Reflections on using art therapy online


September 10, 2020



During my two-year graduate Art Therapy study at New York University, I often wondered how, we, as future art therapists could hold online sessions with our clients. Now this was back in 2011 when technology was just on the cusp of being used in therapy. And for sure, we had a few classes devoted to understanding technology’s effects on our mental, physical and social wellbeing as well as how specific populations such as adolescents, were already using technology as part of their art therapy treatment. While I was intrigued about jumping on the online therapy bandwagon, also called ‘tele-health therapy’, ‘tele-therapy’ , a big chunk of me was apprehensive about it mainly out of comfort sakes. I thought there would be too many variables to control at once to make the online space relaxed, safe and nurturing. Also, there was trepidation of being among several pioneers using technology for treatment which would require much trial and error from a newbie. 


Since then, it would seem that the Covid pandemic forced us to use technology in order to be safe and reduce infections and deaths, especially amongst the elderly and immune compromised. At the same time, the pandemic continues to show us where the gaps lay in our mental healthcare systems globally. Where as some places, particularly in the Western world, have telehealth services, in other places it simply does not exist. The differences are staggering and shocking to say the least; the upside of that is that there is ample room for wiggling and innovating in the sector. Nevertheless, like many of my courageous colleagues, I had no choice but to pivot and adapt in order to continue helping young people with their psychological and social challenges. This is my journey into telehealth thus far.


The journey: feelings and discoveries





Like most therapists, I have always kept a comfortable physical distance from my clients, other than the occasional handshake before a session commences, or putting a hand on a client’s shoulder after an intense session. Being in the same room meant I could catch my client’s direct and indirect cues such as their breathing, sighs, and twitches, as well as anticipate their needs, such as giving a tissue during or after some tears were shed. All of these may not sound significant to the non-therapist, but they add to create a unique sense of connection, an intimate closeness that can only be felt by me being physically there and consciously present. 


I had no idea how any of what I said above would translate to teletherapy with my young clients, especially since they have either challenges that require work on enhancing attention and tolerance. A multitude of questions bombarded my head daily: I wondered whether the same emotional connection can be achieved via a webcam; what it would mean to be emotionally present but not in the same physical room; and how could I keep their focus and trust that what I am doing will still work it was during face to face sessions? 




Interestingly, I was dumbfounded at what I found once I started my journey with teletherapy. First, instead of me feeling physically distant from my clients, I actually felt like being pulled into a new dimension of closeness with them. Here I was in my client’s homes and they in mine. This gave me the impression of getting to know them in another way. One client introduced me to her pet goldfish on screen, another showed up in his pyjamas while holding fast to his stuffed toy (a view of him that I’d never seen before) and another played hide and seek. With the first client, she often commented on how nice my house plants were. As I saw living and bedrooms of various sizes and of varying furniture and many in their relaxed attires, the physical distance between us seemed to be not so bad after all. 


It’s difficult adjusting to online therapy as a newbie


But I did have some challenging adjustments to make along the way. First, I changed the welcome page of my practice website to include a COVID-19 and teletherapy message. Second, I researched which online platforms would be secure enough to hold my session and in accordance with HIPPA rules. It turns out is a pretty good solution, although the sound quality is not always great. Third, I had to change my session hours to times when kids had more privacy. For instance, instead of talking to one of my clients at 2PM I was not talking to them at 10:30AM because their school schedule had changed. Fourth, I have had to rely on using mostly basic art materials with my clients, such as paper, coloured pencils and markers. While my clients with ADHD have been receptive to the changes, it is still a work in progress for my other clients. And lastly, I had to remind myself many a times to stay in my professional mindset while performing house duties in between sessions, including cooking, throwing a load of laundry into the washer and cleaning the dishes.  


Biggest learning point thus far: the difficulty of pacing sessions & ending properly


The biggest learning point thus far for me though has been the pacing of sessions online. It is really quite different with all of my clients. My clients with ADHD for instance impulsively will press keys, even though they already know what the keys can do, and appear in the ‘waiting room’ earlier than they would normally show up to face-to-face sessions; my clients with trauma related issues chronically show up late to sessions, even though there are no reasons for them to since their parents no longer have to drive, find parking or take the tram (train). Also, the pre-initial minutes of a session where I would normally see clients take off their coats, get settled into a seat and make jokes all seem to have evaporated into thin air. I can no longer get a sense of the client’s state of playfulness before the session. Now, it was (and still is) all face-to-face from the get go and somewhat serious. 


Moreover, I sometimes struggle to end sessions smoothly. Normally, I have multiple ways of ending a session, depending on my client’s needs. When working with young clients, especially those with special needs, it is imperative to give a few signals or reminders throughout a session because they can be so immersed in their own world that they don’t hear your comments. These signals can include how long they have on an intervention, finishing up their artwork and collecting their thoughts and/or belongings before transitioning back to their classroom. Now, transitions for most of them are being interrupted by family members calling for dinner, or a sister walking in without knocking first. For clients with ADHD, I am finding myself having to repeat instructions more often than I normally would in my normal face-to-face sessions; for a specific client in particular, I am still unable to close the session before they do. 


A personal challenge


I think the most unsettling aspect of doing tele-health therapy thus far is that I have to see myself constantly during the session. I am being confronted with a mirror, aka the webcam. I felt (and still feel) distracted whenever I catch a glimpse of myself listening. Sure, I can ask my clients to turn off their cameras but that would be a selfish act on my part and would make the emotional connection inconsistent. And if anything, young clients prefer visuals and consistency more than anything else. At the same time, I am sure that they are also jarred by looking at themselves on the screen, which may be adding to the complexity of the treatment process as well. And sure, reducing self-consciousness may be at the heart of a good therapy relationship, but so, too, is consistency, face-to-face interaction and trust. 


Future hopes 


While I am pleased at how quickly I was able to switch lanes, understand my struggles and continue seeing my clients, I have yet to fully adapt and feel at home like I do with face-to-face sessions. I suppose it will take time, just like many changes in life. This is not to say that I am not appreciative of this new tool; in fact, I appreciate the fact that technology (or online video platforms in general, such as Facebook, WhatsApp, etc.) is allowing us to stay connected during these anxiety provoking times and that platforms for therapy work are out there (Thank you!). I only hope that this is a temporary solution, or that it remains a choice for the foreseeable future, especially for us art therapists (or for any other expressive arts therapies). Without proper (educational) training, it can be quite an overwhelming experience for both therapist and client. I remain bothered by the fact that I am not able to tell my young clients who already struggle with uncertainty and change when we can resume sessions at their schools again, with rather comfortable furniture and cozy privacy. 


Until the next blog,


Stay healthy

Stay calm

Stay connected! 

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