Engaging Patients in Video-Based Groups—Building Rapport
When the COVID-19 pandemic interrupted in-person group therapy at Strong Recovery in March 2020, the substance use disorder treatment program implemented videoconferencing for groups. One of the challenges of this shift was how to engage effectively with patients through a video platform.
Three members of the Strong Recovery team spoke with Christine Lasher, director of UR Medicine Recovery Center of Excellence, about how important rapport-building was to this process:
- Julie Achtyl, Program Director of the Strong Recovery Outpatient Clinic
- Charles Brown, Therapist
- John Cardinale, Peer Recovery Specialist
Today we're here to talk with Julie Achtyl director of chemical dependence outpatient services, Charles Brown therapist at Strong Recovery, and John Cardinale peer recovery specialist about some of the more nuanced aspects of moving clients to group therapy by video conferencing in light of covid. Thanks for taking the time to join us today. So we'll start Charles with you today, could you start talking with us about the importance of developing rapport in the context of group therapy and can you help us to understand the role that report plays in this aspect of treatment? I need to be able to establish rapport with my group as quickly as possible because when you look at corona and when you look at the disease of addiction they both move very quickly.
The patients need to understand that not only I care but the clinic cares. We are about establishing this report as soon as possible. Rapport building is also going to take place outside of the group setting as well so that first communication with a patient that first time you talk to them and you explain to them what the group process is like what to expect in group we have to be more intentional with our rapport building so we want to make sure that when we're when we have the patients in the group setting that the rapport is developed between the patient to the therapist but also the patients to each other and that takes a lot of intentional effort.
So Julie: what were some of the operational decisions that needed to be made to ensure that report could be established? A lot of the decisions came from us supporting our clinical team and training them and kind of having to go back to basics really understanding how did we do this in person and how can we translate that to video conferencing. They're two very different extremes but with a lot of overlap of skills. So i'm sure it took quite a lot of planning to get the staff ready in this way and you had very little time to react to the realities of COVID-19 so what steps did you take to actually accomplish this task?
Initially we spent a lot of our time and energy on developing curbside dispensing so I had to pivot very quickly to figure out how do we get ourselves to to do video conferencing. It took a lot of training of myself I had to also work with our partial hospitalization program because they were also doing group therapy so i had to learn from them to be able then to train our staff i went around and met with each staff member individually and as groups to train people and to assess their comfortability and confidence in this transition. I wouldn't have been able to do this as swiftly as i did if it wasn't for the adaptability of our staff.
So Charles speaking from experience, how difficult is it to build rapport when clients are in the same physical space and so what are some of the barriers that you encounter when you're trying to build that rapport? Establishing rapport in a traditional group setting that was fairly easy compared to a Zoom setting. Zoom groups create a sense of urgency that is not in a traditional group. In a traditional group I wasn't battling the disease of addiction and corona i was just battling the disease of addiction.
For traditional groups I just rolled in, but for Zoom groups I have to actually sit down and prepare. But the preparation exciting so I can help the patient get to the silver lining that's in the cloud where they're living. And John what would you say is as well as far as you know engaging people and developing that rapport when you're not in the same physical space with them what would you recommend what are the challenges? These sessions are you know equally as important to the face-to-face sessions that they're used to.
Having people at home and with all the distractions of home they may feel um you know maybe less urgent uh to attend the group because you know they have uh they have other appointments going on and they're just like oh well you know it's a Zoom group and things have been pretty flexible. So maybe it's not as big of a deal think about the interactions that patients are having with each other before the group, and after the group, maybe people are going out to get coffee, maybe people are going to a self-help meeting together, maybe they're just spending a couple of minutes to provide additional support to each other before and after that group.
They don't have that anymore with Zoom so there are some things lost with that natural connecting of group therapy When you're doing it through the this remote medium. And as the therapist it's also distracting because when you think about what you're looking at in an in-person group room, it's four walls with probably minimal things on the walls and you're just sitting there with your group, but here we're looking, we're distracted by things that might be happening behind the scenes, maybe we're looking at something on someone's wall, you have to keep focus on your own distractions which can be challenging and it feels less fluid it feels less natural.
It's this person talks stops, this person talks stops. The next question I had was around training so Charles this is a
question for you: From your perspective what was the most important aspect of that training that Julie mentioned to get you ready to do this type of group therapy? She hosted the first group that I did in Zoom and one writer said uh "Service is not a department, service is an attitude." Julie got that attitude. She helped me to understand the technology behind doing Zoom groups, so it's very important the training that goes into preparing somebody for Zoom groups and I really thank her for that because that was my introduction to Zoom groups.
And it was a great introduction I'll never forget that because Zoom groups are just so exciting, they're filled with passion and you get to see these "aha" moments without patients actually knowing you saw it. I saw you have it. If there's one thing that you would tell a listener that they must do if they were trying to move from an in-person group to a video based group, what would you tell them? Keep your schedule, like keep you know your schedule, have an appropriate place where you know every week you're going to be able to be left alone for you know at least an hour so you can focus on your group.
Yeah just really be prepared for you know you know the various emotions that uh you may be going through in that next hour. And then from a therapist perspective as well Charles, what is the one must-do thing that you would tell a therapist who's getting ready to move this way to this based group therapy what would you tell them to do to get ready? You could have been you may have been a great traditional therapist doing great traditional groups but in the Zoom groups there's a sense of urgency and there's a sense that you can reach out and touch you can change somebody's life but you have to
be alert and on top of your game, so one of the things I would tell a
therapist actually: prepare for the Zoom group. It's very important to understand what the term "online disinhibition effect," means what that means is that a patient may feel more comfortable to disclose even deeper more deeply rooted information history trauma about themselves because they aren't physically present with people. A therapist needs to be prepared to be able to respond to patients who are in crisis because of the pandemic but who may also feel more inclined to share information about them that they've never shared before, so it's very important for the therapist to recognize that they may seek they may need to seek supervision and that they really might be challenged with their therapeutic skills more so than they have been previously.
Why do you think they came back week after week when the groups were in person? And then how did you promote that same desire for them to return to these groups when they were going to be remote from one another? If the therapist is passionate about their group and that shows through in how they care for their group, patients keep wanting to come back week to week. The patient then doesn't look at it as a chore, they don't look at it as work they look at it as that one thing they have to look forward to each week where they can come and be supported by their their peers and be supported by their therapist.
We are working so hard to figure out how do we continue that in a world where we're told to distance ourselves from others, so it's our role in our responsibility to make sure that we work even harder as a therapist to connect these relationships build this support. We worked hard at it in person and as Charles said we're working even harder today. What do you want to say to those listening about the importance of group during this time in our history with COVID-19? Being a peer as somebody in long-term recovery, one of the things that always stuck out to me going to these groups and you know like working on myself just keep coming back.
Like, we just keep coming back and you know do the work and you know have enough you know have enough uh faith in yourself to understand that like this is something that can be worked through and it may not be the easiest thing it'll take a while but um you know in the end it's worth it. Gratitude, patience teaches us to flourish in our discomfort we're trying to help our patients understand the need to be grateful for where you are right now because you've come a very long way. We sometimes have to make our patients aware of how far they have come and help them understand repetition is the mother of skill, we keep repeating these things over and over and over again to them in the group process and sooner or later some of them will get it and understand flourishing is possible.
You don't have to continue to live in this pain world all the time, when the pain becomes greater than the pleasure you will do something different. Well guess what? The group process is that difference. I think about the word control and i think about how control is my silver lining with the pandemic.
What can I control and what can't I control and for the patients there's a lot about the pandemic that they can't control, but what they can control is coming to treatment and being an active participant in their own recovery and also supporting other people's recovery. We're providing this opportunity for patients to take control back in a time that we feel powerless because it provides them an opportunity to safely be connected to others. Thanks again to Julie, Charles and John for joining us today. For more information on the importance of the role in your organization's leadership team in promoting group therapy and developing staff confidence for this new model of counseling, this discussion continues at recoverycenterofexcellence.org
Learn more about therapists’ perspectives on videoconferencing group therapy.
This discussion is part of a series that expands on our article “We’re Not Alone”: Preserving Group Therapy through Videoconferencing during COVID-19.”