Training

Frontline Staff

Family 

Psychoeducation

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

Family 

Psychoeducation

Training

Frontline Staff

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services
Acknowledgments

This document was prepared for the Substance Abuse and Mental Health Services Administration 

(SAMHSA) by the New Hampshire-Dartmouth Psychiatric Research Center under contract number 

280-00-8049 and Westat under contract number 270-03-6005, with SAMHSA, U.S. Department 

of Health and Human Services (HHS). Neal Brown, M.P.A., and Crystal Blyler, Ph.D., served as 

SAMHSA Government Project Officers.

Disclaimer

The views, opinions, and content of this publication are those of the authors and contributors and 

do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services 

(CMHS), SAMHSA, or HHS.

Public Domain Notice

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copied without permission from SAMHSA. Citation of the source is appreciated. However, 

this publication may not be reproduced or distributed for a fee without the specific, written 

authorization from the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

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Recommended Citation

Substance Abuse and Mental Health Services Administration. Family Psychoeducation: Training 

Frontline Staff. HHS Pub. No. SMA-09-4422, Rockville, MD: Center for Mental Health Services, 

Substance Abuse and Mental Health Services Administration, U.S. Department of Health and 

Human Services, 2009.

Originating Office

Center for Mental Health Services

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road

Rockville, MD 20857

HHS Publication No. SMA-09-4422

Printed 2009
Family 

Psychoeducation

Training Frontline Staff

This five-module workbook will help family intervention coordinators 

teach practitioners about the principles, processes, and skills necessary 

to deliver effective Family Psychoeducation services. The workbook 

includes the following topics:

n Basic elements and practice principles;

n The core processes of Family Psychoeducation;

n Joining sessions and educational workshops;

n Ongoing Family Psychoeducation sessions; and

n Problem solutions from actual practice.

For references see the booklet, The Evidence.
This KIT is part of a series of Evidence-Based Practices KITs created 

by the Center for Mental Health Services, Substance Abuse and 

Mental Health Services Administration, U.S. Department of Health 

and Human Services.

This booklet is part of the Family Psychoeducation KIT that includes 

a DVD, CD-ROM, and seven booklets:

How to Use the Evidence-Based Practices KITs

Getting Started with Evidence-Based Practices

Building Your Program

Training Frontline Staff

Evaluating Your Program

The Evidence

Using Multimedia to Introduce Your EBP
What’s in Training Frontline Staff

How Family Intervention Coordinators 

Should Use This Workbook. . . . . . . . . . . . . . . . . . . . A

Prepare program-specific information. . . . . . . . . . . . . . . . . . B

Prepare agency-specific information. . . . . . . . . . . . . . . . . . . C

Visit an existing team. . . . . . . . . . . . . . . . . . . . . . . . . . . . . C

Arrange for didactic training. . . . . . . . . . . . . . . . . . . . . . . . D

Recruit a consultant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D

Cross-train. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D

Module 1: Basic Elements and Practice Principles. . . . . 1

What is Family Psychoeducation?. . . . . . . . . . . . . . . . . . . . . 1

The phases of Family Psychoeducation. . . . . . . . . . . . . . . . . 2

Practice principles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

The family experience. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Core values in Family Psychoeducation. . . . . . . . . . . . . . . . . 4

Program standards. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

How we know that Family Psychoeducation is effective. . . . . 6

Adapting the evidence-based model. . . . . . . . . . . . . . . . . . . 7

Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Exercise: Explore the Benefits of Family Psychoeducation. . . . 9

Exercise: Examine Program Standards. . . . . . . . . . . . . . . . . 11

Family 

Psychoeducation
Module 2: The Core Processes 

of Family Psychoeducation. . . . . . . . . . . . . . . . . . . . 1

Identify consumers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Introduce the program. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Conduct joining sessions. . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Conduct the educational workshop. . . . . . . . . . . . . . . . . . . . 4

Offer ongoing Family Psychoeducation services. . . . . . . . . . . 4

Engage consumers and families continuously. . . . . . . . . . . . 6

Complete Progress Notes. . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Participate in supervision. . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Exercise: Identify Consumers and Families. . . . . . . . . . . . . . . 9

Exercise: Introduce Your Program. . . . . . . . . . . . . . . . . . . . 11

Module 3: Joining Sessions 

and Educational Workshops. . . . . . . . . . . . . . . . . . . 1

Joining sessions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Educational workshops. . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Exercise: Review Progress Notes for Joining Sessions 

and Educational Workshops. . . . . . . . . . . . . . . . . . . . . . . . 13

Exercise: Practice What You’ve Learned About 

Joining Sessions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Module 4: Ongoing Family Psychoeducation Sessions. . 1

Conduct ongoing Family Psychoeducation sessions. . . . . . . . 1

Structure of multifamily groups. . . . . . . . . . . . . . . . . . . . . . 2

Overview of the first session. . . . . . . . . . . . . . . . . . . . . . . . . 2

Overview of the second session. . . . . . . . . . . . . . . . . . . . . . 5

Ongoing multigroup sessions. . . . . . . . . . . . . . . . . . . . . . . . 6

Exercise: Practice What You’ve Learned 

About Multifamily Groups. . . . . . . . . . . . . . . . . . . . . . . . . 13

Exercise: Review the Progress Note for Ongoing Family 

Psychoeducation Sessions. . . . . . . . . . . . . . . . . . . . . . . . . . 15

Module 5: Problem Solutions from Actual Practice. . . . 1

Overview of the module. . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Employment issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Medication issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Exercise: Practice What You’ve Learned About 

Problem Solving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Training Frontline Staff A

Training Frontline Staff

How Family Intervention Coordinators 

Should Use This Workbook

Training Frontline Staff introduces 

practitioners to the basic principles and 

skills they need to deliver effective Family 

Psychoeducation (FPE) services. Use this 

workbook with the Practice Demonstration 

Video and the English or Spanish 

Introductory Video on the DVD in 

this KIT.

Because being part of a team and learning 

how to process information together are 

essential parts of FPE, we recommend that 

you conduct group training sessions rather 

than simply give FPE practitioners the 

workbook to read on their own.

To make the content easy to manage, we 

divided the training into five modules.

The Five Family 

Psychoeducation Modules 

in Training Frontline Staff

1 Basics Elements and Practice 

Principles.

2 The Core Processes of Family 

Psychoeducation

3 Joining Sessions and Educational 

Workshops

4 Ongoing Family Psychoeducation 

Sessions

5 Problem Solutions from Actual 

Practice 
B Training Frontline Staff

How to Complete this Five-Session Training

n Arrange for FPE practitioners to meet at least once a week for 5 weeks. You will cover up to one module 

each week.

n In this workbook, on the page before each module, you’ll find Notes to the family intervention 

coordinator. Review the notes to prepare for the training.

n Copy and distribute the module’s reading materials so that practitioners can read them before 

the training session. You’ll find this booklet on the KIT’s CD-ROM.

n Copy the exercises for each module so that you can complete them during each training 

session. You’ll find the exercises in this booklet on the KIT’s CD-ROM.

n For each session, ask a different group member to facilitate.

n Begin each training session by showing the corresponding segments 

of the Practice Demonstration Video.

n Discuss the information on the video and in the workbook.

n Complete the suggested exercises for that module.

The ultimate purpose of this workbook is to have 

practitioners understand the principles behind the 

FPE model, how FPE is delivered, and the skills 

necessary to provide effective services. We have 

found that practitioners prefer to read one module 

at a time and then discuss that module with 

colleagues as a group. Working through these 

modules as a group creates an opportunity to 

discuss and master the core values and teaching 

principles that are essential to effective FPE 

practice.

Prepare program-specific 

information

In addition to providing the materials in this 

workbook, you should prepare to give FPE 

practitioners information about FPE policies 

and procedures. These include the following:

n Procedures for identifying consumers 

for the program;

n Conditions under which consumers will 

be discharged from the program;

n Procedures for completing FPE Progress Notes;

n Criteria for assessing the program’s fidelity 

to the FPE model; and

n Outcomes that will be monitored.

For sample forms, see Building Your Program

and Evaluating Your Program in this KIT.
Training Frontline Staff C

Prepare agency-specific 

information

You should also develop a plan to train practitioners 

about other policies and procedures that may be 

relevant to the agency in which the FPE program 

operates. These might include the following:

n Consumers’ rights: Practitioners should be 

aware of the state and federal consumer rights 

requirements.

n Billing procedures: Practitioners must know 

how to document and bill for FPE services.

n Safety: Many agencies with existing communitybased programs have materials about safety. 

If training in this area is not already available, 

plan for training in de-escalation techniques.

n Mandated reporting: Practitioners must know 

how to report suspected abuse and neglect. They 

also must know what to do if they find out about 

other illegal activity and threats of harm to self 

or others.

n Other policies and procedures: Consult your 

agency’s human resources office to learn of other 

program, agency, or state policies that the staff 

should know.

Visit an existing team

After your FPE team completes this workbook, 

we suggest that new practitioners observe an 

experienced, high-fidelity FPE program. If you 

are familiar with these materials before your visit, 

your visit will be more productive. Rather than 

using time to explain the basics, the host program 

will be able to show the new FPE practitioners 

how to apply the basics in a real-world setting.

Arrange for didactic training

After using this workbook and visiting an 

experienced FPE program, FPE practitioners will 

be ready for a trainer who will help them practice 

what they have seen and read. Some family 

intervention coordinators choose to hire an 

external trainer to help their team practice FPE 

principles, processes, and skills. The initial training 

should take 2 to 3 days.

Recruit a consultant

Once FPE practitioners begin working with 

consumers, you—along with the agency director—

are responsible for ensuring that they follow the 

evidence-based model. This task can be challenging.

You must facilitate a staff development process, 

apply what you have just learned about FPE in your 

own clinical work with consumers, and, at the same 

time, ensure through clinical supervision that FPE 

practitioners follow the model.

It is easy to stray from the evidence-based model 

and do something similar to but not quite the 

same as FPE. Sometimes this happens because 

practitioners believe they are diligently following 

the FPE model, but they miss some of the more 

subtle aspects of it. In other cases, FPE services 

start well, but, as more consumers are admitted 

to the program and pressure mounts, practitioners 

revert to older, more familiar ways of working.

To ensure that your team follows the FPE model, 

work with an experienced consultant throughout 

the first year of operation. A consultant can provide 

ongoing telephone and in-person support to help 

you with your challenging leadership role.
D Training Frontline Staff

Cross-train

It is important that staff throughout your agency 

develop a basic understanding of FPE. Crosstraining will ensure that other staff members 

support the work that the FPE team undertakes.

As discussed in Building Your Program, we also 

recommend that you train members of your FPE 

advisory group. The more information that advisory 

group members have about FPE, the better they 

will be able to support the program and its mission.

Training is also an opportunity for FPE 

practitioners and advisory group members to 

become familiar with one another. Make sure that 

the advisory group members and FPE practitioners 

introduce themselves and that they are familiar 

with each other’s roles.

To help you conduct your training, we include these 

multimedia materials in the FPE KIT:

n Introductory PowerPoint presentation;

n Sample brochure; and

n Introductory Video.

Once trained, you or your staff will be able to 

use these materials to present routine, inservice 

seminars to ensure that all staff members within 

the agency and advisory group members are 

familiar with the FPE program.

For more information

The information in this workbook provides a 

detailed overview of the FPE model. For more 

information, see the following resources:

Anderson, C., Hogarty, G., & Reiss, D. (1986). 

Schizophrenia and the family. New York: 

Guilford Press.

McFarlane, W. R., (Ed.). (2002). Multifamily 

groups in the treatment of severe psychiatric 

disorders. New York: Guilford.

We consistently found that agencies used these 

additional resources with this KIT to develop 

and manage their FPE programs. For this reason, 

we recommend the first resource to those 

implementing FPE in a single-family format and 

the second resource to those implementing FPE 

in the multifamily group format. For additional 

resources, see The Evidence in this KIT.
Basic Elements and Practice Principles E Module 1

Module 1

Basics Elements and Practice Principles

Notes to the family intervention coordinator

Prepare for Module 1:

n Make copies of Module 1. Your copy 

is in this workbook; print additional 

copies from the KIT’s CD-ROM.

n Distribute the material to the FPE practitioners 

who will participate in your group session. Ask 

them to read it before meeting as a group.

n Make copies of these exercises:

o Explore the Benefits of Family 

Psychoeducation

o Examine Program Standards

n Make copies of these documents 

found in Evaluating Your Program 

in this KIT:

o The Family Psychoeducation Fidelity Scale

o General Organizational Index

o Outcome measures that your agency 

will monitor (if available)

Do not distribute them until your group training .

Conduct your first session:

n	 When you convene your group, view 

the Introductory Video. Discuss the 

video and the content of Module 1.

n Distribute the following:

o The Family Psychoeducation Fidelity Scale

o General Organizational Index

o Outcome measures that your agency will 

monitor (if available)

o The exercises for this module

n Review the distributed materials and complete 

the exercises as a group.

Facilitating the dialogue: One of the 

roles of a family intervention coordinator 

is to facilitate the dialogue during group 

training sessions. Some people have difficulty 

speaking in a group, perhaps because they 

are timid or soft-spoken. Others may feel 

professionally intimidated by those with more 

experience or higher degrees. Conversely, 

some practitioners will be self-confident and 

outspoken and will need to learn to listen 

openly to what others have to say.

As you work together on each module, 

encourage those who are more withdrawn 

to express their views and make sure that 

the more vocal people give others a chance 

to speak. Group training also gives you the 

opportunity to assess the anxiety that FPE 

practitioners may feel about providing FPE 

services. Use your group training time to 

explore and address issues openly.

Basic Elements and Practice Principles 1 Module 1

Training Frontline Staff

Module 1: Basic Elements and Practice Principals

Module 1 explains the basic elements of Family Psychoeducation, including the 

practice principles of the model. This module orients practitioners to how consumers 

and families may benefit from the evidence-based practice.

What is Family 

Psychoeducation?

Family Psychoeducation (FPE) is an 

approach for partnering with consumers 

and families to treat serious mental 

illnesses. FPE practitioners develop 

a working alliance with consumers 

and families.

The term psychoeducation can be 

misleading. While FPE includes many 

working elements, it is not family therapy. 

Instead, it is nearly the opposite. In family 

therapy, the family itself is the object of 

treatment. But in the FPE approach, the 

illness is the object of treatment, not the 

family. The goal is that practitioners, 

consumers, and families work together 

to support recovery.

Serious mental illnesses such as 

schizophrenia, bipolar disorder, and major 

depression are widely accepted in the 

medical field as illnesses with wellestablished symptoms and treatment. 

As with other disorders such as diabetes 

or hypertension, it is both honest and useful 

to give people practical information about 

their mental illnesses, how common they 

are, and how they can manage them.

Many consumers and families report that 

this information is helpful because it lets 

them know that they are not alone and it 
Module 1 2 Basic Elements and Practice Principles

empowers them to participate fully in the recovery 

process. Similarly, research shows that consumer 

outcomes improve if families receive information 

and support (Dixon et al., 2001). For this reason, 

a number of family psychoeducation programs have 

been developed over the past two decades.

Models differ in their format (whether they use 

multifamily or single-family format); duration of 

treatment; consumer participation; and location. 

Research shows that the critical ingredients of 

effective FPE include the following (Dixon et 

al., 2001):

n Education about serious mental illnesses;

n Information resources, especially during periods 

of crises;

n Skills training and ongoing guidance about 

managing mental illnesses;

n Problem-solving; and

n Social and emotional support.

The phases of Family 

Psychoeducation

FPE services are provided in three phases:

n Joining sessions;

n An educational workshop; and

n Ongoing FPE sessions.

Joining sessions

Initially, FPE practitioners meet with consumers 

and their respective family members in introductory 

meetings called joining sessions. The purpose of 

these sessions is to learn about their experiences 

with mental illnesses, their strengths and resources, 

and their goals for treatment.

FPE practitioners engage consumers and families 

in a working alliance by showing respect, building 

trust, and offering concrete help. This working 

alliance is the foundation of FPE services. 

Joining sessions are considered the first phase 

of the FPE program.

Educational workshop

In the second phase of the FPE program, FPE 

practitioners offer a 1-day educational workshop. 

The workshop is based on a standardized 

educational curriculum to meet the distinct 

educational needs of family members.

FPE practitioners also respond to the individual 

needs of consumers and families throughout the 

FPE program by providing information and 

resources. To keep consumers and families engaged 

in the FPE program, it is important to tailor 

education to meet consumer and family needs, 

especially in times of crisis.

Ongoing Family Psychoeducation sessions

After completing the joining sessions and 1-day 

workshop, FPE practitioners ask consumers 

and families to attend ongoing FPE sessions. 

When possible, they offer ongoing FPE sessions 

in a multifamily group format. Consumers and 

families who attend multifamily groups benefit 

by connecting with others who have similar 

experiences. The peer support and mutual 

aid provided in the group builds social support 

networks for consumers and families who are 

often socially isolated.

Ongoing FPE sessions focus on current issues that 

consumers and families face, and address them 

through a structured problem-solving approach. 

This approach helps consumers and families make 

gains in working toward consumers’ personal 

recovery goals.

FPE is not a short-term intervention. Studies show 

that offering fewer than 10 sessions does not 

produce the same positive outcomes (Cuijpers, 

1999). We currently recommend providing FPE 

for 9 months or more.
Basic Elements and Practice Principles 3 Module 1

In summary, FPE practitioners provide information 

about mental illnesses, and help consumers 

and families enhance their problem-solving, 

communication, and coping skills. When provided 

in the multifamily group format, ongoing FPE 

sessions also help consumers and families develop 

social supports.

Practice principles

FPE is based on a core set of practice principles. 

These principles form the foundation of the 

evidence-based practice and guide practitioners 

in delivering effective FPE services.

Practice Principles

Principle 1:

Consumers define 

who family is.

In FPE, the term family includes anyone consumers identify as being supportive in the 

recovery process. For FPE to work, consumers must identify supportive people they would 

like to involve in the FPE program. Some consumers may choose a relative. Others may 

identify a friend, employer, colleague, counselor, or other supportive person.

Principle 2:

The practitionerconsumer-family 

alliance is essential.

Consumers and families have often responded to serious mental illnesses with great resolve 

and resilience. FPE recognizes consumer and family strengths, experience, and expertise in 

living with serious mental illnesses.

FPE is based on a consumer-family-practitioner alliance. When forming alliances with 

consumers and families, FPE practitioners emphasize that consumers and families are 

not to blame for serious mental illnesses. Blaming consumers or families is not constructive 

or helpful and should be avoided. FPE practitioners partner with consumers and families 

to better understand consumers and support their personal recovery goals.

Principle 3:

Education and 

resources help families 

support consumers’ 

personal recovery goals.

Consumers benefit when family members are educated about mental illnesses. Educated 

families are better able to identify symptoms, recognize warning signs of relapse, support 

treatment goals, and promote recovery. Provide information resources to consumers and 

families, especially during times of acute psychiatric episodes or crisis.

Principle 4:

Consumers and families 

who receive ongoing 

guidance and skills 

training are better able 

to manage mental 

illnesses.

Consumers and families experience stress in many forms in response to mental illnesses. 

Practical issues such as obtaining services and managing symptoms daily are stressors. 

Learning techniques to reduce stress and improve communication and coping skills 

can strengthen family relationships and promote recovery. Learning how to recognize 

precipitating factors and prodromal symptoms can help prevent relapses. For more 

information, see Training Frontline Staff in this KIT.

Principle 5:

Problem-solving helps 

consumers and families 

define and address 

current issues.

Using a structured problem-solving approach helps consumers and families break 

complicated issues into small, manageable steps that they may more easily address. 

This approach helps consumers take steps toward achieving their personal recovery goals.

Principle 6:

Social and emotional 

support validates 

experiences and 

facilitates problemsolving.

FPE allows consumers and families to share their experiences and feelings. Social and 

emotional support lets consumers and families know that they are not alone. Participants in 

FPE often find relief when they openly discuss and problem-solve the issues that they face.
Module 1 4 Basic Elements and Practice Principles

The family experience

Mental illnesses bring about such significant 

changes in people’s lives that many families think 

in terms of how life was before and after the onset 

of the illness. Families often provide emotional and 

instrumental support, case management functions, 

financial assistance, advocacy, and housing to 

relatives with mental illnesses. Doing so can be 

rewarding, but also imposes considerable stress.

Family members often find that they lack access to 

needed resources and information. Stressors range 

from practical problems such as paying medical 

bills and obtaining services to issues related to the 

symptoms of mental illnesses.

Family members also must cope with their own 

emotional responses to having a relative with 

mental illnesses. Emotional responses vary from 

optimism and hope to denial, guilt, and grief 

(Tessler & Gamache, 2000; Hatfield & Lefley, 

1987). These feelings may interfere with their 

capacity to support and help their relative in 

the recovery process.

In addition, consumers and families may face 

stigma while coping with serious mental illnesses. 

They may find that friends and relatives begin 

to avoid them. They may isolate themselves from 

natural support networks if they perceive that 

others cannot relate to their experiences. 

Stigmatization and isolation can lead people to 

feel exasperated, abandoned, and demoralized.

Stress, isolation, and stigma can cause tension and 

disagreements between consumers and families. 

Disagreements can be destabilizing or, at least, can 

prevent rehabilitation if they are left unresolved. 

Therefore, addressing these issues not only helps 

to improve the overall functioning of the family but 

also promotes recovery.

FPE addresses these issues by focusing on 

consumer and family strengths. Consumers and 

families often show great resolve and resilience 

when faced with crises related to mental illnesses. 

They demonstrate more adaptive coping when 

they feel affirmed, respected, and valued for the 

information and skills that they possess. For this 

reason, FPE sees families as partners and asks 

them to share their resources and expertise to 

help consumers achieve their recovery goals.

Core values in Family 

Psychoeducation

FPE is based on several core values that permeate 

the relationship among consumers, families, and 

practitioners. These values include the following:

n Building hope;

n Recognizing consumers and families as experts 

in their own experience of mental illnesses;

n Emphasizing personal choice;

n Establishing a collaborative partnership; and

n Demonstrating respect.

Build hope

The long-term course of mental illnesses cannot 

be predicted, and no one can predict anyone’s 

future. However, studies suggest that consumers 

and families who actively participate in their 

treatment and who develop effective coping skills 

have the most favorable course and outcome, 

including a better quality of life (Mueser et al., 

2002). The ability to influence your own destiny is 

the basis for hope and optimism about the future.

FPE practitioners convey hope and optimism to 

consumers and their families. In providing FPE, 

practitioners present information and skills as being 

potentially useful tools that consumers can use 

in pursuing their goals. Informed and involved 

families will feel more empowered to support 

their relatives’ recovery goals. FPE practitioners 

keep an attitude of hope and optimism, even 

when consumers and families may be pessimistic.
Basic Elements and Practice Principles 5 Module 1

Recognize consumers and families 

as experts

While FPE practitioners have professional expertise 

about information and skills for managing and 

recovering from mental illnesses, consumers 

and families have experience in living with mental 

illnesses. Consumers and families know which 

strategies have worked in the past for them and 

which have not.

FPE practitioners encourage consumers and 

families to share their unique experiences with 

mental illnesses and response to treatment. By 

paying close attention to consumers’ and families’ 

expertise, you can more effectively help consumers 

progress toward their personal goals.

Emphasize personal choice

The overriding goal of FPE is to support consumers 

in their personal recovery process. The ability and 

right of consumers to make their own decisions is 

paramount, even when consumers’ decisions differ 

from the recommendations of their family and 

practitioners. Certain rare exceptions to this 

principle do exist, for example, when legal 

constraints such as an involuntary hospitalization 

protect consumers from themselves or others.

In general, avoid pressuring consumers to make 

certain treatment decisions and encourage families 

to do the same. Instead, accept consumers’ 

decisions and work with them to evaluate the 

consequences in terms of their personal goals.

Keeping the emphasis on consumers’ personal 

choice is key to establishing and maintaining a 

strong alliance with both consumers and families. 

FPE practitioners model how respecting consumer 

choices, despite disagreements, builds a trusting 

relationship that promotes positive change.

Establish a collaborative partnership

While FPE practitioners serve a variety of roles, 

they are primarily collaborators. The collaborative 

spirit of FPE reflects the fact that consumers, 

families, and practitioners work side by side in 

a nonhierarchical relationship.

FPE practitioners establish a working alliance with 

consumers and families. Together, they learn how 

to cope with the unique characteristics of 

consumers’ mental illnesses and make progress 

toward their personal recovery goals.

Demonstrate respect

Respect is a key ingredient for successfully 

collaborating in FPE. FPE practitioners respect 

consumers and families as human beings, capable 

decisionmakers, and partners in the treatment 

process. FPE practitioners accept that consumers 

and families may differ in their personal values 

and opinions. They respect consumers’ and 

families’ right to their own values and opinions. 

For example, consumers may disagree that they 

have a particular mental illness or that they have 

any mental illness at all.

Rather than actively trying to persuade consumers 

that they have a specific disorder, FPE practitioners 

respect their beliefs while searching for common 

ground as a basis for collaboration. Such common 

ground could include the following:

n Symptoms and distress that consumers 

experience (perhaps even conceptualized 

generally as stress, anxiety, or nerve problems);

n Desire to avoid hospitalization;

n Difficulties with independent living; or

n Specific goals they would like to accomplish.

By seeking common ground, FPE practitioners 

demonstrate respect for consumers’ beliefs and 

their right to make informed decisions based on 

their values and beliefs.
Module 1 6 Basic Elements and Practice Principles

Program standards

One of the unique features of FPE is that the 

important characteristics of this evidence-based 

model have been translated into program standards 

to help programs replicate effective services. 

An instrument called the FPE Fidelity Scale 

summarizes these characteristics and is available 

to help quality assurance teams assess how closely 

their program follows the evidence-based model 

(See Evaluating Your Program in this KIT). Your 

family intervention coordinator will give this scale 

to you to review and discuss during training.

Basic Characteristics of Family 

Psychoeducation

n Family intervention coordinator

n Session frequency

n Long-term FPE

n Quality of consumer-family-practitioner 

alliance

n Detailed family reaction

n Precipitating factors

n Prodromal signs and symptoms

n Coping strategies

n Educational curriculum

n Multimedia education

n Structured group sessions

n Structured problem-solving

n Stage-wise provision of services

n Assertive engagement and outreach

How we know that Family 

Psychoeducation is effective

FPE is based on research that shows that families 

and consumers who participated in the components 

of the evidence-based model experienced 20 to 50 

percent fewer relapses and rehospitalizations than 

those who received standard individual services 

over 2 years (Penn & Mueser, 1996; Dixon & 

Lehman, 1995; Lam, Kneipers, & Leff, 1993; 

Falloon et al., 1999). Those at the higher end of 

this range participated for more than 3 months.

Studies also show that FPE improved family wellbeing (Dixon et al., 2001; McFarlane et al., 2003). 

Families reported greater knowledge of serious 

mental illnesses; a decrease in feeling confused, 

stressed, and isolated; and reduced medical illness 

and medical care utilization (Dyck, Hendryx, Short, 

Voss, & McFarlane,,2002).

FPE has been found to increase consumers’ 

participation in vocational rehabilitation programs 

(Falloon et al., 1985). Studies have shown 

employment rate gains of two to four times baseline 

levels, when combined with the evidence-based 

practice, Supported Employment (McFarlane et 

al., 1996; McFarlane et al., 1995; McFarlane et 

al., 2000).

Based on this significant evidence, treatment 

guidelines recommend involving families in the 

treatment process by offering the critical 

ingredients outlined in this evidence-based model 

(Lehman & Steinwachs, 1998; American Psychiatric 

Association, 1997; Weiden, Scheifler, McEvoy, 

Allen, & Ross, 1999).
Basic Elements and Practice Principles 7 Module 1

Adapting the evidence-based 

model

Research has shown the greatest amount of 

benefits rom FPE for families and consumers 

with schizophrenic disorders (Dixon et al., 2001). 

For this reason, we recommend that new 

practitioners first provide FPE services to 

consumers with these disorders.

Once practitioners have learned this approach by 

working with people with schizophrenia, they find 

it relatively easy to modify it for other disorders. 

Studies show that FPE may be effectively adapted 

and used for the following disorders:

n Bipolar disorder (Clarkin, Carpenter, Hull, 

Wilner, & Glick, 1998; Miklowitz & Goldstein, 

1997; Moltz, 1993; Parikh et al., 1997; Miklowitz 

et al., 2000; Simoneau, Miklowitz, Richards, 

Saleem, & George, 1999);

n Major depression (Simoneau et al., 1999; 

Emanuels-Zuurveen & Emmelkamp, 1997; 

Leff et al., 2000);

n Obsessive-compulsive disorder (Van Noppen, 

1999); and

n Borderline personality disorder (Gunderson, 

Berkowitz, & Ruizsancho, 1997).

This model also has been adapted and used 

effectively in a variety of countries and cultures. 

For more information about diagnosis-specific 

or cultural adaptations of this model, see The 

Evidence in this KIT.

Summary

This module reviewed the basic elements and core 

values of FPE. This evidence-based practice is 

based on a core set of practice principles, which 

have been translated into program standards that 

agencies may replicate. Substantial research has 

demonstrated its effectiveness.

The next modules give practitioners information 

about the core processes for providing FPE services.

Basic Elements and Practice Principles 9 Module 1

Exercise: Explore the Benefits of Family Psychoeducation

Studies that have explored what makes a difference in whether practitioners adopt a new approach to 

treatment have found that practitioners are more likely to adopt a practice if it addresses an area in which 

they feel they must improve. Share your experiences about where the traditional service delivery system 

has been inadequate and identify aspects of FPE that address those inadequacies.

Some experiences where the traditional service delivery system has been inadequate:

n

n

n

n

n

n

How Family Psychoeducation may address those inadequacies:

n

n

n

n

n

n

Basic Elements and Practice Principles 11 Module 1

Exercise: Examine Program Standards

n Distribute these documents:

o Family Psychoeducation Fidelity Scale;

o General Organizational Index; and

o Outcome measures that your agency will monitor (if available).

n Discuss how your Family Psychoeducation program will be evaluated based on these program standards.

The Core Processes of Family Psychoeducation 13 Module 2

Module 2

The Core Processes of Family Psychoeducation

Notes to the family intervention coordinator

Prepare for Module 2:

n Make copies of Module 2. Your copy 

is in this workbook; print additional 

copies from the CD-ROM in the KIT.

n Distribute the material to those who are 

participating in your group training. Ask them 

to read it before meeting as a group.

n Make copies of these exercises:

o Identify Consumers and Families

o Introduce Your Program

Do not distribute the exercises until the group 

training. Your copies are in this workbook; 

print additional copies from the KIT’s CD-ROM.

n Make copies of your agency’s policies and 

procedures for identifying consumers for 

FPE and discharging them from the program 

(if available). Guidelines for developing these 

policies are provided in Building Your Program

in this KIT.

Conduct your second session:

n	 When you convene your group, discuss the 

content of Module 2.

n Distribute the following:

o Your agency’s policies and procedures for 

identifying consumers for FPE and discharging 

them from the program

o Exercises for this module

Note: This module has no corresponding Practice 

Demonstration Video component.

The Core Processes of Family Psychoeducation 1 Module 2

Training Frontline Staff

Module 2: The Core Processes 

of Family Psychoeducation

Module 2 introduces you to the core processes of Family Psychoeducation, including 

joining with consumers and families, offering education, and understanding the 

nature of ongoing Family Psychoeducation (FPE) sessions. This module also discusses 

the goals and objectives of each phase of the program. 

Core processes of Family Psychoeducation

n Consumers are identified as potential 

participants.

n Practitioners introduce Family 

Psychoeducation to consumers. 

Consumers who are willing to 

participate identify potential family 

members.

n Practitioners meet individually three 

or more times with consumers and 

families. The purpose of these joining 

sessions is to engage consumers and 

families in a working alliance.

n Once practitioners have finished 

joining sessions with five to eight 

consumers and their respective 

families, they offer a 1-day 

educational workshop.

n After completing the 1-day 

educational workshop, practitioners 

ask consumers and families to attend 

ongoing Family Psychoeducation 

sessions offered in either single-family 

or multifamily group format.

n Ongoing Family Psychoeducation 

sessions continue for 9 months or 

more. Practitioners, consumers, and 

families use a structured problemsolving approach to define and 

address current issues.

n Practitioners document consumers’ 

progress using Progress Notes tailored 

to each phase of the program.

n Practitioners meet weekly with the 

family intervention coordinator for 

group supervision.
Module 1 Module 2 2 The Core Processes of Family Psychoeducation Basic Elements and Practice Principles

Although you might think that integrating Family 

Psychoeducation (FPE) core processes and 

paperwork into your daily routine is too time 

consuming and burdensome, these processes 

ensure that FPE services are effective and efficient.

Identify consumers

FPE is effective for a wide variety of consumers. 

However, some evidence shows that FPE is 

particularly beneficial for consumers and families 

with the following characteristics:

n Consumers who have recently experienced their 

first episode of mental illness or are early in the 

course of illness;

n Consumers who are experiencing acute 

psychiatric crisis;

n Consumers who experience frequent 

hospitalizations or prolonged unemployment;

n Consumers or families who have asked to learn 

more about serious mental illnesses;

n Families who have previously benefited from 

a family education program and want to learn 

how to better support their relative; or

n Families who are especially exasperated 

or confused about the illness.

FPE is particularly effective in working with 

families and consumers who are early in the course 

of illness, because most consumers and families 

report the most extreme distress during this time. 

Often in this early period, major rifts develop 

between consumers and families that may 

exacerbate symptoms and disability. FPE has 

prevented and often healed those rifts, as 

participants stop blaming themselves or one 

another and cooperate to help in the overall 

treatment and rehabilitation process.

Initially many agencies choose to offer FPE to 

consumers with schizophrenic disorders because 

the evidence for this model is strongest with this 

group. Once you have provided FPE services to 

consumers with schizophrenic disorders and their 

families, it relatively easy to modify your FPE 

program to provide services to families and 

consumers who have other diagnoses.

The number and types of consumers you identify 

depend on whether you offer FPE in a multifamily 

or single-family group format. If your agency 

intends to offer ongoing FPE services primarily 

in the multifamily format, identify five to eight 

consumers with similar diagnoses and offer 

multifamily group sessions to them. If your agency 

chooses to offer FPE in a single-family format, the 

number of consumers you should identify depends 

on the size of your FPE program.

During this training, your family intervention 

coordinator will review your agency’s policies and 

procedures for identifying consumers for FPE.

Introduce the program

Once your family intervention coordinator assigns 

consumers to your caseload, set up a face-to-face 

meeting to introduce them to the FPE program. 

In the meeting, emphasize that the program is for 

both consumers and their family members. While 

some psychoeducation programs are solely for 

either consumers or family members, FPE services 

are provided to both simultaneously.

Emphasize that participating in FPE is the 

consumers’ choice. After discussing the benefits 

and structure of the FPE program, ask consumers 

if they would like to identify a family member 

with whom they would participate in the program. 

Remember, the term family includes anyone who 

consumers believe is supportive and would like to 
The Core Processes of Family Psychoeducation 3 Module 2

participate in FPE. Therefore, consumers may 

identify people who are not blood relatives.

Most consumers welcome family involvement when 

it is clear that the goal is to help families better 

understand their illness and build support to help 

them achieve their personal recovery goals. 

However, if consumers are not interested in the 

program, respect their decision.

Confidentiality

Some states require that consumers sign a Release 

of Information Form before you may contact their 

family member. Your family intervention 

coordinator should review your agency’s 

confidentiality requirements as a part of this 

training. For more information, see Building Your 

Program in this KIT.

Length of the FPE program

Although the goal is to offer ongoing FPE services, 

some consumers and families may be initially 

unwilling to make long-term commitments. 

Instead, when you introduce FPE, simply ask 

consumers and families to participate for as long as 

they find it useful. Often once people participate 

for a few sessions, they choose to stay long term, 

especially in multifamily groups.

Conduct joining sessions

Once consumers agree to participate in FPE and 

identify a family member, arrange to meet with 

them. These initial introductory sessions are called 

joining sessions.

Joining sessions are considered the first phase of 

the FPE program. Complete this phase by meeting 

with consumers and families at least three times for 

approximately 1 hour.

The overall purpose of joining sessions is to 

engage consumers and families in a working 

alliance. This working alliance is essential to 

providing effective FPE.

Each joining session has distinct goals and 

objectives (see Module 3). Some of the goals 

of joining sessions are as follows:

n Understand consumers’ and families’ unique 

experiences and view of mental illnesses;

n Learn about consumer and family strengths 

and resources in coping with mental illnesses;

n Develop mutual, specific goals; and

n Instill hope and an orientation toward recovery.

You may hold joining sessions with consumers and 

their respective family members together or meet 

separately with them. (That means you would 

conduct six or more sessions instead of three 

or more.)

When deciding whether to meet with consumers 

and families jointly or separately, consider the 

following:

n Consumer and family preferences;

n Consumer diagnosis and illness characteristics; 

and

n The goals of the session.

Tell consumers and families that it is common to 

meet with them individually and jointly with their 

respective family members in the first phase of the 

FPE program. Ask consumers and families how they 

feel about joint and separate meetings. Logistical 

arrangements such as transportation or work 

schedules sometimes dictate whether consumers 

and families can meet jointly. Discuss preferences 

and logistical factors during your first meeting.

Decisions for offering joining sessions separately 

or jointly are also based on diagnosis and illness 

characteristics. For example, recent studies show 

that joining sessions for consumers with bipolar 

disorder are more effective when conducted 
Module 1 Module 2 4 The Core Processes of Family Psychoeducation Basic Elements and Practice Principles

separately (Moltz, 1993). Use your professional 

discretion to determine how best to accomplish 

the goals of each session. See Module 3 for more 

information.

It is important to fully complete this phase before 

you offer ongoing FPE sessions. Practitioners 

who shortchange this process often experience 

difficulties keeping consumers and families 

engaged in FPE services.

Conduct the educational 

workshop

Once you meet the goals of the joining sessions, 

you are ready to offer the second phase of the 

FPE program. In this phase, you will ask family 

members to attend a 1-day educational workshop.

Following a structured educational curriculum, 

the workshop is usually conducted in a formal, 

classroom setting. Two FPE practitioners who have 

completed joining sessions with consumers and 

families facilitate the workshop. The treating 

psychiatrist and other treatment team members 

are often invited to conduct part of the presentation. 

For more information about the structure and 

content of this workshop, see Module 3.

Typically the workshop is conducted solely with 

families—not with consumers—to give families 

a chance to get acquainted. The opportunity to 

interact with others who are in similar situations 

and to speak freely about their experiences 

allows families to bond and develop supportive 

relationships. It also increases families’ 

commitment to participate in FPE.

Some agencies involve consumers in part of the 

workshop to ensure that they receive the same 

educational information as their families. Others 

offer this information to consumers individually 

or in a separate consumer forum.

Use professional discretion to decide which 

educational format will be most effective for the 

consumers in your program. Consider the severity 

of consumers’ symptoms and their cognitive ability 

to absorb educational material when it is provided 

in the joint format. For example, recent studies 

show that joint educational sessions are effective 

for consumers with nonepisodic bipolar disorder 

(Moltz, 1993; Miklowitz & Goldstein, 1997).

If you plan to offer ongoing FPE sessions in a 

multifamily group format, complete at least three 

joining sessions with five to eight consumers and 

their respective family members before conducting 

the 1-day workshop. To ensure that consumers and 

families remain engaged, offer the workshop within 

1 or 2 weeks after you complete the joining sessions. 

You may need to carefully coordinate this.

Offer ongoing Family 

Psychoeducation services

After completing three joining sessions and the 

1-day workshop, ask consumers and families to 

attend ongoing FPE sessions. The third phase 

of the FPE program consists of providing ongoing 

FPE sessions for 9 months or more. You may 

provide these sessions in either the single-family 

or multifamily group format.

Choose a format

The format that you choose will depend on 

consumer and family preferences and needs. 

In general, single-family formats tend to be used 

for the following:

n Consumers and families with strong social 

support networks;

n Consumers and families who exhibit unusual 

resilience or strong coping skills; or

n Consumers who response positively 

to medications;
The Core Processes of Family Psychoeducation 5 Module 2

Multifamily groups tend to be used for the 

following:

n Consumers who are experiencing their first 

episode with mental illness;

n Consumers who are not responding well 

to medication and treatment;

n Consumers who are experiencing other 

complicating issues such as additional 

medical illnesses;

n Families experiencing high stress;

n Families who have separated from their 

relative with mental illness; and

n Families who have been through divorce.

Although initially consumers and families may 

be reluctant to participate in a group, multifamily 

groups benefit both consumers and their families. 

For example, the social stigma related to mental 

illnesses causes many consumers and families to 

feel socially isolated. FPE in a multifamily group 

format connects consumers and families to others 

with similar experiences. It gives them a forum 

for peer support and mutual aid by allowing 

participants to share solutions that have worked 

for them. For this reason, we recommend offering 

ongoing FPE services in a multifamily group 

format, whenever possible.

FPE multifamily groups consist of five to eight 

consumers and their respective family members. 

They meet every 2 weeks for 11⁄2 hours. Two FPE 

practitioners co-facilitate the group.

In the single-family format, one FPE practitioner 

meets with one consumer and his or her family 

members. Meetings are usually every 2 weeks 

for 1 hour.

FPE practitioners commonly work in both 

multifamily or single-family group formats. 

For example, when multifamily group members 

are unable to attend specific group sessions, you 

may offer single-family sessions to accommodate 

scheduling difficulties.

Use single-family sessions to re-engage consumers 

and families who no longer participate in FPE 

services. You may also offer single-family sessions 

to consumers and families who have completed 

an FPE multifamily group. Offer these sessions 

as needed to sustain ongoing family support 

and involvement.

If your agency is only able to offer ongoing FPE in 

a single-family format, refer consumers and families 

to local support groups to ensure that they can 

benefit from peer support and mutual aid.

Focus on current issues

The goal of ongoing FPE sessions is to identify the 

current issues that consumers and families face, and 

to partner with them to address these issues. FPE 

practitioners commonly use a structured problemsolving approach, provide information, and teach 

communication, coping, and social skills.

In general, FPE sessions reinforce the information 

learned in the educational workshop and focus 

on consumers’ personal recovery goals, which 

generally fall into the following categories:

n Issues related to re-entering the community; or

n Issues related to social and vocational 

rehabilitation.

Issues related to re-entering the community

Consumers who are experiencing or recovering 

from acute episodes for which they have been 

hospitalized often have issues related to re-entering 

the community. Personal recovery goals may relate 

to the following:

n Coping with symptoms;

n Medication; and

n Alcohol and substance use.

At times, the symptoms of mental illnesses may 

interfere with consumers’ ability to process 

information presented either verbally or in writing. 
Module 1 Module 2 6 The Core Processes of Family Psychoeducation Basic Elements and Practice Principles

Consequently, communication issues are common. 

Use communication and coping skills training to 

address these issues.

Communication skills training helps consumers 

and families learn new methods of interacting 

to address cognitive difficulties. These skills 

are especially useful for consumers who have 

experienced complications or have not responded 

well to treatment. Their families may feel 

exasperated and, consequently, may exacerbate 

their relative’s symptoms.

In ongoing FPE sessions, model simple and direct 

communication for family members. Reinforce the 

importance of communicating in a low, calm tone 

to counteract sensitivity to stimulation. Other 

techniques include breaking information down into 

small chunks and engaging consumers to ensure 

that they receive information accurately.

When communicating important ideas, encourage 

consumers and families to set aside a specific time 

to talk. Doing so gives consumers and families an 

opportunity to rehearse the communication skills 

that they learn during FPE sessions.

Coping skills training helps consumers and families 

learn new or enhance existing strategies to manage 

stress, problems, or persistent psychiatric 

symptoms. Steps used in coping skills training 

include the following:

1. Identify a problem or persistent symptom.

2. Conduct a behavioral analysis to determine 

situations in which the symptom is most 

distressing.

3. Identify coping skills that consumers used 

in the past.

4. Evaluate the effectiveness of previously 

used coping skills.

5. Increase the use of effective coping skills.

6. Identify new coping skills to try.

7. Model and practice new coping skills in role plays.

8. Gain feedback on the effectiveness of the new 

coping skills and the increased use of previously 

used ones.

9. Further tailor or adapt the coping strategies 

to meet consumers’ needs.

Coping strategies range from relaxation to 

cognitive-behavioral techniques. Practicing new 

coping skills is most effective when consumers 

involve family members and other supporters. 

For more information, see the Illness Management 

and Recovery KIT.

Issues related to social and vocational 

rehabilitation

For consumers who are in the rehabilitation phase, 

FPE sessions focus on their unique recovery goals. 

Consumers commonly identify situations that are 

likely to cause stress or barriers to achieving their 

goals. Use problem-solving, social skills training, 

and role plays to address these issues. For more 

information, see Modules 4 and 5.

Engage consumers and families 

continuously

Engaging consumers and families in FPE starts the 

moment that they are referred to the program. It is 

difficult, if not impossible, to engage consumers 

and families in any meaningful way unless you 

know their needs and goals. For this reason, we 

suggest conducting three or more joining sessions 

to build a rapport and a working alliance. Once 

consumers and families are involved in ongoing 

FPE sessions, your challenge is to focus FPE 

services on helping them meet their immediate 

needs and goals.

The engagement process never stops. Whenever 

you meet with consumers and families, you learn 

more about them. If you want consumers and 

families to stay engaged, you must continue to help 

them progress in a way that is meaningful to them. 
The Core Processes of Family Psychoeducation 7 Module 2

Some consumers and families have had negative 

experiences with specific practitioners or with 

mental health services. Discussing these experiences 

during joining sessions can help to overcome them. 

It may take some consumers and families a while 

to realize that you offer something different from 

what they have received in the past.

At any point, if consumers and families disengage 

from the FPE program, assertively reach out to 

engage them again. Contact consumers and 

families on an ongoing basis through a variety of 

means (by phone, mail, etc.). When appropriate, 

offer to meet with consumers and families in their 

home or their community. Gently encourage and 

demonstrate tolerance of different levels of 

readiness by offering flexible services to meet 

consumer and family needs.

Complete Progress Notes

After every FPE session, fill out an FPE Progress 

Note to document the services that you provided. 

The Progress Notes will help you demonstrate that 

you did the following:

n Met the goals of each joining session;

n Provided all components of the educational 

workshop; and

n Followed the structured problem-solving 

approach.

Progress Notes also help you track consumer 

and family goals, and the progress that they make 

toward achieving them. Make sure that the goals 

consumers develop in the FPE program are 

reflected in their treatment plan.

Ask your family intervention coordinator for a copy 

of FPE Progress Notes tailored to each phase of the 

FPE program.

Participate in supervision

It is important for new FPE practitioners to 

receive supportive supervision. As part of an FPE 

team, you are expected to meet weekly with your 

family intervention coordinator for individual or 

group supervision. Weekly supervision meetings 

are critical to coordinate the timing of joining 

sessions and the educational workshop, to answer 

questions about the model, and to reinforce FPE 

skills and techniques.

Talk with your family intervention coordinator and 

fellow FPE practitioners about how to best respond 

to issues that arise in your FPE sessions. Discuss 

consumers’ goals and the progress that they are 

making toward their recovery.

Every 6 months, your family intervention 

coordinator will also present the results and 

recommendations from your FPE fidelity 

assessment. Discuss this information as a team 

to determine how your FPE program may be 

improved. For more information about the FPE 

fidelity assessments, see Evaluating Your Program

in this KIT.

Summary

In summary, this module introduced the core 

processes of FPE, including joining with 

consumers and families, offering education, 

and understanding the nature of ongoing FPE 

sessions. The next module discusses two of these 

processes—joining sessions and educational 

workshops—in greater detail.

The Core Processes of Family Psychoeducation 9 Module 2

Exercise: Identify Consumers and Families

Answer the following questions to help reinforce your understanding of your agency’s FPE policies 

and procedures.

1. What are your agency’s policies for identifying and referring consumers to your FPE program?

n

n

n

n

2. Under what circumstances will consumers be discharged from FPE?

The Core Processes of Family Psychoeducation 11 Module 2

Exercise: Introduce Your Program

n Role play: Conduct a role play to practice introducing your FPE program. Select three group members 

to play the roles of consumer, family, and practitioner.

n Group discussion: Discuss how you would engage a family member who is overcoming negative 

experiences with the mental health system.

Joining Sessions and Educational Workshops 13 Module 3

Module 3

Joining Sessions and Educational Workshops

Notes to the family intervention coordinator

Prepare for Module 3:

n Make copies of Module 3. Your copy 

is in this workbook; print additional 

copies from the CD-ROM in the KIT.

n Distribute the material to those who are 

participating in your group training. Ask them 

to read it before meeting as a group.

n Make copies of these exercises:

o Review Progress Notes for Joining 

Sessions and Educational Workshops

o Practice What You’ve Learned About Joining 

Sessions

Do not distribute them until the group 

training. Your copies are in this workbook; 

print additional copies from the CD-ROM.

n Make copies of your agency’s 

Progress Notes tailored to joining 

sessions and educational workshops.

Conduct your third training session:

n When you convene your group, view 

the following segments of Practice 

Demonstration Video (approximately 

30 minutes):

o Introduction

o Joining with Individuals and Families

o Joining Session 1

o Joining Session 2

o Joining Session 3

o Educational Workshop

n Discuss the video and the content of Module 3.

n	 Distribute the exercises and Progress Notes and 

complete them as a group

Joining Sessions and Educational Workshops 1 Module 3

Training Frontline Staff

Module 3: Joining Sessions 

and Educational Workshops

Module 3 provides details on two phases of the Family Psychoeducation program: 

joining sessions and educational workshops. Completing these phases is essential 

to the process of engaging consumers and families both initially and throughout 

the program.

Joining sessions

Joining sessions are the first phase in the 

Family Psychoeducation (FPE) program. 

FPE practitioners meet three or more 

times with each FPE consumer and their 

respective family members. Meetings 

typically last for 1 hour.

The purpose of joining sessions is 

to build rapport, convey hope, and 

engage consumers and families in 

a working alliance.

Develop a working alliance

Joining means to connect, bring together, 

or unite. Developing a working alliance 

with consumers and families is essential 

to providing effective FPE. Agencies 

that shortchange this process often have 

difficulties keeping consumers and families 

engaged in FPE services.

In these alliances, FPE practitioners ask 

consumers and families to partner with 

them in the treatment process. Consumers 

and families help carry out the treatment, 

rather than participate as objects 

of treatment.
Module 1 Module 3 2 Joining Sessions and Educational Workshops Basic Elements and Practice Principles

The object of treatment is the illness, not 

consumers or families. This may appear to be a 

matter of semantics to some, but the differences 

are a key for providing effective services. FPE 

practitioners work with, not on, consumers 

and families.

FPE practitioners recognize consumers’ and 

families’ vast knowledge and expertise. The 

working alliance is built on the idea that FPE 

practitioners, consumers, and families join their 

expertise and strengths to support consumers 

in achieving their personal recovery goals. This 

collaborative approach is the foundation for the 

evidence-based model.

To foster this relationship, FPE practitioners do 

the following:

n Demonstrate genuine concern for consumers 

and their families;

n Validate consumers’ and families’ experiences;

n Avoid treating consumers or families as patients; 

and

n Avoid blaming consumers or families for causing 

the mental illness.

To create a relaxed, informal atmosphere, FPE 

practitioners set the stage for forming a working 

alliance by socializing at the beginning and end 

of each joining session. Socializing helps decrease 

anxiety and allows you to get to know consumers 

and family members as people beyond the 

illness. To engage consumers and families, FPE 

practitioners are also open and forthcoming about 

who they are as people.

From the first meeting, practitioners actively guide 

the conversation. Because each joining session has 

tasks to be completed, you must structure them. 

Following a prescribed structure reassures both 

consumers and families, letting them know what 

to expect and what will be accomplished. The tasks 

for each joining session are described on the 

following pages.
Joining Sessions and Educational Workshops 3 Module 3

Joining Session 1

Purpose: To develop a rapport and build a working 

alliance with consumers and families.

Developing a rapport and building a working 

alliance is a long process. It is important to build 

the relationship beyond the illness, so keep your 

manner positive, informal, and collegial. Begin the 

joining session by socializing. After socializing, 

review the session’s agenda.

If your first contact with consumers and their 

families is during an acute psychiatric episode, 

you may have a special opportunity to build a 

strong working alliance. Respond quickly to the 

immediate needs that consumers and families 

present. Demonstrate willingness to help, 

especially in concrete ways.

Establish yourself as a resource and support. 

If consumers and families seek particular 

assistance, offer it. Prompt attention reassures 

both consumers and families and demonstrates 

your commitment to partnering with them in 

consumers’ recovery process.

Do not be afraid to step in and take on roles not 

traditionally practiced. You may act as an advocate 

in navigating the mental health system, make a 

referral for more services, or even help consumers 

and families obtain entitlements or benefits.

If consumers are not currently experiencing an 

acute psychiatric episode, review the last episode 

that they experienced. Identify precipitating events 

and early warning signs with consumers and 

families. To do so, guide them through a review 

of the previous weeks. Emphasize any changes in 

consumers’ symptoms, thoughts, or feelings during 

that time. These changes—which may be either 

quite apparent or barely noticeable—constitute the 

prodromal signs and symptoms for that consumer. 

In most cases, idiosyncratic behaviors come before 

more common prodromal symptoms, for example, 

poor sleep, anorexia, pacing, restless behaviors, 

and irritability. These behaviors become even more 

important in the future to help prevent relapse.

Next, ask both consumers and their families how 

they coped with symptoms. Explore the types of 

strategies that were helpful and those that were 

not. It is important to understand consumers’ and 

families’ unique experiences with mental illnesses.

Managing an acute psychiatric episode is always a 

difficult experience. Show that you appreciate this 

fact and validate the feelings that consumers and 

families share. Relate in a humanistic, caring, and 

hopeful manner.

Some practitioners skip or shorten this phase of the 

FPE program to more rapidly begin clinical work. 

However, shortchanging this step usually backfires 

since consumers and families who do not complete 

joining sessions are more likely to disengage 

prematurely from FPE services.

Tasks for Joining Session 1

n Socialize.

n Review a present (or past) acute psychiatric 

episode.

n Identify precipitating events.

n Explore prodromal signs and symptoms.

n Review family experiences in providing 

support and validate their experience as 

normal human responses.

n Identify consumer and family strengths and 

coping strategies that have been successful.

n Identify coping strategies that have not 

been helpful.

n Socialize.
Module 1 Module 3 4 Joining Sessions and Educational Workshops Basic Elements and Practice Principles

Joining Session 2

Purpose: To explore the emotional impact of serious 

mental illnesses.

In general, you may conduct joining sessions either 

jointly or separately, depending on consumer and 

family preference. However, hearing about 

families’ frustration and anger about the effects 

of consumers’ symptoms is usually best done 

in an individual session. For this reason, FPE 

practitioners often choose to conduct this session 

separately for consumers and their families.

Begin and end each joining session by socializing 

to reduce anxiety and set the tone for developing 

a working alliance. Encourage consumers and 

families to discuss the impact that serious mental 

illnesses have had on their lives. Support, validate, 

and recognize normal human reactions such as 

feelings of loss, despair, grief, anger, frustration, 

and guilt associated with serious mental illnesses.

Next, learn about consumers’ social support 

network. You may complete a genogram (a visual 

representation of family relationships simialr 

to a family tree) during the session. Remember 

to define social supports broadly by including 

neighbors, landlords, employers, or any other 

supportive people.

It is also important to understand the experiences 

that consumers and families have had with the 

mental health system. When those experiences 

are left unexpressed, they can form a barrier 

to developing a strong working alliance, cause 

repetitive complaints, and hinder your ability to 

work on current issues. Acknowledge and validate 

feelings such as anger or frustration to help 

consumers and families overcome past negative 

experiences and allow progress to be made.

Many consumers and family members feel that 

mental health practitioners blame and criticize 

them. Blaming consumers or families for the 

illness is not constructive or helpful and should 

be avoided.

Share basic information about consumers’ mental 

illnesses. Demonstrate the resources that you have 

to offer while showing respect for consumers’ 

and families’ first-hand experience in managing 

their illnesses.

Convey optimism that consumers will be able to 

reduce relapses and achieve their personal recovery 

goals by partnering in the treatment process. 

Having answers for every question is less important 

than conveying a commitment to working together 

to find solutions.

Tasks for Joining Session 2

n Socialize.

n Explore feelings and reactions to having 

a mental illness or a relative with a mental 

illness.

n Identify consumers’ social support network.

n Construct a genogram or family tree.

n Review past experiences with the mental 

health system.

n Convey basic information about the 

consumer’s specific mental illness.

n Socialize.
Joining Sessions and Educational Workshops 5 Module 3

Joining Session 3

Purpose: To identify consumer and family strengths, 

interests, and goals and to introduce the next 

phases of the FPE program.

If you schedule consumers and their families to 

meet separately for this session, consider meeting 

with consumers first. After exploring consumers’ 

strengths and interests, work with them to identify 

goals they would like to work on during the FPE 

program. Setting and pursuing personal goals is an 

essential part of recovery. In FPE, consumers 

define what recovery means to them and identify 

three short- and long-term goals.

Explain to consumers that people are often more 

effective in getting what they want when they set 

clear goals. Help consumers identify goals by 

reviewing areas of their lives with which they are 

satisfied and those that they wish to change. Once 

consumers identify one or two areas on which they 

would like to work, help them break the areas down 

into smaller goals or steps that can be achieved 

within the next few months. Start with goals that 

are relatively small.

Introduce consumers to the last two phases of the 

program—the 1-day educational workshop and 

ongoing FPE services. Describe the benefits of 

giving information to family members and say that 

you would like to invite family members to attend 

the 1-day educational workshop. Tell them about 

the format and components of the standardized 

educational curriculum. If your agency plans to 

involve consumers in part of the workshop or to 

offer a parallel workshop for them, describe those 

details and invite consumers to attend.

Next, describe the last phase—ongoing FPE 

sessions. Review the goals that consumers identified 

earlier and ascertain their support for working on 

them. Explain that ongoing FPE sessions will focus 

on supporting their efforts to achieve those goals. 

Introduce the structured problem-solving approach 

and explain that this is one tool they can use to 

pursue personal goals. Ask consumers if you may 

share their interests and goals with their family 

members. Tell them that you may offer ongoing 

FPE sessions in a single-family or multifamily 

group format and describe the benefits of 

participating in multifamily groups. Ask if they 

would be willing to participate with their families. 

If consumers are unsure, continue to explore the 

decision during additional single-family sessions.

Once consumers give their permission to share 

their interests and goals with family members, 

meet with their family member for a third joining 

session. Review consumers’ interests and goals and 

ascertain family support for those goals. If family 

goals differ from the consumer’s goals, probe to 

fully understand the differences. When possible, 

search for common ground.

Next, introduce family members to the last two 

phases of the FPE program. Review the benefits 

of participating in the workshop and multifamily 

group sessions. Ask about their experiences in 

attending group sessions and what concerns they 

might have, including confidentiality, shyness, 

and feeling pressured to speak in groups or in the 

workshop. Assure them that they may contribute 

only as much as they wish. If families are unsure 

about continuing with the next two phases of the 

FPE program, schedule additional joining sessions 

as needed to continue the engagement process.

Tasks for Joining Session 3

n Socialize.

n Identify personal strengths, hobbies, 

interests.

n Identify short- and long-term goals.

n Introduce the next phases of the FPE 

program.

n Socialize.
Module 1 Module 3 6 Joining Sessions and Educational Workshops Basic Elements and Practice Principles

Pacing and format

The pacing of joining sessions and whether you will 

be able to complete these tasks in three sessions 

will depend on individual circumstances. For 

example, if a consumer is in crisis, you might need 

to shorten the initial joining sessions and complete 

these tasks by conducting additional sessions.

You may choose to conduct joining sessions jointly 

with consumers and families or with consumers 

and families separately. As discussed in Module 2, 

decisions about the format may be influenced by 

consumer and family preferences, diagnosis and 

illness characteristics, and the goals of the session. 

For example, FPE practitioners often schedule 

separate sessions to discuss highly personal matters 

such as romantic entanglements, drug abuse, 

or sexual side effects of medications.

Others believe that it is easier to engage consumers 

and families if they have at least one individual 

joining session. They believe that doing so allows 

consumers and families to speak more openly. 

Use your professional discretion for these decisions 

and remember to remain flexible and responsive.

Educational workshops

Education is one of the essential ingredients 

of FPE. This section introduces you to a 

recommended standardized curriculum that you 

may use to teach families about their relatives’ 

mental illnesses. Information about the timing, 

structure, and format of the 1-day educational 

workshop is also outlined below.

Why offer informational resources?

When people do not have accurate information 

about mental illnesses, they may adopt mistaken 

beliefs or rely on intuition. Unfortunately, many 

effective interpersonal and rehabilitative 

approaches are often counter-intuitive. 

Consequently, despite having their relative’s best 

interest in mind, their actions may interfere with 

recovery. Therefore, it is important to give families 

the information and guidance they need to promote 

recovery and rehabilitation.

Information can help create a shared language that 

allows consumers, families, and practitioners to 

work together. The first message is that no one is 

to blame for mental illnesses. Blaming consumers 

or families is not constructive or helpful.

Next, families must understand basic information 

about their relative’s serious mental illnesses. One 

critical aspect of family education is that it gives 

families hope that they will be able to alter the 

course of illness.
Joining Sessions and Educational Workshops 7 Module 3

Timing

You must respond to the immediate needs of 

consumers and families and answer questions as 

they arise. For this reason, the educational process 

begins during the first joining session and continues 

throughout each phase of the FPE program.

While education is ongoing, the main focus on 

education occurs in the second phase of the FPE 

program. Once consumers and their respective 

family members have completed three or more 

joining sessions, invite family members to attend 

a 1-day or 8-hour educational workshop. Typically, 

the 1-day workshop is offered to a group of 

family members.

During the joining sessions, explain the nature 

and purpose of the workshop. Explain that family 

members will be expected to attend this type of 

workshop only once as a part of their participation 

in the FPE program.

If you offer ongoing FPE sessions in a multifamily 

group format, plan to have the five to eight families 

who will participate in the multifamily group attend 

the same workshop. The workshop gives them an 

opportunity to get acquainted before the 

multifamily group begins.

Schedule the workshop for a time that meets the 

needs of family members. Typically, workshops 

are held on weekend days.

Participants

The workshop is most often conducted solely 

with families—not with consumers—to give 

families a chance to get acquainted. The 

opportunity to interact with others who are in 

similar situations and to speak freely about their 

experiences allows families to bond and develop 

supportive relationships. It also increases families’ 

commitment to participate in FPE.

Some agencies involve consumers in part of the 

workshop to ensure that they receive the same 

educational information as their families. Others 

offer this information to consumers individually 

or in a separate consumer forum. For more 

information about providing information about 

mental illness to consumers, see the Illness 

Management and Recovery KIT.

Educational curriculum

We recommend using the following standardized 

curriculum to teach families about mental illnesses. 

To provide enough specific information, we 

recommend that workshops focus on one specific 

mental illness. For example, all family members 

would have relatives with schizophrenic disorders 

and the information presented would relate 

primarily to these disorders.

The Educational Curriculum Covers 

Six Topics

n Psychobiology of the specific mental 

illness including the basics of brain 

function and dysfunction, and the possible 

causes of the mental illness

n Diagnosis including symptoms and 

prognosis

n Treatment and rehabilitation including 

an overview of treatment options and how 

they promote effective coping and illness 

management strategies

n Impact of mental illnesses on the 

family including how mental illnesses 

affect families as a whole

n Relapse prevention including prodromal 

signs and symptoms, and the role of stress 

in precipitating episodes

n Family guidelines or recommended 

responses to help families maintain a 

home environment that promotes relapse 

prevention
Module 1 Module 3 8 Joining Sessions and Educational Workshops Basic Elements and Practice Principles

Presenter selection

Family members often feel more comfortable if the 

practitioner who knows them and their consumer 

relative facilitates the workshop. For this reason, 

we recommend that the same FPE practitioners 

conduct the joining sessions, educational workshop, 

and ongoing FPE sessions.

Two FPE practitioners usually facilitate the 

workshop. Facilitators are not expected to be 

experts in all areas of the educational curriculum. 

Instead, they choose to present areas in which 

they are comfortable and invite colleagues with 

particular areas of expertise to present the 

remaining educational components. For example, 

the treating psychiatrist should present the material 

on the psychobiology of the specific mental illness.

Once you have selected all of the presenters and 

assigned them areas of the educational curriculum, 

schedule a practice presentation to review the 

materials before the workshop. Practicing with 

colleagues helps increase confidence and gives 

an opportunity for feedback on clarity and rate of 

speech. It may help to videotape or audiotape the 

practice presentations and to rehearse responses 

to common questions.

Educational techniques

The roles of educator may be new for FPE 

practitioners. When educating consumers and 

families, keep the following techniques in mind:

Use an interactive, not didactic teaching style

Teaching in an interactive style makes learning 

an interesting, lively activity. Interactive learning 

involves frequently pausing when presenting 

information to get consumer and family reactions 

and perspectives. Talk about what the information 

means and answer any questions that may arise. 

An interactive teaching style conveys to consumers 

and families that they have important contributions 

to make to the learning process and that you are 

interested in what they say.

Present the material in a conversational tone by 

summarizing the key points and giving relevant 

examples. Avoid the monotony of having just one 

person speak. At all times, communication should 

be two-way; it must never seem like a lecture. 

People learn information by actively processing 

it in a discussion with someone else.

Periodically review information that you 

already covered

Begin and end each segment with a brief summary 

of the key points. Make connections between 

previously learned and new material. To check if 

consumers and families retained the information 

and to reinforce topics that you previously 

discussed, ask them to summarize what 

they remember.

Adopt common language to facilitate 

communication

People have their own ways of understanding their 

experiences, thinking about their lives, and looking 

into the future. The more you can speak the same 

language, the easier it will be to make connections 

and avoid unnecessary misunderstandings.

Break information down into small chunks

Some mental illnesses cause impairment in 

cognitive functioning, which can result in a slower 

rate of processing and the need to present 

information in very small chunks or in a simplified 

format. When educating consumers, take into 

account individual needs.

Consumers who are experiencing psychiatric 

symptoms may need information to be presented 

in different formats, individually, or in shorter 

group sessions. By presenting small amounts of 

information at a time, consumers can learn at their 

own pace.
Joining Sessions and Educational Workshops 9 Module 3

Check for understanding

How often you check for understanding of the 

information will vary from person to person. 

Avoid asking yes or no questions. Have consumers 

and families summarize information in their own 

words. Hearing them explain their understanding 

of basic concepts allows you to know which areas 

they understood and which need clarification.

Multimedia education

Offer the information in the standardized 

curriculum to families in a variety of formats such 

as videos, slide presentations, lectures, discussion, 

and question-and-answer periods. Give each family 

member a folder with handouts of the information 

that will be presented, as well as resource lists and 

Web sites that they can use to find more information.

For example, you might want to include a copy 

of the following Family Guidelines. During the 

session, review each guideline in detail, and ask 

family members for their reactions, questions, and 

experiences. Illustrate the guidelines with examples 

based on the kinds of problems that your families 

described during joining sessions.

Family Guidelines

1. Go slow. Recovery takes time. Things will 

get better in their own time.

2. Keep it cool. Enthusiasm is normal. Tone 

it down. Disagreement is normal. Tone it 

down, too.

3. Give each other space. Time out is 

important for everyone. It’s okay to reach 

out. It’s okay to say, “No.”

4. Set limits. Everyone needs to know what 

the rules are. A few good rules keep 

things clear.

5. Ignore what you can’t change. Let 

some things slide. Don’t ignore violence.

6. Keep it simple. Say what you have to say 

clearly, calmly, and positively.

7. Partner with your relative’s treatment 

team. Understand your relative’s goals 

and the steps outlined in their treatment 

plan.

8. Carry on business as usual. Re-establish 

family routines as quickly as possible. Stay 

in touch with family and friends.

9. Do not use street drugs or alcohol.

They make symptoms worse, can cause 

relapses, and prevent recovery.

10. Pick up on early warning signs. 

Note changes. Consult with your 

consumer relative and the treatment 

team, if possible.

11. Solve problems step by step. Make 

changes incrementally. Work on one thing 

at a time.

12. Adjust expectations. Use a personal 

yardstick. Compare this month to last 

month rather than to last year or next year.
Module 1 Module 3 10 Joining Sessions and Educational Workshops Basic Elements and Practice Principles

Tailor your curriculum

While we recommend that you follow a 

standardized curriculum, your workshop will be 

most effective if you tailor the information as much 

as possible to the participants. Connecting families 

who have relatives with similar diagnoses is only 

the first step. Pay close attention to the educational 

needs that families reveal in joining sessions and 

emphasize this information in the workshop. 

Responding to family needs is the key to keeping 

them engaged in the FPE program.

To ensure that all components of the standardized 

curriculum are covered, follow the agenda below.

Sample Agenda of the Educational Workshop

9:00–9:15 Coffee and socializing

9:15–9:30 Formal introductions and explanation 

of the format for the day

9:30–10:30 Psychobiology and diagnosis 

of the specific mental illness

Basics of brain function and dysfunction

Possible causes of the specific mental illness

Diagnosis

Symptoms

Prognosis

10:30–10:45 Coffee break and socializing

10:45–11:15 Psychiatric medications How they work

Outcomes

Side effects

11:15–12:00 Other treatments options Overview of other treatment options

How they work

Outcomes

12:00–1:00 Lunch and socializing

1:00–3:00 The impact of mental illness 

on the family

The needs of the consumer

The needs of the family

Common family reactions to the illness

Common problems that consumers and families face

What the family can do to help

Family guidelines

The problem-solving method

3:30–4:00 Wrap Up Question and answer period

Scheduling, logistical, and questions about 

multifamily group sessions

Socializing

Agenda adapted from Anderson et al., 1986, p. 76.
Joining Sessions and Educational Workshops 11 Module 3

To start, offer refreshments in an informal setting to 

prompt spontaneous socializing. Have refreshments 

available throughout the workshop. To develop an 

atmosphere of partnership, during the breaks make 

sure that you spend time with families, not solely 

with colleagues.

To start the formal program, introduce yourself, 

distribute the educational packets, and explain 

the day’s agenda. For example, say:

Welcome and thank you for coming on this beautiful 

Saturday morning! My name is Bob Smith and this 

is Peg Rutherford. Some of you already know us 

because we’ve been meeting individually for quite 

some time now.

We want you to know as much as possible about this 

illness—what’s known, and what’s not known, as of 

now. Schizophrenia is a very complex and confusing 

illness. We have found that the more information 

family members have, the better equipped they are 

to deal with problems as they occur.

This workshop is only one step of our work together. 

After the workshop, we will regularly meet as a 

group of families and consumers. We will continue 

to give you relevant information and assistance. 

We have found with the FPE program that working 

together with consumers and families results in fewer 

relapses and rehospitalizations.

We will answer as many questions as possible in this 

workshop today. If we cannot answer something, we 

will find someone who knows the information and 

will get back to you.

While it is important to cover all components of 

the standardized curriculum, present information 

in an open, collegial manner that encourages 

participation. Create an atmosphere that 

encourages families to comfortably ask questions 

and tailor the curriculum to respond to their needs. 

It is important to continue the engagement process 

and strengthen the working alliance.

By sharing experiences, families will discover 

that their problems are similar. This realization 

normalizes families’ experience with mental 

illnesses and counters feelings of isolation. 

They often begin to bond during the workshop 

and build a strong social support network through 

their contact in the multifamily group.

Invite family members to talk about their reactions 

to the information presented. Some common 

reactions are relief at finally knowing some facts, 

anger at being kept in the dark, sadness, despair, 

hopefulness about this approach, and eagerness 

to get on with the work.

Keep in mind that family members are not 

obligated to speak during the workshop. Respect 

families’ decisions about how much they wish to 

share by encouraging discussion and eliciting 

reactions without demanding them.

If you have not done so already, outline the format 

for multifamily groups, emphasizing the structured 

problem-solving approach and its usefulness for 

consumers and families. Present the agenda for the 

first two meetings to generate enthusiasm for 

upcoming sessions.

Give examples of how life has improved for 

consumers and families who have participated 

in FPE. End the workshop on a positive note. If 

possible, families should leave the workshop feeling 

optimistic about being involved in the FPE program.

If you have not done so already, share contact 

information in case families need to reach you 

between sessions. Make sure that you have 

responded to the questions and concerns that 

families have raised, especially questions about the 

upcoming multifamily group. Thank all participants 

for coming to the workshop.

This workshop is modeled after the workshop 

described by Anderson and colleagues (1986). 

For more information about conducting 

educational workshops with consumers and 

families, see The Evidence in this KIT.

Joining Sessions and Educational Workshops 13 Module 3

Exercise: Review Progress Notes for Joining Sessions and Educational Workshops

Distribute a copy of your agency’s FPE Progress Notes for joining sessions and educational workshops. 

Review the components of these forms and discuss as a group.

Joining Sessions and Educational Workshops 15 Module 3

Exercise: Practice What You’ve Learned About Joining Sessions

Select three members of your training group to play the roles of practitioner, consumer, and family member. 

Conduct role plays of Joining Sessions 1, 2, and 3.

Discuss the following:

n How would you engage a consumer who is reluctant to involve a family member in the FPE 

program?

n How would you respond if consumers or family members become upset when discussing how 

mental illness has affected their lives?

n How would you respond to a consumer or family member who shares past negative experiences 

with group sessions?

Ongoing Family Psychoeducation Sessions 17 Module 4

Module 4

Ongoing Family Psychoeducation Sessions

Notes to the family intervention coordinator

Prepare for Module 4:

n Make copies of Module 4. Your copy 

is in this workbook; print additional 

copies from the CD-ROM in the KIT.

n Distribute the material to those who are 

participating in your group training. Ask 

them to read it before the group training.

n Make copies of the following 

exercises:

o Practice What You’ve Learned About 

Multifamily Groups

o Review the Progress Note for Ongoing Family 

Psychoeducation Sessions

Do not distribute them until the group 

training. Your copies are in this workbook; 

print additional copies from the CD-ROM in 

the KIT.

n Make copies of your agency’s Progress Notes for 

ongoing FPE sessions (if available). For a model 

form, see Building Your Program in this KIT.

Conduct your fourth training session

n When you convene your group, view 

the last two segments on the Practice 

Demonstration Video (approximately 

50 minutes):

n Multifamily Groups

o Problem-Solving

o Discuss the video and content of Module 4.

n Distribute the exercises to the group and 

complete them

Ongoing Family Psychoeducation Sessions 1 Module 4

Training Frontline Staff

Module 4: Ongoing Family Psychoeducation 

Sessions

Module 4 describes the last phase of the program—ongoing Family Psychoeducation 

sessions. When possible, these sessions should be offered in the multifamily 

group format. For this reason, the module describes the first three sessions of the 

multifamily group sessions in detail and draws applications to the single-family model.

Conduct ongoing Family 

Psychoeducation sessions

Once consumers and families have 

completed three or more joining sessions 

and families have participated in the 1-day 

educational workshop, invite consumers 

and families to attend ongoing Family 

Psychoeducation (FPE) sessions.

You may conduct these sessions in either 

the single-family or multifamily group 

format. Since you discuss and select format 

options with consumers and families during 

joining sessions, information for selecting 

a format is presented in Module 2.

When possible, offer ongoing FPE sessions 

in a multifamily group format. Multifamily 

groups consist of five to eight consumers 

and their respective family members.

Two FPE practitioners who have conducted 

the joining sessions and educational 

workshop facilitate the sessions. 

Multifamily groups meet every 2 weeks 

for 11⁄2 hours. For consumers and families 

to gain the full effectiveness of the FPE 

program, offer ongoing FPE sessions 

in either format for 9 months or more.

While this phase of the FPE program has 

been found to be most effective when 

offered long term, many FPE practitioners 
Module 1 Module 4 2 Ongoing Family Psychoeducation Sessions Basic Elements and Practice Principles

do not emphasize the long-term nature of FPE 

during the engagement process. Asking consumers 

and families to commit long term may provoke 

anxiety. For this reason, tell consumers and families 

that this last phase of the FPE program will 

continue for as long as they find it helpful.

Structure of multifamily groups

The structure of the first two multifamily group 

sessions differs from the structure of later sessions. 

In the first two sessions, the goal is to establish 

a partnership among group members. Up to this 

point, the working alliance has been limited to 

the consumer, family, and practitioner. When 

consumers and families begin participating in 

multifamily groups, the goal is to extend the 

working alliance to include all group members.

Why structure the first two groups 

differently?

Consumers and families need to get to know one 

another apart from the effects of mental illnesses 

on their lives. The first two sessions are designed 

to help group members learn about one another 

and bond as a group.

Traditional group therapy models emphasize 

expressing feelings. This often sparks conflict 

between family members, disagreement about the 

group’s purpose, and anger or confrontation with 

facilitators. Consequently, consumers and families 

may become overwhelmed and give up on the 

group. In contrast, FPE focuses on addressing 

current issues that pose barriers to consumers’ 

personal recovery goals. Group members work 

together by participating in a structured problemsolving approach. For this approach to be effective, 

group members must share ideas and be open to 

accepting them. It is best to proceed slowly and 

take time to develop trust and empathy.

Through the joining sessions, you developed 

a working alliance with consumers and families 

in the group. In the first two multifamily group 

sessions, you will extend that partnership by giving 

group members an opportunity to bond and build 

their group identity.

Overview of the first session

The goal of the first session is for FPE practitioners, 

consumers, and family members to get to know one 

another in the best possible light. The first session 

is not intended to be an opportunity to share deep 

emotions and feelings about the illness or about the 

group itself. Rather, it is a time for group members 

to get to know one another and discover common 

interests, issues, and concerns. For this reason, 

encourage group members to talk about topics that 

are unrelated to the illness, such as their personal 

interests, hobbies, or daily activities.

Set up the room

Arrange chairs around a table or in a semi-circle 

so that group members can easily see and hear 

one another. Use the same setup at every session. 

Be aware that once the problem-solving sessions 

begin (after the second group session), groups 

often like to be in a semi-circle so they can see 

the blackboard, flipchart, or chalkboard.

Have refreshments available to prompt socializing 

before and after the group. At the start of the 

session, tell group members that they are free 

to move around, get a drink, or use the restroom. 

Make sure that consumers know they can leave 

the room whenever necessary.
Ongoing Family Psychoeducation Sessions 3 Module 4

Be an effective facilitator

During the first two group sessions, be a good host. 

Introduce group members, point out common 

interests, and guide conversations to more personal 

subjects such as interests and hobbies.

Act as a role model. Demonstrate by example that 

you expect people to talk about topics other than 

the illness. This means that you should be prepared 

to share a personal story of your own.

Pay close attention to group members who speak 

and thank them when they finish. Prompt reluctant 

group members with questions or encourage them 

to talk. Some group members may benefit from 

a slow conversational pace to better absorb 

information that they hear.

Think of the group in terms of any group of people 

who meet one another for the first time. Guide the 

conversation to topics of general interest such as 

the following:

n Where people live;

n Where they were born and grew up;

n What kind of work they do both inside 

and outside the home;

n What their hobbies are;

n How they like to spend their leisure time;

n Which recent movies they have seen; and

n What holiday or vacation plans they have.

Structure the first session

Welcome group members and review the format 

for the first two sessions and future group sessions. 

Begin with introductions. Group members 

commonly want to talk about the illness during 

their introduction. Guide the discussion by clearly 

setting the agenda for the first group and modeling 

the type of introduction that you expect. For 

example, say:

Tonight, the goal is to begin to get to know one 

another. Let’s go around the room and each say 

something about ourselves. It is understandable to 

want to talk about the effects of a mental illness, but 

we will get to that during our next meeting.

Tonight, the goal is to talk about other parts of our 

lives. Let’s start by sharing the things that we are 

proud of. I would like to start by telling you about 

myself.

If consumers and families have joined thoroughly 

with you, they will feel less need to focus on the 

illness during the first group session. When you 

participate and talk about yourself, it gives the 

group a model and creates a feeling of partnership.

Some FPE practitioners find it uncomfortable to 

share personal information, since this is a departure 

from the way of conducting traditional therapy 

groups. However, you must create a friendly, 

comfortable atmosphere among group members. 

It may help to rehearse with your co-facilitator 

ahead of time. Think of a few positive, engaging 

stories about family, favorite activities, interests, 

and hobbies.
Module 1 Module 4 4 Ongoing Family Psychoeducation Sessions Basic Elements and Practice Principles

Be prepared to talk for about 5 minutes. For 

example, say:

Hi, my name is Margaret Hanson. Some of you 

have already met me, and some are meeting me 

for the first time tonight. I am a social worker and 

have worked in the community mental health center 

for 15 years.

I grew up in this area and my parents still live in 

the house I grew up in. I have three teenage girls 

who keep my husband and me very busy and 

challenged! Even though the girls are growing up 

and going in different directions, we still like to do 

things together as a family. One thing we like to 

do is go camping.

Over the years, we’ve acquired a lot of equipment 

so the girls could each invite a friend along on our 

trips. This summer, we’re planning a trip to the White 

Mountains, and we’re bringing two large canoes 

since the girls are inviting friends. I especially enjoy 

these trips since I don’t do much of the cooking—

my husband does! It’s so peaceful to camp and to 

spend time in a less harried environment.

We have an old yellow lab that stays home when 

we go camping, but when we’re home, she likes 

to take me for a walk every morning, usually as 

the sun comes up. In my spare time, I garden, scout 

flea markets, spend time with friends, sew, and read. 

Occasionally, my husband and I see a movie, go 

out to eat with friends, or walk the beach when the 

tourists aren’t around. Well, that’s enough about me 

for now. I’m looking forward to getting to know all 

of you better as time goes by.

Then turn to the next person and have group 

members continue around the circle. Thank group 

members after they contribute. Have your cofacilitator sit halfway around the circle and take 

a turn in sequence.

Redirect group members

If group members begin to talk about the illness or 

the impact of the illness on their lives, redirect the 

conversation. For example, say:

We will have time to talk about the illness later on. 

For right now, let’s try to get to know other things 

about one another.

Prompt group members

You may have to prompt some group members 

who offer only a minimal amount of information. 

Ask questions to help them give more details. For 

example, if they like to watch television, ask which 

shows they watch or if they say they like to cook, 

ask which recipes they enjoy most. Strive to point 

out similarities or interests that group members 

share. For example, say:

I notice that several of us like to go to the movies. 

Maybe we can talk about our most recent favorite 

films.

This helps develop relationships and group 

cohesion.
Ongoing Family Psychoeducation Sessions 5 Module 4

Overview of the second session

The second multifamily group session focuses 

on how mental illnesses have changed the lives 

of members in the group. In this session, the goal 

is to continue building trust among group members 

and help them develop a sense of a common 

experience of having a mental illness or a relative 

with a mental illness. The mood of this session is 

usually less light-hearted than the first session, but 

it is the basis for developing a strong group identity.

Structure the second session

Welcome members to the group as they arrive and 

direct them to the refreshments. To start the group, 

outline the agenda for the session by saying:

Thanks for being here tonight. Last time we spent 

time getting to know one another. Tonight, let’s 

begin by catching up for 15 minutes. Then we will 

discuss how mental illnesses have affected our lives.

Begin the socializing with a comment or question 

that is unrelated to the illness such as following up 

with a group member about a planned activity or 

event mentioned during the first session. It is 

important to begin groups by socializing. Encourage 

participation by modeling, pointing out connections 

between group members, and asking questions.

After socializing, say:

Now it’s time to focus on our topic for the evening. 

Mental illnesses have touched all of our lives in 

some way. Tonight, you will each have a chance to 

share your personal story of how mental illness has 

affected your life. You can share as much or as little 

as you would like, but also feel free to ask questions 

and to support one another.

Start by sharing your own professional and personal 

experience. For example, share a story about a 

friend or family member with mental illnesses, talk 

about how you became interested in your work, or 

how you have been affected by treating people with 

mental illnesses. When you finish sharing, turn to 

the next group member and ask:

How has it been for you? How has mental illness 

affected your life?

After group members have each briefly shared 

a story, thank them. Point out any similarities 

to another group member’s experiences.

Save 5 minutes to socialize before ending the 

session. Prompt discussions on concrete topics 

such as weekend or holiday plans. The purpose 

of socializing is to stimulate and encourage 

interpersonal connections. Socializing promotes 

developing social support networks. At the end 

of the session also remind group members of the 

time and date of the next session.

Try some tips for common difficulties

During this session, it may be difficult for group 

members to confide their problems. Offer plenty 

of support and validation to encourage people to 

talk. Be careful to respect personal boundaries by 

conveying that group members can say as much or 

as little as they wish. Ask questions to keep reluctant 

group members talking and to promote connections 

such as similar problems, worries, or stories.

This group session may be the first time some group 

members realize that they are not alone. Encourage 

them to express any feelings that surface while 

discussing these difficult experiences. For example, 

feelings that families commonly have but are 

reluctant to talk about include anxiety, confusion, 

fear, guilt, sadness, and grief. Compared to the first 

meeting, the mood of this session may be sad.

Sometimes group members express their 

unhappiness with the mental health system, 

the agency, or a member of the treatment team. 

Validate these feelings and experiences and ask 

for specific details. But be careful not to let a 

specific problem dominate the session.

Group members who have had an opportunity to 

discuss their experiences during joining sessions 

will be less likely to focus on these issues during 
Module 1 Module 4 6 Ongoing Family Psychoeducation Sessions Basic Elements and Practice Principles

group sessions. For this reason, we recommend 

that you complete all three joining sessions with 

consumers and families before introducing the next 

phases of the FPE program.

If group members start to talk about specific 

problems they want to solve immediately, help 

them return to the agenda by saying:

During the next session, we will begin to look 

at specific problems and work together to find 

solutions. Right now, let’s give [name] a chance 

to share with us how mental illness has affected 

her life.

Depending on the situation, you may also suggest 

meeting outside the group to discuss the problem.

Other difficulties that you may encounter during 

group sessions include people having side 

conversations, interrupting, monopolizing, or 

speaking for others. Address these issues with 

positive redirecting remarks, such as:

That’s interesting; I wonder if Mr. Smith has 

something to say about this.

Your wife says she thinks you’re over the flu. 

How long were you sick?

Understand the importance of humor

Early on, it helps to introduce humor into the 

group dynamic. Let group members know that 

it is acceptable to have fun and laugh. Model 

this behavior as well, when appropriate.

Ongoing multigroup sessions

Many consumers and families have expressed 

dissatisfaction with traditional group therapy 

models because of the high degree of emotion and 

low degree of productivity. FPE responds to these 

concerns by offering a clear agenda for each session 

and a structured problem-solving approach to help 

consumers and families make gains in working 

toward personal recovery goals.

Follow the session agenda

Beginning with the third session, the agenda 

for multifamily group sessions is as follows:

Multifamily Group Session Agenda

Socialize 15 minutes 

Go-around—identify current 

issues 

20 minutes 

Select a single problem 5 minutes

Use structured problem-solving 45 minutes 

Socialize 5 minutes 

Total 90 minutes

As in the first two sessions, two FPE practitioners 

continue to co-facilitate the group. One FPE 

practitioner acts as the primary facilitator and 

leads the group through the agenda and structured 

problem-solving. The other serves as co-facilitator 

and ensures group participation, monitors the 

overall process, and records the problemsolving process.

Record the proceedings on a blackboard, flipchart, 

or chalkboard. At the end of the session, document 

the session on a Progress Note that you can put in 

consumers’ charts. Give consumers and families 

a copy to take home.
Ongoing Family Psychoeducation Sessions 7 Module 4

Similar to the first and second group sessions, 

socialize at the beginning and end of each 

group session. Give consumers and families the 

opportunity to recapture and practice any social 

skills they may have lost due to isolation or 

exposure to high levels of stress.

After socializing, begin the go-around to identify 

current issues related to mental illness that 

consumers and families are managing. It is often 

helpful to prompt the go-around discussion by 

writing this question at the top of a blackboard:

How have you been affected by the illness since 

we last met?

Prompts such as these help group members focus 

on the purpose of the go-around. This is also the 

time to follow up on consumers’ progress toward 

their goals or on their action plan. As each group 

member checks in, have your co-facilitator list 

the current issues on the blackboard.

Discuss each issue individually. Do not point out 

similarities between the concerns of group members 

because doing so causes group members to express 

problems in more general terms. Instead, for the 

purposes of problem-solving, encourage group 

members to use their own words to describe their 

current issues in detail. This will provide a clearer 

and more accurate picture of the issues.

Once you have completed the go-around, review 

each issue. Remember to recognize any progress 

that consumers have made in achieving steps 

toward their goals. If any issues can be readily 

solved, offer direct assistance or advice based 

on the family guidelines.

Many issues that consumers and families identify 

will be too complex to easily resolve. Instead, 

choose one for the group to work on during the 

session. Ask consumers and families for their 

permission to focus on the issue as the group’s 

topic. If agreed, discuss this problem for the 

remainder of the session.

Use structured problem-solving

Structured problem-solving is a six-step approach 

that helps break problems down into a manageable 

form so that solutions can be implemented in small, 

easy-to-follow steps. Experiencing success in small 

steps gives consumers and families hope that 

change is possible. Often a small success will 

motivate consumers to apply the method to other 

aspects of their lives.

Six Steps of Structured ProblemSolving

n Define the problem.

n Generate solutions.

n Discuss advantages and disadvantages 

of each solution.

n Choose the best solution.

n Form an action plan.

n Review the action plan.

Select the problem

The first step of the structured problem-solving 

approach is to select one problem from the list of 

current issues and define it in detail. Selecting and 

defining the problem, while sometimes viewed as a 

rather simple process, is often the most difficult 

step. If the problem is not properly defined, 

consumers, families, and practitioners become 

frustrated and convinced that it cannot be solved.

Some common difficulties that groups experience 

are the following:

n Choosing a problem that is too large or too 

general (for example, “I want to get a job”);

n Not reaching consensus on how to define the 

problem; and

n Phrasing the problem inaccurately.
Module 1 Module 4 8 Ongoing Family Psychoeducation Sessions Basic Elements and Practice Principles

Tell group members that the problem definition 

stage can be challenging. Acknowledging that 

the process is not simple may alleviate some 

frustration later.

To select a problem for the group to discuss, review 

the list and consider the scale of the problems 

identified. For initial sessions, select simpler 

problems so that the group members learn the 

structured problem-solving approach, gain trust 

in one another, and achieve a few successes. Only 

address long-standing or previously intractable 

problems if you can break them down into more 

solvable subproblems.

Share your reasoning for selecting specific problems. 

Thinking aloud while selecting a problem helps 

group members learn how to simplify, clarify, 

and prioritize concerns.

Once you have selected a problem and the 

consumer and family have agreed that the issue 

can be the focus of the group session, emphasize 

that the goal is to teach the problem-solving 

approach and that, with practice, group members 

may begin to use the approach outside the group. 

It is also important to say:

Although the problem may not currently be a 

problem in your life, it is likely that many of you 

have faced or will face a similar issue. Hopefully, 

we can share our experiences and together find 

some possible solutions. Remember if your issue 

isn’t the focus for this session, over the course 

of the group, we will address everyone’s issues.
Ongoing Family Psychoeducation Sessions 9 Module 4

Evaluate Common Problems

Safety issues Safety is always of primary importance. As you review the issues, address any potential 

threats to safety.

Clarify the issue. If the issue is too emotionally charged or is likely to disrupt the group 

process, address the issue apart from the group, and update the group about how it 

was resolved. Discuss your reasons and plans in as much detail as possible so that group 

members have the best possible learning experience.

If the issue is not too emotionally charged or disruptive and can be broken down into 

manageable parts, ask the consumer if you may select the problem for the group 

to discuss.

Managing symptoms, 

substance use, and 

medication issues

Reports of actual or potential exacerbation of symptoms are common problems that 

you may address in the group. Issues about medications and substance use are also 

important. Because these are potentially emotional issues, present or reframe the 

problem in nonblaming terms. Blaming consumers or families is not constructive or 

helpful. Modeling a nonjudgmental, nonblaming approach often can be a good learning 

opportunity for group members.

Life events Sometimes, major events occur (for example, divorce, death, marriage, graduation, 

a birth), that can be unsettling for the whole family and especially for someone with 

mental illness. It is natural for stress levels to rise at such times, even with positive stress.

Changes sometimes occur within mental health agencies, such as a move to another 

building or a practitioner’s resignation that may be as distressing to consumers and 

families as other major life events. You may be able to address these issues in the group.

Disagreement 

among consumers 

and family members 

It is natural for consumers and family members to disagree at times. When exploring 

issues such as these, consider the following:

The intensity of the disagreement

Sometimes an issue surrounded by intense disagreement is better resolved in singlefamily sessions. In such a case, suggest an outside meeting to help with the problem. 

If the disagreement does not seem extreme and is selected for problem-solving, keep 

criticism and emotions to a minimum. Consider reviewing the Family Guidelines 

outlined in Module 3.

Whether the disagreement is a consequence of the mental illness

If the disagreement is a consequence of the mental illness, problem-solving in the 

group can be helpful and elicit solutions that are pragmatic and stress-reducing. 

However, when a consumer and family member are disagreeing, it may be difficult to 

agree on the definition of the problem. One approach is to define the problem broadly, 

such as: How can the Smith family manage their disagreement so that John will not be 

overwhelmed and relapse?
Module 1 Module 4 10 Ongoing Family Psychoeducation Sessions Basic Elements and Practice Principles

Define the problem

The next step is to ask consumers and families 

for more information to help the group clearly 

understand and define the problem. Ask detailed 

questions such as the following:

n What is the current issue?

n When did you first notice the problem?

n When does it occur? How often? 

In what situations?

n Has the problem changed in any way recently?

n Whom does the problem affect? How?

n With what activities does the problem interfere?

n What have you tried to alleviate the problem? 

What were the results?

n Who seems to have the most impact on the 

problem?

Seek consensus on the definition of the problem 

by summarizing it in a single sentence or phrase 

and asking consumers and families if the definition 

makes sense to them. Make sure that you accurately 

define the problem. Incorrectly phrasing the 

problem can cause the group to generate 

ineffective solutions. For example, consumers 

or family members may indicate that the person 

is the problem. Remember, the problem is the 

problem; the person is never the problem.

Once a problem has been defined in a way that is 

acceptable to each member of the family, write it 

on the blackboard.

Generate solutions

Once you define the problem, ask group members 

to offer whatever solution they think may help. 

Do not evaluate solutions now since doing so 

dramatically reduces the number of solutions 

people present. It is often helpful to say:

We know it is difficult to resist discussing suggestions 

as people generate them. However, we have found 

that by discussing them as we go, some solutions 

are left unspoken. Therefore, let’s delay evaluating 

solutions until after all suggestions have been made.

The goal is to generate as many ideas as possible 

about solving the problem. The more solutions 

generated, the more likely one will adequately 

address the problem. For this reason, ask all 

group members to contribute at least one solution. 

Take all ideas seriously and write them on the 

blackboard, even if a suggestion seems wild or silly. 

It is important that group members feel their ideas 

are respected and no idea is discounted.

Discuss advantages and disadvantages 

of each solution

After people have presented all their solutions, 

invite group members to weigh the advantages 

and disadvantages of each. On the blackboard, 

simply write a plus [+] next to the solution when 

someone identifies an advantage and a minus [-] 

after the solution when someone identifies a 

disadvantage. When possible, take time to evaluate 

the solutions as a group. When time is short, some 

facilitators streamline the evaluation process by 

presenting the solutions to the group to review 

and select. Unfortunately, when this process is 

shortchanged, consumers do not fully benefit from 

the others’ experiences.

Choose the best solution

When you evaluate all solutions, review the list 

emphasizing solutions that have the most advantages 

and fewest disadvantages. Then ask consumers 

which solutions they would like to test for 

themselves over the next 2 weeks. Stress that testing 

solutions is for the benefit of everyone in the group 

because everyone is looking for solutions that work.
Ongoing Family Psychoeducation Sessions 11 Module 4

Form an action plan

Once you select a solution, develop a detailed 

action plan. Typically, you will break the solution 

down into small steps or tasks. Specify each step 

by asking:

n What needs to happen first?

n Who will do that step?

n When will that step happen?

n Where will people meet for that step?

Discuss each step or task and assign someone 

responsibility for completing it by a specific date. 

Some plans include tasks that all group members 

may try. Others are designed specifically for the 

consumer and family who presented the problem.

Once you develop the action plan, have your cofacilitator record the steps on a Progress Note form. 

Make copies for the consumer’s chart and for the 

consumer and family.

Review the action plan

When appropriate, tell the consumer and family 

that you may check on their progress during the 

coming week and that you are available for help. 

Remind them that the group will look forward 

to an update during the next session.

At the beginning of the next session (during the goaround), review the action plan and followup on the 

consumer’s progress. Ask:

n What steps were completed?

n What went well?

n What did not go so well?

Praise all efforts and point out any progress. 

If steps were not completed, explore obstacles 

and alternatives. If consumers encountered 

significant challenges that cannot be resolved 

quickly, suggest meeting individually with the 

consumer and family outside the group to explore 

the issue in greater detail. When possible, update 

the group about the outcome to ensure that others 

can learn from the experience.
Module 1 Module 4 12 Ongoing Family Psychoeducation Sessions Basic Elements and Practice Principles

Difficulties encountered

At any point during the group, if consumers or 

families who have identified the problem begin 

to struggle with the process, make sure you have 

accurately defined the problem and that the group 

is addressing the true problem. It is better to stop 

the process and clarify the problem definition than 

to generate solutions that are irrelevant to the current 

issues that consumers and families are facing.

Many issues that the group presents are perceived 

as unsolvable. These are often long-standing 

problems that have resisted all attempts to make 

them better. Group members seldom have much 

hope that things will change. With this in mind, 

collect as much information as possible when you 

select and define problems so that you may break 

large problems down into smaller parts and work 

on them incrementally. When things do change, 

acknowledge the efforts of those involved in 

the change.

In some instances, stray from the 

structured problem-solving approach

Use the problem-solving approach for most 

multifamily group sessions. However, occasionally 

group members may identify issues that are best 

addressed with a different approach. In this case, 

alter the approach by bringing in guest speakers 

or by offering specific skills training. For example, 

research shows that interspersing skills training 

targeted to the symptoms of obsessive-compulsive 

disorder is an effective adaptation of FPE for 

families and consumers with this illness (Van 

Noppen, 1999).

Throughout the FPE program, continue to share 

educational materials targeted to specific mental 

illnesses in different formats (for example, video, 

print, and website resources). Remaining responsive 

to the needs of consumers and families will keep 

them engaged in FPE services.

When needed, offer ongoing 

Family Psychoeducation services 

in a single-family format

You can easily adapt the goals of ongoing 

multifamily sessions to the single-family format. 

Introduce consumers and families to the structured 

problem-solving approach and work with them 

to identify current issues that may be addressed 

collaboratively. Follow the guidelines described 

in the multifamily group format.

While consumers and families will not have the 

benefit of other group members’ experiences, it 

is still possible to identify strengths, resources, 

and strategies that have worked in the past. With 

consumers and families, generate solutions and 

evaluate each one to select the best choice. Next, 

collaborate with the consumer and family to 

develop a detailed action plan.

Tailor single-family sessions to the needs of the 

consumer and family. Keep your work with 

consumers and families task oriented and focused 

on consumers’ personal recovery goals. For more 

resources on the single-family format, see The 

Evidence in this KIT.
Ongoing Family Psychoeducation Sessions 13 Module 4

Exercise: Practice What You’ve Learned About Multifamily Groups

n Role play: Conduct a role play to practice introducing the format of the first two multifamily group 

sessions. Practice how you may introduce yourself during the first group session.

n Group discussion: Discuss as a group how you would redirect a consumer or family member who becomes 

upset during the second multifamily group session.

Ongoing Family Psychoeducation Sessions 15 Module 4

Exercise: Review the Progress Note for Ongoing Family Psychoeducation Sessions

Distribute a copy of your agency’s Progress Note for ongoing FPE sessions. Review the components of this 

form and discuss as a group.

Problem Solutions from Actual Practice 17 Module 5

Module 5

Problem Solutions from Actual Practice

Notes to the family intervention coordinator

Prepare for Module 5:

n Make copies of Module 5. Your copy 

is in this workbook; print additional 

copies from the CD-ROM in the KIT.

n Distribute the material to those who are 

participating in your group training. Ask 

them to read it before the group training.

n Make copies of the following 

exercise:

o Practice What You’ve Learned 

About Problem-Solving

Do not distribute them until the group 

training. Your copies are in this workbook; 

print additional copies from the CD-ROM 

in the KIT.

Conduct your fifth training session:

n Discuss the content of Module 5.

n Distribute the exercise and complete 

it as a group.

Note: This module has no corresponding Practice 

Demonstration Video component.

Problem Solutions from Actual Practice 1 Module 5

Training Frontline Staff

Module 5: Problem Solutions from Actual Practice

Module 5 presents case studies of actual multifamily groups and catalogues a 

variety of responses to two commonly presented issues: finding or keeping a job 

and using medications. Although these examples capture problems and solutions 

that have emerged from real groups, they also apply to single-family sessions.

Overview of the module

Every group is unique. One approach will 

not solve all difficulties that consumers and 

families face. To be successful, solutions 

must be relevant and acceptable to 

consumers and families. This module 

presents the experiences of those who have 

participated in FPE programs. We selected 

two areas—employment-related and 

medication-related issues—because 

they are commonly raised and especially 

challenging. Also, they are a frequent 

source of tension and conflict for 

consumers, families, and practitioners.

Disagreements can be destabilizing or, 

at least, can prevent rehabilitation if left 

unresolved. Rather than trying to resolve 

disagreements directly, the structured 

problem-solving approach allows 

practitioners, consumers, and families 

to alleviate the effects of conflicts by 

finding alternative paths or identifying 

common ground.
Module 5 2 Problem Solutions from Actual Practice

Employment issues

This section begins with two case studies that show 

you how the problem-solving approach has been 

used to define and address employment-related 

issues. It also presents a log of similar problems 

and solutions identified through FPE multifamily 

groups. In some cases, staff from evidence-based 

practice Supported Employment programs have 

co-facilitated these groups.

Pedro’s story

Pedro, a man in his mid-30s, has struggled with 

serious mental illnesses since his late teens. He has 

been able to maintain an apartment and stay on 

medication for years with minimal support, but 

until recently had been unemployed. He is working 

closely with an employment specialist to make his 

part-time job successful, but shares some concerns 

with the multifamily group.

Step 1 Define the problem

In Step 1, the goal is to narrow the definition of the 

problem so that the group can generate practical, 

concrete solutions. To better understand Pedro’s 

concerns, the facilitator asked him to talk about his 

typical workday. Next, the facilitator asked Pedro’s 

sister more questions to understand her perspective. 

This process revealed that, since Pedro had not had 

much work experience, he was uncomfortable with 

co-workers. The facilitator defined the problem as:

How can Pedro become more comfortable with his 

co-workers?

Pedro and his sister agreed with the definition of 

the problem and the co-facilitator wrote it on the 

blackboard.

Step 2 Generate solutions

All members of the group brainstormed and 

generated the following list:

n Tell yourself there’s no pressure to be friends 

with everyone.

n Ask for support.

n Connect with people who do the same job.

n Do the best job you can.

n Plan activities outside of work.

n Make small talk.

n Compliment people.

n Give yourself credit.

n Use humor.

n Join work-related activities such as lunch.

n Bring in food to share.

n Ask questions to get to know others.

Step 3 Discuss advantages and disadvantages

The facilitator read each solution aloud and asked 

group members:

What are the main advantages of this solution?

After the co-facilitator recorded the advantages, 

the facilitator asked, “What are the disadvantages 

of this solution?” The co-facilitator wrote all 

responses on the blackboard.

Step 4 Choose the best solution

The facilitator reviewed the solutions for which the 

disadvantages outweighed the advantages. In these 

cases, the group agreed to cross out these solutions. 

Of the remaining solutions, the facilitator asked 

Pedro which he would like to try. Pedro chose the 

following solutions; his sister agreed that they are 

good ones to try:

n Join a work-related activity; and

n Bring in food to share.
Problem Solutions from Actual Practice 3 Module 5

Step 5 Form an action plan

The group helped Pedro break the solutions 

that he chose down into manageable, concrete, 

specific steps.

Pedro’s Action Plan

n Set aside grocery money.

n Make a shopping list.

n Shop for apricot bread ingredients during 

the week.

n Bake bread on Saturday afternoon.

n Bring bread to work on Sunday.

n Join co-workers for lunch on Sunday.

Step 6 Review the action plan

In the go-round of the next group meeting, the 

facilitator asked Pedro about his experience in 

working on his action plan. The group learned that 

Pedro set aside the grocery money, made a shopping 

list, and bought the ingredients for apricot bread. 

Unfortunately, he burned the bread and was unable 

to bake a second loaf before work on Sunday.

Although he didn’t have any bread to share, he 

did join his co-workers for lunch. He shared his 

breadmaking story and his co-workers laughed. 

He reported that it helped break the ice and he felt 

more comfortable with his co-workers. Facilitators 

and group members praised his courage and efforts.
Module 5 4 Problem Solutions from Actual Practice

Sharon’s story

Sharon is a 38-year-old woman with a schizoaffective 

disorder. She lives alone with her cat and works 

part-time (every morning for 4 hours) in the 

mailroom of a large insurance company. The bus 

stop to work is within easy walking distance of her 

apartment. She likes the routine of working every 

day and has become quite efficient at her job, which 

does not vary too much from day to day. Recently, 

however, some of her work duties have changed.

Step 1 Define the problem

The facilitator asked Sharon to explain how her 

work has changed. Sharon explained that the 

company is handling bulk mailings that must go out 

quickly, increasing tension at the worksite. Sharon 

told the group that she found the fast pace difficult 

and stressful. The facilitator defined the problem as:

What can Sharon do to feel less overwhelmed at 

work when bulk mailings must go out quickly?

Sharon and her parents agreed with the problem 

definition and the co-facilitator wrote it on the 

blackboard.

Step 2 Generate solutions

The facilitator asked group members for possible 

solutions. They generated the following list:

n Quit.

n Talk to the supervisor.

n Set limits for yourself.

n Take more frequent breaks.

n Go to the gym to relieve tension.

n Get a massage.

n Reduce your hours at those times.

n Scream into a pillow.

n Practice stress reduction techniques.

n Seek peer support.

Step 3 Discuss advantages and disadvantages

The group discussed the advantages of each 

suggestion first, then the disadvantages. The cofacilitator wrote all responses on the blackboard.

Step 4 Choose the best solution

After reviewing the advantages and disadvantages, 

the group eliminated several solutions. Sharon 

chose the following solutions; her parents agreed 

they are good ones to try:

n Talk to your supervisor.

n Practice stress reduction techniques.

Step 5 Form an action plan

With the group’s help, Sharon and her parents 

developed the following action plan:

n Approach the supervisor first thing in the 

morning to ask for a meeting time.

n Meet with the supervisor.

n Use stress reduction techniques before and after 

work for 1 week.

Then they conducted a role play in the group so 

Sharon could practice what she wants to say to her 

supervisor. Next, the facilitator introduced a stress 

reduction technique. All group members practiced 

the technique once together.

Step 6 Review the action plan

At the next group session, Sharon reported that 

she had not approached her supervisor during 

the previous 2 weeks. She practiced her stress 

reduction technique, which she liked. Although 

work was still tense sometimes, she reported that 

she feels better about it.
Problem Solutions from Actual Practice 5 Module 5

The following log outlines other employment-related problems and solutions that FPE multifamily 

groups identified.

Log of Other Employment-Related Problems and Solutions

Problem Possible solutions

Finding work n	 Look through want ads.

n	 Walk or drive around the community in search of job openings.

n	 Talk with members of your social support network.

n	 Use the yellow pages to identify jobs of interest.

n	 Visit jobs of interest.

n	 Enroll in a Supported Employment program.

Adjusting to a new job n	 Prepare for your first day (set an alarm clock, pack lunch, practice a bus route).

n	 Ask questions, as needed, about the job.

n	 Review your written job description.

n	 Arrive early to get comfortable with the place.

n	 Take one day at a time.

n	 Work with an employment specialist.

Managing symptoms 

and stress at work

n	 If symptoms affect your concentration, make notes to remember tasks or instructions.

n	 Ask for an accommodation such as a quiet workspace or regular breaks.

n	 Use stress reduction strategies.

n	 Identify a buddy at work with whom you can talk.

n	 Carry PRN medication.

n	 Work with an employment specialist.
Module 5 6 Problem Solutions from Actual Practice

Medication issues

The following case study shows you how the 

problem-solving approach has been used to define 

and address medication issues. This section also 

presents a log of other medication-related problems 

and solutions identified through FPE multifamily 

groups. In some cases, a psychiatrist or nurse cofacilitated these groups.

Darcy’s story

Darcy is a 29-year-old woman who has 

schizoaffective disorder. She is the mother of two 

young children. It is important to her to function 

well enough to care for her family, as well as to 

take one course each semester as she works toward 

her undergraduate degree. Following the advice 

of her doctor, Darcy recently started taking a new 

medication.

Step 1 Define the problem

The facilitator asked Darcy to explain the concerns 

that she had about the new medication she is taking. 

Darcy explained that the medication makes her feel 

tired. She was unable to concentrate in class and 

frequently nodded off.

The facilitator defined the problem as:

What can Darcy do if she’s experiencing side effects 

from her medication?

Darcy and her family agreed with the problem 

definition and the co-facilitator wrote it on 

the blackboard.

Step 2 Generate solutions

The facilitator asked all group members to 

contribute possible solutions. The group generated 

the following solutions:

n Call the doctor.

n Cut down on the medication.

n Ask someone to take notes in class.

n Bring a tape recorder to class.

n Drink coffee.

n Ask a classmate to wake her.

Step 3 Discuss advantages and disadvantages

The group discussed the advantages of each 

suggestion first, then the disadvantages. The cofacilitator wrote all responses on the blackboard.

Step 4 Choose the best solution

After reviewing the advantages and disadvantages, 

the group eliminated several solutions. Darcy chose 

the following solutions; her family members agreed 

they are good ones to try:

n Bring a tape recorder to class.

n Call the doctor.

Step 5 Form an action plan

With the group’s help, Darcy and her family 

developed the following action plan:

n After class on Wednesday, Darcy will set up an 

appointment with her professor. She will tell her 

professor that she is sleepy in class because of the 

side effects of a medication and she will ask if she 

can record the class until her dose is corrected.

n Tomorrow morning, Darcy will call to set up 

an appointment with her doctor. Her family 

member agrees to go with her to the appointment 

for support.
Problem Solutions from Actual Practice 7 Module 5

Step 6 Review the action plan

One week later, the facilitator called Darcy to see 

how she is doing and if she needed any help with 

the action plan. Darcy reported that she had set up 

her appointments. They reviewed what she wished 

to say during each meeting.

At the next group session, Darcy reported that she 

received permission to tape record her class. She 

still fell asleep twice last week but her doctor 

suggested taking her medication at night and that 

seems to help. Her doctor agreed that she should 

lower the dose of her medication if the side effects 

continue for another 2 weeks.

The following log outlines other medication-related 

problems and solutions that FPE multifamily 

groups identified.

Log of Other Medication-Related Problems and Solutions

Problem Possible solutions

Forgetting to take 

medications

n	 Take medications at the same time every day.

n	 Set a timer.

n	 Combine taking medications with another daily activity such as brushing your teeth.

n	 Ask a buddy to call and remind you.

n	 Leave yourself a note.

Difficult medication 

regimes

n	 Talk with your doctor to see if your medication schedule can be simplified.

n	 Write a schedule on your calendar.

n	 Keep a medication record.

n	 Use a pill container. Ask a buddy for help.

Communicating 

medication issues 

to your doctor

n	 Ask for a longer appointment time.

n	 Role-play how you would present your concerns to your doctor.

n	 Ask other treatment team members to speak to your doctor with you.

n	 Ask a family member to join you for your appointment.

n	 Write down your concerns or keep a medication record and share it with your doctor.

Many concerns that consumers raise about 

medications may be viewed as decisional conflicts. 

In other words, consumers may feel conflicted 

about their decision to take medication as 

prescribed. The structured problem-solving 

approach is an effective way to address such 

concerns as long as consumers agree with the way 

that the problem is defined and actively participate 

in weighing the advantages and disadvantages of 

the solutions generated. It is important to create 

an environment in which all group members feel 

comfortable voicing their ideas and consumers feel 

supported in weighing the options and choosing the 

best solution.

Problem Solutions from Actual Practice 9 Module 5

Exercise: Practice What You’ve Learned About Problem Solving

Select three members of your training group to play the roles of practitioner, consumer, and family member. 

Conduct role plays to practice using the structured problem-solving approach in either a single-family or 

multifamily group format.

n Conduct a role play to address an issue related to employment.

n Conduct a role play to address an issue related to medication.


HHS Publication No. SMA-09-4422

Printed 2009

26171.0709.7765020404