Virtual Meeting Ground Rules for Effective Group Therapy Sessions

Unlike one-on-one therapy between a patient and a psychotherapist, group therapy is exactly what its name suggests—the treatment of multiple patients at once by one or more healthcare professionals. 

This approach can be used to successfully treat a variety of conditions, including, but not limited to, trauma, anxiety, depression, post-traumatic stress disorder, and attention-deficit/hyperactivity disorder.

Since groups have different dynamics compared to a two-person setting, it is important to establish counselling group rules to guide the behaviour of each individual in a group psychotherapy scenario.

Table of contents

1. What is group therapy?
2. Rules for group therapy
3. Challenges to online group psychotherapy
4. Virtual group therapy guidelines
5. Digital Samba for virtual group psychotherapy

What is group therapy?

But let us first look into what this type of therapy means and how it is defined: Group therapy is a psychotherapy modality where one or two therapists work with multiple clients simultaneously, fostering collaboration to enhance individual symptoms and self-awareness. Recognised by the American Psychological Association (APA) as a distinct speciality, it has been shown to be as effective as individual therapy, making it a cost-effective method to expand access to mental health support in underserved populations. Various theoretical approaches to group therapy provide insights into group dynamics and guide therapists in their interventions, with the therapist's confidence playing a key role in the group’s initial functioning. 

Types of group therapy:  

• Interpersonal group therapy: Focuses on improving secure relationships by addressing parataxic distortions—misinterpretations influenced by past experiences. The therapist fosters a cohesive environment where clients can explore and resolve these distortions collaboratively.

• Psychodynamic group therapy: Encourages self-insight by uncovering unconscious conflicts and facilitating projections and transferences within the group. The non-directive approach helps clients address deeply rooted emotional struggles through shared group dynamics.

• Social systems group therapy: Examines clients’ roles within interconnected systems, such as family and therapy groups, to understand relational patterns. The therapist manages subgroup boundaries and promotes open discussions to maintain a balanced group dynamic.

• Cognitive behavioural group therapy: Uses structured sessions to explore the relationships between thoughts, emotions, and behaviours, often including psychoeducational components. This approach is goal-oriented, with a defined number of sessions and active collaboration among group members.

• Psychodrama: Employs dramatic role-play to help clients gain insights into their own experiences and those of others in the group. The therapist directs the enactments, encouraging the exploration of suppressed emotions and new perspectives.

• Redecision therapy: Combines Gestalt and Transactional Analysis to revisit and reverse self-limiting childhood decisions through emotionally charged memories. It involves intensive sessions where clients reconnect with their inner child to achieve meaningful change.

• Existential group therapy: Addresses fundamental concerns like loneliness, anxiety, and existential guilt, focusing on the human condition. The therapist fosters openness and authenticity, creating a space for clients to explore deeper existential issues.

Rules for group therapy

After examining the various types of group psychotherapy, it is essential to understand how to create and maintain a respectful and confidential environment in a group setting. This ensures a supportive space where individuals can connect with others facing similar challenges, fostering personal growth and healing. To ensure its effectiveness, establishing ground rules is crucial for creating a safe and respectful environment that enables all participants to fully engage and benefit from the process.

Establishing ground rules in group psychotherapy

To ensure its effectiveness, establishing ground rules is crucial for creating a safe and respectful environment that enables all participants to fully engage and benefit from the process. These guidelines not only foster trust and openness but also help ensure that the group remains focused on its therapeutic goals. Below are some common ground rules typically established in group therapy:

• Confidentiality: Confidentiality is a cornerstone of group therapy, where members agree to keep all shared information private. This includes refraining from discussing group content with anyone outside the sessions. By protecting personal disclosures, confidentiality builds trust among participants, encouraging openness and vulnerability, which are essential for meaningful therapeutic progress.

• Respectful communication: Respectful communication involves active listening and creating a non-judgmental space for all participants. Members are encouraged to let others finish speaking before responding, avoid interruptions, and refrain from side conversations that may distract from the group discussion. This ensures that everyone feels heard and valued, enhancing the sense of inclusivity and support.

• Voluntary participation: Participation in group therapy should always feel voluntary, with members given the freedom to share at their own pace. This means participants can choose to observe or pass on certain discussions or activities without fear of judgment or pressure. Allowing this flexibility respects individual comfort levels and fosters a sense of safety within the group.

• Punctuality and attendance: Regular attendance and punctuality are vital for maintaining group cohesion and progress. Being present and on time demonstrates a commitment to the group and respects the collective time and effort of all members. This consistency helps create a structured and predictable environment, which is especially important in therapeutic settings.

• Sobriety: Participants are expected to attend sessions free from the influence of alcohol or drugs. This rule ensures a clear, focused, and authentic group dynamic where all members can engage fully. Sobriety is particularly important for maintaining a supportive and distraction-free therapeutic environment.

• Non-fraternisation: Non-fraternisation refers to avoiding exclusive relationships or excessive socialisation between group members outside the therapy setting. Such relationships can create power imbalances or cliques, potentially disrupting the cohesion and equality within the group. Maintaining boundaries helps preserve the integrity and therapeutic focus of the group.

• Collaborative establishment and revisions: These ground rules are often established collaboratively at the beginning of therapy, allowing members to voice concerns or preferences. Regularly revisiting the rules ensures they remain relevant and reinforces the group’s commitment to a safe, inclusive, and supportive environment. Therapists play a key role in guiding discussions about these rules and addressing any challenges that arise.

By adhering to these guidelines, group therapy can function as a secure and productive space, enabling participants to focus on their personal growth and collective healing. But how do these guidelines translate to online group psychotherapy? What are the rules in a virtual space? Before we tackle these questions, let us first look at the challenges telehealth group therapy faces.

Challenges to online group psychotherapy

Transitioning from in-person group therapy to a virtual setting presents unique challenges for therapists and clients alike. Weinberg (2020b) highlights four key obstacles to consider: managing the frame of the treatment, navigating a disembodied environment, ensuring therapeutic presence, and addressing the issue of the transparent background. These challenges require creativity and adaptability to maintain the therapeutic efficacy of online group therapy.

Managing the frame of the treatment

In traditional group therapy, therapists control the environment, from the arrangement of furniture to ensuring privacy. This physical setting provides a "holding environment" crucial for creating a sense of safety and structure. Online, this responsibility shifts to clients, who must ensure their spaces are private, quiet, and conducive to therapy. Therapists can mitigate this by including guidelines in the group agreement, such as requesting participants to connect from distraction-free locations. While this shift may initially seem like a loss of control, it can encourage clients to develop adaptive coping skills by taking responsibility for their therapeutic environment.

The disembodied environment

Physical presence in therapy facilitates emotional regulation through subtle nonverbal cues like eye contact, body language, and tone of voice. Online therapy removes many of these elements, potentially weakening the therapeutic bond. For example, therapists and co-leaders lose the ability to exchange meaningful glances or interpret body language fully. To counter this, therapists can focus on heightened awareness of facial expressions, which are often more visible on video calls and actively involve clients in recognising and sharing their physical sensations to bridge the gap created by the virtual medium.

The question of the presence

Therapeutic presence, described as a therapist's ability to be fully present and engaged, is harder to achieve in online settings due to physical and digital barriers. Distractions, technical issues, and the absence of physical cues can dilute the therapist's connection with clients. However, therapists can enhance their presence by using appropriate self-disclosure, addressing mistakes empathetically, and inviting clients to engage their imaginations to recreate the group’s traditional dynamics. For instance, asking clients to visualise a physical circle of participants can help foster a sense of connectedness.

The transparent background

In physical therapy settings, interruptions or unusual behaviours, such as a person entering the room or a pet appearing, are typically acknowledged and explored for their therapeutic implications. Online, these background occurrences often go unnoticed, creating a "transparent" dynamic. Therapists need to pay attention to these details and incorporate them into the session to maintain therapeutic depth. For example, if a participant's background interruption occurs, exploring its potential meaning can deepen the therapeutic process and reinforce group norms.

Virtual group therapy is a relatively new approach, lacking the long-standing traditions of in-person methods, but it offers significant opportunities for innovation and adaptation.

Virtual group therapy guidelines

To ensure the effectiveness and integrity of online sessions, establishing proper guidelines is essential for maintaining the success of virtual group meetings. While the core principles of confidentiality, respect, and engagement remain unchanged, their implementation must account for the unique dynamics and etiquette of the digital environment. Virtual group therapy relies on a "digital playground" for interaction, presenting both challenges and opportunities. Adapting foundational rules to suit the online setting is crucial for maintaining a safe, respectful, and productive therapeutic space. Here is a list of rules for virtual group counselling:

Confidentiality

• Private space: Participants should ensure they are in a private, secure environment to prevent unintentional breaches of confidentiality. This might include using headphones and choosing a location free from interruptions.

• Platform security: The therapist should use a secure video conferencing platform with encryption to protect the group’s privacy.

• Recording policy: Explicit agreements should be made about not recording sessions to maintain trust and confidentiality.

Respectful communication

• Muting when not speaking: To avoid background noise and ensure clarity, participants should mute their microphones when not speaking.

• Using chat features appropriately: If the platform includes a chat function, it should be used respectfully and sparingly to avoid distracting from the group discussion.

• Waiting for turns: In the absence of physical cues, participants may use features like the “raise hand” button to indicate when they wish to speak.

Voluntary participation

• Camera and audio option: Participants can choose whether to have their cameras on or off, depending on their comfort level, but are encouraged to communicate this choice to the group.

• Adapted activities: Activities may be modified to allow participants to engage at their own pace, considering the limitations of a virtual setup.

Punctuality and attendance

• Testing technology: Participants should log in a few minutes early to test their internet connection, camera, and microphone to avoid delays.

• Attendance tracking: Virtual platforms often track log-ins and duration, allowing therapists to monitor attendance discreetly.

Sobriety

• Visible engagement: Sobriety can be harder to gauge in virtual settings, so therapists may rely on verbal check-ins or observe engagement levels to ensure participants are present and focused.

• Policies on behaviour: Ground rules can emphasise the expectation of full presence, including being free from substances.

Non-fraternisation

• Limiting side chats: To prevent exclusive interactions, the use of private messaging between participants within the platform should be discouraged.

• Therapist oversight: The therapist may set clear boundaries about post-session communication among members, reminding them of the need to maintain group integrity.

Collaborative establishment and revisions

• Digital agreement: At the start of virtual therapy, these rules can be shared as a digital document or slide, with participants given time to ask questions or suggest amendments.

• Regular check-ins: Therapists can dedicate time during sessions to review the rules and address any issues unique to the virtual format.

Adapting these rules to a virtual setting ensures that the group maintains a safe, cohesive, and productive dynamic, enabling participants to benefit fully from the therapeutic process despite the physical distance.

Digital Samba for virtual group psychotherapy

Digital Samba’s video conferencing API is designed to support the unique needs of virtual group therapy, seamlessly enabling adherence to critical rules and guidelines with its high-quality, secure, and user-friendly features. Here's how Digital Samba can enhance these practices:

Confidentiality and privacy

Digital Samba ensures end-to-end encryption, safeguarding all communication within the virtual group therapy session. Features like password-protected meetings, role-based access control, and session-specific tokens help maintain confidentiality by restricting access to authorised participants only. Additionally, data hosting in GDPR-compliant environments ensures privacy and compliance with international data protection standards.

Respectful communication

The platform supports active listening and smooth interaction through high-definition video and crystal-clear audio, which minimise disruptions and facilitate a natural conversational flow. Features such as virtual hand-raising and the ability to manage participants' audio prevent interruptions, promoting a respectful and non-judgmental environment. Customisable layouts allow group leaders to prioritise focus on speaking participants, ensuring everyone feels heard.

Voluntary participation  

Digital Samba’s intuitive user interface ensures participants can join sessions effortlessly without technical barriers. Features like optional camera usage and the ability to mute oneself empower participants to control their level of engagement. Breakout rooms provide safe spaces for smaller discussions, accommodating varying comfort levels within the group.

Punctuality and attendance

Automated scheduling and calendar integration help participants stay on time and organised. Real-time notifications and reminders ensure everyone joins promptly, maintaining group cohesion. The API also offers attendance tracking features, enabling therapists to monitor participation discreetly.

Sobriety and focus

By offering distraction-free modes and the ability to blur or customise backgrounds, Digital Samba minimises potential disruptions in participants’ surroundings. The platform’s stable connectivity and user-friendly design allow clients to stay fully engaged, reducing frustration and maintaining focus during sessions.

Non-fraternisation

To uphold boundaries, Digital Samba enables controlled chat functionality, allowing therapists to disable private messaging among participants if necessary. This feature helps maintain professional dynamics and prevents exclusive interactions that could disrupt group cohesion.

Digital Samba’s robust API offers the tools necessary to support the etiquette practices required for virtual group therapy but also makes participants feel that they are meeting in a safeguarded environment. Its secure, high-quality, and feature-rich platform empowers therapists to deliver effective online sessions while upholding the core principles of confidentiality, respect, and engagement. If you are a therapist or developer seeking a modern, secure virtual space for your group sessions, feel free to contact our sales team. They will not only showcase the robustness and feature-rich capabilities of Digital Samba but also demonstrate how easily our video conferencing API can be integrated into your psychotherapy website or application.

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