Adapting to the Use of Teletherapy During COVID-19 (Part 2), by Dr. Jaime Marrus

As discussed in the previous blog the COVID-19 pandemic has impacted families and our practice in many ways.  I described the (many unexpected) positive of our use of telehealth in the previous blog, while here I delve into the challenges we have encountered and how we have addressed them.

Cons/Challenges of Conducting Remote Psychotherapy Sessions and How We Have Addressed Them:

1. Fewer materials: It goes without saying that one of the biggest challenges of conducting virtual sessions is the lack of therapeutic “stuff” readily at hand for our clients. For our practice, this ranges from our sensory gym space (in Bayside) where children are able to get the movement and/or sensory input they need to regulate, communicate, interact (or just plain have fun) during sessions, to our therapeutic play materials, such as people figures, doll houses, play kitchen sets, blocks, balls, and various games.
   • Solution/Tip: Get creative!  Sometimes I ask the child to take me on a tour of their home (with parental permission) to see if I can encourage them to engage with materials that would lend themselves to a virtual interaction. For some of my older clients, we have engaged in problem-solving around this together, and some of my favorite ideas have been virtual Chess, Boggle, and other games that truly rely on our interaction, rather than materials.
2. Technology issues: Of course, tech glitches will always be a factor to consider during virtual sessions.
   • Solution/Tip: Do your best to prepare. Make sure that your own device is charged and free of issues (to the best of your ability) prior to session, and provide some expectations and guidance ahead of time for how your client or family can do the same.
3. Some kids are not very responsive “through the screen:” Depending on developmental level and a variety of other factors, some clients may not be as engaged this way.
   • Solution/Tip: Again, get creative! Think ahead and perhaps engage some family members to brainstorm preferred activities that may be translated on screen. And/or, consider shifting the approach and take on more of a coaching role with parents (as discussed in the previous blog), which will likely elicit important information to use in treatment overall.
   • Please note that this “barrier” may work in the opposite direction as well. We have a number of child clients who have been MORE engaged virtually than during in-office sessions. Although this may seem, and sometimes certainly can be, a “pro” of virtual sessions, it is important to consider this as meaningful information about the client (and to explore why this may be the case.)
4. Less privacy: This applies to both the child/family, and the professional. In most cases, concerns about privacy have not been an issue for families that we treat and it has rather proved a benefit (discussed above) as more family members become involved. However, this is important to consider for preteens, adolescents, and young adults, and people who live in smaller or more crowded homes.  Likewise, virtual sessions often provide more of a window into the clinician’s personal life, which clients typically have limited knowledge of. For example, children or pets may come into the frame of the video or be heard in the background.  Some parts of the clinician’s living space may be visible.
   • Solutions/Tips: Prepare ahead of time for yourself and your clients. Be mindful about your background space, and encourage clients to do the same. Discuss limits to confidentiality and privacy with clients before the first virtual session.

Taken together, we all know how difficult the COVID-19 pandemic has been on all people, including personally and professionally.   We are glad to have experienced many positives in our work, as well as our ability to think outside of the box to address the challenges we have encountered.  All that said, while we look forward to being back in the offices “as usual” as soon as possible, we have a feeling that we will incorporate many of these new strategies when we do to create another “new normal.”  After all, evolution and development are valuable for us all!