Psychoeducation with drawing, cards and games

What it is

Psychoeducation is explaining what is going on with someone, and what can help. It is often about a diagnosis, such as ADHD. Parents of a child with ADHD then get information and tips about their child’s behaviour, about their own reactions to it, about ways to deal with it differently and about how they can adapt the environment. In the treatment plan for a child with ADHD, this is usually the first part.

For adults it comes down to this: you try to understand and recognise your symptoms, so that you know better what causes your problems and what you can do about them. The GP, psychologist or psychiatrist helps with this.

Creative psychoeducation is the same explanation in a different form: your client draws, chooses cards, comes up with an image or plays a game.

Why it matters

Questions remain after a diagnosis. A diagnosis puts a name to what someone has often noticed for a long time, and that can help in finding support that fits. But a diagnosis also stirs up a lot, and not everyone reads easily. An explanation that your client shapes themselves can come closer to their own life than a leaflet.

Taking part can help you remember. Kinderen uit de Knel is a group programme for parents who remain in fierce conflict after a divorce, with a separate group for their children. Psychoeducation works better there when parents also experience it in exercises, because then what they learn sticks better. That is about one programme for one group, so it does not mean that every creative form works. But it is a reason to have people do something as well as explaining.

An image gives you something to talk about. For people who find reading difficult, there are picture stories. Such a picture story connects with how people see and experience their own world, and gives starting points for a conversation. A drawing or a card can give you something to talk about in the same way.

How to do it

1. Ask what your client wants to understand. Start with a question, for example what is still unclear since the diagnosis, or when your client notices it most. The answer decides where you start.

2. Get the content from a reliable source. The explanation of the diagnosis itself comes from whoever made the diagnosis or is treating your client. Talk with your client about what they have already heard. Read a reliable text together, such as the page about ADHD on Thuisarts, the Dutch health information website from GPs. Do not make up your own explanation of causes or medication. If there is a question about that, write it down together for the practitioner.

3. Choose a form that fits. A few options:

   • Drawing. Draw an ordinary week together as a timeline, and put a cross where things often go wrong. Or ask your client to draw how it feels when everything comes at once.
   • Cards. With Talk Cards, your client chooses a photo, and a question comes with it. With Strength cards, your client chooses cards about what they are good at. That way it is not only about what is hard.
   • An image or comparison. Let your client come up with their own image for how it feels, for example “a radio playing ten stations at once”.
   • A game. With the Reflectierad you spin a wheel and get a question about one part of your life, such as work and education, or relationships.
   • Videos and comics. The learning module ‘Weet wat je kan’ (‘Know what you can do’), for people with a mild intellectual disability, works with short videos and comic-strip drawings. That makes the module easier to understand.

4. Keep it small. One subject at a time is enough.

5. Let your client do the work. Your client draws, chooses and moves things around. You ask questions and listen. Do not take over the pen, even if that is quicker.

6. Take the step to tomorrow. After each explanation, ask what it means for your client’s week, and choose one thing together to try out. A tip for adults with ADHD, for example, is to put in your diary what you are going to do that day, and how long it will take.

7. Check whether it has come across. Use the teach-back method: ask your client to tell you in their own words what you talked about. Make the question about yourself, so that it does not feel like a test. For example: “I would like to know whether I explained it well. What are you going to tell them at home?”

8. Give something to take home, after the explanation. The drawing or the chosen cards go home with your client. Only hand out information material after a good explanation, and not instead of one.

9. Involve the people close to your client, if your client wants that. With children, psychoeducation is also about the parents: how they react, and what they can do differently. ‘Weet wat je kan’ is also meant for conversations with the client, the people close to them and their support workers. Always ask first whether your client wants that.

10. Point to people who have been through it themselves. Point people with ADHD to Impuls & Woortblind (in Dutch), an association for and by people with ADHD and dyslexia, among other conditions. The association holds meetings all over the country where you can meet others with ADHD.

Choices you make

• Playful or childish. With ‘Weet wat je kan’, some participants found the drawings a bit childish at first, but during the module most participants noticed that it helped them. So explain why you choose a particular method, and give your client the choice.
• With others or alone. In a group or at a meeting, you learn from recognising yourself in others. Personal things are better discussed one-to-one. A mix can work well: the explanation together with your client, and recognition among people who are going through the same thing.
• An image makes it simple, but can also mislead. A comparison helps you understand something. It can also suggest something that is not true, for example that something will go away by itself. Let your client choose their own image, and check it against what the practitioner said.

Points to watch

• Stay within your role. You do not make a diagnosis, and you do not explain causes or medication. You help your client understand the explanation and apply it to their own week, and you tell them that. If in doubt, talk to your client’s practitioner, if your client agrees. Does your client think they have ADHD? Then the GP refers them to the ggz (Dutch mental health services) for an assessment.
• Watch your words. Say “people with ADHD”, not “ADHDers”. Use the words your client is comfortable with.
• Look at what someone can read. Does your client find reading hard? Then pictures and talking work better than text. Also read Recognising and discussing low literacy.

Questions

Does this also work for subjects other than ADHD? The methods themselves suit many subjects: you can use drawing, cards and an image of your own for anything. But the content differs per diagnosis. So look it up each time in a reliable source, such as Thuisarts for adults or the NJi (Netherlands Youth Institute) for parents and children.

My client does not want to draw. What now? If your client is hesitant, say that it does not have to look nice. If they really do not want to, choose another form, such as cards. You can also write down what your client says yourself, or make a list together.

Find out more

• Recognising and discussing low literacy
• Writing at B1 level for your clients
• Self-direction and digital tools
• Digital tools for people with a mild intellectual disability