Online therapy for children and teens with OCD works as well as in-person therapy: how to maximise your child’s online sessions
Over the years there has been some concern that online therapy is not as effective as in-person therapy. I feel for adults this view has changed. With children and teens I still notice some hesitancy amongst families. For some young clients the idea of talking with a new person online is very daunting and in a post-lockdown era I imagine children and teens have technological fatigue, at least with Zoom and Google Meet (I’m sure Roblox and Snapchat are still fine). However, I wanted to write this article for any parents and caregivers that have doubts about the effectiveness of online therapy for OCD for their children, while outlining some considerations to get the most out of online therapy for children and teens as adaptations need to be made.
I almost exclusively work in-person with a few exceptions as that is what I enjoy and it allows me to bring in more play elements for the younger ones, as well as allowing me to create a space conducive for therapy. However, accessing an OCD specialist in-person can be a challenge, so it is worth spending some time discussing why therapy online is still as effective. Play elements can still be used online, the therapist just gets more creatively resourceful. Adaptations include the child having art items such as pencils and paper to hand, there are digital sandtrays, and most online video platforms have a whiteboard that allows the child and therapist to interact in a playful way. Play can be an important way to engage the child in therapy, connect with the therapist, and help the therapist go through the therapy tools in a child-centred way. Play is also a key way young kids communicate. For teen clients this is less important, but creativity is still useful for engagement.
When appropriate and the child or teen is open to it it can be useful to have the parents in the room, especially when there are accommodations that the parents can reduce. Having the parent in the room for some of the session can be useful for everyone to be on the same page. Online therapy makes this much simpler as the parent can be in at the start or end, with both parents more readily available. In person I have found it’s hard for both parents or caregivers to attend due to work commitments and taking care of other siblings.
During exposure and response prevention therapy (ERP) in the therapy room it can be challenging to find ways to do exposures for the child’s OCD because sometimes they are mostly triggered in their own environment. Online therapy allows for the exposure work to take place in the home, allowing for the kids to move around the house and do exposures bringing the therapist with them. This only happened historically when a therapist did a home visit, but this was prohibitive because of time and cost.
It’s worth thinking about whether online can work for your child and teen. Sometimes young people can find it hard to engage online, but a lot of the time they roll with it and the therapeutic outcomes can be similar. A discussion with your child will help you find out if they are open to online therapy. Sometimes an initial session can be booked to see how they find doing therapy online.
Here’s a message from one of the centre children and young people therapists, Bistra Slavkova. Bistra works solely online:
The BACP guidelines emphasise the importance of specialised skills and extensive assessments for young people receiving remote therapy. Key criteria include using safe, dependable platforms, protecting confidentiality, controlling digital risk, and keeping professional boundaries, with a focus on developing the therapeutic relationship without in-person contact.
As a BACP registered Children and Young People Psychotherapeutic Counsellor, I transitioned from in-person practice during and after the COVID-19 pandemic to exclusively offer online therapy for young people dealing with OCD. This transition was a crucial response to the needs of many young people across the UK and globally, who may find it challenging to attend school, be around others, may be attending boarding schools, or struggle to leave their homes and travel.
Online therapy for OCD empowers young people to reclaim their lives and build resilience by providing them with more control over their environment and how they support themselves during sessions. I typically encourage young clients to have a snack and a water bottle nearby, particularly after school. Bringing a soft toy or their pet to sessions is also recommended to offer extra comfort.
Being able to present interactive tools, games, and digital resources, has proven very beneficial helping young people express themselves and work through OCD challenges. By using ERP and acceptance and commitment therapy (ACT) as my approach to treatment for OCD, young people are able to practice exposure steps in a safe place in online sessions. The treatment also allows them to develop their autonomy and resilience by practicing committed actions based on their values and what is important to them, choosing to engaging in therapy in a way that best answers their needs and wishes.
Moreover, online therapy has shown to be particularly beneficial and often preferred alternative to in-person sessions, for neurodiverse young people, who may need a parent or carer nearby, a quieter and less overwhelming space, more control over distractions and access to comforting tools.
Considerations to making online therapy work for your child:
Therapy is a safe space. A physical therapy room provides a place they can’t be overheard by family members or other people which boosts openness. At home or where ever they do online sessions please make sure they feel confident they won’t be listened to by anyone else.
The therapist isn’t in-person with them, so having a parent close to support if needed can be helpful. This is also important if there is any risk to the child such as historical or recent self-harm. Parents should ideally have their phones on during sessions so that the therapist can reach out if needed. Although, making online therapy safe for your child is something the therapist will raise if concerned.
Technical reliability: A working computer (or other device) that can handle online tools such as Google Meet or Zoom, and a reliable WiFi connection.
Play materials: have resources to hand to get creative.
Movement: sometimes movement breaks can be useful, or bringing in movement based mindfulness skills.
Developmental fit: if 50 minutes is too long, the therapist can suggest doing 30mins with the child and 20mins with parent.
Is it nice to be in-person for therapy? Yes. But it is not needed for similar therapeutic outcomes. If your child or teen is open to online sessions and can engage online it is worth considering if there are no in-person options locally to you, or if your child is not fussed about in-person sessions. Limited access to local OCD specialists does not have to stop your child from accessing evidenced based care.
We hope this article has helped,
Stuart (and Bistra)
If interested in online therapy for your child or teen please contact us through the contact us page >