Telehealth With Children

 

We have collected some clever ideas from some clever therapists about doing play therapy using telehealth, and are happy to share them!

A good length for telehealth play therapy is approximately 30 minutes, of course depending on the child.  If it goes longer that's fine too, but 30 minutes is a good starting point. Use the rest of the session time getting input from the parent/guardian and talking with them about the course of therapy providing them with coaching and support.

Give parents a preview of what the session will look like so they can prepare ahead of time.  Send a supply list (if needed, or just a heads up).

 

Show me your space.  If the child is using a mobile device like a smart phone, laptop or iPad, ask the child to show you their home, or their room. (Make sure you clear this with their parent/guardian ahead of time). Have them show you their favorite things in the space.  Great for building rapport and helping the child feel like you are part of their world.

Create a calm down bag.  Make it super personal, ask questions about each thing that goes into it.  How would you use it?  Show me.  Make a list of when it could be used (they can write or you can write).  If you write send a pic of it after to the parents.  As homework ask the child to continue adding to the bag until you see them again.

Show me your worries.  1) We need something to represent BIG worries, medium worries, small worries.  What would go in the BIG worry category?  Is there anything in the room to represent that worry? Could they draw it?  Have a page for each category. 

 Ask, "How can we talk to these worries? What would you say?"

 Homework: ask the child to talk to their worries, see if they can make any of them smaller. 

 

Favorite books.  Have them bring a few of their favorite books to the session.  You do the same in case they don’t bring any or it goes awry. Have them tell you the stories, or you can read them as they show them (or their parent). 

Prompts: -If they were a character in the book how would it change?

            -If worries took over the book how would it change? (sadness, silliness, kindness, happiness, rudeness, etc).

            -Let’s make a sequel!

 

Show me how you help around the house.  Show me your routines.  What are your chores? What are you proud of?  What are you able to do all on your own? How have these changed as you have grown? (parent assistance). What else has changed about you? (Make visuals of this, turn this into art, stuffed animal play, Legos, etc).  But show me what has changed about you and blossomed?  (as the therapist you contribute to this as you have seen them grow).

 

Favorite games.  Ask the child to move your game piece. Have them teach you how to play. You can give prompts etc. the same way you would in the office. 

 

Interpersonal skills/empathy- Have a tea party/dessert party/lunch date.  Who would they invite (if younger have stuffed animals there.  If older just have them act out their friends/siblings and what they would do)?  What would the rules of the party be?  You can act out poor/good behavior.  Change roles. 

 

Magic wand. Have them choose a magic wand. They get to go around the room and turn things to magic.  What would it be?  What would change? How can we use this when you are struggling?

 

*All the while observing and strengthening parent/child interactions.  Help clarify, ask questions, “wonder”, etc.  Afterwards you can debrief with parents if necessary.

Bibliotherapy: Giraffes Can’t Dance.  Check out the Giraffes Can't Dance blog for ways this book can be used for growth mindset, self esteem, regulation, and social skills. If you don’t have this book there is a link to you YouTube video of the book.  You can send the client the link and they can pull it up on their computer (  https://www.youtube.com/watch?v=vZjsLK5vwNU  ) – OR if your program has a screen share it can be co-viewed this way too! This blog has a download packet of three printable worksheets to use BUT if a client does not have a printer you can ask the parents to have markers and paper ready and the client can create the worksheets themselves! Supplies: Giraffes Can’t Dance (or video), printed handouts (or computer paper), markers, crayons, pencils, or pens.

Guided Imagery: Safe Calm Space. Have kids watch Peace Out Guided Relaxation For Kids – Balloon by Cosmic Kids Yoga. Explore where their balloon took them and have them draw a picture of their safe, peaceful, calm space. Supplies: Paper, crayons, markers, or colored pencils. There are several versions available at

https://www.google.com/search?client=firefox-b-1-d&q=peace+out+guided+relaxation+for+kids

Pick a Miniature: Your client’s likely have a giant collection of their own miniatures in their home.  You could have clients pick a miniature for a wide variety of feelings and ask them to explain how each miniature is like that feeling.  You could have them pick miniatures to represent their strengths, their goals, or what they are like when they are with each member of their family.  The sky is really the limit here. Supplies: Have the client gather a collection of their own miniature objects.

Mindfulness Scavenger Hunt: Have the child do a scavenger hunt finding and collecting five things they see, four things that make noise, three things with texture, two things that smell, and one thing they taste.  Supplies: Printer OR have the therapist read off each item one by one.

Gratitude Scavenger Hunt: The link below takes you to an amazing gratitude scavenger hunt with free printables. Supplies: Printer OR have the therapist read off each item one by one.

Mindfulness: Get a free printable download of 12 “Mini Mindfulness” activities for kids here and 8 free printable breathing exercises here.  Supplies: Printer (therapist only) OR read a copy of the exercises on your screen or alternative screen.

Bibliotherapy: Last Stop on Market Street. Check out my blog HERE for how I use this book for gratitude.  Don’t have the book? No worries – there is a version HERE that the author reads on YouTube. If you worry your client isn’t old enough to click the link the parent can sit in and the child and parent can watch the book together. Supplies: Last Stop on Market Street (or the video), a thank you card OR paper and markers, crayons, or colored pencils.  https://www.google.com/search?client=firefox-b-1-d&q=gratitude+scavenger+hunt

Emotional Hedbandz: Get these inexpensive printable feeling cards at the link below and hold it up to the camera without looking (or disable/cover the part of the program where you can see yourself). Explore emotions by taking turns asking one question each about the emotion until both emotions (or all with family) have been identified.  The low budget version? Have the family write feeling words on small slips of paper.  BONUS if you can find elastic, string, or a headband to hold the feeling card up.  Supplies: Printer OR slips of paper to write emotion words on.   https://www.teacherspayteachers.com/Browse/Search:headbands%20game%20emotions

Quick Draw: This is a Terry Kottman technique and can be found in her book Doing Play Therapy.  For this activity you agree on a fairly short time limit.  The limit doesn’t actually matter and it can be altered and flexible.  I usually go between 30 seconds and 2 minutes. Have the child get several pieces of printer paper and fold them into quarters. Each section is a new drawing. Using the time limit you instruct a child to make a new drawing in each section.  Prompts can be anything you think would fit the child and can include things like drawing their proudest accomplishment, what mad looks like, what they worry about the most, the place they are the happiest, their favorite subject in school, the last time someone was angry with them, the last time they felt guilty about something, etc.  After you go through 4-8 rapid drawings you circle back and use each drawing as a jumping off point for a discussion. Supplies: Paper and crayons, markers, or colored pencils.   

Feeling Heart: Help young people understand and articulate all the complex and complicated feelings that are in their heart.  Unsure of what a feeling heart is?  Check out an example and free printable worksheet here! Supplies: Printer and crayons, markers, or colored pencils.  No printer? Have the client or their parent draw out a heart on plain paper.

Music Body Outlines: I talk about these amazing feeling faces here BUT they also have body outlines included in the free printables!  You can encourage the child to do a body feeling map OR one of my personal favorites play three songs of varying nervous system activation (ie soothing, happy and upbeat, angry and aggression) and have them listen to each song through.  After each song have them map out what feelings they felt, where they felt it in their body, and compare the three.  Supplies: Printer and crayons, markers, or colored pencils. Don’t have a printer?  Coach their parent to make three sheets “ginger bread man style” body outlines.

Recipe for a Good Friend: Use the book This Moose Belongs to Me to process what it means to be a “good friend”.  Process what expectations Marcel has for his moose and if they are realistic.  Don’t have the book – watch the video here! Develop your own recipe for a good friend with this free download.  Be creative and check in with parents ahead of time about what snack objects may be on hand at home.  Brainstorm what ingredients are used to make up a “good friend” and include a recipe of how to put it all together.  The sky is the limit!  For fun you can use trail mix to identify each trait (ie. raisins = fun, M&Ms = loyalty, etc.).  You can also alter this for what it means to be a good family member and enjoy the snack as a family!  Lastly – if there is no way to have the actual trail mix – brainstorm what would be in the mix and you can use this as a bridging activity and make the actual trail mix when you are back in the office! Supplies: Printer and crayons, markers, or colored pencils. Snack food to make a “trail mix”.  Don’t have a printer?  Use a blank sheet of paper to create a recipe or snag a parent’s blank recipe card.

 

Big Feeling Eaters: Check out my blog post here about Big Feeling Eaters complete with how to make this emotional containment activity out of a Kleenex box.  This is a great strategy for emotional regulation!  Are you worried the family you work with won’t have a Kleenex box?  You can make this activity out of an envelope (because almost EVERYONE has those) or to be honest with some thoughtfully folded and taped paper.  Check out some examples here and here! Supplies: Kleenex box, craft paper/wrapping paper, and art supplies OR envelope and art supplies.

Yoga: Cosmic Kids Yoga has an amazing YouTube channel with a TON of exciting yoga practices (Frozen, Harry Potter, or Pokémon anyone?) OR download these FREE kids animal yoga pose cards. Supplies: Yoga mat OR a towel works just fine!

UNO: You can play UNO online with clients using sites such as this one. Use the same “therapy rules” you have in office.  My favorites are identifying feeling triggers, warning signs, and coping skills for every color switch.  For me green = anxious, blue = sad, yellow = happy, and red = mad.  Don’t have a screen share option?  You can use what is called a “Tab Resize Extention” for Google Chrome to allow the screen to split.  Supplies: None!

Sand Tray: Okay – now most of our clients do not have a sand tray on hand at home.  BUT most of them have miniature toys and computer paper.  For this activity have the client or parent tape together four sheets of computer paper in a rectangle.  Have the child or parent gather up the typical “categories” including people, animals, fantasy figures, plant life, minerals, environments, transportation, miscellaneous objects.  You can have the client start out by drawing what kind of ground the “tray” will have on the paper. Then, do your sand tray work as usual! Supplies: Miniatures, art supplies, paper.  

New Tune, New Mood: Identify with the child what mood they would like to have in the moment.  This could be happy, excited, calm or anything else.  Create a playlist with the child of their favorite songs that get them in this mood.  They could design an album cover and list the songs out.  You can play the songs together and encourage the child to move their body in what ever way feels comfortable for them.  Supplies: Paper and crayons, markers, or colored pencils.

Holding on and Letting Go: Have the child trace each one of their hands.  In one hand (or just use the fingers if you want less prompts) write what the child has control over.  You can write a list draw pictures, or a combination of both.  In the other hand write what the child doesn’t have control over and needs to “let go”.  Again - use words, pictures, or a combination.  For further deepening you could have the child separate the page and “destroy” what needs to be let go.  That could be ripping it up, crumpling it, throwing it in the garbage, etc.  Supplies: Paper and crayons, markers, or colored pencils.

Distress Tolerance Skills

Sometimes you’ll run into a problem that’s simply out of your control. It can be easy to think “This isn’t fair” or “I shouldn’t have this problem”, even though those ways of thinking only make the pain worse. Radical acceptance refers to a healthier way of thinking during these situations. Instead of focusing on how you would like something to be different, you will recognize and accept the problem or situation as it is. Remember, accepting is not the same as liking or condoning something. Learning to accept the problems that are out of your control will lead to less anxiety, anger, and sadness when dealing with them.

Situation: You find out that you were not selected for a job where you felt that you were the best candidate.

Typical Thinking: “This isn’t fair—I did everything right! Iwas the best one there. They can’t do this to me.”

Radical Acceptance: “It’s frustrating that I didn’t get the job, but I accept that they felt someone else would be a better fit.”

Self-Soothe with Senses
Find a pleasurable way to engage each of your five senses. Doing so will help to soothe your negative emotions.

Vision - Go for a walk somewhere nice and pay attention to the sights.

Hearing - Listen to something enjoyable such as music or nature.

Touch - Take a warm bath or get a massage.

Taste - Have a small treat—it doesn’t have to be a full meal.

Smell - Find some flowers or spray a perfume or cologne you like.

Distress Tolerance Skills
Negative feelings will usually pass, or at least lessen in intensity over time. It can be valuable to distract yourself until the emotions subside. The acronym “A.C.C.E.P.T.S.” serves as a reminder of this idea.

Activities
Engage in activities that require thought and concentration. This could be a hobby, a project, work, or school.

Contributing
Focus on someone or something other than yourself. You can volunteer, do a good deed, or do anything else that will contribute to a cause or person.

Comparisons
Look at your situation in comparison to something worse. Remember a time you were in more pain, or when someone else was going through something more difficult.

Emotions

Do something that will create a competing emotion. Feeling sad? Watch a funny movie. Feeling nervous? Listen to soothing music.

Pushing Away
Do away with negative thoughts by pushing them out of your mind. Imagine writing your problem on a piece of paper, crumbling it up, and throwing it away. Refuse to think about the situation until a better time.

Thoughts
When your emotions take over, try to focus on your thoughts. Count to 10, recite a poem in your head, or read a book.

Sensations
Find safe physical sensations to distract you from intense negative emotions. Wear a rubber band and snap it on your wrist, hold an ice cube in your hand, or eat something sour like a lime.

© 2015 Therapist Aid LLC Provided by TherapistAid.comRadical Acceptance

Coping Skills

Coping skills for staying in the present

Here's the 54321

Name 5 things you can see in the room with you.

Name 4 things you can feel ("chair on my back" or "feet on the flood)

Name 3 things you can hear right now ("fingers tapping on the keyboard" or "TV")

Name 2 things you can smell right now (or, 2 things you like the smell of)

Name 1 good thing about yourself.

Safe Place

"Creating an Imaginary Safe Place"

Imagine a safe place- can be real or imaginary  What do you see - especially colors?

 What sounds do you hear?

 What sensations do you feel?

 What smells do you smell?

What people or animals would you want in your safe place?

Imagine a protective bubble, wall, or boundary around your safe place Imagine a door or gate with a guard at your safe place.

Imagine a lock and key to your safe place and only you can unlock it.

You can draw or make a collage that represents your safe place.

Choose a souvenir of your safe place- a color, an object, a song.

Keep your image of your safe place so you can come back to it when you need to.

Simple Mindfulness Exercises

Journal

Sit down in a quiet place, set a timer, and journal for 10 minutes.  Don’t think too much about what you are going to write, just start with how you are feeling right now, in the moment.
 

Walking

Go for a walk, without listening to music or a podcast.  Engage your senses and notice the world around you. Turn inward and notice how your body feels, and notice any emotions you may be experiencing.  Don’t overthink or over analyze - just notice.  

Mindful Eating

Let's say you decide to do mindful eating with an orange. Your job is to eat the orange slowly, without rushing. Mindful eating means really paying attention to what you're eating. You can do this mindful eating exercise with your eyes open or closed. 

  1. Start by holding your orange. Roll it in your hand. Notice how it feels.

  2. Hold the orange near your nose. What does it smell like? Take a whiff of the bittersweet smell of the orange peel.

  3. If you have your eyes open, notice how the orange looks. Pay attention to whether the skin is smooth or bumpy. If you hold it firmly, is it squishy?

  4. Slowly peel your orange, paying attention to how it feels in your fingers. Notice the juiciness, and whether the inside of the orange smells different from the outside.

  5. Is your mouth watering? Go ahead and taste your orange. Notice how it feels on your tongue, and against your teeth. Notice the flavor, the texture, and the juiciness as you chew each piece slowly. Take your time as you chew, taste, smell, and feel each bite of your orange.

 

Mindful Breathing

With this exercise, you focus your attention on breathing. You want to pay attention to your breath in an easy way — on purpose, but not forced.

  1. Sit up in a comfortable way. Close your eyes.

  2. Notice your breathing as you inhale and exhale normally. Just pay attention to your breath as it goes in and out. Can you feel the place where the air tickles your nostrils? 

  3. Pay attention to how the breath gently moves your body. Can you notice your belly or your chest moving as you breathe?

  4. Sit for a few minutes, just paying attention to your gentle breathing. See how relaxed you can feel just sitting, breathing in and out. 

  5. When your mind starts to wander and think about something else, gently guide your attention back to your breathing.


 

Mindful Word

  1. Think of a word that seems calm or soothing. This could be a word like "peace" or "love" or "peaceful" or "snowflake" or "sunlight" or "hum" or "calm."

  2. Think the word to yourself. Say it silently and slowly in your mind. Say your word to yourself with each breath you take, in and out. Keep your attention gently focused on your word.

  3. When your mind wanders, guide your attention back to your word, and keep saying it gently and slowly while you relax and breathe.

  4. Can you do this for a whole minute? Can you do it for 5 minutes?