Implementing Empowerment Psychoeducation
in a Psychosocial Rehabilitation Setting
Lindsay A. Phillips, Psy.D.
P.O. Box 15234
Reading, PA 19612
Danielle N. Schade, Psy.D.
Psychologist and Program Manager
Veterans Affairs Medical Center, Coatesville
1400 Blackhorse Hill Road
Coatesville, PA 19320
Phillips LA & Schade DN (2012). Implementing Empowerment Psychoeducation in a Psychosocial
Rehabilitation Setting International Journal of
Psychosocial Rehabilitation. Vol 16(1) 112-119
this article, we address why empowerment psychoeducation may be
beneficial for individuals participating in services in a Psychosocial
Rehabilitation (PSR) setting.
provide a case example of how empowerment psychoeducation was
implemented in a group at a recovery-oriented wellness center.
We review the published literature that informed this group, and
provide an overview of the topics addressed in sessions, including
applications of empowerment, motivation, “personal medicine,”
overcoming stigma, and personal recovery process. We discuss our
observations in implementing this tool.
Conclusions and Implications for Practice:
Empowerment is a frequently discussed topic in the PSR literature, and
discussion about empowerment in PSR settings is valuable for all
parties involved. We strongly recommend that other providers in
PSR settings consider implementing a psychoeducational group on
Keywords: Empowerment, Psychoeducation, Psychosocial Rehabilitation, Psychiatric Rehabilitation
article addresses why empowerment psychoeducation may be beneficial for
individuals participating in services in a Psychosocial Rehabilitation (PSR)
setting, and we provide a case example of how empowerment psychoeducation was
implemented in a recovery-oriented wellness center. PSR, by its very definition is, “a holistic
approach that places the person- not the illness- at the center of all
interventions” (Weinstein & Hughes, 2000, p. 35). Empowerment is a mechanism through which PSR
services can be better focused on the individual and not on an illness. Cattaneo and Chapman (2010) define
empowerment as “an iterative process in which a person who lacks power sets a
personally meaningful goal oriented toward increasing power, takes action
toward that goal, and observes and reflects on the impact of this action” (p.
this group as an important way to fill a gap in the available programs at the
wellness center, since participants at the center were transitioning from a
medical to a recovery model, and often needed encouragement to take an active
role in their treatment and participation. Mental illness and traditional treatment
models (i.e., those with power differentials between service providers and
service users) have had disempowering effects on individuals (Oades &
Deane, 2007). Recovery is an active
process and for many, recovery-oriented treatment allows an individual to move
from what was once a passive role in treatment to a role that is now active and
empowered (Glover, 2007). Empowerment
psychoeducation can explore how individuals can be more active in their
recovery process and recovery center. Furthermore,
an empowerment group that promotes active involvement, such as this one, leads
to skill building that can be transferred to encourage individuals to actively
participate in their treatment and in their communities.
empowerment is a commonly discussed facet of PSR (Barton, 1999; Corrigan, 2004;
National Empowerment Center, 2008; Substance Abuse and Mental Health Services
Administration, 2006; Weinstein & Hughes, 2000), there is limited
literature addressing engagement in psychoeducation and discussion on
empowerment in PSR settings. We aim to
address how all parties involved in PSR settings can actively engage in applied
empowerment through psychoeducation, skill building, and discussion.
is a key facet of PSR and recovery-oriented values. The Substance Abuse and Mental Health Services
Administration’s (2006) statement on recovery identified empowerment as one of
the ten “fundamental components of recovery” (p. 1). They define empowerment as the following:
have the authority to choose from a range of options and to participate in all
decisions—including the allocation of resources—that will affect their lives,
and are educated and supported in so doing. They have the ability to join with other
consumers to collectively and effectively speak for themselves about their
needs, wants, desires, and aspirations. Through
empowerment, an individual gains control of his or her own destiny and
influences the organizational and societal structures in his or her life. (Substance
Abuse and Mental Health Services Administration, 2006, p. 1)
empowerment is widely discussed (Barton, 1999; National Empowerment Center,
2008; Substance Abuse and Mental Health Services Administration, 2006;
Weinstein & Hughes, 2000), and
services, such as clubhouses, supportive housing and employment, and peer
support have been identified as empowering resources (Corrigan, 2004), there is
limited discussion in the literature about engaging in psychoeducation and
conversation with individuals about empowerment itself. Psychoeducation informs individuals on topics
that are central to their recovery process and empowers individuals to be
active in their recovery because they have knowledge and information (King
& Lloyd, 2007). Empowerment
psychoeducation, hence, utilizes an empowering modality to engage in education,
discussion, and practice of this important element of PSR.
empowerment is the mechanism through which individuals realize their control
(Substance Abuse and Mental Health Services Administration, 2006), engaging in
active interventions that center on empowerment seems essential to recovery-oriented
services. Empowerment psychoeducation
should be included in the repertoire of groups and services in a PSR setting. The benefits of empowerment include
improved self-image, self-efficacy, confidence, and hopefulness, as well as
increase ability to cope with daily life, greater satisfaction with treatment,
and higher likelihood of reaching treatment goals (Linhorst, Hamilton, Young,
& Eckert, 2002).
Historical Significance of Empowerment
Over the past several decades,
treatment for severe mental illness has evolved considerably due to a myriad of
converging theoretical, political, social, and economic factors. By 1955, there
were 559,000 individuals in the United States
living in state psychiatric institutions (Lamb & Weinberger, 1998). The 1960s marked the beginning of
deinstitutionalization, as new psychotropic medication enabled patients to
improve and made medicating people on an outpatient basis a viable, less
expensive alternative to long-term hospitalization. Consequently, public mental hospitals began to
close. It was hoped that individuals
with mental illness could receive treatment while living in the community via a
comprehensive network of services, but inadequate funding and development
prevented community-based services from providing adequate care of a large
proportion of former patients (U.S. Department of Health and Human Services,
1999; McFarlane, 1995). A system that
formerly placed individuals in a passive role as “consumer” of service, now
expected individuals to integrate into the community at large. But how do these individuals make the
transition successfully? What enables a
person to move from the role of passive patient/service recipient to one of
active community contributor? Empowerment is a key factor.
Implementation of Empowerment Psychoeducation
Philosophy Behind Implementation
motivation for writing this article was our experience in implementing a weekly
psychoeducational group in a recovery-oriented wellness center. The center provided services, including groups
and activities, on weekdays for adults with a mental illness. The topic of empowerment was chosen as a group
topic for this setting due to the emphasis on empowerment in PSR literature (Barton,
1999; Corrigan, 2004; National Empowerment Center, 2008; Substance Abuse and
Mental Health Services Administration, 2006; Weinstein & Hughes, 2000), as
well as our observation that the adults attending the center were relatively
disempowered at the time. They would
come to the center and socialize, however would not actively engage in the
therapeutic activities. Additionally,
while they knew some key PSR terms, including empowerment, they were seeking to
find ways to apply these terms to their lives.
and Eckert (2003) discuss seven factors that promote empowerment. First, some degree of symptom control is
needed so that individuals are able to engage in decision-making. Second, the
individual must possess decision-making skills required to make meaningful,
thoughtful, and deliberate decisions. Third,
the individual needs access to resources (e.g., emotional support, advocates,
logistical resources). Fourth, concrete
incentives for participation in decision-making promotes empowerment. Fifth, the setting/environment must have
structures and processes through which individuals can participate in
decisions. Sixth, individuals should
have meaningful and plentiful information about their options when making
choices. Finally, a supportive culture
that welcomes and nurtures involvement in decision-making promotes an individual’s
psychoeducation in a collaborative and empowering manner. Social empowerment “must embody a co-equal
interaction between individuals and social environments” (Neese-Todd &
Pavick, 2000, p. 95). Although this
psychoeducational group was facilitated by a staff member, participants were encouraged
to engage in active discussion and social interaction. The facilitator’s role was to provide
psychoeducation, but more importantly, to facilitate collaboration between all
participants and the facilitator and to build rapport (Deane & Crowe,
2007). Corrigan (2004) asserts that
collaboration and participant input are core ways to support empowerment for
individuals with mental illness. Hence,
empowerment psychoeducation is not just about empowerment; empowerment
psychoeducation can actively empower individuals to participate in services. For example, we used discussion questions to
generate participation, and pointed our similarities in responses to build
rapport between participants.
Additionally, we discussed other community and wellness center resources
that could be used to help participants apply the facets of empowerment to
a key demonstration of empowerment in facilities that operate with PSR principles
is involvement of individuals in planning their own treatment (Neese-Todd &
Pavick, 2000). Because of this, individuals who participated in this initial
empowerment group were encouraged to suggest future topics or areas in which
they believed the group will benefit.
When participants suggested topics, this was acknowledged at the start
of the session to demonstrate the value given to suggestions. For example, participants wanted to focus on
their personal recovery process, so we included this topic. During our discussion, participants asked if
we could make a list of healthy leisurely activities, so we made a list on a
poster board that remained in the center, with all participants contributing
Practical Aspects of Implementation
to philosophical principals followed, we delineated a specific format for the
group, as well as objectives and an agenda for each session. Each group lasted about 45 minutes and
focused on posing a topic related to empowerment. This group was initially implemented once a
week for 11 weeks (the number of sessions was limited for logistic, scheduling-related
reasons). The first half of each session
was psychoeducational. The psychoeducational component of each session included
discussion questions and occasionally used handouts and a white board with markers
to highlight key concepts. The second
half of the group engaged in active discussion of the topic and how to apply
the topic to increase feelings of empowerment and recovery-oriented action. We thought it was especially valuable for
participants to talk about the actions they could take to apply the topics to
group that inspired this article educated participants on the meaning of
empowerment. Moreover, it helped individuals
develop in key topic areas. We will now
discuss this list of topics to encourage other individuals involved in PSR
settings to consider how they can promote psychoeducation and discussion on
empowerment. This is not an all-inclusive
list. All participants in empowerment psychoeducation can consider what topics
they wish to include when engaging in empowerment-related psychoeducation and
discussion. The topics addressed in our
implementation of an empowerment group included applications of empowerment,
motivation, “personal medicine,” overcoming stigma, and personal recovery
process. Our goal in is to promote using these or similar topics that help
individuals engage in discussion and application of empowerment. We will share discussion questions we used for
each topic, and we believe that these questions might also be valuable areas of
discussion between peers, in individual treatment, and even as casual
discussion topics for those family members and loved ones who read this article.
Applications of Empowerment
first few meetings of the empowerment group focused on generally discussing
empowerment. In these sessions, the
facilitator defined empowerment (specifically as having power or the ability to
accomplish) and provided a rationale for why an empowerment group was starting.
Participants also provided their own
personal definitions of empowerment. The
discussions centered on questions such as:
When have you felt empowered or disempowered?
Can you think of a time when you felt
Can you think of a time when you felt empowered?
How do we empower or
What can you do to
feel empowered or take charge of your life?
Participants also spent some
sessions discussing “self talk,” exploring how what they say to themselves is
either empowering or disempowering. Participants
used a psychoeducational worksheet to explore this topic and developed phrases
that they could use to empower themselves. We noticed that in the early
sessions, participants could provide definitions of terms, like “empowerment,”
but did not know how to actively apply the terms to their lives. The discussion questions and exploration of
“self talk” seemed to be helpful in that participants began to provide examples
of their challenges and goals for life improvement and empowerment.
few meetings of the empowerment group focused on motivation and how it relates
to empowerment. The facilitator used
psychoeducational handouts on motivation and wellness. Additionally, the group applied the topic of
motivation to the group participants’ experience in the PSR setting in which
the group was held. The discussions
centered on questions such as:
Why is it important to be motivated?
Do you think that staying motivated here will
help you in other areas of your lives? If so, where?
At their suggestion, participants also generated lists of
how they stay motivated (for example, some shared about talking walks in the
morning, and others discussed drinking mint tea). Future sessions addressed questions, such as:
Did anyone try the suggestions we made for
getting motivated/getting up and active?
How did they work?
If they did work, how can you keep this motivation
and empowerment going?
(2004) noted, “I have learned that psychiatric medicine is not the only
type of medicine that is important to recovery. Personal medicine, or those things that raise
our self esteem and make life worth living are vital to recovery” (para. 2). The facilitator introduced this topic and
linked “personal medicine” to empowerment by explaining that this is a part of
empowerment and feeling that we can make changes in our lives that are
completely under our control. Participants
in this group discussed what they consider to be their “personal medicine.”
with stigma can be an important topic for individuals to address (Heijnders
& Van Der Meij, 2006; Kirkwood & Stamm, 2006), especially as it relates to feeling
empowered. Sessions on this topic
focused on practical applications and addressed the following questions:
What could/should we do if we hear a
disempowering or stigmatizing statement?
What would you do if you overhead someone with
whom you were close saying something disempowering? What if it were someone you
did not know? ·
Are there times that you could assertively
address and times you would not address with the person but instead would cope
with your emotions on your own?
What emotions might arise in such a situation?
How would you cope with them? ·
If you did decide to address a person who made
such a statement, what would you do? Has this ever happened to you? Participants also role-played situations in which they
addressed stigma in the past and situations may face in the future. Most of the role-play situations were
generated by members sharing some negative experiences they had in which they
were the target of an inappropriate comment, or in which they wish they had
better advocated for themselves with a treatment provider or other individual.
Personal Recovery Process
the closing sessions of this empowerment group addressed how individuals viewed
their personal recovery process. They
also employed what they learned about empowerment to their personal recovery
process, addressing questions, such as
How can feeling empowered help your recovery
The final session of this group focused on setting
empowering, recovery-oriented plans for the future.
closing, in this article, we provide a rationale for why interventions in PSR
settings should have a direct focus on empowerment. Such interventions can provide education on
empowerment, promote discussion on empowerment, and should most importantly, be
provided in a manner that empowers individuals to actively participate.
learned some valuable lessons from doing this group. Although we found that participants had heard
about the terms and concepts we were discussing, they never previously
considered active implementation (such as what they might do to cope with
feeling disempowered). Because
participants knew the terms but not the applications in their lives, we learned
that we needed to discuss actions and behaviors that they could take, rather
than just defining important terms. This
also helped participants move from being passive in groups and discussions to
exploring ways in which they can be more active. The topics we discussed are important in many
settings beyond a psychoeducational group, and we encourage peers, family
members, and treatment providers to explore these topics together.
the group discussed in this article was not subjected to any empirical
evaluation, future systematic investigation of psychoeducational programs, such
as the group described in this article, are needed. Additionally, the phenomenon of empowerment
should be subjected to further empirical investigation. Barton (1999) has also suggested outcome
studies on empowerment and this article echoes that suggestion, particularly in
regard to whether services are empowering and which elements of PSR settings
individuals find to be empowering. Empowerment is a key tenant of PSR, and
future research, program development, and discussion should address this
important facet of recovery.
How can feeling disempowered hurt your recovery
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