Launching Online Group Counseling

By Barb Veder and Kelly Beaudoin

The digital world touches almost every aspect of people’s lives, both at home and in the workplace. As creative minds continue to build technology-driven solutions, once seemingly permanent barriers to information, products, and services are disappearing. Such is the case in Employee and Family Assistance Programs (EFAP), where the scope and accessibility of services have greatly increased with digital technology.
Online Group Counseling, a recently introduced service in EFAP, blends the benefits of group counseling with the accessibility and anonymity possible through digital access. In this type of counseling, participants discuss a similar issue(s) with a counselor in group meetings and benefit from having a shared experience, building relationships, and gaining encouragement from others. Creating groups online means that participants are able to anonymously access support via their smartphone, tablet, or computer, whenever and wherever they like.
The clinical value of therapeutic group solutions has been consistently proven over time. Researchers have discovered that in group counseling:

* Topics of discussion can be quite broad. Group counseling is inclusive. Regardless of the cause, members of a group focused on reducing anxiety, for example, can draw benefits from this form of counseling (Hoffman 2015).

* Group dynamics inspire confidence and validation and encourage learning. Individual members of a group influence each other’s behavior and thinking. Research suggests that groups derive their strength from the sharing of experiences. As a result, members benefit from a safe environment where they experience support, self-assurance, understanding, validation, and encouragement from one another. In a group setting, participants learn from similar experiences and internalize new ways of thinking. These dynamics not only influence learning patterns within the group, they also carry over to the relationships that individuals have outside of counseling. The circle of influence of the group is larger than the context in which it exists (DeLucia-Waack 2013).

* An individual’s flexibility is developed. Whether participating as a passive observer or an active participant in role-playing exercises and feedback, individuals are exposed to multiple social situations, nurturing their ability to be open to new interactions and helping them develop flexibility in their points of view and situational responses (DeLucia-Waack 2013).

* Following a specific theory ensures that the group functions properly. Group counseling following a specific model that encourages an atmosphere of engagement is unifying. Moreover, in matters of contention, suggested solutions are more readily accepted, and group cohesion is formed. In a best case scenario, an underlying group theory that is “intertwined with group purpose and leader techniques” should be used.

* Cognitive Behavior Therapy continues to prove its effectiveness. Cognitive Behavior Therapy (CBT) is one such established base, its efficacy has been proven by rigorous testing and study. CBT focuses on developing new responses to situations by breaking down a person’s reaction to stimuli. It then helps the individual create and adopt a positive response, such as goal setting, to replace negative behaviors that inhibit that person’s ability to adjust to a particular situation.

* Cognitive Behavior Group Therapy has shown favorable treatment outcomes. Akin to CBT, Cognitive Behavior Group Therapy (CBGT) encourages positive outcomes in treating topic-driven groups. Studies on social anxiety disorder show that in some cases, CBT and CBGT’s outcomes are more effective than medication-based treatment. In one recent study on using CBGT to treat anxiety, the more pronounced symptoms that individual group members displayed upon entering treatment, the higher the clinical value they experienced or the greater the success (Weck 2015).

* A BCBT group approach is being used in the military. Using what he coined Brief Cognitive Behavior Therapy (BCBT), researcher David M. Rudd used a group method of counseling to address suicide prevention. He identified soldiers as unique in suicidal thoughts because of three key factors: 1) They are exposed to intense violent events that can perpetuate unique trauma, 2) They have access to weapons, and 3) They have limited access to prolonged psychotherapy while in combat. Rudd states that BCBT is not considered a stand-alone treatment, but one that is supportive of other therapeutic goals, as it specifically isolates suicidal tendencies of the individual until other forms of psychological treatment become available (Rudd 2012). This demonstrates the value that short-term CBT contributes to overall treatment of mental health issues.

Digital Group Counseling – Why Now?

* A desire for anonymity is driving the development of digital mental health solutions. When a preference for anonymity over face-to-face encounters exists, it often prevents an individual from getting the care they need (Fogliati 2014). While psychological digital services are not for everyone, research continues to cite online programs’ positive clinical results, including their ability to reach individuals who otherwise would not seek support.

* Online identities foster a sense of freedom. A clear example occurs in digital chat exchanges, wherein individuals may disclose information about themselves more easily due to a sense of unrecognizability. This allows participants to express emotions or thoughts that they may not otherwise share (Grubb 2015). Individuals who demonstrate a preference for digital solutions, however, must still be assessed to ensure that it is the appropriate solution to their unique circumstances.

* Digital counseling addresses the stigma of treatment and, in some cases, an absence of counselors. Digital delivery of mental health services has been proven to address many of these restrictions (Veder 2014b), and without a discernible impact on the success of the counseling (Veder 2014a).

Digital Counseling isn’t Always the Best Choice
A person who is experiencing high-risk symptoms must be connected with intervening support immediately. Also, in-person and online counseling differs when it comes to patient interaction. For instance, ongoing supervision of participants is needed while maintaining the structure of the group to avoid impact on other participants.
While an atmosphere of anonymity is paramount to online group counseling success, anonymity also has potential drawbacks, including an increased risk of individuals unleashing negative comments, which could lead to the development of a negative environment for other members (Grubb 2015). While participants’ identities cannot be recognized in the online group, the counselor still has tools to track each individual for ongoing progress and risk assessment and to mediate group interactions.

Ease of Use is Vital
Regardless of the digital platform, online group counseling must be easy to navigate and clinically valuable to prevent attrition. The initial assessment and ongoing monitoring of an individual must identify risk factors, set expectations, and connect them with appropriate care in a timely manner.
Identification by first names only in the online group, whether the name is real or fictitious, maintains anonymity. Linking these names to the participant’s offline record:

* Provides contact and assessment information and
* Enables the facilitator to track progress and identify an individual who may require assistance outside the group setting – but without impacting the group or compromising anonymity.

Facilitators must have a clear risk triage path as a critical, documented component of best practices for online group counseling.

Digital Services are here NOW
Technological breakthroughs dictate that digital offerings, rather than being a “future possibility,” be immediately linked with any and all new service developments.
Consequently, online group counseling grounded in Cognitive Behavior Therapy and best practices of digital behavioral health, and complemented by digital anonymity, has the potential to:

* Reach a wider audience;
* Offer earlier support; and
* Provide positive clinical outcomes to participants.

Many EFAP providers recognize the exciting opportunities group counseling offers but have stumbled over how to preserve anonymity. Morneau Shepell’s established leadership and experience in digital health enables them to extend these services to include online group counseling. Whether individuals choose in-person or online counseling, however, the goal is to provide them with the highest standards of clinical care.

Summary

Organizations that offer an online counseling program as part of their EFAP can be considered trendsetters in the field of employee health and wellness. By providing another avenue for employees to access support, employers are able to reach more individuals seeking help, assist them in getting the treatment they need, and even attract new users to company-provided EFAP services, contributing to a healthier and more productive workforce.

Barb Veder, MSW, RSW, is the Vice President of Clinical Services and Research Lead with the Canadian-based Morneau Shepell, considered a leading pioneer in delivering alternative EAP counseling modalities. Contact Barb at bveder@sheppell.com. Kelly Beaudoin, BA, is the Clinical Communications Manager with Shepell.

References

DeLucia-Waack, J., Riva, M. (2013). Handbook of group counseling and psychotherapy. Safe Publications.

Fogliati, V. (2014). Self-guided online interventions: Can older adults use them to reduce anxiety and depression? Elsevier. Retrieved from http://journalofinternetinterventions.com/self-guided-online-interventjions-can-older-adultsuse-reduce-anxiety-depression.

Grubb, H.J. (2015). Computer mediated self-help: A qualitative analysis of communication norms and self-disclosure in codependents anonymous online self-help groups. California State University, Sacramento.

Hedman, E., et al. (2011). Internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: A randomized controlled non-inferiority trial.

Hoffman, J. (2015). Anxious students strain college mental health centers.

Rudd, D. (2012). Brief cognitive behavioral therapy (BCBT) for suicidality in military populations. Military Psychology, No. 24: 592-603.

Veder, B. (2013). First chat: attracting new EAP users through online text-based chat services.

Veder, B., et al. (2014a). Employee and family assistance video counseling program: A post launch retrospective comparison with in-person counseling outcomes. JMIR Publications. Retrieved from http://www.medicine20.com/2014/1/e3.

Veder, B., et al. (2014b). Online EFAP service offerings: Re-examining user demographics and access patterns. Morneau Shepell.

Weck, F., et al. (2015). Effectiveness of cognitive-behavioral group therapy for patients with hypochondriasis (health anxiety). Journal of Anxiety Disorders, No. 30: 1-7.