201 | Telehealth for Child-Centered Play Therapy: Does It Work?

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You're listening to the Play Therapy Podcast with Dr. Brenna Hicks.

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Your source for centered and focused play therapy coaching.

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Hi, I'm Dr. Brenna Hicks, The Kid Counselor.

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This is the Play Therapy Podcast where you get

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a master class in child-centered play therapy

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and practical support and application for your

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work with children and their families.

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In today's episode. I am answering a question from Laura

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and she is curious about

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doing CCPT

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via telehealth

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and I've been given this question quite a bit in

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the Collective and we've chatted through this several times,

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but not necessarily on a podcast.

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So Laura, I really appreciate you emailing in and asking about this.

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So I'm going to read her question and we'll go through this in just a second. However,

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yesterday

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was the 200th episode.

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So this is officially 201

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and we posted about it in the Collective,

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but I wanted to just take a moment to say a huge thank you,

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Eric and I, Eric does all of the behind the scenes podcast stuff.

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So I know you only ever think about me, but

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Eric is just as involved in the process.

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He does all of the editing, all of the transcribing,

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all of the images and everything, just

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I record and send it off to him and he takes care of everything else. So

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we both as a team are so grateful for each and every one of you.

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We hit 350,000 downloads yesterday as well as our 200th episode.

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What an incredible testament to your faithfulness, your commitment

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and your love of CCPT.

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And when I started this, I had absolutely no idea how this would unfold. So,

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super grateful to you all.

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Thank you so much for the 200th episode yesterday and the 350,000-th download.

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Oh my goodness.

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That means that you all not only listen to the podcast,

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but you listen to every single episode.

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So

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really grateful. Thanks so much.

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Wanted to celebrate that with you because this isn't a Brenna victory.

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This is an all of us victory.

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And that means that all around the world, kids are

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getting treatment that they need and

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they're getting skilled treatment and intentional treatment

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and the kids are better, the families are better and we are better clinicians.

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So huge moment to celebrate. Thank y'all.

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Give yourselves a little high five or a pat on the back or something. Ok.

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So let's get back to Laura's question.

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So she says

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that she discovered CCPT through a play therapy course in her program. What?

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That's exciting.

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OK. So then she says,

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can CCPT be done over telehealth?

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I recently started my clinical internship at a community behavioral health center

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in Washington. Is it common for clinic? Oh, sorry.

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It is common for clinicians at this site to see many of their clients

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over telehealth rather in person due to access barriers to getting into the office.

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For example, single parent has to work and can't drive et cetera.

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I'm about to start seeing an 11 year old

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client who was previously seen in a school setting

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by a clinician. From my internship,

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the child is transitioning to a new school

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so they won't be able to see that clinician anymore. Hence the transfer,

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the clinician,

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let me know that it is likely that I will see this client via telehealth

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if that ends up being the case and we can't find a way to meet in person.

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How can CCPT be done over telehealth? I only ever hear about remote play therapy

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being extremely directive,

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but I don't want to go down that path because of the medium of our sessions.

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How can I embody the pillars of CCPT over telehealth? Thanks so much for all you do.

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All right, Laura from Washington State. Thank you for the email and

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let's get some precursory discussion out of the

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way and then I'll share some additional thoughts.

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So first and foremost,

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it's common for clinicians at the site to see many of their clients over telehealth.

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Ok. I think that that's appropriate and makes sense for kids

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14 and up

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and then obviously into adulthood. So, if the client is 14 or older,

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I think telehealth can work

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and they've proven that it is

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effective.

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I'm air quoting effective because it's never as effective as it is in person.

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But

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I think that 14 and up with abstract reasoning with the ability to

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verbally process things with the ability to

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cognitively and intellectually reason through scenarios.

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I think someone 14 and older could benefit from telehealth.

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Since you're talking about an 11 year old, we immediately rule out telehealth.

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And

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I know that might be a shock to some of you. And I know many,

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many child centered play therapists even or children's therapists

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offer virtual sessions and in person sessions,

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let me share a story related to this topic

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when COVID hit, Florida shut down for six weeks.

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So we scrambled as a center.

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I had multiple therapists and we were all full caseloads with kids.

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So we had, gosh, I don't even remember how many kids we might have had.

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I wanna say maybe 80 kids

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on our client

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roster.

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We did not switch to

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CCPT online.

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We converted

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70 or so families to CPRT online

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because

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we did not have a proven model that CCPT was effective virtually.

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But we did have a proven model that CPRT

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was effective virtually.

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So we converted 90 something percent of our families to CPRT

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and we did a 10 week CPRT program virtually with families and then parents were doing

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CCPT in their homes in lieu of the children coming to us.

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And then as soon as the CPRT curriculum ended, 10 weeks later,

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some

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did not return because the relationships that they'd built

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and CPRT had created change in their families.

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And we just did one final termination session with the child

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and then others were early in the process and needed more sessions.

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So then we easily transitioned back into us as the therapist working with the child.

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It was like we just took a 10 week break

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and parents stood in the gap for us in between.

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So I'm telling that story to let you know,

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I'm not against telehealth as far as sessions.

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However,

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play therapy

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is predicated on

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you being present and engaged

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and able to participate

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in play

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and you can't do it on the other side of a screen.

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So the few parents that did not convert to CPRT,

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we gave them the toy list from CPRT

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and we had them set up a play area just like if they were participating

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in CPRT and going to do a play session with their child at their home,

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they set up the U shaped

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on top of the rug toy layout, just like CPRT recommends.

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And then they set up the camera for us

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and

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they left the room and the child played while we sat on the

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other side of the screen and we quote did CCPT.

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But let me share my personal experience with that.

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It worked for the first one or two sessions

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because the child was actively in the midst of work.

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So when they were in our play rooms,

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they were right in the middle of certain themes, certain types of work

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dealing with their issues.

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So they were able to continue that for 1 to 2 weeks.

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But the excitement wore off, the new wore off the

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allure of having, you know, the screen and you're in your own home,

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all of that disappears

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and they start covering the camera with tape

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or putting the tablet or phone flat so that you can't see anything

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and they start carrying you around and showing you their

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dog and their kitchen and their bike and their room.

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And which is that connective and relational? Sure.

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But is it CCPT? No.

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And when they can't ask you to play with them

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when you can't pick up a sword and sword, fight with them

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when you can't be the cop and they'll be the

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robber when they can't color a picture with you.

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When it, it prohibits all of the things that make CCPT so rich for a child.

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So just because you're there and just because you're using the therapeutic

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interventions verbally,

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you know, you're using the pillars, you're using the reflective responses

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that hasn't changed,

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but the engagement and the interaction is ripped out of the process

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So only,

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you know,

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one or two weeks worth of valuable work took place as far as CCPT was concerned.

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Did we preserve the relationship? Yes. Did we maintain connection?

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Yes.

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Did they feel like they hadn't lost

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that

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investment in

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us as a therapist? And the time that we spent together? Yes.

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Were there benefits is what I'm trying to say, of course.

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But did we see any substantial meaningful work during those six weeks?

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We didn't really,

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but guess what happened as soon as they came back and they were back in the playroom,

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they took off. Why? Because it was a holding pattern.

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It was let's get through this where I can't see you and I

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can't wait to come back and be with you in the playroom.

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So my experience is that

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it is not effective. Does it

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provide some benefits in other arenas? Of course,

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but can the child do the actual deep work that they need to do?

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in my experience? No.

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And in all of the other therapists at my center, we all were in agreement

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that it was almost like we hit pause for six weeks and

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then as soon as kids could come back into the play room,

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it was like, oh, ok, thank God. And then they were right back into where they left off.

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So Laura, I hope that you can see this child in person

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and let me speak to what

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was said earlier in your email.

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You said

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it's common for clinicians at the site to see clients

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over telehealth because of the barriers getting to the office.

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The only reason that's taking place is because

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the center doesn't have a policy against it.

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When clients call us, we set really clear expectations

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and we have never once given one family an indication

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that virtual sessions are even an option because they're not for us.

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So if a lot of clinicians are seeing kids virtually,

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it's because the center doesn't have a policy against it.

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And I personally, I don't mean for this to come across as harsh or abrasive.

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But I personally think that's doing a disservice to the families

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and

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parents don't know any better parents would love the convenience of saying,

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oh good.

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I don't even have to drive you anywhere. You can just get online and do a session.

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It's not effective for kids.

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And our number one job as a child-centered play therapist is to do what

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I know my coaching, people are screaming at me, advocate for kids

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100% of the time always and forever.

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So Laura, I would argue that you advocate to this family

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that you really want this to be effective and you really want

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this to be helpful and you want to give everything you can

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to ensure the outcomes are what the parents are really

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seeking in wanting the child to be in therapy.

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And the best way to do that is to be in person and it's same time, same day every week.

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And there are no other alternatives.

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If you set clear expectations, clear boundaries and you give a why

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the rationale is always important though, why matters.

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So my therapist tell me all the time.

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So

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we have to make it clear that there's a reason

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for us saying you need to get your child here.

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Your child needs to be in the playroom with me in person

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real time, face to face

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and we have to do this work together.

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So if you advocate and you educate,

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there should be no reason why this family will not be willing to come to a session

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and look if they

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have to work,

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then maybe you offer a 5pm slot to this family so that it can be after work.

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There are ways around work schedules, there are ways around single parenthood,

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there are ways around lack of childcare

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and quite honestly, one of the things that I,

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I train my people and the coaching and one of

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the things I talked to the therapist at my center about

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is

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the reason that someone gives you is never the real reason.

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So if they say, oh, we can't afford it, we have to stop. That's not the real reason.

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If they say, oh, I have to work, I can't bring them. That's not the real reason.

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That's the lip service reason,

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but there's always more to the story.

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So without knowing the rest of the story,

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it's our job to be very clear and very intentional

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about what our expectations are and what best practice is

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and why we have policies to ensure that this is going to be effective.

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So, Laura, I hope that encourages you.

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I hope that encourages all of you because for those of

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you that work at a center that maybe offers virtual sessions,

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I don't know if you wanna say put your foot down or

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draw your line in the sand or put your flag in the,

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in the earth.

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I don't know what you wanna say, but at some point, you need to say

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I am only going to see kids in person

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because that is what CCPT is. There has never once,

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not once ever

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been something that says you should offer CCPT virtually,

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no data has ever come out and said that.

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So best practice is always to do what we know works

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and we know that face to face in the playroom is extremely effective.

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So that's what we need to be doing.

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All right, Laura from Washington. Thank you so much for the rest of you.

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Thanks for being a part of the Play Therapy Podcast family.

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I love you all so much. Please, please, please. If you're coming to the conference,

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sign up for the meet up, I'm trying to get a headcount.

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So I need you to go to playtherapypodcast.com/meetup

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and RSVP

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just so that I have a knowledge of how many people are coming

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already. A lot of you have. Thank you so much. If you've already let me know

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and we're gonna have to figure out what we're gonna do and where we're gonna be.

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So I'm trying to work out logistics.

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All right, love y'all. Have a great day. Bye.

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Thank you for listening to the Play Therapy Podcast with Dr

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brenna hicks. For more episodes and resources.

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Please go to www.playtherapypodcast.com.