While 72% of Australians live in major cities, 8.0% are in outer regional areas and 1.9% in remote or very remote locations. The last group are younger, with a higher percentage of Indigenous people and 24 times more likely to be hospitalised for domestic violence than city dwellers. This great need is poorly met by a decline in full time equivalent allied health practitioners of all types.
COVID was devastating, and for the first time, families who had easily accessed family therapy for child and adolescent difficulties found themselves as remote as if they were in Coober Pedy. In response family therapists were forced to consider how best to offer effective, safe, and ethical services that could benefit family members of all ages and locations. Vermeire and Van den Berge (2021) identified key challenges of online therapy including; working in the clients home where the session can easily be interrupted, the disciplining of bodily interactions in new and less active ways, a favouring of words leading to a sense of interrogation and the screen narrowing our view and overlooking broader and less visible contexts.
Guided by Cecchin’s position of ‘irreverence’ towards these challenges the authors adopted a position of playfulness ‘an atmosphere, attitude or mood that could be invited into the therapeutic space.’ They provide practical advice for working in this way. Before the first meeting they recommend sending an e-mail to all participants asking that they bring crayons and toys, ensure they have a comfortable place to sit and consider who they would like to attend the meeting. They are also asked to write down questions to be addressed in the first session and bring a red object to put in front of the screen if they do not wish to answer a question or feel uncomfortable. On entering the clients world a child can be invited to show the practitioner around and for the therapist to be sensitive to intruding and ask permission if unsure. Attention should also be paid to privacy and who else may be present but off screen.
The challenge of maintaining a broad systemic perspective on a narrow screen can be addressed by encouraging the use of a whiteboard to draw the system or represent all those involved using toys or pieces of paper. These people can then be ‘interviewed’ about their opinion and advice and fully integrated into enquiry and intervention. Connecting children and their families to the broader social network is also central to the task of therapy. Finally, the use of e-mail and drop box is encouraged to maintain the thread between sessions.
The strategies suggested by Vermeire and Van den Berge are valuable tools for systemic therapists working with families and including children as active and contributing participants. Now we are less constrained by limitations of lockdown we can utilise the learning from online work during Covid for those families who may never access face to face services due to the remoteness of their homes but who are in as much or greater need than their city counterparts.
Vermeire, S. and Van den Berge, L. (2021) Widening the Screen: Playful Responses to Challenges in Online Therapy with Children and Families Journal of Family Therapy 43: 329–345