Social workers at the Glenrose Rehabilitation Hospital (GRH), Capital Health Region of Alberta, used telephone technology as a means to provide group treatment for rural patients and families who are survivors of spinal cord injury (SCI), brain injury, and stroke. Distance; lack of transportation, finances, or child care; busy timetables; and weather can be barriers to attendance in groups. The use of telephone technology in group treatment removes some of these barriers (Galinsky, Schopler, & Abell, 1997). We wondered whether new skills are required to facilitate these groups and whether group process is affected. To answer these questions, we conducted a literature review and found only a few articles that focused on the development of telephone group facilitator skills (Galinsky et al.; Kurtz, 1997; Stein, Rothman, & Nakanishi, 1993). Most of the information discussed the effect of telephone technology on group process and development rather than specific group skills (Colon, 1996; Galinsky et al.; Houtstra & Mallon, 1999; Kurtz; Stein et al.; Wiener, 1998), so we interviewed our colleagues at GRH.
The GRH social workers had differing views concerning the effect of telephone technology on group process. Some colleagues experienced little to no effect on group process and development. Others believed that only certain types of groups were suitable to using a telephone. Because of the differing views in the literature and in discussion with our colleagues, we questioned whether there is enough information to be definitive.
DESCRIPTION OF GRH TELEPHONE GROUPS
All six groups developed at GRH shared a similar structure, with the exception of the SCI family group, which was open ended and was the only group that combined in-person and telephone group members (see Table 1).Two of the six groups were cofacilitated. The decision to cofacilitate was based on staffing resources and the clinician's preference. Participants came from either the current inpatient population or the recently discharged outpatient population.
TELEPHONE GROUP PROCESS AND FACILITATION SKILLS
As group facilitators new to the use of telephone technology, we questioned whether group development and process would be affected by the technology, requiring us to alter or use different group skills. Our review of the literature and discussion with colleagues revealed that, in some groups, it became more difficult for group members to interact and engage without face-to-face interaction. One colleague found that telephone groups are better suited for psychoeducational purposes as opposed to therapeutic interventions. Galinsky and colleagues (1997) said, "Technology can interfere with the communication process and group bonding, causing delays in the development of cohesion" (p. 185). In the early stages of group development, the GRH social workers experienced a need to be more direct due to low initiation by the participants, and they found the groups became more interactive in time. The authors found they needed to be even more instructive by having participants speak to each other rather than through the facilitator in the early stages. Galinsky and colleagues concluded, "Leaders may find they need to be more active in guiding group process in technology-based groups than in face-to-Face groups" (p. 187).
"In contrast to face-to-face groups, telephone groups may offer anonymity that helps group members feel more comfortable and may allow participants to achieve closeness at a safe distance. As a result, increased self-disclosure and bonding may occur earlier in the group process than in a face-to-face group" (Colon, 1996, p. 158). From the author's experience, there are no differences in group development related to the use of the technology. In the SCI family group,
the development of trust and cohesion may have
to begin again with each session due to the open
group format. …