Diary of an ACS Intern – Being a Therapist while Sheltering in Place

Written By: Casia Ravi, Clinical Trainee at ACS, On-Campus Counseling Program

attending to every verbal and, especially, nonverbal cue while sitting in someone’s presence is a significant part of the role of a therapist. Sheltering in place because of the coronavirus has offered those of us working in mental health the opportunity to quickly get up to speed on offering “teletherapy”—therapy by phone or videocall.

Adolescent Counseling Services has nimbly adapted its programs to continue to offer an array of its services remotely, from parent groups to even traditionally school-based services. Research supports the use of teletherapy as being as effective as in-person therapy for most clients.

For those of us clinicians working at Woodside High School, our new reality—until at least May 1st—will be to continue to offer psychotherapy services to students by either videocall or telephone. Gone for now are the days of sending passes to students’ classes. Or the days of quickly consulting a colleague in the office next door. The safe space offered by our counseling office, where students could drop in to cope with the stressors of the day, has been—figuratively speaking—shuttered for now. Yet, regular sessions with our established clients can continue. Through teletherapy, we can also serve our growing list of new clients who are now interested in receiving counseling.

So what does this new reality of therapy for our teens look like for us as clinicians?

Within the last two weeks, we have been reaching out to all of our teenage clients and their parents or guardians to explore their interest in continued mental health support while school is closed. We offer the options of weekly, biweekly, or as-needed sessions that are conducted either by videocall or telephone to the client wherever they are. We are now emailing, calling, and texting our clients—things typically outside the realm of school-based therapists—in order to schedule appointments. We are utilizing email to share mental health resources with all of our families. For those of us with kids, we are challenged to find a way structure our availability around the constraints of having our own children at home now too, and coordinating child care and work calls with spouses who are also working from home. We are eking out confidential spaces in our homes, using headsets and other techniques to protect our clients’ confidentiality.

I have been surprised that several of the teens with whom I’ve been working, thus far at least, are preferring to hold our sessions over good old-fashioned telephone rather than by videocall. Particularly with the clients whom I am only hearing on the phone and not visually seeing, I am finding I need to quickly adapt to discover other strategies to gauge what is going on for my clients and how they are feeling from moment to moment. I may need to ask many more concrete questions, such as “are you in a private space right now?” “can others in the home hear you right now?” or “what are you feeling right now?” For some teens in more humble homes, the only private space available to them may be their bathroom.

How are teens coping through shelter-in-place?

Because of coronavirus, teens are facing many significant losses. Imagine spending hours and hours preparing to perform a musical that was then cancelled. Or missing out on nearly the entire season (final season for some seniors) of a sport you’ve dedicated years to. Some schools are already canceling prom and potentially event graduation. Some of these things only touch some of our teens. But, for all of them, there is reduced contact with their peers. Connecting with peers is a key aspect of normal teenage development. They are also being forced to learn how to learn in an entirely new way and at a self-directed pace, which requires much more self-organization and foreplanning, skills that teenage brains are still developing. They also are picking up on coronavirus-induced family stressors, like reduced work hours/lost jobs, potentially diminishing family businesses, caring for siblings, etc.

Keeping our routine counseling appointments is one small way that I’m hoping, as a therapist, I can contribute to offering a sense of normalcy in the midst of all of the very dynamic changes that are happening right now for our kids. We clinicians are also keenly aware that the longer we are all stuck at home, the more anxiety and other challenges may arise for our teens, which could significantly heighten the need for mental health support. Certainly, many adults right now are facing increased anxiety and stress due to the coronavirus pandemic.

Resources for parents during Coronavirus and this time of social distancing:
• Parent/Caregiver Guide to Helping Families Cope with the Coronavirus Disease 2019 (COVID-19) (The National Child Traumatic Stress Network)
• Quaranteened: Parenting during the time of social distancing (New York Times)