Chapter Six – Psychoeducation

Although therapy for trauma-related problems often involves the processing of traumatic memories, psychoeducation is also an important aspect of trauma treatment.

Many adolescent survivors of interpersonal violence were victimized in the context of overwhelming emotion, narrowed or dissociated attention, and, in many cases, a relatively early stage of cognitive development; all of which potentially reduced the accuracy and coherence of their understanding of these traumatic events. In addition, interpersonal violence frequently involves a more powerful figure who justifies his or her aggression by distorting objective reality, for example by blaming victimization on the victim. These fragmented, incomplete, or inaccurate explanations of traumatic events are often carried by the survivor into adolescence and beyond.

Therapists can assist in this area by providing accurate information on the nature of interpersonal trauma and its effects, and by working with the youth to integrate this new information and its implications into his or her overall perspective. For example, older adolescents with sexual abuse histories frequently ask about the reasons for their abuse, in an effort to address feelings that they were in some way responsible. In such instances, accurate information on the prevalence of abuse, the typical motives of perpetrators, and socially-transmitted myths regarding victim complicity may lessen the client’s self-blaming attributions.

Handouts and Other Media

Whether it occurs in individual therapy or in a guided support group, psychoeducation sometimes includes the use of printed handouts. These materials typically present easily understood information on topics such as the prevalence and impacts of interpersonal violence, common myths about victimization, and social resources available to the survivor.

The therapist should keep several issues in mind when deciding what written material to make available and how it should be used (Briere & Scott, 2012):

• The quality of the materials
• The reading level required
• The language of the materials
• The cultural appropriateness of the information or depictions
• The risk of insufficient cognitive-emotional integration – especially if the materials are merely handed-out without sufficient discussion or application to the client’s own history or current situation.

Most importantly, handouts should be considered tools in the psychoeducation process, not stand-alone sources of information. Didactic material, alone, may not be especially effective in changing the beliefs or behaviors of victimized individual. Instead, the therapist should ensure that the information is as personally relevant to the youth as possible, so that whatever is contained in the handout or media is directly applicable to his or her life, and thus has greater implicit meaning.

Books

Clinicians may also refer the client to readily available books that are “survivor-friendly.” Although obviously limited to those with adequate reading skills (a significant problem for some traumatized adolescents), such books allow clients to “read up” on traumas similar to their own, and potentially experience validation around their personal experiences and concerns. Some books may be too emotionally activating for youth with unresolved posttraumatic difficulties, however, at least early in the recovery process. Others may contain erroneous information, or suggest self-help strategies that are not, in fact, helpful. For these reasons, the clinician should personally read any book before recommending it to the adolescent; not only to make sure that it is appropriate to his or her needs, and is factually accurate, but also in terms of its potential to activate significant posttraumatic distress in those unprepared for such emotional exposure.

Verbal Information During Therapy

Although written psychoeducational materials can be helpful, it is often more useful for the therapist to provide such information verbally during the therapy process. This is especially true for “street kids” and other youth who, for whatever reason, have not progressed far, or well, in the educational system. Because the information is directly imbedded in the therapeutic context, it is often more relevant to the client’s experience, and thus more easily integrated into his or her understanding. Additionally, psychoeducation provided in this manner allows the therapist more easily to monitor the client’s responses to the material, and to clear up any misunderstandings that might be present.

General Focus of Psychoeducation

Whether through written or verbal means, clinicians often focus on several major topics when working with adolescent (and other) trauma survivors. These include:

• The prevalence of the trauma (e.g., in contrast to the youth’s impression that only he/she has been victimized);
• Common myths associated with the trauma (e.g., that victims ask for or deserve victimization);
• The usual reasons why perpetrators engage in interpersonal violence (e.g., to address their own needs including a desire to dominate the victim or as a reflection of their own inadequacies);
• Typical immediate and longer-term responses to trauma (e.g., posttraumatic stress, depression, intimacy issues, or significant substance use);
• Reframing substance use/abuse and “acting out” or tension-reduction behaviors as adaptive strategies that, nevertheless, may have serious negative repercussions; and
• Resources available to the trauma survivor (e.g., printed information, self-help groups, shelters, advocacy groups, or supportive legal or law enforcement personnel). For some youth, accessing spiritual support may be helpful.

As is noted on the chapter on cognitive processing, psychoeducation is probably best understood as a component of a larger strategy: an attempt to assist the youth in updating (and/or actively countering) the understandings, beliefs, and expectations that he or she developed during earlier adverse experience. In some cases, the adolescent is provided with information that is more accurate than what he or she believes (psychoeducation). In other instances, therapy may involve opportunities for the client directly to work with these thoughts and beliefs until a more benign and reality-based understanding arises (the cognitive therapy described in Chapter 9). In many cases, these two approaches can be combined.