Online Psychotherapy Groups PDF

The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... Online Psychotherapy Groups B Y FAR THIS IS THE SHORTEST AND THE YOUNGEST CHAPTER...

The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... Online Psychotherapy Groups B Y FAR THIS IS THE SHORTEST AND THE YOUNGEST CHAPTER in the book. Shortly before the publication of the sixth edition we encountered a sudden explosion of a new way to deliver group psychotherapy.1 In an extremely short period of time, literally within a matter of a few weeks in early 2020, the COVID-19 pandemic changed the practice of group psychotherapy, shifting face-to- face groups to online group therapy.2 This new format, which we will refer to as video- teleconferencing (VTC) group therapy, has sustained group therapy during the many months of physical distancing necessitated by the pandemic. Though we have much yet to learn, there is sufficient scientific literature and accrued clinical wisdom to date to articulate some principles for group leaders running VTC groups. It is dicey to predict the future, but we fully expect VTC groups to be part of our field long after the COVID-19 pandemic recedes. In the following discussion we will describe what is unique about VTC groups and what is consistent with our previous discussion about group psychotherapy practice. Much about VTC groups is the same as in face- to-face groups—time, size, duration, and focus— but the group members meet on a screen rather than live in an office. Participants are able to see 1 of 13 12/16/2024, 3:52 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... one another onscreen even though they are many miles apart. The trajectory of change has been dramatic, and many group therapists have taken a rapid and deep dive into this work. Some therapists have noted the change from group circle to group screen is as profound as the change from the couch to the group circle in the early days of group therapy.3 Overall, VTC groups have maintained group therapy continuity and access to care, but not without substantial growing pains. VTC GROUPS: EARLY FINDINGS VTC groups were used prior to the COVID-19 pandemic and there is evidence that group therapy can be effective in this format. Brief, well- designed, well-planned VTC groups have reported outcomes comparable to in-person group therapy, notwithstanding some initial hesitation on the part of both clients and therapists. VTC treatment has been used to provide group cognitive-behavioral therapy (CBT-G) for depression, cognitive- processing group treatment for veterans with PTSD, groups for dementia caregivers and for cancer patients to address psychological distress, as well as treatment for a range of other clinical populations.4 Although some clients and therapists have initially found this new format to present challenges, support and training readily offset initial misgivings.5 What is evident at this early point? Client satisfaction appears to be good. Participants have 2 of 13 12/16/2024, 3:52 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... reported feeling less alone, better informed, and well supported. Groups had high participation rates, low dropout rates, and excellent completion rates. Group cohesion measures in VTC groups do appear to be less strong than in traditional face-to- face group therapy, but not to the degree that therapeutic outcomes are compromised.6 Client privacy concerns were not prominent even before COVID-19, when VTC was done on older technical platforms that were less secure and less HIPAA compliant than the ones now available. The number of platforms has expanded exponentially, and developers are now paying greater attention to the security of client health information. The rapidly expanding use of VTC has increased these concerns and alerted practitioners and clients alike to privacy issues that will need to be addressed through the development of even better online platforms. ALTHOUGH THE ISSUE HAS NOT BEEN DEEPLY STUDIED TO DATE, it appears that VTC groups utilize all the familiar group therapeutic factors.7 No doubt as we gain more clinical experience with VTC, we may need to develop new ways to conceptualize group cohesion, group dynamics, and group process in VTC groups. Research is understandably limited at this early point, but it will no doubt emerge over the years to come. We also need to understand how starting a VTC group by design, as opposed to transitioning to one from an in-person group out of necessity, impacts a 3 of 13 12/16/2024, 3:52 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... group’s functioning. The rapid and forced transition to VTC groups generated a range of reactions, including feelings of loss and upheaval among participants, and these feelings colored their experience in therapy. The transition was also associated with widespread anxiety about the physical, economic, and psychosocial upheaval precipitated by the COVID-19 pandemic. Although therapists are growing more comfortable with the technology, many are still uneasy about relying on the Internet to deliver care.8 We have all had frustrating encounters with problematic Internet connections that are distractions from the work of the group. GUIDELINES FOR GROUP PSYCHOTHERAPISTS Ethical guidelines require therapists to practice only in those areas in which they are competent. For the VTC group therapist, that includes competence in using the VTC technology. The group leader’s administrative tasks have always included responsibility for securing a safe, stable, secure environment for the group. Now it also entails managing the VTC technological platform.9 It can be challenging enough to organize a group within the bricks and mortar of one’s own familiar office or institution. Consider then how much more difficult it can be to establish a workable group environment that now includes nine group members each calling in from their 4 of 13 12/16/2024, 3:52 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... home, office, or car. VTC therapists must obtain written, informed consent to employ the VTC platform. In doing so, they must clarify the nature of the contract, including the limits of their ability to be responsive to clinical emergencies when therapy is delivered online. Since the client and therapist may be at great physical distance, the therapist must make a clear backup plan with clients to ensure client safety and access to emergency care. Hence, access to all group members’ phone numbers is essential. Moreover, the therapist and client may encounter problems with their Internet connections, and a phone connection can be a useful back-up plan. Group members may need some instruction in how to use the platform. An important point is how clients wish to name and identify themselves online. Attention to this detail can protect against inadvertent privacy breaches. We have seen group members unpleasantly surprised to see their family name on the screen, for example. Even learning what kind of lighting is best or how to position oneself with the camera requires discussion and experimentation to enhance the video quality. As VTC grows in popularity, professional guidelines for the effective and ethical practice of online care will undergo development and revision.10 Practitioners should be aware of their respective professional association and jurisdictional licensure requirements. In all instances it is essential to ensure a HIPAA- compliant platform. 5 of 13 12/16/2024, 3:52 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... A common question, for example, is whether a professional in one state can treat a client in another state in which the therapist is not licensed. What if the treatment begins in one state, and then the client moves to another state and wishes to continue in therapy? Which ethical priority should guide the therapist’s decision—continuity of care, or licensing jurisdiction issues? This is a widening gray area and requires federal attention to match legislation with contemporary practice patterns.11 Informing clients about group participation during pregroup preparation now needs to include instruction about using the online platform and articulating each member’s responsibility to protect one another’s privacy. Group members must also appreciate that privacy and confidentiality are harder to ensure online even with a secure platform. There may be other people in a client’s home who may overhear the group, for example—a problem that even the best software cannot prevent. The online group leader must emphasize that group members participate without intrusions and distractions from their personal setting. The boundaries protecting the group may come under pressure in the online world, and addressing these issues with the most up-to-date technical information is essential. For example, meetings should be password protected, and participants should never share their passwords with others. Participants should not connect to the session using unsecured WiFi—for example, from a coffee shop or hotel room. Meeting information should 6 of 13 12/16/2024, 3:52 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... never be posted on social media. Screen-sharing, recording, and file-transfer features should be disabled. Finally, be sure to use the most up-to- date version of your VTC software, as security patches may help prevent problems. As VTC therapy becomes more common, these recommendations will evolve, so it is important to stay well informed. Despite all your precautions, some clients may not like the VTC option. In our early VTC experience we had one group member refuse to switch to the VTC group because it required participating from her home, and this threatened her ability to separate the group from her personal life. Another client asked for a leave from his group, lamenting the loss of the inner sanctum of the group room and the opportunity it offered to discuss deeply personal issues. He felt that meeting online, with his family nearby in his small home, would strip him of his sense of privacy and safety. VTC GROUP CHALLENGES AND OPPORTUNITIES In addition to the unique challenges VTC groups face, they must also confront many of the same challenges as in-person groups: building group cohesion, creating constructive group norms, and addressing antigroup behavior, unhealthy group pressures, and scapegoating.12 We anticipate that there may be an increase in dropouts as a result of 7 of 13 12/16/2024, 3:52 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... the transition to VTC, and there are reports of long-running groups withering in reaction to the shift. For vulnerable clients who experience emotional dysregulation, some of the technical difficulties of VTC may be almost too much for them to contain. For example, having a group member’s Internet connection fail in the midst of deep emotional work is particularly disturbing. VTC groups simultaneously reduce and increase members’ access to information about one another. Group members and therapists lose access to nonverbal communication and may feel constrained by seeing only faces onscreen. Moreover, one cannot establish meaningful eye contact in VTC, particularly when the screen displays a gallery view with thumbnails of six or eight participants. One cannot tell who is looking at whom in the group, and on a computer screen it is virtually impossible to convey a calming, comforting, empathic response nonverbally. Scanning the group members to detect signs of engagement or distress is similarly difficult. At times, the audio and visual functions may be out of synchrony, adding a further sense of disjunction. These VTC drawbacks can be quite disheartening; some group therapists have described the limitations as equivalent to “working with one hand tied behind their back.” Adding this layer of uncertainty, unfamiliarity, and apprehension to the process may amplify therapist countertransference.13 Are there positive offsets to these potential losses? Undoubtedly, the answer is yes. Group 8 of 13 12/16/2024, 3:52 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... members are now “invited” into each other’s homes. This can add texture to the relationships between group members. Each member’s personal life, pets, and art and furnishings are better illuminated to the group.14 The image of a member’s child coming onscreen and sitting on his or her parent’s lap may be worth a thousand words. Keep in mind that everything is grist for the mill in a group meeting, including an exploration of what is being brought into the group’s purview. Conversely, a member’s failure to protect the group session from intrusion and distraction will require exploration. Some therapists and group members report very positive experiences in online groups. They believe that VTC groups are effective and efficient, especially as they sidestep hassles with commuting to a meeting place and finding a parking place, or having to take public transit. Members who travel may still attend when they are out of town. Some group members experience a heightened intensity, depth, and focus in VTC groups. Indeed, some clients feel more comfortable in VTC groups than when meeting in person and are more willing to take interpersonal risks.15 The interpersonal distance created by the online setting may serve a facilitating and protective function. Shame and the fear of judgment may be reduced. Keep in mind that the normal warm-up to the group—walking to the meeting or sitting in the waiting room and chatting with other members—is absent. Some leaders actively encourage a deeper focus on engagement in the meeting and ask 9 of 13 12/16/2024, 3:52 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... members to turn their full attention to the group, closing out the external world for the time of the session. Leading a VTC group is different from leading an in-person group and requires flexibility, adaptability, and a spirit of openness to its potential, as illustrated in the following description. > In one of the first sessions after abruptly transitioning from an ongoing in-person group to VTC as a result of the COVID-19 pandemic, Harold, a sixty-five-year-old retired teacher, became quite emotionally expressive. In uncharacteristic fashion, he was moved to tears talking about the impact of the pandemic. He was fearful for the health of his family and the mounting sense of loss of the familiar around him. It had been an emotionally charged session. The impact of isolation and the threat of illness and death had shaken us all. It appeared as though Harold was carrying much of the emotional vulnerability we had all been feeling in the group. The group members longed for our familiar in- person meeting, but we realized that the video session at least enabled us to meet. It was the best we could do at this time. The meeting was made more difficult by some Internet access problems that forced another group member, Sue, to come in and out of the meeting. This disruption 10 of 13 12/16/2024, 3:52 PM The Theory and Practice Of Group Psychotherapy https://sdc-evs.ebscohost.com/EbscoViewerService/ebook?ststoken=A... distressed her and added to our feelings of vulnerability and helplessness in securing our sense of connection. In response, another member of the group, Sam, said that if we had been in the group together as we normally were, he would have offered Harold and Sue a comforting hug. That was no longer an option in a VTC meeting. I (ML) joined in expressing disappointment that we could not meet in person, but suggested that we could fully harvest the warmth and caring in Sam‘s offer. I added that our session had been filled with a sense of the preciousness of our emotional connections to one another. We were doing as well as we could with VTC, and I hoped for a return to our familiar face- to-face meetings. But it was clear that our connection to one another mattered enormously—even more now, with the physical distancing required of us at that moment, than previously. We could not predict when we could meet in person again, but we could continue to make excellent use of the group.