Child Psychotherapy in the Time of the Coronavirus
How are those of us who work with young people adjusting to conducting sessions online? Deirdre Dowling, a child, adolescent and adult psychoanalytic psychotherapist, reflects on the first 10 days of taking her practice online during the Covid-19 pandemic, observing the profound impact on the children, teenagers and supervisees she works with – and on herself.
I go for a short walk in the garden between seeing patients online. It’s a warm sunny morning. There is such a contrast between the beauty of the first Spring flowers, the primroses and few daffodils in the borders, and the anxiety that all of us are grappling with in the first weeks of the coronavirus pandemic.
I am a child psychoanalytic psychotherapist working in private practice with several young patients under 10 years and a few teenagers who I had to quickly convert to seeing online about 10 days ago. I also supervise a number of child psychotherapists working in schools, CAMHS and privately, all facing the challenge of working out what service, if any, they can offer the children they have been seeing. I wanted to share my thoughts and experiences, hoping these will resonate with those of others as we try to work our way through this difficult time.
First, the practicalities. At first, I tried social distancing in my work with children aged between 7 and 10 years, asking their parents to provide their toys. Of course, it did not work. Every few minutes a child would cross the invisible boundary I had in my mind, leap next to my chair to show me a picture or ask for help building a model.
I felt unable to say ‘stay away’ so, after just one day, I decided to move to online therapy with children. This was uncharted territory for me, using FaceTime, Skype and Zoom. I had been sent a short BACP video by a colleague, Can I Work With Children & Young People Online? The presenters, Jan Stiff and Susan Utting-Simon, pointed out that this work would feel very different, as we would probably be speaking to teenagers in their bedrooms, and they would be more in control of the interaction, now we were seeing them on their home territory. Both proved to be true, but what was most pertinent was the impact of this sudden change in their lives, the teenagers’ discomfort at having to manage an enclosed family life at a time of high tension and anxiety.
I felt rather lost about how to work with young children via a screen, and I had little time to prepare. So I asked the parents to settle their child at a table near a screen, a phone or an iPad with some of their chosen play materials and we would take it from there. It was fortunate that I knew many of the parents well so they trusted me to ‘have a go’, very much wanting me to keep the relationship going, even if it wasn’t psychotherapy in its usual form.
Younger children – imagination and adjustment
Child psychotherapy online turned out to be more possible than I thought. The children and I made up imaginative games we could play online. I asked a little 7-year-old boy to start a story and we developed it one line each. He began, ‘There was a lonely giraffe who wanted some friends’, and the story developed into a reflection of his difficulties in making friends. Next, distancing himself from the intensity of this story, he began building a Lego garage, and we chatted as I watched. He told me he was upset about being stuck at home without the company of his school friends, how he was more exposed to the teasing of his older brother. His parents were busy, preoccupied with trying to manage their own work and set up online school for the children, so they did not have time to listen to his upset. I think he was just finding it all so strange.
A 4-year-old little girl, with her mother in the background, spent the session showing me her toys and insisting they were better than mine, proving that she did not miss coming to see me. It was hard for her to say ‘Goodbye’, so we needed her mother’s help to manage this.
What I have noticed is that in these first weeks, the younger children seem less obviously caught up with the anxieties of the virus, and more preoccupied with adjusting to their new life at home.
Teenagers – shock and loss
The teenagers I saw online were struggling more obviously, much more aware of the sense of crisis in their lives. First, there was the shock of the cancellation of GSCE exams, with the implications of losing their chance to prove themselves. Then there was the reality of suddenly having to cope with their already fraught relationships at home, made worse by being cramped inside the house, without the structure of school and peer group support.
Listening to one depressed young man, I felt concerned. So much had happened so quickly that his fragile coping mechanisms seemed quite shaken, the darkness of a depression made worse by feeling so alone.
Supervision and self-care – ‘nameless dread’, camaraderie and new growth
I am writing this as if it has been straightforward making these changes. But it has felt like paddling a small boat forward in a stormy sea of uncertainty, faced each day with more worrying news about the spread of the virus, trying to control my own fears while focusing on the work.
It was almost harder to listen to the perplexities faced by the therapists I supervise. Those working in schools saw their familiar setting shut down and were desperately trying to work out whether it was possible to continue their work online, without the close working relationship with parents that usually makes this work viable.
By the end of this working week, I was greatly relieved to have my own supervision, where I could try to make sense of what has felt so hard to bear in the work. It was, I discovered, the fears and distress all around, friends, colleagues, family, that could feel overwhelming at times. The sense of unreality and ‘nameless dread’ about what lays ahead with the pandemic and how long it will last.
Help has come from the camaraderie of friends and colleagues, the conversations on FaceTime and the humorous videos sent through WhatsApp. I have also retreated into the garden at any opportunity and planted far too many seeds in my greenhouse, as if determined to ensure that there is new life ahead.