Group therapy moved to video at scale in 2020 and a great deal of it stayed there. Studies since have generally found outcomes comparable to in-person groups across common presentations, with similar cohesion scores and similar completion rates.
The evidence base is younger than the decades of in-person group research, and anyone telling you it’s settled is overselling. The direction is consistent enough to act on.
What video genuinely makes better
Groups exist at all. The largest effect by a distance. A specialist group — for a particular condition, a particular population, a particular language — needs six to ten people who want it at the same time. In one city that’s frequently impossible. Across a whole state it is straightforward.
This is why online groups are disproportionately the good ones: they can be specific in a way a local group can’t afford to be.
Attendance. Weekly for a year is a large ask with a commute attached. Remove the travel and completion improves, and in a treatment where the work depends on stable membership, attendance isn’t a side issue.
Access for people who can’t travel. Agoraphobia, chronic illness, caregiving, disability, no car. For a substantial group of people the alternative to an online group isn’t an in-person group; it’s nothing.
What it costs
Two things, and they’re worth taking seriously.
The five minutes either side. In a room, people arrive early and linger after, and a meaningful amount of cohesion is built in that unstructured time. A call that starts and ends on the hour has none of it. Good leaders build it back deliberately — opening the room early, a few minutes at the end — and where they don’t, the group stays thinner than it should be.
The body. You lose posture, position, who turns toward whom, who leans back when a particular member speaks. In a process group, where the material is what happens between people, that’s a real loss of data.
It’s a smaller loss than expected — faces carry a great deal — and it isn’t nothing.
Where the room still wins
Social anxiety, arguably. The honest exception. On video you can angle away, watch your own face, and control your exposure, and those are precisely the safety behaviours the treatment is meant to remove.
Online groups still work well for it, so this is a preference rather than a contraindication —but if an in-person group is available, it’s worth choosing.
And anyone without a private space. Which is a larger group than people assume, and it’s the most common practical reason online groups fail for someone.
What to ask a remote group
Does the room open before the start time? Is there any time at the end? How do you handle it if someone becomes distressed and drops off the call? And what is the camera expectation?
The answers tell you whether the leader adapted the format or simply moved it to a screen.