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Telehealth methods come to group counseling

How a group can meet miles from a mental health provider but still benefit
The counselor, a graduate student specializing in counseling, was participating from many miles away, via a screen

It didn’t look like a typical group therapy session. The group members may have been arranged in a circle, but the counselor wasn’t physically present. Instead, the counselor, a graduate student specializing in counseling, was participating from many miles away, via a screen.

This was a grief support group organized by counselors from the Texas A&M Telehealth Counseling Clinic. Although the clinic has years of experience providing one-on-one mental health services via teleconference, this was the first time they had tried it in a group setting.

“The group started with a community need,” said Carly E. McCord, PhD, a licensed psychologist and assistant professor at the Texas A&M School of Public Health and the director of clinical services at the Telehealth Counseling Clinic. “We had given a workshop for people who had lost a loved one, and participants started asking when the group would meet again.” The clinic’s staff members had planned for a one-time event, but once they saw a need and had people who thought it would be beneficial for them, they decided to hold recurrent sessions.

McCord and the graduate student counselors wrote about their experience and what they learned from the group in The Journal for Specialists in Group Work.

One of the basic aspects the group had to work out was seating arrangements. At first, the room was set up like a classroom, with participants facing a screen in the front where the counselor would be. “The participants themselves were unhappy with this setup, so they took it upon themselves to rearrange the chairs into a circle,” McCord said. This might have been due to the group’s instant rapport; a side effect of the group being held in a small town was that all of the participants already knew each other, a factor that had pluses and minuses. “One of the elements that makes counseling effective is taking things to a deeper level than you’re willing to share with your friends,” she said, “so having a group made up of people you already interact with may inhibit the group’s effectiveness.”

Still, in follow up surveys, all of the group members said that the service they received from their counselor was as good as they thought they would receive in person, and that the location was far more convenient for them than it would have been to drive to the nearest mental health provider, about 45 minutes away, and so without the group, they would have gone without services. “This is a way to improve the mental health of rural populations and help eliminate the health disparities these residents face,” McCord said. “At the same time, it’s a great training opportunity for our students.”

The graduate students who work and train as counselors at the clinic have a lot of freedom to create their own groups, and another one that they brought together focused on identity development for LGBTQ+ individuals. They have also partnered with the Center for Population Health and Aging at the School of Public Health to offer a stress-busting group for caregivers, both in person and via telehealth. Often clients will start with individual counseling and then when the clinic starts to see a critical mass of people with the same concerns, they may start a group for them. The group members don’t even necessarily have to live in the same geographical area. One continuing group with open enrollment focuses on mindfulness meditation.

“The latest group, mindfulness meditation, allows people to participate from many local sites and to see everyone else on split screens on their monitors,” McCord said. “One of the problems with groups in rural areas is getting enough people together in one small town with the same concerns to be available at the same time and willing to participate in services.”

Other problems with group telehealth services—and telehealth in general—is the potential for technical difficulties, which might be compounded with multiple connections from multiple sites. Background noise can also be an issue, and noise from one site can distract people at the others.

Still McCord says that the benefits far outweigh the drawbacks. “It’s so important to offer different levels of service,” she said. “Some people might not want or need individual sessions but find they can get the help they need in a group setting.”

To join the mindfulness meditation group or to get more information about any of their services, contact the Telehealth Counseling Clinic.

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