On Sunday, February 28, the Child & Adolescent Initiative hosted a Zoom meeting to discuss the experience of treating children and adolescents on virtual platforms during the pandemic. Nine people, representing 5 countries and multiple U.S. states, attended. The group discussed their creative ways of working in light of their respective region’s unique health and safety restrictions/guidelines.

Sonya Morgan was brimming with creative tele-play ideas such as the online sand tray and a document camera used to project games, children’s literature, toys and activities in order to create a shared viewing experience. This led to a discussion of the shift from the typically very open-ended quality of play therapy in the office to the possible need for more structure oat least preparation on the part of the therapist before sessions, while still allowing the child to mold the hour according to her needs. Jen Paul discussed ways to create an embodied virtual experience by using air fist bumps and high-fives near the computer camera or sharing music over video with adolescents. Denise Davis brought up some of Howard Gardner’s ideas for this moment, in particulars mutual storytelling technique to open up dialogue with children having difficulty opening up over video. She also spoke about using Winnicott’s Squiggle Game on the shared screen. Sarah Furlong opted to see children masked and in-person, leaving time for sanitation between sessions, using specific toys for each child, and providing individual washable blankets for the children in the hour. Sarah, a teacher in her past career, felt that this was what worked for her, so she did all that she could to create a safe in-person space despite the pandemic. Sarah also suggested some Pinterest sights that gave ideas for therapists working with children on video platforms. Renee Siegel managed to play board games over video with both child and therapist having the same game in their respective homes.

Many people entered a child’s world through tours of their bedrooms and homes and this raised the possibility that perhaps our virtual platforms expanded some aspects of our work. For example, Yossi Tamir shared a beautiful story of a therapist that he supervised, who participated in a bedtime routine, involving the parents as well as the therapist in story-telling. Meeting pets and getting an intimate view of the child’s bedroom/home for which we don’t have the opportunity in the office, was another enhancement of this modality. Fusun shared a story about a suicidal client whose mask sat just below her eyes; interestingly, this led to a more honest clinical encounter where her smile could not falsify her emotional experience. All of these situations created more alive, less virtual experiences despite the medium used.

When the group wondered about how all the world’s children are managing when they get to play, but have to do so in masks, Rosalind Kindler assured us that she could see the children at the school across the street playing masked at recess, playing as fully as they always had. Of course, we will not know for some time what the real developmental impact of the pandemic is and Simon Caprilli suggested that there should be a global Taskforce to review this issue.

The shift in the therapeutic modality drove the implementation of different pre and post therapy rituals. For example, some members created handouts on therapy guidelines for youth and parents in order to help children maximize the video therapy experience (e.g. taking a walk before the session, turning off other screens 15 minutes prior to the session, setting up the space with appropriate toys/supplies, and making sure that the child or adolescent has privacy). Issues of privacy and confidentiality appeared to be one of the more common challenges encountered on the remote platform. For example, some children have wandered off screen and some adolescents have been more hesitant to share for fear that a parent or sibling is eavesdropping (particularly challenging for the more anxious patient or intrusive parent). Children’s distraction is another problem that therapists confront.

Lastly, the group discussed emergence from the pandemic and how we make decisions about the return to in-person work with children and adolescents. This is of particular importance in working with unvaccinated children since close physical contact is so much more a part of this clinical experience, with children sitting on laps and handling toys used by both patient and therapist. Decision-making varied based on each therapist’s own vulnerability, comfort level and geographic location.

We thoroughly enjoyed this lively and cooperative discussion about working with children and adolescents through the pandemic and appreciated each person’s unique point of view and experiences. Through this experience we learned that for members of our list serve Zoom may provide a more comfortable opportunity for discussion among members than some of the online discussions we have previously held. We are hopeful that this platform may enable us to meet together several times during the year for discussion around the distinct clinical experiences we encounter in our work with children and adolescents. We are currently planning a Zoom meeting in May (look for announcements coming soon) and we want to remind all members of the Child & Adolescent Initiative that the list serve is available for your use at any time to raise a question or ask one another for resources.