Teletherapy: Making the Most of the New Normal

Nobody knows where this is going or what our profession will look like when the worst is over. Those of us who prefer a hands on approach with clients will have to get used to providing services in a less interactive fashion. As with many things, our new normal will be different. Like many other speech language pathologists I was not planning on having a crash course in teletherapy, but the unplanned is now reality. I am learning that teletherapy can offer enhanced versatility and allow the tailoring of treatment in a manner that best suits my clients and their families. However, this realization has not come without acknowledgement of the challenges behind this new norm for service delivery.

Whether you are just starting out in the field or are a seasoned veteran, the way we provide services will be forever changed by COVID19. On the positive side, this has allowed for more flexibility in treatment implementation and families are looking at alternative treatment access options. Changing service delivery models in sustainable ways is an opportunity for us as professionals to make positive long-term changes in our field.

On the down side as with all changes, there is grief. Losing the in person connection of service delivery will be difficult for many clinicians, the little things like high fives and fist bumps as well as the big ones, loss of colleague interaction and in-person social connectedness with our clients and families. In order to meet the demands of these new challenges it is important as a therapist to first take care of yourself. Caregivers often feel selfish considering their own needs, but if you do not thoughtfully prepare yourself for how you conduct therapy in new ways you will not be able to effectively meet the needs of those you serve. Self care takes many forms and if you have not done so already, now would be a good time to develop these skills.

In addition to personal grief, COVID 19 has brought on a collective grief wrought by societal change and general anxiety and worry in the community at large. Grief is summarized as sadness felt after suffering loss. Although that is a fine cursory definition, it does not really give grief true meaning. Grief is a deep and sometimes complex response to loss. Behavioral health provider and social worker at Mayo Clinic Health System, Jessie Wolf says, "Even though it's often associated with death, grief can be the result of any sort of loss or major life change. Losing your job, getting divorced, even moving — these all can elicit feelings of grief."

While grief may often feel insurmountable when it first grasps hold of your life, there are ways to cope with grief. Supplying yourself with knowledge and grieving tactics is the best way to combat your loss. Wolf provides some tips to help you during the grieving process.

• Give yourself permission to feel. Grieving is a normal part of dealing with loss. But you cannot grieve if you do not allow yourself the opportunity. Be sure to recognize the need to grieve and let it run its natural course. Your emotional health will be better served if you face your grief.

• Journal about positive memories. This can apply to any sort of loss. Even if you have lost your house, a journal about positive memories and experiences will help you focus on the good times. In terms of a loved one's death or divorce, journal about why you loved them and the joy you shared together.

• Talk to someone. Even though talking to someone about your feelings seems simple, it can be extremely challenging. People may feel safer shutting everyone else out during their time of grief. Resist that urge and find a confidant to share with.

• Understand grief affects everybody. Grief is not age-specific or limited to certain populations. Children, teens and adults all grieve. Recognize this fact and expect signs of grief from all involved parties, no matter the age. And remember, everyone has their own unique form of grieving. There is no textbook way to grieve.

• Lend a supportive ear to others. Maybe someone else's grief does not affect you in the same way or much at all. It is still important to support your loved ones during their grieving process. Be there to listen and comfort them.

With kids, listening and being supportive is critical. Be sure to let them work through the process, and answer their questions directly as they arise. Neglecting to answer questions or answering questions in a roundabout way may lead a child to make up stories and even blame themselves for the death or loss.

Parents are now working from home and in addition to parenting, they are expected to be teachers and full- time care givers to their children without respite. Being fully present at their child's teletherapy session may not be their top priority. This can be challenging for the best of therapists especially considering the limited attention span of many clients. In addition to self-care, it is important to be thoughtful regarding how you approach teletherapy. In the broad spectrum of our profession, speech language pathologists are providing teletherapy services in a variety of different settings. Regardless of where you provide teletherapy, here are some general guidelines to implementing successful sessions while also supporting ourselves

1)Communicate with your families. They understand that teletherapy is not long term in many cases. The converse may also be true and their child may be thriving in this new format, celebrate this success with them and help pave the way to support future interventions via this means.

2) Set up a work space for yourself. This may be challenging but it is important to think about your comfort and access to materials. Protection of client privacy needs to be considered especially if you are conducting teletherapy sessions from home. Space is important for your clients as well. Encourage your families to find a place in their home where their child can be comfortable. In some cases, teletherapy will occur throughout the house and maybe even the yard. Be creative, be flexible, go with the flow. Remember, play is the work of childhood. Take advantage of the free time your clients now have out of school and support parents and caregivers in finding the best ways to encourage play with and for their child. 

3) Re-evaluate your therapy goals. You may find that some of your goals do not incorporate themselves well into teletherapy sessions. COVID-19 has created a temporary shift from targeting longer-term goals to working on more immediate challenges of adjusting to schedule changes and increased home time. Take advantage of this opportunity to build some long-term positive communication habits into the family dynamic.

4) You have a unique advantage to see clients in their home environments tune in and observe. How are their communication skills different? How do they interact with caregivers and siblings? Many of these observations will give you the opportunity to provide parent training in new and creative ways and allow you to tailor your treatment plans accordingly.

5) No where is the balance of typical and atypical development more apparent than in telepractice. Think about what typical children do, they hide, they avoid, they do not listen to their parents. Be careful not to expect more out of your clients than you would a typically developing child.

As with so many things, no one knows what to expect of the new normal. Finding our way as professionals is not always easy and extra time and attention to self-care is necessary. In order to be an effective clinician it is important to face your own emotional challenges. Teletherapy is here to stay, it is possible to find a balance between in person and online service delivery. We have an unprecedented opportunity as professionals to shape the future of our profession for the better, let's take care of ourselves so we are up to the task.