americans may prefer a logical and structured approach to treatment, as opposed to a flexible approach that focuses on affective issues. Thus, psychoeducation with its focus on skill building and problem solving may be a treatment of choice. African Americans view the family in broader terms than the “nuclear family” view of Caucasians; therefore, when inviting family members to attend sessions it might be appropriate to include aunts, uncles, or grandparents in the invitation. Similarly, Latino/a families might include extended and nonblood relatives as part of the immediate family system.

When working with immigrant and first-generation minorities, it is important to avoid using children as interpreters, even though they may be more skillful in the majority language than their parents. This can cause significant problems and complications in exchanging information and impede the outcome of treatment.

How Psychoeducation Works

Therapist’s Facilitator Role

The role of the therapist and the therapist-client relationship in psychoeducation differs from that in more traditional forms of counseling and psychotherapy. In psychoeducation, the therapist serves as facilitator and teacher. While counseling and psychotherapy often focus on remediation of a problem, psychoeducation often pays equal or greater attention to the prevention of problems and the development of strengths. The therapist is largely responsible for determining the goals and activities of psychoeducation and for tailoring the intervention to the needs, motivations, and relative strengths and weaknesses of each client.

Stages of Psychoeducation

Most psychoeducation models have common traits and techniques. Programs typically begin with a comprehensive assessment of client needs, strengths, and weaknesses. This allows the therapist to form a collaborative alliance with the client while gaining valuable understanding of how to best tailor the intervention to fit the client. Building on the client’s strengths allows for a focus on the present. The client’s past experiences are also incorporated into treatment to identify areas for improvement.

The next stage usually involves a didactic component. This can be fairly structured (e.g., a classroom lecture) or more informal (e.g., group discussion). As transfer of information is a primary function, this phase is often a large proportion of the psychoeducational intervention. Additionally, it is frequently integrated with other steps in a program, rather than presenting the educational information in one stand-alone module.

Outcome of Psychoeducation

Psychoeducation makes a difference in people’s lives by enabling them to improve their own (or a loved one’s) health, abilities, relationships, or functioning. Psychoeducation attains this goal by providing relevant information to clients about a problem, illness, or source of distress that is present in their life. Improved knowledge about a problem allows clients to better utilize methods of reacting to it. This leads to a decrease in the stress, conflict, or impairment caused by the problem. Psychoeducation also changes clients’ lives by increasing their skills in areas such as communication, problem solving, coping, medication adherence, modification of routines, environment adjustment/management, and social connections.

References:

  1. Brown, N. W. (1998). Psychoeducational groups. Philadelphia: Accelerated Development.
  2. Fristad, M. A., Goldberg-Arnold, J. S., & Gavazzi, S. M. (2003). Multi-family psychoeducation groups in the treatment of children with mood disorders. Journal of Marital and Family Therapy, 29, 491-504.
  3. Goldstein, M. J., & Miklowitz, D. J. (1995). The effectiveness of psychoeducational family therapy in the treatment of schizophrenic disorders. Journal of Marital and Family Therapy, 21, 361-376.
  4. Iodice, J. D., & Wodarski, J. S. (1987). Aftercare treatment for schizophrenics living at home. Social Work, 32, 122-128.
  5. Lukens, E. P., & McFarlane, W. R. (2004). Psychoeducation as evidence-based practice: Considerations for practice, research, and policy. Brief Treatment and Crisis Intervention, 4, 205-225.
  6. McFarlane, W. R., & Cunningham, K. (1996). Multiple family groups and psychoeducation: Creating therapeutic social networks. In J. V. Vaccaro & G. H. Clark (Eds.), Practicing psychiatry in the community: A manual. Washington, DC: American Psychiatric Press.
  7. Simon, C. (1997). Psychoeducation: A contemporary approach. In T. R. Watkins & J. W. Callicutt (Eds.), Mental health policy and practice. Thousand Oaks, CA: Sage.
  8. Sue, D. W., & Sue, D. (1990). Counseling the culturally different: Theory and practice (2nd ed.). New York: Wiley-Interscience.
  9. Williams, C. A. (1997). Psychoeducation. In N. K. Worley (Ed.), Mental health nursing in the community. St. Louis, MO: Mosby.

See also: