Therapy IRL: Starting the conversation

Posted: June 9, 2020

We’re all starting to take a peek around the curtain. We’re getting notices about hair salons starting to open. Dentists and orthodontists are starting to schedule routine care appointments. Many of us have started socializing a little bit without the help of Zoom – outdoors, 6+ feet apart, BYOE (Bring Your Own Everything). And so, it’s not surprising that there’s more and more conversation about what it might look like for there to be face-to-face therapy again; that is, therapy IRL (In Real Life).

This is a conversation I’ve been having more and more lately, as parents call asking what my policy is on seeing children face-to-face, rather than the default teletherapy that quickly (and necessarily) became the norm. The kinds of calls that are coming in are generally from parents who fall into one (or more) of the following categories:

Parents who are calling about a child who was struggling with some kind of anxiety or depression before we all went into coronavirus lockdown and the situation appears to have gotten worse.
Parents who are calling because they have a child whose anxiety was manageable before COVID-19 hit, but they’ve seen a spike in their child’s anxiety over the last couple of months.
Parents who are calling because they are feeling stretched thin in their capacity to effectively manage their child’s challenging behavior at home, and they need some technical support.
Parents who are calling because their own history of anxiety has resurfaced over the past few months, and they’re worried about how it might be showing up in how they parent their children right now.

In all of these cases, parents couldn’t see teletherapy working for their child (or themselves), and so they’re wondering if face-to-face therapy is an option now. To be sure, teletherapy has done wonders for many, many people over these past months. There is an emerging evidence base to support the use of teletherapy – not just during extreme circumstances like a pandemic, but during “regular” life, too. But just as there is no single approach to therapy that will work for everyone, teletherapy is not for everyone – and it can be particularly difficult for children.

In any conversation about this topic of whether or not to see clients (children or adults) face-to-face, the #1 question to contend with is, “Is it safe?” In the best of the conversations I’ve had about this topic that question has been reframed, so that rather than asking, “Is it safe”, the question becomes, “How can we make it as safe as possible?” What we know is that it is currently not advised to have two or more people talk to each other indoors for a prolonged period of time. This, of course, is the exact description of what traditional therapy looks like: two or more people talking to each other indoors for a prolonged period of time. What we are still figuring out, though, is the set of protocols that, if taken together, can create the conditions within which kids – and, of course, adults – can safely get the help they need.

So: the short answer to the question of “Therapy IRL?” is, well, yes... and for some people, no. Yes, there are therapists who have already begun seeing clients in-person. And, no: there are therapists who state they won’t be seeing any clients in-person for the foreseeable future. I am not advocating for the wholesale adoption of one position or the other. To be sure, there is a lot to factor in to make sure that you and your child stay safe -- and that therapists stay safe, too. But I do think it’s a conversation we can start to have – that we should start to have – especially if you have a child who has been suffering – or if you’re suffering yourself.