I feel like I have done teletherapy 101, 102, and 103 in the space of a week. I thought I would share some of my reflections (no pun intended) and experiences so that we can all learn together.

All my sessions so far are with children of school going age.  Grade R, 1, 2 need an adult right there to check on them. Grade 3’s and upwards are coping more independently.

Before lockdown (aka BC- Before Covid19),  I realised that there was a possibility of switching to teletherapy. I armed myself with a 24 hour supply of social-media groups to prepare. I also overwhelmed myself in the process! I researched what I needed in order to equip my virtual office, and purchased a decent headset with a microphone. I linked my Macbook to the network via an ethernet cable to minimise internet speed fluctuations, and I was ready…

Or so I thought….    

Even with all the planning in the world, taking the first step into an actual session was nerve-wracking. In order to navigate the learning process, I needed to practise. We have had a number of  “family-Zoomerings” and I thought that one of my young cousins could assist. However, it was soon evident that headstands on the couch and pulling funny faces at me did not facilitate any therapeutic interaction.

I coerced  enlisted the help of Sharon from Kween B  Sharon had posted that her daughter Ava was starting at a new school, and I realised that she could not get any support during lockdown. It would be a mutually beneficial relationship. I would learn about doing tele-therapy and Ava would hopefully benefit from my trials.

Session 1 was okay.  It was an introduction. Some casual chatting and trying to gauge where Ava was at.

Report – “It was fun, but…”   (I should have known)

Session 2 was a disaster.

I had prepared something that was engaging and exciting. Ava told me it boring.

Lesson #1

Just because you think something is exciting, don’t assume the child will. (Caveat, it wasn’t actually that boring, but I placed too many demands on her, so she opted out)

Lesson #2

Do a tech-check with the parent before your session. There were two major problems that could have easily been avoided.

• The sound wasn’t clear. She could hear me, but I could not hear her well. Bear in mind I was using my fancy new headset and microphone. In my panic,  I flipped the mic up to mute it and it snapped. End of new headphones.   My headset had almost become a security blanket for me. I fell apart when they stopped working. I couldn’t continue without them. (I am now using my iphone earphones and they work perfectly).
• I use the  screen-sharing option in my sessions with PDFs and /whiteboard and annotation.  The problem was Ava could not take control of the mouse, and therefore she couldn’t ‘interact’ with the stuff on my screen. I was doing a lot of talking and expecting the child to take in all this information. It was too much for her. It must have been SO boring to listen to my voice drone on and on.

I now do a tech-check with every parent before starting any formal sessions. I share my screen, my ipad, and I ensure that they are able to get control of the mouse. If there is a problem, then there is someone available to fix it. Tech issues need to be solved by the adult. The child just needs to show up.

However, having done all of this, I had two tech issues today.

For some strange reason, I could not log into Zoom this morning. In general, I have found that the internet connectivity is better in the mornings when using platforms like Zoom. Once the whole of USA is online, the connectivity is less stable.

When you rely on technology, you are at the mercy of technology. You need to know how to troubleshoot without panicking. In one of my sessions today, the child couldn’t hear me. I could hear her. My mic was on, my speakers were working. She wasn’t muted;  her profile showed a microphone next to her.

Solution – Turn up the volume. She had muted the sound on her laptop. It wasn’t my fault.

As much as I hate seeing myself on camera, the kids are really comfortable with it. In fact sometimes they forget you can see them.

Lesson #3

Make sure you are looking at the camera and not at your keyboard or your notes that are next to you.

One of my kids happily started munching on a biscuit. We were using the whiteboard at the time, and I was a little square in the corner of the screen. I could see he wasn’t well focussed, but I didn’t say anything to him because it’s okay. He is at home. I gave him a ‘look’ and he suddenly asked “can you still see me?”  I acknowledged I could see him enjoying the biscuit.

Lesson #4

Set boundaries.

After he had finished the biscuit, he took out a yoghurt and finished off his snack by licking the lid (together with accompanying slurping sounds). It was towards the  end of the session. He was clearly tired and I got the message. But next week, our session is at the same time, and snacks will be allowed after the session. Although the child is in their home environment,  if he had to spill the yoghurt onto the computer, or clog the keyboard with biscuit crumbs, I don’t want to be held accountable for the damage to the computer.

Lesson #5

Engage fully

One child had a pink mark on her cheek. I wasn’t sure whether it was eczema, makeup,  or if my eyes were deceiving me, so I kept quiet. Towards the end of the session, she took something out and proceeded to rub it on her face. I still wasn’t quite sure what it was, so I asked her. Turns out, it was a pink highlighter that she was using to decorate her face. If a child was doing this in an in-person session, I would have had no hesitation in questioning the mark in the first place. I was reluctant to do this because I doubted myself. (BTW it was not a toddler). Her behaviour on camera perhaps literally highlighted her difficulty and this was a difficult task.

Lesson #6

Trust yourself

This is a learning curve for everyone. As therapists we have an underlying knowledge of why the children are having difficulty. We just need to translate this knowledge using a different medium. Boom cards are fantastic to facilitate interaction on screen. I am becoming addicted to creating my own and in doing so, they are helping me break down tasks into steps.

The only way to do this is to practise. You may have disasters, and you need to accept them as part of the learning curve. No-one will be harmed if you have a below-par session.

This video  from St John’s D.S.G Pietermaritzburg    will help put you at ease.

Good-luck, Tele-on.

I look forward to hearing about your experiences.