Adapting to the Use of Teletherapy During COVID-19, by Dr. Jaime Marrus

Welcome back!  As the pandemic continues, we are continuing with our “Ch-Ch-Ch-Changes” blog series.  This blog highlights the positive impact that we have found of COVID-19 related restrictions and changes on our intervention with our clients.  The next blog will detail the challenges we have encountered and how we have addressed them.  

To briefly reflect, we as a society have now been dealing with the impact of the pandemic for more than 7 months.  Many employees continue to work from home, schools vary between using “blended” models of remote and in-person learning, full-time remote-only, and full-time in-person models with COVID-19 precautions in place.  Thus, families are continuing to navigate and adapt to a number of challenges that have presented based on these logistics and disruptions in typical routines.  In our group practice, we, too, have continued to navigate and adapt to these changes, mostly by providing psychotherapy (and aspects of evaluations) virtually through a HIPAA-secure video platform.  We have found many benefits and challenges for remote sessions.   Many of these have been unexpected, but all have provided us with opportunities to reflect, learn, and grow as a practice.

Pros/Benefits of Conducting Remote Psychotherapy Sessions:

1. Increased involvement from other family members, and a better understanding of family dynamics: As families have become more comfortable engaging in virtual sessions, we have often been better able to observe and understand family dynamics than we have in the office. Family members have been more often present in the home (and therefore during sessions) than there would be in the office. It is thus often easy to incorporate siblings and other family members, even if only for a few minutes at a time. This has allowed us as clinicians to develop deeper relationships with the entire family, which we strongly believe promotes the therapeutic process overall for all family members. 
2. Live coaching: Remote sessions allow for in-vivo problem-solving and coaching in a family’s natural environment. Very often, parents report struggles at home that do not occur in the office setting. With virtual sessions taking place “in the home,” we are  able to observe and then coach families through challenging moments.  Regularly seeing the family’s natural environment provides a much greater understanding of what strategies will be effective and we can fine-tune them on a more individualized basis.
3. Natural generalization: We often tell parents how little it matters if a child demonstrates a skill or capacity during our sessions in the office once a week, but does not do so in other environments/with other people. Without generalization, gains are much less meaningful and impactful in terms of the child’s overall functioning. What a child does (or does not do) in their home, with their family, or at school, than I do about in my session is much more important, because that is where and with whom they spend the most of their time. Enter virtual sessions! These sessions provide increased opportunities for generalization, because we are working on skills (virtually) in the home, with their family members, in their everyday interactions.

While we deeply miss working in the office “as usual” during this pandemic, it is wonderful to see how virtual treatment has positively impacted so many of our clients and families. Stay tuned for the next blog on the challenges of virtual treatment and how we have addressed them. Stay safe and be well!

1. More flexible scheduling: Sessions typically occur once per week for 45 minutes and require transportation to the office, amongst other logistical factors (e.g., child care for another sibling). Since the onset of the pandemic, many of these previously limiting factors no longer applied and have led to greater variation in session duration and frequency.  For example, increasing frequency (once weekly to twice weekly) and decreasing duration (from 45 minutes to 30 minutes) is often appropriate for children working at more foundation developmental capacities.  This has been helpful in supporting sustained attention and engagement throughout the session, as well as providing increased consistency for the family to address their goals.