To think this therapy program is unfair

[Happiestyearofmylife]

Nhs dbt program they are saying people have to have their camera on to take part. My dd is very self conscious and also has social communication problems. They say it’s because she could have someone else in the room with her but surely you could with the camera on? I understand it for the group bit but it also has a 1-1 bit where only her own problems will be talked about and they still want the camera on Aibu to think people shouldn’t not be allowed therapy over this?

Can she have the camera on but place a Teddy or something on the screen....
I don't know anything about dbt but it seems a tough ask for someone who needs therapy.

Dd had her camera facing her frogs but Mike on. Would that be acceptable?

The people running the group session just didn't want a screen of blank squares

I think that doing online thherapy is difficult enough without a service user/patient refusing (if this is, indeed the case in this instance) to have their camera on.
A big part of DBT is the therapeutic relationship and having the camera off creates an additional barrier to this.
DBT is not an easy option therapy and, if your daughter struggles with having her camera on, then perhaps she is not ready to participate.

I am a psychologist and wouldn't have a therapy session (or run a group) with someone who didn't have their camera on. Therapy is about so much more than just the words being said- I look out for non verbal cues such as facial expression and body movement. Also, it's unfair on the others who do have their camera on, and impacts on the dynamics of the group.

It would be incredibly tough on the people leading it and the other participants if people have their camera off. It's clearly really challenging for your dd and I do feel for her but equally by turning her camera on, this is the beginning of making positive changes surely? Self consciousness eases for mixing with the group and being able to bond a bit. I would bet every person attending will find it hard in some way.

My DD has social communication problems (as part of ASD) and also won't engage with therapy virtually. Her team made reasonable adjustments for her, and she was allowed face to face therapy, even during the lockdown earlier this year. If your DD has a disability (not sure what her dificulties are?) and can't access the therapy in the usual format, then they are obliged to make reasonable adjustments and provide something accessible.

I get that but surely adjustment should be made.

Asd but they are already saying to her they expect her to fully engage with the group despite her communication struggle

I did a group managing emotions course on zoom and we were told to have our cameras on...I wasn't particularly comfortable but I did it as understood why. They have to set expectations and that is one of them. And as it went, it was way better than I thought, meeting others with similar issues.

OP you need to insist. They will try to shirk their responsibities because it makes life easier for them, but she will be covered by the Equality Act and they have a responsibility in law to make reasonable adjustments. People with ASD may struggle with virtual communication (including phone/zoom), and adjustments should be made if this is the case. Not having the camera on would certainly be reasonable in this case, as it doesn't cost anything and would mean she can access the therapy.

** I think that doing online thherapy is difficult enough without a service user/patient refusing (if this is, indeed the case in this instance) to have their camera on.
A big part of DBT is the therapeutic relationship and having the camera off creates an additional barrier to this.

DBT is not an easy option therapy and, if your daughter struggles with having her camera on, then perhaps she is not ready to participate.**

^This

We run a group programme at work. Patients have to sign confidentiality agreements about keeping cameras on, being alone in a room and not being able to be overheard. Seeing them is essential to see if they are engaged eg nodding along, upset and even to make sure they’re still awake! It does allow us to check if people are alone - we’ve been able to see people on mute talking to someone off camera or someone walking through a room too.
Normally we’d run the group face to face and it’s really hard delivering the same content over the internet. You can’t feel the energy in the room or pick up on the subtle changes in body language. Having cameras on is essential to effective interventions.
As a clinician, I’ve gone from really struggling to put my camera on in virtual team meetings at the start of last year to now being totally able to block out that horrible preview of myself in the corner of the screen (or sticking a post it note over it in the start!), so I do understand why she finds it difficult, but honestly it’s essential. It’s absolutely exhausting running a group over the internet because you’re trying to monitor and react appropriately to give your patients the best possible experience. If we couldn’t see participants it would be impossible.
I also do one to one sessions over the phone and over Attend Anywhere (NHS video app), being able to see someone gives me so much more information, I can see if someone is taking care of their appearance and how that varies during the course of our sessions, if they present with flat or blunted affect, if they give a tiny wry smile or nod. One of my colleagues refers to it as bandwidth - seeing someone in person is the ideal, taking away from that to video call and then telephone call really narrows that bandwidth of information and ability to develop trust and a therapeutic relationship.
I hope your DD gets the support she needs and has a happy and healthy future ahead of her.

Could she have it on but use a post it note to cover the little square that shows her face/video feed? This may help her forget about it?

I find if you mention that she is disabled and covered by the equality act they tend to backtrack.

The other option is for them to provide therapy face to face, which would probably be better for the "therapeutic relationship" but probably a ballache for them to arrange.

Not having the camera on would certainly be reasonable in this case, as it doesnt cost anything and would mean she could access the therapy

Would she though? Or does it mean she'd just be able to sit through it? And how would it impact on other patients?

How old is she?
Can she speak to the therapist herself to better understand rather than you advocating for her.

20

@Porcupineintherough

Not having the camera on would certainly be reasonable in this case, as it doesnt cost anything and would mean she could access the therapy

Would she though? Or does it mean she'd just be able to sit through it? And how would it impact on other patients?

This. It sounds like they're concerned that having the camera off poses a risk to the safety and dignity of other clients, as it increases the risk of them being overheard. Or simply worrying about being overheard, and so feeling unsafe.

From what those delivering the therapy say, it also compromises it's efficacy.

It's hard to say that that's reasonable.

Yanbu.
This prevented dd taking part in sessions.

I get their point but of course you could be in the same room and not in view of the camera if you sat there and didn’t speak.

In that case they will have to provide something different then - like face to face therapy. You can't just exclude people from your services just because they're disabled and can't access your normal way of working. If she was in a wheelchair and the group met of the 3rd floor of a building with no lifts, they would also have to provide something different or change location.

TBH OP I'd be a bit concerned that the staff working with her have little understanding of ASD. Which wouldn't be at all unusual in NHS mental health services IME! But may mean she may not receive appropriate help :(
My DD is younger and under CAMHS, but she was transferred to the learning disabilities team, because although she has no learning disabilities, they at least seemed to have a clue about autism.

I think they have to have some ground rules, it’s incredibly difficult to run a group or carry out 1-1 therapy if some people have their cameras off.

Part of DBT is about bonding, learning how to react in social situations, building self esteem and rapport. It’s not fair on the other people in the group who have their cameras on. And the therapist probably wants to check everyone is engaged, not distressed, not losing focus etc.

As DBT is so hard to get in the U.K. I think she should go by the rules or give up her space to someone else.

Where I work we can’t physically run a group as we don’t have a room big enough in any of our buildings to socially distance everyone in. We are keeping a waiting list for those who can’t use video groups, but we have no idea when that will be authorised yet, so it can be another 18 months, who knows!
We have to have minimum numbers of patients in a group as we have to justify the clinical use of time that running a group takes (not just the actual delivery of the 2 hours a week or whatever it is) so can’t have a smaller group. The other thing that people sometimes don’t understand is the power of a group. People sometimes think that individual personalised work is the “gold standard”, however what research shows is that the group dynamic and shared experience of your peers can be far more powerful than individual work, but you need a certain number of people to achieve that (obviously the precise number varies depending on the type of group etc).
Honestly, it isn’t as pp has suggested that we just want to do the easiest thing (if you’d seen the governance we’ve had to fight through, hours spent redesigning content, preparing and debriefing in our own time), just sitting in room wearing a mask would be a thousand times easier. Clinicians want to deliver the best possible therapies they can to give the best possible outcome for our patients. We’re really aware that often patients get one shot at something and we want them to do well. There’s a sound clinical rationale for keeping cameras on, it’s not just that we don’t want to talk to a blank row of squares (I do that in another webinar type group!)

It’s not fair on the other people in the group who have their cameras on.

This is absolutely no reason not to provide adjustments for disabled people. That's like saying blue badges aren't fair on non-disabled people. IT's pure discrimination.

@AndyKaufmanIsAlive yes of course. If the camera is an insurmountable barrier to the OP's dd and the therapy cant go forward without the camera, then it's not suitable and an alternative should be offered.