Something a lot of my clients struggle with is thought stopping. Thought stopping refers to shutting down a thought that is unpleasant, distressing, or uncomfortable. We are all constantly thinking, all the time, without even trying. Sometimes when a thought is upsetting, it can be hard to let it go.
Kids sometimes have trouble understanding that they could have a thought that they don’t want to have because thinking often feels deliberate, so I use this activity to help them see that thoughts can be automatic and not intentional. Then I use a mindful visualization activity to help them replace a “bad” thought with something calming or enjoyable.
You can create your own template or use the one I created below!
Today I want to talk about chess as a therapeutic intervention over telehealth.
My first practicum supervisor told me that, to be a good therapist, I had to learn to play chess. He recommended chess as an intervention for clients of all ages, especially kids, and since then I have always kept a chess board in my office. It’s really popular with many of my clients, so when I moved to telehealth full-time, I wanted to see if I could bring this intervention with me. Chess takes focus, planning, patience, frustration tolerance, and executive functioning – all things that can be part of a child’s treatment plan!
Fortunately, Lichess lets you create a special link to play chess with a friend online. My husband and I used Lichess when we were living apart while I completed graduate school, so I was already familiar with it before I started doing telehealth. You can choose whether games will be timed (kids who have high anxiety might struggle with a time limit, but kids who have trouble remembering it’s their turn can benefit from the added structure), and there are several variations you can choose from if the client wants to mix it up.
Now, I am not a chess master by any means, but compared to most 8-year-olds, I am quite good. Different therapists will have different approaches to this, but when I play chess with a client, I might change my “difficulty level,” but I don’t let them win. Kids have told me they appreciate this because they know, when they win a game, they truly beat me.
That being said, Lichess has an option when you create a game with a friend to have custom setup (on the website, this option is called From Position). If a child wants, they can have me start the game with fewer pieces or give themselves extra pieces to make the game easier or more interesting. They can also choose to play Antichess, Racing Kings, Horde, or a few other variations.
Compared to playing chess in-person, I’d say Lichess has some definite pros:
Kids can add extra pieces that you might not have on hand.
You can choose whether or not turns are timed.
When you select a piece, the game automatically shows you where you can move that piece – less time is spent teaching the child the game.
You can “take back” moves, but only if the other person approves it, so the therapist can use this as part of their interventions if they choose.
You can “take back” as many moves as you want because the computer remembers all the moves you’ve done.
The game tracks whether or not someone is in check, so that frees up the therapist to focus more fully on the child.
The child can’t flip the board out of anger if they lose. 🙂
Cons of chess online are:
If you are taking a non-directive approach, you can’t let the child change how different pieces move or add their own rules. Computers don’t really understand child-centered play therapy.
Kids have to ask every time they want to “take back” a move – you can’t set it to just let them do this if they want to. (Of course, this can be a great way to work on impulse control!)
You can choose your next move before your opponent takes their turn, which has proven tricky with highly impulsive children who are trying to stay in the moment with me.
If you want to play chess with a more non-directive approach, PlayingCards.IO has a chess board that allows you to move the pieces any way you want and change the rules to the game. The drawback is that this variation doesn’t show instructions, so if you are teaching a child the “correct” rules, you will have to talk them through it.
So there are options for structured and non-directive chess in telehealth. Either option can help kids build executive functioning and frustration tolerance.
This one-hour course is intended to help college and university professors implement the tenants of trauma-informed teaching in college-level courses. It also specifically applies these ideas to online classes, as many universities are offering online learning this fall. The course is available for purchase for $20.
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In my Introduction to Trauma-Informed Teaching course on Skillshare, I talk about the Adverse Childhood Experiences study from the CDC and Kaiser Permanente. Basically, the study determined that certain stressful or traumatic life experiences in childhood have a huge impact in adulthood and can lead to mental illness, physical illness, and early death. Kids with higher ACEs scores are more likely to have certain behavioral and learning problems in the classroom – hence the need for a trauma-informed approach to teaching.
What situations are considered ACEs? The researchers determined that the following life events cause significant stress or trauma: emotional, physical, and sexual abuse, neglect, witnessing domestic violence, divorce, and having a parent who abused drugs, had untreated mental illness, or went to prison. What do these experiences have in common? Usually, they involve long-term stress, feelings of chaos and lack of control, and cause the child to realize that the adults they rely on might not be able to keep them safe.
For the past several months, children in the United States and around the world have experienced chaos, uncertainty, change, and instability due to the COVID-19 pandemic. They have to ask themselves questions that might not have occurred to them before: Will someone I care about get sick or die? Is it safe to go places? When will I be able to go back to school? What if my parents don’t have the power to keep me safe?
Basically, every child in 2020 is getting a plus one to their ACEs score simply by existing during this time. What can we, as the adults who care for them, do?
Bessel Van Der Kolk, author of The Body Keeps The Score and leading expert in childhood trauma, shares in one of his courses that trauma response often has less to do with the trauma itself and more to do with the support a child receives after the traumatic experience. That is why being trauma-informed is so important. Parents, daycare providers, teachers, and therapists need to approach children through this lens now more than ever.
In April 2020, I wrote an article for The UpTake about telemental health and telepsychology. At that time, I had been working remotely for about one month and had just gotten certified in telemental health. I also thought that working from home was a short-term solution. Weeks have become months, and although schools are looking to resume in-person classes this fall, my practice continues to be entirely online. Although I already had some experience and training in telemental health, there has been a bit of a learning curve, especially with young children.
With these challenges, though, there is a silver lining. Clients of all ages who struggle with leaving their homes (due to agoraphobia, sensory issues, or severe depression) who normally would have cancelled or missed appointments because they could not get to my office can meet with me without having to get out of bed. Those with unreliable transportation don’t have to find a way to get to me because I can come to them. Sioux Falls Psychological Services says, “We meet you were you are, offering hope,” and that is true in a literal sense now more than ever!
If you’re dealing with mental illness, whether symptoms are new or have affected you for years, telemental health offers access that was not possible years ago. Although clients who are used to in-person sessions have had to adjust to online therapy, most are able to do so, and research has shown that treatment outcomes for telemental health are comparable to in-person sessions.
Bernice Lewis says, “Normal’s just a setting on the washing machine,” and she’s right. There is no one way to feel or be.
But I think it’s important to talk about our “new normal,” or living in the era of COVID-19. The Washington Post says that 34 out of every 100 Americans has met criteria for a major depressive episode, an anxiety disorder, or both so far in 2020. Typically, about one in 10 Americans meets criteria for a mental illness, and 6.7% have a depressive episode in a given year.
This is something to think about. A lot of people who come to see me at my clinical practice express concern about being strange or abnormal for needing therapy. Many of them have a history of trauma, stress, or challenging life events. When they explore it, they often realize that their mental health symptoms make sense in the larger context of their lives. I can’t count how many times I’ve told someone, “With what you’re describing to me, I’d be concerned if that didn’t make you anxious/depressed/etc.”
We are going through massive shifts in our world. People are stressed out, anxious, and depressed because we live in a stressful, anxiety-provoking, and depressing time. Behaviors that would have been concerning a year ago are necessary for our safety in parts of the world. It’s understandable to feel this way, and it is okay to ask for help!
According to Twitter, today would have been Robin Williams’s 69th birthday. In honor of that, I dug up something I wrote just after he died, which is still relevant today.
Here are some myths and facts about suicide and mental illness:
If he/she/they had had more/better friends, he/she/they would not have died. I addressed this somewhat in my last post, but I will keep saying it until people understand: That is not how depression works. Mental illness does not follow this kind of logic. Would you say that a cancer patient might have pulled through if only they had better social support? Yes, a solid network of friends is important when it comes to overcoming mental illness, but it certainly does not prevent suicide. When someone is in a suicidal mindset, they are not thinking about their loved ones. They are just thinking about the pain that they are in. I am NOT saying that their choice is selfish, but that the level of suffering that comes with clinical depression is so great that you are not capable of thinking of anything else. Have you ever had a kidney stone? Were you thinking about the people who would be inconvenienced by a commitment you were missing? Maybe it crossed your mind, but I would be willing to bet that your primary concern was how much pain you were in and how to make it stop.
He/she/they was/were not brave enough to keep fighting. Suicide has nothing to do with bravery. Again, mental illness does not follow this kind of logic. Suggesting that people with suicidal thoughts are cowardly is counter-productive. That kind of negativity only serves to further beat down individuals who are already struggling. This same argument applies to calling those who have died by suicide selfish.
People with depression just need to be stronger and get over it. When I am feeling upset, I really try to avoid saying that I feel “depressed” because depression isn’t equal to sadness. Depression is a pervasive state of being that transcends more fleeting moods. There is a reason why a diagnosis of clinical depression requires that symptoms be persistent for a minimum of two weeks: Because depression is more than just feeling low or sad for a short while. Think about it. If it were so easy to “snap out of it,” why would anyone kill themselves?
But he/she/they didn’t seem depressed. This plays into the myth that depression has to look a certain way. Most of us have a picture in our minds of what we think depression looks like, and while there most likely exist cases that fit this image, no two cases are identical. Everyone copes differently, and there is no way to know for certain what someone else is thinking and feeling. Some people prefer not to show their emotions and may seem stoic or even sad when they feel fine. Others project a similar demeanor in response to the pain they are in. Some use humor to cover how they are feeling. Others joke constantly because they feel happy and want to share it. It is impossible to paint a picture of depression because no one picture could accurately encompass every experience.
He/she/they just wanted attention. Suicide is not something to trivialize, and that is what this statement does. I hear this a lot in response to people who use means with lower lethality for a suicide attempt. This phenomena stems from the stigma I have been talking about. When we teach people that they are weak or lesser than if they seek help for mental illness, it becomes difficult to say “I need help” or “I am depressed/thinking about hurting myself.” When you feel you can’t express your pain in a healthy or productive way, it comes out by other means. Are the individuals in these cases seeking attention? Technically yes, in that they desperately want and need help that they do not know how to seek. There are much easier ways to get attention. That is not what suicide is about, and it is insensitive and stigmatizing to claim otherwise.
“Genie, you’re free.” This quote circulated Twitter for days after Robin Williams died, and it really bothered me, as both a mental health professional and as a person. I need to explain why this quote in this context made me so angry. Sure, it sounds poetic. But let’s take a minute to really think about what this statement implies. Essentially this quote is stating that, because he is dead, Robin Williams is now “cured” of his mental illness. After a celebrity dies by suicide, the suicide rate goes up for a short while, and the implication that death is freeing is a dangerous one. Imagine you have been struggling with suicidal thoughts. You hear that Robin Williams, a world-famous actor, has killed himself. You then see a huge outpouring of emotion from his fans saying that he is now “free.” Suddenly that tweet sounds like an argument in favor of ending your life. Although it is true that asking someone if they are having suicidal thoughts will not cause them to become suicidal, saying to a friend, “I’m worried about you. Have you had thoughts of wanting to hurt yourself?” is hugely different from asserting that suicide is somehow a cure for mental illness, and when it comes down to it, that is what this quote is saying. Please do not romanticize tragedy. It’s dangerous.
If you are thinking of hurting yourself, please reach out. In the United States, the National Suicide Prevention Lifeline is available 24 hours a day, 365 days a year (or 366 days this year). They provide support and help for those in need and information about long-term services.
I wrote this post for kids who have had something bad or scary happen to them.
This is Vera. She has lived with me for about three years now.
As all my clients know, I love animals and absolutely adore my cats. Those who are currently receiving services as I work from home have gotten to meet them on camera.
A little back story on Vera: we aren’t sure exactly how old she is because she was brought into the rescue as a stray. We don’t know where she was born or whether she lived with other humans before us, but we do know some things about her based on her behavior.
We know that Vera gets easily startled by loud noises, and she runs away and hides from strange people. We know she hates the stepladder (I like to say it’s because she never met her biological ladder). We know she had short hair when they found her, but after getting enough to eat for several months, her coat grew long and soft.
We might not know exactly what Vera’s life was like before we met her, but we know that she probably felt scared a lot of the time, and she had to always be on the lookout for danger. We know that she still looks out for danger a lot of the time, no matter how safe she is at our house.
Vera has a hard time letting go of the fear and worry that helped her survive when she lived outside. This happens to a lot of people, too: when something bad or scary happens, it’s hard not to be on the lookout for something bad or scary in the future.
Vera might never completely stop feeling scared when the microwave beeps or when I get the ladder out to reach something up high. But she will always know that we love her, and we will always keep her safe.
When we work with children, it is vital that we remember that their brains are different than our adult brains. The frontal lobe, or the part of the brain in charge of talking, logic, and impulse control, continues developing well into our 20s and possibly our 30s, depending on which study you read. Have you ever wondered why college students Act Like That? It’s because the part of their brain in charge of making good choices isn’t fully online yet.
Children have not learned the skill of communicating their feelings with words, both because they haven’t been alive long enough to practice, and because that part of their brain isn’t there yet. It’s up to us to give them the tools to tell us what they need.
Since it can be hard even for adults to find words for our feelings, I’ve found it helpful to give kids visual aids. One of the first things I give a lot of the families at my clinical practice is a feelings thermometer that teaches kids how to notice how strong their feelings are on a scale from 1-10. A lot of templates for this activity exist online, but here is one that I put together:
This worksheet helps kids with two skills: noticing feelings inside their bodies and sharing that information in a way that the adults taking care of them can understand. Often, a child will not identify that they feel angry until they are FURIOUS, and it’s hard to come down without an outburst. The feelings thermometer helps them start to notice when their anger is at a 3 instead of an 8.
They also practice communicating and asking for help from adults so the adults can understand and then provide that help. When the parent hears, “I’m feeling scared at a 5/10,” they can use that information when deciding the best way to help the child cope.
If you’re not sure where to start in giving kids the tools to express their feelings appropriately, the feelings thermometer is a good first step.