Troubleshooting Tele-Play: Solutions to 5 of The Most Difficult Tele-Play Issues
If anyone asked me what my practice was going to look like for Play Therapy and EMDR in 2020 this wasn’t exactly what I had envisioned. By this I mean – not in my wildest dreams did I imagine that I would be doing therapy 100% online with clients and spending a good chunk of that time in a makeshift office in my garage. If you know my story you know that telehealth was part of my practice before COVID-19, BUT nowhere near all of it, and the shift to all the activities, consents, procedures, and paperwork all at once was difficult!
As we are all settling in to Tele-Play for some of us this will be the platform that we use for the foreseeable future. For others integration back into the office and sanitizing toys, ohhhh ALL the sanitizing, is the next chapter. I think we can all agree that Tele-Play is here to stay in one form or another – either for clients who aren’t comfortable and/or have a pre-existing condition where they do not want to risk being in the office or *the way I hope it will be* integrated into normal practice as a way to increase consistency when life happens. Sibling sick and can’t be left at home? Tele-play! Unable to make it into the office because of work schedule? Tele-play! AND if you are from a snowy state like me – blizzard? Tele-play!
So inevitably you have run into some of the difficulties, mishaps, and frustrations that can happen with Tele-Play. Maybe you have gone on a bike ride with your client, jumped on the trampoline, had a tour of their whole house, or had to set a limit about not taking you into the bathroom.
A recent blog comment by Ashley reads “What if they run out of the room? What if they turn off the camera/program? What if they take the device and go on other programs? What if they don’t listen to what I say? [When a client leaves the room with permission] will she come back?” These are all great questions and I felt they deserved some more thorough attention!
Okay let’s break it down!
What if they run out of the room? What if they leave with permission but don’t come back?
This is where policies and procedures are key! All of these procedures are discussed in detail with clients and parents before starting sessions. Did this sentence just make you anxious because you have no idea what I am talking about? No worries – you can introduce and orient to these at any time!
So one of my rules is I always have my business cell phone within arms reach. I have whatever parent/guardian is with the child at the time of the session’s phone number. We have agreement that they will be able to be reached immediately at any point in the session. I also have an agreement that if a session gets interrupted for any reason (tech down, the kid running out of the room) and cannot resume within two minutes (longer for things like going to the bathroom) I call the parents and have them support re-engagement.
What does re-engagement look like? It depends! One of the biggest things to consider is, if this were your office how would you handle these behaviors? Some therapists might meet the child where they are and just be present in the waiting room. Other therapists would give the child space. Still others would set a limit stating that choosing to leave the playroom is choosing to end the session and engage with the parent for the last portion.
The key is to work within your theory or framework and identify the function of leaving. For kids that just get excited and distracted sometimes it might work to have a parent camp out outside the door and issue gentle reminders for the child to stay in the room. For others who are dysregulated or have some apprehensions or anxieties about engaging then there are more complex elements to consider. You need to pair with parents and work to have the parent as an external co-regulator for the child.
What if they turn off the camera/program? What if they take the device and go on other programs? What if they don’t listen to what I say?
Now the questions above were about keeping the child in the room, this next set of questions is how to engage with the child when these problems come up during session. I promise you these things will happen – the camera gets turned off, they exit out a program, or they are just plain old playing video games or Minecraft during your session. Ugh.
The first lens I look at is “Is this behavior therapeutic”? Take the example of the child who wants to feel in control, a child who feels distant from you, or a child who feels abandoned. Could play themes come out of turning the camera on and off? You bet! Your theory depends on what you do next – tracking, creating an activity around this dynamic, etc.
Now, this may or may not be different if the child is turning off the camera to hide something. Could this be similar to a client who goes into a tent in your play room and doesn’t want you to see what they are doing? Yes! However, sometime it means a client is doing something they should not be doing both in the playroom and in the context of their home environment. For this type of behavior a limit would need to be set. This might include those policies and procedures of contacting parents and having them create the structure to enforce limits within the session.
Now, there are some ways you can tell if a client could be going on another program. If there are different lights flashing on their face, if their face is close to the screen but they are distracted, their eyes are going back and forth and are not set at a steady gaze that we would expect if they were paying attention to you on the screen, their affect (excitement or defeat) does not match the context of the therapy setting, or if you hear rapid typing. For teens old enough to have a cell phone, this could be looking at their lap frequently. Does this always mean they are on another program? No – unfortunately there is no fool proof way to call out this behavior.
With this, I usually start with a wondering or noticing of what I am observing. Then you can create some tweaks – such as having them sit far enough back where you can see their hands OR having a parent come in to ensure that all other programs are off. I am told that there is a way that a parent can lock the child onto one screen, but honestly I haven’t ever used this method so that might be some digging on your own if you have a client where this is an issue.
Lastly – what if a client just refuses to do what you say? Well…..doesn’t that happen in our offices too? I hope it’s not just me! So - how you handle it depends on your theory! Sometimes this behavior comes from a hypoarousal state where the client doesn’t want to do anything OR sometimes it comes from hyperarousal state and they are having behaviors from a flight/fight response. These behaviors typically may need limits at some point. I tend to pull limits in a bit sooner in Tele-Play due to the potential if there is escalation to need to call parents into the room and the lag that it may take from calling to parents present. This is different from in your office when you can immediately and physically be present with the limit.
Limits might look like “One of the things we cannot do during our time together is break your toys, but you can do almost anything else that you would like!”. I like the limit setting process from the book Child Centered Play Therapy by VanFleet, Sywulak, and Sniscak where after stating the limit (in the example), if the child is not able to comply you state the limit with a warning. If the child still does not comply then you enforce the consequence from the step prior. In Tele-Play this might look like the child’s time during the session ends and you continue the rest of the session as a parenting session.
Wheew! That was a lot AND I hope it got you thinking about how in office troubleshooting of problems can be translated to your Tele-Play sessions! Let me know in the comments what the biggest Tele-Play obstacles you have overcome (without any client information of course!) and how did you do it?
Want to learn more about specific Tele-Play Therapy techniques? Check out this training HERE!
Omu’s stew brings the whole neighborhood to her door. Thick red stew to be exact. The most delicious stew anyone has ever tasted to be more precise.
The community trickles in throughout the day enticed by the most delicious smell, and each time Omu hears a knock she gives! Bowls upon bowls head out her door for the entire day. At the end of the day as Omu goes to grab a bowl for herself it’s all gone. As soon as her heart starts to sink, she hears another knock – everyone has shown back up at her home. Not to take, but to give!
I have fallen in love with this story about giving, community, and togetherness. It is about the gifts that we give others, and when we need it most, how others pour into us. Oh, and the book is BEAUTIFUL too! In case you are wondering – Omu is pronounced AHH-moo and is the Igbo term for “queen”. In the story (and for the author Oge Mora) it means Grandmother.
I created this FREE worksheet bundle and want to show you how I have been using it in sessions with young people! These worksheets are a great fit for Tele-Play, in office sessions, for school based services, or nearly anywhere else you may do therapy! It is great for kids to strengthen their sense of connection, self esteem, sense of contribution to others, and identify how to get needs met!
So this first set can be used in SO many ways. Usually I have a client start and work from the “Filling Up Our Bowls” sheet. They label the big bowl in the middle as themselves. From here they can cut out and paste (or draw their own) bowls of people they pour into – parents, grandparents, guardians, friends, teachers, and YES even their therapists! These bowls are placed around their bowl and I encourage clients to choose color that represents the person they are pouring into. Maybe blue for their brother? OR green for their best friend?
Next to each bowl coach the child to write the way they pour into this person. It could be inside the bowl, around the bowl, coming up like steam – anywhere will do! Could it be that they share their humor, compassion, tech skills, or love for sports? YES!
Then using the same color as the bowl of the person they are focusing on, write with that color inside the child's bowl of how that person pours into them. With the example above, using blue, how does their brother pour into and support them? Is it by always being there to talk? Sharing? Suggesting fun things to do together? AND in green for their best friend, does that person give them compliments, help them with homework, or show compassion?
Sometimes it may make sense to just work off of the “Whose Bowl Do You Fill” worksheet and identify the way the child gives to others. This can be tricky if the child only has a couple of people they believe they pour into OR has more bowls than are created. However, we are play therapists so we adapt – turn it over and create more bowls OR cut a smaller worksheet out of the larger one!
This next worksheet, "Recipe of ME!" can be used in tandem or in place of the first set. Omu draws the entire community in with her delicious smelling, thick, red stew! This worksheet is used to increase self esteem and identify what draws others to the young person you are working with.
For the literal children you could coach them to write words and characteristics that others like and appreciate about them. In metaphor you could have the child draw the ingredients in their version of “thick red stew”. On the outside you could create a recipe card of what each of the ingredients means – do the carrots mean kindness? Are the onions like empathy? Does the salt mean a little sass or humor?
Click HERE to get the free downloadable worksheet bundle! I would SO encourage you to buy this book - it's $15.00 right now on Amazon. Prefer smaller book stores? Find a list of independent Black owned bookstores HERE!
What other activities do you use to help with self esteem, connection, and relationships? Drop a comment below!
PS Want to know why I am so book obsessed lately? I've been living, breathing, and playing with books getting ready for my new bibliotherapy training - check it out HERE !
Books are one of my favorite ways to connect with clients and help them work towards their goals. I like to say that Play Therapy and Bibliotherapy are like chocolate chip cookies and ice cold milk – the perfect match! Or, if you are like me – cream and coffee, Vanilla Sweet Cream Cold Brew to be exact. I am a bit of a book fanatic and it always seems like I am adding “just one more” to the cart. My latest came in the mail last night and I can’t wait to dive in with clients.
Bibliotherapy (the use of books treatment of mental health) is used as a directive play therapy technique that I most often pair with Cognitive Behavioral Play Therapy…because, well, that’s my theory! When I’m not doing Child Centered Play Therapy of course, which sometimes might include books because the child can do “almost anything” they would like.
One of the things I absolutely LOVE about Bibliotherapy is it can be combined with so many other directive play therapy approaches depending on your specific theory and the client’s specific goals. Honestly – I have yet to find a topic that is NOT covered by a book. I’m sure it’s out there somewhere, waiting for an author to bring it to life!
Bibliotherapy is SO MUCH MORE than taking out a book and reading a story to a child. Bibliotherapy is the use of books in therapy to help children cope with emotional and behavioral problems as well as life changes. Literature is used not only to bring about an interaction between the child and therapist BUT with the child and the book as well. It also pairs the receptive experience of hearing the book with the expressive experience of engaging in a paired directive play therapy activity afterwards. Pretty cool, huh?
There are also two types of bibliotherapy - interactive and reactive. As well as processes to select literature (for your play room in general AND for your specific client) and stages of therapeutic change to look for. In short – it’s complicated BUT when you get the rhythm down SO worth it. My guess is that if you are working with kids and using books you may have some of this down already!
I have been keeping lists of books since my first “real job” as a therapist. I can remember wanting to soak everything in and being in awe of another therapist on my school based team talking about this thing called “Play Therapy”. She would often bring up books that might be useful for the clients I was struggling with so I started a word document, well because I love lists and organizing.
Since then that list has grown exponentially as I add books to my collection, hear about books in consultation, put books on my “most wanted list”, read articles, attend trainings that mention books, and casual amazon browsing. I once heard a therapist say they have over 300 books in their collection - #goals.
As I was compiling that list (over 230 books to be exact) for THIS training, I wanted to share with you some of my most loved books for emotional identification and regulation. I gathered the 70 books that are used and loved by therapists for this work, as I deeply believe that most children can benefit from general emotional regulation work. Click HERE for the free download!
The list includes the general emotional regulation and identification books as well as topics of anger, anxiety, sadness, and jealousy! I think these types of books are the most “bang for your buck” type of books because you can use them with so many different clients.
THEN it’s time to get creative – what directive play therapy activities could you use that will resonate with your clients to help deepen the Bibliotherapy process? Not sure where to start? Check out some inspiration and free resources for using Bibliotherapy and Play Therapy HERE, HERE, and HERE. To get inspired for how to grow your multicultural book collection check out this source list HERE!
Want to dive deeper? Check out my training Bibliotherapy: Healing Children Through Stories and Play Therapy! AND don’t forget to grab your free download for 70 Books for Emotional Regulation and Identification HERE! Let's Get Inspired!
Drop a comment below with YOUR favorite books you think therapists need to know about!
We have a serious problem. There is a significant diversity gap in the number of books published about and by People of Color.
Despite making up 38% of the population, in 2016 Black, Latinx, and Native authors combined wrote just 7% of new children’s books. In 2018 books were significantly more likely to be about animals (27%) than that featured Black/African American characters (10%), Asian Pacific Islander/Asian Pacific American (7%), Latinx (5%), or American Indian/First Nation (1%) characters.
In 2015? Only 14.2% of children's books featured diverse characters. In 2017 the Cooperative Children’s Book Center breaks it down that of the 3,700 books published that year 25% of books were about People of Color and only 6% of these books had authors or illustrators who were People of Color. This highlights that although there is an increase in books that feature diverse characters, they are not being authored or illustrated by People of Color.
So, what does this mean for Play Therapists? Well, I think it means that we have to be extremely intentional with how books featuring children of diverse backgrounds show up on our bookshelves in our play room. I would encourage you to take stock, right now, and evaluate what percentage of books do you own that feature diverse characters? And I’m not talking about a supporting character or diverse children in the background – actually featuring the stories and lives of Children of Color? What voices are missing from your collection?
Now, get a plan! What are you going to do, what are the specific steps, to help increase the diversity in voices of not just books featuring diverse stories BUT seeking out authors and illustrators who are Black, Latinx, Asian Pacific Islander, American Indian, or First Nation?
I wanted to share with you my favorite sources for diverse books to get you to “add to cart” these beautiful, wonderful, and diverse stories.
There is much work to be done – and lucky for us shopping for books is so much FUN! Let’s fill our bookshelves with these multicultural stories!
My home state of Minnesota is hurting. Black communities are hurting. This nation is hurting.
I want to own the responsibility of having the privilege of speaking to child therapists through this blog on a semi routine basis. I want to use this platform to acknowledge the current state of our nation and my home state of Minnesota. I am writing this against the backdrop of days of protesting in Minneapolis and around the country for the senseless murder by police of George Floyd. A father, a partner, a son, an athlete, a musician, and described by his friends and family as a beautiful spirit.
In all of this, I want to fully acknowledge my privilege - to turn off the TV, check out of social media, and not worry about my safety while living my normal life. I can drive my car, go to the store, be out in nature, and a million other things without worrying about my safety just because of the color of my skin.
I am hoping that in all of this trauma, continued racism, unrest, heaviness, and darkness, we also will not let the dialectic of light and hope go unnoticed. Communities are coming together to clean the streets, board up buildings, provide free crisis counseling to those in need, and secure food and supplies for the communities affected. Communities are coming together to grieve. Communities are coming together to heal. There is still much work to be done. It’s messy. It’s uncomfortable. AND let’s not also forget to honor the light.
To therapists of color and especially Black therapists, I’m sorry. I’m sorry for your pain, for your trauma, for your re-traumatization, for the reality of daily life in this country. I am listening. I see you.
To my fellow White therapists being an ally is a verb. Acknowledging and understanding our privilege, attempting to understand racism, prejudice, and the experience of people of color is continuous. It is our job, not the job of our friends, family, peers, and colleagues of color, to educate ourselves, learn, and act. We need to identify how to be stronger allies in dismantling racism and to be actively anti-racist. AND if you haven’t started in this journey you need to dig deep and ask yourself why. The best time to start was years ago, but the second-best time to start is today, right now.
Still don’t know what more you can do? Check out these anti-racism resources or this article. Also if you want to help Minneapolis and surrounding Minnesota communities affected check out this resource list HERE or to donate to Black-led, community-centered organizing efforts in Minneapolis check out a list HERE.
Now, as a therapist who sees children - if you aren’t a member already please consider joining the Facebook group “The Journey of Cultural and Racial Diversity in Play Therapy” run by Kadesha Adelakun, LCSW, RPT-S. It is a wealth and knowledge of resources to help support clients of color. Also, check out these articles HERE and HERE that prove that it is never too early to talk about race and racism with children. I would also encourage you to look through this resource list of 30 children’s books to help support conversations with children about race and racism. Not so sure about how to start this conversation with clients? Check out this guide from Elizabeth McCorvey, MSW, LCSW to stop hesitating and start the difficult conversations.
I would also encourage you if it isn’t something you do on a regular basis – take stock of your playroom and tools you use in tele-play. How many characters of color do you have in your miniature collection? Books featuring characters of color on your shelves? Puppets in your collection? Where are all of these placed in your office? When a client of color comes into your office what would their experience be like?
Also, I know I am nowhere near perfect and these questions to consider and list of resources are nowhere near complete. Drop a comment below with other resources you have or that are helpful to support clients of color within your practice! Let’s continue to show up for our clients, our colleagues, and our communities, continue to be an ally, and continue to promote anti-racism within our practice.
I'm Ann Meehan, an LPCC,