Creativity, Adaptability Keep Clients Engaged in Group Therapy

For nearly a year and a half, the COVID-19 pandemic has been an equalizer that has brought uncertainty to both substance use disorder patients and caregivers alike. But for Christina Kocol, LPC, CAADC, CGP, a therapist and group facilitator for Green Circle Collective in Philadelphia, the pandemic has presented an opportunity to innovate and learn from those with whom she’s working.

At the upcoming National Conference on Addiction Disorders West, Kocol will discuss the essential benefits of group therapy in a post-COVID world. Ahead of her appearance in Denver, she spoke with Addiction Professional about the most significant ways in which group therapy sessions have been impacted, adapting to changing circumstances when facilitating groups both in person and online, and embracing the knowledge and creativity shown by patients in challenging situations.

Editor’s note: This interview has been edited for length and clarity.

Group therapy as a concept was turned on its head by the pandemic. What were some of the biggest impacts you observed, and how have things evolved since then?

I was lucky in that when the pandemic hit, I was working at a residential rehab facility. I still had a pretty normal work schedule. We were using a lot of COVID safety precautions. I didn’t do anything online, but the facility I was at had an IOP program that was drastically impacted. Trying to figure out how to continue to get people engaged and have meaningful connection that group allows when it’s done in person, that was a big struggle that my colleagues had. I also host workshops, and I’ve done digital workshops for a long time. For me, transitioning into that COVID space, I was able to help people because I had some experience with digital platforms. It wasn’t as challenging for me to make that transition. It was nice to be able to explore with other people how can you make group more meaningful. A lot of it has to do with being explicit and setting up a quality container. That’s one of the things we’ll talk about in the presentation. What are the expectations to make sure everyone is clear on that from the beginning so that when you create that specific time, it doesn’t feel like a Zoom meeting you were just on. It feels like its own thing that is special and unique. Once you have that container and those expectations, what happens in that container is up to the group.

With regards to your main work, how did COVID impact the way you set up group therapy sessions at your residential facility?

I was predominantly in-person at my residential drug and alcohol rehab facility. My main work was in person running groups pretty conventionally. For me, it was more about how do I get creative on COVID protocols? People didn’t want to wear masks, and we couldn’t sit in as tight of a circle. So, it was reconfiguring the physical space. Just like in the Zoom, in the physical space, there needs to be a container. One of my rules is that I don’t want there to be extra chairs. If there is an extra chair, it means we’re waiting on somebody. If we’re not waiting for anyone, let’s tighten the circle and make it more intimate. That was one area where I had to loosen my expectations for group for safety protocols.

How did patients respond? Were they OK with changes, and did they seem to get as much out of sessions as they had prior to the pandemic?

I took it as an opportunity to demonstrate the parallel process of life in group, which I believe in strongly. I believe group is important in the drug and alcohol world because we were having to go with the flow and learn things and implement them on an almost daily basis for the first few weeks. It allowed me to model for people what is flexibility and taking new information and synthesizing from what I believe to be right and true and safe for people, and then implementing that. One of the most valuable things as a group facilitator is to be transparent about how I run the group. It shouldn’t be a man-behind-the-curtain, “Wizard of Oz” situation. You should get all of the good tricks. Everyone who comes into my group should be able to run a group themselves one day because I’m giving them all of things I know to be true to create the safety and knowledge and awareness. I found that to be especially valuable during COVID because I didn’t know what tomorrow would bring, but these are the restrictions and protocols and expectations today. What can we do to continue to build emotional and intellectual safety in our group today with these parameters?

What have been some of the biggest takeaways you’ve had during this period that could be applicable moving forward post-pandemic to continue to improve group therapy?

I think the pandemic has been a valuable equalizer. Historically, and in my experience going into the drug and alcohol world and working at different facilities with different populations, there is often a paternalistic point of view—you’re the patient, I’m the clinician, you should listen to me. But when the pandemic hit, it was scary for all of us. The suggestion I have given to others I was collaborating with who were running groups was that folks in drug and alcohol treatment are some of the most creative, thoughtful, interesting and unique people. They have a lot of important wisdom on how to be flexible and get what you need out of the moment. Most of the folks I’ve met in recovery are really homed in on how to get their needs met in creative ways in the moment. Capitalize on those qualities as something valuable. Instead of the learning coming from clinician to client, it’s soliciting clients for their own strengths and values. I get to model now in this program [at NCAD], I will be soliciting from the folks I’ll be working with and teaching: What are the strengths you’ve found? One person’s strengths over here might be another’s a-ha moment. That’s part of the magic of group. Not everyone knows everything you know, so get it out there and someone could pick up what they need.