Audio: James Sussex, Workplace Options Clinical Team Lead  

Hi everybody, I’m James. I’m Clinical Team Lead in the UK. I’ve also got experience across the last several years in private practice, the corporate sector, charities, and other NGOs working alongside depression, anxiety, stress, relationship issues, borderline personality disorder, and more. What we’re here to talk about today though is psychoeducation and a little bit about what psychoeducation is.

But more importantly, how this fits within the scope of how we work and how we can foster an understanding and therefore empowerment in our conversations with clients, participants, and service users.

Psychoeducation doesn’t necessarily mean teaching, instructing, or simply information giving. Collaboration is key, and what psychoeducation can help us to do is to work with somebody to show them how things work e.g. diagnosis or disorders or experiences that they’re going through, or it could be a phenomenon. It could be an experience, or it could be an event that’s happened to them.

It’s about offering a tool and psychoeducation is about offering a tool to help understanding and to foster understanding. Understanding in turn will help with coping, so it’s not just for people that are going through the experience itself, it’s also for family members, for friends, and people that are affected by the ripple effect in that sense.

As an example, we can look at anxiety. So just imagine a situation where a participant service user or client calls in and they’re feeling anxious. There may be times when you speak to somebody who might even be going through a panic attack at the moment of the call. So you can clearly hear the symptoms of anxiety manifesting. Maybe they’re not breathing or maybe they’re breathing too much. Maybe there’s shallow and fast breathing. You could also get a sense in the flavor of the tension that the person is going through as they’re caught in that sort of eye of the anxiety storm.

What we can provide in that situation is de-escalation and holding and containment, and that’s very, very important. But what about after? What happens next? A lot of the time, the person on the other end of the phone, the chat, or even in the face-to-face situation may not have the language to describe what’s going on for them.

Sometimes they’ve never had this experience before. Other times it may have happened, but they haven’t known what’s going on. Or other times they may think there is something medically, physically wrong. And actual facts when we probe into it, you know, the person that’s had medical tests, blood test and nothing’s come back. So at this point, we may have an idea that we are of course talking about anxiety in conjunction with what’s going on.

In collaboration with the other person and always through a pluralistic viewpoint we can offer some psychoeducation that can be done in a way that is meaningful for the person, for the participant, for the client, or for the service user or family member or friend. And it can be done in a way that fosters understanding. It can be done in a way that harnesses empowerment.

Knowledge is power and therefore the provision of information fosters empowerment and we could do that in many different ways. One of those ways is through metaphor and storytelling. As humans, we love to tell stories, and we like metaphors and imagery, and this is a key way that we learn. Explaining anxiety as a reaction to risk, threat and danger could be the first step in that storytelling.

So for example, somebody is going through a big life change. What we also know is that there are other pieces to the puzzle, so it could be that big life change. It could be the COVID situation that we’ve been through. It could be a relationship break up. It could be absolutely anything that adds to that wait.

If storytelling is an element of psychoeducation, then it can be a way that we explain overwhelm. Once we’ve explained what anxiety is in this way, we can explain it as a reaction to threat, risk, and danger. But it’s about putting a context to that. One of the things I like to do with participants is to invite them, always invitation-only, invite them. So imagine that we were walking down the road, 10,000 years ago, all of a sudden we turn the corner, and we see and come face-to-face with a saber-toothed tiger. And what’s going to happen in that moment is one of three things: you’ll decide to fight or fly or run or freeze and do nothing. And this is how we can explain the anxious reaction. If anxiety is a reaction to threat, risk, and danger – this is how it can manifest. And what’s going to happen in that moment is overload, essentially, is what we’re going through. So the end of the line implication is that, actually, perhaps anxiety is not all bad. It’s doing its job as a response to overwhelm, and then it can be about using imagery, using the metaphor to perhaps talk about whatever is causing that overwhelm.

So imagine one of the things that we can invite participants to do is to imagine that inside the stomach they have a bucket or a measuring jug. And if we keep filling it up or we keep throwing things into the bucket, eventually, what’s going to happen? Is it we’re just going to get more and more full overtime? And we can invite the participant to think about what’s going to happen when we get to 80 or 90% capacity and even hundreds. What happens if one more thing happens? What happens if we add more, we add one more thing to the bucket. We add a little bit more liquid to the jug, then there won’t be enough room to contain what’s just been added. So it will spill over the side and this is where we then start feeling anxious. This is the overspill, the point at which we start to experience that anxiety is the point of overspill. So it’s about in a sense thinking about what might be contributing to a sense of generalized anxiety or contributing to that stress. What has filled up the stress thermometer and what has made the temperature rise to such a degree that actually things become unmanageable, and thereafter overwhelming.

Sometimes it’s a bit like holding onto 1000 helium balloons and what’s going to happen over time is that the helium balloons are going to lift you off slowly. And eventually, your feet will be off the ground, and when your feet are off the ground, control will be lost. Each of the balloons represents something that adds to that anxiety bucket. So by using imagery, using metaphor we’re able to come up with something actionable, something relatable. And that is the key thing in psychoeducation that it has to be relatable in order to make meaning for the participant in the context of what they’re going through. Experience with anxiety can be useful but encouraging storytelling around it is the key to fostering that understanding. Asking and collaboration are really important in working with psychoeducation with participants. And you could start with something as simple as what color would the anxiety be if you could describe it? What would it look like? And sometimes the feedback that you might get would be an array of creative different images and stories.

Previously myself, I’ve had feedback from certain people who say things like it’s a monster or it’s a dark cloud that follows me around and it blocks out the sun. And some of the key themes that come out of those images or about being overpowered, being out of control, unable to make choices. So storytelling adds power. It adds weight to the image of the anxiety and what’s going on there. And then using metaphors together and storytelling together, we can really come up with ways to explain how that process works. And I like to explain with participants that anxiety is a little bit like a Jack-in-the-Box and what that means is that it’s a lot easier to spring out of the box at any given moment than it is to just stuff it back in.

And this is why maybe after a traumatic event, for example, years down the line, it could be that we’re still having these reactions at any given moment. And that’s power because it’s actionable. It’s understandable. And that’s not just about sitting down and explaining what anxiety is, which we can also do, but it’s giving something to somebody. It’s a learning tool, a self-learning tool, that is about giving something that is actionable. Psychoeducation can occur verbally. It can occur through worksheets, or text, or any means. But if those means aren’t meaningful for a participant, then it’s not going to have the impact that we need it to have, or that we want it to have even. It must have a context that is meaningful because it needs to have something that can be taken away, and working on that, building on that. We can understand the components of anxiety, for example through metaphor, through imagery, answer, explanation.

Going forward, it can be about building on that image. It can be about building on that knowledge when in those anxious moments. And let’s be clear that because we’ve offered some psychoeducation, it does not mean that these anxious moments, for example, are not going to happen anymore. They will and they will pass. And that’s what we do with those moments. In this sense, psychoeducation can offer hope. And where there’s hope, there’s a segue into self-compassion, especially if we are able to understand what it is that’s going on for us. If we’re able to provide a framework for what’s going on in those moments; “Yes, I’m having a panic attack”, “Yes, I know what’s going on”. And the self-compassionate part can be the part that comes in because of the knowledge that we have to say “It’s okay. It will pass”. At the moment I’m out of the game, but I know what’s going on and if I know what’s going on I can do something and it’s okay. This is what’s happening. I’m not alone. I’m not by myself in this.

If it’s not okay, then perhaps it will be going forward, and so in that sense, knowledge gives strength to the arm, and this is my own philosophy. After being in the army a long time ago, knowledge gives strength to the arm was the motto of my regiment. I always come back to this in terms of the educational processes that happen in therapy. If we do more than pay lip service to psychoeducation, then we can have a real impact for the people that we work with. And this is absolutely true in the single-session therapy environment.