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Structuring the group experience: A format for designing psychoeducational

groups
Susan R. Furr a
a
University of North Carolina at Charlotte,

Online Publication Date: 01 March 2000

To cite this Article Furr, Susan R.(2000)'Structuring the group experience: A format for designing psychoeducational groups',The
Journal for Specialists in Group Work,25:1,29 — 49
To link to this Article: DOI: 10.1080/01933920008411450
URL: http://dx.doi.org/10.1080/01933920008411450

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PSYCHOEDUCATIONAL GROUP WORK

Structuring the Group Experience:

A Format for Designing
Psychoeducational Groups
Susan R. Fun:
University of North Carolina at Charlotte
The design of an effective psychoeducational group begins with a strong theoretical
foundation and evolves into a highly interactive experience that fosters growth and
development in participants. This article presents a six-step model that enables the
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designer to move from ageneml statement ofpurpose to a session-by-session design

that includes didactic content, experiential activities, and processing. By following
this model, the group facilitator is able to develop a psychoeducational group that
provides a logical sequence of learning activities that foster cognitive, affective,and
behavioral change.

Structured groups as a therapeutic modality have experienced a rise

in popularity as the use of short-term treatment models has increased
(Rice, 1995).Morrill, Oetting, and Hurst (1974)set the stage for the use
of psychoeducational groups in the creation of their model that placed
emphasis on the roles of prevention and development as well as reme-
diation in counseling. This movement was further supported by the
work of Ivey (19761,who believed that the helping role should include
education and skill development. In 1990,the standards for training
group workers were revised and adopted by the Association for Special-
ists in Group Work (ASGW) (ASGW, 1991)and included four advanced
group work types or specializations. These four types of group work
were viewed as reflecting current and future work demands for counsel-
ors. Included in these specializations were guidance/psychoeducational
groups that have the goal of preventing the development of debilitating
dysfunction along with increasing coping skills. Conyne (1996)recom-
mended that graduate programs develop new curricular approaches to

~~

Susan R. Furr is an assistant professor of counseling in the College of Education at the

University of North Carolina at Charlotte. Correspondence regarding this article should
be sent to Susan R. F u n , Department of Counseling, Special Education, and Child Devel-
opment, 5054 Colvard, University of North Carolina at Charlotte, Charlotte, NC 28223;e-
mail: [email protected].
JOURNAL FOR SPECIALISTS IN GROUP WORK, Vol. 25 No. 1, March 2000,29-49
Q 2000 Sage Publications, Inc.

29
30 JOURNAT, FOR SPECIALISTS IN GROUP WORK / March 2000

teach the advanced group-work type competencies. Clearly, psychoedu-

cational groups have become a vital part of group work.
Currently, psychoeducational groups cover a myriad of topics and
may include affective and existential topics as well as cognitive-
behavioral ones. Some of the developmental issues addressed include
theme groups on loneliness (McWhirter, 19951, marital enhancement
(Durana, 19961, athletes in transition (Constantine, 19961,stress reduc-
tion in the workplace (Kagan, Kagan, & Watson, 19951, and parenting
(Sheeber & Johnson, 1994). In situations that require adjustment t o a
life-changing situation, groups have been developed for parents who
have an adolescent with a mood disorder (Fristad, Gavazzi, Centolella, &
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Soldano, 19961,for persons diagnosed with HWAIDS (Pomeroy, Rubin,

Van Laningham, & Walker, 19971, children with parents in addiction
recovery (Cwiakala & Mordocb, 19961, foster parents of sexually abused
children (Barth, Yeaton, & Winterfelt, 19941, cancer patients (Fawzy &
Fawzy, 19941, children of cancer patients (Taylor-Brown, Acheson, &
Farber, 19931, and divorce adjustment (Zimpfer, 1990).
A growing utilization of the structured group model is occurring in
the area of educating persons with psychiatric disorders such as depres-
sion (Sherrill, Frank, Geary, & Stack, 19971, cognitive disturbances
(Commissaris, Verhey, & Jolles, 19961, bipolar disorder (Bauer &
McBride, 19961,bulimia (Kaminski& McNamara, 19961,panic disorder
(Shear, 19951, schizophrenia (Gallagher & Nazarian, 19951, and sub-
stance abuse (la Salvia, 1993). This sampling of groups demonstrates
the broad appeal and efficacy of using the psychoeducational group as
both primary and supplemental treatment modalities.
Because the psychoeducational group is becoming an integral part of
service delivery in the counseling field, developing the skills to design
appropriate counseling experiences is essential for today’s practitio-
ners. The design of an effective structured group must be well crafted for
the experience to be both meaningful and effective. Graduate education
often overlooks the development of this skill as most textbooks focus on
group process rather than group design (Conyne, 1996).The goal of this
article is to explain the balance between content and process in the
psychoeducationalgroup. Although the group literature is more process
oriented, the current climate demands more content focus. In this arti-
cle, a step-by-step guide is provided for translating an innovative idea
into a successful structured group. Although the content of each group
will vary, the process of design remains consistent. By following the
steps of this process, the group leader can create an effective vehicle for
client change.
Furr I STRUCTURING PSYCHOEDUCATIONAI, GROUPS 31

MODEL OF STRUCTURED GROUP DESIGN

Drum and Knott (1977) described one of the first frameworks for
designing structured 'groups and stated that such groups had a prede-
termined plan and goals. Topics for the group are predetermined and
use discussion stimulus leads, structured activities, or a highly struc-
tured series of questions (Berg, Landreth, & Fall, 1998). Intentionally
structured groups promote specific goals within a planned framework
that is time specific (Winston, Bonney, Miller, & Dagley, 1988). Corey
(1990) stated that structured groups serve the purposes of "imparting
information, sharing common experiences, teaching people how to solve
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problems, offering support, and helping people learn how to create their
own support systems outside of the group setting" (p. 11).Meichenbaum
and Navaco (1985) evolved a model that included cognitive preparation
and skill acquisition, rehearsal, application, and practice. These models
have in common a preselected theme, specific goals, teaching of mate-
rial, and activities to illustrate the material.
The model for design of a structured group presented in this article
was originated by FUR and Fulkerson (1982)and entails two phases of
development. The first phase is the conceptual phase that includes
three steps: (a)statement of purpose, (b) establishing goals, and (c) set-
ting objectives. The second phase is the operational phase that also
includes three steps: (d) selection of content, (el designing experiential
activities, and (f) evaluation. The design process moves from a broad
conceptual framework to implementation of specific content. A unique
feature of this model is that the foundation of the conceptual phase is
counseling theory. Whereas other design models have goal setting as a
first step, this model emphasizes the need to build the group on sound
theoretical principles. When goals evolve from a theoretical perspective
of the topic, the group design will be more cohesive and sequenced in a
logical progression. Each topic and activity w ill provide the foundation
for the next topic.
Another feature of this model is its emphasis on processing the activi-
ties. Although process is implied by other models, this model is explicit
in having the leader determine the direction of the processing prior t o
conducting an experiential activity. DeLucia-Waack (1997a) indicated
the need for descriptions of group activities to include directions for
processing. She stated that although group activities in the professional
literature are often described in great detail, little attention is given to
the processing of the activities. In this model, a balance is maintained
among the didactic, experiential, and processing components of the
group. The outcome of following this model is the development of a
clearly articulated group that ensures the group content will remain
32 JOURNAL FOR SPECIALISTS IN GROUP WORK/ March 2000

consistent across a variety of leaders and settings. To illustrate this

process, an example of the six steps from a group on building self-esteem
is provided in the appendix.

Step 1: Statement of Purpose

Ideas about structured groups usually evolve from clinical practice.
Similarities among client problems may determine the group topic.
Often, practitioners observe that certain types of clients could benefit
from learning particular skills. Once that observation occurs, a struc-
tured group is the next logical step. At this point, the practitioner needs
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t o establish a statement of purpose that is an explicit statement of the

reason for the group's existence. This statement will answer the follow-
ing questions: (a) What is the primary content focus of the group? (b)
What population would benefit from participating in this group? (c)
What is the purpose of intervention (remediation,prevention, or devel-
opment)?(d)What is the expected outcome of participating in the group
(changein cognitions, affect, behavior, or values)?Without a clear state-
ment of purpose, the group will not have a clearly delineated direction.
The statement of purpose provides a guide for the development of goals
and objectives that in turn determine the content of the group.
Once the group focus is identified, the designer needs to consider his
or her theoretical orientation t o the topic. Theories guide beliefs about
how change occurs in individuals that may occur in awareness, knowl-
edge, insight, or behavior (Gladding, 1990).Each designer will make
assumptions about the type of change that he or she expects based on a
specific theory or the integration of several theories. Being aware of the
theoretical assumptions helps the designer maintain a consistency
among the different elements of the group. Without this awareness, the
sessions may lack a thematic focus and leave the participant confused
about the connections between the content and experiential activities.
To develop the theoretical perspective of the group topic, it is impor-
tant to review current research related to the topic. "he literature will
help identify theoretical frameworks that have proven effective in
addressing particular problems with specific populations. If a group
leader has limited experience with a particular populations or problem,
the leader should consult with more experienced professionals and get
supervision.

Step 2:Establishing Goals

Goals indicatehow an individual may change as a result of participat-
ing in the group experience and are derived from the theoretical
Fun / STRUCTURING PSYCHOEDUCATIONAL GROUPS 33

perspective indicated in the statement of purpose. Change can occur on

cognitive, affective, behavioral, existential, and physical levels, and the
designer needs to specify the type of change expected from group partici-
pants. The goals need to be consistent with the theoretical approach
selected in the statement of purpose. For example, if an insight-oriented
theory is chosen, then goals should not focus on behavior change.
Furthermore, a review of relevant literature is needed to provide a
strong foundation for selecting goals and objectives. Once the group
topic is selected, books and articles on that topic can help define the kind
of change that can occur in the group. The example in the appendix
descdbes goals that were derived from theoretical perspectives and
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research in the area of self-esteem. Ideas derived from Rogers (1961)

contain the concept of unconditional self-acceptance, whereas research
on cognitive behavior modification (Meichenbaum, 1977) provides the
basis for changing self-talk. The professional literature in the field of
counseling and group counseling addresses many psychoeducational
topics. Using key words of the topic, a PsychLit search can be conducted
t o identify previous research and practice articles related to the topic of
the group. Many articles may also contain specific activities that can be
used in the group format.
For a goal t o be effective in guiding the group design, it needs t o meet
several criteria. First, the goal must be reasonable in that it is challeng-
ing for the participants but is also achievable. If participants have unre-
alistic expectationsof what can be achieved through the group, they will
become disillusioned with the group process and perhaps disappointed
in their own abilities to change. The goals should be designed so that
there is a high probability of success in making the desired changes. For
example,the leader of a stress management group may state that a goal
is to help participants reduce stress; however, this wording is too gen-
eral. A more focused goal would be t o help participants identify and
modify self-statements that increase feelings of anxiety.
Goals also need to be written in terms that are measurable so that
participants can self-evaluate their own level of achievement. Goals
that are measurable assist the member in recognizing that the group
has certain limitations in its scope. Rather than believe that a group will
be a cure-all for a particular issue, the member will enter the group with
an understanding of what can be accomplished within a time-limited
model.
Clearly defined goals also allow the participant t o evaluate whether
the outcomes facilitated by the group are consistent with his or her per-
sonal value system. Participants need to believe in the value of making
the changes advocated by the group if the group is t o be effective. Often,
a group is designed to target a specific population without considering
34 JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2000

whether that population sees a need to make a change. "he group may
focus on teaching behavior-change skills without examining the values
associated with the behavior. Unless the participants see the group
goals as congruent with their own values, they will not commit to the
change process. For example, a group on job-seeking skills may empha-
size the importance of making eye contact that may be in direct conflict
with the social values of a cultural group. Both the leader and the par-
ticipants could experience frustration if pertinent cultural values were
not recognized.
In determining goals, the designer needs t o be realistic in what can be
accomplished in a time-limited setting. It is tempting to focus on long-
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range change when in reality, short-term goals are the essence of what
can occur during the group. "he designer may find it helpful to visualize
the group as a springboard for future change by providing the members
with tools for future growth. If a group is designed effectively, the short-
range goals will provide successivesteps that will enable the participant
to reach long-range goals.

Step 3: Setting Objectives

Whereas goals are the compass setting the direction for the group,
objectives provide the road map on how to get there. Once the goals have
been established, the designer determines the best way to reach the
goals. Objectives establish the connection between theory and applica-
tion and specifythe steps necessary for reaching the group goals. In set-
ting objectives,the designer makes assumptions about the way in which
a psychological concept evolves. These assumptions are derived from
the research and literature on the group topic and provide the steps to
change.
In the appendix, one of the goals cited focuses on learning t o modify
negative self-talk. "he objectives then have to delineate steps to reach-
ing that goal. In this case, the participant must learn t o define the differ-
ent types of self-talk, identity when he or she engages in negative
self-talk, become aware of how the negative self-talk affects his or her
self-esteem, and learn to change the negative statements to positive or
coping statements. The designer would then use these steps to deter-
mine how t o reach the goal of reducing negative cognitions.
A crucial element in group design is the identification of the specific
steps necessary for change. It is the role of the objectives t o put these
steps into practice. The session-by-sessioncontent comes directly from
the objectives that need to be written in a specific manner. Objectives
indicate what must happen if the goal is to be met, thus providing an
outline for the content. Once the objectives are specified, the designer
Furr / STRUCTURING PSYCHOEDUCATIONAL GROUPS 35

can choose from many creative approaches to meet the objectives. If the
objectives are successfully implemented, the goals will be met. Because
change can occur on multiple levels (behavioral, cognitive, affective,
existential, and physical), objectives need t o reflect the level being tar-
geted. Although many concepts involve change on multiple levels, an
objective often will focus on only one component of change. For example,
improvinga person’s self-esteem may be related to developingan uncon-
ditional positive regard for one’s self as well as changing negative cogni-
tions. Because both components need to be addressed, two separate
objectives would be developed to ensure that change is facilitated on
affective and cognitive levels.
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Because change is a multidimensionalprocess, the designer will have

to make assumptions about the most appropriate sequencing of the
objectives. Each objectiveneeds to be sequenced so that it leads logically
t o the next objective.As mentioned previously, the literature and theory
provide guidance on the sequencing of goals, objectives, and activities.
In the example provided in the appendix, it may be important that
attention be given to changing negative cognitions before a person is
able to believe that he or she is deserving of unconditional positive
regard. This example assumes a rational emotive therapy (RET) per-
spective (Ellis, 1979) that states changing thinking leads to changing
emotions. If a designer chose a different perspective such as Gestalt,
changing feelings may precede changingthoughts. Proper sequencingof
objectives allows the group to follow a natural progression in which one
level of learning provides support for the next level.

Step 4 Selection of Content

Group content is organized into three components: didactic, experi-
ential, and process. The didactic component focuses on the information
t o be taught directly t o participants. One distinguishing factor of the
structured group is the commitment t o teaching psychological princi-
ples. Because structured groups are generally brief in duration, partici-
pants do not have time to discover all of the information for themselves.
In fact, it is assumed that the leader has some knowledge that partici-
pants may not be able to discover through normal group interactions.
The didactic approach allows the leader t o take a directive role in teach-
ing information appropriate to the group topic. Through the use of
mini-lectures, the leader can provide the background knowledge needed
for facilitating the change process.
A major feature of the didactic component is an interactive lecture in
which the leader encourages comments and questions from the partici-
pants. Instead of just presenting the definition of a concept, the leader
36 JOURNAL FOR SPECIALISTS IN GROUP WORK/ March 2000

would invite participants to share their ideas of the concept and then
weave these comments into the definition the leader wanted t o convey.
Participants can be asked to provide personal examples of how the
material applies to their own lives so that the information becomes more
than an intellectual exercise.
These didactic mini-lectures typically range from 10 to 15 minutes
but may be less depending on the age and attention span of the partici-
pants. The leader must be careful not to overload the participants with
more information than they are able t o process. Each lecture segment
builds on previous segments until the concept being introduced is fully
examined. The didactic segment begins with the simplest aspect of the
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concept and then expands to more complex ideas.

Although didactic information is a vital part of the structured group,
change is dependent on the participant's ability to apply the concepts to
life situations. Experiential learning allows the material to be encoun-
tered on a personal level. To learn by doing rather than just by listening
results in a deeper and more complex educational experience. As the
participant becomes more involved in the learning process, he or she
takes more responsibility for applying the information t o personal
situations and consequently will be better able to use the knowledge
outside of the group setting.
Experiential activities need to be grounded in theory just as the
didactic component evolves from theory. The design of the activity will
depend on what the theoretical assumptions say about which dimension
(cognitive, behavioral, affective, physical, or existential) is critical to the
concept being addressed. If time management is viewed from a behav-
ioral viewpoint, activities may concentrate on examining how time is
used daily and changing the order of activities. However, if time man-
agement is examined from a Gestalt perspective, then activities may
center on examining how unfinished business interferes with engaging
in the present.
Although the leader can maintain a degree of control over the presen-
tation of didactic material, he or she can only determine the direction of
the experience. Each participant may experience the activity in a differ-
ent way because of his or her individual growth needs. The group leader
must be prepared t o address individual questions and outcomes of the
exercise. The way in which the leader deals with these differences is
through the third content component: process.
"he goals of the process component are to help participants connect
the experiential and didactic components. Once the experiential learn-
ing has occurred, participants may renew their interest in the informa-
tional component. They may need to clarify the conclusions they derived
from the experience or examine questions that arose from the
Furr / STRUCTURING PSYCHOEDUCATIONAL GROUPS 37

experience. By linking the experience with the theory, the participant is

better able to generalize the experience t o a broader life context. Ulti-
mately, the process component becomes the linkbetween the group con-
tent and the participant’s life outside of the group. Where the
experiential component personalizes a concept for the participant, the
process component integrates the new awareness with the individual‘s
conceptual framework.
Including specificdirectionsfor processing the experiential activity is
crucial to the success of the activity (DeLucia-Waack, 1997a). Many
group leaders trust that appropriate processing questions will emerge
from the group responses to an activity; however, it is beneficial for the
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leader to think through the purpose of the exercise and evolve questions
that facilitate member understanding of the experience. Processing
may include discussion about what happened in the activity;what were
participants’ reactions to the activity; what thoughts, feelings, or
insights were generated; and how these insights can be applied to the
participants’ lives outside of the group. Kees and Jacobs (1990) sug-
gested that processing questions begin with the concrete level and move
t o the abstract level. Initially, questions focus on processing what hap-
pened in the activityitself and then move t o reflection on reactions t o the
exercise. Questions then can address how the activity has affected the
group process. Later questions examine the impact of the exercise on
members’ feelings, thoughts, and insights as well as ways the experi-
ence can be applied to their lives outside of the group.
Another aspect of the processingcomponentis the sharing of the lead-
er’s observations about the activity. WhiIe participants are engaged in
the experiential component, the role of the leader is to observe the group
interactions and to note issues and concerns that arise for participants,
These issues and concerns then can be shared and examined during the
process component. During this time, cognition and affect become inte-
grated and assimilated into the participant’s frame of reference. When
the leader does not devote enough time to this component,the chance for
transfer of learning to occur decreases.
The amount of time devoted to each of the three components is
dependent on the dimension the leader is addressing (cognitive, behav-
ioral, affective, physical, or existential). “he dimension chosen as the
primary focus depends on the theoretical perspective selected for the
group. Some dimensions require more emphasis on the didactic,
whereas others need to concentrate on the experiential and/or process-
ing. In general, cognitive and behavioral dimensions focus more on the
teaching aspect and are followed by practice activities. Affective and
existential dimensions demand more experiential activities and exten-
sive processing. The physical dimension needs to focus on the
38 JOURNAL FOR SPECIALISTS IN‘GROUP WORK/ March 2000

experiential activities with less emphasis on processing. For example,

teaching relaxation skills may focus the majority of attention on the
experiential with some brief introduction and follow-up processing,
whereas the topic of letting go of a past failure may need much time
devoted to exploration of the affective dimension along with time to gain
closure on the feelings through the processing component.
For the group design to have an impact, an appropriate balance of the
three components of didactic, experiential, and processing is necessary
or participants w illnot become fully involved with the group. Although
the didactic content is what often attracts a participant to the group, it is
the actual activities that make group stimulating and involving. Experi-
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ential activities or exercises are the driving force in effective structured

groups. The content must be presented in such a manner that it impacts
the participant in meaningful and lasting ways. Although exposure to
information is important, the participant needs to take ownership of
that information and translate it into his or her own frame of reference.
To achieve the appropriate balance, the following timelines are sug-
gested for each component: cognitive (60% didactic, 15% experiential,
and 25% processing); behavioral (40% didactic, 40% experiential, and
20% processing); affective (30% didactic, 40% experiential, and 30%
processing); existential (20% didactic, 40% experiential, and 40% pro-
cessing); and physical (25% didactic, 50% experiential,and 25% processing).

Step 5: Designing Exercises

Many excellent exercises already exist and can be adapted to meet
the needs of a particular group. Before choosing to incorporate an exer-
cise created by someone else, the designer must first identify the theory
and goals behind the exercise and determine if the exercise is congruent
with the current group theory and goals. The exercise needs to be appro-
priate for the age and experience levels of participants to ensure that
participants have sufficient developmental resources to benefit from the
experience. Congruence between the dimensions addressed in the
didactic component and the dimensions experienced in the exercise is
essential.
Exercises can be grouped into several general categories from which
the designer can create numerous variations. Each category will be dis-
cussed separately along with the goals of that category.

Self-assessment.One category of exercises is based on self-assessment

instruments with the goal being to increase the participants’knowledge
of their proficiency with regard to the topic of the group. Self-assessment
allows each individual to specify areas of change he or she is willing to
Furr / STRUCTURING PSYCHOEDUCATIONAL GROUPS 39

undertake and thereby to set appropriate goals. A second benefit of us-

ing some type of self-assessmentis that the same measure can serve as
an indicator of progress at the end of the group experience. For some
group topics, instruments with well-documentedreliability and validity
exist. However, it may be necessary to create some type of self-efficacy
instrument that addresses the participant’s beliefs about his or her con-
fidence concerningaspects of the concept or an instrument that assesses
the participant’s knowledge about a topic. Other self-designed instru-
ments may have the participant rate self-perceived behaviors in situa-
tions related to a concept being discussed in the group. For example,
group participants in an assertion training group may rate their ability
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to act assertively in certain situations (i.e., expressing anger) with par-

ticular individuals such as family members or authority figures.

Cognitive restructuring. A major focus of many structured groups is

on changing cognitions. Cognitive restructuring exercises concentrate
on changing self-talk and disputing irrational beliefs. Selftalk is de-
fined as subvocal speech that usually serves to direct one’s actions and
evaluate one’s behavior (Meichenbaum, 1977).It is the ongoing conver-
sation with one’s self that can arouse emotions or instigate action. Once
a person changes his or her thought pattern or challenges an irrational
belief, both the affective reaction and the behavior are modified. To en-
gage in cognitive restructuring, the sequence of change is (a)recognition
of inappropriate self-talk, (b) restructuring the content of self-talk, and
(c) repeated implementation of the readjusted self-statements. For ex-
ample, in a group focused on managing stress, participants may be
asked t o identify self-statements that increase their anxiety and then
modify these statements to become more calming.

Role-playing. Role-playingis a category of exercises that is related t o

the behavioral dimension. The goal of role-playing is t o facilitate behav-
ior change particularly in interpersonal situations. Role-playingallows
participants t o rehearse new behaviors in a supportive environment
and to receive feedback in a constructive way. An integral part of role-
playing is feedback that may come from observers or from a videotape
that allows for self-observation. For feedback to be effective, the ob-
server must be able to discriminate between appropriate and inappro-
priate behaviors. One method of teaching discrimination skills is
through modeling in which the leader provides examples of the targeted
behavior as well as examples of ineffective behaviors. Role-playing is
frequently used when teaching any type of communication skills in
groups such as marriage enrichment, job interviewing, or friendship
building.
40 JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2000

Imagery. The use of imagery exercises allows the designer to move be-
yond the constraints of the immediate setting (Heppner, O’Brien,
Hinkelmen, & Humphrey, 1994;Myrick & Myrick, 1993).By encourag-
ing the participant to use his or her imagination, an exercise can take
the participant to a setting specific to his or her own issue. Imagery exer-
cises can focus on either behavior or affect. Visualizing how one is sup-
posed t o act can actually improve performance. The use of imagery in
systematic desensitization also is well documented (Renneberg, Gold-
stein, Phillips, & Chambless, 1990).
Imagery increases intrapersonal awareness on both the affective and
existential dimensions. Suppressed emotions may be brought to the sur-
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face through reliving experiences, and life meaning may become clearer
as one projects his or her life into the future.

Creative arts. The use of art (Gladding, 19981,music (Gallant, Holo-

sko, & Siegel, 19971, and drama (Winder, 1996) can be beneficial to
adults as well as children. Use of these creative media allows the partici-
pant to express ideas or feelings that may be difficult to convey in words.
Because of the hands-on nature of these activities, participants are en-
gaged on multiple dimensions-physical, cognitive, and affective. Of-
ten, the goal of creative activities is to encourage expression of difficult
emotions, and the subsequent processing of the creative activity facili-
tates the development of a new cognitiveframework about the feelings.
Although the use of drama may initially sound similar t o role-
playing, there are some important distinctions. Role-playing is directed
toward learning a new behavior, whereas drama allows for exploration
of interpersonal dynamics. An example of this type of drama is the use of
family sculpting (Lawson, 1989)where a participant can fully examine
his or her position within the family. Other group participants are
placed in the roles of family members, creating a living portrait that
shows the individual participant’s relation to the other family members.
This process allows the participant to examine feelings related to his or
her position in the family.

Body awareness. A final category of exercises involves the physical

body and the way in which the participant interprets physical sensa-
tions. Body awareness exercises facilitate knowledge of physical signs
connected to affect and behavior. Relaxation exercises are the most
popular example of a body awareness experience. Many Gestalt exer-
cises are related to sensory awareness and are based on the view that
the body is inseparable from thoughts and feelings (Passons, 1975).In-
creasing this awareness can lead to increased recognition of denied emo-
tions and the way in which cognitions lead to blocking affect.
Furr / STRUCTURINGPSYCHOEDUCATIONALGROUPS 41

Homework. In addition to in-group activities, the leader may want to

add an out-of-groupassignment to reinforce the skills and concepts in-
troduced during the group. Homework allows participants t o practice
outside of the group what was learned in the group (Gazda, 1989).Usu-
ally, homework is assigned at the end of the session and can serve as a
way of closing the session as well as providing continuity t o the next ses-
sion. It can focus on thinking, feeling, and/or behavior experiences and
can take many forms such as observing self or others, recording reac-
tions, practicing skills, and self-exploration through journaling. If par-
ticipants are asked to complete a homework assignment, time needs to
be allotted at the beginning of the next session for processing reactions.
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Otherwise, participants will not gain the full value of the activity, and
the opportunity to provide corrective feedback is lost.
Exercises are not limited to the categories previously described.The
designer is limited only by his or her imagination. The importance of
well-designed (and well-processed) activities cannot be overempha-
sized. It is the exercises that personalize the information for the partici-
pant and facilitate the integration of the concepts into the participant’s
cognitive framework. Without exercises, the psychoeducational group
would become a vehicle that only conveys information rather than
changes perceptions and behavior. As discussed previously, the experi-
ential activities must be thoroughly processed to realize the maxixnum
benefit.

Step 6: Evaluation
An essential part of any structured group is evaluation. If a group is
to be effective, the designer must test the ideas and determine which
components facilitate change.Process evaluation refers t o the effective-
ness of the session-to-session activities, whereas outcome evaluation
Iooks at the degree of individual change. Process evaluation is an ongo-
ing activity and is important because members’ perceptions of their con-
nectedness to the group often predict who will drop out and who will find
the group effective (DeLucia-Waack, 1997b).Throughout the group, the
leader needs t o consult with members about their perceptions of the
group and its activities. This type of evaluation may occur informally as
the leader asks whether the informationpresented has been helpful or if‘
an activity was meaningful. The leader may decide t o have a brief
evaluation midway through the group to see if group needs are being
met. Although a group design may not be able to be adapted t o every sug-
gestion, the leader often can make minor adaptations t o respond to a
member request. A number of process measures have been developed to
evaluate group leadership behavior, group climate, therapeutic factors,
42 JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2000

and in-session behavior. Many of these instruments are discussed in a

comprehensive review of process and outcome measures by DeLucia-
Waack (1997b). For example, the Group Sessions Rating Scale (Cooney,
Kaddes, Litt, & Getter, 1991) can be used in psychoeducational groups
to evaluate the perceived effectiveness of specific group interventions.
Outcome evaluation is increasingly important in demonstrating the
effectiveness of psychoeducational groups and can take several forms.
The most rigorous form is closely aligned with research design in which
participants are pretested on objective criteria prior to entering the
group and posttested on completion of the group. Although a number of
instruments exist to measure specific constructs, caution should be used
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in selecting these instruments because the construct addressed by the

group may not change dramatically in the short span of a structured
group (Baldwin, Collins, Kostenbauer, & Murphy, 1988). Although
skills may be learned and cognitive frameworks influenced, the global
construct may take longer to change.
Speer (1998) classified outcome measures into different categories
and provided examples of instruments in each category. These catego-
ries include (a) client’s self-reports of distress, (b) client’s self-reports of
symptoms, (c) client’s self-reports of functioning and role appraisal, (d)
significant other reports of consumer functioning and role performance,
(e) public gatekeepers as sources of data, (f) functioning and role ap-
praisal by independent observers, and (9)functioning and role appraisal
by providers. He emphasized that information does not have to be lim-
ited t o data collected from the participant but can include reports from
others in the environment who directly observe the participant’s level of
functioning. For example, teachers can observe improvement in conflict
resolution skills, and school records can indicate a decrease in office
referrals, better academic performance, and increased attendance.
Another form of assessing outcome is centered on goal attainment.
Participants are measured on how well they obtain the goals outlined by
the group leader or how well they reach the goals they write for them-
selves at the beginning of the group. Items in the evaluation are specifi-
cally linked t o the group content. An example of this type of item used in
the Building Self-Esteem Group is “I can identify when I make negative
self-statements” with the rating ranging from strongly agree to strongly
disagree. One benefit of this process is that it allows the participants t o
review the process they have just completed and teaches them to self-
evaluate.
Member satisfaction is another common form of outcome evaluation.
In this form of evaluation, participants report their subjective reaction
to the group rather than an objective outcome. They may evaluate the
leader’s style, the content of the group, and the group activities. Member
FUR / STRUCTURING PSYCHOEDUCATIONAL GROUPS 43

satisfaction reflects the degree of attractiveness the member has to the

group and can focus on how satisfied the member is with his or her indi-
vidual progress and the level of satisfaction with the group interaction.
Satisfaction in itself is not sufficient to create change but is a facilitative
condition for nurturing change.

RECOMlVlENDATIONS

A pitfall for many new designers is having a focus for the group that is
too broad. Initially, a topic such as building self-esteem appears t o be an
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exciting prospect for a structured group. Once the designer begins writ-
ing goals and objectives, it will become evident that only a limited
number of the main concepts can be incorporated into the group. One
way of dealing with containing the scope of a group is to consider design-
ing sequential groups on the same topic. The first group could establish
the foundation concepts with subsequent groups building more complex
skills. Another approach is to design parallel groups that complement
one another. For example, a group that concentrates on assertion train-
ing could follow a group with a self-esteemfocus because assertiveness
is a skill helpful for maintaining a healthy self-esteem.
Another challenge for designers is making the time commitmentnec-
essary for documentation of the group design. Designers usually get
excited about creating the ideas but lose some interest when the design
process becomes tedious. If the documentation is to be complete enough
for repetitive use, the designer must be willing to include substantial
detail. It is very easy for the designer t o assume that he or she will
remember what was intended by a brief phrase or abbreviation only to
realize much later that he or she cannot recall the meaning of a n activ-
ity. Ideally, instructions should be written in enough detail so that
another professional with similar training can lead the group without
confusion.
At times, the designer must let go of an exercise that he or she views
as extremely powerful but that does not fit the goals and objectives of a
particular session. Too often, a leader begins with the exercise and tries
t o build the session around it. “his approach forces the designer to
evolve the goals from the exercise rather than from the theory, resulting
in inconsistency among the sessions.Deducingthe content from the the-
ory allows the content to flow easily from one sessiont o another and sup-
ports a logical sequencing of material.
The designer needs to recognize that a natural evolution of the group
exists and that the nature of sessions will change as the group pro-
gresses. Early sessions need t o provide members with a sense of safety
44 JOURNAL FOR SPECIALISTSIN GROUP WORK I March 2000

so they need to be high on the support factor. It is important to limit the

amount of risk-taking activities members are asked to complete until
group cohesion forms. Initially, self-disclosure activities should be lim-
ited to surface topics while gradually moving to a deeper intrapersonal
level. As the need for support decreases, the leader needs to shift t o
information and activities that are more of a challenge t o the partici-
pants. Unless the participants feel that more is being demanded of
them, the group will lose its appeal and involvement will decrease. Each
session needs to maintain an appropriate balance of the support and
challenge factors.
A delicate relationship exists between using group process skills to
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respond t o group dynamics and maintaining the structure of the group.

Because the leader cannot fully anticipate how individual members will
respond to the material, theleader must be able to react spontaneously.
However, there will be a tremendous temptation to allow process to
overshadow content. When process becomes dominant, the group is no
longer psychoeducational and evolves into a therapy group. At times, a
leader must demonstrate great restraint and not pursue an individual’s
personal issues at a deeper level. For many leaders, staying with the
group plan and allowing for only minor deviations is the greatest chal-
lenge of structured group leadership.
Finally, group leaders need to remain aware of members who may
benefit from a referral for additional individual or group therapy. Even
when appropriate screeninghas occurred, a group member may experi-
ence a crisis or become aware of deeper level issues. If this situation
occurs while the group is in progress, the group leader will need to meet
individuallywith the member and evaluate whether the member should
continue with the group. Because of the structure provided by the group,
the member may be able t o manage the emotional situation without cre-
ating a distraction in the group. However, the leader and member may
feel that the group would not be productive for the member and would
need t o make a referral. It is the responsibility of the leader t o maintain
a current list of referral sources and assist the member by coordinating
the referral (Gladding, 1999).

IMPLICATIONS FOR GROUP COUNSELORS

The design of an effective psychoeducational group is a highly

involved endeavor. The benefits of following this process is that the
group retains a strong theoretical foundation while creating stimulat-
ing activities that enable the participant to actively engage the mate-
rial. Once the design has been completed,implemented, and refined, the
Furr / STRUCTURING PSYCHOEDUCATIONAL GROUPS 45

group can be repeated easily by different facilitators without any loss of

effectiveness. The time spent in the initial design may appear to be over-
whelming at first, but if the designer truly wants an effective product
that will stand the test of time, the investment is proven beneficial.

APPENDIX
Structured Group on Building Self-Esteem

Step 1: Statement of Purpose

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The group, Building Self-Esteem, is designed for college students who desire
to develop more positive feelings about themselves. The group design is based on
the assumption that self-esteem is learned through interactions with others.
Self-esteem is defined as the ability to know one’s self, both strengths and limi-
tations, and to accept and value one’s self unconditionally. Individuals are not
born with positive or negative esteem but with the capacity to develop in either
direction.

Step 2: Goals
1. To develop an understanding of the relationship between self-talk and
self-esteem and to learn to modify inappropriate self-talk.
2. To develop an awareness of how feelings relate to self-talk with special
emphasis on the ways people use self-talk to cancel out positive feelings.
3. To help participants understand how beliefs, self-talk, and feelings influ-
ence behavior and to assist participants in identifying changes that can
lead to behavior change.

Step 3: Objectives
Objectives for Goal 1:

a. Participants will learn the definition of self-talk and be able to differenti-

ate between positive, negative, and coping self-talk.
b. Participants will be able to define the relationship between self-esteem
and self-talk and will identify how their personal self-talk affects their
self-esteem.
c. Participants will learn to identify personal negative statements and ways
to change these negative statements to positive or coping statements.

Step 4: Content
Self-talk andselfesteem. At this point, the concept ofself-talk and its involve-
ment in self-esteem is explained. What one says to one’s selfis one ofthe most ac-
cessible factors to an individual in changing his or her level of esteem. As a way
46 JOURNAL FOR SPECLALISTSIN GROUP WORK I March 2000

of illustrating this point, have the group think about getting back a test paper
with a poor grade and then ask them what things they say to themselves that
keep them from maintaining their self-esteem. Emphasize that being aware of
what they say to themselves is what the group will be working on in the remain-
ing sessions. Explain the principle: Changing self-talk changes feelings about
one's self.

Step 6: Exercises
Changing self-talk

a. Distribute handout on self-talk that contains examples of negative self-

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talk in the leR column. In the right column, an example is provided on

how to change the negative self-talk to positive or coping self-talk. The
leader asks members to read the first example and describe the differ-
ences between the types of self-talk. The leader also may ask for personal
examples of negative self-talk and demonstrate ways to change these to
positive or coping self-talk.
b. Small group activity.The group is asked to break into t i a d s and read the
remaining examples on the handout. They are then to change the nega-
tive self-talk to positive or coping statements. Once this task is com-
pleted, they are to identify a personal statement they typically say to
themselves that serves to reduce their self-esteem. Participants then
help each other in restating self-talk in a way that does not decrease self-
esteem.
c. Regroup and discuss. The leader asks the triads to share examples of
negative statements and the revised positive or coping statements. Pro-
cessing questions may include: How does your negative self-talk affec
your feelings about yourself? How did your feelings toward yourself
change once you switched t o a positive or coping statement? What are
some of the ways in which you can apply these principles during the next
week?

Step 6: Evaluation
a. Process evaluation:At conclusion of second session, ask members to iden-
tify what they had learned from the activities and how they can use this
information to meet their individual goals for change. In addition, ask
memberswhat activitiesand information had not been helpful to them.
b. Outcome evaluation: Compare pretest evaluation on definitions of self-
esteem and self-talk with posttest evaluation.
c. Outcome evaluation: Give participants a list of negative statements and
have them change the statements to positive or coping Statements.
Furr / STRUCTURING PSYCHOEDUCATIONAL GROUPS 47

REFERENCES

Association for Specialists in Group Work. (1991).Association for Specialists in Group

Work Professional standards for training of group workers. Journal for Specialists in
Group Work, 17,12-19.
Baldwin, C. L., Collins, J. R., Kostenbauer, T., & Murphy, C. B. (1988).Research choices
for measuring outcome of high school groups. Journal for Specialists in Group Work,
13,2-8.
Barth, R., Yeaton, J., & Winterfelt, N. (1994).Psychoeducational groups with foster par-
ents of sexually abused children. Child and Adolescent Social Work Journal, 11,405-
424.
Bauer, M., & McBride, L. (1996).Structuredgrouppsychotherapyfor bipolar disorder: The
Downloaded By: [EBSCOHost EJS Content Distribution] At: 01:58 10 June 2009

life goals program. New York Springer.

Berg, R. C., Landreth, G. L., & Fall, K A. (1998).Group counseling: Concepts and proce-
dures. Philadelphia: Accelerated Development.
Commissaris, L., Verhey, F., & Jolles, J. (1996).A controlled study into the effects of
psychoeducation for patients with cognitive disturbances. Journal of Neuropsychiatry
and Clinical Neuroscience, 8,429-435.
Constantine, M. (1996).Retired female athletes in transition: A group counseling inter-
vention. Journal of College Student Development, 36,604605.
Conyne, R. (1996).The Association for Specialists in Group Work training standards:
Some considerations and suggestions for training. Journal for Specialists i n Group
Work, 21,155-162.
Cooney, N . L., Kaddes, R. M., Litt, M. D., & Getter, H. (1991).Matching alcoholics to cop-
ing skills or interactional therapeutic experience in group psychotherapy. Journal of
Consulting and Clinical Psychology,59,598-601.
Corey, G. (1990).Theory and practice of group counseling (3rd ed.). Pacific Grove, CA:
BrookdCole.
Cwiakala, C., & Mordock, J. (1996).Let’s discover health and happiness play groups: A
model for psychoeducation of young children with parents in addiction recovery. Jour-
nal of Child and Adolescent Group Therapy, 6,147-162.
DeLucia-Waack, J. L. (1997a).The importance of processing activities, exercises, and
events to group work practitioners. Journal for Specialists in Group Work,22,82-84.
DeLucia-Waack, J. L. (1997b).Measuring the effectiveness of group work A review and
analysis of process and outcome measures. Journal for Specialists in Group Work,22,
277-293.
Drum, D. J., & Knott,J. E. (1977).Structuredgroups for facilitating deve1opment:Acquir-
inglife skills, resolvinglife themes, and making life transitions. New York Human Sci-
ences Press.
Durana, C. (1996).A longitudinal evaluation of the effectiveness of the pairs psychoeduca-
tional program for couples. Family Therapy, 23,11-36.
Ellis, A. (1979).The practice of rational-emotive therapy. In A. Ellis & J. Whitely (Eds.),
Theoretical and empirical foundations of rational-emotive therapy (pp. 61-100).Pacific
Grove, CA BrooWCole.
Fawzy, F., & Fawzy, N. (1994).Astructured psychoeducational intervention for cancer pa-
tients. General Hospital Psychiatry, 16,149-192.
Fristad, M., Gavazzi, S., Centolella, D., & Soldano, K. (1996).Psychoeducation: A promis-
ing intervention strategy for families of children and adolescents with mood disorders.
Contemporary Family Therapy, 18,371-384.
48 JOURNAL FOR SPECIALISTS IN GROUP WORK / March 2000

Furr, S., & Fulkerson, K (1982,March). Theory. design, and implementationofstructured

groups. Paper presented at the meeting of the American Personnel and Guidance Asso-
ciation, Detroit, MI.
Gallagher, R., & Nazarian, J. (1995).A comprehensive cognitive-behaviordeducational
program for schizophrenic patients. Bulletin of the Menninger Clinic, 59,357-371.
Gallant, W., Holosko, M., & Siegel, S. (1997)."he use of music in counseling addictive cli-
ents. Journal ofAlcohol and Drug Education, 42,42-52.
Gazda, G. (1989).Group counseling: A developmental approach. Boston: Allyn & Bacon.
Gladding, S.(1990).Let us not grow weary of theory. Journal for Specialists in Group
Work, 15,144.
Gladding, S . (1998).Counseling as an art: The creative arts in counseling. Alexandria, VA:
American Counseling Association.
Gladding, S. (1999).Group work: A counseling specialty. Englewood Cliffs, NJ: Prentice
Downloaded By: [EBSCOHost EJS Content Distribution] At: 01:58 10 June 2009

Hall.
Heppner, M. J., OBrien, K. M., Hinkelmen, J. M., & Humphrey, C. F. (1994).Shifting the
paradigm: The use of creativity in career counseling. Journal of Career Development,
21,77-a6.
Ivey, A. (1976).The counselor as teacher.Personne1 and Guidance Journal, 51,591-597.
Kagan, N., Kagan, H., & Watson, M. (1995).Stress reduction in the workplace: The effec-
tiveness of psychoeducational programs. Journal of Counseling Psychology, 4471-78.
Kaminski, P., & McNamara, K.(1996).A treatment for college women at risk for bulimia:
A controlled evaluation. Journal of Counseling and Development, 74,288-294.
Kees, N . L., & Jacobs, E. (1990).Conducting more effective groups: How to select and pto-
cess group exercises. Journal for Specialists in Group Work, 15,21-29.
la Salvia, T. (1993).Enhancing addition treatment through psychoeducational groups:
Journal of Substance Abuse Treatment, 10,439-444.
Lawson, D. M.(1989).Using family sculpting in groups to enrich current intimate rela-
tionships. Journal of College Student Development, 30,171-172.
McWhirter, J . (1995).Emotional education for university students. Journal of College
Student Psychotherapy, 10,21-38.
Meichenbaum, D. (1977).Cognitive behavior modification: An integrative approach. New
York Plenum.
Meichenbaum, D., & Navaco, R. (1985).Stress inoculation: A preventive approach. Issues
in Mental Health Nursing, 7,419-435.
Morrill, W., Oetting, E., & Hurst, J. (1974).Dimensions of counselor functioning. Person-
nel and Guidance Journal, 53,354-359.
Myrick, R. D., & Myrick, L. S. (1993).Guided imagery: From mystical to practical. Elemen-
tary School Guidance and Counseling, 28,62-70.
Passons, W . R. (1975).Gestalt approaches in counseling. New York Holt, Rinehart &
Winston.
Pomeroy, E., Rubin, A., Van Laningham, L., &Walker, R. (1997)."Straight talk": The ef-
fectiveness of a psychoeducational group intervention for heterosexuals with
HIVMDS. Research on Social Work Practices, 7,149-164.
Renneberg, B., Goldstein, A. J., Phillips, D., & Chambless, D. L. (1990).Intensive behav-
ioral group treatment of avoidant personality disorder. Behavior Therapy,21,363-377.
Rice, A. (1995).Structured groups for the treatment of depression. In K. R. MacKensie
(Ed.),Effective use of group therapy in managed care (pp. 61-96).Washington, DC:
American Psychiatric Press.
Rogers, C. (1961).On becoming a person. Boston: Houghton Mi&.
Shear, M. (1995).Psychotherapy for panic disorder. Psychiatric Quarterly, 66,321-328.
Furr / STRUCTURING PSYCHOEDUCATIONAL GROUPS 49

Sheeber, L., & Johnson, J. (1994).Evaluation of a temperament-focused, parent-training

program. Journal of Clinical Child Psychology, 23, 249-259.
Sherrill, J., Frank, E., Geary, M., & Stack, J. (1997).Psychoeducational workshops for eld-
erly patients with recurrent major depression and their families. Psychiatric Services,
48, 76-81.
Speer, D. (1998).Mental health outcome evaluation. San Diego: Academic Press.
Taylor-Brown, J.,Acheson, A, & Farber,J. (1993).Kids can cope: A group intervention for
children whose parents have cancer. Journal of Psychosocial Oncology, 11,41-53.
Winder, J. H.(1996).Counseling adult male survivors of childhood sexual abuse: Areview
of treatment techniques. Journal of Mental Health Counseling, 18,123-133.
Winston, R. B., Bonney, W. C.,Miller, T. K.,&Dagley, J. C. (1988).Promotingstudent de-
velopment through intentionally structured groups. San Francisco: Jossey-Bass.
Zimpfer, D. (1990).Groups for divorcdseparation: A review. Journal for Specialists in
Downloaded By: [EBSCOHost EJS Content Distribution] At: 01:58 10 June 2009

Group Work, 5,51-60.