Background and Justification for the Group
The main activities of the psychoeducational groups include “role playing, problem solving, decision making, and communication skills training” (DeLucia-Waack, 2006, p. 11). In this respect, psychoeducational groups have certain goals and topics to focus on regarding the common problems faced by members of this counseling group. Sessions are held in closed groups and do not admit new members after the beginning because there are several stages and each stage has a certain purpose. The major purpose of the current group counseling is to encourage those patients engaged into the weight loss programs and provide them with e certain feedback. Telephone counseling and computerized counseling can be used as well.
Objectives
The main group objectives include the following points:
- Applying results of the literature review to the design of counseling sessions.
- Group counseling sessions should be design with regard to ethical considerations.
- Develop multicultural awareness of counselors.
- Integrate different theories and methods into the structure of counseling sessions.
- Incorporate knowledge of dynamics, member screening, group organization, and leadership competences in designing group counseling sessions.
Desired Outcome Goals
The major desired outcome goals include the following issues:
- Knowledge on different theories and methods integrated by various researchers that should be retrieved while reviewing the literature.
- Cultural awareness of possible reactions of representatives of various cultural groups.
- Well-structured sessions aimed at educating group members.
Literature Review
The effectiveness of group counseling as well as of psychoeducational approach in general can be prejudiced in terms of lack of a standardized procedure or a system assessing the efforts of counseling group members and a counselor. It is natural that education and counseling are different forms of a cognitive method. However, it is necessary to establish a set of grades to be used while implementing information acquisition in counseling therapy groups. The study by Neuner et al. (2004) supports an idea that counseling can be used in refugee settlements with people that have received a certain trauma.
As you probably know, the refugees can be representatives of different countries. In this respect, the counseling therapy provides counselors with an opportunity to develop cultural awareness with people presenting different cultural layers from various parts of the world.
Trauma is a complicated issue that is claimed to be treated through specialized methods that have demonstrated effective results. Though the counseling approached does not have evidence supporting its effectiveness and cannot be treated as the universal method for refugees with trauma, it can be a part of therapy as well as psychoeducational component. People that are aware of their problems can easily cope with those.
A counseling therapy method helps in developing the awareness of people in terms of cultural diversity and problems encountered. Neuner et al. (2004) suggest that psychoeducation should be combined with other types of therapeutic interventions while dealing with refugees presenting different cultures. As trauma should be approached differently than the weight loss, it requires a different approach.
Different problems require different approaches. Some approaches are universal and can be applied to most individuals regardless of their age, status, background, education, ethnicity, or other parameters that help to define different formal groups for surveys and other types of researches. The study conducted by Lipton, Falkin & Wexler (1992) shows numerous approaches of therapeutic interventions in the form of individual counseling provided to drug abusing individuals during the week and group counseling in the form of small groups of individuals encountering the same problem. In this case, it is necessary to emphasize the issue of privacy as most individuals are concerned with their personal problems being discussed by other people. The issue of confidentiality should be of paramount importance for group counseling therapy with regard to the personal problems shared with other members of the same group.
The effectiveness of cognitive approach is disputable for drug-using individuals. As suggested by Lipton, Falkin & Wexler (1992, p. 12), “Drug education and information programs are for basic support of other programs. Their cost is low and can be maintained by inmates in resource centers, but they do not constitute treatment”. However, cognitive approach can be considered rather effective taking into account the self-help groups and counseling therapy meetings.
It is obvious that a healthy lifestyle should be propagated among all people representing different social classes and age groups, groups of people according to their education and background or income rate. The study presented by Lipton, Falkin & Wexler (1992) dwells on the effectiveness of different approaches with drug addicts. It is possible to assume that the education is treated as an additional method for those who want to be healthy and do not need a feedback.
Counseling interventions can be considered one of the most effective elements of psychoeducational interventions in all cases relevant to the lack of knowledge on the concept, disease, or other issues. The status of citizens appeared to be exaggerated in the contemporary society as well as in the feudal country of the eighteenth century. Separations and divorces have become an integral part of the movement for rights of women that are claimed to be equal with those of men. Some women cease the valance in their families by means of a divorce or a separation, though children in such families with a single mother can become outcasts of the community regarding the norms of behavior established for the community members. The study by Smith & Smith (2000) demonstrated professional counseling interventions with parishioners from three different segregations and their attitudes towards separated or divorced people.
Divorce can be considered as a social phenomenon with some reasons and consequences that can affect other members of society, especially children from separated/divorced families. The counseling interventions in the case of Smith & Smith (2000) were aimed at developing awareness and understanding of the difficulties encountered by separated and divorced people with parishioners from different churches.
Recipients were asked to fill in questionnaires in accordance with their understanding of the divorced and separated people as well as their attitudes towards those being divorced or separated. In this respect, counseling interventions appeared to be effective in terms of developing the awareness of parishioners toward separated and divorced people and changing attitudes towards those people and some problems encountered by separated and divorced people. As you can see, psychoeducational component can be highlighted in case of developing awareness and changing attitudes.
Professional counseling can be considered effective in the most unexpected areas of human activities. As people tend to share their problems with their friends as well as with counselors, it is necessary to identify individuals that can be treated as trustworthy. In this respect, religion appears to be one of the most influential factors because most people that believe in god try to ask for some encouragement from clergymen or other people that can provide them with some confidence or soothing.
The study by Peterson (2002) demonstrates the effectiveness of church counseling in the corresponding establishments. As the professional counseling is aimed at helping people to cope with their problems and overcome certain difficulties existing in their lives via developing awareness, changing attitudes, or providing a feedback. The same measures are usually taken by preachers in churches of different segregations. When people have some problems, they should cope with those.
Some people appear to be unable to cope with their problems by themselves and need some moral help and encouragement. When a church priest advises parishioners on some activities and measures to be taken, this can be considered a psychoeducational component. The study by Peterson (2002) focuses on the professional counseling and a role of a professional counselor in church with regard to the professional approach to the issue of counseling taking into consideration separate individuals, families, and group interventions. In this respect, professional counseling at churches can be as effective as in all other areas with different people encountering different problems. Psychoeducational component is very important, especially with individuals who lack knowledge on certain issues and need a feedback from a counselor.
The importance of being aware of health problems and possible consequences of Pap smear results is vital. When you are not sure about something, you should require some additional counseling. The study by Miller et al. (1997) provides us with a definite evidence of effectiveness of counseling for Pap smear results. Abnormal Pap smear results and preliminary telephone counseling can help in developing awareness of possible consequences of the disease necessary therapies to prevent further development of the ill cells.
The counseling approach is performed via telephone calls; these interventions appeared to be effective in most cases and can be used to make women of different ages and social groups aware of measures to be taken and make them ready to many stages of painful procedures to prevent cancer tumors, though the research conducted for the study by Miller et al. (1997) was targeted at low-income minority women.
When a woman knows more about possible consequences of various therapies and interventions, she is ready for further procedures. Knowledge helps people to learn more about concepts and diseases that frighten them. Being aware of the real numbers of those who can fight the disease on the early stages, people start trusting therapeutic interventions and do not panic being diagnosed as those having cancer. Telephone counseling was used as a preventive measure for women that were going to the colposcopy in the study conducted by Miller et al. (1997). When a person is ready for other consequences than just a visit to a doctor, the patient can prepare herself to a complex of procedures to be taken as a preventive or medicinal therapy. In this respect, telephone counseling is a form of psychoeducational component.
Effectiveness of psychoeducational interventions can vary for patients facing different problems. When a person exaggerates the risk of having cancer, counseling interventions should focus on both the risk of having cancer and on the general information on the disease. Lack of knowledge can lead to exaggerated anxiety and inability to take appropriate measures or procedures necessary to overcome anxiety.
The study conducted by Lerman et al. (1995) demonstrates women who had first-degree relatives with the cancer disease and exaggerated their perception risk of it. The research was aimed at counseling these women on the real risk that they can have. The results of the research demonstrated that the counseling sessions appeared to be not very effective because of lack of knowledge on cancer with the counseling group members.
As the education on the most spread diseases can facilitate the reaction and help perceiving appropriate procedures, it is necessary to initiate counseling in medical centers and other establishments that can afford such interventions. Women with cancer were not targeted in the research conducted by Lerman et al. (1995), while the basic target group included women aged 35 years and older who had relatives of the first degree with cancer history.
If the closest relatives have cancers, patients start exaggerating their risk of perceiving this disease which should be ceased. Counseling interventions as a psychoeducational component can reduce the number of women with risk anxiety on breast cancer. First-degree relatives with cancer history can be considered the factor that causes the concerns of women on their risk of perception. Counselors should explain the essence of the disease and the real risk of perception, so should the relatives.
Telephone interventions can be used in many different ways to help people cope with their problems as a form of counseling sessions for separate individuals in the conditions of confidentiality. When some people do not want to talk about their problems in groups for some reasons, they do not refuse from receiving telephone counseling. In this respect, it is necessary to face different variants. The study by Zhu et al. (1996) shows that telephone counseling interventions can be considered from different ways, suchlike the initiative of the telephone intervention and the number of those. In this respect, the initiative may be from a patient or from his/her counselor; the number of telephone sessions ranged from one to four. The figures mean a lot in this case because it is necessary to focus on the effectiveness of single telephone interventions that can help smokers to take their first step on the way to the healthy lifestyle.
When people cannot cope with their problems by themselves, they can receive some encouragement or immediate feedback from counselors via group counseling sessions or telephone counseling as an alternative type of intervention which is more cost-effective, though appeared to be less effective for smokers willing to quit smoking. The telephone counseling interventions demonstrated in the study by Zhu et al. (1996) were aimed at facilitating ceasing attempts for smokers. The results demonstrated effectiveness of telephone counseling interventions that were initiated by patients but were preliminarily arranged. Single interventions can be considered the ones with low effectiveness. However, telephone counseling can be treated as an alternative type of counseling sessions with psychoeducational component.
Psychoeducational component can be considered one of the most powerful when people are afraid of something. People should be informed about all aspect both negative and positive of some measures or interventions. The study by Bertera & Bertera (1981) argues on the issue of cost-efficiency of telephone counseling compared to the group counseling sessions at clinic with hypertensive patients.
The experiment conducted shows that the effectiveness of telephone counseling was approximately equal to the one of group counseling. The study suggests the groups consisting of primarily aged Afro-Americans with low-income rate. As the sample size was not very sufficient, it is impossible to talk about recommendations, rather it is reasonable to mention that “…telephone counseling is at least as effective as face-to-face counseling in helping patients to achieve and maintain blood pressure control; telephone counseling is about twice as cost-effective as clinic visit counseling as a patient tracking technique…” (Bertera & Bertera, 1981, p. 628).
Regardless the number of sample groups it is necessary to conduct further researches in order to define the appropriate measures with people who should control their high blood pressure. If people cannot afford group-counseling, it is necessary to provide them with the intervention that is as effective as group counseling but is two times more cost-effective than the abovementioned intervention. Cost-effectiveness of interventions should be of paramount importance while working with low-income rate patients regarding the financial situation in the contemporary society.
The study by Bertera & Bertera (1981) focuses on psychoeducational component of interventions, whereas others emphasize medicinal component. In this respect, the telephone counseling sessions can facilitate education of hypertensive patients about their high blood pressure and some measures that should be taken.
The importance of modern technologies can scarcely be overestimated. We use telephones and internet to get a feedback and purchase a book. It is necessary to use technological progress in psychoeducational counseling therapy because we can make group sessions more effective through the internet and via using online databases to share experience, knowledge, and innovative methods. As suggested in the study conducted by Tate, Jackvony, & Wing (2006), the Internet counseling appeared to be very effective for those who tried to lose some weight. This can be presented as a new method for group counselors who can support the group members even outside the group sessions.
This technique can be rather effective regarding the increased number of Internet users and computer-friendly people that develop their communication skills via Internet chats and other types of messages.
The role of feedbacks received by group members is important, especially if the group members lack communication skills and need some encouragement and appraisal to increase their self-confidence. The research conducted by Tate, Jackvony, & Wing (2006) has demonstrated effectiveness of “automated computer-tailored feedback in an Internet weight loss program” (p. 1625). The effectiveness of feedback and encouragement is as important as human counseling groups.
However, some issues do not require automated feedbacks or other types of feedback. If a group member requires a feedback, he/she is not likely to be self-reliable and needs permanent encouragement. You can provide such members with the Internet-based support every time a group member needs it. You can also be sure that not only people concerned with weight loss require counseling therapy in the form of immediate feedback on the phone or via the Internet connection.
As counseling can be performed via telephone as well as via the Internet, it is necessary to emphasize the effectiveness of interventions relevant to the use of modern communication and information technologies. Some counseling interventions can appear to be ineffective for some problems, while other demonstrate a high level of effectiveness compared to the results of the control groups that received neither group counseling nor telephone/Internet counseling interventions.
The study by Tate, Jackvony, & Wing (2003) appeared to demonstrate high effectiveness of Internet counseling provided for patients that were engaged into the Internet weight loss program and had some risk of type 2 diabetes. The main difficulty was that patients were engaged in a different activity and were asked to participate in the counseling sessions. However, the interventions of weight loss that were supported with Internet counseling on the issue demonstrated better results that those without any counseling.
The type 2 diabetes was considered as an obligatory parameter for those participating in the experiment conducted by Tate, Jackvony, & Wing (2003). Preliminary loss of weight as well as pregnancy excluded patients from the potential participants. The loss of weight is a burning issue of the modern global society. Researcher from all countries attempt to find a way not only to lose weight but also to fix the result without any probability to gain overweight again after the experiment or a set of procedures. In this respect, the Internet counseling demonstrated effective results with most patients regarding the risk of the type 2 diabetes. Education played a role of psychoeducational component and facilitated the weight loss as well as fixing the results at one level.
Theoretical Approach
The most appropriate method that should be used by psychoeducational groups is the cognitive one because the counselors should acquire more information in order to be able to teach the members of counseling groups. As psychoeducational groups are aimed at developing the awareness of some aspects, rules, or basic requirements, cognition is the best way to learn something. A psychoeducational component is present in different types of counseling interventions. Telephone counseling is suggested to be a cost-effective type of counseling interventions, though group counseling interventions often appear to be more effective in terms of long-lasting results.
Ethical Practice
Ethics of counseling interventions include the risk of breaches of confidentiality that can happen because of different people learning personal information about each other with regard to not meeting before interventions. If a counselor learns some personal information about the patient, he/she should not distribute it; neither should other members of the counseling group. In this respect, some people may prefer individual counseling interventions rather than the group counseling because of the risk of being discussed in public. Many people are ashamed of their problems and prefer not to be defined as those having some problems.
Besides, as suggested in the study by Tate, Jackvony, & Wing (2003), the patients should be informed about the confidentiality and prohibited about the violation of this rule. As soon as a counselor finds an appropriate approach to ensure safe and confidential sessions, the group counseling interventions can be considered effective in terms of results.
Group Organization
It is necessary to state that the main target group of counseling interventions in the current research paper includes people engaged into the weight loss programs. The research addresses other groups relevant to counseling interventions in groups, though the current paper regards the weight loss as a topic to be aimed. The group should be organized in the manner of at least two groups: a research group and a control group. The research conducted by Basseches & Mascolo (2009) proves that psychoeducational therapy should be approached regarding four stages. The first stage includes the knowledge on the nature of sessions and necessity of its implementation into practise.
As soon as a person realizes what is happening now and anticipated results of sessions, he/she is sure to attain greater success in learning the techniques that can be used to cope with his/her problems and help others to cope with similar problems (as psychoeducational therapy is created for people to be able to help others). The second stage is aimed at reducing the effect of some problems. The third stage is aimed at reaching goals established for every person individually. The fourth stage deals with general acceptance of techniques introduced during sessions. Moreover, “core mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance” are modules existing within the psychoeducational therapies (Basseches & Mascolo, 2009, pp. 90-91).
Member Screening
The group should include people that did not have recent experience of weight loss; also, it is necessary to exclude people with pregnancy or some problems with high blood pressure, diabetes, and other factors that can influence the course of counseling interventions. It is necessary to take all possible measures to avoid group members quitting sessions and the project in general. The groups should be organized in the way of at least two groups: the first group should be engaged into group counseling session, while the second group should be excluded from counseling interventions (this would be a check group) and be engaged into weight loss program only.
Consent Form
As a rule, a consent form includes consent from parents or guardians, or other people that take care of the patients. The current research is aimed at developing awareness of pros and cons of diets with regard to weight loss and possible consequences of unwise measures taken by patients regardless of the doctor’s prescriptions or prohibitions. The weight loss may include the right to use personal data while conducting a research and an obligation to check the results and share these results with researchers and a counselor as violation of some rules and regimes can influence the results of the whole research.
Location, Materials, and Other Considerations
The location of group counseling should be a comfortable place, though it is necessary to exclude any mentioning of food or other factors that would distract patients from a counseling session. It is necessary to avoid public places or places where many people can appear to be witnesses of counseling interventions. The most appropriate choice in this case seems to be a clinic or a medical center. The materials necessary for counseling sessions include handouts because this should be a part of the first-stage sessions. Moreover,
Group Session and Activities
As sessions are integral parts of all types of group therapies, it is necessary to consider the way and importance of planning sessions for psychoeducational therapies. As you cannot predict the reactions of all group members, you should do everything possible to foresee the reactions of different people with regard to their social status, background, age, ethnical diversity, and other factors that can help you anticipate certain results of the sessions.
As suggested by Brown (2003), it is necessary to outline the objectives for each session; compose a list of materials that may be useful for the current session; a minilecture or a monologue that would introduce the information you want to present at the current session; and a certain set of activities or exercises aimed at acquiring information and integrating it into practise (p. 94). You should plan both the content of the session and the sequence of exercises and time that every set of activities may take.
DeLucia-Waack (2004) suggests some activities to be used in different stages of the group counseling therapies. The first type of activities includes initiating focus and establishing interaction. In this regard, this activity is important to learn about the peculiarities of every patient and problems encountered by each person (being aware means being ready to prevent certain difficulties and foresee problems).
The second type of activities is used after the interaction has been established; it includes facilitating the interactions. As suggested by Trotzer (1999, p. 396), facilitating “activities should be derived from or suggested in response to a situation or dynamic that has emerged in the group” (as cited in DeLucia-Waack, 2004, p. 80). And the third type of activity introduced by DeLucia-Waack (2004, p. 81) is integrating activity used in the end of sessions to consolidate the effects reached during the sessions.
Evaluating the Group
As a rule, the assessment of group counseling appears to be not very effective because of the nature of these interventions. As claimed by Neuner et al. (2004), it is impossible to use counseling sessions for all types of disorders and guarantee good results because the effectiveness of these results is difficult to assess. Thus, the results of the members of a counseling group engaged into the weight loss program should be assessed according to the results of the major program (the loss of weight) and its effectiveness. If the average weight of the patents participating in counseling sessions is less than that of non-members of counseling sessions, we can talk about the effectiveness of sessions.
Leadership Development
The leadership development is an important part of counseling sessions, especially while talking about people with equal possibilities and primary data. When people feel the competition, for instance, in the weight loss programs, they are likely to make every effort to surpass the results of their group members.
Conclusion and Recommendations
The main conclusion concerns the effectiveness of counseling interventions with people engaged into the weight loss programs. The counseling sessions can take place in groups or via telephone and Internet interventions. Counseling interventions appear to be an integral part of psychoeducational therapy and are required be people who seek feedback and encouragement.
Reference List
Basseches, M., & Mascolo, M. F. (2009). Psychotherapy as a developmental process. New York: CRC Press.
Bertera, E. M., & Bertera, R. L. (1981). The cost-effectiveness of telephone vs. clinic counseling for hypertensive patients: A pilot study. AJPH, 71 (6), 626-629.
Brown, N. W. (2003). Psychoeducational groups: process and practice (2nd ed.). New York: Routledge.
DeLucia-Waack, J. L. (2004). Handbook of group counseling and psychotherapy. Thousand Oaks, California: SAGE.
DeLucia-Waack, J. L. (2006). Leading psychoeducational groups for children and adolescents. Thousand Oaks, California: SAGE.
Lerman, C., Lustbader, E., Rimer, B., Daly, M., Miller, S., Sands, C., Balshem, A. (1995). Effects of individualized breast cancer risk counseling: A randomized trial. Journal of the National Cancer Institute, 87 (4), 286-292.
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Neuner, F., Schauer, M., Klaschik, C., Karunakara, U., & Elbert, T. (2004). A comparison of narrative exposure therapy, supportive counseling, and psychoeducation for treating posttraumatic stress disorder in an African refugee settlement. Journal of Consulting and Clinical Psychology, 72 (4), 579-587.
Peterson, J. (2002). Nonsectarian counseling in churches: A delicate balance. Counseling and Values, 46 (3), 226-236.
Smith, J. A., & Smith, A. H. (2000). Parishioner attitudes toward the divorced/separated: Awareness seminars as counseling interventions. Counseling and Values, 45 (1), 17-27.
Tate, D. F., Jackvony, E. H., & Wing, R. R. (2003). Effects of internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: A randomized trial. JAMA, 289 (14), 1833-1836.
Tate, D. F., Jackvony, E. H., & Wing, R. R. (2006). A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an internet weight loss program. Archives of Internal Medicine, 166, 1620-1625.
Zhu, S. H., Stretch, V., Balabanis, M., Rosbrook, B., Sadler, G., & Pierce, J. P. (1996). Telephone counseling for smoking cessation: Effects of single-session and multiple-session interventions. Journal of Consulting and Clinical Psychology, 64 (1), 202-211.