Working with children in a teletherapy context

During the COVID-19 pandemic, many mental health providers started offering teletherapy to stay connected to their clients. For some, this involved a crash course in technology they may have never used before. But despite learning how to use teletherapy platforms with adult clients, many highly skilled therapists lack confidence in their ability to bridge the digital divide with kids.  So if any of the following concerns sound familiar, know that you’re not alone.

• “I’m used to using traditional techniques that require props or supplies (like a sand tray) when I work with kids. How will I structure sessions without my usual ‘stuff?’“
• “Confidentiality is so important. How can I ensure that family members and caregivers respect my client’s privacy during digital sessions?”
• “My office environment is designed to promote positive outcomes for my clients, no matter their age. How will I keep my younger clients engaged in a non-traditional therapeutic setting?”
• “I learn so much from my client’s body language, facial expressions, and tone of voice. If I’m not in the room with them, what will I miss?” 

Fortunately, with a little experimentation and practice, you can overcome these challenges and deliver quality care for kids using teletherapy. 

How kids can benefit from teletherapy

Every method of delivering care has its own unique benefits. Teletherapy is no exception. Whether you’re operating on a totally remote model or delivering hybrid care (a mix of teletherapy and in-person support), your younger clients can benefit from teletherapy in a variety of ways.  For example, with teletherapy, your clients gain more flexibility. This can add up to fewer missed sessions. In the past, if a child was under the weather, out of town for a school break, or busy with sports or other after-school activities they would be unable to attend their session. Now with teletherapy, you can still see your client and busy family schedules don’t necessarily need to interrupt their care. Teletherapy can also give you a look into an otherwise obscured part of your client’s life. Unless you conduct home visits as part of your practice, traditional therapy gives you a somewhat limited view of your client’s home life and family dynamics. Typically, you’d only see your client’s parents when they drop them off and pick them up from sessions or when you schedule a meeting with them. With teletherapy, you might gain a small window into your client’s life you might not otherwise see. This additional insight can help you better conceptualize your client’s needs and offer more targeted support.

Best practices for kids in teletherapy 

Ready to boost your confidence in your ability to serve kids and families in a virtual or hybrid teletherapy practice? These best practices will help set you and your clients up for success.

1. Tailor your intake process for teletherapy: It might go without saying, but ensuring you receive accurate information during the intake process for teletherapy will set you and your clients up for success. Gather accurate information about where your client will be situated during remote sessions (in case there’s an emergency) and ask your client’s parents to update you if there’s going to be a location change.
2. Set expectations around client privacy: Boundaries around privacy are critical, no matter your method of delivering care. But with teletherapy, you might need to take some extra steps to help well-meaning parents understand the importance of confidentiality in digital sessions. Let them know that their input is important and schedule regular check-ins with them to enhance engagement and promote collaborative care.
3. Plan for interruptions: Kids and teens might be understandably hesitant to open up when parents or other family members are listening. So work together to make a plan for when sessions (inevitably) get interrupted. This could mean having a hand signal or codeword that means “someone is listening” and “coast is clear” so that your client can safely communicate with you if they need to pause the session.
4. Create engagement rituals for yourself: What does it take for you to be fully present and engaged with clients in a non-traditional setting? Only you can answer that. But some therapists say taking a screen break between sessions, stepping outside for some fresh air, or doing some light stretching helps them reduce distractions and bring their full selves to teletherapy.
5. Be flexible when things don’t go as planned. Have patience with yourself and your clients if things don’t go the way you expected. When things go awry in a teletherapy session, remember that this happens with in-person sessions too and it’s just part of the process. Be present and flexible and don’t be afraid to be silly and play to get things back on track.

Creative teletherapy activities for kids

Whether you’re working with kids virtually or online, a little creativity and flexibility can go a long way. Here are three creative ways to keep your young clients engaged in teletherapy. 

1. Get creative with digital tools: Look for ways to use the digital landscape to your advantage. Depending on the telehealth platform you use, you can find all sorts of ways to build creativity and playfulness into your sessions. Choose a silly avatar or background and become a character your client feels safe with, implement digital board games or video games, or play some music and take a dance break.
2. Consider sending supplies: Send a care package with supplies to use in your remote sessions. If you’re used to using props in your sessions with kids, send some in the mail. These don’t have to be expensive items. But imagine your client’s delight at opening a special package from you that contains coloring supplies, a stress ball, play dough, bubbles, etc. Of course, talk to their parents first and make sure to have their permission.
3. Use what kids already have at home: Most families have all kinds of items that could be used in a therapeutic setting, so get creative. For example, if a client accesses their session from a playroom with a dollhouse, games like Jenga, etc., look for ways to introduce them in your session. You can also speak to your client’s parents ahead of time to prepare them for what might be needed in a session.

Learn more

Building a digital private practice doesn’t have to mean working in isolation. And at Rula, we’re on a mission to help mental healthcare work for everyone — including therapists serving clients ages five and up.  If you’d like to learn more about best practices for supporting kids and families through teletherapy, we invite you to view our recent webinar entitled “Working With Children in a Telehealth Context.” Hosted by Anne Jackson, Rula’s Clinical Quality Coach, this conversation features a panel of experts who specialize in working with children. They share tips and tricks for engaging children via telehealth, common pitfalls to avoid, and the techniques they use to create positive outcomes in sessions.