Zoom-Based Group Therapy with Inmates Released En-Masse Because of the COVID-19 Pandemic

Background: The COVID-19 crisis has brought teletherapy to the fore, since in the current quarantined environment, remote therapeutic interactions are the only feasible mode of engagement. In Philadelphia, the crisis triggered the release of hundreds of inmates into the community, amidst concerns about their enhanced infection risk. This study examines a smart phone-based group intervention on the Zoom platform, for released inmates with high levels of psychosocial needs. An evidence-based group therapy model called CHATS (Challenges, Alternatives, Triumphs, Solutions) was implemented in weekly groups lasting 1.5 hours, and facilitated by two clinicians per session. Participants discussed their challenges, alternatives to triggers, and triumphs experienced in the last week, and developed homework solutions for themselves for the next week. The evidence on the effectiveness of teletherapy is weak, and there are almost no studies on Zoom-based group therapy initiatives. This is one of the first studies to explore the feasibility and therapeutic possibilities of a Zoom-based group intervention with a vulnerable population, at high risk of substance use, homelessness, mental illness, and COVID-19 infection.

Methods: We utilized a mixed methods approach, conducting qualitative interviews with group participants (n=15), and facilitators (n=4). We also conducted content analyses of group sessions (n=10). A grounded theory approach utilizing sensitizing concepts was utilized to code data, and interpret results. Concepts from Yalom’s theory of group therapeutic factors were utilized to inform the sensitizing and interpretive schema.

Results: Attendance was uniformly high, with each session attended by an average of 10 members. The Zoom environment significantly shaped three aspects of therapy: the group and facilitation processes, and the therapeutic factors. The intimacy of visible home environments shaped group process by: 1) facilitating engagement, 2) amplifying the “here and now” by connecting group dynamics to home surroundings, and 3) undercutting therapist-client hierarchies. Moreover, while partially hidden body postures were challenging to, participants routinely provided insight into their levels of engagement by switching their cameras off when disengaging, and at times, being fully engaged even when their environments could not be fully contained (when they were moving around). Group facilitation was enhanced by the fact that co-facilitators were able to exchange information with each other on group dynamics in real-time, using chat features. Moreover, multiple crises, always a feature of a group with such high needs, were easier to engage with simultaneously, and as a team. Finally, several of Yalom’s therapeutic factors came into focus in this environment and context. The ability to meet regularly as a group, while in quarantined isolation, was a triumph for the group, enhancing existential motivations, building cohesiveness, instilling hope, facilitating the exchange of critical information for survival, and building an altruistic social learning family environment. Innate strengths emerged, and were expanded on by the group. As one member commented, repeating a prevalent sentiment in the group: “As ex inmates, we know how to do this better than others.”

Implications: The results indicate the feasibility of engaging with released inmates through Zoom, and shed light on how the platform shapes group therapeutic processes.