Telehealth and Play Therapy

We child therapists have been thrown into unchartered waters of having to provide remote therapy services to our child and family clients and many are feeling like they are floundering. We are all in this together as we figure out how to do this. Telehealth and play therapy are not concepts most of us ever dreamed would go hand in hand. And yet… here we are.

Necessity is the mother of invention – Plato

I understand that those who practice the purest form of child centered play therapy are really struggling… I have included a statement from Dr. Dee Ray below that may be helpful to you if this is the case. And if you are willing to adapt, adjust and learn ways to bring more structure to your work in order to utilize telehealth with your clients I want to offer some resources for you here.

Meyleen Velasquez, LCSW, RPT-S has a collection of videos to help you get started with telehealth and play therapy here. 

Please be sure to join and follow my community group on Facebook called Growing Your Child & Family Counseling Practice and note the pinned post at the top of the feed that is loaded with resources. Be sure to sign up for 2.5 hours of free play therapy training AND get my resource-rich emails in your in box HERE. 

I have bundled three of my recorded trainings that are telehealth FRIENDLY for play therapy activities for young children, older children and in between at 50% off the normal fee to help therapists at this time. You’ll get 7.5 hours of NBCC and APT non-contact training hours. Go HERE for more info.

If you are a prescriptive play therapist, already using more directive play therapy or you are open to adapting to this surreal pandemic situation in order to maintain contact with your clients, I want to direct you also to some work my colleague Tammi Van Hollander, LCSW, RPT-S has put together here.

Below is a statement published by Dr. Dee Ray, revered author and researcher for child centered play therapy. I am providing this here on my site as I provide help, support, resources and consultation to play therapists because it’s important to hear her perspective. Please consider her points below especially if you identify as a purely child centered play therapist. Also, keep in mind that while of course you can not do the purist form of CCPT via telehealth, you can track, reflect and return responsibility and stay connected to your child clients in creative ways through telehealth as well.


Child-Centered Play Therapy and Telehealth

by Dr. Dee C. Ray
With a substantial number of play therapists moving to online services, considerations of intervention are critical. The foremost concerns are regarding ethical and competent delivery of services. All play therapists engaging in telehealth should be well-trained in the medium of providing mental health services online and should approach delivery with the highest level of ethical regard for confidentiality and ensuring client safety. In addition to these considerations, the best fit of medium to intervention is a significant concern especially specific to the facilitation of Child-Centered Play Therapy (CCPT). The following statement is specific to the delivery of CCPT intervention through an online medium.
Child-centered play therapy (CCPT) is a theoretically-grounded and evidence-based intervention that recognizes the relationship between therapist and child as the primary healing factor for children who are experiencing emotional and behavioral challenges. CCPT practice is particularly concerned with providing an environment of safety in order to facilitate the child’s exploration of self and letting go of rigid behaviors resultant from a threatened self-concept. Consequently, the child-directed nature of sessions is one unique and essential feature. The child decides session content by taking the lead in play and interaction. The therapist facilitates the child’s exploration and attempts to empathically respond to the child’s worldview by not guiding goals or therapeutic content (Ray & Landreth, 2015).
Because CCPT encourages the child to lead and the therapist to follow, it may appear as if CCPT is good fit for telehealth sessions. While it is certainly true that a therapist may be able to continue to build and maintain a relationship through an online medium, there are fundamental dynamics worthy of consideration. In a review of historical and current literature, Ray (2011) identified six functions of play in CCPT including 1) fun; 2) symbolic expression; 3) catharsis; 4) social development; 5) mastery; and 6) release of energy. When CCPT is working effectively, the child may be using play for any of the six functions.
Fun, social development, and mastery functions may work well in an online medium whereas symbolic expression, catharsis, and release of energy are less of a fit. CCPT is heavily structured through the provision of the playroom (a contained environment of safety), the physical presence of the trained play therapist, and the child’s ability to lead the play. When the function of play for the child is symbolic expression, catharsis, and release, the potential for dysregulation within the child is likely.
A child may become highly dysregulated in the context of working through their internal confusion, playing out their reactions to their perceived environment, or trying out various coping skills. During these times, the physical presence of the play therapist is necessary to send the message of physical and emotional safety. A real person who is there to walk with the child through this scary place of exploration. A play therapist who is breathing next to child.
A play therapist who is connecting with the child through full body movement and facial expressions. A play therapist who can move closer to the child if needed. A play therapist that the child can touch if they need to feel grounded in reality and care. If done effectively, a child’s participation in CCPT evokes strong feelings and behaviors because the child is working on the edges of development, health, relationship, and regulation. Hence, the facilitation of CCPT sessions is rarely a good fit for an online medium.
However, there are ways in which a CCPT therapist can continue to provide services to children and families during a crisis when physical proximity is not possible. The primary focus should be providing support and relationship to the parent/caretaker so that they may provide those same gifts to the child.
1. Conduct parent consultations in which the therapist engages in support and problem-solving with the parent to address immediate issues.
2. Engage in skill-building with parents in which you use the opportunity to teach relationship and communication skills.
3. Conduct Child-Parent Relationship Therapy/Filial Therapy with parents in individual or group online format. Caution: You should engage in CPRT/Filial only if you have been trained to do so.
4. Move to more directive techniques related to skill-building with the child. From a CCPT perspective, directive techniques are driven by the therapist’s agenda, and hence, would not be the optimal intervention for children who are struggling emotionally and behaviorally. However, directive techniques are likely to keep a child temporarily regulated which is a worthy treatment goal when helping children maneuver through a crisis period when emotional support systems are limited.