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By Allison Torres Burtka

May 2026

Virtual intensive outpatient programs (VIOPs) are common in certain counseling contexts, such as substance use disorder. They’re less common in grief and loss counseling, but that seems to be changing.

Virtual IOPs, or VIOPs, typically combine virtual group sessions and one-on-one counseling. They’re being used more often in grief and loss counseling for a few reasons, including convenience, accessibility and the sense of community that they create among participants, says Kera Passante, LPC, NCC, vice president of therapy at Sunflower Sober.

“Grief is so isolating, and virtual IOPs are intense dosages of community. Being in a virtual room with others who understand what your loss is like, the specific weight of a particular type of grief or loss, is going to create more of an accelerated bond and healing,” says Passante, who has led VIOPs for grief and loss.

People dealing with grief and loss may need more intensive counseling than traditional once-a-week sessions can offer. VIOPs address needs that fall somewhere in between weekly counseling and inpatient treatment.

“The advantage of groups is that they provide some sense of peer validation, which is useful,” says Kenneth J. Doka, PhD, professor emeritus of the College of New Rochelle and senior vice president for grief programs for the Hospice Foundation of America. A prolific author on death and grief, Doka has led many in-person groups focused on loss.

Trent Nguyen, PhD, LPC, NCC, a counselor with Grouport, has led VIOPs for grief and loss. He has seen firsthand how participants benefit from VIOPs. “The main thing that helps them the most is that they see other people struggling with the same issues and they feel like, ‘Hey, I’m not the only one,’” he says.

Virtual programs eliminate many barriers that participants face, such as lacking transportation, worrying they’ll run into someone from their group in their daily lives and living in areas without access to specialized care. In-person IOPs may not be available.

“I think that this is the future of counseling,” Nguyen says. “For a lot of participants, they feel more comfortable doing virtual, online counseling because they are in their environment. They don’t have to drive 45 minutes and go to an office.”

Why VIOPs Make Sense

Sometimes, weekly counseling is enough to address grief and loss. But some people need more than that. “Grief needs a lot of repetition and relationship and witnessing, and virtual IOPs provide a container for that, where it’s structured, it’s ongoing and it allows grief to be revisited over time,” Passante says. “It’s an opportunity for people to escape isolation and receive consistent support.”

With VIOPs, the group sessions supplement the one-on-one counseling. Research on VIOPs in other contexts, including post-traumatic stress disorder, substance use disorders and eating disorders, has shown that virtual programs are as effective as residential treatment.

A study published in May 2025 in the Journal of Medical Internet Research found that outcomes for eating disorders were similar in virtual and in-person IOPs, and depression and suicidal ideation outcomes improved more for the virtual participants than for the in-person participants.

Although grief-focused VIOPs are less common, Passante says VIOPs often address grief and loss. “Grief and loss are implicitly baked into most mental health and substance use disorder virtual IOPs.”

For example, she says, “People who have experienced substance use disorder are often experiencing death in their life at a greater rate than other folks due to overdose. They may also be experiencing a lot more identity loss if they are trying to get sober or abstain and that means that they have to end some of their relationships.”

Grief and loss take many forms that sometimes overlap. Along with death, types of loss include identity, livelihood, safety and health.

Group therapy can be effective for a wide range of losses, including divorce, alienated children and people who have gone missing, Doka says.

Counseling also can address secondary losses that result from a primary loss, such as death. “Let’s say I’m married and my spouse dies, and then I also find that her relatives have become more disconnected from me,” or issues arise with them having less access to their grandchildren, Doka says. Another example is someone losing their income, as a primary loss, and then having to move, as a secondary loss.

Nguyen recalls a client who lost her home in a California wildfire. She had been meeting with him individually, and he recommended an eight-week IOP. Afterward, “she came back and told me how helpful it was for her to be in the presence of others who have experienced loss and grief,” he says.

VIOPs also allow counselors to match participants with others who are experiencing similar types of grief and loss but don’t live nearby. This enables clients “to feel a greater sense of community, normalization and belonging,” Passante says. They also may appreciate the virtual format “because of stigma, shame and just societal pressure in not wanting to unload in front of people that you might also run into at the grocery store or the PTA meeting.”

One example of VIOPs’ usefulness in a specific group is in the LGBTQ+ community, in part because attending an in-person group for LGBTQ+ people may be dangerous in some places, Passante says.

Losses in this community might include identity loss and death due to targeted violence. “That’s going to be much better taken care of and held in a group of like people compared to a broader death group,” Passante says. “If you can curate the group experience based on the type of loss, that creates a much more cohesive environment.”

What Does a VIOP Look Like?

In-person and virtual IOPs generally have a similar structure: a program that lasts eight to 12 weeks, including weekly individual counseling sessions. Programs also might include a weekly family counseling session.

Group sessions may last anywhere from two to four hours, and they may meet between two and five days per week. Nguyen’s group VIOP sessions usually last two hours. “I have had participants in the past say, ‘Man, what are we going to talk about for two hours?’ And guess what, when we get into it, the same person will say, ‘I cannot believe two hours can go by so fast.’”

The optimal number of participants in an in-person group might differ from the optimal number in a virtual group. “Virtual IOP is going to be very dependent on how many squares can be seen on one page,” without having some participants show up on a second page, Passante says. For her part, she can see about eight other faces on her computer screen clearly, so she wouldn’t want a VIOP group to be any larger than that.

As counselors, “we are acutely aware of subtle changes in someone’s affect, demeanor, their body language, and if you have to flip from screen to screen, you could likely be missing some very significant content that can be brought back into the group and could also tell you a lot about a particular person’s state of mind and impairment level and their needs,” Passante says.

Clients work with their counselor individually, and “they may bring those personal issues to the group, and whatever happens in the group, they also bring it to their individual sessions,” Nguyen says.

VIOPs that work well tend to have a good balance, Passante says. “If a client is receiving 10 hours of care per week, programming must balance psychoeducation, skill-building and relational processing.”

Nguyen says groups function best when they’re not homogenous because people of diverse ages, backgrounds and experiences bring in different perspectives that can be helpful. “I think those dynamics make a huge difference in terms of counseling outcomes,” he says.

At least two therapists should be facilitating the group, and it’s best if they are as different from each other as possible, both in background — such as age, gender and physical ability — and in their approaches, according to Nguyen. This way, the group can be more dynamic, and if the facilitators disagree about something, the participants can witness how the two work out their differences.

When a VIOP Is Appropriate

A VIOP may be helpful with any type of loss and grief, but whether someone is ready for this type of program depends on where they are in their healing process, Nguyen says. “For some folks, the trauma may be a bit too fresh. The loss and grief may be too recent.”

But a few months later, they may feel stuck in their own rumination. “That’s when I believe an IOP is truly helpful for them, to break out of that rumination process,” Nguyen says.

Some people’s needs are too intensive for group counseling, or their personality isn’t suited to group counseling, Doka says. In addition, he says, groups must be well-run. “You have to have the right mix of personalities. Sometimes groups can be very effective, and sometimes they could be not only ineffective, but actually problematic.”

A counselor may do an assessment session to see whether someone is ready for a group. In screening, counselors might separate people based on the type of loss, age, gender or other factors, Passante says.

The counselor also needs to be ready to lead a virtual group. “Grief and loss work is unique and adds an extra layer of complexity and skill, but group work, as compared to individual work, also uses a very different skill set,” which graduate programs may not provide, Passante says. “If someone has not received experience post-grad in doing grief and loss work or done group work specifically, we’re going to want to see advanced training in that.”

Also, a counselor who has facilitated in-person groups “might see a learning curve to be able to deliver the same therapeutic effectiveness virtually,” Passante says.

Solid knowledge of group dynamics is a must. “The clients can pick up the expertise of that therapist. If the therapist has never run a group before, the clients will feel so hesitant to put themselves out there,” Nguyen says. “Besides understanding group dynamics, the therapist also has to know grief, loss and trauma — both the content and also the process of how groups operate,” Nguyen says.

In some circumstances, “facilitators have to be vulnerable so that they can kind of role-model how to let go of past trauma and past grief,” Nguyen says.

Counselors who aren’t in a position to offer a VIOP can refer clients. “Referrals typically work best when grounded in both clinical fit and continuity of care,” Passante says. “Ideally, clinicians start by clarifying the client’s needs and then identifying programs that align with those factors, rather than referring solely based on availability.”

Counselors should also vet programs if possible, “to understand the structure, frequency, group composition, facilitator credentials, and how progress and communication are handled,” Passante says. “Clear expectations with the client about what a VIOP is (and isn’t), how it complements individual counseling, and how transitions in and out of care are supported can make referrals much more successful.”

Sources of referrals include health insurers and provider directories. Attending conferences and networking with other counselors also can help you find appropriate places to refer clients, Nguyen says.

“Many programs are open to brief consultation calls with referring clinicians, which can help ensure alignment before a referral is made,” Passante says.

Practical Considerations

With VIOPs, legal and ethical issues include licensing across state lines, confidentiality and consent, and counselors’ training and supervision.

Although counselors are required by law to keep what clients say confidential, group participants aren’t. “But we encourage participants to keep things confidential,” Nguyen says. “If they want to share with their loved ones, we say that you can share things but don’t mention anyone’s name.”

In a virtual environment, counselors may need guidelines to protect participants’ identity, privacy and confidentiality, as well as ensure compliance with the Health Insurance Portability and Accountability Act, or HIPAA. These may address keeping cameras turned on, unmuting, and making sure participants are in a private space or wearing headphones. “Creating clear group agreements can help create safety within the group,” Passante says.

“In the context of grief and loss, it can be incredibly emotional, perhaps even traumatizing,” Passante says, so the program should be set up intentionally. This might mean “the deeper material comes in the middle of the three hours, for example, and the first hour is opening up, checking in, warming up, developing safety and rapport.” She uses opening and closing rituals as well, such as having participants choose affirmations or a mindfulness and grounding exercise at the end of the session.

This “makes sure that everyone is sort of packed up in safety before they log off for the day,” Passante says. “At the end, when everyone says goodbye, you just log off and you don’t actually see them, where, in person, after you close the group and people are putting chairs away and walking out the door, there’s a possibility of seeing someone crying outside the room and maybe needing a little extra support.”

Passante recommends a strong investment in facilitator training and supervision, including continuing education units for specialized areas. Supervision can include attention to things such as countertransference. “All of us, at some point in our lives, are going to experience grief and loss, so it can bring up a lot for clinicians personally,” she says. Support for counselors may include self-care, vicarious stress prevention, burnout prevention and secondary trauma prevention.

“I am a big believer in proactivity when it comes to that, so when you first bring a clinician into your program, front-load that you’re going to regularly check in about burnout,” Passante says. “With grief and loss specifically, it is going to bring up a lot emotionally, and we need to take care of our clinicians, too.”