The Clinician’s Couch: a Thing of the Past?
written by Liza Bennigson, Associate Director of Marketing and Communications
In early March, as surreal rumors of a shelter-in-place order for the Bay Area began to percolate, CHC immediately began transitioning to a remote-first model of care for kids, teens and young adults.
Thanks to a HIPAA compliant healthcare platform on Zoom, the nonprofit mental health agency could continue to deliver best-in-class education and mental health services during shelter-in-place, with the level of trust and expertise the community has counted on for nearly 70 years. “We had been researching best practices and utilizing telehealth for some time,” says CHC’s Chief Executive Officer, Dr. Rosalie Whitlock. “So we were ready.”
Like many organizations going remote these days, CHC leadership quickly realized that its value is not confined to a physical building (despite its colorful, welcoming waiting room). It’s all about the people: the brave families who would do anything to help their one-of-a-kind kids overcome obstacles to reaching their full promise and potential, and the tireless experts supporting them every step of the way.
What took a little longer to realize was that, from the safety of clinicians’ homes and comfort of clients’ couches, a sort of magic was happening.
While restrictions were put in place all around us—no school, no sports, no parks, no toilet paper—teletherapy was removing boundaries, providing unprecedented access to people’s lives as they lived them.
Why It Works
You know that feeling you get after an eye-opening meeting with your mentor, life-affirming session with your therapist, or “aha!” moment-fueled coffee with a confidante? How you just wish you could bottle up their advice and take it home with you, or record everything they say to revisit when you need it most?
Just as Supernanny swooped in to tackle tantrums and sleep training on the spot, teletherapy offers families the help they need in real-time, on their home turf. It allows access to other members of the household, facilitating live parent coaching and sibling interventions. Many kids are more relaxed at home, sporting pajamas, showing off their Lego sets, leading virtual home tours, and introducing favorite stuffies. Dogs, cats bunnies and lizards instantly become therapy animals, easing tensions on-screen. Zoom backgrounds are a tool for everything from ice breakers to exposure therapy. By accessing teletherapy from the privacy of home, masks can be removed, both literally and figuratively, leading to greater expressiveness and human connection.
Therapy in Real Life (IRL)
CHC’s whole-child, multi-disciplinary approach features experts from a variety of fields working together to provide comprehensive and customized care for kids, teens and young adults. Here are some of the ways CHC experts have been leveraging teletherapy to collaborate with families to support their clients in meaningful and sustainable ways.
For children struggling with distance learning or disengaged with all-things academic, teletherapy allows therapists to offer encouragement, executive functioning coaching, and best practices for at-home learning. By breaking down actual assignments into manageable chunks, students learn organization, time-management and study skills. A CHC therapist recently coached the parents of an 8-year-old to create a daily timeline to help her track and manage her own schedule, boosting confidence and reducing reliance on her full-time working parents.
Many of us have accepted the fact that distance learning, while requiring a Herculean effort on the part of teachers and parents, is not how most kids are wired to develop academically or social-emotionally. But rather than worrying about academic setbacks, teletherapy can help children, teens and young adults leverage other opportunities for growth while sheltered-in-place. Empathy, family connection, creativity, patience, flexibility, frugality, responsibility, simplicity, gratitude, tolerance, compromise and mindfulness are all critical life skills that we can use this time to hone. And teletherapy is an invaluable tool to facilitate SEL development while coping with stressors like boredom, disappointment, family tensions, missed milestones and the lack of social outlets. For example, a CHC therapist recently led a role-play activity for an 11-year-old and her parents to practice identifying, reacting and talking about various emotions.
Teletherapy also opens new doors for Occupational Therapists (OTs). What better time to teach kids how to share space and set boundaries or create a functional and flexible learning schedule? OTs have been partnering with parents to utilize household items for visual motor integration, create obstacle courses to enhance gross motor skills, transition away from screen time, incorporate chores into sensory-processing activities (e.g., meal preparation, folding laundry, taking out trash, cleaning, etc.), establish bedtime routines, regulate emotions, practice social skills and control impulses through turn-taking games. For example, a CHC therapist recently guided the parents of a 5-year-old to make a yarn maze in the living room to practice directives like “step over” and “crawl under.”
Speech and Language Therapy
Speech and Language Practitioners (SLPs) have been making breakthroughs via teletherapy by helping families create optimal home environments to account for auditory processing challenges and other modifications normally used in the classroom (e.g., quiet study areas, processing and repeating directions, comprehension checks). SLPs have also advised families on how to implement IEP goals during home-based activities; promoted social skills by facilitating “playdates” or “hangouts” online; incorporated speech and language goals like articulation, inferences and summarization into the client’s academic program; provided visual supports to help students stay on task; and built confidence and communication skills to prompt students to ask for help. SLPs can consult with teachers to discuss ways to break down assignments for learners with diverse needs, and suggest books, videos and games for families to reinforce specific goals. SLPs can provide weekly parent consultations to share strategies and activities to practice the client’s goals within the parameters of existing structures and routines. Most importantly, assignments can be customized to reflect each client’s interests. A CHC SLP recently helped the parents of a 5-year-old incorporate nature vocabulary and concepts into family hikes. Another CHC SLP encouraged the parents of a 4.5-year-old to use a flying remote control toy as a means for the child to practice alerting his parents and siblings about obstacles the toy might hit.
For clients considering medication, shelter-in-place poses a unique opportunity for parents to be present during the acclimation phase, keeping an eye out for side effects and managing challenging transitions. Other parents might be thinking about decreasing their child’s dosage or taking a “medication vacation” with the absence of triggers like academic pressures and social stimuli. Either way, children can adjust to increased or decreased dosages in the comfort and privacy of their own homes. Via telehealth, seasoned adolescent and child psychiatrists can prescribe and manage medication needs to reflect changes in moods, behaviors and other variables.
When one member of the family is struggling, the whole family struggles. Teletherapy can help improve communication and family dynamics by bringing an impartial clinical expert into the equation, helping resolve issues like:
- Shifting roles (“How am I supposed to be a parent, a teacher, a professional and a human being, all at the same time?”)
- Sibling conflict (“How do I help them get along?” “Are there activities that they can do together that don’t involve me?”)
- Marital tension (“I have never spent this much time with my partner. Our parenting styles are clashing now more than ever.”)
- Family stress (“We are all getting so tired of each other! How can we create boundaries and personal space to survive the next few months?”)
Group Therapy + Support Groups
Sometimes we need to vent about the people we love most. It’s normal and healthy to share grievances, ask for help, and support others who are having a hard time. Parent and peer groups are ideal settings for these conversations and many of us miss the ability to interact with people going through similar challenges. Using teletherapy, we can connect with others from the safety of our own homes. In a group setting, we can find guidance and acceptance from people who understand, and realize that we are not alone.
Even the most at-risk teens with suicidal and self-harm thoughts and behaviors can access comprehensive DBT services through the RISE Intensive Outpatient Program, featuring a collaboration of experts from CHC and Stanford Children’s Health. The program is fully operational via teletherapy, allowing it to expand its borders beyond the Bay Area, to serve teens and families that wouldn’t otherwise be able to attend 4-day/week live sessions in Palo Alto. Thus, teletherapy is helping more teens build lives worth living and avoid ER visits and hospitalizations during the pandemic and beyond.
One of the most significant disadvantages of shelter-in-place regulations is the complete and sudden absence of social experiences. School campuses, parks, birthday parties and extracurricular activities are where kids learn how to interact, cooperate, negotiate, compromise and work as a team. While certainly not a replacement for the real thing, group therapy offers an opportunity to practice these skills virtually, and reduce feelings of isolation, loneliness and insecurity. During shelter-in-place, CHC has continued running its High School and Middle School Multi-Family DBT Skills Groups remotely, and recently launched an “Apart, Together” processing group for teens with mild to moderate mental health symptoms who might benefit from peer and professional support.
Meanwhile, parents can access CHC’s online support groups, classes and coaching to help ease anxieties around responding to children’s challenging behavior, supporting teens during shelter-in-place, and setting more realistic expectations for their kids (and themselves). CHC’s ADHD Parent Support Group is growing, and a new “Parenting during Uncertain Times” group recently launched. In the past 6 weeks, CHC has conducted 14 live webinars for parents on everything from “Is My Child Falling Behind?” to “How to be a Parent, a Teacher and a Human (all at the same time). By allowing audiences to access live webinars from home, attendance has doubled as compared to in-person classes for the entire year prior.
Support + Self-Care
When it comes down to it, it’s really up to each of us whether we consider mental health “essential” or “non-essential.” But the consequences of not taking care of ourselves and our families during this pandemic—emotionally and physically—are as dire as the virus itself.
For now, we don’t have access to teachers who pull us aside at pickup to tell us that they’ve noticed concerning behavior from our child, or a parent who saw our child being bullied on the playground, or a coach emailing us about our child skipping practice, or even our child’s friends sharing the latest drama during carpool. “At CHC, we believe in the promise and potential of every child as well as the capacity and innate strength of every parent,” says Dr. Ramsey Khasho, Chief Clinical Officer. “But in order for us to thrive, we need a village, and the time has come for us to learn how to tap into that village in new and innovative ways.”
Right now our village is sheltered-in-place, protecting their families, experiencing good days and bad days, just like us. Without the additional eyes on our kids, the burden of responsibility and opportunity to intervene falls on us as parents. But as we all navigate challenges that we never could have anticipated, we find unprecedented opportunities for support along the way, preparing to reemerge even stronger than before.
The Future of Therapy?
We will get through this. Someday, people will feel safe about leaving the security of their own homes and close-knit circles. When that day comes, many may opt to return to the therapist’s office and once again experience that human connection face-to-face. But the idea of therapy may be changed forever for families who appreciate a safe, convenient and comprehensive continuum of care. “And for those who don’t live anywhere near a trusted clinician, can’t get an appointment at their local practice, want to work with a bilingual or culturally-relevant therapist, lack transportation or have vulnerable teens going off to college in other cities, teletherapy can open doors and offer hope,” adds Dr. Khasho. “And isn’t that what we’re here for, after all?”
CHC teletherapy services are available now. Care Managers can arrange a free 30 minute Care Consultation so you can explore options with an expert. We invite you to call or email our Care Managers at 650.688.3625 or firstname.lastname@example.org to set up an initial Parent Consultation appointment.