Telehealth Activity: Light Brite

Who remembers Light Brite? When I found this activity, I immediately started humming the jingle even though in hindsight, “Turn on the magic of colored light” kind of doesn’t make a lot of sense.

I hadn’t used (or even thought of) Light Brite in decades (I’m so old), and I stumbled across the virtual version by accident. It’s not something I had available in my in-person office, but after trying it out in some telehealth sessions, I think it has some great therapeutic implications.

Giant light brite by Jordan is licensed through CC BY 2.0

The virtual Light Brite is available here, and you can use it in telehealth by sharing your screen and granting your client screen control. Detailed instructions for using the Light Brite and saving your images can be found here. The website is intuitive and self-explanatory.

This site can be used like other art-based interventions, with the therapist prompting the child to create a scene about their family, feelings, life, or anything else you want to explore. You can also present the Light Brite as a non-directive intervention.

The last year has really shown that there is no end to internet versions of in-person activities, and telehealth offers so much more than I ever imagined. I’m glad it’s sticking around.

Feedback Time!

I’ve been blogging for several months now and have a few features I’ve been focusing on. It’s time for you, my awesome readers, to tell me what I should focus on going forward.

Photo by Element5 Digital on Pexels.com

I created this site to be a wealth of resources for mental health professionals, parents, and anyone who wants to learn more about mental health. That’s a pretty broad range, mostly since the word “focus” has never really been a part of my vocabulary.

So, which types of blogs do you want to see more of? Is there anything you want to see less of? Help me make this site the best it can be for you.

Therapy with Kids: What Makes an Activity Therapeutic?

I have noticed that many play therapy activities involve games developed in the 1970s and 80s. Additionally, a lot of the pushback against telehealth with kids has been that screen-time activities are not sufficiently “therapeutic.” This makes me think of how people initially thought card games would be the death of family time, since people would play the game instead of having conversations with each other, and yet games like Uno and Go Fish make great therapy activities, both in person and online.

Photo by Daniel Eliashevsky on Pexels.com

It reminds me of that quote from Socrates: “The children now love luxury; they have bad manners, contempt for authority; they show disrespect for elders and love chatter in place of exercise. Children are now tyrants.” People have been lamenting about “kids these days” for more than 2400 years.

That’s why, if a child asks if they can try an activity in session, I never say “No” on the grounds that the activity is not therapeutic because, in fact, I just have yet to figure out how to make the activity therapeutic. In February of 2020, I never would have considered using Minecraft in a therapy session, and now there are webinars detailing how to make the activity therapeutic and fit with a child’s treatment plan, including this free one!

Many of the telehealth activities I have been using were suggested by children. When I transitioned to working from home in March 2020, I was very honest with my clients that we would be “learning together” what works best for their sessions now that we were online. I decided that I would try anything they suggested, as long as it was safe and could be done in a HIPAA-compliant way.

If you think about it, children don’t get control over much in their lives. Adults decide where they live, what school they will go to, how they spend their weekends, and so on. Even if kids get a say in what’s for dinner or what outfit they will wear, choices are limited based on what adults provide. This means that giving kids a level of control in their therapy sessions is a powerful thing.

Since therapy is all about relationship, the rapport established by giving children a voice in their sessions is therapeutic in itself. Of course, it’s always best if an activity builds rapport and emphasizes another component of the child’s treatment plan.

When a client requests an activity that is not therapeutic in an obvious way, ask yourself:

  1. Why does my client enjoy this activity? Does it help them feel calm or relax them? Does it let them act out big feelings in a safe way? Does it present a challenge they are able to overcome?
  2. How does the activity parallel to the child’s life? Are there similarities to something they have experienced?
  3. What emotions come up for the child as they do the activity? How can those emotions then be processed and addressed in the therapy setting?

These questions are just a starting point, but approaching any activity through a lens of curiosity and creativity can expand your options for therapy sessions infinitely. How could this approach change your approach to therapy with kids?

Interview with Carol Wulff, LSW, Author

As a child therapist, I’m always looking for books to help kids understand their mental health, their symptoms, and learn coping skills. Carol Wulff, LSW, shared with me her experience of writing William, the What-If Wonder on His First Day of School.

Carol Wulff

Carol is a social worker and mother of someone who lives with anxiety. William’s story is based on the life of her son (who is now an adult and gave consent for his story to be shared). She changed some details, including the child’s name, but she said that her son had “shivers” the first time he read the book because “that’s exactly what it was like.”

She shared with me feelings of guilt that her son had mental health issues and how she overcame this. Her journey of helping her son learn to cope with his anxiety is a great resource and source of support for other parents going through similar experiences.

When her son began to exhibit anxiety, he asked “What-if” questions, and Carol tried to reassure him but found that this was not an effective way to alleviate his worries. Through treatment with a therapist, Carol learned how to redirect her son in productive and healthy ways. In fact, her co-author for the series was her son’s therapist when he first started treatment. She reported that, even in adulthood, he refers back to his childhood therapist: “I remember I’m bigger than my worries.”

William, the What-If Wonder Cover

Reassurance is not always helpful with anxiety because anxiety is not logical. I told Carol what I tell many of my clients: “If anxiety were rational, I’d be out of a job.” When doing research for these books, Carol noticed that, although many children’s books about anxiety exist, “There weren’t a lot of books that introduced the child to what they could do about their anxiety.”

With William’s stories, Carol emphasizes problem solving over reassurance because we do not always know what will happen in an unfamiliar or anxiety-provoking situation, so instead of telling William everything will be okay, she focuses on teaching William how to problem-solve when an unexpected or scary situation comes up. We cannot predict everything that will happen, but we can arm kids with the confidence that they can overcome difficulties, and they can either figure out a solution or ask for help.

Carol shared with me that part of her motivation in creating William is to push for early intervention for kids with symptoms of mental illness. Her approach is to write books that help therapists and parents talk to kids about their feelings and provide developmentally appropriate education to kids. Her goal with the series is to present many scenarios that might bring up anxiety in kids so that parents, teachers, and therapists have go-to resources when kids bring up “What-ifs.”

Carol does readings of her book and shared that she can see in kids’ eyes the understanding of William’s experience and the sense of relief that “somebody gets it.”

William, the What-If Wonder & His Sleepover Worries coming soon!

The next book in the series, William, the What-If Wonder and His Sleepover Worries is coming out soon, and Carol has ideas for more books, including helping kids manage anxiety about storms. I can’t wait to see what she shares next.

Telehealth Activity: Pop-It

Pop-its, based on my extensive research, are the latest fidget toy that all the Young People are talking about (and, of course, by “extensive research,” I mean my clients have been talking about them).

Not only are Pop-Its great for kids with sensory issues, but you can use them interactively in your sessions. Scratch has several virtual Pop-Its available, and for my purposes I prefer to use this one.

This is the physical Pop-It I keep in my office.

For an interactive game that requires some strategy and focus, there is a simple game you can play using the Pop-It. Start with all the bubbles the same way. When it is your turn, pop a number of bubbles in one row (it can be any number you want as long as all the bubbles you pop are in the same row). You can choose any row as long as there is at least one un-popped bubble in that row. The object of the game is to make your opponent pop the last bubble on the board.

You can play this game over telehealth by sharing your screen and taking turns with screen control.

I’ve noticed that Scratch has endless options for virtual fidgets and sensory games, with the option to design your own! If I knew more about computers, I would try my hand at making some myself, but so far all I’ve managed to create are glitches. (Like I say to my clients, though, “That’s ok! I’m good at other things.”)

Kids love when I can incorporate something they like in real life to their telehealth sessions. As with all fidgets, the sensory component changes when you go virtual, but the familiarity of this activity is great for engagement.

The Weekly Mews with Armani

Apologies in advance for typos – I just got back from the Art Market and Armani immediately snuggles I to my lap. Can’t get to the computer so I’m writing on my phone.

You can’t disturb this face 💜

As many of you know, Armani is back in the Cone of Shame. He didn’t like his Libre this round and kept trying to chew it, so he has to let the area heal.

Miffed kitty

There is good news, though! The vet is very happy with Armani’s sugar levels. He can reduce his insulin for a bit. We are going to do one more round with the Libre, and if he continues on his current trajectory, he could go into full remission.

Did you know cats can go into remission from diabetes? Are we studying this??

Goof

He has gotten so much stronger since he got sick in November, and we are so happy for him.

Baby 💜💜💜

I’m not confident in my ability to add the donation box using the app, but you know where to find it if you feel compelled. If Armani gets full remission and no longer needs the insulin I’m going to stop adding that box to these posts, since the purpose was to help cover his treatments.

Thank you all for supporting Armani! He loves you!!

Interview with Dr. Stacey Freedenthal, LCSW, Author

Content Warning: This article talks about suicide and suicide prevention in general terms.

I would like to start off by thanking Stacey for her patience with me. We met a while ago, and I have not been able to make the time to actually write this up until now.

Stacey is a social worker and author who focuses on suicide prevention and has an amazing website full of resources for people living with suicidal ideation, people who love people living with suicidal ideation, and mental health professionals.

Dr. Stacey Freedenthal

Stacey is the author of Helping the Suicidal Person: Tips and Techniques for Professionals, an excellent book for providers to address fear about working with suicidal clients regardless of their theoretical orientation, and she runs Speaking of Suicide, a Facebook community for people “touched in any way by suicide or suicidal thoughts.” Stacey “wrote the book I wanted to read” as a new practitioner, though her book is accessible to providers at all levels.

She shared with me that many existing books emphasize on immediate risk assessment and safety planning without focusing on “what to do to help people feel better.” She wanted to move the emphasis from practitioner liability to client need. She also wanted to share what she has learned in her career in suicide prevention.

Helping the Suicidal Person cover

Surprisingly, Stacey has seen some pushback in her work. She told me, “It shocked me how many people hate suicide prevention,” and she wrote an excellent blog piece about why she is so passionate about this topic. Even though the vast majority of suicide survivors say that they are glad they survived, people get upset that she wants to prevent someone from dying from suicide if that is what they “want” to do.

Unfortunately, in the field of psychology, we often emphasize clinician liability over client need. Stacey was at a training where she was told to send clients to the emergency room “the minute they mention suicidal thoughts.” When asked how we justify hospitalizing so quickly when hospitalizations can do more harm than good when they are not the right resource, the presenter said, “It doesn’t matter if it helps [the client] … it protects you.” Stacey cited multiple studies that show that “it’s indisputable that, for many people, hospitalization is traumatic.”

It is so important for clinicians to be well-versed in risk assessment and determining when hospitalization is needed. Stacey noted that she was taught, “If there is a suicide, then there was a failure” by the clinician. Although we want to prevent suicide, placing the emphasis on therapists “failing” our clients by not hospitalizing ends up doing more harm than good. Stacey cited an article by a psychiatrist that pointed out that we don’t call it a failure when an oncologist loses a patient to cancer.

This attitude does a disservice not only to clients, but to their loved ones: telling someone they “could have” prevented someone’s death. We can be there for someone, offer appropriate support, do our best, and still miss the mark. We unfortunately cannot magically know whether someone is going to act on suicidal thoughts, and Stacey has blogged about this topic. She asked, “How do we predict the future?” The fact is, we can’t. This is why we do our best to monitor, assess risk, and walk with our clients on their journey.

If you or someone you know is experiencing suicidal thoughts, help is available. The National Suicide Prevention Lifeline is available 24/7 in the United States for those in crisis. Call 1-800-273-8255 to speak to someone.

Ap Review: Combined Minds

I previously wrote about Calm Harm, an ap designed to help people through urges to self-harm and teach mindfulness and coping skills. The creators of Calm Harm have created another ap called Combined Minds, which aims to offer support to people who care for someone with a mental illness.

Introduction Screen

Lots of aps exist to help people living with mental illness, and plenty of literature exists about coping skills and reaching out for support. But often times people who want to support a loved one find themselves at a loss. They might ask the loved one, “What can I do to help?”

Although well-intentioned, this puts it on the person struggling to decide what they need and ask for it specifically. Yes, that is a good skill to develop, but sometimes people need someone to offer specific help rather than simply asking what that help ought to be.

Activities for anxiety, depression, self-harm, eating disorders, digital addiction, and safety plan

Combined Minds provides education about mental illness as well as resources for support and specific things that you can do in the moment if your loved one is having a hard time. It walks you through creating and following through with a safety plan and gives information about setting healthy and appropriate boundaries.

Although friends and family are not a substitute for professional support (even I can’t treat my own loved ones despite my license), this ap can help you understand what your loved one is going through and give you specific, concrete tips for walking with them on their mental health journey.

Telehealth Activity: Multiplayer Cars

One toy that got a lot of use in my office is my box of matchbox cars. So many kids enjoy racing (either against me or against themselves) and building elaborate tracks.

In telehealth, Madalin Cars Multiplayer lets me incorporate car games into my telehealth sessions. The first thing I noticed about this game is that kids can pick from way more cars than I have available, and they can customize the color of their car. The trade off is that they can only be one car at a time, but the customization options means that that car can look exactly how they want it to look.

Custom car options

In this platform, click “Play,” choose your car, then select “Multiplayer.” When the list of available rooms loads, create your own room. Uncheck “Create public room,” as this will ensure that the room is private. When your client is at the screen showing the list of rooms, have them type in the name of the room you created (this is case sensitive) and click “enter room.” This will bring them into your private room and prevent strangers from joining your room.

Home screen

Although you cannot customize the room, the platform gives options for racing and various stunts that are a lot of fun. Plus, when you crash the cars, they get dented, which can let kids work through aggressive urges without damaging property, and you can click “Repair” to watch the car fix itself.

Fast car

Other single-player car games could work for telehealth, with the client pulling up their preferred game and sharing their screen with you, but I like this one for the interactive options.

I love finding a new way to bring an in-person activity to my telehealth office, especially when we can both play together while preserving confidentiality.