“Knowledge is the antidote to fear.”
– Ralph Waldo Emerson
Relief swept over her like sweet rain quenching the parched desert.
“That makes a lot of sense. Thank you!”
Alison had told me she’d been diagnosed by her doctor with depression and how she feared she was “stuck with it”. She’d been becoming more and more depressed about her diagnosis.
Building rapport through mirroring your client’s experience
I had simply described to Alison the cycle of depression – how spending too much time ruminating during the day leads to overdreaming at night, which saps motivation and energy during the next day.1 Once people start to ruminate less, it seems they exchange overdreaming for more replenishing slow-wave sleep, and the depression starts to lift.
Alison was pensive.
“I do overthink! I’m always in my head! And yes, the mornings are often the worst part of the day. Even if I sleep through the night I feel exhausted when I wake up!”
So the explanation I’d provided here:
- Mirrored her experience, thereby helping her feel understood and deepening our rapport.
- Made sense on an instinctive as well as a common-sense level. No need for complicated chemical theories! She suddenly saw depression as an explicable mechanism,not some scary, inescapable fiend.
- Gave her hope, because if we could meet her emotional needs better and help her ruminate less, the depression might just lift, even within a 24-hour cycle.
This was, although I didn’t think of it as such at the time, psychoeducation.
Psychoeducation – when and how to use it
I’d used psychoeducation to help Alison reframe her worries about depression.
If we can usefully give clients sensible and clear knowledge and information, or at least the latest ideas on their difficulty and also a sense of what can be done for them and by them, then we are using psychoeducation for their real benefit.
In psychiatry and physical medicine it’s certainly important for the patient to be as well informed as possible as to their prognosis, possible lifestyle changes they may need to make for a better prognosis, medical treatment possibilities, and other possible options for treatment.2
Providing this information in a relatable, clear, compassionate way takes skilled communication from the medical professional.
And in the field of psychotherapy and coaching, too, we can offer our clients clear understanding – as long as we bear some important caveats in mind.
Triggering the power of expectancy
Expectation is powerful. The placebo response can produce physical and psychological cures purely through the power expectation can have over physical and mental processes.
When a therapist ‘psychoeducates’ a client from a severely limited perspective, they may be setting an expectation as much as telling the client how it is. We are in danger of ‘hexing’ our clients with negative suggestions.
For example, if a therapist is wedded to the idea that all therapy is necessarily painful and long, they are doing the client a disservice if they don’t let them know that not all therapists share this pessimistic ideology and be clear that it is an ideology.
I’ll illustrate that with an anecdote.
Ideology can be miseducation
One client I saw had been to a Jungian therapist before me for his depression. He told me the therapist had told him that the therapy would be “agony” for him and that he should schedule a day off work the next day after therapy every week to “get over” the upset and pain of the therapy.
He duly did find the therapy terribly disturbing and needed time to recover from it each week. He was amazed to find that not only did he feel better after therapy with me each week but also that the depression began to lift quite quickly, which he had been told wasn’t possible.
What this man had experienced with “The Jungian” hadn’t been psychoeducation, but rather suggestion.
An ideology may be simply a set of beliefs which are more grounded in theory than observation or research.
This doesn’t mean that the ideology will always be wrong or wide of the mark, but when psychoeducating a client we need to be clear what is really valuable for them. We need to differentiate between actual, practical knowledge and personal opinion. We need to be clear on what has been reasonably verified and what is mere therapeutic belief.
‘Hexing’ clients with dangerous therapeutic ideology is the opposite of real psychoeducation.
Dangerous ideas posing as knowledge
Back in the 1990s there was a school of psychotherapy I will not name which taught its students that every – and I mean every – physical and emotional problem stemmed back to a forgotten act of sexual abuse.
A student of this school had made public a chart she’d been giving to clients showing which ailment stemmed from precisely which kind of sexual abuse.
So if a client had a stutter or suffered epilepsy or started having panic attacks because they were being bullied at work, the therapist was to inform the client that in all probability they had been sexually abused as a child, had repressed it, and needed, with the help of the therapist, to ‘bring it to the surface‘ in order to cure the disease or emotional problem.
Now practitioners working from this ideology were no doubt sincere and well intentioned, but their attempts at psychoeducation in the form of explaining to all and everyone that they ‘must’ have been sexually abused – insisting on it, in fact – were dangerous in the extreme.
So with the caveats that information may in some cases be misinformation and can also act as suggestion, and remembering that trying to inculcate within our clients non-commonsensical ideologies is not psychoeducation, what pointers can be useful when we think about providing our clients with psychoeducation?
Tip one: Do a thorough assessment
Before you can effectively psychoeducate your clients, you need to have a clear understanding of their condition and how it is impacting their life.
Start with a thorough assessment, including gathering information about their symptoms, their history, and any other relevant factors. This will help you tailor your psychoeducation to their specific needs and challenges.
You may not even deem psychoeducation to be necessary, but if you do…
Tip two: Know why you are psychoeducating
What is your reason for giving an explanation and information to your client? How will it help them see their situation more clearly? Feel less stigmatized? Be more hopeful?
Depending on the client, somescientific explanation may be useful and help them reframe positively, but we also need to be careful not to confuse or overwhelm our clients with too much jargon.
For example, when treating post-traumatic stress disorder I may briefly go into a little detail as to how, after using the Rewind Technique, we can expect that the memory will no longer stimulate the amygdala (the fight-or-flight part of the brain) to activate a kind of regression back into the traumatic time.
I might talk of how they can expect the traumatic memory, as it detraumatizes, to become comfortably stored in the ‘narrative’ parts of the brain up in the neocortex. I say that when this happens they’ll be able to recall the formerly traumatic memory when and if they choose to, calmly and comfortably (while still, of course, retaining the knowledge that it was awful at the time).
The flashbacks and nightmares will stop because the memory will be tagged in a different part of the brain.
Notice this actually accords with how the brain does traumatize and sets a positive expectation for the client before using Rewind.
But whatever we psychoeducate about, we always need to be clear and relatable.
Tip three: Use clear and accessible language
When explaining complex concepts, it can be easy to slip into technical jargon or academic language that clients may not fully understand.
Make sure to use clear, accessible, relatable language, using everyday terms – or at least explain the jargon in relatable ways. I’d avoid using acronyms or technical terms unless you have explained them clearly first.
So if I talk about the amygdala in the brain I’ll describe it as the ’emergency centre’ of the brain that deals with fight-or-flight responses, and so on. Of course, my client may already know all about the amygdala… but they might not.
And talking of ’emergency centres’…
Tip four: Psychoeducate through metaphor and simile
We can take unhelpful metaphors such as a ‘panic attack‘ (itself quite a scary metaphor!) and reframe them into more hopeful – and, in fact, more accurate – metaphors or similes.
So I might suggest that panic is more like an alarm response going off, and that the metaphor of ‘attack’ is unnecessarily scary (though undoubtedly catchy and memorable!). I might suggest that a car alarm doesn’t ‘attack’ the car whenever it goes off. I might suggest, then, that a ‘panic attack’ is really more like a car alarm that needs to be reset so that it doesn’t keep going off unnecessarily.
Now we’ve used a metaphor (alright, a simile!) to reframe a panic attack as less fearful and simply something that is useful – vital, even – in its place, but can sometimes be ‘set too sensitively’ and therefore need to be ‘retuned’ to go off only when it really needs to. Notice again that the new metaphor (for what before was a panic ‘attack’!) is in fact a more accurate representation of what actually happens, as no one is actually ‘attacked’ by their own fight-or-flight mechanism.
Before describing the cycle of depression I might suggest that depression is like a ‘flat battery’ that needs recharging – again, this actually quite fits the reality and implies hope that wellbeing can be restored.
Next, we can be a bit more prosaic.
Tip five: Provide written materials
In addition to explaining concepts verbally, we might sometimes provide written materials such as handouts, workbooks, or websites that clients can refer to between sessions.
This can help reinforce the information you have shared and give clients a reference they can revisit when they need it. Again, we don’t want to overload them with reams of material, but if, for example, I teach a client a self-hypnotic technique, I might write it down for them or email the structure of it to them later.
We might give them rudimentary written information on psychotropic drugs (while emphasizing they should never just stop taking anything cold turkey).
We also might need to reinforce why the client is seeing us.
Tip six: Emphasize the benefits of treatment
When clients are struggling with mental health issues, they may feel overwhelmed or hopeless about their condition. It’s important to emphasize the benefits of treatment and how psychoeducation can help them feel more in control of their symptoms.
So, for example, if a client has told me they “must be crazy” to have obsessive thoughts or compulsions, we might talk about the universal human need to feel safe and have a sense of control and order. In this way, psychoeducation and therapy can ‘normalize’ emotional problems and therefore help destigmatize them.
If you’ve treated clients for similar issues successfully before, you can describe how other clients got better as a strong positive implication for your client as regards their treatment.
Tip seven: Encourage questions and feedback
Psychoeducation is a collaborative process. It’s important to create an environment where clients feel comfortable asking questions and providing feedback.
Encourage clients to ask questions or provide feedback on what they find helpful or confusing. This can help you refine your approach and tailor your psychoeducation to their specific needs.
Therapy should in no way resemble a dry academic lesson, and much of my therapy won’t be psychoeducation, but certainly here and there it can serve to:
- Build rapport and a sense of recognition. Your psychoeducation should chime with the actual experience of your client. It should make logical and intuitive sense to them.
- Provide clarity. Psychoeducation should simplify an issue, not complicate it.
- Engender hope. This comes back to knowing why we are using psychoeducation rather than just using it for the sake of it.
Psychoeducation can be a powerful tool for therapists to help their clients better understand their mental health condition and learn effective strategies for managing their symptoms. By incorporating these tips into your practice, you can create a supportive and collaborative environment that empowers clients to take control of their mental health.
Seeing the pattern of one’s own state of mind ‘from the outside‘ as it were can be the first step to gaining control over it – as Alison found when she started to leave the desert of depression behind for good.
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