For school-based therapists using telehealth for the first time, it may have been a while since you’ve treated with a parent present. Even clinic based therapists may be used to having the child’s parent wait in the waiting room, or at the very least, sit in a corner while you work with their child.
Getting to have the parent present is a blessing for many reasons including:
1. More opportunities to train and educate
2. Improved follow-through with home program
3. Ability to increase the functionality and relevance of your therapy through consistent parent interviewing
You don’t need me to tell you, though, that adding the parent to the mix, especially when they are sitting right next to the child the whole time, changes the dynamic of the treatment session, and may add some new challenges.
As I connect with other professionals working in telehealth, I frequently hear examples of poor family interactions. In 90% of those cases, I think the issues could have been avoided if more thought went into setting expectations prior to starting treatment. You, the parents, and the child, should know exactly what is expected. Remember that virtual learning is also new for the families, and setting clear expectations will put all of you at ease.
Here a few topics to cover when setting expectations:
2. Home environment
3. Parent presence and involvement
4. Child’s behavior
• Whether it’s through an informational handout or a brief phone/video consultation with the family, you’ll want to discuss your expectations for use of technology before your first session.
Ask the family:
• Which of the following devices do you have available: phone, tablet, chromebook, PC, or Mac?. If they have multiple, let them know your preference. If they only have a phone, let them know of any barriers or limitations that may come up, just so they know ahead of time and no one is caught off guard.
• Do you have the ability to sit near your Wifi router or connect directly to the internet through a hardwire?
• Is it possible to ask other family members not to stream games or videos during our session? (Make sure and explain to them that this can vastly improve the connection quality. If it is not possible, just let them know they may experience more glitches and that you will work through them together.
• If you are using a Mac or PC, do you have Firefox or Chrome browsers downloaded? (If they don’t, ask them to get one of these ready before your first session).
Prior to starting, discuss where and how you’d like the camera and device to be set up. For young children and parent coaching based sessions, you may want them to place their camera so that a whole play area is visible. Consider asking them to put a blanket on the floor and use that as their “arena”. That way they always know where to be to stay in view. For older children that will sit in front of the camera, ask the family not to sit with a window behind them (this compromises lighting).
Discuss whether other siblings or families members will be present for the session. Assure them that if siblings need to present you can absolutely make this work and find ways to incorporate them. I find that if the parent is aware that you’re alright with sibling involvement, they will be more relaxed and allow you to take the lead on the session.
This is a big one. You may be incredibly uncomfortable directly asking the parent to be more or less involved with the session, once there’s already been an awkward moment or two, I sure am. The best way to avoid this is to establish your expectations before the awkward moment comes up. Here are some statements you might make, either in a handout or during a consultation:
“As a therapist, I am very dilerabate with how much assistance I provide your child when I ask him to try something. Sometimes I have to make things difficult on purpose. If he doesn’t respond right away, don’t feel the need to prompt him. There will be moments where I might want your assistance in giving him hints or encouraging his participation, but when that happens, I’ll let you know.”
Don’t be afraid to have a discussion about what you’re expecting from the child. It’s possible that the parent of a 3 year old assumes you want their child to sit perfectly still for 60 minutes, whereas you may be thinking “yea right”.
Talk to the parent about the level of structure and routine you expect from the session. Do you need the child to accomplish three pre-planned activities, or are you wanting the child to take the lead? If the child says “hey I want to show you my lego tower?”, are you totally alright with them running to grab it?
You probably are (depending on the child), and that little movement break may make the session a whole lot more enjoyable for everyone, but the parent might not realize that unless you say something.
The moral of the story here is that teletherapy changes the dynamics of a session; you can’t prevent that. You do, however, have the power to make it a positive change. Set the stage by making the family feel comfortable, setting clear expectations, and encouraging open-communication.