For many types of problems, the most effective and efficient way to do therapy is to meet primarily with parents. This does not mean that parents are doing anything wrong to cause the problems—instead, we know that parents spend many hours per week with their child, while a therapist might only spend one hour a week with them, so parents have much more power to make meaningful and lasting change.

In sessions with parents, we will often talk about times when the problem came up this week (for example, when their child got very upset, could not follow a direction, or was scared to do something). We explore together all the factors that might contribute to why the child felt and behaved the way they did. Then, we think together about how we can address those problems. Do we need to teach their child a specific skill, or give them practice with a certain situation? Is there a different way the parent could approach the situation that might help their child to respond differently? Parents implement what we talk about in between sessions, then report back about how it went.

When children join sessions, we often have a specific goal. For example, for children with OCD or anxiety, we might help them to practice facing their fears (e.g., practicing being far away from a parent within their home, or touching something that feels contaminated) while parents are coached to provide the appropriate level and kind of support. For children and parents who are struggling to enjoy play time together, I might watch a parent and child play together while I coach the parent through an earbud.  Or, we might talk together with a child about something hard that has happened or will happen in their life.

No matter what, though, children are not expected to just sit still and talk during sessions. It is common for them to be in and out of the room (it is one of the ways that they regulate their anxiety and discomfort), or entertaining themselves within earshot while parents talk to the therapist (a great opportunity to say things that we want them to overhear!). We include children in the session for just as long as their attention and emotional capacity allow, and shift to parent work for the remainder of the time.

Yes! The most effective and efficient therapy for young children relies heavily on parent-only sessions. This means that parents would meet alone with the therapist, and they can join by video from home, from work, or even from a parked car. For this kind of work, there is no difference in effectiveness of in-person versus tele-health treatment.

When young children join sessions, parents are still an integral part of the session, so children are never expected to sit in front of the computer and just “talk” for an hour. When we use video to see a child in their home, we are usually getting a much more accurate picture of how the child behaves in their everyday life. This helps therapists to have a more accurate understanding of the problem, which leads to more effective and tailored treatment.

One of the biggest benefits of tele-health is the convenience. As long as you’re located in Michigan, you can join from wherever you are without having to trek across town to pick up your child and bring them to an office.

When I did primarily office-based work, one of the comments I would hear constantly from parents was “My child doesn’t behave like this at home—let me tell you what they’re really like.”  And it’s not surprising—any child is likely to act differently in an unfamiliar office environment with strangers than they would in the comfort of their own home with their parents. Since shifting to tele-health, I rarely hear this perspective. In the initial play observation session, when I have parents and children play together while I watch via video, I turn my video off after introducing myself to the child. In most cases, children seem to behave like they normally would at home within just a few minutes.

Young children are typically not great at generalizing from therapy. For example, if you teach them a coping skill in an office, the likelihood of them using that skill at home in their everyday life is unfortunately quite low. With tele-health, we remove some of the barriers. We are teaching them skills while they’re in the exact environment where we want them to use them, with the tools they have access to at home, and with their parent right with them to support them in using the skill.