How Will Online Counseling Work with Children and Adolescents?

By Abigail Squires, MS, LCMHCA

Many parents, guardians, and clients themselves wonder —and are even skeptical—of how a video therapy session might work.  While we as therapists are grateful to be able to use the telehealth platform to help people during this difficult time, this virtual service can certainly come with its complications.

After about a month of conducting video sessions with my child and adolescent clients, I can say that I am pleasantly surprised with how effective this has been. With all the changes in our world lately, I was concerned about how this would affect my weekly sessions – especially with counseling for children and adolescents. Consistency in therapy is especially important during a time where so much is unknown.

If you are wondering what a video session looks like, I would love to explain what I have been sharing with my clients and their parents and guardians.Picture of Video Counseling with child

I have been using a virtual video platform that does not require either the client or me to install anything on their device in order to use it.  That makes for a seamless start to the session.

First, I send the client a link to the session. When they click on the link, a page opens in their internet browser and asks them to enter their name. Once the client has checked in, I will click on their name to begin the session. These programs typically work best if all other windows and applications are closed while using it.

I ask that a parent or guardian be present to help with opening the session, schedule future appointments and payment. This allows me the opportunity to greet the parent and ask how the week has been going. I understand that a lot of parents are currently very overwhelmed. It feels so helpful to connect for even a few minutes. Of course, parent sessions conducted through video are also encouraged!

Parents then leave the room and I begin the session. I request that the client video chat me in a private space so that it feels comfortable and confidential just like our in-person sessions. Clients are asked to have paper and something to write with. Art supplies such as colored pencils or markers are a bonus, but certainly are not required.

I have been enjoying having an interactive “Q and A” type check-in with my clients where they can write down their answers and keep them secret until we go over them together. Games and other icebreakers are implemented at the beginning of our sessions. Other therapy methods are also used and clients are asked to write answers or draw pictures on their sheet of paper that we can discuss. The counseling techniques I use will change from session to session. However, being able to show clients my examples and then see their work has been more interactive than I could have imagined it would be.

Some of my clients are used to pulling out toys, games, and other materials in my office during session. I feel that this hands-on approach can still be embraced by having them gather some items prior to our session such as: Legos, building blocks, Play Doh, stuffed animals, or whatever the client may have, in order to include that element.

Depending on the client, I might also ask them ahead of time to have any previous homework I assigned to them, their journal, or other materials we have been working on. For some clients, I continue to assign homework that I will email to their parent or have the client write down in their agenda. The nice thing about this is that nothing can be forgotten at home!

Though sometimes the sound breaks up, and sometimes the screen becomes pixelated, these sessions have allowed some valuable time to connect one-on-one with my child and adolescent clients. Coronavirus (COVID-19) has evoked anxiety and distress for many of us. It is important to remember that we have all had our schedules and routines turned upside-down. I am grateful that I have been afforded the opportunity to meet with my child and adolescent clients who are able to share their concerns and feelings in a safe environment.  The benefits of counseling still continue for those who need it – even through video sessions!