Roblox

I am speaking specifically about Roblox today, but you can use these same techniques with Minecraft or The Sims depending on the child’s interests.

Don’t mind me, I’m just living my best life with Zoom backgrounds and filters!

A big part of therapy with kids is sharing in the child’s interests. Yes, we want to work on making good choices, modifying behavior, and developing appropriate coping and communication skills, but none of that can happen unless I’m able to connect with the child. And the fastest way to connect with anyone is to share in their interests.

When I was doing primarily in-person sessions, many of my clients would talk to me about a game, Roblox. I have never played this game myself, but thanks to my clients, I know a lot about it. A big part of the appeal for many players is that the game allows you to create your own character and home, and you can customize these things as much as you want. There are default options to choose from, but you can be as specific as you would like and can create a world to your exact specifications.

Can you tell where I’m going with this?

I’ve done many guided visualization exercises over the years that involve creating a space that is calm or happy for my clients. Roblox lets us do the same thing in a more literal sense. Since customizing the world can be time-consuming, I typically have the child show me a world that they already created.

As the child shows me the living space they set up, I ask questions like:

  1. What was most important to you when you created this space?
  2. How do you feel when your character spends time here?
  3. Which items are your favorites, and why?
  4. What would you do if you were in this space for real?
  5. What does it smell like here?
  6. Was there anything you chose not to include?

Similarly, I ask the child to introduce me to their character, whose appearance they can customize completely if they choose.

  1. Tell me about your character.
  2. In what ways is the character like you?
  3. In what ways is the character different from you?
  4. In what ways do you wish you were more like your character?
  5. As you created your character, what was it important to you to include?
  6. Was there anything you chose not to include?

I should note, it’s helpful to let a parent know you are using this intervention as well as the rationale behind it. Otherwise, you will get phone calls and emails asking why the child was playing video games in their session. You could do a similar intervention with games like Minecraft, but the point is to help the child create a space that is just for them and help them be mindful of what they like about the space. Talking about their character can also help with building self-esteem and setting goals.

Antistress

The home screen on the Antistress app

I’d like to share one of my favorite therapy apps: Antistress. I actually first heard about this app from a client who had found it helpful. The app basically has several sensory items and activities that can help with boredom, fidgeting, anxiety, and self-regulation. There is a free version and a paid version, with the paid version taking a one-time fee to unlock more choices, but you can also temporarily unlock the paid version by watching an add. (Usually I try to only recommend apps that are free to download.)

They update regularly with new options, and there is a way to submit suggestions to the developers. Although some of the options have the feel of a flash game, the activities are focused on mindfulness and are appropriate for kids of all ages. I’ve shared screenshots of some of my favorite choices. Which is your favorite?

Who doesn’t love a virtual fidget spinner?
This stress ball screams when you throw it around the screen.
Virtual glass for when you want to smash something
Prompting for belly breaths
And, of course, virtual bubble wrap!

Color Your Emotions

I created this activity to help kids express a feeling that they might not have words for. The worksheet below shows an outline of a body and asks kids to color in where they are experiencing a feeling using a color that reflects the feeling, but another way to do this activity is to give the child a blank piece of paper and have them draw what the emotion feels like to them.

When we experience strong emotions, the part of our brain that controls language goes offline. It can be helpful to learn techniques to put that part of our brain back in charge, but sometimes kids need to be able to express a feeling without the pressure of having to put words to the feeling. Using this technique, adults can discover what children are feeling and offer appropriate support even if the child is not in a place to put words to the feeling.

If the child likes the idea of using colors to express feelings, you can have them assign colors to feelings when they are calm so that, in the moment, you know what each color means to them.

Color Your Emotions Worksheet

Drawing out the feeling will help the child process it and communicate it in a way that is appropriate and understandable. Once the child feels calm, you can go back to the worksheet and talk them through the best way to handle that feeling.

For more tips on helping kids communicate their feelings, check out I Don’t Want To Be Bad on Amazon!

Backgrounds

The intervention I want to talk about today isn’t a specific game, so I am writing in a different format than I usually do in this series. Details about the client interaction that I describe below have been changed for privacy, but the spirit of the story is in tact.

The Enterprise is one of the many, many places I’ve held sessions in the past six months.

Since March, I have gotten much more comfortable holding online sessions with kids, but in the beginning one of my biggest struggles was holding their attention long enough to have a productive session. In my office, kids can run around, and I can just follow them. If a child disengages or shuts down, I can get down on the floor and join them at their level. But when I’m on camera, I can’t move or even control what I am looking at.

Early on in my work from home life, I asked a child if we could talk about the difficulty they were having engaging with me on Zoom. I asked what might help them focus, and they said (this is paraphrased), “I’m sorry, Dr. Amy, but before our meeting I was watching Godzilla, and that’s just more interesting than you are.”

They were absolutely right; I’m not as interesting as Godzilla.

So I asked them to wait a moment, went on Google Images, found a picture of Godzilla, and made it my virtual background. It was magic! Suddenly our meeting was much more interesting.

If a child is struggling to pay attention, I’ll ask them where they would rather be and find an image that matches that, or I will find a background of their favorite television show or a special interest they have. Some kids have used the virtual background for imaginative play and will tell me that I need to be in jail, or my house is on fire, and I find a background that fits that. I’ve done sessions on the moon, at the bottom of the ocean, in a cave, and at Disneyland. This is definitely one of my favorite Zoom tools for telehealth with kids.

Praise for I Don’t Want To Be Bad

(It’s October 3rd!)

I am so excited and pleased to share that I Don’t Want To Be Bad currently has a five-star rating on Amazon! I wanted to thank everyone who has shared, purchased, or reviewed. This is a lifelong dream come true for me and has given me the confidence to pursue other projects.

I Don’t Want To Be Bad is available in paperback and ebook format on Amazon!

Here’s what readers are saying about I Don’t Want To Be Bad:

This workbook is a great resource for communicating with kids and preteens about their emotions and thoughts. Every page offers an array of activities for parents/guardians and children alike, from journal entries and coloring pages to ice breakers, activities and conversation topics. …  Dr. Marschall brings her expertise to the forefront here and the material is very approachable and easy to comprehend.

Amanda (Verified Purchase)

More praise for the book:

I Don’t Want To Be Bad is a very practical, hands-on book detailing concepts that parents, educators, and mental health professionals should find interesting and useful. The book follows a distinct pattern: short explanation of concepts -> how the current exercise helps -> the exercise itself, occasionally followed by relevant notes. The examples are sound, practical, and plentiful. They range in difficulty (from the child’s perspective) so that each concept builds upon the last. The exercises given are intended for multiple use until mastery is achieved, and not to be rushed through. This means that this book and its contents will remain relevant over time as the child grows.

Senseandrew (Verified Purchase)

Feedback from a mental health professional:

This book is well written and practical. It provides clear language to help parents better understand the brain and the possible reasons for their childs behavior. I find it useful as a clinician, and clearly written, so I can give it to clients. The activities give parents practical solutions that help build their skills towards a healthier family.

Jeflesner

Thank you all for your support! For those who left such kind reviews, I hope my next project is as beneficial to you as this one has been!

Press Pause on Impulsivity

Impulse control is one of the last abilities our brains develop, so children and teenagers really struggle with this. Sometimes this gets labeled as disobedience, but kids are literally not capable of controlling their impulses the way that adults are.

This activity helps kids work on improving impulse control by visualizing a remote control and trying to “pause” and think before making choices. Adults can help them by cuing the child to press pause as the impulsive behavior is starting.

Photo by Ian Panelo on Pexels.com
Remote control worksheet

Image text:

STOP!
Imagine that you're watching yourself on a screen right now. You are holding a remote control in your hand, and you see yourself about to make a choice. Look at the remote, and press "pause." This causes you to freeze on the screen!
Now that you're paused, you can fast forward in your mind and see what might happen next. What are you about to do? What might happen if you make that choice? Are you happy with that choice and its consequences? If not, rewind and think about what different choice could have an effect that you are happy with.
Maybe you didn't hit "pause" until after you had made a choice. That's okay! You can still rewind and see what was happening before, and you can think about what you could do next time. You can also rewind further and see what might have lead up to that choice to help you notice what things might make you want to behave a certain way so that you can change how you react or avoid those things in the future.
Adults might help you remember to press pause. This is because they want to help you notice when you might need to pause, and they want to help you make good choices. But you don't have to wait for an adult to remind you! You can press pause any time you want to remember to think before doing something.

Sand Tray Therapy

At my first practicum site, the director told us that we were welcome to use any child-friendly intervention we deemed appropriate except for sand tray because she didn’t want to deal with the mess. Well, Dr. Karen Fried found a way to not only eliminate the mess associated with sand trays but also make this intervention possible on telehealth!

Photo by Jorge Sepu00falveda on Pexels.com

This site does not create a link that you send over Zoom like the other activities in this series. Instead, either the therapist or client screen shares. If the therapist is sharing their screen, they will want to grant remote access to the client so the client can create their sand tray.

Before using this activity, therapists should make sure they have completed continuing education to be competent in sand tray therapy.

I have to say, I really like doing sand tray work online. Here are the benefits I’ve found:

  1. Kids can put the same character in the sand tray multiple times, so there are more options.
  2. Kids can adjust the size of the characters the put in the tray, which opens up the scene for more interpretation based on which pieces they make larger or smaller.
  3. It’s really easy to save the image once the child is done, and it saves right to the therapist’s hard drive.
  4. No clean-up!

My hesitation with online sand tray work is:

  1. The existing research on sand tray therapy focuses on in-person, so it’s possible the online version is less effective and we just don’t have the data yet.
  2. There’s a sensory component to sand tray work that you lose when you go online, which I guess is the trade off of not having to vacuum sand out of your office.

This is a great way to bring sand tray therapy into the telehealth setting!

What Do Risk Assessments Look Like?

Content/Trigger Warning: Suicidal Ideation

September is Suicide Awareness Month, so my best friend, Cirien, helped me create a mock risk assessment. Many people wonder what it looks like if you tell your therapist you are having suicidal thoughts that you don’t want to act on, so I created this video to show how I respond when a client shares this with me.

Disclaimer: This only represents how I would handle the situation as a professional. I recommend asking your therapist what their policy is for responding to passive suicidal thoughts.

Passive suicidal ideation is very common, but telling your therapist about these thoughts can be scary.

What other videos would be helpful to see? Let me know!

I Don’t Want To Be Bad available at Full Circle Co-Op

A local book store, Full Circle Book Co-Op, has agreed to stock I Don’t Want To Be Bad! As with purchasing online, copies are $9.99, but part of the profits will go to a local business that does awesome things in the Sioux Falls community!

Come by and check out other local authors, have a beer, and find all the second-hand books you could ever read.

Dominoes

Before I started working from home, I had a huge box of dominoes in my office. I rarely used it for its original intent, as kids much prefer to build with the tiles or make a path that they can then knock over. But when I was looking for games that could be played over telehealth, I found virtual dominoes! This is actually from the same website that hosts the Mancala game I shared before.

Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com

This is, of course, the more traditional dominoes where you line up pieces with matching numbers of dots. I have not found a version where you can create tracks and knock them over, so if someone reading this has found something like that, please let me know.

Traditional dominoes can be a good therapy game, as it requires focus and planning, frustration tolerance, and social skills. There are some definite advantages to playing online:

  1. If one of your treatment goals is to work on executive functioning, the fact that the game will not let you “cheat” or change the rules helps keep the child focused on a specific goal.
  2. The computer keeps score for you, so if you are like me and don’t understand how scoring works, that part is covered.
  3. When it’s your turn, the pieces in your hand that you can play are highlighted, so the choices are more obvious to the child. (This is especially good because some kids who are still learning the game in my office will ask me to look at their hand and help them choose, which isn’t an option online, so the game sort of does that for me.)
  4. Who else loves dominoes as a therapeutic intervention but hates cleaning up all those tiles? On the internet, you don’t have to clean up.
  5. There is a timer bar, and if you do not take your turn, the game goes for you. This is a helpful focus intervention with natural consequences.

Cons of online dominoes:

  1. There is no option to play without keeping score.
  2. There is no option to change the rules if you want to take a more child-focused or non-directive approach.
  3. There is no option to turn off the timer.

Basically, like a lot of these games, the computer programmer didn’t think about what would happen if you were playing the game with a child who wanted more control of the game itself. (If you hadn’t already noticed, this is a theme among online board games, unless you’re on PlayingCards.IO!)

As always, thanks for reading!

Photo by Craig Adderley on Pexels.com