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.
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).