Psychoeducational Group Therapy Changes The Face Of Managed Care
Robert M. Siegmann, MSW, MBA and Patty Bower, BSW, LSW
Originally published in Journal of Practical Psychiatry and Behavioral Health
In this article, the authors describe an innovative psychoeducational group therapy model first developed for use in an economically disadvantaged rural clinic. This new system enabled the clinic to serve many more clients, improve patient satisfaction, and dramatically increase revenues. The model is based on a combination of psychoeducation and group therapy delivered in the format of “group classes”. The authors discuss materials and skills needed to set up such a program and how to deal with confidentiality problems, referral sources, publicity, and community education. Most importantly, they explain how such a system can increase efficiency and improve the outcome of therapy in a managed care setting where costs must be contained.
KEY WORDS: psychoeducation, group therapy, managed care, rural health care
It takes people to make people sick and it takes people to make them well again.”
-Harry Stack Sullivan, The Collected Works of Harry Stack Sullivan
Though their presenting problems vary, a considerable portion of hospitalized patients have decompensated as a result of some interpersonal crisis, often a real or threatened loss of a key interpersonal relationship. Furthermore, the great majority of patients are bedeviled by chronic interpersonal problems…”
- Irvin Yalom, Inpatient Group Psychotherapy
Quinco's Board of Directors challenged its management team to introduce a service delivery system that would circumvent rationing of care, particularly to those citizens who had little or no money and thus no choices about where they sought services, i.e., our “social mission” clients. Our response to that charge was to develop a service philosophy that emphasizes consumer responsiveness (i.e., no waiting lists), consumer accessibility (i.e., multiple specialized offices “out where the people are”), and consumer acceptability (i.e., medical office and business office analogs).
We decided to introduce a new paradigm for clinical services, a brief therapy group
model emphasizing psychoeducation. We focused our planning for this model in those
offices that exist to serve all clients regardless of ability to pay (i.e., our social
mission offices). Our plan was to prevent rationing of our psychoeducational group
services, to increase client volume, and to improve cash flow in the process. We succeeded
beyond our highest hopes.
We piloted our psychoeducational group model in our Jennings County office. (Jennings
County was the setting for Jessamyn West's books The Friendly Persuasion and Except for Me
and Thee.) This clinic was staffed with one full-time and several part-time clinicians
and, because it was in one of our poorest counties, required more than $50,000 a year in
subsidies to remain open.
In the years since we began the psychoeducational model in Jennings County, we have
tripled the value of services billed, quadrupled our collected revenues, and have an
overall customer satisfaction rating of almost 99%!
Community response to our changed format has been overwhelming. As a result of new contracts and requests for service, we have hired more full-time clinicians. We have “destigmatized” mental health services in this small, rural community and have expanded our psychoeducational format to other social mission offices. This new service model includes both process and psychoeducational groups and recognition of managed care philosophy.
GROUP THERAPY
Freud’s patients lived in a structured and mechanistic world ... [and] did not
lack social connectedness ... In therapy what was needed was a sacred and private place
within which to explore the feelings and wishes that society prohibited. Typically, the
situation is reversed today. Individualism is so dominant that social connections are not
formed or, if formed, soon unravel ... The pathologies of the modern era are primarily
difficulties in gaining and tolerating authentic intimacy (i.e., modern mankind's
fragmented ability to relate) ... Group therapy seems to be a natural antidote to the
predominant disorder of our age.” 1
Group therapy has been a clinically accepted modality since World War II, with benefits
documented by many authors. In fact, group treatments have been shown to be more effective
than no treatment, placebo treatments, and, in some circumstances, other psychological
treatments.2
Yalom was the first to present a comprehensive formulation of the beneficial factors of
group therapy. He identified the important curative factors as the installation of hope,
understanding that one is not alone (universality), developing social skills, learning to
express feelings (catharsis), challenging maladaptive patterns (corrective reexperiencing
of the primary family group), existential concerns, receiving feedback from others,
imitating effective behaviors, learning to help others (altruism), reducing isolation and
developing a sense of belonging (cohesion), interpersonal learning, and imparting
information (education).3 Research on these curative factors has identified
catharsis, insight, interpersonal learning, and cohesion as particularly useful in group
therapy.1 However, additional research has supported Yalom’s contention that
the importance of specific curative factors shifts over the lifetime of the group and that
particular factors are seen as most therapeutic depending on the type of group or client
and the developmental stage of the group.2
PSYCHOEDUCATION
Joseph Pratt, MD, an internist at Massachusetts General Hospital, is widely credited as
the founder of group psychotherapy. Interestingly, his approach was primarily
educational in nature. In 1905, he established a group of 15 tuberculosis patients. The
format was to educate patients about their illness and to encourage discussion about their
common problems in a small group setting. Pratt reported very positive results. 1
Since then, engaging clients in specific knowledge development and skill-building
techniques has been accepted protocol in a variety of areas. For instance, a primary facet
of treatment for many physical illnesses (e.g., diabetes) is teaching patients skills
necessary to maintain compliance with their treatment regimen. This has been a
longstanding strategy for patients in chemical dependency programs who are taught about
the nature of their dependency and trained in skills needed to maintain sobriety. With the
deinstitutionalization of mentally ill or mentally retarded patients, the emphasis of
intervention has been to teach daily living skills in order to increase patients’
level of independence and allow them to live and work in their own communities instead of
state hospitals.
Patients with psychiatric disorders generally benefit from learning about the causes
and nature of their illnesses and about behaviors and patterns that may help to
alleviate their symptoms. Persons lacking certain skills (e.g., how to parent, how to
control anger, how to cope with stress) benefit from skill-building activities. Virtually
all clinicians, except for the most nondirective, teach through the therapy process.
However, they tend to use private tutorials rather than a group format and their teaching
is typically not done in a formalized or consistent fashion, posing problems for
replication and research.
Research on group therapy has shown it to be an effective mode of treatment.4
Structured group therapy has been effective in treating depression5 and eating
disorders.4 Structured groups have been shown to be superior to unstructured groups
for divorce adjustment, agoraphobia, psychiatric inpatients, incarcerated felons, and
problem solving. Regardless of group composition, it appears that structured groups
typically produce greater change than unstructured groups, especially in a brief
format.6 Although research has not yet definitively identified the particular agents
of change in group psychotherapy (i.e., the ideal group composition for which clients
suffering from what type of psychopathology), both structured and unstructured groups are
becoming more prevalent and, increasingly, the preferred mode of treatment.
APPLICATION OF PSYCHOEDUCATIONAL GROUP THERAPY TO MANAGED CARE
We believe that this model is a more than credible response to managed care, a primary goal (if not the primary goal) of which is to better conserve scarce resources. Managed care companies have tended to focus only on reducing the length of the individual therapy process. While this is clearly a useful strategy in reducing costs, it is by no means the only or the most effective approach. Group therapy can be offered for well below half the cost of individual therapy. A single therapist can see four to eight people during a given time period instead of one person. For the same expenditure, a client can be seen for 20 group sessions instead of five to eight individual sessions. For most patients, group therapy is at least as effective as, if not more effective than, individual therapy.
Research in the chemical dependency field shows that treatment over a longer period of
time is more effective in promoting sobriety than highly intensive treatment for a brief
period.7 This may also hold true in general outpatient populations. By purchasing a
longer course of group therapy for the same price as a brief series of individual
sessions, the effectiveness of treatment may well be improved.
Why hasn’t the managed care industry encouraged more use of group therapy?
Perhaps the industry is merely reflecting back what they see in our field, telling
clinicians to practice as we conventionally practice (individual therapy), only to do it
more briefly and cheaply. As clinicians, it behooves us to encourage the managed
care entities to understand the benefits of a model that uses psychoeducational group
therapy in addition to individual brief therapy.
OUR MODEL
A bachelor’s level social worker and a psychologist took considerable initiative
in designing this new delivery model. Both had group therapy experience and understood the
marketing and financial dilemmas facing their office. They were given certain financial
parameters and the subsequent freedom to create a clinic predominantly based on a
psychoeducational group therapy model. As part of this project, they developed a small
library of psychoeducational literature, including useful audiovisual materials. Our
clinicians experimented with the menu of offerings, comparative ratios of structured
psychoeducation to process therapy groups, and comparative use of time-limited versus
open-ended groups. The result was an amalgamation of those factors. Approximately
15 to 18 groups per week are offered in both time-limited and open-ended formats (see the
Appendix for a sample menu of the groups offered). Three distinct varieties of group
styles evolved (the percentage of groups offered in that style is shown in parentheses):
1. Highly structured psychoeducation groups (25%)
2. Composite psychoeducation and process groups (50%)
3. Process groups (25%)
Psychoeducation Groups
This highly structured format consists of providing problem-focused or skill-building
education in one- or two-hour time-limited groups. There is opportunity for discussion of
the presented material but there is very little true processing of personal issues. There
are several occasions when psychoeducation is sufficient to meet consumer needs. For
example, at the court’s request, four of our offices provide a 90-minute divorce
education program called “Children First!” in which parents are taught the
potential effects of divorce on their children. This is a one-time requirement for parents
who are divorcing and have children under the age of 18. A second reason for pure
psychoeducation groups is that there are clients for whom group therapy does not work.
For instance, there are people who are unable to maintain confidentiality for a
variety of reasons; there are clients who are clearly in need of treatment but continue to
engage in antisocial behaviors; and there are clients who are unmotivated to participate
in treatment, such as forced referrals by courts or other government entities. Our
approach with noncompliant clients is to limit the number of available sessions, have
shorter meeting times (e.g., one hour), expand educational and skillbuilding content,
and eliminate the process component. For example, our One-to-Grow-On psychoeducation
series consists of education and exercises aimed at enhancing clients’ basic coping
skills in order to improve their personal effectiveness and instill a positive sense of
self-efficacy.
Process Group Therapy
At the other end of the spectrum is process group therapy. Since group therapy has been
written about and practiced extensively, there is no need to describe it here any further.
In one of our clinics where we serve a predominantly sophisticated clientele, we
use process groups extensively because we believe that this form of treatment has clear
benefits over a traditional individual model. Even if the psychoeducation aspect of the
model we are describing is not adopted, most clinics and their patients would benefit by
substantially increasing the number of process groups.
Composite Psychoeducation and Process Groups
The majority of clients are treated in composite groups where the first portion of the
session is devoted to education and the second half is more traditional “process
therapy”. The therapist provides information about a topic and then
facilitates interactive discussion about how this pertains to the clients’ problems.
Composite groups are moderately structured with a predetermined theme for each session,
yet the therapist individualizes material for the group members during the subsequent
discussion.
These groups are usually ongoing with open entry and exit, a concept Yalom describes in
his book Inpatient Group Psychotherapy. Inpatient units by necessity operate groups with
open entry and exit. We have adopted this concept in the outpatient arena. For example, in
a 10-session curriculum for depression, we allow new clients to enter at any session. We
try to shape the curriculum so that a given session is understandable and valuable
whether or not the client attended previous sessions. Clients may also continue to rotate
through the full curriculum of the group more than once. We have found that clients
benefit from going through the same curriculum for a second or even third rotation, since
they are sometimes so distressed that their comprehension level is minimal the first time.
During a second rotation, they not only understand the material better, but also find that
they can successfully implement some of the knowledge and skills they learn.
Changing the Whole Service Delivery System
In starting our clinic model, we followed a practice used by Irvin
Yalom. In 1966, he
started nine new groups at his clinic within a period of 8 weeks by administratively
closing off the option of individualized treatment and routing all patients to group
therapy. These patients reported satisfaction levels equal to those carefully selected and
referred to group therapy.9 We similarly made group therapy the principal
treatment option, with patients not given the choice of receiving individual therapy
unless it was a clinical necessity. Much as occurred with Yalom’s clinic, our groups
filled rapidly. Our experience with instituting this model in other clinics in our own
facility, as well as in other centers, is that, when clinicians and administrators adopt
the model wholeheartedly, patients and referral agents find it attractive.
ROLES AND GUIDELINES
Developing Psychoeducational Materials
In this model, we focused on high-incidence, treatable diagnoses and on high-risk
issues (e.g., depression, family conflict, attention-deficit/hyperactivity disorder). For
each group, we decided on the essential information that clients should know about the
cause and nature of the given illness or problem area. Based on available research, we
selected the skills and behaviors that would be beneficial for clients to learn. Materials
were organized by group topic in stand-alone modules. We tried to keep the language and
concepts simple and remove jargon, because most clients in a rural area simply don’t
understand the language that therapists use. In delivering information, we use a
multimedia approach (entertainment), blending lecture, overheads, video, and written and
oral exercises.
Preparing for the Teacher/Group Therapist Roles
Our most common kind of group involves teaching during the first half and process therapy during the second half. Discussion tends to follow the topic that has just been taught to the clients but focuses on their personal issues and how the new information can help their situation.
In the first half of the class, the facilitator takes the role of teacher, instructing the participants about the topic and about skills that are useful in coping with and alleviating the illness or problems. To create accurate expectations, the facilitator states at the beginning of each session that participants will not be dealing in depth with any of their personal problems during the first half of the session. However, there will be times when they will be asked to reveal examples from their own lives that relate to the course material, the purpose being to further elucidate a concept rather than to encourage discussion and personal revelation. The participants’ role during the first half of the session is to be students. Their task is both to absorb the information and to apply that material to their day-to-day life.
The second half of the class is a structured group therapy session and should be led by
a person with adequate clinical training. At the beginning of this portion, the
therapist should orient patients, especially new ones, on what to expect. The
facilitator’s role shifts from teacher to active therapist who facilitates
participants’ personal change by helping members request, receive, and provide
feedback and focus on dealing with their problems and developing further strengths.
Because the therapist has only 45 minutes to an hour to run a group therapy session with 6
to 12 patients, she or he should develop an impression of the patients’ problems
and concerns and how the didactic information relates to their personal issues during the
hour spent educating the clients. The participants’ role is more that of clients in
group therapy who are expected to share problems and concerns and to discuss how they want
to make corrective changes in their lives. Interaction between the members is very
desirable, as is providing mutual support and empathy. It is therefore important that
the therapist help clients develop good relationship skills (e.g., teach clients how to
listen and support each other, how to receive and provide feedback, how to self-disclose,
how to show good eye contact and speak in a fashion that is neither meek nor
overpowering). Such interactions help people realize that they are valued human beings,
that they are not flawed, and that they have the ability for mutual caring and respect.
It is important for the therapist to create a warm, accepting, supportive atmosphere
for the patients, both by modeling this and by encouraging such behavior among group
members. The therapist needs to help group members learn to feel comfortable
giving feedback in a supportive and caring manner and to think in a more realistic and
less negative fashion. Thus, the therapist needs to redirect the clients’ focus to
areas that are more amenable to change while also emphasizing the positive aspects of
their lives and their personal strengths, with the goals that the patients will ultimately
be able to do this for one another and for themselves.
Even in the most carefully matched groups, clients may feel like they are not
benefiting from or not suited to a particular group. Sometimes animosities or awkward
relationships of which group leaders are unaware exist among members. For this reason,
it is advisable to encourage clients to share with group leaders in private their
discomforts concerning being in group therapy. Whenever such a problem occurs, it is
recommended that the client be transferred to another group focusing on similar issues.
CONFIDENTIALITY
Many clinicians believe that groups are particularly hard to run in rural communities
because of privacy and confidentiality issues. It may be harder for people to maintain
secrecy because many of them know each other outside the treatment setting. Individuals
who are unfamiliar with psychotherapy may have trouble distinguishing between therapy and
socializing. Our clinicians therefore paid special attention to confidentiality in
developing this model. They deal with confidentiality within the group by prescreening
members to assess their ability to fully comprehend the concept of confidentiality, using
a group rule list, continually reiterating the importance of confidentiality, and
confronting and discussing breaches when they occur. At the outset of every new group, a
packet of group rules is distributed to members and discussed. These rules not only stress
confidentiality but also serve to educate group members concerning the purpose and
operation of groups. Whenever a new member is added to a group, the group’s
rules are verbally reiterated and the importance of confidentiality is stressed again.
If the therapist becomes aware of a willful breach of confidentiality by a group
member, it is necessary to confront the infraction in the group immediately. Typically,
the importance of confidentiality is reiterated and the guilty party is warned that he or
she will be removed from the group if there is a recurrence of such an event.
Confidentiality in the community is dealt with by creating multiple group alternatives,
developing knowledge of the community and its residents, and not hesitating, to transfer
someone when mistakes in placement are made. Within any community, there are individuals
who should not be in groups together. In a small community, it is especially important to
offer numerous alternatives so that individuals can be separated from persons they may
feel uncomfortable relating to in a group. Examples of such relationships include enemies,
ex-spouses, mistresses and ex-lovers, relatives, employers and employees, and sexual
perpetrators and victims. To avoid problematic combinations of group members, it is
ideal to have at least one therapist who is well acquainted with the community and its
members. While this will not eliminate all potential problems, it significantly decreases
the probability of group members having an outside relationship with each other.
Some individuals are unwilling to protect the confidentiality of’ themselves and
others and are consequently inappropriate for inclusion in the usual psychotherapy group.
Adolescents are particularly at risk of breaches in confidentiality because of the
importance of social contact and communication in their daily lives.
CONSUMERISM AND PUBLICITY
Our offices sponsor a free community education seminar each month. It is advertised in the newspaper so that residents are aware of the activity whether they attend that particular seminar or not. In addition to conveying useful information, the seminars give community residents an opportunity to meet our therapists, see our facilities, and learn about our psychoeducational group offerings.
Our staff developed an informal survey to screen current and potential referral
sources, to educate them about the value of psychoeducational groups, and to obtain
feedback on desired and potential group offerings. The survey begins with a statement such
as the following: “We are improving our services by providing more skill-building and
educational groups for our clients. People appear to profit a great deal from learning
specific skills to help alleviate their problems when going through the therapy process.
The benefits of psychoeducation are ... Some of the groups which we are developing include
..." We then ask why they refer people to counseling and if they believe
skill-building groups and classes would be beneficial to the people they serve. We also
ask what kind of groups they would they like us to offer in an effort to target their
clientele and to be more consumer-responsive. The clinicians in our Jennings County office
also developed a newsletter to facilitate regular communication with referral agents.
Schedule changes, new group offerings, and public education seminars are noted in
this newsletter.
Finally, we continually survey clients anonymously on their level of satisfaction with
our services in order to help us improve our model.
OUTCOME
At the Jennings County Clinic of Quinco Behavioral Health Systems, we successfully
modified the service delivery system to offer 15 to 18 psychoeducational groups per week
with only two therapists. This new model has been very well received by the clients we
serve and beneficial to referral agents and the community. The following ten points
exemplify our success.
1. Our clients are better educated in a whole array of knowledge and skill areas. The education given in these groups is extensive, interesting, and constantly improved.
2. This new model satisfied referral sources, who like specific skill and competence development delivered in a consistent, replicable format. Referral sources know specifically what clients will receive when referred to our office. This is rarely the case with individual treatment.
3. We have taken most of the stigma out of receiving mental health services by allowing clients to go to “classes” rather than be “in therapy”
4. The group therapy environment provides client with more support and the opportunity to develop relationship skills. Many people seeking mental health services lack good relationship skills and the ability to feel like a part of a community. Properly run groups address these issues and improve patients’ interpersonal effectiveness.
5. This model increases accessibility to all potential clients. Waiting lists and rescheduling difficulties have been nearly eliminated by having multiple group opportunities available.
6. We are better utilizing scarce resources. An individual therapy model is akin to trying to provide public education one student at a time with private tutors. Through this group model, we are providing more pragmatic services to a greater number of patients with fewer clinicians.
7. The model saves clinicians’ time and energy. Outside of initial intakes, clinicians do not have to worry about wasted time from cancellations or no-shows. Furthermore, these particular clinicians found themselves energized by blending the roles of group therapist and teacher.
8. Through this model the Jennings County office nearly quadrupled their billings and collections over a three year period, providing greater financial stability.
9. The increased revenues allowed us to provide more indigent care and created opportunities for further expansion of services. We expanded clinic staff and facility space.
10. Our clinicians developed training materials to teach their innovative techniques to the rest of the Quinco staff and to clinicians at other mental health centers,
CHOOSE PSYCHOEDUCATIONAL GROUPS? THE PATIENT, REFERRAL SOURCE, AND PROVIDER
PERSPECTIVE
From the patient or consumer perspective, this model reduces the stigma of mental
health service, helps to concretize and demystify the abstract, and offers the customer an
opportunity to be "educated” instead of "being in therapy."
For many potential patients, particularly in rural communities, the benefits of
psychotherapy are quite difficult to comprehend. When we make the concept less obscure and
demystify it by identifying skills or knowledge to be gained, potential patients and
families more easily understand how mental health professionals can be of benefit to them.
While persons in some suburban communities might openly discuss being in therapy and even
wear it as a badge of honor, we find that most people in rural communities are embarrassed
about needing to obtain mental health treatment. When our therapists began to refer to
treatment groups as “classes”, they found that clients who had previously shied
away from “therapy” were more comfortable with, and were even attracted to,
“classes”. People in this rural community who would never admit to neighbors or
bosses that they were in therapy seemed very comfortable saying that they were taking a
class to develop a skill. To help with acceptance by clients, groups are often
given appealing names, e.g., “Healing the Wounded Heart”, to assist women
recovering from child abuse, or “Escaping the Fool's Circle”, for teens learning
better methods for dealing with their anger.
Referral sources appreciate this model because of the specific skill and competence
development and because the service is delivered in a consistent, replicable form.
Many referral sources are frustrated because it is difficult for them to explain to
potential clients what the therapy process is or what they will gain from it. This model
makes the referral procedure easier. Referral agents were pleased to know that a specific
knowledge base and set of skills would be taught during treatment. We have found that
referral sources want service delivered in a consistent, replicable format that is not
clinician-dependent. Because clinician styles differ dramatically and we perform
behind closed doors, it is beneficial to referral agents (as well as clients and service
providers) if there is more consistency with particular types of diagnoses or problems,
which is the whole emphasis behind practice protocols.
This model benefits the clinicians and providers by reducing waiting lists and
scheduling difficulties, allowing for increased billings (productivity), making it easier
to deal with multiproblem families, and offering meaningful service for low-pay or social
mission clients.
Waiting lists are the bane of our profession. (If someone breaks a leg, our health care
system does not schedule an appointment in three weeks.) We try to see every patient for
evaluation within two to five days. We can offer rapid accessibility because, in the
group therapy model, clinician time is not tied up with vast numbers of individual
appointments. There are also fewer scheduling difficulties, since secretaries can simply
reschedule a missed appointment for the next week. The flip side of accessibility for
patients is saving clinician time and energy wasted by cancellations and no-shows.
Therapists today work with families who have increasingly severe problems. A group
model takes some of the pressure off the individual therapist and can instill hope in
therapists who are working with multiproblem families.
In many states, government funds have targeted chronically mentally ill adults and
severely emotionally disturbed children. Large numbers of people with no means to pay full
fees are also in need of and can benefit from treatment. This model allows a low-cost
method to treat these adults and children.
CONCLUSION
We believe that psychoeducational group therapy is an excellent model for providing
mental health services in rural areas. Obviously, starting a new model is never easy. It
takes time, training, and effort for clinicians and managers to become comfortable with
this new model and the new roles involved.
To successfully implement this model, the clinicians and the organization must make
some changes. Regardless of orientation, most clinicians practice in an individual mode
because it is their area of expertise and what they are most comfortable with. In this
model of service delivery, clinicians need the training and ability to teach and to
provide group therapy. Many clinicians have at least minimal experience teaching classes,
and some have training in group psychotherapy. With additional training and supervision
on, most clinicians can develop the skills needed for this format. Supervision and
discussion groups can also help clinicians become more comfortable with this mode of
treatment.
The organization must be willing to train and support its clinicians in this new model.
Typically, systems inside or outside the organization reward individual therapy
more than group therapy. This is a major obstacle. If reimbursement rates are extremely
low for group compared to individual therapy, then individual therapy will be the
preferred mode of treatment. If organizations don’t give therapists ample credit for
running groups, it is more challenging to change the delivery model. To effectively
implement this service model, the organization needs to examine its values, its
communication with third-party payers, and its style of support to clinicians.
References
1. Rutan, JS, Stone WN Psychodynamic Group Psychotherapy. 2nd Ed. New York: The
Guilford Press
2. Bednar R, Kaul T. Experiential group research: Can the canon fire? In: Bergin
A, Garfield S, eds. Handbook of psychotherapy and behavior change, 3rd Ed. New York; John
Wiley; 631-63.
3. Yalom ID. The theory and practice of group psychotherapy. 3rd Ed. New York: Basic
Books.
4. Bergin AE, Garfield SL, eds. Handbook of psychotherapy and behavior change. 3rd Ed.
New York: John Wiley.
5. Lewinsohn PM, Antonuccio DO, Breckenridge JS, Teri L. The coping with
depression course. Eugene, OR: Castlia Publishing.
6. Flowers JV, Booraem CD. A psychoeducational group for clients with heterogeneous
problems: Process and outcome. Small Group Res 1991;22:258-73.
7. Ojehagen A, Skjaerris A, Berglund M. Prediction of posttreatment drinking outcome in
a 2-year outpatient alcoholic treatment program. A follow-up study. Alcohol Clin Exp Res
1988;12:46-51.
8. Yalom ID. Inpatient group psychotherapy. New York: Basic Books; 1983.
9. Yalom ID. A study of group therapy dropouts. Arch Gen Psychiatry
1966;14:393-414.
APPENDIX
Specific Group Offerings
Certain groups (e.g., depression, anxiety reduction, child and teen groups) are run on
a regular basis, whereas others (e.g., pain management, anger control groups) are run
intermittently. Other offerings are made on an experimental basis, such as a group to help
pregnant women learn pain and stress management techniques. The following is an example of
our curriculum:
Depression
Focuses on depression and loss issues, including loss of health, employment, loved one,
etc.
Up with Kids
For children, grades 1 through 6, with behavior difficulties at home or school. Focuses
on peers, self-esteem, and socialization.
Opening the Door to Recovery
For women who have been in abusive relationships or have children who were abused.
Issues addressed include rape, incest, molestation, victimization, healing, and
recovery.
Attention Deficit Parenting
Psychoeducational group for parents of children with attention-deficit/hyperactivity
disorder (ADHD). Issues include understanding ADHD, rules and limits for children
with ADHD, and supportive parenting.
Radiance
A women's educational and therapeutic support group focusing on assertiveness,
depression, and self-esteem.
Footings
For adolescents, ages 13 to 18. Focuses on peer problems, family difficulties, school
problems, relationships/social skills, improving behavior, and self-esteem.
Little Amigos
For preschool children. Focuses on self-esteem, relationships, and stress.
Growing Pains
Ongoing group for parents and adolescents. Addresses adolescent development, blended
family issues, effective limit setting, and family relationships.
Parenting Plus
Offered periodically on an as-needed basis. Focuses on improving assertive parenting
skills through effective limit setting, supporting, and coaching.
Bridges
Supportive group for those with more chronic care issues. Focuses on issues of support,
socialization, and maintenance. Some focus on skill building, such as meal planning and
preparation.
Stress for Success
Teaches clients relaxation skills, such as breathing exercises, progressive
relaxation, and other techniques.
Fit and Trim
Addresses the needs of overweight adolescents and their adult counterparts. Clients
explore weight loss problems, learn about healthy eating styles, and develop healthy
lifestyle changes including exercise.
Transitions
Addresses the needs of new immigrants who are in transition to a new culture and new
language.
Responding without Fury
Focuses on teaching social skills and specific exercises which allow the client to
respond to family members, employers, etc. without rage or violence. Persons with active
substance abuse are referred for addictions treatment first and persons with severe
histories of violence are excluded.
Education for Families of the Mentally Ill
A six week program designed to help families understand and cope with chronic mental
illness.
Lifelore
A group for adults over 65, providing specialized attention to the unique and
psychological concerns of aging.
Additional Potential Groups
- Pain Control
- Agoraphobia and Anxiety
- Chronic Illness
- Men’s Issues
- Assertiveness Skills
- Women’s Addiction
- Adult Self-Esteem
- Child Self-Esteem
- Children of Divorce
- Children of Alcoholics
- Education for Families of Chronically Mentally Ill
- Smoking Cessation
