Group therapy uses many of the same approaches as individual therapy and research has shown it can sometimes be more effective. The use of group therapy during the social isolation brought on by the COVID-19 pandemic has proven more helpful than ever. Patients connected through virtual telehealth apps form a sense of belonging, build a support system, re-establish a sense of community, and reduce feelings of social isolation even while logging in remotely. While a great tool for behavioral health, using telehealth for group therapy does have some legal and ethical challenges to be cognizant of. However, the future of healthcare is moving towards more self-service options and telehealth is here to stay.
Privacy is a central concern in the legal and ethical framework of using telehealth for group therapy. Group therapy has been infrequently used in telehealth in the past so best practices and guidelines are still emerging. Privacy guidelines have been relaxed due to COVID-19 and the federal government has waived penalties for HIPAA violations through a “good faith” provision for telehealth for the duration of the public health emergency. However, psychologists should still refer to the APA Ethics Code and to the APA Practice Guidelines for Telepsychology.
Create detailed consent forms so patients are aware of any risks, benefits and limits to confidentiality while using telehealth for group therapy. It should be clear that these sessions involve multiple people and are conducted outside controlled office settings. Have a policy in place on handling confidentiality breaches such as non-group members coming into the room and overhearing a meeting.
Advise group members to login for their online session in a space free of distractions, other people and where they can speak freely. They should wear headphones or keep the volume low to prevent anyone nearby from hearing. Tell them to inform others near their location not to disturb them during meeting times. Form policies around whether patients can login via their phones or with their cameras off. Also consider if patients should be allowed to wear a non-threatening disguise to protect their identity while on camera.
For the best security through your system, use a HIPAA-compliant telehealth platform as those have been evaluated for security, privacy and encryption best practices. Also consider using an embedded telehealth tool that is a part of your Electronic Health Records (EHR) system. That will reduce your workload, prevent errors and lower the risk of burnout.
While there are many legal and ethical considerations surrounding using telehealth for group therapy, the benefits of group interaction are many. Increased access to healthcare is one of the primary benefits of telehealth. Beyond the COVID-19 pandemic, the future of healthcare can be improved with these telehealth technologies. We just need to move carefully forward while thinking about protecting patients’ privacy.