Conducting group therapy in a virtual setting has many benefits, but it also presents unique challenges. With creativity, patience, practice, and flexibility, therapists in a telepractice setting can create a warm, therapeutic space for children and adolescents. In this article we’ll review the benefits and challenges of virtual therapy, and go over some some helpful tips and resources for practice later on.
Convenience is perhaps the most significant benefit of virtual therapy. With no commute time and no parking issues, the convenience of telepractice for families is typically significant, making therapy more accessible.
Telepractice is often more convenient for the therapist as well. When I switched from in-person services to telepractice in 2020, I saved over 90 minutes of commute time every workday, giving me extra time for other duties like documentation, scheduling, and report writing.
Another benefit is that most children and adolescents are familiar and comfortable with computers, tablets, and smartphones, so they often find virtual therapy to be a good fit and typically seem comfortable in the online environment.
There are many online games, activities, programs, and assessments available to make the whole process easier and more fun.
The biggest challenge for me when I switched to telepractice was a learning curve as I navigated familiar school psychology tasks in a completely new environment, which initially felt awkward.
Other potential challenges include: Access to computer(s); scheduling issues; technical difficulties; maintaining student attention and engagement; having to depend on other people (parents/guardians or school personnel, depending on the situation) to sign into sessions and to provide support (materials, headphones, redirection, prompting, etc.); and logistical challenges.
Make sure your online platform and any methods of communication and scheduling are HIPAA and/or FERPA compliant, as appropriate for your needs/setting.
Before your first online session: practice, practice, practice. Then practice some more. Using your online platform (for instance, Zoom, Kanga, or a dedicated platform provided by your employer), become thoroughly familiar with all of the site’s features, to the point where basic tasks become so rote that you could almost do it all in your sleep. In actual sessions, the focus should be on therapy clients, rather than being distracted and stressed about trying to figure out how to play a game or share a video or write on a whiteboard or adjust the volume.
Join social media groups for your profession and/or professional organization forums where you can share questions and ideas to improve your virtual practice.
If practicing in a school setting, remember to make sure that your services are in compliance with student Individual Education Programs (IEPs) or Section 504 plans (if applicable), as well as with state/district/school policies.
Consider your ideal group size; appropriate group size can vary, depending on factors like client ages, needs, and developmental levels. In general, it’s typically best to start out with a smaller group size, with the potential to add other group members, if appropriate, at a later date.
Be thoughtful and use clinical judgment in determining how best to group children and adolescents. Considerations in determining group members should include a variety of factors, including: therapy needs/goals, age, grade, developmental level, interests, scheduling, and personality compatibility.
Scheduling can be a particular challenge and it can be difficult to find a day/time that works for everyone. Start by reaching out privately to each parent/guardian and/or school personnel support person (depending on the situation) to get an idea of possible days/times and to gather more information. Also, review issues like confidentiality, as well as general procedures and expectations, with support people prior to the first session.
Consider logistics in advance. For example, if you are working in a school setting and all of the students in your group are in the same school, how will that work for virtual therapy? Will each student have a computer or tablet, or will some students be sharing? Do all the students have headphones? Etc.
Remain flexible to deal with unexpected issues that will need adjustment.
Keep a consistent structure to groups in order to provide predictable routines. For example, you may want to start with a brief check-in/sharing time, then do a quick review of the last session’s main points, then move to the current session’s topic/activity, followed by a brief summary and goals/exercises. Turn-taking can be facilitated with the use of online tools such as a spinner or a timer.
When starting virtual therapy, it’s good to immediately familiarize clients to the online setting, including how and when to mute/unmute their microphones, how to ask a question without interrupting someone who is talking (the chat feature comes in handy!), whether it is okay to turn cameras off at any point, how to use the cursor as needed, etc. Reminders and help from your onsite support person may be needed.
When starting a group, it is a good idea to come up with some collaborative group rules which can then be made into a visual reminder.
As with any therapy process, policies of confidentiality and the limits to confidentiality should be covered in the first session and reviewed as necessary.
Note: Depending on the online platform, tech tips will be different; the following suggestions are for Zoom.
Games and Activities: Some online platforms, such as Kanga, have a readily available list of games and therapy activities, as well as other tools such as timers, spinners, and dice, which can be used in the virtual therapy room. If using Zoom, here are some resources to help you find free games and activities for your therapy sessions: