Can Zoom Increase Group Therapeutic Outcomes? A Case Study Involving Therapeutic Improvisational Theater for Veterans with Addiction and PTSD

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Patricia A O’Gorman, PhD,  Samuel M. Hall, MA, MAC, CASAC, &  Col. C. David Merkel, MD

Patricia A O’Gorman, PhD

Zoom has exploded into the recent vacuum created by the need to socially distance in all walks of life, including for therapeutic improvisational theater for veterans in long-term residential care who have addiction and post-traumatic stress disorder. This innovative program developed by St. Joseph’s Addiction and Treatment Centers was designed to explore enhanced treatment modalities that could reach this population of veterans with both honorable and less-than-honorable discharges from all branches of the military, for whom shorter stays in other programs were unsuccessful.

A pilot program begun in the spring of 2019 based on the use of a key concept of improv learning envisioned providing vets with a new cognitive framework: learning to saying “Yes, and …to facilitate a focus on positive alternatives as a way to consciously build their resilience.

Samuel M. Hall, MA, MAC, CASAC

The original model called for improv groups to be held at the local theater, led by their staff with experience in theater and comedic improvisation and by the center’s consulting psychologist, who has experience in trauma and resilience. Group therapy was then conducted by the psychologist at the center. Early outcomes of this approach were positive. In the words of one veteran: “I had to learn patience, acceptance, how to work with others, and how to be comfortable with being uncomfortable. There were days I wanted to throw in the towel and say I’m done with it all, but in those moments of doubt and uncertainty, my greatest moments of growth and change started to manifest.”

Due to precautions necessitated by COVID-19, this group was moved to a Zoom platform accessed by veterans at their residential setting on one screen and the improv facilitator and the consulting psychologist on their separate screens. Group members do a numerical check-in as they begin the improv section, and a check out after the group therapy section.

Col. C. David Merkel, MD

The veterans reluctantly agreed to try this approach with one stipulation: to not add new members, keeping the group at six. The length of the group was shortened to 60 minutes, bookended with 15-minute check-ins and a 45-minute therapy group following the improv group. The results have exceeded those of the in-person format.

Since moving to the Zoom platform, there has been a 10% increase in their check-in self-rating and about a 40% increase in their check-out numbers. Checking in is now at a 5–6, and checking out at a 9–10 on a 10 point scale. Their anecdotal responses have indicated a greater sense of trust and greater intimacy despite ongoing physical and psychological challenges, which make getting themselves organized for an activity that requires a high level of energy more difficult. Their increasing comfort is leading to greater risk taking as they explore alternate solutions to their addiction and trauma, and enjoy increasing support, comfort, and freedom.

Plans are now being developed to formally research this unique program in the hope of shedding light on how the use of Zoom technology can increase the therapeutic gains with no “Zoom fatigue.”

Patricia A. O’Gorman, PhD, is the consulting psychologist for both the veterans and adolescent programs at St Joe’s Addiction and Treatment Centers in Saranac Lake, NY. She is the former director of the Division of Prevention for National Institute on Alcohol Abuse and Alcoholism (NIAAA), and a cofounder of the National Association for Children of Addiction. She is the author of 10 books including Healing Trauma Through Self-Parenting, and Self-Parenting in the Age of COVID-19 (in press). More information is available on

Samuel Hall is an Army Veteran, who has a master’s degree in Marriage and Family Therapy and is a credential Master Addiction Counselor (M-CASAC). He currently serves as the Director of Col. C. David Merkel, MD Veterans Residence at St. Joseph’s Addiction Treatment and Recovery Centers.  He has extensive experience working with adolescents, veterans and various other underserved populations.  The Merkel Veterans Residence is the first New York State Office of Substance Abuse Services (OASAS) licensed program, and the only veteran’s specific program, to certified in the Sanctuary Program.

Col. C. David Merkel, MD, received an A.B. degree from Hamilton College in 1955 and MD, C.M., from McGill University in Montreal in 1963. In 1969 he completed a surgical residency at the Hartford Hospital in Hartford, Connecticut. Joining the Adirondack Surgical Group in 1969, David continued to practice surgery in Saranac Lake until his retirement from the practice. He was also Medical Director at St. Joseph’s Addiction Treatment & Recovery Centers. Dr. Merkel enjoyed a rewarding career in the United States Army Reserve from 1965-1997 when he retired as the Commander of the 376 Combat Support Hospital.