Rapid Adoption and Implementation of Telehealth Group Psychotherapy During COVID 19: Practical Strategies and Recommendations
Open accessAbstract
Behavioral health services have been tasked with rapidly adopting and implementing teletherapy during the SARS-CoV-2/COVID-19 pandemic to assure patient and staff safety. Existing teletherapy guidelines were developed prior to the pandemic and do not capture the nuances of rapidly transitioning in-person individual and group-based treatments to a teletherapy format. In this paper, we describe our approach to quickly adapting to a teletherapy technology platform for an intensive outpatient program (IOP) guided by cognitive and behavioral modular principles for adults with serious mental illness. A review of existing guidelines was conducted and the staged approach for teletherapy implementation (Muir et al., 2020) was selected as the most appropriate model for our organizational context. We describe the most pertinent implementation strategies and report our preliminary findings detailing the feasibility of IOPs delivered via telehealth. This model of rapid teletherapy implementation offers practical clinical guidelines for administrators and clinicians seeking to transition traditional in-person behavioral health services to a teletherapy format.
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Most stakeholders, including patients, employers, organizations, and managed care, gave clinicians a grace period to adjust and learn during the rapid telehealth transition.
“Most stakeholders — patients, employers, organizations, managed care — allowed clinicians a grace period to adjust their practices and learn (Puspitasari et al., 2021).”
From Overcoming Clinician Technophobia: What We Learned from Our Mass Exposure to Telehealth During the COVID-19 Pandemic (2022) · cites this paper as Puspitasari et al., 2021
In “Behavioral Health Programs That Adopted and Implemented Teletherapy After COVID-19” (page unavailable), the paper says clinical workloads were temporarily reduced while clinicians adapted to new workflows, and that training and consultation were available. This supports an organizational adjustment period, but it does not say that most stakeholders—including patients, employers, and managed care—gave clinicians a grace period. (LLM, conf=0.85)
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BackgroundMental Health Care Guidelines for Telemedicine During the COVID-19 Pandemic: Scoping Review
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“Discussion of how providers may prepare and best inform patients in regard to TMH [7, 10-13, 16-19, 37, 40, 44, 48, 50, 53, 55, 56, 61, 63-66, 69] 23 Patient orientation of telemental health care “Consent must be obtained within the framework of the legal provisions enforced by each country.”
InfluentialData-Informed Advances and Technology Augmentation
Lutz, W. (2022) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2022.02.008 · Cited by 5 · see citing works
Wathen, C. C., & Vargas, E. A. (2023) · The Journal for Specialists in Group Work · doi:10.1080/01933922.2023.2190783 · Cited by 5 · see citing works
“First, there needs to be more telehealth skill training and supervision by group counseling professionals (Puspitasari et al., 2021).”
BackgroundClinical health psychology in healthcare: Psychology's contributions to the medical team
Bogucki, O. E., Kacel, E. L., Schumann, M. E., Puspitasari, A. J., Pankey, T. L., Seime, R. J., Sperry, J. A., González, C. A., & Morrison, E. J. P. (2022) · Journal of Interprofessional Education & Practice · doi:10.1016/j.xjep.2022.100554 · Cited by 6 · see citing works
Self-citationLiu, C. H., Rodebaugh, T. L., & Saxbe, D. (2022) · Clinical Psychological Science · doi:10.1177/21677026221129815 · Cited by 5 · see citing works
“Calls early in the pandemic for interventions by clinical scientists have not, as far as we can tell, resulted in widespread innovations in treatment beyond adaptation to telehealth modalities (Puspitasari et al., 2021).”
BackgroundFurmańska, J., Rutkowska, E., Lane, H., Meixner, J. M., Marques, C., & Martins, M. J. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1679186 · Cited by 4 · see citing works
Sims-Rhodes, N., Cornwell, H., Barena, E., Dubre, V., Elliott, K. S., Nabulsi, E. H., Yuen, N., Sass, S. M., Miller, A., Tiruneh, Y. M., et al. (2024) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s472060 · Cited by 4 · see citing works
Colí, E., Gavrila, L., Cozzo, D., & Falcone, R. (2024) · Counselling and Psychotherapy Research · doi:10.1002/capr.12779 · Cited by 4 · see citing works
Telehealth Psychoeducational Groups With Latinx College Students: Findings From Focus Groups
Terrazas-Carrillo, E. C., Garcia, E., Rodriguez, K., Malagon, A., Gonzalez, M., & Garcia, S. (2023) · International Journal of Group Psychotherapy · doi:10.1080/00207284.2022.2159414 · Cited by 3 · see citing works
“The advantages and disadvantages they describe are also heavily influenced by the COVID-19 pandemic that forced us to shift these psychoeducational groups to a telehealth format (Puspitasari et al., 2021).”
BackgroundInfluentialImplementation strategies for telemental health: a systematic reviewPreprint
Appleton, R., Barnett, P., Juan, N. V. S., Tuudah, E., Lyons, N., Parker, J., Roxburgh, E., Spyridonidis, S., Tamworth, M., Worden, M., et al. (2022) · medRxiv · doi:10.1101/2022.04.29.22274367 · Cited by 3 · see citing works
The therapeutic alliance during remotely delivered therapy: A Delphi study with health professionals
Tyrell, S., Bucci, S., & Berry, K. (2025) · British Journal of Clinical Psychology · doi:10.1111/bjc.12544 · Cited by 2 · see citing works
“Implementing support and training to help patients familiarize themselves with the technology involved (Puspitasari et al., 2021) may negate frustrations that would otherwise interfere with alliance building.”
Simmons, J., Condol, P., Herting, N. A., Monroe, A., & Silovsky, J. F. (2025) · The Journal for Specialists in Group Work · doi:10.1080/01933922.2025.2576108 · Cited by 2 · see citing works
“Group therapy using telehealth is not only feasible but also demonstrates low attrition rates and positive outcomes, even for populations with significant mental health concerns, such as rural residents (Puspitasari et al., 2021).”
Gingras-Lacroix, G., Guilmette, D., Tremblay, G., Ferlatte, O., Brodeur, N., Labra, Ó., Houle, J., Roy, P., & Dionne, É. (2023) · Santé mentale au Québec · doi:10.7202/1106396ar · Cited by 1 · see citing works
Greig, A., Benedetto, E., Livitz, I., & Huang, H. Y. (2025) · Behavioral Sciences · doi:10.3390/bs15020154 · Cited by 1 · see citing works
“…TGP has the potential to improve treatment access to vulnerable and underserved populations, who most often obtain treatment in safety-net public health settings, including those with high clinical risk (Childs et al., 2020; Puspitasari et al., 2021) and complex social needs (McInnes et al., 2014).”
Parpottas, P. (2025) · Psychology International · doi:10.3390/psycholint7010010 · Cited by 1 · see citing works
Online Therapy in Turkey during the Covid-19 Pandemic: Examining the Experiences of Psychotherapists
Eker, E., & Genç, E. (2025) · Türk Psikolojik Danışma ve Rehberlik Dergisi · doi:10.17066/tpdrd.1494059 · Cited by 1 · see citing works
“Thus, it has made psychotherapy more accessible, flexible, and cost - effective (Puspitasari et al., 2021; Stoll et al., 2020).”
Adoption and Acceptance of Telehealth Technologies in Mental Health Services during COVID-19
Sunil, T. P., Selvan, R. S., Lukose, W., Soumya, K., & Basi Reddy, A. (2024) · International Conference on Computational and Characterization Techniques in Engineering & Sciences (IC3TES) · doi:10.1109/ic3tes62412.2024.10877513 · Cited by 1 · see citing works
Kapfhammer, H. (2022) · Springer eBooks · doi:10.1007/978-3-662-65873-4_11
Ramos, C., Madrigal, C., Aguirre–Acevedo, D. C., Giraldo, M., Acosta‐Baena, N., Aponte, C., Aguillon, D. F., Gómez, M., Espinosa, A., Madrigal, L., et al. (2023) · Journal of Alzheimer s Disease · doi:10.3233/jad-220941
The COVID-19 Pandemic as a Trauma Trigger
Jeftić, A., & Sasao, T. (2023) · doi:10.1093/oso/9780197615133.003.0027
Psychosocial telemedicine interventions for schizophrenia
Kimhy, D., Ospina, L. H., Messer, S. J., Sharma, V., Datta, S. S., & Stroup, T. S. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015260
Teletherapy could miss a distinct group among patients with pain and opioid use disorder
Wilson, S. C., Otto, A. M., & Wachholtz, A. (2024) · Discover Psychology · doi:10.1007/s44202-024-00300-9
“…the facilitation of this transition for primarily talk-based interventions was supported by pre-existing guidelines and evidence of telehealth efficacy [2]; however, the adaptation of interventions with behavioral, physiological, or other interactive components was relatively less straightforward.”
Page, E., Vass, V., & Sabucedo, P. (2024) · Psychosis · doi:10.1080/17522439.2024.2430479
“Group facilitation warrants a different skillset online than it does in-person (Evans et al., 2020); challenges range from facilitators’ own computer literacy (Puspitasari et al., 2021) to having to adapt existing techniques for a virtual environment (Cypers & Lopez, 2021).”
Counselor Perceptions and Experience of the Shift to Telehealth
Levitt, D. H., & Kadelski, C. (2025) · Journal of Professional Counseling Practice Theory & Research · doi:10.1080/15566382.2025.2479087
“Since 2020, there has been a growing body of research pertaining to telehealth counseling, wherein practitioners cite concerns about client privacy, confidentiality, safety, quality of care, administrative functions, and technology (Gentry et al., 2021; Puspitasari et al., 2021).”
Treichler, E. B. H., Bangal, J., McBride, L. E., Gomez, E., Seaton, S., Jain, J., Trieu, H., Granholm, E. L., Light, G. A., & Rabin, B. A. (2026) · Frontiers in Health Services · doi:10.3389/frhs.2026.1837307
“Background: Collaborative Decision Skills Training (CDST) is a promising group intervention for adults with serious mental illness (SMI) intended to increase collaborative decision-making (CDM) at the patient-clinician level.”
InfluentialAdditional file 3 of Implementation strategies for telemental health: a systematic review
Appleton, R., Barnett, P., Juan, N. V. S., Tuudah, E., Lyons, N., Parker, J., Roxburgh, E., Spyridonidis, S., Tamworth, M., Worden, M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22607993
Additional file 2 of Implementation strategies for telemental health: a systematic review
Appleton, R., Barnett, P., Juan, N. V. S., Tuudah, E., Lyons, N., Parker, J., Roxburgh, E., Spyridonidis, S., Tamworth, M., Worden, M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22607990
Additional file 1 of Implementation strategies for telemental health: a systematic review
Appleton, R., Barnett, P., Juan, N. V. S., Tuudah, E., Lyons, N., Parker, J., Roxburgh, E., Spyridonidis, S., Tamworth, M., Worden, M., et al. (2023) · Figshare · doi:10.6084/m9.figshare.22607987
Psychological interventions for migraine
Grazzi, L., Rizzoli, P. B., Montisano, D. A., Lambru, G., & Raggi, A. (2026) · Nature Reviews Neurology · doi:10.1038/s41582-026-01223-w
“These interventions include telehealth services for psychological counselling or psychotherapy, which were widely implemented during the COVID-19 pandemic in 2020–2021 131,132 .”
Roos, L. E., Berard, L. D. H., Stienwandt, S., Cameron, E. E., Hunter, S. K., Pharazyn, A., Leurquin, K., Kaminski, L., Katz, L., Mota, N. P., et al. (2026) · Behavior Therapy · doi:10.1016/j.beth.2026.10.008
- Authors
- Puspitasari, A. J., Heredia, D., Gentry, M., Sawchuk, C., Theobald, B., Moore, W., Tiede, M., Galardy, C., & Schak, K.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Puspitasari, Ajeng J.
- ORCID
- Venue
- Cognitive and Behavioral Practice
- Publisher
- Elsevier BV
- Published
- 2021-11
- Volume
- 28
- Issue
- 4
- Pages
- 492-506
- ISSN
- 1077-7229 (ISSN-L)
- PMC
- PMC8223010
- OpenAlex
- W3177010012
- Cited by
- 45
- References
- 71
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 8 · 2023: 12 · 2022: 12 · 2021: 2
- FWCI
- 7.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cognitive and Behavioral Practice (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- telemedicine, group therapy, COVID-19 pandemic, intensive outpatient treatment, severe mental illness, cognitive behavioral therapy, implementation strategies, feasibility, behavioral health services
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