Nearly half (42%) of Americans will see a counselor at some point in their lives. Mental health stigma is fading, inspiring people from all walks of life to seek therapy when they need it. Just 23% of respondents to one survey said they would never see a therapist. As communication and interaction styles change, however, so too do people's preferences for therapy.
Online startups are increasingly offering telemental health services. Mental health clients like the convenience and flexibility of online therapy. Indeed, a 2019 survey found that just 44.5% of participants prefer traditional in-person therapy. Online group therapy affords therapists a chance to reach more clients while empowering clients with the wisdom and experience of other people facing similar challenges. It also presents a number of ethical and privacy concerns. Here’s how therapists can master the challenging balancing act of online group therapy.
Online Group Therapy: The Basics
Online support groups are highly popular, offering insight and compassion to people experiencing a wide range of issues. Online group therapy does more than just offer support. In this setting, therapists treat a group of people with similar mental health challenges. Therapists must understand that their role extends beyond mere facilitation of the group. They are treatment providers who must offer effective, evidence-based therapy that meets each client’s needs.
Traditional group therapy allows a cohort of clients to form close bonds that can be catalysts for change and healing. The experiences of each group member are vital and can reassure each participant that they are not alone. Online therapy can offer these benefits as well, but there are some important distinctions:
- It may be more difficult for group members to establish close relationships.
- Group members may be less committed to online therapy, causing them to drop out.
- Reading body language and other subtle cues can be more difficult, making it challenging to assess individual well-being and group dynamics.
- Depending on the therapy format, group members may have chosen online therapy because of concerns about privacy. This may mean they are more reluctant to share.
- Online formats may create a permanent record of what people say in therapy. This raises serious privacy concerns.
Privacy Concerns in Online Group Therapy
All forms of online therapy present privacy issues, including compliance with the Health Insurance Portability and Accountability Act (HIPAA). Third parties may intercept online communications in numerous ways, including by:
- Viewing unencrypted communications
- Gaining access to a therapist or client’s computer
- Stealing or phishing for passwords
Group therapy poses even more concerns because group members may violate one another’s privacy. For example, a group participant could surreptitiously record therapy sessions or allow third parties to witness group therapy. Without verifying group members’ identities, it is also possible for third parties to participate in therapy to gain access to personal data. For example, an abusive spouse might participate in a chat-based therapy group in an attempt to gain information about their partner.
All therapists have an ethical duty to protect their clients’ privacy. Online group therapy presents other ethical concerns, too, including:
- Group dynamics. Interactions between group members should be therapeutically beneficial. Bullying, privacy violations, and other concerns can thwart progress.
- Adequate therapeutic support. Therapists must be active participants in the group and must balance the need to create a comfortable, supportive group with the requirement to provide clinical support.
- Client safety. Therapists have an ethical duty to take reasonable steps to protect clients’ safety, including from other clients.
Making Digital Group Treatment Effective
Online group therapy can be highly effective. A 2019 study, for example, found significant symptom reduction among participants in a depression counseling group. A number of strategies can ensure participants get excellent symptom relief while minimizing privacy and other concerns:
- Treat only issues with which you have experience and training. Do not work outside your usual scope of practice.
- Screen group members to determine whether they are an appropriate fit for the group dynamics and goal. An individual meeting or counseling session can help you assess each member.
- Structure groups around a specific issue or commonality, such as recovering from narcissistic families, depression, borderline personality, or life experiences such as a recent assault. General-purpose therapy groups are less likely to be successful.
- Use a cohort model. Do not add new members to the group with each session.
- Monitor time spent supporting each group member and ensure each group member gets clinical support during each session.
- Set clear treatment goals for the group and for individuals.
- Outline group rules from the beginning and intervene when members violate these rules.
- Establish rigid privacy controls, such as communicating only across encrypted channels.
- Consider using only video sessions. This ensures that group members cannot surreptitiously allow other people in the room and makes it easier to verify each member’s identity.
- Enact policies for verifying each member’s identity. Depending on your state’s licensing rules, you might not be allowed to treat people in other states. You must also know whom you are treating so that you can intervene if they become a danger to others or to themselves.
- Discuss privacy and other concerns with the group and establish protocols for reducing security threats. For example, you might require that group members only access therapy across a secure home network, not in a busy coffee shop.
- Use a secure platform and require all group members to do the same.
- Devise a specific structure and set of goals for each session. Then distribute an outline or agenda to group members ahead of each session.
- Use homework and outside assignments to encourage group members to practice new skills and continue making progress outside of the group setting.
- Use group dynamics as a springboard for discussion. In many groups, people repeat the very dynamics that cause distress in their daily life. Address these dynamics when you see them and encourage group members to practice alternative approaches in their sessions.
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- A look at ethical issues in group counseling. (2018, November 1). Retrieved from https://www.gcu.edu/blog/doctoral-journey/look-ethical-issues-group-counseling
- Renn, B. N., Hoeft, T. J., Lee, H. S., Bauer, A. M., & Areán, P. A. (2019, February 11). Preference for in-person psychotherapy versus digital psychotherapy options for depression: Survey of adults in the U.S. Nature Partner Journals Digital Medicine, 2(6). Retrieved from https://www.nature.com/articles/s41746-019-0077-1
- Schuster, R., Kalthoff, I., Walther, A., Köhldorfer, L., Partinger, E., Berger, T., & Laireiter, A. (2019). Effects, adherence, and therapists’ perceptions of web- and mobile-supported group therapy for depression: Mixed-methods study. Journal of Medical Internet Research, 21(5), e11860. doi: 10.2196/11860
- Summary of the HIPAA privacy rule. (2013, July 26). Retrieved from https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html