Does Childhood OCD Go Away?

If your child has OCD, you may worry at times about what the future holds. It seems like such an unfair burden for a young child to deal with. Maybe you’ve wondered whether your child’s OCD symptoms will eventually fade away, so she will be free to live life without constant worry. If you have, you aren’t alone.

“Does childhood OCD ever go away?” is one of the most common questions I hear from parents, especially at the beginning of therapy. And it’s totally understandable! OCD symptoms can be debilitating and time consuming. Handwashing, repeated checking, asking for reassurance, or long rituals are exhausting not just for the child, but for the whole family. Nobody wants a child be stuck with those symptoms forever!

I can’t predict what the outcome may be for your child, but I do know that therapy can lead to big, positive changes in the lives of kids with OCD. Today, I am digging into the research to see how common it is for childhood OCD symptoms to completely resolve. I’ll also take a look at what we can do to help all kids with OCD start feeling better.

How Common is Childhood OCD?

Childhood OCD is more common than you might think. While we may talk more about forms of anxiety and depression affecting kids, OCD also often starts early in life. Most studies estimate that 1-3% of kids have OCD, although their symptoms might fly under the radar for a long time. This is because because they can be hard to spot.

OCD most often starts when a person is a child or teen. Pretty much everyone with OCD starts getting symptoms before age 25. For childhood-onset OCD, the average age of onset is around 10 years old. It is common for boys to start noticing symptoms a little earlier, while girls might not develop OCD symptoms until later.

Some people may not get treatment for OCD until they reach the late teen or adult years, but their problems often began years earlier, during childhood.

You Can’t Outgrow Childhood OCD Without Help

Looking at the research, one thing that is really clear is that OCD is not likely to go away on its own. It’s not something that a child is likely to just outgrow or forget about. Kids with OCD need specialized therapy. The right counseling can help them learn how to deal with the intrusive thoughts that cause their anxiety and push them to repeat actions over and over.

OCD symptoms tend to ebb and flow over time: sometimes they’re better, sometimes they’re worse. Stress often plays a part in how bothersome OCD symptoms are. Some studies suggest that a small number of people might be able to “outgrow” their OCD without therapy: about 1 in 5. However, it can be a little tricky to tell if someone has really gotten rid of their OCD, or if they’re just in a low-stress time of life when it isn’t noticeable. It’s possible for symptoms to go away entirely when stress is low, only to return again during a more difficult time.

There’s also a risk that a child’s OCD could get worse without treatment. This can lead to small inconveniences, like chapped skin from too much handwashing, or major life impairments, like difficulty getting out of the house. Children with OCD are at an increased risk of also having other mental health problems, like anxiety and depression. Later in life, people with untreated mental health problems sometimes turn to unhealthy coping mechanisms like drugs and alcohol if they don’t have other good ways to deal with their symptoms.

The good news is that most people with OCD feel better after therapy. About 70% of people who get specialized treatment for OCD will improve, and usually they improve by a lot. The great news is that kids often get better results from OCD therapy than adults do. Catching symptoms early and getting help quickly leads to fewer symptoms later in life. Most kids will still have some leftover symptoms after therapy, but a small number of kids might see their OCD go away.

Sometimes, OCD Goes Away Completely (But Not Always)

Different experts have different opinions on whether or not it’s possible for OCD to completely go away. I don’t think I can argue with the experts! It’s not entirely clear whether people get cured of their OCD, or if they just go into remission from OCD. “Cured” means the symptoms are gone forever, while “remission” means the symptoms go away for a while, but may come back later.

Being the nerd that I am, I’ve looked over a handful of studies looking at the likelihood of OCD symptoms going away after therapy. It seems like it is possible for some people, and there are a few factors that increase a person’s odds. Kids whose symptoms start when they are young have better chances of remission than teens or adults. So do people whose symptoms are milder, and who are able to get therapy quickly. Finally, people who do not have other mental health problems alongside their OCD fare better than people who are also dealing with anxiety or other conditions.

Depending on the study you look at, you’ll see researchers estimating that anywhere from 32% to 70% of people go into remission after therapy, meaning that their symptoms are gone for a long time, or have gotten so mild that they aren’t getting in the way of things. However, this is different than being cured: there’s no guarantee that the symptoms might come back. The number of kids who are cured is much smaller and open to debate. Some experts guess that 20% of kids with childhood OCD are cured, while others think OCD never completely goes away.

You Can’t Always Cure OCD…And That’s OK!

As we just talked about in the last section, there’s a big difference between remission and cure. With good treatment, many kids with OCD will go for long stretches without problems. However, expecting your child to never have another OCD thought ever again for the rest of her life probably isn’t realistic. While some kids may fully outgrow their OCD, many won’t. Most experts consider OCD to be a chronic condition that, once you have it, sticks around for the long term.

That may be demoralizing to hear. The words “chronic illness” can sound very hopeless, especially if your child is struggling intensely right now. But just because OCD can be a lifetime diagnosis doesn’t mean it’s a life sentence. You may remember from earlier in this post that OCD affects 1-3% of people. That’s a pretty solid number! There are lots of kids and adults out there who are thriving, enjoying life, and just so happen to have OCD.

Help is Available for Childhood OCD in Charlotte, NC

OCD doesn’t have to run your child’s life. If you are tired of repeated worries and rituals taking up your family’s time, therapy can help. In counseling, kids can learn that OCD is just a way that some people’s brains think—and they have control over which thoughts they listen to and which they don’t. A skilled therapist can help a child gradually “talk back” to their worries and face their fears. Eventually, OCD stops being such an overwhelming urge and turns into background noise.

I’m a therapist based in Davidson, NC, just outside of Charlotte. I’m also someone who had childhood OCD! Everybody’s symptoms are different, but I remember what it felt like to be spending so much time every day dealing with worries I didn’t want to have. I love helping other kids manage their OCD fears so they can get back to enjoying childhood.

Cognitive Behavioral Therapy is a great option for OCD, and younger kids often benefit from play therapy, too. Is Davidson, NC a long commute for you? We can work together online if you live anywhere in North Carolina, New York, or Florida.

Want to learn more? Email me to ask a question or request an appointment.

Signs of Depression in Children and Teens: Know When to Get Help

The pandemic hasn’t been easy for any of us, but teenagers have been hit particularly hard. From the loss of highly anticipated milestones like prom and homecoming to the social isolation of ongoing lockdowns, it’s been a straight-up bummer of a year. Middle and high school aren’t usually a walk in the park under normal circumstances, so it’s understandable that many tweens and teens have felt more down than usual under these exceptional circumstances.

It’s normal (and natural and human) for any of us to feel a little down this year—kids included. But if you are like many of the parents I know, you may be trying to figure out where the line is between normal sadness and clinical depression when it comes to your child. How can you recognize when a typical reaction to a stressful situation is becoming something more?

Any childhood mental health struggle is cause for concern, but depression can feel extra scary due to the highly publicized rise in suicide rates over the last decade for young people ages 10-24. Most children and teens with depression won’t experience the serious suicidal thoughts that put them at risk. However, it’s helpful to be familiar with the signs and symptoms of depression and take them seriously when they arise. Let’s take a look at some common signs of depression in kids and teens, so you’ll know when to get help if your child is ever in need.

What Causes Depression in Children and Teenagers?

You may have heard that a chemical imbalance is to blame for depression. Many of us have heard of serotonin, and how a lack of it might lead people of all ages to feel depressed. While serotonin and other chemicals in the brain are a part of the puzzle, the causes of depression are much more complicated. Many parts of the brain are involved in depression. In fact, researchers are still trying to figure out exactly what happens in our brains and nervous systems that makes some of us more vulnerable to feeling depressed.

Outside factors like stress and trauma play a major part in depression, too. Any of the following can contribute to a child or teen’s depression:

• Genetics: having a close relative with depression puts a child at increased risk

• Trauma or ongoing stress, especially if the trauma happened early in a child’s life

• Major life changes, like an unwanted move, a breakup, or a divorce or death in the family

• Chronic physical health problems

• Social isolation

• Poor sleep or nutrition

There isn’t usually a “smoking gun” that we can point to as a cause of a child’s depression. It’s more common that several factors have built on each other over the course of months or years and eventually led to a depressed mood. This is even true for kids during the pandemic: as stressful as it has been, the pandemic itself isn’t usually enough to trigger a major depressive episode. However, if your child was already vulnerable due to genetics, stress, or other life changes, they may be having a harder time with depressive symptoms now.

How is Depression Diagnosed in Kids and Teens?

A pediatrician can be a good first stop if you’re concerned about depression symptoms in your child or teen. However, they’ll probably point you in the direction of a mental health professional to make a definitive diagnosis. Pretty much any mental health worker—a counselor, social worker, psychologist, or psychiatrist—is capable of diagnosing common issues like depression.

Therapists use a manual called the DSM-5 to help them when determining whether a child (or adult) is suffering from depression. The DSM-5 gives specific guidelines about the type and number of symptoms a person needs to have in order to qualify as having depression. This gives therapists something concrete they can turn to, rather than just using their intuition or guessing.

According to the DSM, kids and teens need to have at least 5 of these 8 symptoms in order to be diagnosed with Major Depressive Disorder:

• Depressed or irritable mood most days (this one is mandatory!)

• Decreased interest or enjoyment of activities most days

• Unintentional changes in weight or appetite

• Noticeably slower thoughts, speech, or movement

• Feeling tired or low on energy

• Feelings of guilt or worthlessness

• Difficulty thinking, concentrating, or making decisions

• Repeated thoughts about death or suicide, or making a suicide attempt

In addition to having 5 of these, a child’s symptoms have to get in the way of daily life and cause emotional distress to qualify as Major Depressive Disorder. They also can’t be due to another cause, like drug use or a medical condition.

Just because a child doesn’t fully meet criteria for MDD doesn’t mean they aren’t depressed! There are several other forms of depression that may not be as severe or dramatic as MDD, but can still really get in the way of enjoying life.

Signs of Depression in Children

It can be hard to imagine a very young child being depressed: isn’t early childhood supposed to be the most carefree time of our lives? While not as common as anxiety, about 3.2% of U.S. kids ages 3-17 have been diagnosed with depression. Interestingly, young boys (10 and under) seem to be more at risk of depression than young girls.

Little kids may show symptoms of depression differently than older children. It can be harder for them to put their feelings into words, so you may notice that young children’s signs of depression show up more in their behavior. In addition to the symptoms above, here are some signs of depression more specific to younger children to look out for:

• Trouble concentrating at school

• Frequent physical symptoms, like headaches and stomach problems, that don’t respond to treatment

• Sleep problems: either having a hard time sleeping, or sleeping way too much

• Seeming “cranky”, overly sensitive, or quick to cry

• Difficulty handling rejection or criticism

• Low self-esteem

If you’ve noticed multiple signs of depression in your child that have persisted for more than a few weeks, it’s a good idea to have a conversation with your pediatrician or a mental health professional.

Symptoms of Depression in Teenagers

It’s common for depression to begin in the teen years. Teens have to grapple with body image, sexual identity, and social issues that are different from what any other age group experiences. What’s more, teens are navigating all these challenges in a rapidly changing body, while simultaneously trying to manage intense academic pressure on the way to college or a career. It’s no wonder so many teens feel isolated, misunderstood, or suffer from low self-esteem that may pave the way for depression.

Interestingly, while depression is more common in boys in the early years, the opposite is true among teens. By adolescence, girls are significantly more likely than boys to experience depression. Regardless of gender, depressed teens may not fit our stereotypical image of a withdrawn, quiet, sad-seeming person.

Teens experience their emotions intensely, and their depression can often look like outbursts of anger rather than outbursts of tears. They are also more likely than younger children to express their feelings in impulsive and potentially harmful ways, like substance use or self-harm.

Depression symptoms specific to teenagers include:

• Dropping grades at school, especially if the drop is fairly sudden and unusual for the teen

• Feeling hopeless or disinterested about the future due to a belief that things will never get better

• Frequently talking about death and dying

• Withdrawing from friends

• Dropping out of extracurricular activities they used to care about

• Abusing drugs or alcohol as a way to cope with feelings

• Cutting or other forms of self-harm

Speaking to your child’s school counselor or doctor can help you make a plan for your teenager if you notice any of the symptoms above. Any child who talks about suicide or self-harm should be taken seriously. If you worry your teen is at risk of making a suicide attempt, call 911 or your local crisis hotline for help right away.

Counseling for Teens and Tweens with Depression in Davidson, NC

Therapy can make a big difference in a child’s life. The teen years are tough for pretty much everyone, but learning coping skills at an early age can make them a little easier to get through. One of the reasons I love working with tweens and teens is that they’re old enough to learn many of the same skills adults learn in therapy, which means they have a leg up on their current challenges as well as the ones they’ll face in their twenties and beyond.

I use the roleplaying game Dungeons and Dragons as a form of group therapy for tweens with depression. I also provide more traditional talk therapy both in-person and online for tweens and teens. Group therapy can provide kids with the social support from their peers that is so critical to good self-esteem. Individual counseling allows us to take a closer look at the thought patterns that fuel a teen’s depression, and practice coping skills to manage negative thinking.

If your child’s sadness is caused by a recent loss, you can play a big part in giving your child the coping skills to manage grief in a healthy way. My activity book for caregivers and kids is designed to help children ages 5-11 get support and process feelings of grief through simple, play-based activities you can try at home.

If you’re looking for help in the Charlotte area, you’re welcome to request a session at my Davidson, NC teen therapy office. Not local to Charlotte? I also see kids for online therapy throughout North Carolina, Florida, and New York. For more information, contact me here.

How Do I Talk to My Child About Counseling?

You know your child better than anyone, and lately, things just don’t seem right. Maybe you have noticed your child seems to be more worried than other kids her age. Or, you’ve been waiting to see if your child’s tantrums were just a phase, but they’ve stuck around long past the toddler years. After consulting with friends, the pediatrician, or “Dr. Google”, you’ve decided that child counseling could help. How do you tell your child you’d like her to see a therapist? It’s not a conversation most families have every day, which can make it feel awkward. In this post, I’ll share some tips from my experience as a children’s therapist on how to introduce therapy to your child in a positive way.

Common Concerns When Discussing Counseling

The most common concern I hear from parents is that their child will think something is wrong with them if they see a counselor. Views on mental health are changing quickly, but there can still be a stigma attached to getting therapy. The last thing a child struggling with anxiety, depression, or low self-esteem needs is another reason to feel different or “bad”!

Parents of younger children often worry about separation anxiety during sessions, especially if this is one of the issues bringing a child to therapy in the first place. Will it be too frightening for their child to meet with a therapist alone? What be done to help soothe their child’s fears?

When the child is a preteen or teen, there’s sometimes a worry that kids will “shut down” or not be receptive to attending therapy if it wasn’t originally their idea. Any suggestions from Mom or Dad might be viewed with suspicion by a teen or tween. How can we explain therapy in a way that encourages kids to keep an open mind?

If any of these worries sound familiar to you, congratulations! Your concerns are totally normal and you’re in the right place. Keep reading for some tips on how to handle this important talk with your child.

Don’t Bring Up Therapy in the Middle of a Fight!

There isn’t one right way to bring up the subject of therapy. However, there are a few that are…not so great! This is one to avoid. As frustrating as arguments with your child can be—especially if this is your millionth meltdown this week—don’t let this be the way your child learns about therapy.

Telling your child you’re sending them to a therapist between screams or from behind a slammed door virtually guarantees they’ll view therapy as a punishment. It increases a child’s feelings of shame and embarrassment, which won’t help them get better. What’s more, it can turn children off to the whole idea of therapy. They enter their first therapy session feeling resentful and not trusting the therapist to be on their side. That is a hard place to start.

Instead, wait until everyone is feeling good to start a conversation about therapy. This way, your child won’t connect going to a therapist with bad behavior. Avoid times of the day when you know you or your child will be stressed, tired, or hungry. A quiet evening after dinner or snack time after a good day at school is a great time for this discussion.

Describe the Problem as Belonging to Everybody

It’s often easiest to start the “counseling talk” by identifying the problem at hand. Even if your child is showing the most symptoms, it helps to acknowledge that parents have a role to play in therapy, too. This way, the child doesn’t feel like she’s a problem that needs to be fixed: everyone is in this together.

Try to describe the problems you’re seeing in a matter-of-fact, non-judgmental way. It helps to empathize with the emotions your child is feeling, even if the behaviors may be tough. Avoid making assumptions about why the problem is happening, if you aren’t totally sure, and stick to the what instead. If you think a child’s struggles were set off by a particular event, you can always “wonder aloud” about the possible connection.

For example, if your child is having anxiety about going to school, you could try saying: “I have noticed you have had a lot of stomach aches and worries lately, and they usually happen right before it’s time to get on the bus for school. It must be terrible to feel so nervous every day! I wonder if starting in your new school has been scary. I don’t always know the best way to help you with your worries.”

Once you’ve outlined the problem and how it’s affecting your family, you can move on to talking about therapy itself.

Explain What a Counselor Is to Your Child

Children need to know that a counselor is someone who can help them—and you—deal with their big feelings. They need to know that therapy is common and not something to feel ashamed of. In fact, we could all use counseling at some point in our lives!

When I meet younger children, I often describe myself as a “feelings doctor” even though I don’t have a doctorate degree. Most little kids are very familiar with going to their pediatrician’s office, so it’s a good comparison to make. If you have a cold or hurt your arm, a doctor can help you feel better. If your worries, sadness, or anger are bothering you, a feelings doctor can do the same thing. It’s important to explain that feelings doctors can’t give shots!

I tell older children that a therapist is an adult whose job is to be there to listen to them. A therapist is different than a teacher or parent, because they can’t give out punishments or make the rules. They are also different from a friend, because you don’t have to worry about offending your therapist or giving them a turn to speak in conversation. Therapists also keep what you say private, which is helpful and reassuring for older kids to know.

Talk About How Child Counseling Works

When describing child therapy, it helps to keep things simple. Sometimes, over-describing the situation only adds to the anxiety. You might consider something like this: “When you see your therapist, you can talk or play about anything you want. She’ll help you with your strong feelings and will keep the things you say private. She’ll also meet with me to help me understand you better.”

You can also prepare your child for what the therapy session will look like. If you’ll be meeting the therapist in person, describe where the office is and how it looks. Young children are often excited to know that there will be a playroom filled with toys! Tell your child where you’ll be during their session, for example, that you’ll stay in the waiting room nearby.

If you’ll be meeting online, explain how that will work to your child. Most kids are intimately familiar with Zoom these days, but they may still have questions about how much privacy they’ll have or who exactly will be on the call with them. You can pick out a quiet, private location for video calls with your child, and practice logging into the therapy platform together. Younger children may want to pick out a few toys or art materials to “show” their therapist on the first day.

Looking for a Child Counselor in Davidson, NC?

I live and work in the Lake Norman area, just north of Charlotte, North Carolina. If you’re in my neck of the woods, I specialize in working with preteen anxiety and trauma at my Davidson child therapy office. If you aren’t local to Charlotte, I also work with kids throughout New York, North Carolina, and Florida using online CBT and play therapy. And no matter where you live, my coping skills courses are available to access and use at home.

Want to see if we might be a good fit? Feel free to drop me a line to ask questions about what to expect in therapy, or to schedule an intake appointment.

5 Things I've Learned From Playing DnD With Middle Schoolers

If you’d told me in 2019 that I’d spend 2020 hosting Dungeons & Dragons groups for middle schoolers, I would have been…very surprised, to say the least. But 2020 was a weird year! As the pandemic and quarantine moved our social lives online, my therapy practice moved online, too. Online D&D groups are a big part of my life now—and, honestly, a highlight of my week.

When I first moved to North Carolina from New York, I joined a “DnD” group on a whim as a way to make friends. I learned that DnD is perfect for this: it’s an easy, low-stress way to socialize, especially if you are someone who doesn’t love small talk. There’s enough structure to the game that you aren’t left staring at someone, wondering what to say next. It’s creative, a little goofy, and sometimes surprisingly heartfelt. Because you are playing as a character, it’s hard to feel like you’re making a fool of yourself: any mistakes are the character’s fault, not yours.

When quarantine started, I realized that so many of the tweens I knew could use a structured, creative outlet like DnD to help them feel connected while social distancing. It’s been so fun to watch kids who have never played before take to the game easily, and use it as a way to support each other through a tough time.

Playing DnD with middle schoolers has taught me a lot about the game, the value of online friendships, and it’s even debunked some myths about middle school. Here’s what I’ve learned after 6 months of DnD with tweens.

“Mean Girls” Are a Myth

I have to admit that as a tween therapist I have perpetuated the myth of the “Mean Girl” many times. I grew up with the movie, and I remember how miserable 6th grade was for many of us. You couldn’t pay me to go back to 6th grade! While it’s true that middle school friendships can be filled with drama, there’s nothing inherently “mean” about girls this age. In fact, middle school girls really want to support each other.

It can be hard to be kind and supportive 100% of the time in a stressful school environment, where everyone is competing with each other and you’re worried about grabbing a spot at the “good” lunch table. In our groups, though, players know they are working toward a common goal: they’re here to make friends, and they take that responsibility seriously.

Far from “mean girls”, tween girls are some of the most welcoming and inclusive people I know. We’ve had girls from all walks of life join these groups, and their differences have not just been accepted, but celebrated. When they are set up for success, middle schoolers are an accepting bunch. Adults could learn a thing or two from watching them play.

Having Fun is Good Therapy

It’s easy to get hung up on the serious side of therapy—making sure you are working in a way that’s effective, and backed by solid research. I can geek out on this stuff all day: I love approaches like Cognitive-Behavioral Therapy that use scientifically proven techniques to help kids cope with anxiety and trauma.

Creativity, joy, and fun are as important for our mental health as any coping skill. In fact, it’s pretty hard to do any kind of therapy with kids if it’s not fun. Children learn through play. We can talk about social skills until I’m blue in the face, but talking will never be as effective for learning as playing is.

For kids who are struggling with depression, fun may be just what the doctor ordered. Depression is caused not just by the presence of bad things in life, but an absence of good things. We all need opportunities to learn new skills, flex our creative muscles, and just plain enjoy life. We call these opportunities “positively reinforcing activities” in therapy, because they leave us with a sense of accomplishment or fulfillment.

In quarantine, kids are getting fewer positively reinforcing activities than they should. DnD is an opportunity to be playful, make a terrible pun or inside joke reference, and generally act like a goofball for 90 minutes with a circle of friends. That’s good therapy in and of itself.

“Online” Doesn’t Have to Mean “Impersonal”

I worried a little about getting girls together across multiple states for these groups. They’d never met in person: heck, I had not met a lot of them in person. How would the group gel, having only met online? I think adults from my generation (elder millennials) and up still think of online hangouts as being more distant and removed from the real thing.

Gen Z doesn’t have the same feelings about online friendships. They’re digital natives; video chatting is just a part of daily life. It was a little humbling the first time a tween girl taught me something about how to use the Zoom platform, but I’ve embraced it now. Having structure to follow and a clear reason for meeting together online helps the sessions feel very personal and “real”.

…In Fact, It Can Help Anxious Kids Connect

Online school has been a dream come true for some of my tween clients with social anxiety. At last, they can learn without feeling like all eyes are on them! While I want my anxious clients to learn how to face their fears and handle face-to-face school with confidence, online hangouts are a great way to practice socializing with less fear.

Meeting online means we can gradually ease anxious kids into socializing without feeling put on the spot. Not ready to turn your camera on? That’s okay, this isn’t school. Nervous about talking on mic because your voice is shaky? No problem, lean on the chat function until you’re feeling more comfortable. While I always want players participating as fully as possible, tech gives us an option to turn down the intensity while new players build up confidence.

You’re Not Alone (Even If It Feels Like You Are)

At least once a week, a tween client tells me through tears that they feel totally alone. Nobody likes the stuff they do, nobody listens to their music or watches their favorite anime. Everybody has already found their clique, and nobody’s looking for new friends. It’s terrible to feel like you’re missing out, and even worse to feel like you’re the only person who is so isolated.

If these groups have taught me anything, it’s that you’re never alone. There’s somebody out there who is passionate about the same things you are. Somewhere, somebody is staring at their phone, too, wishing it would light up. In fact, there are probably multiple somebodies, and they’re probably closer to you than you think. Kids who attend the same schools or who live in the same towns have “discovered” each other through DnD groups, never knowing they had so much in common.

This has to be true for adults, too, right? Online groups mean that we can all find the people who like the same weird, goofy stuff we do—even something as weird and goofy as DnD.

Interested In DnD For Your Tween?

I’ve got you covered! As I write this, we’re about to embark on a new group adventure, and we have additional 6-week sessions starting periodically. We have groups available specifically for middle school girls, as well as groups that are open to all genders. Games are currently open to kids in New York, North Carolina, and Florida.

You can learn more about the groups I currently offer, fees, and other FAQs on my Dungeons & Dragons Therapy page. If you’d like to chat more or ask about enrolling your child, email me here.

Looking for something a little different? Consider joining us at Young Dragonslayers, which uses D&D for fun and friendship-building rather than counseling. These games are not facilitated by therapists, and are open to kids in all 50 states.

Can You Do Cognitive Behavioral Therapy Online?

If you or your child has struggled to get help for anxiety in the past, Cognitive Behavioral Therapy can feel like a breath of fresh air. As a children’s therapist myself, it’s so gratifying to see kids who have not seen improvements from from other forms of therapy blossom in this kind of counseling. Cognitive Behavioral Therapy is considered the “gold standard” for anxiety treatment. But what happens if you can’t meet with a therapist face-to-face? Is it possible to do Cognitive Behavioral Therapy online? Happily, the answer is yes. Let’s talk about how it works, and what you can expect from your online appointment.

What’s the Deal With Cognitive Behavioral Therapy (CBT)?

Let’s start with a basic overview of what Cognitive Behavioral Therapy is, and how it works. Cognitive Behavioral Therapy—also known as CBT for short—was developed in the 1960s by a psychologist named Aaron Beck. This makes it fairly “new” as far as therapy approaches go, but old enough that we have studies to show it’s effective. Actually, we have a ton of studies: CBT is probably the most-researched form of therapy that exists.

The core idea of CBT is that our feelings don’t just come out of the blue: they are determined by our thoughts and behavior. That might not sound like a big deal at first! However, it means that we don’t have to be at the mercy of our emotions. They don’t just happen to us: we have some power over what we feel and how we choose to express our feelings. CBT provides a toolkit to help people learn how to feel like they are in control of their emotions, instead of the other way around.

The “cognitive” part of Cognitive Behavioral Therapy refers to learning how to notice your own unhelpful thought patterns. The “behavioral” part involves noticing vicious cycles, and identifying things you can do proactively to help yourself feel better and manage strong emotions. By putting those two parts together, we can better understand and cope with our own emotional reactions. That’s CBT!

What Will I Do in Online Cognitive Behavioral Therapy?

If you’ve never done therapy online before, it can be hard to imagine. Will it feel awkward? What do you actually do in an online CBT session? I can’t guarantee what your exact therapy experience will look like, because every therapist is different. They’ll also recommend different techniques based on your particular situation. However, here are some common CBT techniques that you might encounter, and how they work in online therapy.

Relaxation and Coping Skills: Pretty much everyone is familiar with the advice to take deep breaths when you are stressed. The relaxation skills you’ll learn in CBT offer similar ways to calm down your body and brain. Your online therapist can teach skills like mindfulness, muscle relaxation, and guided visualization over video conference. It’s a very similar experience to sitting on the therapy couch.

Cognitive Restructuring: In CBT, you will learn how to catch yourself when you have a thought that is overly negative or exaggerated, and question whether or not you have evidence that it’s true. In online CBT, you’ll use a worksheet or spreadsheet to help yourself track when stress-inducing thoughts happen, and work through them step-by-step with your therapist. In my office, I ask clients to share their screen so we can both literally be on the same page. You’ll also learn how to come up with more helpful thoughts to say to yourself the next time you’re feeling worried.

Roleplay: Acting out a difficult situation in session can help you put the skills you’re learning into practice, so that it becomes easier in real life. This can be especially helpful for people with social anxiety, or for times when you need to have a hard conversation. Roleplay is great for boosting social skills and making it easier to be assertive. As long as you have a decent video connection, roleplay works great online—and sometimes feels a little less awkward from the comfort of your own home!

Thought Logs: Your therapist may ask you to keep a brief diary of events that triggered negative emotions during the week. This could include descriptions of what was happening, how you felt at the time, any thoughts you noticed, and how you dealt with the situation. You can share the results with your online counselor by email, screenshare, or using a Google Doc. This can help both of you develop more insight into common problems.

Does Online CBT Work As Well As Face-to-Face Therapy?

More people are considering online therapy now than ever before. Because it’s still a fairly new idea, you might be wondering it’s as effective as traditional, in-person counseling. Luckily, there is a lot of research on CBT we can look at for answers. Studies have shown that online CBT is just as effective at treating mental health problems like anxiety, depression, and panic attacks. People see significant mental health improvements in online CBT, and they’re able to maintain their progress over the long term.

Any form of therapy has its upsides and downsides. Even though it is equally effective overall, there are a few things to consider if you’re looking into virtual therapy. You and your therapist can only see each other from the shoulders up on a video call. This might make it harder for your therapist to read your body language. Talking to someone on video conferencing takes some getting used to, and if you are working or attending school online you might already be experiencing Zoom Fatigue.

There are some advantages to online therapy, too. It’s much more convenient to attend therapy from home. You never have to worry about traffic, and it’s a lot easier to fit your appointment into a busy schedule. It might even make it possible to see a therapist who would be too far away or hard to reach in person. Some people also prefer the anonymous feeling of meeting online, where you don’t have to sit in a waiting room with other strangers.

Does Online CBT Work With Kids?

Older children take to online therapy pretty naturally, because they’re already so comfortable with technology in their daily lives. I love using CBT in online therapy with kids ages 8 and up. It is especially helpful for kids who are struggling with anxiety or strong feelings that haven’t gotten better in other types of therapy.

Because CBT is direct and skill-based, it translates easily to an online format. Kids start learning coping skills right away, so they’re able to feel better faster. Having specific skills to learn and goals to reach helps kids stay focused and engaged, even when we aren’t sitting together in the same room. I like to spend half of each therapy session working on a specific skill or idea, and then include play therapy in the second half . This helps us make good progress while still leaving room for creativity and fun.

Online CBT for Kids in North Carolina

I’m a counselor, play therapist, and drama therapist who helps kids in North Carolina. I’m also a huge fan of Cognitive Behavioral Therapy for children with anxiety. If you’re interested in this approach, I’d love to help you get started!

My counseling office is located in Davidson, but I can work with kids throughout North Carolina, as well as in New York and Florida. You can learn more at the links above, or by checking out my other blog posts on CBT. If it seems like we could be a fit, feel free to reach out to me.

Online Trauma Therapy: How TF-CBT Helps Kids Heal At Home

2020 has been a weird year. The pandemic has been a trauma event for the whole world: we are all going through it together. As Covid continues on and case counts rise and fall, regular life carries on, too. Kids are experiencing traumas like accidents, illnesses, and violence just like they were before the pandemic began. How do you get your child the trauma therapy they need while staying at home? In this post, I want to talk about online TF-CBT, and why it’s a great option for kids’ trauma therapy both now and in the future.

Why Consider Online Trauma Therapy?

Families may consider online trauma therapy for a variety of reasons, some of which are not unique to 2020. Depending on where you live, it might be hard to find a counselor who knows how to treat childhood PTSD. Other life circumstances can make it hard to find time to drive to a counselor’s office in the middle of a 9-5 work day. Health conditions might also prevent a child or parent from easily being able to travel. Here are a few situations where online trauma therapy can help:

• You really connect with a therapist who lives in your state, but not your town

• You live in a rural area where it’s hard to find a trauma specialist

• You or your child is living with a chronic illness or disability

• You and your ex-spouse have joint custody, so your child travels between two far-apart homes

• Your child’s schedule is extremely busy, and it’s hard to squeeze in another appointment

Doing therapy online means you can see therapists all over your state. You have way more options! If you’re looking for someone who specializes with a specific age group or a particular problem, online therapy broadens your horizons.

What is TF-CBT?

TF-CBT stands for Trauma-Focused Cognitive Behavioral Therapy. It’s a form of therapy that was created to help kids with PTSD symptoms following a trauma. If you imagine a stereotypical therapy session, what comes to mind? Do you picture going into a room and talking about your earliest childhood memories while a therapist nods and says “How does that make you feel?” If so, that’s not what happens in online TF-CBT.

This style of therapy is skill-based, meaning kids learn coping tools they can use in the here-and-now to get some relief quickly. It is also fairly short-term, meaning that children will usually attend therapy for a matter of months. TF-CBT is designed for children from age 3 to age 18. Any child who can put their trauma experience into words is likely to be a good fit for this therapy approach.

How Does TF-CBT Work Online?

TF-CBT is divided into three parts. Here’s how each of them works online:

In the first phase of TF-CBT, kids learn about trauma symptoms and practice coping skills to manage them. Children learn that many other kids have gone through similar experiences, and felt the same way they do now. They rediscover how to soothe their body and mind when trauma symptoms send them into high alert. A TF-CBT counselor can model how to practice relaxation skills on video chat, email handouts to families to practice at home, and share educational books and videos online.

In the second phase of TF-CBT, children gradually begin to face their fears. Many children are bothered by upsetting memories or flashbacks after a trauma. They may also be fearful of situations or people that remind them in some way of what happened. In this middle part of the therapy process, the therapist helps the child gradually expose themselves to scary situations or memories in a careful way. Children can use their new coping skills to manage strong feelings as they arise.

An important way children face their fears is by creating a trauma narrative: a story about their trauma experience from their own point of view. This can be done online using a shared Google Doc for older kids, or by using online comic strip or art programs for younger children. Either way, the therapist is there at all times to make sure the child isn’t overwhelmed.

Finally, children and parents meet together. Kids have an opportunity to share their story with their parents. Meanwhile, parents have the change to show children that nothing they think or feel is too scary to be mentioned. This helps children and parents strengthen their bond after trauma, and paves the way for the child to graduate from therapy. I really enjoy seeing families curled up together on the couch to read their child’s story: it’s much more comfortable than being in my office!

The Benefits Of At-Home Therapy for Trauma

While I love seeing children for face-to-face therapy, online counseling has a few distinct benefits to offer. Until I started practicing online, I’d never considered its hidden perks! Here are a few advantages to consider if you’re considering at-home trauma therapy for your child:

• Online therapy can feel less overwhelming than being face-to-face. This can be especially helpful for shy children who are nervous about talking to a strange adult. When kids are in my office, they’re very aware that I’m close by and looking at them. Online, though, I seem a bit more removed. This makes it easier for some children to open up.

• Being at home means being close to comfort objects. If a child gets overwhelmed during a home session, they are already in a place that likely feels safe and comfortable to them. Pets, stuffed animals, siblings, and photos of loved ones can all be brought into sessions for emotional support.

• As a therapist, I’m able to watch children write and create their stories in real-time. A shared Google Document allows me to observe a child’s thought process as they’re writing, without having to awkwardly peek over anyone’s shoulder. This can be really helpful when children are sharing memories of trauma, because I can spot important details quickly.

Looking for an Online Child Trauma Therapist in North Carolina, New York, or Florida?

I’m a Davidson-based children’s counselor who specializes in childhood trauma and anxiety treatment. I’m also a big proponent of online therapy for kids! I love online counseling because it gets rid of many barriers that make it hard for kids to get good quality therapy. If you’re not local to the Charlotte area, I offer online TF-CBT throughout North Carolina, New York, and Florida.

If you’re looking for an online trauma counselor for your child, you can learn more about me or reach out to schedule an appointment. I’m always happy to chat and answer questions before scheduling.

You can also learn more about TF-CBT and trauma here or by checking out my blog posts on the subject.

Online Therapy for 11-Year-Olds? 5 Ways Preteens Benefit from Virtual Counseling

I love working with kids online. While there are a few things that just can’t be done virtually (it’s pretty hard to make slime on a video call), this form of therapy has so many hidden perks that I hadn’t considered before diving headfirst into the online world. In particular, online sessions have proven to be an awesome fit for my preteen clients. 10, 11, and 12-year-olds are at a great age for this style of work, due to their maturity level, the reasons they commonly come to therapy, and the way they naturally communicate. In this post I’ll be unpacking the 5 reasons preteens and online counseling are a match made in virtual heaven.

11-Year-Olds Are Digital Natives

By the time today’s 11-year-olds were born, Facebook, Twitter, and Amazon were already a thing. They’ve never known a world without an iPhone, and they’ve probably been using it to FaceTime with grandma and grandpa since they were toddlers. Video conferencing feels natural to most tweens, because it’s been the norm their entire lives. While the technology may feel cold or impersonal to us, it’s the primary way most tweens connect with their friends.

The technical difficulties that could easily fluster an adult are no big deal for most tweens. They know their way around a computer, and they can figure out many minor issues alone without missing a beat. I have been consistently amazed by how easy it is for my preteen clients to navigate our online sessions.

Preteens Crave Privacy and Independence

Around age 11 or 12, many parents notice their children start to crave their own personal space. They may spend more time tucked away in their room, or prioritize social events over family activities that they used to enjoy. While the change can be unsettling, it’s a totally normal part of growing up. As children become teens, they start a process called separation-individuation: they are learning to think and do things for themselves, without their parents help, as they prepare for adulthood.

Online therapy sessions give preteens more agency over the therapy process. They can log on and off by themselves, and don’t need to catch a ride from a parent. They can chat with their therapist from the comfort of their own room, knowing that there aren’t other kids, therapists, or parents sitting in a waiting room just outside their door. Headphones or text chatting can ensure conversations are kept private from siblings’ ears. When tweens are empowered in this way, they may feel more invested in their own therapy.

It’s Easier to Talk About Touchy Subjects

Have you ever tried to bring up one of those “after school special” subjects with your preteen kid? Drug use, peer pressure, puberty…the stuff nobody really feels super comfortable talking about? Eye rolls, exasperated sighs, or indifferent shrugs often ensue. It’s not always the easiest thing for tweens to talk about these subjects in therapy, either. Sitting on a couch in a random lady’s office while she perches on a chair 3 feet away from you making direct eye contact can feel…weird.

Online therapy gives kids some physical and emotional distance that can make easier to open up about this stuff. It can feel safer and a little more anonymous behind a screen, and typing is sometimes easier than talking out loud. I have had so many surprising conversations with my tween clients using the chat feature that I’m not sure would ever have happened in face-to-face therapy. From boy drama to moral dilemmas to painful past experiences, we have chatted (and typed) about it all.

Preteens Have Packed Schedules

I swear that nearly every preteen on my caseload is in a traveling sports league that meets approximately 25 times a week. Plus music lessons. Plus girl scouts. Plus school. Academic demands get way more intense in middle school, and so do extracurriculars. Coping with a full schedule and commuting from activity and activity can be stressful, and might even contribute to anxiety for some kids.

From a practical standpoint, online sessions ease stress because it’s one less thing that kids (and parents) have to drive to. Sessions are easier to schedule, because there’s no risk of getting stuck in traffic. Online therapy has allowed me to work with kids who might otherwise not have been able to attend therapy due to their parents’ work hours or their own after school activities. In the middle of a busy school week, there’s something kind of nice about being able to take a breather at home, and show up for therapy in your house slippers with a favorite drink or snack on hand.

Online Therapy Offers New Ways to Be Creative

I know I mentioned earlier that you can’t make slime in online therapy, and that is true: I really miss slime! While some play therapy standbys don’t translate quite so well into the online world, virtual therapy has opened up a world of new opportunities to get creative in therapy sessions. It’s not better or worse than in-person counseling, just different—but cool!

Tween clients can collaborate on Google Docs with me to write stories together in real time. They can show me content from Instagram influencers they look up to, and give me a glimpse into their inner world that I wouldn’t otherwise see. I don’t think I ever would have considered running online Dungeons & Dragons groups for middle schoolers before starting virtual therapy, and now they are a highlight of my week!

Looking for Online Therapy for Your 11-Year-Old?

Preteens are my favorite age group to work with in therapy. You can learn more about my online therapy practice here, or contact me to schedule an appointment. I’m able to work with clients online in North Carolina, New York, and Florida. My (virtual) door is always open!

I love working with this age group so much, that I created an online course just for them. Worry-Free Tweens is a self-help video class that teaches anxiety coping skills to kids ages 8-12. You can access it right away to start learning new strategies for you and your child.

Online Social Groups for Kids Can Help Beat the Pandemic Blues

2020 is a weird year for pretty much everyone, but it might be especially tough for kids. Children need to be around other children in order to grow and learn, and the pandemic has made this hard to do. Preteens and teens, who are in a developmental stage where friendships become central to life, might be hit especially hard by social distancing. If your child is struggling with depression or loneliness, online social groups can be a great way to reconnect with old friends or meet new people. Here are a few things to consider if your child is considering joining a group!

The Benefits of Online Groups for Kids

If you’ve noticed signs of depression or anxiety in your child, your first thought might be to seek out a counselor. One-on-one therapy can be a great option for many kids, giving them new coping skills and a chance to work through their feelings with an adult who isn’t a friend or family member. However, if a child is feeling lonely or struggling socially, there are some things that individual therapy just can’t provide as well as a group.

Any time a child has the opportunity to socialize with peers, it benefits her emotional wellbeing. Here are a few ways that extracurriculars, clubs, and online group classes of any kind can benefit kids’ social and emotional growth:

• Group activities give kids a real-life opportunity to practice social skills like turn-taking, compromise, and starting and maintaining conversations.

• Learning and mastering a new activity helps kids feel more confident and boosts self-esteem.

• Group activities provide a chance to meet like-minded kids who might become good friends.

• Socializing with others can help treat and prevent depression.

The Benefits of Therapy Groups for Kids

In addition to the benefits listed above, therapy groups have a few extra perks that can make them particularly effective for kids struggling with anxiety, depression, or social skills difficulties:

• Being in a therapy group helps kids realize they are not alone with their feelings: they’re in a room with other kids who share their experience and get what it’s like.

• Children in therapy groups have the opportunity to help and support each other, which is empowering.

• Being in a group more closely mimics the “real world” experiences kids are likely to have once they leave the therapy office: if they can use their coping skills in group, they can use them outside of group, too!

Small Online Classes Encourage Kids’ Interests

No matter what your child’s interest, there’s probably a group out there to learn about it. Outschool offers small group online classes for kids on pretty much every subject under the sun, from video game design to cupcake baking to how to draw Baby Yoda. I find that smaller groups tend to feel less awkward for kids (and adults!) than big ones, which might make it easier to socialize in classes like Outschool’s. Class lengths vary, too, from multi-week courses to one-off classes, so it’s not a big commitment to give it a try.

Online Communities Connect Tweens and Teens (Without Roblox or TikTok)

While not exactly a group activity, kid-friendly online communities can be valuable for preteens and teens because they’re budget-friendly and available 24/7. If you’re looking for an alternative to social media or the typical Minecraft and Roblox fare, check out this awesome list of age-appropriate online communities from Commonsense.org. I’m particularly intrigued by the Harry Potter Alliance, an online club for kids that uses the Harry Potter series to encourage social activism. Am I too old to join?!

Online Gaming Groups Help Children Practice Social Skills

Often, kids who are struggling to make or keep friendships could benefit from brushing up on their social skills: things like how to keep conversations going, deal with conflict, and speak up for themselves assertively. But what kid really wants to go to a place where they feel like their social awkwardness is under a microscope? Not only is learning social skills through play less uncomfortable for kids, it’s also likely to be more effective: role playing conversations with an adult is never going to be exactly the same as talking to another kid.

Game-based groups offer kids an opportunity to socialize and practice skills in a low-pressure environment, and these types of groups often translate easily into online sessions. I am currently running Dungeons & Dragons-based therapy groups for kids in my own practice, and I’ve found that the game gives kids some structure that makes getting to know each other online feel less awkward, while still giving plenty of opportunities to be creative.

Need More Help Finding an Online Social Group?

The resources I’ve listed here are available to kids throughout the US, but ongoing social distancing means local opportunities are likely popping up in your community, as well. Many dance, art, and music studios are offering distant group learning options for kids, and your local library may be able to give you information about other nearby programs. Older kids might be interested in online foreign language classes offered by local chapters of language and culture societies like the Alliance Française, which are often available online and reasonably priced.

If you’re local to North Carolina, New York, or Florida, my D&D therapy groups might be a good option. Not local to one of these states? Consider my sister site, Young Dragonslayers, where we run non-therapeutic D&D groups for kids focused on friendship-building and fun. I also offer an online coping skills class for tweens, which can help your child learn to manage worries from home.

If you’d like more information on these online social groups or other counseling services, you are always welcome to contact me.

Why Do So Many Kids and Teens Have Depression During the Pandemic?

In normal times, I don’t see many kids or teens with depression coming to my office for help. It’s much more common for me to meet children who are struggling with anxiety, or who have been impacted by a recent trauma. I figured that the coronavirus pandemic would bring more of the same: lots of kids feeling super anxious about the virus, or who were experiencing the pandemic and quarantine as a traumatic event.

At first, this was true: I did see lots of anxious kids in March, April, and May. But things have changed recently. Suddenly, it seems like almost every child I meet has symptoms that warrant a diagnosis of depression. Given these new struggles, I thought it would be helpful to talk about childhood depression today: what causes it, how to spot it, and how to know when to get help.

What Causes Depression in Children and Teens?

When you imagine depression, you might picture it as the result of bad things happening in a child’s life: for example, a divorce, a serious illness, or bullying at school. Kids who experience these kinds of events can absolutely feel depressed, but for many kids, depression happens without a clear cause.

Sometimes, it isn’t negative experiences, but a lack of positive ones that leads to depression. Many psychologists believe that depression happens when we lose our ability to socialize with others, and participate in activities that are fun or rewarding. A child who is feeling isolated may begin to feel depressed, and this can set off a vicious cycle: kids who feel depressed lose interest in activities they used to enjoy, which leads to more social isolation. This can make it really hard to beat depression, and symptoms tend to get worse over time.

For other children, genetics and biology might play a part in depression. Scientists have identified at least one gene that may be linked to depression, and people who have an immediate family member with depression are up to 3 times more likely to experience depression themselves. An imbalance of chemicals in the brain, such as serotonin, might also contribute to depression for some kids.

How Quarantine Increases Depression Risks for Kids

As the pandemic wears on, many children seem to be developing depression symptoms who didn’t struggle with depression before. Even if a child doesn’t know anyone who has fallen ill, they may still notice changes in mood. Kids and teens who haven’t been directly affected by the coronavirus are still finding themselves feeling down, crying more easily and often, and losing interest in the activities that used to excite them.

When you think about depression as coming from a lack of positive experiences, rather than an excess of negative experiences, this starts to make a lot of sense. Most children have remained physically safe and unharmed during quarantine, but they’ve lost many of the activities that add joy to life. Social distancing is critically important, but it has some side effects that increase the odds of depression for kids and teens. For example:

• Many clubs, classes, and extracurriculars have been canceled or postponed.

• Online school is very structured, and kids miss out on the casual chats with friends in the halls, cafeteria, etc. that help to build friendships.

• Most children are going on fewer face-to-face hangouts and playdates with friends, and may have limited options for outings.

• Kids who have recently moved or changed schools have very few ways to meet new people.

Which Kids Are Most Affected by Pandemic Depression?

Quarantine may be especially hard on preteen and teen-aged kids, because being away from other young adults makes it harder to develop and grow. Friends play an increasingly important role during the preteen and teen years. Older children are expanding their horizons, becoming more independent, and developing their own identity, and they need their peers to accomplish these tasks.

Children of any age who already struggled with social anxiety or feeling isolated may also be at increased risk of depression. Kids who had a strong social network before the pandemic tend to be faring better right now, because it’s fairly easy for kids to maintain close friendships online. On the other hand, kids who were already lonely feel even more so right now, and they have few opportunities to meet new people or turn acquaintances into closer friends.

Signs of Depression in Children and Teens

Let’s be honest: a lot of us are feeling a little down right now, and that’s normal and okay. It can be hard to differentiate between everyday quarantine malaise and symptoms of depression that might require extra support. This can be especially true when we’re dealing with kids. Here are a few signs and symptoms of depression to keep eye out for if you are concerned about your child:

• Ongoing, prolonged feelings of sadness and hopelessness

• Pulling away from friends and activities that used to be fun

• Sleeping too much or too little

• Being irritable or extremely sensitive to criticism or rejection

• Fatigue, low energy, or low motivation

• Headaches, stomach aches, or other physical symptoms that don’t have a medical cause

• Decrease in self-esteem

• Thoughts about death or a wish to be dead

When (And How) to Get Emergency Help

Most children and teens who are depressed do not have thoughts about suicide. However, it’s important for parents who suspect their child may be depressed to be on the lookout for warning signs that could indicate a child is thinking about or seriously considering suicide:

• Isolating from family and friends

• Writing, drawing, or talking about death in a preoccupied way

• A sudden, major shift in personality

• Increasingly aggressive or risky behavior

• Giving away important belongings

• Threatening suicide

Any time a child threatens suicide, it has to be taken extremely seriously. Parents who worry their child could be at risk of seriously hurting themselves should head to the nearest emergency room, where a child can get help right away.

If your child is struggling with suicidal thoughts, there are resources to help. Parents or children can call the Suicide Prevention Lifeline for help at 1-800-273-8255. Teens can also text “home” to 741-741 to contact the Crisis Help Line, where they’ll be put in touch with a crisis counselor who is trained to work with young people. Both these services are free, and available 24/7.

Help for Kids and Teens With Depression During Quarantine

Social support systems are our best weapon to fight depression, especially during quarantine. You can help your child by encouraging her to find new ways to stay in touch with friends. I find that online socializing feels less awkward and more “real” when there is some structure to it: for example, playing a game, cooking a recipe, or even watching a movie together. Small groups or one-on-one Zoom hangouts also tend to feel more natural and less intimidating than large group calls.

Any activities that are new, different, or give a sense of accomplishment can help. You can gently encourage your child to accompany you on grocery store runs, walks, or other outings for a change of scenery. Kids with depression may be incredibly reluctant to get out of the house, but the more they do it, the easier it will become.

If you’re noticing big changes in your child’s mood, counseling can help get your child back on the right track. Cognitive behavioral therapy can help young people notice the overly negative thought patterns that fuel depression and keep them feeling down. It can also help them to learn coping skills to deal with intense sadness, and discover activities they can enjoy even in the midst of the pandemic.

Online therapy for kids is available in many communities, and some counselors have begun offering online social groups for kids, like my Dungeons and Dragons gaming group for girls. If you’d like to learn more about the group or my approach working with kids online, you can contact me here.

4 Ways to Keep Kids Engaged on Zoom (and Avoid Zoom Fatigue)

Remember when unlimited screen time was a child’s dream come true? I’ve been joking with my kid clients that the pandemic is teaching all of us to be careful what we wish for: maybe being on screens all day isn’t as much fun as we imagined it would be! As schools reopen and many students find themselves gearing up for another semester online, I thought might be helpful to discuss the phenomenon of Zoom fatigue: what it is, why it happens, and how we can help keep kids engaged and having fun on their school calls.

What’s Zoom Fatigue, and How Does It Affect Kids?

Have you ever finished a long day of back-to-back video conference calls and found yourself feeling surprisingly drained, even though you’ve been sitting still all day? That’s Zoom fatigue, a pandemic-era term for the physically and emotionally sluggish feeling some people describe after spending lots of time on video conference calls. Depending on your workload and how easily affected you are, you might feel a little irritable or flat-out tired.

Kids can be affected by Zoom fatigue, too, and I find that large group calls are often the hardest for them to manage. Older children can make the connection between their low energy and Zoom calls, but younger children may not be able to articulate what is hard for them about Zoom meetings. Here are a few signs and behavior changes to look out for that might mean Zoom fatigue is setting in for your child:

• Reluctance or tearfulness when it’s time to join a call, even when it’s a social or fun meeting

• Irritability or meltdowns that immediately follow Zoom calls

• Fidgeting, difficulty sitting still, and trouble focusing

• Unusual frustration or arguments with peers during meetings

• Headaches, eye strain, or other physical complaints

If you’re noticing some of the symptoms above in your child, keep reading: there are ways adults can help make this temporary new normal easier for kids to manage.

But Wait! Zoom Isn’t All Bad News

Even though this post is about how to handle Zoom fatigue, I don’t want to leave you with the impression that all online activities are horrible. I’m a firm believer that online meetings aren’t necessarily better or worse than face-to-face. Zoom meetings are just different, with their own pros and cons, and we are still figuring out how to do them well.

For some kids, online sessions have some major advantages over meeting in person. Research shows that people who struggle with social anxiety feel more at ease online, which can make interacting over Zoom a more positive, less intimidating experience. Children with social anxiety may find it’s easier to make the first steps towards speaking up in class or talking to peers when there’s no pressure to immediately meet face-to-face.

There’s also a thought that meeting online equalizes some of the factors that could lead to bullying and teasing in person. For example, differences in height and other physical traits are less noticeable in Zoom meetings, where everyone is seated and your whole body isn’t on display. I wonder if online classes have also reduced teasing about the clothing children wear, since it’s hard to pass much judgment on an outfit when it’s mostly out of frame.

Zoom Engagement Tip #1: Add More Movement

It’s challenging enough for many kids to remain seated at a desk all day, but classes used to be broken up by recess, as well as trips to the bathroom and water fountain, gym class, and walks between classrooms. All those little breaks added up to a decent amount of movement throughout the day. In online meetings, kids aren’t getting any of those opportunities to move. Being sedentary all day long can drain energy, lower mood, and make it more difficult for kids to focus.

You can help your child minimize the drain of sitting down all day on calls by intentionally building more movement into your day. Use 20 minutes of your child’s lunch break to take a walk outside, or try out a yoga video on YouTube. Encourage your child to get out of her chair and stretch between calls, rather than simply waiting for the next one to begin. Hopefully, teachers are finding ways to incorporate movement in to their lesson plans, but any added opportunities to move can combat fatigue.

Another way to add more movement is by giving your child a fidget toy to use while seated. Kids aren’t getting the same sensory-rich experience on Zoom calls that they’d be getting in person, which can make sitting still in front of a screen even harder. A quiet, non-distracting fidget toy such as a Tangle or a Boink can help children keep their bodies engaged without pulling focus from the teacher.

Zoom Engagement Tip #2: Create the Right Space

When the pandemic first started, I assumed I’d be working from home for a matter of weeks. I grabbed a hard plastic folding chair, propped it awkwardly in the corner of a spare room, and figured I’d be good to go. Two weeks later, I was getting tension headaches, my energy was low, and I was starting to feel the drag of Zoom fatigue. Setting up a designated office space with a comfortable chair has made a big difference in my stamina for doing online conference calls.

One benefit of virtual meetings is that we get to control our own environment. We control the temperature of the room, we can sit in a way that feels comfortable, and our favorite drinks or snacks are available to us pretty much any time. When I see children for online therapy, they often have their favorite toys, blankets, and even pets on hand to help them feel comforted and grounded during session.

If you started off online school the way I started online therapy—preparing for weeks, not months, of working remotely—the new school year is a good time to reassess where and how your child is taking Zoom calls. You don’t need a Pinterest-worthy home office setup, but giving a child a designated, comfortable place to work can make it easier to stay focused as well as a more enjoyable experience. Here are a few tips to consider if you’re creating a “Zoom space” for your child this fall:

• If your child will be joining calls from his bedroom, encourage him to sit at a table or desk rather than lying in bed. I’ve found when kids are joining calls from under the covers it leads to low energy, poor focus, and a general desire to go back to sleep!

• The larger the screen, the easier it is for children to stay focused. Phones are not great for virtual calls, tablets are better, and a laptop or desktop computer is your best bet, if one is available.

• Position your child’s computer at eye level to reduce strain and simulate “real” eye contact. All you need is a stack of books under your computer, and this can make a world of difference on Zoom calls.

• It can be really tempting to pull up a second window to start a game or chat with friends during online calls: we’re all used to multitasking on computers, and it’s harder to get caught! Consider helping your child reduce distractions during school time by installing an app that blocks social media or other websites during study time.

• Adding some sensory elements to your child’s work area can help offset the lack of sensory stimulation they’re getting from Zoom calls, which don’t often engage the full body the way in-person learning does. Weighted blankets, textured pillows, fidget toys, or scents that calm or energize your child can be helpful grounding tools as well as a way to make work time feel more fun and special.

Zoom Engagement Tip #3: Shift Your Schedule

Many schools are including more asynchronous learning this year, meaning that classes will be pre-recorded and available for children to watch at any time. This gives parents (and kids) a lot more freedom in figuring out a learning schedule that works for them and reduces Zoom fatigue. I think this is another silver lining of online learning: if your child is not a morning person, or learns better when they can have frequent breaks, they no longer have to conform to the typical 8-to-3 school day schedule.

On a personal note, adjusting my own schedule was the most helpful thing I have done to combat Zoom fatigue. Even though you’re sitting still, virtual calls can take a lot out of you! Communicating with other people online sometimes takes a little extra effort, especially when you’re still adjusting to the format. Working longer hours over 4 days worked well for me doing in-office work, but ended up being too much screen time for online calls. Spreading my sessions out over 5 days gives me more breathing room, and I’m much more energized for my meetings.

If you have some flexibility with your child’s school schedule this year, here are a few points to consider that may help combat Zoom fatigue:

• If possible, give your child some control over her own schedule. Many children have felt very powerless during the pandemic, and being able to choose when to do school work can be empowering.

• Consider breaking up the school day into smaller chunks, or spacing out the work over a longer span of days in order to reduce the consecutive hours spent in front of a screen each day.

• Keep your schedule consistent whenever possible. Encourage your child to go to bed and wake up at the same time each day to promote healthy sleep. Maintaining predictable times for meals, study time, and play time can be reassuring for kids and reduces anxiety. It can also help kids maintain the habits and structure they’ll need when in-person school resumes.

Zoom Engagement Tip #4: Be Picky!

At the beginning of quarantine, many of us experienced a tidal wave of social Zoom calls. While we are all craving connection and looking for ways to spend our newfound free time, it’s okay to be selective, too. This is especially true for children, who may have a hard time staying engaged on social calls after a long day of school.

Just like any other activity, Zoom calls can become too much of a good thing. Be picky about what social calls you and your child agree to, and prioritize the meetings that are most important. If you notice your child is already feeling worn out from school calls, it’s totally fine to turn down the optional class check-in or book club chat. This allows your child to conserve his time and energy for the stuff that really matters.

In general, smaller calls cause less fatigue than larger group calls. Conversation flows much easier and feels more natural when you aren’t accidentally interrupting 10 other children. If you have an option for your child to meet with peers individually or in small groups, give this format a try. It’s likely to be a more fun experience for all involved, and you may find your child connects more easily with friends when there are fewer kids on the call.

I hope this post has been helpful to you as you navigate another highly unusual school year. Please drop me a line if you have questions or found this article helpful—I’d love to hear how you are managing online school! If you are looking for online counseling for your child, my (virtual) door is always open. I’m able to offer therapy to children and families in New York, North Carolina, and Florida.

If you’re looking for non-therapy resources, my online courses teach coping skills to kids to manage anxiety and stress. Check out Worry Free Tweens, which helps kids ages 8-12 learn how to cope with panic, anxiety, and worries.

Online Therapy for Minors: What You Need to Know

Telehealth is more popular than ever before. By now, many of us are probably used to consulting with doctors, physical therapists, and counselors online. Given the current stresses in the world, there are many children and teens who could really benefit from having an understanding person to talk to.

However, many of the “big name” companies for online therapy primarily cater to adults. In this post I’ll go over what you need to know about online therapy for minors. This information should be helpful whether you’re a parent looking for therapy on behalf of a child, or a young person seeking therapy for yourself.

What’s Online Therapy, and Who Uses It?

Online therapy goes by a lot of names: teletherapy, telehealth, virtual therapy, video therapy…ultimately, all these terms describe the same idea. Online therapy is mental health treatment that is done over the internet, using a video conferencing platform. Sometimes when people hear “telehealth”, they think of “telephone”, but online therapy almost always includes both sound and video. Most therapy sessions take place using programs that are very similar to Zoom or Google Meet, but with more security in place to make sure the conversation stays private.

Some reasons a young person might choose online therapy are:

• They have chronic health or mobility problems that make it hard to meet in person

• Their family is taking precautions because of the coronavirus

• They live in a rural area where it’s hard to find a local therapist

• They or their parents have busy schedules that make it hard to drive to an office

• They just feel more comfortable doing therapy from home

How Do I Find an Online Therapist Who Works With Kids Under 18?

Some of the large, national companies who provide online and text therapy only serve adults. The ones that do see minors typically only see teenagers ages 13 and up. In general, I think your best bet is to find a therapist who is licensed in your state and specializes in kids or teens. This is especially true if you are looking for therapy for a younger child. When you’re selecting a therapist this way, you are able to learn more about them and their approach, and ultimately have more control in choosing a therapist whom seems like a good fit for you and your family.

You can use therapist directories like Psychology Today to search for counselors in your area who work with minor clients in your city or state. TherapyDen is another great option for searches: it’s a smaller directory, but gives you lots more information about each individual therapist, including their commitment to social justice and inclusivity. If your finances are limited, Open Path Collective is an awesome resource that may be able to help you connect with a private practice therapist who can offer you a reduced fee for appointments.

Will a Minor Child’s Therapist Talk to Their Parents, Too?

Most people under the age of 18 don’t have the legal right to keep their therapy sessions 100% private, because they have a parent or guardian who is legally in charge of their care. A parent or legal guardian can access a child’s medical records at any time. On the other hand, can you imagine going to a therapist knowing that everything you say is going to be shared with your Mom or Dad? It makes it very hard to open up, and almost guarantees that therapy won’t be effective.

It can be a little bit of a balancing act to respect a minor’s need for privacy while also making sure parents feel included and have the information they need to help their child. Even though parents have a legal right to know everything, most therapists who work with minor children will ask that a parent allow treatment to remain mostly private.

When I work with young people, I usually share what I am doing with parents—for example, what coping skills I’m teaching or what our therapy goals are—but I don’t share personal things that a child has told me without permission from that child. That way, kids can feel secure in knowing that I’m not going to tattle on them to their parents, but parents can also feel secure in knowing what is happening in treatment.

How Does Confidentiality Work Online for Kids Under Age 18?

Even for therapists who keep sessions with minor children private, there are a few situations in which a parent must be told what is going on. All therapists have to follow a code of ethics which includes a promise to always inform a parent or caregiver if a child is in a very dangerous situation. This is called mandated reporting. The three major reasons that a therapist might need to break confidentiality with a minor client are:

• The therapist suspects that a child is being physically or sexually abused

• A child is at risk of self-harm, or of hurting someone else

• The therapist hears about an elderly person or a person with a disability being abused

If a therapist has to report one of these events, only the information needed in order to keep everyone safe will be shared. For example, if a child is feeling suicidal, a therapist will share this with parents and, if needed, other professionals who can help. The therapist wouldn’t share unrelated information with those people, like how a child feels about family or friends.

Therapists can share this kind of information with parents in emergency situations, but in general, therapists can’t share information about a minor client with anyone else unless they have specific permission to do so. Teachers, employers, extended family, or other people in a child’s life won’t be told anything about therapy without written permission.

Can a Minor Seek Out Therapy Without a Parent’s Consent?

The short answer is: it depends on where you live. I wish young people never found themselves in this position, but I know that sometimes teens feel unsafe telling their parents about their need for therapy. Each state has its own rules about whether or not minors can be in therapy without a parent knowing, and in most states, the rule is that anyone under 18 needs written permission from their parent or guardian.

This article from Teen Vogue has some helpful information and advice if you are a minor looking for therapy and find yourself in this difficult situation. Another good suggestion I’ve heard is to reach out to your school’s counselor: they can help you right away, it’s confidential, and they will know about your state’s rules and resources you might have in your neighborhood.

If you are in an urgent situation and you need help right now, here are some crisis hotlines that are open to teens:

Crisis Text Line
Suicide Prevention Lifeline & Chat
The Trevor Project (LGBTQ Friendly)

Online Therapy for Minors in North Carolina, New York, and Florida

If you are looking for therapy for your minor child, or if you’re a young person doing your own research, I offer online therapy for children and preteens. Most of my clients are between the ages of 9 and 13. I’m licensed in New York, North Carolina, and Florida, so I can see kids for online therapy in any of these states. If you’d like to learn more about online counseling or make an appointment, you are welcome to contact me.

If you’re the parent of a child or tween looking for online help, my coping skills course might be a good support as you consider your therapy options. Worry-Free Tweens is an educational class for kids and parents, and teaches some of my favorite anxiety management skills for this age group.

How Preteens Are Stressed About Covid-19 (And How You Can Help)

Preteens are often left out of discussions about mental health. Not quite little kids and not quite teenagers, it can be harder to find resources that are meant just for them. I was interviewed recently for an article on Healthline about how kids of different ages are dealing with coronavirus stress, and it inspired me to dig a little deeper into how tweens, in particular, are being impacted by the pandemic. I’ll be sharing some of the worries I’ve noticed are on preteens kids’ minds, and how parents can support their tweenage kids through this time.

What’s Considered “Preteen”?

For the purposes of this post, I’ll be considering ages 10-12 as preteen kids. Typically, kids in this age group are getting ready for or just starting middle school. Many children this age—especially girls—are dealing with the physical and emotional changes of the beginning of puberty. Lots of preteen kids are still playful and imaginative, but they’re also developing more of an interest and awareness of teen culture. It’s an interesting in-between time in a kid’s life, and it’s one of my favorite ages to work with in therapy.

Preteens Worry About Family Due to Covid-19

Preadolescent kids have more strongly developed empathy than kids in the younger age ranges. Whereas younger kids may be most worried about their personal safety during the pandemic, preteens have more awareness of how the coronavirus might also impact people around them. Since preteens have more access to the internet and media, they’re more likely to know basic facts about the pandemic, and understand that kids are not usually seriously affected by the virus. However, they’ve also heard that older people are more susceptible, which can lead to worries.

Many of the preteens I work with are voicing concerns about the well-being of their adult family members, both physically and financially. Lots of kids in this age group are aware of the impact the pandemic is having on employment and businesses, but they usually don’t have an in-depth understanding of their family’s own financial situation, which can lead to worries. Here are a few common worries I’m hearing from preteens about family:

• Worries that grandparents, great-grandparents, or other elderly family members or friends may contract the coronavirus and get seriously ill.

• Worries about their parents’ health if the family is affected by COVID-19, particularly if parents have pre-existing medical conditions.

• Worries about whether their parents can afford to be out of work, fears about having enough money to support the family, and concerns about how these financial changes could impact daily life.

How to Help Preteens With Family Worries

While children don’t need to know all the details of a family’s finances, it can be really helpful for preteens to hear reassurance from parents right now about how the family is planning to deal with financial setbacks. It’s often enough for kids to learn that there are no worries about continuing to put food on the table, or to hear about the family’s plans to get financial assistance to help support the family business.

On a similar note, discussing how the family is planning to care for older family members, and the steps that family members are proactively taking to stay safe, can alleviate some anxiety for preteens about the family’s health. Encouraging preteens to FaceTime or text family members who are living alone or have health concerns can empower them to feel involved in helping their relatives, and keep family connections going while social distancing.

Preteens Are Susceptible to Coronavirus Rumors

Many preteen kids have similar access to the internet and smartphones as their teenage siblings, but their critical thinking skills aren’t as developed as an older teen’s. Since the coronavirus is still dominating the news cycle, kids on the internet are likely getting all sorts of information about it when they go online, and this information may or may not be reputable. Even if your tween child doesn’t have this kind of access, her friends likely do, which allows rumors to quickly spread and become exaggerated as they pass through a social group.

Getting age-appropriate information about the coronavirus tends to reduce anxiety, but on the flip side, reading sensationalized news stories or information from questionable sources can make preteens’ anxiety worse. Many preteens view influencers on social media and YouTube as being trustworthy and relatable. They may not be as skeptical about information that’s presented as fact from what they perceive to be a trusted source.

How to Help Your Preteen Sort Out Coronavirus Facts From Fiction

Here are 3 common misconceptions I’m hearing from many preteen clients, and how you can help your child to make sense of all the information they may be getting from friends, the internet, and social media:

Where the virus came from: Conspiracy theories abound about the “real” source of the cornavirus, which can lead to increased confusion, anger, and fear for tweens. You can help your preteen by presenting the facts that we know for certain, as well as acknowledging that there are things we still don’t know for sure. It might be helpful to point out that when we don’t know something, people are tempted to fill in the blanks with information that might not be true.

Newly discovered symptoms of COVID-19: Doctors are making new discoveries all the time about how the coronavirus impacts people. However, there is also a lot of misinformation online about what problems can be symptoms of coronavirus. Tween kids need help making sense of what they’re reading, and understanding that many of these complications are very rare.

Racist content online: Sadly, some kids are telling me that they are reading or hearing things from others that express racism towards Chinese people for “giving” us the coronavirus. This can be really confusing for preteens who aren’t sure what they’re supposed to believe. You can help your child by making clear in no uncertain terms that we can’t blame any ethnic group for this illness.

More Support for Preteens Dealing with Coronavirus Stress

Many preteens are going to be able to muddle through this pandemic with some extra support and patience from the adults around them. However, if you’re noticing that your preteen’s anxiety seems to be getting worse over time, is much more intense than other kids his age, or is getting in the way of daily life, it could be a sign your child needs extra help to cope with this stress.

After seeing so many preteens struggling, I created a class called Worry-Free Tweens to help kids learn coping skills for anxiety and stress management. It’s a self-paced course that’s available wherever you are.

Online therapy can be a great option for preteens, who are usually tech-savvy enough to manage sessions without a lot of help from parents. Sometimes, just having an adult to vent feelings to who isn’t a parent can help preteens unload some of their stress. A licensed counselor can also arm your child with coping skills to help them deal with intense feelings and get through stressful times more effectively.

If you’re in North Carolina or New York, I’m able to provide telehealth to kids in these states. You can reach out to me here. If you are located elsewhere, check out Psychology Today for options near you.

Online CBT Therapy for Kids With Anxiety

Kids weren’t meant to sit inside all day, isolated from friends while overhearing scary things on the news. Our “new normal” in quarantine may be especially tough for kids, who are so reliant on their daily routines to help them feel safe in the world. If you have noticed a spike in your child’s anxiety symptoms since the coronavirus, you’re not alone. It’s an understandable response to a very strange, stressful time in our history. Fortunately, one of the most effective treatments we have to help anxious kids—cognitive behavioral therapy—translates easily into online work with a therapist. In this post I’ll be sharing the basics of how CBT can help kids with anxiety disorders, and how it works to get CBT therapy online.

What Is CBT, and How Is It Different Than Other Forms of Therapy?

What do you imagine when you think of therapy? Maybe that stereotypical image comes to mind of a patient lying on a couch, free associating about their childhood experiences while a therapist quietly nods. While some therapists still practice this more “old school” form of therapy (and it really works for some people!) therapy doesn’t always have this look and feel. CBT is a very popular approach to therapy that offers another way to deal with stress, anxiety, and mental health struggles.

CBT stands for Cognitive Behavioral Therapy, and it’s a style of therapy that focuses on helping people learn new ways to deal with problems in the present, rather than gaining insight into the past. While you might discuss past experiences with a CBT therapist, in general the goal is finding solutions in the here-and-now. To do this, clients in CBT therapy learn how to spot the negative thinking patterns and self-talk that can lead to exaggerated worries and depression.

In CBT therapy, your child might…

• Learn coping skills to manage stress more effectively

• Gradually practice facing her fears in order to overcome them

• Learn how to identify overly-negative thinking

• Practice replacing negative self-talk with more positive, realistic self-talk

• Learn social skills to express herself confidently and assertively

What Makes CBT So Popular for Kids with Anxiety?

One big reason CBT has become so popular for treating childhood anxiety is that it can help kids feel better faster. The coping skills children learn in CBT can be used right away to start managing anxiety, panic, and stress, so many children notice some improvement in their moods early on in treatment. CBT is often a shorter form of treatment, and in general, people in CBT need fewer sessions of therapy than people who aren’t. Kids who get CBT therapy for anxiety symptoms may be able to progress through therapy more quickly, and return to their lives with skills to handle future problems.

Another reason for CBT’s popularity is that there is a ton of research to show it’s effective. As a therapist, I like knowing that the skills I’m teaching kids to manage their anxiety have been studied over and over, and have been shown to be the most helpful tools for the job. I like feeling confident that the therapy techniques I’m using are the most likely to help a particular child, and have been shown to be safe.

How Does CBT for Children Work With Telehealth?

While some forms of therapy may look and feel a little different when conducted online, in my experience CBT sessions via telehealth feel pretty similar to my in-office sessions! Because CBT is more task-oriented and involves more learning and teaching, it’s a natural fit for online therapy. While I often incorporate games, art, and play into my child therapy sessions, CBT puts an emphasis on helping kids put their thoughts and feelings into words, too. I think the fact that it’s a more verbal form of therapy helps make online sessions flow smoothly.

If your child is enrolled in online CBT therapy, she might participate in activities like these:

• Role-play difficult situations with a therapist to figure out healthier ways to respond

• Learn relaxation skills in session, like deep breathing and mindfulness techniques

• Practice turning negative self-talk into more positive or realistic self-talk

• Set goals to practice at home during the week, such as practicing a relaxation skill or raising her hand more often in class

• Learn more about how anxiety works, which can help kids feel less alone with their feelings

Online CBT therapy might use books, worksheets, and other teaching aids to help children get the most benefit from learning new skills. I sometimes email simple worksheets to parents that kids can use to track negative thoughts during the week. I sometimes assign other “homework” assignments as well, such as practicing a new skill during the week or trying to reach out to friends more during quarantine. Usually, CBT homework requires no more than 5 minutes a day of work—I know kids are overloaded with school assignments right now, and I don’t want to add to that stress!

Online CBT Therapy for Kids in North Carolina, New York, and Florida

If your child is having a hard time dealing with anxiety during quarantine, CBT can help her manage this stressful situation and equip her with tools that she can use to deal with anxiety even after quarantine ends. As a first step, you may want to consider my online course, Worry-Free Tweens, which teaches CBT-inspired coping skills to anxious kids ages 8-12.

If you’re in North Carolina, New York, or Florida and looking for online therapy for your child, my (virtual) door is always open. I love using CBT to help kids and tweens overcome anxiety and worry. You can reach out to me here to learn more.

Pros and Cons of 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 onscreen 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. If you’d like to chat more about online therapy, or set up an appointment for your child, I’m located in the Davidson, NC area and happy to help. You can contact me here.

Is Online Therapy for Kids Legit?

A lot has happened in the world since my last post! If you’re in North Carolina, today marks the beginning of a 21-day shelter-in-place order to help prevent further outbreak of COVID-19 and, hopefully, flatten the curve. This is a big deal for kids and families, who may suddenly be adjusting to a “new normal” that involves a lot more togetherness, unstructured time, and canceled plans. Part of my own new normal has been diving headfirst into the world of online therapy for children, and in this post I’ll be telling you all about what I’ve learned so far.

Are You Skeptical About Virtual Therapy? It’s OK—I Was, Too

I wish I could tell you that I’ve been 100% enthusiastically on board with online therapy for years and years, but that just isn’t true. Like many therapists, I have clung to the belief that in-person is always better. To my mind, online therapy was a “second place” option at best. After all, therapy is all about the healing relationship and connecting with the kids in my office: how can that work as well over a computer screen? How would play therapy work without a playroom?

When the new coronavirus started circulating in my area, there was no doubt in my mind about switching over to online sessions. I didn’t want to risk spreading germs to my immunocompromised families, or send a child to visit with Grandma and Grandpa not knowing if they might have picked up the virus in my playroom. “Second place” therapy in this situation, I figured, was better than no therapy at all.

Then I started actually doing online sessions, and I quickly realized what online therapists have been saying for years: online therapy is different, but equal to in-office counseling. In fact, sometimes it has an edge over face-to-face therapy when it comes to helping kids and families.

What Online Counseling Looks Like With Kids

Online counseling—also called Teletherapy, or distance therapy, uses video conferencing so that clients and therapists can see and hear each other in real time. If your child is familiar with FaceTime, Skype, or even Snapchat, they’ll probably have an intuitive understanding of how to use an online therapy platform. Most video chatting platforms used in therapy are designed to look and feel a lot like Skype or Zoom, but with more protections in place to prevent hacking and safeguard sensitive health information.

In my practice, I ask that children participating in online therapy have access to a computer with high speed internet in a room with a door that closes, in order to protect their privacy. It’s also helpful for kids to have paper, pencils, and markers available to use in session, just like they’d have if they were in my office. That’s likely all that older kids will need to have a successful virtual counseling session, but younger kids often enjoy having a few of their own toys on hand, as well. I’ve been introduced to lots of loveys and other special childhood toys this month!

Today’s Children Have Grown Up Using Technology to Connect

I often try to remember how I felt or reacted to things when I was the same age as my kid clients. This is helpful a lot of the time, but it held me back when I started considering online therapy. I tried to picture how I would have felt at 7, 8, 9, or 10 years old, talking to a counselor on our big family computer in the living room. It felt foreign and weird to think about, and I imagined it as a cold and clinical experience. At that time in my life, computers were still new, and the technology felt like it was separate from my day-to-day life.

However, my kid clients didn’t grow up like I did—and they probably didn’t grow up like you did, either. They’ve been FaceTiming aunts and grandparents since before they could talk. Many of them log many hours a week chatting with friends while playing Roblox or other multiplayer games with friends online. Communicating through technology doesn’t feel cold and detached to these kids: for many of them, it feels more familiar and “safe” than sitting on a couch and talking to an adult in real life.

There is Research to Support Teletherapy for Kids

When I’m trying to decide if a therapy treatment is legit, I turn to the research. It’s important to me that the techniques I use with kids have evidence to back them up, which is one reason why I love cognitive behavioral therapy. Luckily, there’s a growing body of research on teletherapy, and it comes to the same conclusion I’ve reached watching my clients in online sessions: online therapy can be just as effective (and sometimes more effective) as face-to-face counseling, even for kids.

Several peer-reviewed studies have found that people with anxiety and depression can get relief from online therapy, and that their improved mood continues after treatment is over. Researchers have also studied how kids respond to computer-based therapy, and found that it can be helpful for both depression and anxiety. According to the study, kids spend so much time on their phones and other devices that this form of therapy may come more naturally to them.

My Verdict On Online Therapy for Kids: It Is, in Fact, Legit

While some play therapy activities can’t be done online (I miss my sandbox!) there are plenty of reasons to consider online therapy as a different but equal way to get mental health help. Your child might be surprised to find they feel more comfortable chatting with their counselor from home, surrounded by their toys and pets. It may not be what we’re used to, but it’s legit.

Still looking for a therapist, but need some online help? My self-help course for kids teaches coping skills from an educational perspective, rather than a counseling one. Worry-Free Tweens was designed to help anxious kids ages 8-12 feel more in control of anxiety.

Still wondering about whether teletherapy could work for your child? Reach out to me here to learn more about online therapy for kids in the Lake Norman area.