These days, we all crave human connection more than any time before. The COVID-19 pandemic has changed our lives dramatically, increasing stress and uncertainty and limiting much of our access to social support. With  physical distancing regulations, virtual gatherings fill the vacuum of interpersonal interactions. Additionally, many individuals do not feel they can receive the support they need from the people with whom they live, and often seek help from those outside their immediate families. For instance, many frontline healthcare providers have reached out to Project Parachute to request support groups.

Group treatment is an effective intervention for individuals interested in making significant changes in their lives. Groups facilitated by clinicians provide support and a safe opportunity to practice new identities, roles, and social skills. Group interventions were first adopted to remotely-delivered formats decades ago, first through telephone groups and later over the Internet, and have received robust empirical support. At these trying times, most of us are familiar with the technologies available to convene a group of individuals virtually, i.e. Zoom, Microsoft Teams, and many other platforms.

Virtual groups do also bring their own set of challenges. Online interactions can be more difficult to process and address. Unaware of many of the non-verbal cues, cross talks are more common than in face-to-face interactions (have you seen this piece from The Onion?). When group members have never met face to face, there is more chance of inaccurate assumptions that need to be addressed in treatment. And sometimes it may be harder to engage members who are more reserved or shy.

Here are some considerations for online group treatments:

Review the virtual group settings. Your clients will be better served when a structure is in place to ensure your leadership and monitoring of the group. Make sure the chat feature is disabled, so that group participants cannot interact with one another without your oversight, and focus their attention on the entire group. Disable the option to join before the host and enable the virtual waiting room. This way, you can have an option to check in with each group participant prior to admitting them to the group.

Maintain group participants’ safety. Each time you send the group invite, remind participants they need to access the group from a video and audio enabled device. If this is not available for them, evaluate in advance whether this participant can safely participate via the telephone, and what would be the impact of such participation on other group members. When you welcome each group member separately, you should each session review some details pertinent to their safety and confidentiality. First, ask them to verify their location, to make sure they are physically located in a state or country where you are licensed to provide treatment. Next, confirm whether there have been any changes to their emergency contact information.

Ensure group members’ privacy. Many individuals are used to perceiving information on the Internet as public, and may need a reminder that the group treatment is considerably different. Ask participants to keep only their first name on their window, so that they are not searchable by other group members. At the first meeting and then periodically, remind participants that taking screenshots of the group or recording it on their device is forbidden. Further, help your clients become mindful about the location at which they participate in the group. Some clients set themselves in a common area of their home, where they compromise the privacy of other group members. If participants do not feel that they can speak confidentially at their home, help them brainstorm some ideas for partaking in the call elsewhere, for instance in their car (if they are able to access sufficient internet there).

Should group therapists and participants hide their video? For individuals with social anxiety or eating disorders, observing yourself while talking can potentially provide an exposure opportunity. For many of us, it may serve more as an unnecessary distraction. In real life, we lead groups, speak with patients, and communicate with others without constantly observing our own facial expressions, hair style, appearance, and background. Therefore, consider hiding your video and asking group members to hide theirs, to increase focus on the interactions and the content of the group.

Harness the capabilities of the virtual platform. Get creative with the screen sharing feature most platforms offer, and unleash your playfulness. In the past month, I have used virtual handouts and worksheets, psychoeducational videos, calming music during a mindfulness exercise, online games such as Kahoot, the white board feature, and even a virtual visit to the Carlsbad Caverns National Park (check out the latter!).

 

Mental health is compromised during the COVID-19 pandemic. Virtual groups making empirically-based interventions and social support available and scalable are more crucial now than ever. Consider supporting your clients through this channel and adding online group interventions to your services.

 

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