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Advice from our director of child, adolescent & family services

Natasha A. Varela, LCPC
• April 08, 2020

The Family Institute’s director of child, adolescent & family services, Natasha Varela, LCPC, took time recently to answer some questions about providing teletherapy to some of our younger clients.

Tell me a little bit about how your team has made the transition over the past several weeks to provide all of your sessions via teletherapy.

About two months ago, totally separate from any concerns about coronavirus, I had a conversation with another therapist on my team about how we might start thinking through the possibility of providing teletherapy to children and adolescents.

Now, at the beginning of April, my team of more than 15 child and adolescent therapists and The Family Institute’s team of more than 90 staff therapists are two weeks into providing 100% of our sessions online. We are fortunate to be part of such a forward-thinking and dynamic group at times like these, when we can learn from one another, give feedback and provide support. As we say at The Family Institute, when you work with one of us, you work with all of us.

As soon as businesses and organizations started transitioning to working from home and school closures were announced, our team started brainstorming about and problem-solving for how we could use teletherapy with our kids.

What advice would you give to parents of younger clients who may be hesitant to make the shift from in-person therapy to online?

Parents, stay connected with your therapists! We can help to coach and support you (in addition to your children) during this time.

Parent involvement is huge. It can be helpful for a parent to participate during the entire session, especially for kids under 10. The mere act of a parent and child stopping, and spending time together focused on the same thing can be therapeutic.

For teens, parents play an important role in helping to provide as confidential of a space as possible for their child to engage in therapy. Can family members go for a walk during the therapy session? What about using a white noise machine?

Can you talk about the importance of flexibility when approaching teletherapy sessions with children and adolescents?

We are all needing to make lots of adjustments during this time, and we can also be open to thinking and working outside of the box. Maybe an hour once a week will be particularly challenging with some children who have a shorter attention span — consider 30 minutes twice a week or spending half of the session with the child and half of the session with the parent.

For children who benefit from “play” therapy, the therapist can have a “look” around the room to see what the client/family might have in the play area that can be used during sessions (i.e. legos, stuffed animals, tea cups, etc.) and the therapist can provide parent coaching/feedback with the client and parent on the screen. For children who benefit from “art” therapy, art can still be incorporated into the session if the client has tools (paper, markers, paint, play doh, etc.) and the therapist can have the client talk about what they are creating and working on during the session and/or share the picture/sculpture/art work with the therapist before the end of the session.

Privacy and confidentiality is super important to adolescents and teens, acknowledge that and ask the client if they are in a space where they feel they can open up. If there are constraints, therapy can still be valuable, though not in the same way. Use the whiteboard and chat functions to communicate with the client in a more private way. Sometimes there is more privacy than others, so take advantage of those times.

Any general tips to share for anyone considering teletherapy sessions?

Turn off your notifications. Just like in person sessions, you should limit your distractibility — shut down your email, don’t look at your phone. Make the choice to put distractions away and use the time of your session to connect and focus.

What advice would you give to other therapists who are having some challenges making the transition to providing virtual sessions?

Learn the technology. At The Family Institute, we use a HIPAA-compliant version of Zoom for our teletherapy sessions. With it, we screen share with our clients to show them videos (don’t forget to turn on and share the sound!). There are a lot of great resources and various online content that can be used during virtual sessions — I love having my clients go through mindfulness activities with a robot. We also give our clients control of the screen — they can draw on the whiteboard and use the chat window. This allows them to actively participate during the session. I’ve also found success screen sharing story books with younger children and, with older kids, screen sharing worksheets, as often used in CBT, and emailing them the completed form after the session.

Is there anything else that you’d like to add?

We are committed to providing the best possible care for our clients and now is a time when they need us most. We will continue to be here for our clients and learning from one another as we navigate through this together. And, we’ll come out the other side with some great strategies for working with children and adolescents virtually, tools that will continue to be useful into the future in the changing landscape of behavioral health.

Learn more about teletherapy at The Family Institute

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Natasha A. Varela, LCPC

Director of Child, Adolescent & Family Services
Therapist

Natasha Varela, LCPC, began her clinical practice working with children and adolescents in crisis. She is an expert in crisis interventions and stabilization, and has worked with high risk youth and their families to help improve functioning in all areas of life, including interpersonal, family, social, academic and occupational functioning. Mrs.