I have lost count of the in-person therapy sessions that didn’t go to plan- I’m pretty sure most of us have after years in this career. It seems like something none of us can control, no matter how thoroughly we read and prepare for the client. How often did the person not match what you envisioned based on the information you were given? I’ve had to laugh to myself in order not to cry when thinking, “Did this kid change that much since the last therapist?” This isn’t even about negative behavior (that’s a whole other post). It could be that the goal you spent so much time preparing materials for is met after your first meeting (hurray- but now what?). It could be that the kid matured over the summer and is no longer obsessed with Paw Patrol or Minecraft (making the themed visuals you slipped in as motivation irrelevant). It may be that the therapeutic techniques you’re using just aren’t clicking and you’re losing the client’s interest. There are many more reasons, but those are the first that come to mind.

Providing services via telepractice won’t reduce these occurrences. However, there are ways you can be prepared for these moments that won’t make you feel that rush of heat take over when you would typically start to panic. 

1. If the client is new to you, use a generic break-the-ice activity so you can get an idea of what the client is capable of (e.g., if they use AAC, you can explain to the aid/facilitator that you are probing to see the prompt levels needed to respond using it). When I say generic, I mean have 1-2 pictures with minimal words in a Google Slides or PowerPoint presentation. Use questions that involve introducing themselves, talking about their family/pets, what they want to be when they graduate, and this or that type of activities (e.g., McDonald’s or Taco Bell; cats or dogs; the pool or the beach). Generic activities like this can be used for practically anyone at any age in a group or seen individually. With an activity like this saved and easily accessed on your desktop- your initial virtual sessions with each new client should be covered (check and done). 

2. The beauty of teletherapy is that the people you’re working with only see what you’re sharing on the screen (rarely, you should ever choose to share your entire screen). Have multiple activities open and available at whim for each session. This sounds like a lot, but it only takes a couple of extra minutes to ensure you have an easy, moderate, and difficult version of the activity ready to whip out when you realize what you’re currently doing isn’t appropriate. This is faster than scrambling in your therapy room through games or flashcards. If it isn’t the difficulty level that needs to be changed but the activity itself, always stay logged in to the websites you are subscribed to and give yourself easy access by bookmarking them to your server tab. 

3. Have something along the lines of a choice board for the client to choose from. This can be visuals for links to certain therapy activities (e.g. maybe a specific lesson makes the goal click for that client), positive reinforcement (e.g., a selection of YouTube music videos they can choose from between activities), or even brain breaks (e.g., a timer you can set for them to put their head down for a minute or get up and stretch). These resources are helpful for dealing with clients who are clearly fatigued, losing motivation, or needing behavior management. It may sometimes feel like filler, but there is a reason for them. You will appear professional, confident, and with a plan to the people on the other side of the screen. 

You probably already used a variation of these tips when providing in-person services, but now it is time to adapt and apply them in the virtual setting. It always seems daunting at first, but once you do it- you’ll see that it just takes a few clicks of the mouse to adjust your plan when things aren’t going your way.