Kid's Korner

Working Online with Children: Tips for Remaining Playful and Effective in Challenging Times

Due to the COVID-19 Pandemic, therapists around the world are rapidly adapting therapy to the online format. Our online forums and supervision sessions are full of conversations about Zoom fatigue, online security and how we best support our clients, even while we too are experiencing the stress of the pandemic.

However, when it comes to working with children online, there are many additional issues. Most therapists working with young children rely heavily on using creative and playful approaches and may rely far less on ‘talking therapy’ than therapists working with adults or teens. How do we adjust this to an online format?

I was fortunate to work with a 7-year-old boy diagnosed with OSDD online for two years, prior to this pandemic. Based on my learning from this quite long-term online therapy I have a few tips.

Firstly, it is quite normal to initially feel reluctant about this type of therapy with children. In fact, when I was asked to see this young boy, from many states far away, via video sessions, I initially said no, but the parents persisted. I agreed to try it. In fact, I saw him weekly for two years and was able to visit him periodically in his town and work collaboratively with another therapist, Joy Silberg, in her office. 

Here are some ideas for how I adapted myself to online therapy:

I was quite an actor! I exaggerated all of my actions to keep his attention. 

I continued to use toys in therapy, just like I would in the room. I have a basket of puppets that I used. I moved my laptop to the baskets of puppets and he picked out his favorites. I began to use them in communicating. He engaged with the puppets freely on difficult issues.

His mom had drawing supplies for him to draw pictures of his parts and she showed them on the screen to me and sent them on her phone in real time. With various toys in my office, besides puppets, I would demonstrate co-consciousness and cooperation, and unity. (Stacking dolls, magnetic figures of people joined together, etc.).

We also played the game, Don’t Break the Ice, since we both had that game in each location.  We would take a turn on our own game.  I engaged in a lot of simulated play.  I pretended to throw a high ball to him, and he pretended to catch it. I praised him for catching the high ball.

We did the “shaking dance” together to help him release negative feelings. We both stood up and shook our bodies-a sensory motor activity that was very effective online.  We also did a stomping dance when he felt very angry.  I would mirror him whenever possible to build attachment between us and help him feel empowered. His mom would move the laptop around so that I could see him.  He got a drum as a gift and that was a wonderful tool for him to drum his feelings and sing songs about how he felt. Of course, just as in office therapy, there were times when he was low keyed and I had to give him space to come around to talk about a difficult week he had.

It is also still possible to work with parents online and teach them strategies to support their child. In this case I taught his mom how to do Havening, a new sensory technique in trauma treatment in which the mom would gently stroke his hands, upper arms and face that activates delta waves in the brain for calming effect. This was very helpful in building attachment between mother and son and instil a sense of calmness and safety to all parts of him. He told me at the end of our time that Havening was the most helpful. I highly recommend it. 

Now that COVID 19 has made it so that I am doing all online therapy sessions, I requested parents of a 4-year-old boy to have his favorite toys, Legos, available during the sessions. He proudly showed me the spaceship he constructed out of 240 pieces. I praised him on his patience, creativity and skills.  I also asked him how he felt about making such an amazing spaceship and he changed his demeanor.  He gave me his typical response, “I don’t know,” as he has done in my office. I grabbed my finger puppets with different emotions, held them up to the screen, and asked him to tell me which one he felt.  With some hesitation, he pointed on the screen the happy face.  I then asked him to make that face and he smiled.  I then mirrored him and exaggerated it.  He joined in with me exaggerating that emotion as well as angry, sad, etc. He was bouncing around in his living room and at times moving up to the camera having a ball that this game of exaggeration!  I was actually amazed at how interactive our play was compared to his time in my office. It required me to be the “best worst actor,” but he loved the interaction. This child who was so shut down in my office, but came alive on screen. 

To make online successful, I ask parents to have their child’s favorite toys, stuffed animals, art supplies, drums, and clay that can be used for therapeutic interventions.  While some countries are currently in a state of lockdown and getting new supplies may be challenging, most homes with young children have enough toys and objects around. With a bit of creativity (some silliness too), we can make it work.

So, be creative and use what you can to engage children. Use whatever approaches that the child likes, and whatever resources the parents have available to help the child feel empowered and to manage traumatic feelings.