What is Play Therapy?: An Interview with Ofra Obejas, LCSW
Curt and Katie interview Ofra Obejas, LCSW, RPT-S, about working with children in therapy. We look at what therapists often get wrong, important factors to understand, specialized training required (including play therapy), and what you actually do in therapy session with children.
Click here to scroll to the podcast transcript.
Click here to scroll to the podcast transcript.
An Interview with Ofra Obejas, LCSW, Registered Play Therapist – Supervisor
Ofra Obejas, Registered Play Therapist – Supervisor level, is a professional player. She works with elementary- to middle-school aged children. She’s been called by some of her clients a “kid grownup.” (That’s her rapper name.) She’s taught at the University of San Diego Play Therapy program and presents webinars and courses on clinical topics related to children’s issues.
In this podcast episode, we talk about Play Therapy
We reached out to our friend, Ofra Obejas to talk with us about how to work with kiddos and what additional training is needed to work effectively with children.
What do therapists get wrong when working with children?
- Treating children like mini-adults
- Not understanding the skill involved in play therapy
What are important factors for therapists to understand when working with children?
“It’s more scary to the children when the adult is incongruent and not showing their true feelings. It’s less scary to see somebody angry than it is to see somebody pretending that they’re not angry, but they are.” – Ofra Obejas, LCSW
- Children have a different culture (i.e., the tooth fairy is real)
- The therapist’s role as translator for what children are saying
- Children will make you feel what they feel (e.g., powerlessness, never getting anything right)
- The importance of showing feelings to children as a therapist (versus remaining a blank slate)
What do you do with children in therapy sessions?
- Psychodrama and re-enacting situations
- Therapists can use any theoretical orientation
- Ways to interact with the child
- Paying attention to transference and countertransference
- Case conceptualization, including family therapy and work with parents
What specialized training is most effective for working with children?
“So, what is the therapy on a bumper sticker? If you had to put it in three words, it’s notice it, sit with it, and make meaning of it. Or in an experiential [play therapy] model, it’s: you observe it, you name it, and then you model how to cope with it.” – Ofra Obejas, LCSW
- There are specialized protocols for working with children with many different orientations
- Identifying which orientation suits you
- How to understand what is being reenacted and how to respond: Notice it, sit with it, make meaning of it; Observe it, name it, model how to cope with it
What boundaries should therapists set when working with children and families?
- Unit of treatment (family, individual, who was showing up to the session?)
- Treatment goals (what are we working on?)
- What children are allowed to do in the session
- Interactions with caregivers and the responsibilities caregivers have during sessions
What does online therapy look like with children?
- The challenges with working with children online
- Online sand tray, online dollhouse, online puppet theater
- Creating a virtual play room
- New trainings for VR therapy for children
- Watching children play video games online
How has the pandemic impacted children?
- This was dependent on how well parents were able to self-regulate and stay within the window of tolerance (was there someone who could help the child to regulate)
- Lack of socialization and difficulty in having conversations
Our Generous Sponsors for this episode of the Modern Therapist’s Survival Guide:
Thrizer is a new modern billing platform for therapists that was built on the belief that therapy should be accessible AND clinicians should earn what they are worth. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer, you can potentially save them hundreds every month, with no extra work on your end. Every time you bill a client through Thrizer, an insurance claim is automatically generated and sent directly to the client’s insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly, directly into their bank account. By eliminating reimbursement by check, confusion around benefits, and obscurity with reimbursement status, they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick to get set up and it works great in completement with EHR systems. Their team is super helpful and responsive, and the founder is actually a long-time therapy client who grew frustrated with his reimbursement times The best part is you don’t need to give up your rate. They charge a standard 3% payment processing fee!
Thrizer lets you become more accessible while remaining in complete control of your practice. A better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Sign up using bit.ly/moderntherapists if you want to test Thrizer completely risk free! Sign up for Thrizer with code ‘moderntherapists’ for 1 month of no credit card fees or payment processing fees! That’s right – you will get one month of no payment processing fees, meaning you earn 100% of your cash rate during that time.
Simplified SEO Consulting
Have you spent countless hours trying to get your website just right and yet, it’s not showing up on Google and it doesn’t seem like anyone’s able to find it? Simplified SEO Consulting has a unique solution. They’ve been training therapists to optimize their websites, so they show up better on Google for the past 4 years. But let’s face it, with the busy schedules we all keep it can be hard to find the time to optimize your website even when you learn how. So, they are hosting a 16-day cruise in July 2023 going from LA to Hawaii and back. When you join them, you’ll get intensive SEO education and coaching during the 10 days at sea. Most importantly, you’ll have plenty of time to sit next to the pool and implement everything you’ve learned and then ask their team for feedback. Yes, it’s the perfect excuse for a Hawaii vacation. But it’s also a time to both learn about SEO and actually implement what you learn.
The upcoming cruise is a unique opportunity to learn to optimize your own website, have time to practice what you learn and the ability to get feedback from leading SEO professionals in our field.
To reserve your spot before it fills up, go to https://simplifiedseoconsulting.com/training-cruise-for-better-seo/
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!
Ofra Obejas’ website: redondovillagecounseling.com
Relevant Episodes of MTSG Podcast:
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
Consultation services with Curt Widhalm or Katie Vernoy:
Connect with the Modern Therapist Community:
Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Curt Widhalm 0:00
This episode of the Modern Therapist’s Survival Guide is brought to you by Thrizer.
Katie Vernoy 0:03
Thrizer is a modern billing platform for private pay therapists. Their platform automatically gets clients reimbursed by their insurance after every session. Just by billing your clients through Thrizer you can potentially save them hundreds every month with no extra work on your end. The best part is you don’t have to give up your rates they charge a standard 3% processing fee.
Curt Widhalm 0:23
Listen at the end of the episode for more information on a special offer from Thrizer.
Katie Vernoy 0:28
This episode is also brought to you by Simplified SEO Consulting.
Curt Widhalm 0:33
Have you spent countless hours trying to get your website just right and yet, it’s not showing up on Google and it doesn’t seem like anyone’s able to find it? Simplified SEO consulting has a unique solution. They’ve been training therapists to optimize their websites, so they show up better on Google. But let’s face it with the busy schedules we all keep, it can be hard to find time to optimize your website even when you learn how. So they’re hosting a 16 day cruise in July 2023 going from LA to Hawaii and back. When you join them, you’ll get intensive SEO education and coaching during the 10 days at sea. Most importantly, you’ll have plenty of time to sit next to the pool and implement everything you’ve learned and then ask their team for feedback. Yes, it’s the perfect excuse for a Hawaii vacation. But it’s also time to both learn about SEO and actually implement what you learn.
Katie Vernoy 1:24
Listen at the end of the episode for more information on Simplified SEO Consulting.
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 1:43
Welcome back modern therapists. This is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists where we help explore the things that therapists should be aware of in our practice and the way that we help our clients. And continuing to, I don’t know kind of pursue topics like their Pokemon, well, we gotta catch them all. We are joined today by Ofra Obejas, LCSW registered play therapist supervisory level to help us talk about doing play therapy correctly with children. Another one of our topics that despite for how long we’ve been going, we haven’t really covered in depth. So thank you for coming and joining us and sharing your expertise with us.
Ofra Obejas 2:29
Thank you for having me.
Katie Vernoy 2:30
We’re so excited to have you here. You’re a friend of the show, and a friend of mine, and so glad that we get to finally put you on. I think we’ve mentioned you on a couple of podcasts because you always are awesome and give us some feedback on what we’re what we’re talking about. But now we get to pick your brain on the things that you know. But before we get started, I’m gonna ask you the question we ask everyone, which is who are you and what are you putting out into the world?
Ofra Obejas 2:55
I’m a child therapist in the Los Angeles area. And I also teach webinars and courses on topics related to children therapy on different platforms.
Curt Widhalm 3:06
So I work with teens, which are in some ways, just mini versions of adults. And the way that we do therapy with them, sometimes we incorporate some different activities, but I kind of shy away from working with younger kids because surprise, they are not just mini-mini adults. What do therapists usually get wrong in working with children when it comes to just kind of especially their first sessions of what they’re trying to expect to do?
Ofra Obejas 3:37
Well, you nailed it. You’re right that children are not just the adults that come in the size small. And working with them doesn’t mean just talking slowly and using a dumbed down vocabulary like you know, I’m thinking if you work with adults and self injury, you work with kids on self booboo. It’s more than that.
Katie Vernoy 3:56
Stop self boobooing.
Ofra Obejas 3:57
Yes, stop your self boobooing. So some therapists who are just starting out and they’re worried about not getting enough work might say that they work with everyone: adults, teens, children, you know, you check the boxes, 0 to 5, 5 to 12, 12 to 18 without having any particular experience. And I sometimes get refugees from these therapists. My clients who have gone to somebody else and I always ask them, what did the other therapist do with you? And what I hear is that they are just using adult talk therapy and they’re doing it with children. And in one case, a therapist who worked with one of my refugees took the term therapeutic interview literally and interviewed the child. So I would encourage…
Katie Vernoy 4:46
With a light over the top like and why did you do that young man?
Ofra Obejas 4:51
I can imagine. Or when you hear the word such and such what comes to mind? When they really interviewed/asked questions, the kid said he asked me, he just asked me questions. And I hope your listeners who get curious and want to work with this population, at least get some familiarity, some experience, some training before they say I work with children.
Katie Vernoy 5:14
I think it’s something where you know, play therapy, it sounds like you’re just playing. And I think that’s another thing that you and I have talked about is that there’s actually a skill to play therapy.
Ofra Obejas 5:27
Yeah. And something I hear from adults who might have tried a different therapist is, well, they just played with my kid. Or I had a client family recently, who said, you know, the kid is still doing the behavior. It’s time to stop this play therapy thing, we need some real therapy.
Katie Vernoy 5:45
So what is real therapy for kids?
Ofra Obejas 5:48
So real therapy for kids takes into account all the ways that children are different from adults, you know, if you work with adults, even if you had poor therapy training, or as long as you know what you’re doing, what you’re doing is talking to a peer basically. At worst, you’re like a good friend who is a good listener and has empathy.
Katie Vernoy 6:11
Ofra Obejas 6:11
But kids have different developmental stages, they have different brains, they have a different nervous system. When we work with different populations we’re very careful as therapists to be sensitive to issues of diversity.
Katie Vernoy 6:26
Ofra Obejas 6:27
Learning different cultures. Well what is a more different culture than a child? You’re practically having an alien in your office. You don’t We don’t relate. You know, we’ve forgotten what it’s like to be kids. We never understood ourselves as kids, we really need to understand everything is it is different about kids, they are the world is different. You know, the Santa Claus and the tooth fairies are real. So so we think we’re going to have a rational conversation? When parents bring kids to therapy, it’s not always the kids who wanted to come to therapy, and they don’t know what it is. They might not know how to describe what they’re thinking or what you’re feeling. And they don’t know what this thing is. As a therapist, it is our job to tease it out.
Katie Vernoy 7:14
Yeah, I think it’s really important to recognize that a lot of kids have no idea what therapy is and didn’t want to come.
Ofra Obejas 7:22
Yeah, although if they come into a play therapy room, like the room that I have, it doesn’t take much to convince them.
Katie Vernoy 7:29
Ofra Obejas 7:29
But I do prepare the parents in what to say. A lot of times we act as translators, when we hear kids say things, they don’t always mean it literally. They don’t mean what they say they don’t say what they mean, which we kind of take for granted with adults. But I’ve had so many parents call me and say my kid wants to kill themselves. Oh, what did they say? They say I wish I was dead. And then I am the translator explaining to the parents well, no, that’s just the figure of speech. Well something is happening, but let’s find out what it is. But you know, the most important thing in my orientation, and it took me a long time to figure it out is how close to the surface the transference countertransference, is with children. They don’t tell you what they feel. But they will make you feel what they feel. A child sets up the people in their world, other kids, parents, teachers, any adults, the therapist to feel what the child is feeling, because they might not know how to describe it, but they will know what to do to make you feel it. And that is such an important tool and took me a long time to develop it. And I’m still in training. So for example, what is something that is very common with children is they don’t feel that they have any power. The adults have all the powers, the teachers, caregivers, family. So the first thing a child might do coming to my office is put me in handcuffs.
Katie Vernoy 8:53
Ofra Obejas 8:54
Now I know what it feels like to have no power. And if they’re really good, they would tie my hands behind my back.
Katie Vernoy 9:01
Ofra Obejas 9:02
I really, I really don’t have any power now. So immediately, I understand this is what they’re trying to show me. Or let’s say with a teenager, working with a teenager who has severe social anxiety. And I’m trying to understand a world on an iPad and she shows me things that she looks at on the internet. And I say Oh, so you’re a fan of somebody on Instagram? She says it’s not called a fan. You follow them. Oh, okay. You follow these people, you follow you, you follow their posts? It’s not posts, it’s stories. So I’m starting to feel like I can’t get anything right. Every time I open my mouth, I might sound even more stupid. Ah, okay. That is her world. This is what she’s trying to show me. I’m worried about what other people think about me. I’m worried about not being liked. I’m worried about embarrassing myself? I feel it. And now I can name it for her, even if she didn’t know how to say it. And now we can start using the therapeutic tools. So I can say something like, I’m really nervous. It’s really scary to not know what people will think when I say something, I might sound stupid. Wow, that’s tough. It’s like I’m being nervous all the time. I’m worried about what you might think about me. And then of course, I can start modeling and practicing the therapeutic tool, the cognitive restructuring, the positive self talk, the exposure, incremental exposure to goals, and that is the treatment. But first, I had to pay attention to what is it that she’s trying to show me. And like I said, it took me a long time. We are not using any more than model of the therapist as a blank slate. So when I graduated, I was under the impression that I needed to be a professional. That means not showing my feelings, keep my feelings out of the room. And it took a lot for me to get that I was doing something wrong. Because I working with children was trying very hard not to show anger, no matter what the kid did, I would never get angry. I really kept it together. And the kids did not see a true authentic expression for me. They would break things, they would mess up things and you know, it got harder and harder to know the smile gets tighter and tighter. Oh, okay. I’m not mad at you, through clenched teeth. And I learned that it’s more scary to the children when the adult is incongruent. And not showing their true feelings. It’s less scary to see somebody angry than it is to somebody pretending that they’re not angry. But they are. And the kids would up the ante if you’re not showing what they want you to show you don’t get it, they’ll up the ante. Oh, I just slimed your couch. I put slime all over your couch. Are you angry now? Oh, no, no, I’m not angry. Oh, how about I break a toy? Are you angry now? Are you angry now? And this level of aggression in my playroom was off the charts. I said, I am doing something wrong. I don’t know what it is. But I need to figure this out. And I found the right training, which happens to be Colorado Play Therapy Institute. Now it has a different name. And I started noticing and showing what I was really feeling and naming it. And that is the work with children. And I did not know this when I graduated even though it was in a children and youth concentration program.
Curt Widhalm 9:36
You know, one of the regular questions that we ask it goes back to the training that therapists get. And I know at least for my education, when it came to kind of the children’s therapy aspects that a big piece of it just seemed to focus on developmental stages. I’m sure that there was other things but, you know, now that were 15 plus years later, those are the parts of that class that I kind of remember. But I remember in those classes feeling like okay, yeah, but what do we do with this? And that’s what you’re speaking to as far as having to get this more specialized training or learning from experience. What is your experience, especially as a supervisor in this of how to best bridge kind of moving into this stage of learning what to do? Or how to do these steps that you’re talking about? So that way we can be more beneficial to our clients sooner.
Ofra Obejas 13:28
You know, the the question you asked, What do you do with children? Some people might be familiar with the late Violet Oaklander, who wrote a book Windows to Our Children. And I was lucky enough to get to meet her in person and be involved in the training with her and she said that she wanted to name that book: What do you do with children? What do you actually do in the room with children? And you take whatever orientation you have, is it gestalt? Violet Oaklander happened to be gestalt. Is it CBT? And just interacting with the child, a lot of it is psychodrama, reenacting situations as if they’re happening, whether with toys or with sandplay, or with puppets, but it’s just taking the conversation with an adult to another level of just let’s pretend it’s happening. And we’re acting as if it’s happening to us right now. That is a part that is missing in a lot of graduate programs, even ones that concentrate on children, like the one I was at is what do you actually do in the room? You take whatever orientation you are familiar with, and you bring it in and you comment on it. And like I said before, you notice how am I feeling? What is the kid setting me up to feel? And following the lead of the child? They will be very good. They’re very good at showing you what they want. And what is it that they’re interested in showing you? Not what do you want to ask, but they’ll ignore you completely and just say, let’s do this. Follow along and pay, you know, again, paying attention to the transference-countertransference?
Katie Vernoy 15:11
Yeah, I know, when I was doing that little bit of play therapy that I did before I felt like I was in over my head. I definitely had clients replaying traumatic scenes over and over again, I don’t know how many times I was killed and resuscitated and how many times I was shamed and bullied in a school setting. It was it was really very interesting. But it seems to me especially what you’re talking about, Ofra, it’s gone beyond non directive play therapy, where you kind of sit and let the kid play. And you kind of reflect back like, it seems like there really is a need for specialized training. What does that look like? And how do you choose which orientation or modality to use when working with kids?
Ofra Obejas 15:51
Yeah, how do you know what to try? With the play therapy program that I trained in and then later taught at the University of San Diego has 22 classes.
Katie Vernoy 16:02
Ofra Obejas 16:02
And different modalities, gestalt, EMDR, CBT, sensory motor. Whatever it is, that you are gravitating towards, resonate with, there is a version of it with children. There is a special protocol in EMDR, for working with children. Tt’s whatever you want to do. You can find a class that says you can do this with children. And in many of those classes, I said, this isn’t for me. That is not what I want to do. This doesn’t resonate with me, I resonated more with experiential. I had a teacher in my graduate school practicum, who trained with the Nortons, which I know a lot of people don’t know, it’s like if you were a group therapist, and you trained with the alum. The therapist in the agency where I did my practicum, in a child guidance center taught us how to do play therapy in the room by showing videos of what he did, and you take whatever you want to take from it. So like I said, it’s not just take the adult interview and do it in a room with a child. And Katie, you said a lot of reenactments. What are we reenacting? Part of the training is Okay, so what are they trying to show me? And how do I respond? How do I do the therapy with this? Sometimes when I teach I say, what is therapy? I mean, we’re always talking about therapy. What is it that we do? Are we like being framed? Are we listening? So what is the therapy on a bumper sticker? If you had to put it in three words, it’s notice it, sit with it, and make meaning of it. Or in experiential model, it’s you observe it, you name it, and then you model how to cope with it. And when you mentioned the reenactment with a child, okay, the child is showing you something? Is he scared? Or is he trying to show mastery? I’m not afraid I can do it. And then you name it. Oh, I see. Blah, blah, blah, happening. I feel this or that. And what is the name for it? Oh, this is being nervous. This is being scared. This is being frustrated? What do we do when we are feeling this way? Oh, let me show you. When I’m scared. I take a deep breath. And then I’ll look around, I remind myself that I’m in the room and I’m safe. And that is the same as you would do with an adult just like you really breaking it down to the components.
Curt Widhalm 16:30
I want to talk about case conceptualization here, because when I do work with younger kids, as a trained Marriage and Family Therapist, I kind of conceptualize, okay, we’re going to get to doing parent work to being able to, you know, kind of create this space to help reinforce what the goals are that get done in the therapy room. My intention from almost the beginning is all right, let’s get this to family work. I know that you’re not a marriage and family therapists and might not have that same conceptualization. So I’m wondering how you come up with kind of the unit of treatment that you’re looking for from the beginning, as far as how you start to conceptualize the work that you’re doing here?
Ofra Obejas 19:08
Yeah, no, it’s not really that different. I know that there’s a belief that maybe MFTs and LCSW and LPCC are completely different. I haven’t seen any difference. I…
Katie Vernoy 19:19
Ofra Obejas 19:20
…went obiously to social work program. But as social workers, we’re learning about systems and of course, marriage and family therapy and the family is a system. So how do you decide Well, who do you treat? Well, is it a individual issue with the child? Like the child is afraid of the dark, can’t fall asleep? Is it a parent/child issue, or relationship issue or family environmental issue? And you figure out is the child an identified patient? Is it the families struggling through something and the child is the canary in the coal mines?
Katie Vernoy 19:54
Ofra Obejas 19:54
We don’t have a different approach clinically as social workers. I’m not sure about LPCC, but I’ve worked alongside MFTs and I didn’t see any difference. And then the joke, my LCSW friend says, when you go to all these conferences for MFTs, and there’s nothing about children, no classes, like, the name is marriage and family therapist. Families usually have children. Why? Why is it always the couple and the individual existance in the family as a system? And you figure out, do I need to change the system? Do I need to change the environment? I don’t remember if you had Stevon Lewis on your podcast?
Katie Vernoy 19:54
We did. Mmhm.
Ofra Obejas 20:35
You did. And he says, said something I really like. Sometimes working with a child is working with somebody who has a tiger at home, and you work with them, and you figure out what to do with the child. And then they go home. And then people ask the child, why do you still get bitten by the tiger? And that’s community mental health in a nutshell. Working with underserved population working with the child only and Curt your right, you get a look at the family and say, Am I just going to work with a child? Or am I going to work with the whole system with the parents?
Curt Widhalm 21:08
Do I need a client for 15 years or 15 sessions?
Ofra Obejas 21:15
Yes, yeah. And it’s sometimes difficult to work with the whole system, because even when it’s just the child, the child’s issue, the parents want to be seen. And of course, they matter. I don’t believe in black box, you know, you drop the child off, I do what I do today, I’m like give him back to you. And I don’t tell you anything, I do believe in involving the parents. At least tell them what I’m seeing and what they can support. But sometimes parents are so dysregulated, when they come to the session, that it becomes all about them.
Katie Vernoy 21:48
Ofra Obejas 21:49
That’s one of the reasons to set very, very strong boundaries, and not have a parent takeover decision, or God forbid, complain about the child in front of the child. I always tell parents, imagine you go to a couple of counseling, and it’s always like, Oh, let me tell you therapist, what he did, or what she did. We don’t do it here. You can you can tell me in between sessions.
Katie Vernoy 22:11
Yeah, I think that there’s a lot of boundaries that are really important in this treatment, because there’s oftentimes a lot of different relationships. I mean, I would joke that, you know, the unit of treatment is whoever I can get to come. And so oftentimes, that would be like a caregiver and the kid and maybe a sibling when they didn’t have extra childcare or something. Like it was just whoever’s there, let’s do this thing. But it seems like you’re you’ve got relationships with each member of the unit of treatment, whatever that is. And then there’s also so many people that are emotionally dysregulated. How are the clinical boundaries different within this type of treatment? It kids are different, like, I know, I had kids that wanted me to adopt them, who would hug me. I know, I had parents who all of a sudden I became a co-parent. And I had to really push back against that. And so talk, I guess a little bit broadly about boundaries? Because it seems like there’s so many different things to consider there.
Ofra Obejas 23:06
Right? So the unit of treatment is the boundary, who’s who is showing up? Who am I expected to work with? And what are the goals? Setting the goals is so helpful in figuring out what are we working on? What are we not working on? Are we working on family issues? Or are we not? I once expected to see a child who was seven and five people showed up? And I just looked and said, What is it that we’re doing here? I pulled the mom aside and I said, What do you see happening here today? Oh, well, you know, you said you work with children and my so my seven year old and also my 12 year old and also my 18 year old and everybody was there. And I said, Well, maybe I can help them too. But not today. We’re not going to all be here today for one size fits all session. So defining who’s coming in, if I need to have a parenting only session to say, here’s what I’m seeing. Here’s what the parents can do to support the treatment. We’re just going to do a separate session. The parent, really who’s showing up I like something Angela Caldwell said and I don’t know. I don’t remember where it was. She’s dealing with caregivers who are not available to come in. And she said, if they’re alive, they’re available.
Katie Vernoy 24:21
I think that was on our podcast. We’ll have to share that one in the show notes.
Ofra Obejas 24:25
I’m a listener but you know when it comes to boundaries, with a child again why it’s so important to know what you’re doing and be grounded in training. I wrote down a list of everything that’s happened to me with children. It’s really different working with them. The worst thing an adult client could do to you is be mean to you. Like say something hateful or hurtful…ignore you.
Katie Vernoy 24:45
I mean the worst thing they could they could come with a weapon. They could sexually assault you.
Ofra Obejas 24:49
Katie Vernoy 24:50
But that is a whole other podcast episode,
Ofra Obejas 24:53
Right within talk parameters.
Katie Vernoy 24:55
Ofra Obejas 24:55
Of course, they could be also unsafe. Of course, they can ignore your advice or…
Katie Vernoy 24:59
Ofra Obejas 25:00
…dismiss you. But with kids, you know, they’re children, and they’re going to act childishly. So here’s some things that have happened to me already mentioned being handcuffed. I’ve had children punch me, kick me, call me names, mock me, shush me, blindfold me, groped me, kiss me. I’ve had private parts shown to me despite my objections.
Katie Vernoy 25:22
Ofra Obejas 25:22
One kid had a whole session au natural, sand thrown in my face, I got locked out on my own office, I had a child bolt out of the room and hide in the building, and I couldn’t find them at the call the parent and they say, I don’t know where your kid is. They trashed my room. And like you said, Katie, they climb onto your lap and tell you that they love you. And you better know how to deal with these things. And you’re not there to be the disciplinarian and tell them that they were bad and they shouldn’t do this. You have to know how to acknowledge what they’re feeling. Communicate the limit, and redirect.
Katie Vernoy 25:59
Ofra Obejas 26:00
Sometimes you have to do it with grownups too.
Katie Vernoy 26:01
I think that’s more why I’ve not worked with kids is dealing with the parents in that role of parent. I obviously work with a lot of folks who are parents, but it becomes very different when a parent is coming about their kid. Whether it’s being very frustrated at their indifference and like, fix my kid, it’s their problem, or the overbearing like, I will be involved in every session, parent, that is just very, very overwhelming. But it seems to me that it’s more complex and I think people see it as more of a throwaway. Because like, well, you know, my first internship, I was thrown to the wolves in community mental health and worked with little kids. And so of course, I know what I’m doing. And, you know, this is how I get clients and seeing kids because, you know, there’s not that many kid therapists and, and what I’m really hearing is, there’s a lot more nuance, even then, when I was trained about how we make sure to take care of these kiddos in treatment.
Ofra Obejas 26:05
Yeah, and a good point is that the parent over involved are under involved, and not to forget that the parents are grieving. No parent ever looked at their newborn baby and said, I wish my kid grows up and needs therapy.
Katie Vernoy 27:15
Ofra Obejas 27:16
So you, you cannot completely ignore them. A lot of psychoeducation with the parents, and something that I have yet to really master is involving the parents in a limited way. A limited way not to shut them off, but to set the boundaries around it. And to be very clear about what we are and aren’t going to do. And if they need their own therapy, how to get their own support, and that this is not the session for individual therapy for the parent. But of course you have to acknowledge it. I had one mother participate in the session. And she asked me point blank, let me know if I’m doing anything wrong. And I was like, oh, okay, well, you know, here’s something little that you can change that I noticed. And she just attacked me. And I went, Oh, dumb, stupid. Me. I forgot that she’s a client too. And I took her literally. What she really meant was, I want you to tell me that I’m not doing anything wrong.
Katie Vernoy 28:15
Ofra Obejas 28:16
And I just I forgot, I forgot. She’s also a patient. And I took her literally and I was like, okay, my bad. Totally my bad and totally forgot her situation. So yeah, it’s so much more complex because when you work with a child, you work with at least three people. Even if one of them is MIA, there is still an entity, like a missing, an absent parents. That absence is also a factor and exponentially more difficult, and which is why a lot of people are quitting. Every week, I hear another therapist saying I don’t work with kids anymore. Can’t deal with the parents. I just don’t need the headache. Logistically, it’s a nightmare. And I just don’t want to be that bothered anymore. And I feel this way too. Sometimes I just want to see adults online and live the good life. But you know.
Curt Widhalm 29:08
What has online therapy been like with kids, especially during COVID. Not only have they been dealing with COVID. But making that transition? I know in our practice, we’ve just kind of seen a lot more effectiveness in the office than we have been able to see online. A lot of kids clicking over to different tabs, leaving the room or just kind of putting their devices on silent. What have you seen as far as the transition for things like play therapy over the last couple of years?
Ofra Obejas 29:39
Yeah, it is very difficult sometimes to work with kids online and I am not good at it. I will not see a young child for the first time online. I don’t know how to establish rapport through screen with a child. But just like they are online companies that do therapy for adults online like what’s company called worse help. Yeah, there’s companies like that for kids too. It can be done. I have experienced where you have that you’re looking at the ceiling, the kid is out of the picture. But it’s also nice to see the room, their pets, there’s a little advantage working with kids online, they don’t stink. But yeah, I have done online sandtray, online dollhouse, online puppet theater. So technology’s helpful. And I have some colleagues who really invested in doing a virtual playroom. Like their playroom, and it’s virtual and you can go places and do things. It’s amazing. There are people training to do therapy with children, VR.
Katie Vernoy 30:46
Ofra Obejas 30:47
It’s like a whole new training. And I think it’s fantastic. It’s not for me, and that’s why I’m not a good person to talk about it, because it’s exhausting for me. And I really need to be in the room with a person, even with adults. With a pandemic, I never stopped working online, because it’s not for me, it’s not a good match for me. But I really encourage people who want to do it to find the right training. There are good ways to do it. And I had to do it with some kids, even though I was in person, some parents were not comfortable bringing the kids in, and I would watch the kids do their online games. And even you can do a lot when kids are playing with you online. They’re also online with other people. And you can see them being bullied, you can see how they react to other kids. There’s a lot of good material. It’s not what I want to do. But you know, I was thinking since 2020, there are people who therapists went to grad school online, did their practicum online, and have yet to see it show up in person.
Katie Vernoy 30:47
Ofra Obejas 30:49
And I think, well, obviously, it can be done. But I think it’s like, you know, going on, on an airplane where the pilot who only did simulation?
Katie Vernoy 31:58
Yeah. I mean, but online therapy is a thing. I mean, I think they are learning that. But I think it is it is interesting, because there’s I’ve also seen just the kids in my life, not clients become much, much better at video calls. And so I would imagine that the kids are getting better at it. But you know, this is a question I’ve been wanting to ask as many people as possible, but I think there are children who have been so impacted by the pandemic. So to me, it seems like there’s more and more ways that we can help them. But there’s been huge developmental delays, we talked with Dr. Barbara Stroud, about the zero to five crowd. There’s a lot that’s been going on. And I think a lot of parents are just really worried. So so maybe you can speak into a little bit about how kids have been disproportionately impacted by COVID.
Ofra Obejas 32:49
I think that the thing in epidemic, the key to managing was to know how to stay regulated. In other words, what Dan Siegel calls staying within the window of tolerance. So you don’t get hyper aroused, and fight or flight or hypo aroused, and collapse and shut down. But kids need somebody to help them regulate, to show them how to do it. And when the parents themselves were so ramped up, there was nobody to help the kid you know, you have two adults and two kids in the house. And everybody is working and doing school remotely. And literally and figuratively, the bandwidth is just not there.
Katie Vernoy 33:28
Ofra Obejas 33:29
It was the impact on the kids. I had a mom call me from her car saying, I just cursed my kid. And I’m out of the house now crying. I just like I just can’t deal with it anymore. And yeah, kids have gotten very good at doing things online. You’re right. I’m not sure if they’re missing the connection, even when they’re online.
Katie Vernoy 33:52
Ofra Obejas 33:53
You’re just not in the room with with, with your friends, that social distancing, which is basically physical distancing. Some kids were very good at staying connected to their friends, especially boys who play online games. Well it’s no different, yeah, did just kept doing it and had a great old time. And some have forgotten how to have a conversation. I had kids literally say, I don’t know how to talk. I’m gonna go back to school, and I don’t know how to have the conversation. So I think we have a long way to go in using online better.
Curt Widhalm 34:32
Where can people find out more about you and your practice?
Ofra Obejas 34:38
I’m sure you’re going to put my website in the show notes. And that’s the best way to get ahold of me Redondo Village Counseling, because I’m in Redondo Riviera village area. And also it takes a village Haha.
Katie Vernoy 34:53
I love it.
Ofra Obejas 34:54
I also just finished a live webinar on SimplePractice. It will be available at SimplePractice Learning, there’ll be recording available and I’ll do some more courses for them in the future.
Katie Vernoy 35:04
Curt Widhalm 35:06
And you are correct. We will put that in our show notes, and you can find those over at mtsgpodcast.com. Follow us on our social media. If you enjoy the show, please consider being a patron and helping support us in doing what we do or join our modern therapists Facebook group. And until next time, I’m Curt Widhalm, with Katie Vernoy, and Ofra Obejas.
Katie Vernoy 35:30
Thanks again to our sponsor, Thrizer.
Curt Widhalm 35:33
Thrizer is a new billing platform for therapists that was built on the belief that therapy should be accessible and clinician should earn what they are worth. Every time you build a client through Thrizer an insurance claim is automatically generated and sent directly to the clients insurance. From there, Thrizer provides concierge support to ensure clients get their reimbursement quickly and directly into their bank account. By eliminating reimbursement by cheque, confusion around benefits and obscurity with reimbursement status they allow your clients to focus on what actually matters rather than worrying about their money. It is very quick and easy to get set up and it works great with EHR systems.
Katie Vernoy 36:14
Their team is super helpful and responsive and the founder is actually a longtime therapy client who grew frustrated with his reimbursement times. Thrizer let you become more accessible while remaining in complete control of your practice. Better experience for your clients during therapy means higher retention. Money won’t be the reason they quit on therapy. Sign up using bit.ly/moderntherapists and use the code ‘moderntherapists’ if you want to test Thrizer completely risk free. You will get one month of no payment processing fees meaning you earn 100% of your cash rate during that time.
Curt Widhalm 36:47
Once again, sign up at bit.ly/moderntherapists and use the code ‘moderntherapists’ if you want to test Thrizer completely risk free. This episode is also brought to you by Simplified SEO Consulting.
Katie Vernoy 37:02
These days most people go to Google when they’re looking for a therapist and when they start searching you want to make sure they find you. Simplified SEO Consulting offers a variety of training options to help meet you where you are in your website journey, led by professionals with a background and education and mental health who truly understand our field. The upcoming Cruise is a unique opportunity to learn how to optimize your website have time to practice what you learn, and the ability to get feedback from leading SEO professionals in our field.
Curt Widhalm 37:31
To reserve your spot before it fills up go to simplifiedseoconsulting.com.
Katie Vernoy 37:37
Once again go to simplifiedseoconsulting.com to check out all the information on the cruise.
Thank you for listening to the Modern Therapist’s Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter and please don’t forget to subscribe so you don’t miss any of our episodes.