The COVID-19 pandemic has forced many services to turn online including psychotherapy. While numerous studies demonstrate that tele-psychotherapy is generally effective and equivalent to in-person care in diagnostic accuracy, treatment effectiveness, quality of care and patient satisfaction, limited studies have been done evaluating the effectiveness of teleplay therapy in comparison to traditional play therapy (Hilty et al., 2013; Langarizadeh, 2017; Thompson, 2016). Different from tele-psychotherapy, where talking is the main agenda, play therapy utilizes the use of physical toys and places great importance on the interaction of the client with the physical environment. Thus, when therapists and clients meet virtually instead of meeting face to face for play therapy, a great deal is compromised. But in the midst of the pandemic that leaves some no other choice, can those challenges be mitigated?
What is Teleplay therapy?
First, let’s begin with what teleplay therapy is and what it looks like in a typical session. Teleplay therapy is a form of therapy where therapists use play-based interventions through online video sessions with the aim of achieving the same goals as therapists would in a traditional play therapy session. This means that just like a traditional play therapy session, the goal of tele-play therapy is also towards diagnosis, treatment, prevention, and control. Because a teleplay therapy session is not done in the therapy center, clients would have to provide their own space and equipment. Ideally, clients would prepare a private room where he/she cannot be interrupted, a computer, tablet, or other technology with a camera that can facilitate a video call, and a hard surface such as a table or floor where the client can play. Clients that have access to devices that are more portable such as a tablet, a phone, or wireless earphones would be recommended to use them for greater flexibility and portability in the play process (Yasenik).
Depending on the client’s age, needs, preferences and therapy goals, clients would need other materials ranging from drawing paper, crayons, and markers, action figures/miniatures, building blocks or Legos, mini whiteboard with erasable markers and other creative tools (Yasenik). Unlike in a traditional play therapy session where the therapist would usually provide needed tools, therapists would have to expect limitations in play materials and prepare to work with very few items. Other than traditional toys or creative tools, therapists can utilize online platforms such as the Personal Investigator (PI), an interactive computer game that was designed to be used in psychotherapy sessions (Peace, 2020; Schueller, 2018).
Like any other therapy session, clients can first expect therapists to discuss consent and other relevant ethical concerns. Then, beginning the play process, therapists would instruct and guide clients through the game that they have prepared. Therapists may want to consider communicating on the instructions as well as the general process of the therapy with the client’s caregiver if the client is a child for materials to be prepared. Additionally, such conversation would include a discussion of when caregivers in collaboration would be involved in the session (Yasenik).
When is Teleplay therapy usually used?
Teleplay therapy was originally founded to provide services to those in remote geographical locations where traditional therapy services are not yet available (Yasenik). In most cases, it is utilized for that reason. However, clients may also choose to do teleplay therapy instead of traditional play therapy due to preferences to be in one’s own home, transportation challenges, preference for therapists of an international background and others. Tele therapy is currently the only option for many clients in this COVID-19 Pandemic due to social distancing and safety procedures.
What are the advantages of teleplay therapy in comparison to traditional play therapy?
Because teleplay therapy is usually done from the client’s home, clients are bringing therapists into their safe and personal space, where they are most comfortable. Thus, teleplay therapy may be more effective than traditional therapy in decreasing the barrier clients may have towards therapists and the therapy process. Young children, especially, may feel uncomfortable and unsafe when left alone with a therapist in a therapy room, but do not have to face this when going through a therapy process from their own home. Therapists get a new opportunity to get to know clients in a different light when clients show therapists their room, their favorite items, or even their pet. Furthermore, using technology for play therapy may excite technology-driven clients to participate in therapy (Dion, 2021). Beyond advantages in the therapy process itself, teleplay allows therapists to reach patients wherever they are. Clients that do not have access to therapy centers because of their location or transport challenges can still meet with a play therapist. Additionally, clients facing judgements from others because of mental health stigmas may find it more comfortable to discreetly participate in therapy from their home.
What are the disadvantages or challenges of teleplay therapy in comparison to traditional play therapy? Can teleplay therapy replace traditional play therapy?
Challenges with teleplay therapy are likely to be in relation to privacy challenges, distractions, technological challenges (malfunction, lack of access, etc.), lack of physical presence, and a challenge to analyze the client’s full body language from the perspective of the therapist (Dion, 2021). Clients may not have available space where he or she can be uninterrupted during a play session. Alternatively, clients may have available space, but may find that the people they live with are uncooperative. For instance, a single mother of young children may find it hard to leave her children or prevent her children from entering the desired room for therapy. Furthermore, it may be hard for a therapist to make sure that clients are focused on the therapy session. Clients may be distracted by noise in their home or may be accessing their phone without the therapist knowing.
Additionally, teletherapy in general is not a perfect fit for every client. Some clients may need the physical presence of a therapist to support them through a difficult time, but technology mediated therapy lacks the warmth of face-to-face therapy. Furthermore, parents may be needed to supervise young children or clients with mental illnesses in teletherapy when traditionally, therapists can work with clients alone (Dion, 2021). Clients who face family problems may find it uncomfortable to be so close to their family while doing therapy. Similarly, clients facing family or marital problems may find that they lose a sense of escape when doing therapy, because they are still under the physical space where their problems occur. Therapists may also find it difficult to access a client’s non-verbal cues when they can only see the client from the chest up (Dion, 2021).
For such reasons, teleplay therapy may not be fitting for everyone and cannot yet replace traditional play therapy. However, teleplay therapy still offers a promising alternative during unique times such as the current pandemic. As such, are there ways in which therapists, clients, or caregivers can overcome those challenges?
What can therapists, clients or caregivers do to make the best out of a teleplay therapy session?
- Be more directive and communicative.
- Give clear and detailed instructions on activities.
- Ask more questions regarding how the client is feeling about the experience (e.g., are you tapping your feet, are your hands sweating?).
- Communicate when technological difficulties occur or when therapists desire that the technology is handled differently (e.g., when moving the camera to view the client’s drawing).
- Discuss with clients or caregivers on the preparations they should make beforehand (what tools are available and needed, how to set up the space, etc.).
- Communicate the importance of the session going without any interruption to clients and caregivers beforehand, so that they may arrange for privacy during the session.
- Emphasize to clients or caregivers that the success of the therapy session depends on the cooperativeness of clients or caregivers.
Clients or caregivers should:
- Prepare materials and spaces according to the therapist’s instructions as best as they can.
- Avoid any distractions such as phones.
- Be communicative with therapists of questions and concerns.
(Yasenik; Dion, 2021; Peace, 2020)
Dion, L. (2021, August). Does Teletherapy Work in Play Therapy. LFPS Podcast.
Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The Effectiveness of Telemental Health: A 2013 Review. Telemedicine Journal and E-Health, 19(6), 444–454. https://doi.org/ 10.1089/tmj.2013.0075
Langarizadeh, M., Tabatabaei, M., Tavakol, K., Naghipour, M., & Moghbeli, F. (2017). Telemental Health Care, an Effective Alternative to Conventional Mental Care: a Systematic Review. Acta Informatica Medica, 25(4), 240. https://doi.org/10.5455/aim.2017.25.240-246
Peace, E. (2020, September 9). 5 Play Therapy Activities Using Telehealth. Samaritan Center. https://samaritan-center.org/5-play-therapy-activities-using-telehealth/.
Schueller, S. M., Stiles-Shields, C., & Yarosh, L. (2017). Online treatment and virtual therapists in child and adolescent psychiatry. Child and Adolescent Psychiatric Clinics of North America, 26(1), 1–12. https://doi.org/10.1016/j.chc.2016.07.011
Thompson, R. B. (2016). Psychology at a Distance: Examining the Efficacy of Online Therapy (thesis). Portland State Univeristy, Portland.
Yasenik, L. Tele-Play Therapy. Dr. Lorri Yasenik. https://www.lorriyasenik.com/tele-play-therapy/#:~:text=Tele%2DPlay%20Therapy%20is%20a,of%20on%2Dline%20video%20sessions.