Teletherapy and Kids, Volume 6: Scattegories

Before checking out today’s post, please go to my resources page to see other telehealth interventions for kids!

When I think of Scattegories, I think of my first job at a dry cleaner. On slow days, one of my co-workers would get it out of her car, and we would play to pass the time. This is a game that I actually didn’t use in my pre-COVID-19, in-person therapy practice, but it is one that I’ve found interesting uses for in the past several months.

(There were no pictures of Scattegories but Scrabble felt similar enough to include here) Photo by Pixabay on Pexels.com

When I first transitioned to all telehealth, some clients and I did the Alphabet Game, where you choose one category and try to think of something for every letter of the alphabet. We would alternate between something “fun” (like animals or desserts) and something “therapeutic” (like emotions or coping skills). This is a spin on that activity.

In Scattegories, you are given a list of topics and a letter, and you have to think of something in each category that starts with that letter. This website lets you create a game using a private link. You choose the number of categories and time limit (or you can opt for no time limit), and send the link to your client. You can pick specific categories or add your own, or the game can choose at random.

In therapy, this activity can be used to work on executive functioning (having to think creatively, focus, and use the allotted time appropriately), bring up topics related to treatment goals (by making those topics the categories listed), and improve cognitive flexibility (by having to find creative ways to fill each category).

Why do I love Scattegories for telehealth?

  1. As with some of the other games, you can use a time limit to work on anxiety with timed tasks, or you can have no time limit at all.
  2. You can input custom categories based on the client’s treatment goals as talking points for your session.
  3. You can also choose from available categories to save time if you don’t want to come up with your own.

As with everything, there are also drawbacks:

  1. I really recommend manually choosing categories rather than hitting “random” because the online version has some choices that are less kid-friendly, like “name an alcoholic drink.”
  2. You can’t choose what letters you want to use for the categories because it is randomly generated (although you could play this game without the website above and choose the letters yourself).
  3. As with Pictionary, you are supposed to type your answers, which is challenging for some kids.

Scattegories is a game that I didn’t think of as therapeutic before I started using it with telehealth, but it has some definite advantages. Kids seem to have a lot of fun with it, and it helps us indirectly incorporate their treatment goals into a fun activity.

Thoughts On Self-Diagnosing

Many people struggle to acknowledge when they are having trouble with their mental health, and this happens for a few reasons. First, stigma about what it means to have mental illness can put people in denial about their symptoms. They don’t want to be labeled “crazy” or “unstable.” Second, mental health is health that relates to your brain. Your brain is the organ that is supposed to alert you when something is wrong, so when the issue is in your brain, it can be harder to label.

That being said, it is possible and common to notice mental health symptoms in yourself. This is especially true in the age of the internet, where education about mental health is more available than ever before, and people are more likely to realize that their difficulties aren’t just due to “laziness” (I hate that word, but that’s a topic for another day).

Photo by cottonbro on Pexels.com

Although the internet is also filled with false information about mental health, there are a number of helpful websites that can give good information about different mental illnesses, as well as online communities for moral support and to help people feel less alone. This, combined with poor access to mental health resources, can lead to people identifying with a diagnosis that has not been given by a mental health professional.

Now, as far as treatment plans go, an accurate diagnosis is very helpful because there is symptom overlap for many mental illnesses, and diagnoses with similar presentations might respond best to different treatments. This is why I spent five years in graduate school and why they pay me the…um, medium bucks.

That being said, no one knows you like yourself. Sure, OCD and anxiety can manifest similarly (or you can have both). Someone might come to me to be evaluated for OCD, and I might find that their symptoms better fit a diagnosis of Social Anxiety Disorder, but they were still right to notice that something was wrong and they needed support. But you would be surprised how often someone guesses their diagnosis before I tell them my professional opinion.

If you find yourself identifying with a set of symptoms, and engaging with that community helps you, I feel like that can only lead to more support for more people. The rise of telehealth should make psychological evaluations and treatment accessible to more people, but in the meantime, increased self-understanding and community support is a wonderful thing.

Get Grounded

Grounding is a mindfulness tool that helps us “detach from emotional pain” by “focusing outward on the external world” (Lisa Najavits, Ph.D.). When someone experiences a trigger and needs to pull themselves into the present moment and out of their body sensations, grounding activities help them do this.

Photo by Pixabay on Pexels.com

Look at the baby bird in the picture above. How many adjectives can you use to describe it? See if you can list 20 different words to describe what you see in the picture.

Notice how this activity shifted your focus out of your body and onto the photograph. Similarly, when someone feels stressed or experiences a trauma trigger, they can choose something in their environment and describe it in detail to focus their brain on the present moment rather than what is going on inside of their body. If someone is visually impaired, they can do a similar activity describing a sound they hear or how an object feels in their hand.

I’ve found grounding activities to be incredibly helpful for those with trauma as well as anyone working on better coping skills to regulate their emotions.

More grounding techniques can be found in my book, I Don’t Want To Be Bad!

Teletherapy and Kids, Volume 5: Pictionary

Make sure you check out the other posts in this series!

Although I am not certified as an Art Therapist, I have done continuing education in art therapy and lead a group for teenagers who want to explore how their creative side can help them cope with mental illness. There are a lot of great ways to use art in a session, and even over telehealth, clients can bring their art supplies and work on something creative while engaging with you. But today I want to talk about an interactive activity that you can do in a telemental health session.

Photo by Sharon McCutcheon on Pexels.com

This website lets you play Pictionary in a private room with one or more clients at once. You can specify the time limit and the number of rounds, and there is the option to add your own prompts. I have found that the prompts I input don’t show up unless I choose “Use custom words exclusively,” so if you want to go this route, I suggest creating a long list of choices.

One reason I like playing Pictionary with my clients is that it takes the emphasis off of making the image “perfect” and focuses more on the process of making the drawing. Some kids become frustrated quickly because their drawing doesn’t look how they picture it in their heads, but with Pictionary, the only goal is for me to be able to tell what they are trying to draw. This is great for emotion regulation, mindfulness, and learning to see art as a coping skill rather than a task that needs to be done a certain way.

There are some definite benefits to online Pictionary that don’t always apply in person:

  1. If you are trying to set a boundary with time limits, the game cuts you off when time is up, so you can use this intervention without having to be the “bad guy.”
  2. Auto-generated prompts are so handy!
  3. The website above gives you clues if time is running out, which can help with problem-solving skills.
  4. When using this activity in a group, the game automatically assigns an order – no arguments over whose turn it is or who gets to go first.

As with everything, there are also drawbacks:

  1. There isn’t an option to have no time limit.
  2. You have to choose words from options presented, and sometimes all three options are difficult to draw or are characters you or the child isn’t familiar with.
  3. It can be challenging to draw on a computer screen.
  4. On some devices, like tablets or smartphones, it can be hard to see the drawing tools, which can be frustrating.
  5. The words are presented in written format, and answers are given by typing them in, so this doesn’t work with children below a certain reading level. (For some kids who can read the words but have trouble typing, I have them just say their guess.)
  6. The game keeps score, and you cannot disable this option, so every game has a “winner” and “loser.”

Overall I really like Skribbl as a teletherapy option, but there are drawbacks to doing art on the device. You can get around the scoring, time limit, and written prompts issues if you use Zoom whiteboard or drawing on paper and holding it up to the camera instead of going through the website, but this takes away the option of automatically generated prompts.

Art is a hugely therapeutic tool, and I think we just have to determine for ourselves what form it can take in a telehealth session.

Photo by Marko Blazevic on Pexels.com

The Chicken or the Egg: Depression and Withdrawal

One thing many people already know about depression is that people who are depressed often withdraw socially. While it’s true that social support is an important component of alleviating depression, this sometimes gets misconstrued as, “If I want to help my loved one, I need to force them to be in social situations.”

Photo by Pixabay on Pexels.com

You might ask yourself, “Why can’t they just force themselves to be social? Don’t they know that would make them feel better?” The fact is, depression is exhausting. And for many people, social situations are draining. When a person is already exhausted, the last thing they are capable of is forcing themselves to be in a social situation.

Many of us have seen a loved one come out of a depressive episode as they have engaged more with others, so of course we want to recommend what we think will help! But there’s a logical fallacy at play here: often times, as someone’s depression improves, they want to be more social. It’s not that socializing is making them better, but the fact that they are getting better is what is allowing them to socialize.

Wanting to help a loved one who is struggling is a good impulse, but trying to force them to heal a specific way is never productive. You can be there for someone and show your support without trying to push them too hard, and you can help them get in touch with professionals who can treat their symptoms.

We’re All In The Same Boat

Last night, I sent out a tweet. Like most of my tweets, it probably wasn’t read by too many people, but it got me thinking, and I wanted to speak to this metaphor a bit more.

Since the pandemic started, I have heard and seen people stating that we’re all in the same boat. These comments seem to come from wealthy people who, aside from being asked not to socialize, aren’t being hit with the economic side effects of COVID-19.

Are we all in the same boat? Yes, but the boat is sinking, and some people are refusing to accept this fact because “The Titanic is unsinkable!”

Are we all in the same boat? Yes, but the 1% are safely life boats only filled to half capacity when we already don’t have the resources available to save everyone.

Are we all in the same boat? Yes, but some of us know we have a spot saved on the next life boat, and some know they will need to find some way to survive in the water and hope that help comes in time.

Are we all in the same boat? Yes, but for some it’s a moderate inconvenience, while for others it means death.

“We’re all in the same boat” doesn’t mean we are all going through the same crisis, and it shouldn’t be used to erase privilege or downplay what others are going through.

Life Hacks: Skin Picking

Excoriation Disorder refers to an obsessive-compulsive type disorder that involves picking at the skin, often until it bleeds. It can be damaging to the skin and embarrassing for those who struggle with the behavior. Evidence-based treatments for the disorder include Cognitive Behavioral Therapy, Habit Reversal Therapy, and antidepressant medication.

Photo by Chermiti Mohamed on Pexels.com

Whether someone meets the criteria and is diagnosed with Excoriation Disorder or they pick at their skin for another reason (for example, as a way to cope with other forms of anxiety, hyperactivity, or secondary to Autism), sometimes part of the reason that the behavior is difficult to stop is that the act of picking the skin produces a specific, pleasing sensation.

Have you ever watched a pimple popper video? If you are one of the many people who finds those videos “oddly satisfying,” you might have some understanding of why someone could find skin-picking gratifying.

The reason we want to curb this behavior is that it can be harmful. Skin picking can lead to scars or permanent damage to the skin, and open sores from this behavior can get infected. But for many, the dopamine output they get, that feeling of satisfaction, makes it difficult to stop.

Photo by icon0.com on Pexels.com

If you (or your child) is struggling with skin picking, one way to get the gratification that comes with picking without the bodily harm is to take putty (silly putty or thinking putty both work well for this) and mix it with grains of rice. Just a tablespoon or so of rice for a large jar of putty is enough – you can re-use the same rice for this activity several times. The sensation of picking grains of rice out of the putty is very similar to skin picking without the physical harm!

It’s easy to store and carry these items with you, or you can set aside time specifically for this activity. This way, you get the positive sensation in a healthier way!

Teletherapy and Kids, Volume 4: Uno

Be sure to check out the previous pieces in this series!

Are you even a child therapist if you don’t play Uno at least once a day at your practice? It’s an excellent way to build relationship, it’s fun, there’s a combination of strategy and luck involved, and kids of all ages already know how to play.

Photo by fotografierende on Pexels.com

A couple of my clients have struggled to get the links working properly, so I actually have played Uno in telehealth with a physical deck of cards. If you and the client both have Uno, you can each deal your own hand and hold up the card you are playing to the camera. This requires a level of trust with the client, but it can be a lot of fun.

Uno Freak lets you create private games with your clients. When you open the link, you are greeted with a screen that prompts you to create a game:

You can choose what settings work best for you

Typically, I make the room name and password something simple like Amy1 and use the same name and password. You can start with anywhere from 1-50 cards, but if you start with 50 the game can glitch because you might run out of cards in the pile. I recommend “Random Player Order,” as this will make the game alternate who goes first. I never check “Registered Players,” as I don’t want clients to have to create an account, and I always “Hide from Lobby,” as this is an added security layer to keep random people from joining your game (although if you password protect the game, they shouldn’t be able to join without the direct link anyway).

Uno also has some flexibility that other online games don’t have: you can choose to draw rather than play if you want to “go easy” on your client.

Pros of Uno as a telehealth intervention:

  1. I’ve found that kids have been more cooperative and stay engaged in the game even if they are losing, simply because the game automatically draws for them rather than them having to draw cards themselves.
  2. You can choose to add “bots” to your game if the child wants the feeling of a larger group.
  3. The game keeps track of “points” in between several games, which can be added fun.
  4. No shuffling!

Cons:

  1. Again, you can’t change certain rules (like draw once and then pass versus drawing until you can go).
  2. Since you click “Uno” instead of saying it, some kids don’t verbalize they are almost out, which means I sometimes don’t realize they are about to go out.

Uno was one of the first telehealth websites I found because I knew, no matter what my practice looks like, I had to have Uno for my clients.

Photo by Edgar Colomba on Pexels.com

I Don’t Want To Be Bad: Kindle Edition

When I first looked into self-publishing I Don’t Want To Be Bad, it was important to me to go the paperback route because I pictured it as something people could hold in their hands, dog-ear, and mark up as they desired. I also wasn’t sure how to best format this type of book for an e-reader.

The more I thought about it, though, the more I realized that this was my vision for my book but not necessarily the only vision of what it could be. It was pointed out to me that, although I made the paperback available in every country that Amazon would let me, many parents looking for this kind of resource can’t or don’t want to wait for shipping. They might also prefer the convenience of having the book on whatever device they carry with them. Not to mention, print books carry the added cost of paper.

So I set aside my idea of what my book ought to be and re-formatted it for Kindle. The price is lowered by approximately what it costs to create a paperback copy, and it can now fit in your pocket with the entire internet. I hope this can make it accessible and reach more people with its message.

Thank you for reading. If you enjoyed I Don’t Want To Be Bad, tell me what other resources you’d like to see and I can try to put them together!

The Case for Primary Care Therapists

Stigma continues to be a serious problem in mental health, and anxiety about what it means to have a therapist can be a huge barrier to someone seeking services. Although we all have different life experiences and many people do not experience mental illness as defined by the DSM-5, every single person alive has an experience that is the worst thing they have ever been through. We need to normalize asking for and receiving help.

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Over the past four years that I have practiced as a clinical psychologist, I have had a number of clients reach their treatment goals and “graduate” from therapy. A number of these have asked, instead of terminating therapy completely, to continue to touch base with me on occasion, ranging from once a month to a couple of times per year. These appointments typically consist of checking in on symptoms, getting updates on any big changes in their life, and seeing what their needs are. Occasionally, I get a call in between these appointments because the client is struggling and needs to come in sooner.

I would argue that everyone ought to have a “primary care therapist” in the same way that we have primary care physicians: you don’t necessarily make regular appointments, but you know who you would call if you experience symptoms, and you check in a few times a year whether you need to or not.

Of course, there is the ongoing issue of accessibility for people who are low-income, uninsured, or living in rural areas. Telehealth helps with accessibility to an extent but does not completely solve the problem. There is also the issue that, in many parts of the United States at least, there are not currently enough licensed mental health professionals to meet the need, which is something that was discussed at the American Psychological Association 2020 convention.

But imagine if the question, “Do you have a therapist?” had the same answer as, “Do you have a primary physician?” It would not be unfamiliar or strange to make an appointment with a therapist because everyone does it!

I understand that this is not something that could be rolled out tomorrow, but I think re-conceptualizing mental health as something that everyone seeks out and actively works on throughout their lifespan would be a huge step toward eliminating stigma.