Psychoeducation and Motivational Enhancement with Competency Restoration Clients

Written By Amelia Sorensen
January 2022

Psychoeducation is simultaneously one of the most important concepts (and treatment techniques) in the practice of psychology and also one of the most broad/versatile concepts in psychology. I've heard the term used in clinical settings, where it can be defined as an evidence-based "intervention with systematic, structured and didactic knowledge transfer for an illness and its treatment, integrating emotional and motivational aspects to enable patients to cope with the illness...” (Ekhtiari et al., 2017). However, I've also heard the term simply used to describe wellness initiatives in corporate settings with non-clinical populations. Ultimately, the definition can change based on the setting in which it is used and the population for which it is aimed. Therefore, what exactly do we mean by psychoeducation at Psychological Assessment Inc. - a setting where clinicians work with various clients who are involved in the criminal justice system? What exactly does it entail and what are the considerations in using psychoeducation with clients in a forensic setting?

When I’m working with minors who have been ordered to participate in our competency restoration program, I am not only focused on educating them about court proceedings, their charges and their rights, but I’m focused on helping them identify their thoughts/beliefs about themselves and others, which in turn, may contribute to how they interact with their attorneys and how they behave in (as well as outside) of court. For some, this may look like pinpointing certain conversations, words or actions of others that may indirectly lead to certain emotions for the client (i.e. frustration/anger). Once these precipitants and emotions are identified, then psychoeducation may involve teaching the juvenile various emotion regulation skills - like breathing exercises or the 3R technique (regulate, relate, and reason) - that will allow them to take in important information and advocate for themselves. Many of the juveniles I see have had several adverse childhood experiences, which have shaped their actions, decisions, and worldviews, so even discussing with them how the human brain responds to these experiences and how they can rewire their brain to cope with the various stressors that they are faced with, may be helpful for them inside and outside of court. For instance, if the juvenile is getting into fights while in custody and participating in competency restoration, this is potentially going to hurt or delay their case and may warrant some psychoeducation around alternative behaviors that may be more helpful to them.  Psychoeducation may also look like teaching a juvenile with ADHD, who is going to need to sit still in court for several hours, how to manage this daunting task and ask for breaks when they need it.

Depending on the client’s cognitive abilities, learning style and readiness to change/level of ambivalence, the clinician may need to simplify the psychoeducation or use different methods of presenting the information to the clients in order to increase understanding and buy-in. A great book by Amy Wenzel (2013), called “Strategic Decision Making in Cognitive-Behavioral Therapy,” focuses on the use of psychoeducation and motivational enhancement to improve rates of treatment success and compliance. When I’m working with my competency restoration clients and engaging them in session, I am not only thinking about where and when psychoeducation may be beneficial, but I’m consistently taking stock in the client’s level of motivation to put forth their best effort, since this has a huge impact on what they absorb during our session. In her book, Wenzel discusses the importance of assessing where the client is in terms of their readiness to change by identifying whether they are in the precontemplation, contemplation, preparation, action or maintenance stages. Though these stages have generally been used to describe people who are in treatment for psychiatric symptoms and their readiness to change, I think this model still applies to people who are mandated for competency restoration training and can be used to describe their readiness to learn. I (as the clinician) can then use this information to inform how I go about “joining” or building rapport with the client, how I frame training for the client and which interventions will be most likely to increase or maintain motivation. These interventions might include identifying short-term goals, providing psychoeducation around the client’s own psychiatric symptoms which may impact their competency, identifying and modifying negative attitudes towards training, and brainstorming ways in which the client can overcome obstacles to engaging in training. It's worthy to note that many of the interventions I may implement are relational in nature, as their usefulness to the client – and the overall success of the client in our program – hinges, at least partially, on the relationship between trainer and client at any given moment. In conclusion, psychoeducation and motivational enhancement, as well as connecting with our clients on a basic human level, are all vital components in competency restoration training, and in the work we do with mandated clients at PAI.