GROUP PSYCHOTHERAPY USING VIDEO CONFERENCING FOR SURVIVORS OF TRAUMA DURING A PANDEMIC

Vol 7 #4

Caroline Giroux 1, Christina Bourne 2

Author information:

1 Associate Clinical Professor, Psychiatrist, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]

2 Family Medicine and Psychiatry 4th-year resident, University of California, Davis Medical Center, Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA. [email protected]

Global disasters and pandemics like the one we are currently experiencing with COVID-19 (aka coronavirus) generate strong emotions, whether it is fear, despair, sadness, anger, confusion or numbness. Survivors of trauma can be especially vulnerable during this time due to their already higher allostatic load in response to repeated efforts to adapt to stressors over time. Past traumatic events might have shaken beliefs about the world; they might develop mistrust of others or in their own perceptions of reality. Also, a lack of sense of safety can be exacerbated by the severe disruption of normalcy as we are gradually closing down social functions, public places, psychotherapy clinics, and other activities that can enhance resilience.

Our clinic at UC Davis has developed a resilience-based program for survivors of trauma in 2018 and we found out early on that the group experience has been very healing. The bonding during sessions plays a role in restoring people’s dignity, establishing a community, and normalizing and validating the wide response to trauma. During the seventh session of a 12-week curriculum, nine of the women participants (three of whom are at high risk due to age and immunocompromised status) reiterated how they had learned from each other and appreciated the safe space.

Co-facilitators (including the authors of this article) have witnessed transformations during the group experience as participants move away from toxic relationships, are able to be self-advocates during intimidating court proceedings in our victim-blaming culture, and become more empowered to make decisions about their future.

Our services began shutting down last week in response to the COVID-19 outbreak and we were advised to suspend all group activities. This advice was justifiably rooted in public health concerns, due to the risk of transmission, but was also recommended because of the potential lack of insurance reimbursement for group tele-psychiatry visits. The latter did not sit well with us. We galvanized our core team to propose solutions. We discussed and processed our current dilemma and proposed an alternative solution to stay in touch: Zoom video conferencing We wanted to ensure that patients maintained the unseen but palpable connections through these unprecedented circumstances and continued to work on their recovery by maintaining a rhythm. Issues regarding reimbursement were sorted after our united effort to continue the group using technology.

March 17, 2020 was our first time using a Zoom group meeting to maintain these connections. From our experience, video conferencing is not only feasible but highly recommended in order to continue to provide quality care. These groups build resilience for our patients and community members and for ourselves as physicians and care providers by offering interventions with a sense of purpose.

Our initial impression that there was a need for such a service was mirrored by five participants who were able to join. This included one participant who was out of state to be with loved ones in this time of crisis. One group member added that she was disappointed when the clinic initially called to cancel after the decision had been made to suspend group activity, but then was delighted to be called back 15 minutes later once this decision had been reversed.

We proceeded as usual with check-ins, everyone being in awe that this was working, despite an initial fear for some about self-perceived technology illiteracy. We did the mindfulness exercise before the group processing and after, with a closing excerpt from an inspirational book written by a life coach to emphasize one of the discussed topics. There was a fruitful and balanced discussion, every participant sharing intimate details of their trauma and empowerment processes. It was very inspiring to witness how members supported each other as well. The use of technology didn’t seem to interfere with the usual flow. We even saw a cat, who stole the show, as it was purring by the screen, triggering some good laughter and making it all more therapeutic.

This experience confirms to us that whenever there is a crisis, such as this, for which no one is really prepared, it is important to think fast about practical solutions as we question automatic or systemic measures that might end up being re-traumatizing. Instead, maintaining a level of connection constitutes trauma-informed care and healing for all. While we must support precautions and physical social distancing, we hope that there will be more such attempts at maintaining normalcy and psychological connections within empowering spaces for all those we strive to help.