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12 telehealth group therapy activities

Discover effective telehealth group therapy activities that foster engagement in virtual settings. Transform your online sessions with these proven techniques.

November 14, 2025 • Updated on March 13, 2026

By Ryan DeCook, LCSW

6 min read

By Ryan DeCook, LCSW

I had poured myself into preparing for my first ever coping skills telehealth group. I was all settled in with my camera and agenda set. I was ready to change these clients’ lives. I took a breath, went through my introduction, and posed my first question to engage the group. Crickets.

I was met with a wall of turned off cameras and complete silence, feeling as though I was leading the group for myself. If you’ve been there, you know that feeling. What I didn’t know then is that telehealth groups require a different approach. Engaging group activities and establishing group norms turned out to be the main key to breaking through the virtual barrier.

Understanding the virtual therapy landscape

Telehealth therapy has surged since the 2020 pandemic. A March 2024 survey found that 54% of Americans had at least one telehealth appointment. That is up from only 10% of Americans as of June 2019. Mental health services have shown to be a dominant portion of telehealth services: Another study estimated that between 43 and 51% of all telehealth appointments were specifically for mental health services including telehealth therapy groups. When I was leading a therapy group in 2020, we moved from in-person to online, and quadrupled the number of participants within a matter of months. 

Research on the effectiveness of telehealth therapy has been promising. Multiple studies have shown comparable outcomes for in person and telehealth group therapy. Attendance rates and accessibility for outpatient mental health services has also proven to increase through telehealth offerings. 

While the research shows many positives that make telehealth groups worthwhile, it is not without cited challenges. Limited therapeutic alliance, the speed of developing group cohesion, greater ease of breaking group cohesion, and longer silences have all shown to be barriers associated with telehealth groups. It can be harder for clients to feel connected to one another. Some reasons for this, cited in these research articles, include the lack of full nonverbal cues, more limited presence of the therapist, and increased access to distractions. These are all factors that need to be considered and adapted for when leading online therapy groups. 

Setting the foundation for successful virtual collaboration

If a telehealth group is going to be effective, safe, collaborative, and engaging there are things that need to be put in place. Platform selection is the first choice to make. Since privacy is a noted concern for telehealth group clients, it is essential to inform clients that the platform adheres to applicable HIPAA privacy and security standards. Platforms should also offer optional features that are conducive to engagement such as chat features, emoji capacity, breakout rooms, a “raise hand” feature, screen sharing, and whiteboard capacity for educational purposes. 

Establishing group norms is one of the first steps when a group meets together. Ideally, this is done collaboratively. The American Psychological Association recommends some important norms to establish: clients being in a private space where they are free to speak, wearing appropriate clothing, not being distracted or doing anything distracting, and following group protocol if they are disconnected from the group. A few other norms to consider include establishing a crisis protocol, committing to group confidentiality, and requiring cameras to be on. Cameras can help enhance engagement significantly. 

Preparation and education before the first session is important. This includes expectations about the group, explicit instructions of how to use the platform, and recommendations on how to get the most out of the group. Research has shown that virtual engagement levels are not as high for adults over the age of 40, highlighting that explanations of technology and the group process should be detailed clearly for older adults. Smaller groups may also be considered as a better fit for more connection with older adults. High levels of interactive engagement with platform features, games, and activities should be applied for child and adolescent groups. For clients with disabilities, accommodations should be utilized (e.g. screen reader capabilities). 

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Telehealth group therapy activities for collaboration

You may have already developed some quality in-person group therapy activities or group therapy activities for kids and teens. However, if those groups are ever conducted online, offered through a hybrid model, or if you’ve started a new telehealth group, you will need to have some go-to activities that are optimized for virtual platforms.

Interactive icebreakers for virtual group cohesion 

1. Common ground breakouts: Guidelines and research support the use of breakout rooms for building connection through smaller subgroups. In the common ground activity, the therapist would split the group into smaller breakout groups. Prompts or poll questions are then presented that the group discusses together.

2. Show and tell: Studies highlight the unique advantages of being at home during a therapy session. For example, when a client is in their space, they can incorporate their possessions into the session. During a show-and-tell activity, every participant can select and share about a meaningful object from their home with the group. 

3. Emotion check-in: Encouraging clients to name emotions can be a great way to start groups, build skills, and open some vulnerability amongst the clients. In the digital setting, a therapist could share their screen with a feelings wheel for clients to reference and have each client pick a feeling. Or clients could share an emoji in the chat and then explain their choice to the group. 

Communication-focused activities for deeper connection

4. Breakout rooms for Dialectical Behavior Therapy skills practice: Dividing the group into smaller groups and giving them a chance to practice DBT Interpersonal Effectiveness skills with one another has proven to be effective and can build more connections among clients.

5. Story chain: The therapist starts the story with a connected prompt (e.g. “Today I felt validated when…”). Each client in the group takes a turn sharing a sentence or two that adds onto the story. After the story is finished, the group reflects on themes and observations from the story. 

Mindfulness and grounding exercises for virtual groups 

6. Mindful breathing: Guided breathing exercises are easily adaptable for a telehealth context. The therapist can guide the entire group through the breathing for 5 to 10 minutes. It can be useful for the therapist to turn their camera off to avoid distracting clients and instead share their screen with a visual cue or timer to guide the breathing. 

7. 5-4-3-2-1 Sensory grounding: Mindfulness through connecting with the senses is a great way to help clients find grounding. The therapist can prompt the group together to notice 5 things they see, 4 things they feel (touch), 3 things they hear, 2 things they smell, and 1 thing they taste. Clients should note these things internally. Once the exercise is completed, clients can be prompted to share observations and insights to help build group connection and shared learning.

Discover more mindfulness-based therapy techniques from Headway.

Collaborative problem-solving activities 

8. Problem-solving roundtable: This exercise is adapted from Problem-Solving Therapy (PST). Clients take turns presenting a problem situation (not a crisis). The therapist shares a worksheet on the screen and prompts the group to help fill out the worksheet together. The steps of the worksheet include defining the problem, brainstorming solutions, weighing the pros and cons of each solution, and selecting one solution to test. 

9. Consensus challenge: The therapist presents a scenario such as being stranded on a desert island. The group is split into smaller breakout rooms and asked to rank the top items they would want to have in that scenario. The group discusses, debates, and ranks the items. Then, the therapist brings the whole group back together and reviews the results.

Closing activities that reinforce group connection

10. Appreciation circle: Each client is given the chance to share one thing or one person that they feel appreciation for from the group that day. This gives members the chance to build empathy and positive connection when words of affirmation are shared. 

11. Goal-setting and homework assignment: Providing clients with homework can enhance therapeutic work. This can be done in a virtual setting. Therapists give homework to clients in the group and share any supportive resources. Clients are then encouraged to share with the group what they will commit to work on between group sessions. This enhances group accountability and higher likelihood of completing the homework. 

12. Group reflection rounds: The therapist prompts each client to share a reflection from the group that day. This could be something they learned, or something they will take forward with them. This reinforces learning, shares insights with the group, promotes a sense of belonging, and normalizes shared experiences. 

Measuring success in virtual group collaboration

Telehealth groups require measurement to determine outcomes, much like any other type of therapy. There are both qualitative and quantitative ways to do this:

  • Quantitative: Brief mental health assessments such as the PHQ-9, GAD-7, and PCL-5 can be completed by clients after each group. This tracks the effectiveness of the groups and the activities on their mental health. The Outcome Questionnaire-45 and the Group Questionnaire are two more validated assessments proven to give feedback that can support groups and prevent deterioration of group cohesion.
  • Qualitative: This data is important for understanding the nuances of the group’s effectiveness and client experience. Structured group reflections and open-ended survey questions can be helpful ways to gather this feedback. This information can also be informally derived from client check-ins and check-outs. 

This qualitative and quantitative data can provide opportunities to make adjustments in the midst of a group process or for the next rounds of groups. As you thoughtfully implement the right activities for your telehealth therapy groups, you will experience what I did: more turned-on cameras, better collaboration, reduced awkward silences, and improving outcomes of group therapy. 

Explore more telehealth therapy techniques

Headway offers many clinical support resources to help you provide the best care for your clients. Curious about telehealth approaches for other clients? Here are more ideas from Headway:

Let Headway support your online practice

A combination of telehealth-adapted group activities — along with solid group processes — and thoughtful measurement can lead to engaging groups. As you implement these group strategies, your practice still needs attention. 

Headway can help support that work on the back-end. With insurance credentialing and billing, a built-in EHR, documentation tools, and assessments, you can lighten your administrative duties and provide effective group care. Plus, our integrated telehealth platform makes it easier than ever to conduct sessions virtually. Our HIPAA-compliant platform works hand-in-hand with our documentation, scheduling, and billing tools, saving you steps — and the hassle of having to switch between a million different programs. It’s teletherapy, simplified.

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This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.

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