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5 tips for telehealth with kids

Written by Amy Marschall, PsyD

A child therapist holding a telehealth session with a young girl.

Therapists are still reeling from the impact that the COVID-19 pandemic has had on therapy. While sessions continued with the use of telehealth options, gone was the safe space of a shared room with our clients. And though all mental health providers faced challenges with providing a new kind of care, those of us working with children faced additional trials. Holding a young client’s focus on a digital platform—one that did not allow us to follow them if they moved around the space—required therapists to completely rethink play therapy and kid-friendly interventions.

Wondering what you can do to keep your younger clients engaged in telehealth sessions? The following five tips are essential to boosting your practice in the world of online therapy.

1. Be honest about the experience

Although telehealth sessions will follow the same general outline as any “normal” in-person session, the change will be an adjustment for the therapist and the client.

Make a point of reassuring your clients that you are there for them and that they can still have sessions, but tell them honestly that you will be learning together as you transition to telehealth. Be realistic about challenges you might face and open with your own emotions about the situation.

Because of your own transparency, clients will feel more comfortable sharing their questions and concerns with you—and you can use the opportunity to model communication and regulation skills.

2. Be flexible with your interventions

If you use a nondirective therapeutic approach, you’re used to giving your young clients some level of control over their sessions. This helps clients engage because they have a say in the activities.

Ask children what they want their session to look like, what they wish they could do in therapy, or which games or activities they enjoy. Then see how you can incorporate this feedback into your sessions. You may find brand-new activities that you can share across clients.

As a child therapist, you should not try to force a specific intervention, but instead should make whatever happens organically in the session therapeutic. You can pull treatment goals into a myriad of games and activities.

3. Get creative

Creativity is one of the most important aspects of child therapy, as every young client learns, develops, and copes differently. At first, telehealth sessions can feel limiting because you and your clients are not sharing physical space. But if you think about it, the internet actually expands your options.

What kinds of activities does your client enjoy doing on their tablet, phone, or laptop? How can you make those activities therapeutic? What skills does the child need to play those games, and how can those skills tie into their treatment goals?

Don’t be afraid to try something new in a session or experiment with interventions you have not tried before. The possibilities in a telehealth session are endless.

4. Make technical issues therapeutic

Technical issues can be the most frustrating part of telehealth sessions. Dropped calls, audio or video problems, and low bandwidth can interfere with sessions at any time and are incredibly annoying for you and your clients.

However, technical issues offer yet another opportunity for intervention. When faced with an issue, a client must engage in problem-solving during their session. In real time, the client might have to ask an adult for help, try different things to find a solution, or cope with feelings of frustration, annoyance, or anger.

When technical difficulties arise in a session, you can see it as an intervention and pull from these skills, making the moment therapeutic. You also get to show your clients that you are going to stick with them and work through challenges together.

5. Have an arsenal of interventions

Although your clients can provide great ideas for their sessions, it’s your job as the therapist to guide them and to introduce things that will help them move toward their treatment goals.

Even when children are unsure about what they want to do in a session, they can be picky about the activities you suggest. When a child lets you choose a game, give them a couple of options rather than simply picking something. It is helpful to have several activities on deck to suggest if a child does not take to your first idea or needs to practice a specific skill.

I use keywords and therapy skills to label my various telehealth interventions. This helps me decide which choices are the best fit for the client and streamlines writing my notes.

Having your sessions online doesn’t have to upend your entire process of working with young clients. Although telehealth adds challenges to therapy with kids, it also creates opportunities for innovation, flexibility, and connection. After transitioning your clients online and adding some new interventions to your repertoire, you can reinvent your therapy process—wherever it may be.

Check out two of my favorite telemental health interventions—completely free!

Want more kid-friendly resources? Try these new strategies for keeping children and teens engaged online.

More kid-friendly telehealth options

As clinicians make the switch to remote therapy, the need for kid-friendly telehealth interventions has become more crucial than ever. In the “Telemental Health with Kids Toolbox ,” I’ve created an arsenal of flexible, creative, and fun virtual interventions that will allow you to provide effective, evidence-based treatment while still capturing the attention of even the youngest clients.

Inside you’ll find over 100 ready-to-use telehealth games and exercises designed to offer the same therapeutic benefits as in-person session activities. Each intervention includes suggested age ranges and step-by-step instructions—equipping you with the tools you need to effectively and confidently provide treatment through a screen. You’ll also receive guidance on how to create your own kid-friendly, virtual interventions that are unique to your practice.

Order your copy today.

Amy Marschall, PsyD, is a licensed clinical psychologist in South Dakota who works primarily with children and adolescents. She is a certified clinical telemental health provider (CTMH) and is also certified in trauma-focused cognitive behavioral therapy (TF-CBT). In 2016, she helped build a task force at Sioux Falls Psychological Services to develop an ethical and effective model for providing telehealth services to people in rural South Dakota without access to mental health resources. In 2017, she co-developed and presented a seminar on ethical and legal guidelines for telemental health and has been providing those services in South Dakota ever since.

Learn more about Amy Marschall’s educational products, including upcoming live seminars.

About the publisher

For more than 40 years, nonprofit organization PESI, Inc., has provided cutting-edge continuing education to professionals across the nation. Working alongside the world’s leading experts, PESI educates and instructs the general public, public organizations, private industry, students, and professionals in acquiring, developing, and enhancing their knowledge and skills.

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