HOW BEST TO STRUCTURE AN ONLINE THERAPY SESSION by Karolina Koman
During the uncertain time of lockdown and self-isolation because of the coronavirus pandemic in the UK in 2020, we are about to enter the online therapy world. Virtual creative arts therapy sessions will be offered to children in a form of interactive videoconferencing and will require a space for the therapy to be conducted privately, robust internet connection and a laptop/ tablet with a camera, microphone and a speaker – a mobile phone would not be appropriate. As we work with children, we will need to be in contact with a primary carer willing to facilitate set-up. The primary carer might be needed to support the child throughout online session or could be included in the therapy where appropriate, particularly when working with younger children, those with additional needs, and new referrals. An additional online consent would need to be gained, outlining the procedures in place for the online format, how we would ensure confidentiality on an online platform, and including safeguarding protocols. All the sessions will be recorded to ensure everyone is protected.
The online practice may be slightly different to in-person practice at schools which tends to be largely child-led and more spontaneous. The activities will depend on what is creatively possible on a chosen online platform. We will be using Zoom as it offers end-to-end encryption and is GDPR compliant. It also offers a better platform for musical activities and has some good safeguards for confidentiality. Creative arts therapy sessions would probably need to be slightly more structured and require more preparation time. It is important to connect with the caregivers at the start to explain the online therapy plan and consider individual or family sessions. Presenting a clear plan and structure to caregivers and children could help elevate some of their uncertainties around online therapy platform. This could also allow us, therapists, to have a higher sense of confidence and comfort in this new way of working.
Part of the session structure would be calling the caregiver before the session and allow them time to set-up for the child to use computer/laptop and ensure the sound and connection is working well. To ensure privacy during an online session, a child could be encouraged to make their own ‘Do Not Disturb’ sign and keep it on the door for the duration of the session. This would mirror the usual in-person session, giving a child a sense of safety and security.
A typical online creative arts therapy session could look like this:
A familiar hello song is a good way for the child to transition into the therapeutic space. It helps to build rapport and trust with the child and initiate interaction and participation.
This is to help understand the child’s emotional state, offer opportunities for self-expression, and help children identify and label their own feelings. Depending on the age and cognitive abilities, children may be supported in this with the use of feeling cards, feeling charts, fun games or simply offering a space to talk.
Warm-up activities help to prepare children for the session, make them feel more at ease and engage the imagination. An example of this could be Magic Silly Sound Ball activity from the Cat Corner website.
The main activity in the session would usually refer to therapeutic aims and help children explore different issues creatively. This could be a musical activity or any activity from the website, depending on the child’s individual preferences and needs.
Mindfulness / positive psychology activity
Encouraging children to practice mindfulness/ positive psychology will give them the tools they can use outside of therapy to improve their general well-being, attention, self-regulation, and social skills. It is also a nice way to bring the session to a close. An example of this could be Mindful Breathing from the Cat Corner website.
A familiar goodbye song helps to bring closure to a music therapy session and transition back to home space.
While recognizing the value of intentional approach and structure during online sessions, it is important to remain flexible and tailor interventions to fit each child’s individual needs. Children can take the lead in choosing resources available at home they would like to use during the sessions and engage in nondirective play if they wanted to. The main aims for online therapy should still be about retaining therapeutic relationship, meeting children where they are and maintaining as much of a sense of normalcy as possible.