The nationwide lockdown has left us having to resort to alternative ways of accessing services we were used to experiencing in person. From online classes with teachers to working remotely from home, we’ve had to adjust. But can this online solution be applied to something as personal as individual therapy? We asked educational psychologist Kathy Krishnan about the efficacy of virtual therapy, especially when it comes to play therapy for children.
Can you explain your way of practice in an in-person setting?
In traditional therapy, the therapist uses their training, skill and presence to facilitate a therapeutic experience. The active engagement of play, which can be through toys, games and other mediums, becomes the vehicle of communication which the therapist uses to explore the emotional world of the patient. This includes verbal and non-verbal communication within the therapeutic experience. Within adult therapy, verbal communication and observations are actively used to navigate therapy.
How are you managing to do this and connect with your patients virtually?
Online therapy has become the new normal within a world of social distancing and lockdown. The traditional therapy format has been challenged to develop an alternative route of building and maintaining emotional connection via online therapy using tools such as Zoom and WhatsApp video. The therapist also has a selection of carefully selected toys that the child may have used before in a session.
The therapist then uses whatever the child plays with together with toys the therapist has selected as a response to the toys selected by the child to facilitate a therapeutic experience. This could include paper, pens, Lego® or dolls to mediate a therapy experience similar to how it would unfold in a face-to-face session. Adult, teen and parent sessions will remain facilitated via verbal communication and observations.
What are the ethical and legal considerations around this such as filming the session or discussing highly confidential information?
The therapist will be obliged to maintain the same ethical boundaries as prescribed with face-to-face sessions, such as confidentiality and privacy. Their role remains taking every precaution to create a safe space.
How do you control the sessions and pick up the non-verbal cues and energies from a patient that you would normally be able to do in an in-person setting?
Online therapy can be described as the therapist needing to adjust to create a four-dimensional experience for the patient. The therapist must work to create an experience for the patient of being seen, with the therapist being attentive and present using verbal communication and observational skills to maintain connectedness.
The therapist has to shift to a symbolic holding space of emotional reflection, containment and tolerance of the patient’s emotional world, and make meaning of every aspect that is visible, unconsciously communicated and more challenging to connect without physical closeness. The complex interplay of theory, skill, experience and openness between the therapist and patient, becomes the necessary vehicle to seek hard emotional spaces using an online medium.
From what age do you feel it’s appropriate to conduct these virtual sessions?
The physical setting of an online session will vary with children and require different types of support from the parent/s in comparison to older patients. I find online therapy to be successful irrespective of age and it creates as rich an opportunity for therapeutic growth and communication as conventional in-person therapy.
With children, play therapy continues using an online medium with the child using their own selection of toys while the therapist engages in making meaning of the play. Therapy for children via an online medium requires the therapist to partner with the parent to create a safe therapeutic experience. This could include advising parents on how to set up a space for the therapy session and what support you would need from them.
Some clients may find online therapy very convenient and may want to continue with Zoom or WhatsApp sessions after lockdown. Would you be happy to offer this?
Working in person with my clients or patients remains a preference, but as a therapist, online therapy has opened a dynamic opportunity for learning, adjusting and reflecting. I find that online therapy does not detract from having an engaging journey within the therapeutic process and that the skills and tools used within a therapy room are as versatile via an online process. Online therapy versus in-person therapy offers a different type of connectivity and relatedness, but both can remain holding and supportive.
If SA continued to have lockdown for many more months and virtual sessions continued, what elements/benefits do you believe patients would eventually start missing out on?
The personal experience that face-to-face sessions offer will be hard to replace as the intimacy of these sessions offers a different quality for connecting with a patient. Though some patients may adjust easily, it may be more challenging for other clients to replicate this intimacy through an online experience. The potential continuity of lockdown and social distancing will place an undue emotional burden on patients, which may compromise a patient’s freedom to choose their preference on how to access therapy.
“The lockdown requires an adjustment and modification of skills to maintain and develop a different normal, both with our loved ones and within our therapeutic spaces.”
Do you charge differently for these virtual sessions, and have the medical aids put out a memorandum about how the billing of these consults should be charged for with perhaps a different tariff code?
Currently, the Medical Health Council and most medical aids have agreed that online therapy will be covered within the same billing format as with personal contact sessions. Any amendments will need to be navigated only if relevant.
What is your take on COVID-19? Is it a message from the universe telling us to slow our lives down and connect more with our immediate family? Or is it something as simple as teaching us to practise better hygiene and wash our hands more?
COVID-19, lockdown, social distancing, the rapid pace of imposed change and our new normal has imposed a new canvas on how we live and make meaning of our world. As we travel this unchartered journey creating a map for ourselves and those we love, we have to discover new ways of understanding and connecting with ourselves and our loved ones.
Final thoughts…
Imposed social distancing and lockdown has redefined my awareness of how connectivity can be facilitated. Connectivity is defined more intentionally by the quality of how we find each other rather than the physical presence of each other. As such online therapy versus in-person therapy will remain relevant with the continued ideal, which is how the therapist and the client make a connection that allows for growth.
Kathy Krishan is an educational psychologist working in private practice in Norwood, Johannesburg. She has a special interest in working with children from infancy to five years of age. This therapeutic style includes the incorporation of the parent/s to help them build an improved understanding of their child. Support is also offered for individual therapy, parent counselling and parent courses.
Contact Kathy Krishnan for more information about virtual therapy or if you need support at kathy.krishnan@gmail.com or call her on 084 220 0229.
