Pros and Cons of teletherapy/online therapy for Kids

While many people may not have considered online therapy as an option until quarantine forced us to take a lot of our lives online, it’s been around for years. Large companies like Talkspace and BetterHelp have mostly appealed to millennials who are comfortable with technology and may not have much time during a 9-5 day to make it to a brick-and-mortar therapy office. In addition, plenty of private practice therapists have used online therapy to help reach people who may not otherwise be able to access therapy, such as those in rural areas or people living with chronic illness. Until recently, though, most online therapy services were for adults, not kids.

Because I didn’t see many online children’s therapists out in the world, I was skeptical about whether kids could benefit from this kind of help. Since I want to help my community flatten the curve, when quarantine hit I decided it was time to find out for myself! While I am looking forward to the day when I can go back to my playroom, I have made so many exciting discoveries about online therapy that I would never have realized if quarantine hadn’t pushed me to give it a try. In this post I’ll be sharing some of the most surprising “pros” I have discovered about online therapy for kids, as well as the “cons” to be aware of, since no form of therapy is the perfect fit for every child.

What Kids Are a Good Fit for Online Therapy?

Online therapy, or teletherapy, may not be the best fit for everyone. However, in the past few weeks I have seen some children and families benefit more from online sessions than they have from in-person therapy. Here are a two scenarios where I’ve found online therapy has an edge over face-to-face counseling:

Children whose behavior problems only occur at home.

I can’t tell you how many times I’ve had parents tell me that their child’s behavior at home and in my office is a night and day difference. Some parents have even asked if they should film their child’s behavior, because they’re afraid I won’t believe how tough things can really get behind closed doors.

While I don’t recommend filming your child, online therapy gives me a better chance at seeing behavior problems firsthand. Since kids are participating in therapy from home, in a familiar place, they often behave more naturally than they would in my office. Since I’m present on the screen but not physically in the room, it’s more likely that kids will fall back into familiar patterns with the parent as if I’m not there. This gives us the opportunity to work through the problem together, as it’s happening, in real time.

Kids who have a hard time opening up about tough subjects.

While many kids enjoy and appreciate individual time spent with a counselor, I have found that some kids feel too exposed or overwhelmed in face-to-face sessions to get vulnerable about painful experiences. Play therapy and art therapy techniques can help give kids the feeling of “safe remove” from an issue that they need to open up, but so can online therapy.

Some kids may feel a little bit less “under the microscope” when they’re talking through a screen or typing, which can make it easier for them to speak their mind. I’m finding that many of my clients who are recovering from grief or trauma are able to speak more directly about their experiences than they were in my office.

The Pros of Online Therapy for Kids

Online counseling isn’t better or worse than face-to-face therapy—just different. Here are a few of the potential benefits that online therapy can offer for kids with anxiety, trauma symptoms, or behavior problems.

  • Online therapy can feel more confidential, which can make it easier to open up about difficult subjects.
  • Video and text chatting mimics the way that children are most comfortable communicating with friends.
  • Kids can design their own “safe space” for therapy sessions that includes all their favorite comfort items: loveys, dogs, and favorite snacks allowed!
  • For parents with demanding work schedules or non-traditional hours, online sessions can be easier to manage than in-person therapy, because there is no commute required.
  • Home-based sessions can help kids and therapists work through tough behaviors at “the scene of the crime,” which can make it easier to practice new skills. Some kids enjoy doing roleplays of difficult situations using their own toys as props to find better ways to resolve conflicts with siblings or friends.
The Cons of Online Therapy for Kids

For some kids, individual virtual counseling may not be the best option. While some of these issues can be problem-solved in session, other kids might benefit more from another form of therapy, such as family counseling, parenting skills coaching, or face-to-face sessions, when available. Here are a few factors that I have observed can make individual online therapy more difficult for kids:

  • Preschool children have a harder time paying attention to a screen for a full therapy hour, and seeing a familiar face on screen instead of in real life can be a little confusing. For very young kids, shorter “check-ins” with a therapist paired with parenting support sessions might be a better bet.
  • Some kids with ADHD may have a tough time with online therapy, since it might require them to sit still for longer. This is especially true for younger children. Adding in extra movement to sessions can help, but individual online therapy may not be the best fit.
  • It’s a little harder to pick up on nonverbal information in online therapy, like subtle facial expressions, body language, and small changes in tone of voice. This is true for both the therapist and the client. If a child already has a hard time picking up on these social cues, online therapy can make it more challenging.
  • Online therapy sessions rely mainly on sight and sound, and so the sensory experience is not as rich as in-person play therapy for kids with sensory processing needs. Adding sensory play materials like play-doh and scented markers at home can help to address this.

Learning about the pros and cons of online therapy for kids has inspired me to keep offering it as a service even in our post-quarantine world. I have a feeling that for many kids, combining face-to-face visits with occasional online sessions could give them the best of both worlds and make therapy more accessible for many families.


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