Could Group Therapy Help During the Pandemic?

Post written by B. Imei Hsu, RN-LMHC

Starting in 2020, I reverted to a protocol that I had not needed to enact in several years.

I began a waiting list. And I was not happy with that. Let me explain.

This is not a practice I have ever wanted for my community. From an ethical point of view, a waiting list can give a false sense of security to both the client and the therapist if there isn’t a set of guidelines and reasonable timelines that are communicated when a client makes requests for reasonable availability as well as suitability of a therapeutic alliance.

As people look for available therapists, they are running into the same challenge: most therapists in the Greater Seattle area are reporting that their schedules are full.

Don’t Give Up! It can be discouraging when you finally call to make an appointment, only to find out the counselor you so carefully chose has a really long waitlist or isn’t taking new clients. You might feel like it’s a sign you’ll never get the help you need, but that isn’t true.

From Open Counseling What to do when there’s a waiting list

The COVID-19 pandemic has changed the landscape of mental health therapy, and the waiting list has become an aspect of delivering mental health services. Many therapists made the transition from in-office counseling sessions to online sessions, and with a block of time that was once dedicated to commuting and maintaining a professional office, those extra hours were often transferred to client hours in order to help meet the demand for mental health services. Yet even with more counselors offering online counseling than ever before, you may still find that there is limited availability.

While it is left up to the discretion of the practitioner to determine how many client hours should be opened in their work week, my own professional ethics that help determine patient flow revolve around the following:

  • health of the provider and the provider’s ability to enact self care
  • the totality of the severity of issues of the typical weekly flow of clients
  • the amount of time needed to keep up with administrative tasks associated with the counseling practice
  • wiggle room for urgent issues and rescheduling

While it is it true that most therapists do not want to turn away clients when they are in need, therapists must triage clients seeking therapy and help refer them elsewhere when it is determined that the client is in considerable distress or crisis and needs more immediate attention.

Still, therapists only have so many hours a week that they can safely provide care to their counseling community. Overcrowding their schedule can cause client needs to go unaddressed; it can also cause burnout in the therapist.

And while individual counseling provides flexibility for clients to change days and times of time to suit their needs, it does not always help the provider to meet the overall needs of the counseling community.

During the past month, I’ve been leaning towards offering group therapy as a possible solution to the high demand for counseling in a time where most therapists, including myself, are at the top of their capacity with no end in sight. I find this ironic, because in the past, most clients declined group therapy because they viewed therapy as “me time” in which that time was seen as the hour in which each person could focus on healing.

The COVID-19 pandemic has changed how we see healing – not just as an individual process that occurs during “me time”, but as a process that happens within the context of relationships. After a year of isolation and distance, Group Therapy delivered via HIPAA compliant video conferencing may help to change the face of mental health services.

What has happened to us as a community because of COVID-19? Here’s just a few thoughts:

  • We have covered our faces – and part of our identities — in order to reduce the risk of illness and slow the spread of the virus.
  • We have physically distanced ourselves from one another, again for the same reason. This has caused widespread isolation and loneliness for adults and children.
  • Some have become mistrusting of one another in the absence of repeated socialization that happens in places of work, school, and activities outside the home such as shopping, playing in team sports, and even gabbing with others in the neighborhood
  • We have taken to more forms of one-way communication, especially after hours of sitting in front of screens for Zoom calls. Texts and other asynchronous forms of communication have taken over many of the interactions that require listening, patience, processing time, and the reading of body language to connect with and affirm one another.
Could Group Therapy Help During the Pandemic?

When I was first introduced to the concepts of Group Therapy, I saw it as the kind of therapy one did in the hospital during a very long stay due to recovery time, or a type of therapy created around a topic that was very specific and intense, such as Eating Disorder group therapy for a specific age group, such as teens to young adults.

While there isn’t a problem with this view, this perspective, in my own reflection, is limited. The reality of Group Therapy is that it is style of therapy that is appropriate for most people and most issues except for more severe forms of mental health issues. With a skilled group leader, a defined theme or content that helps clients select the group, and a clearly communicated beginning, middle, and end, a group context often allows individuals to progress through the phases of therapy faster than they might with individual therapy.

An additional bonus is that for the cost of the average group therapy session (around $45-50 a session), it is more affordable as well. Yet the intriguing part for us all is that a group may help therapists see more clients who need attention NOW versus having to wait weeks if not months for an available counselor. The counselor opens 1.5-2hours per week for 12 to 16 weeks, yet that time serves 12-15 clients who make the commitment to attend group therapy sessions until the group ends.

Finally, Group Therapy is often conducted with a co-therapist. This means that for the price of a group therapy session, each client has the eyes of two licensed mental health clinicians on them. I consider that “more bang for your buck”.

I enjoyed being a Group Therapy provider in the past, and I believe I would enjoy it again in 2021. The bigger question I have is this: will today’s client choose Group Therapy to meet their needs? If today’s client spends a couple of weeks trying to find an available therapist with whom they find some affinity, only to be told there is a waiting list that may be three weeks to one and a half months before an opening may be available, will Group Therapy be something people try if the group description is a good match?

These are questions I’m trying to answer before April 2021. If the answers start coming back in the affirmative, I’ll be advertising for group therapy clients soon. The hope is to alleviate the burden for people who have been searching for a therapist for a long time. And it would be my pleasure to invite a co-therapist who balances my therapeutic style with fresh thinking and other lenses in life experience.

Do you have comments about Group Therapy you would like to share? Feel free to reach out in the comments (and indicate if you would like keep your comment anonymous, as that is the default for me when I edit comments before republishing).


COVID-19, Physical Illness, and Depression

It’s no wonder the Disaster Distress Hotline in the U.S. has seen a 338% increase in crisis calls from February 2020 to March 2020.

Yet as a Nurse and a Therapist, I never imagined that deep into April, I’d be sitting at my desk in my Seattle artloft, gazing out the windows that look out over Elliot Bay and the stadiums, and see roads empty of people. An occasional pigeon flies by, the Olympic mountains shout their glorious presence, and all the humans of this city are under a Stay Home Order by Governor Jay Inslee.

More than 17 million Americans have filed for unemployment benefits in the past four weeks. Over 23,000 Americans have died from complications of COVID-19. Children and young adults have had their educations interrupted, their graduations to higher education still promised, yet the immediate future seems difficult to predict as we anticipate a recession. Healthcare workers in some areas are scrambling for appropriate PPE (Personal Protective Equipment) so they can do their jobs with less risk of becoming ill themselves. And the correlations between disasters, financial strain, and a rise in domestic violence calls to authorities are proving to be true as well.

Could it be worse?

Chronic Illness and COVID-19: A Disaster Within a Disaster

Yes, it can be worse. And for many of us, the dangers have been lurking everywhere for longer than the coronavirus pandemic has been in existence in the U.S.

Those who have compromised lung function (i.e. asthma, COPD), are immunocompromised (cancer, HIV/AIDs, malnutrition, some rare genetic disorders), or are otherwise more susceptible to infection (i.e. you get colds, flus, pneumonia easily), are people who have been warned to stay away from public spaces and take extra precautions during the COVID-19 pandemic.

These people have been asked to take more extreme measures than the rest of the public. For example, in the early phase of the arrival of Patient Zero (the first known case of COVID-19 in the U.S.), one of my health team members got my attention by emphatically stating, “You absolutely cannot afford to get sick, do you understand? Do whatever it takes to keep yourself away from the public, starting now.”

Although I already have theoretical and practical training in dealing with infectious diseases, I admit that I left the doctor’s office shaken. I was supposed to schedule another follow-up appointment, but we cancelled it, understanding that there would likely be no point of putting it on the calendar unless it was absolutely necessary.

I began to think along the lines of what this novel coronavirus does to the bodies of those who don’t have the recovery path of the 80% who experience moderate to severe flu-like symptoms but recover over the course of two weeks:

  • You experience shortness of breath and respiratory distress that is absolutely frightening
  • You are separated from your loved ones, taken to hospital surrounded by people who look like astronauts or Peeps with plastic shields
  • You may be intubated and aware of that intubation (before being put under to tolerate being placed on a ventilator), which is uncomfortable and also frightening
  • You may be placed into a temporary coma
  • You may or may not have recollection of procedures, surgeries, medications, or other heroic acts done to you to keep you alive

So on the one hand, it’s very likely that those who experience more complex and complicated illness and recovery from COVID-19 could also become depressed in the short term. And it’s possible that that depressed feeling from what you’ve just been through can lift as your body returns to more and more normal functioning, such as being able to breathe on your own, get out of bed, and leave the hospital.

And, it is also possible that depressed feelings around being ill can linger long after the body has recovered from a primary illness.

As we learn more about this coronavirus, recovery from long-term effects of COVID-19 suggest that many people who survive their battle with this disease will still be feeling the effects of it for one to two years, in the form of secondary organ failures, scarred lung tissues, disability, and chronic depression.

From this point forward, your life has changed due to the trauma of care, the disruption to your life, and the road to recovery afterwards. It’s the kind of recovery path that can wipe out your finances, even with good healthcare insurance, because the cost of recovery goes beyond the billable event.

Speaking as one who lives with an incurable autoimmune disease and a genetic kidney disorder, I can say I experientially understand what a fast and tremendous change, foisted upon someone who was otherwise healthy, can do to your life.

Some of the trouble begins, however, when you realize you’ve survived something like this, but you still feel terrible. You get told you’re one of the “lucky ones,” and behind a grimaced smile, you’re wondering”

…what if I can’t find work again? What if my body never feels normal again? What if I feel depressed and anxious for a long time?

It’s a crisis, a disaster within a disaster. Even if the body heals, the mind might take much longer to pick up the pieces and try to move on. Depending on how you as an individual responds to the trauma you just underwent, you might be feeling grief, sadness, a lack of energy or motivation to return to more pleasurable things, anger, denial, or even, a feeling of nothingness. Meh. Blah.

Post-COVID-19 Depression: A Need for Support

There is a strange relief when you find out you’re feelings are not abnormal, and you’re not alone.

While most of us would never wish another human being to have to face the terror and pain involved with physical illness, we gravitate towards those who have shared experiences with our own. Support groups are a good example of this. So are Social Media groups that gather people with a similar interest or experience. To be a fly on the wall with a group where every member has been struck by lightning, yet lived. Cancer support groups, alcoholics in recovery, victims of domestic violence — all kinds of groups for all kinds of experiences.

I do think that post-COVID19, there will be support groups formed that gather individuals together to help process what happened to them, beyond the facts and figures, beyond the statistics and politics.

We will create safe spaces for people to process their fear, anger, sadness, and uncertainties about what comes next.

We will encourage people to talk about feelings of depression and anxiety as they come to grips with what may be a longer, more drawn out “normal” regarding the way they respond to everyday events.

We will be trying to meet real, human needs, even though others make light of their milder cases of COVID-19. We will meet those with complex recovery issues with compassion and understanding.

Update: as of 08.01.2020 I’ll be assisting with closed debriefing groups among healthcare and healthcare related workers processing trauma, exhaustion, and racism experienced during the pandemic response. I believe that while those interactions will be confidential, what I will learn from the process of helping will be transferable to my work as a therapist in the greater community.