The International Journal of Psychosocial Rehabilitation
Implementing Empowerment Psychoeducation
 in a Psychosocial Rehabilitation Setting


Lindsay A. Phillips, Psy.D.
Assistant Professor
 Albright College
lphillips@alb.edu
P.O. Box 15234
Reading, PA 19612


Danielle N. Schade, Psy.D.
Psychologist and Program Manager
Veterans Affairs Medical Center, Coatesville
danielle.schade@gmail.com
1400 Blackhorse Hill Road
Coatesville, PA 19320




Citation:
Phillips LA & Schade DN (2012). Implementing Empowerment Psychoeducation in a Psychosocial 
Rehabilitation Setting
 International Journal of Psychosocial Rehabilitation. Vol 16(1) 112-119



Abstract
Topic. In this article, we address why empowerment psychoeducation may be beneficial for individuals participating in services in a Psychosocial Rehabilitation (PSR) setting.
Purpose: We provide a case example of how empowerment psychoeducation was implemented in a group at a recovery-oriented wellness center. 
Sources: 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 empowerment.

Keywords: Empowerment, Psychoeducation, Psychosocial Rehabilitation, Psychiatric Rehabilitation



Introduction
This 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. 647).

We saw 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.   

While 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.  

Why Empowerment?
Empowerment 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:
Consumers 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)

Although 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.

Since 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
The 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.
Linhorst 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 empowerment.

We utilized 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 their lives.

Similarly, 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 ideas.

Practical Aspects of Implementation
In addition 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 their lives.

Empowerment Topics
The empowerment 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
The 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 disempowered?
        Can you think of a time when you felt empowered?
        How do we empower or disempower ourselves?
        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.

Motivation
The next 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?  

“Personal Medicine”
Deegan (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.”

Overcoming Stigma
Coping 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
Finally, 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 process?
        How can feeling disempowered hurt your recovery process?
The final session of this group focused on setting empowering, recovery-oriented plans for the future.

Conclusions
In 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.  

We 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.

Although 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.


 

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