off ered at the end of meetings that would not usually engender such responses.


Issues to discuss with the family


Being more active: T e therapist is likely to have to conduct the session in a much more active way than they might usually do – for making explicit who might talk next, set ing parameters for who can talk and for how long. Note that you will probably ask more questions in lieu of being able to ‘feel’ what is going on in the room. Embodied responses might get altered or misread through the screen and might need to be checked. Initial questions to ask: Is there a safe space to conduct the call? Who else can hear? Who is ‘in charge’ of the devices on which the call is connected? Is there reliable broadband? Are device chargers at the ready? Ensure device microphones can pick up all voices. If this is hard – who will be spokesperson? What will that do to the communication? Using one or multiple devices: Just like a professional team meeting, if family members each have their own device and suffi cient broadband capacity, and are able to do so, it seems to work best with everyone on their own separate device, and to manage the session so that everyone can see everyone else’s faces. What to do in case of distress or escalation – establish this as part of the contract very early in the conversation, for every participant. What’s the plan if someone decides to hang up?


How issues of risk will be managed – how can this plan be discussed and agreed and shared? How to ensure voice entitlement for everyone – make use of the ‘raise your hand’ facilities in some video consultation platforms; develop a virtual talking-stick What will happen when the call goes ‘wonky’ – what’s the plan if there is lag? We probably all have experiences that are supposed to be synchronous but are anything but, when there is lag in a video call or when the screen temporarily becomes pixelated and then jumps. Naming and agreeing what to do about this is vital. Length of the session – so far, families seem to like shorter, more frequent sessions. On the Zoom platform, unless you pay for longer sessions, the call ‘times out’ aſt er 40 minutes, which may be enough for many families and therapists because the concentration required with video is diff erent to that in the room; or you might use the 40 minutes then have a


4


break and team discussion, then reconnect, if necessary. Drawing and mapping activities – if you usually draw in a session, how might you continue to do so and share your positioning-compass, genogram or whatever with the family, as you proceed? T is can be done by simply holding what you have made up to the screen or via ‘share screen’ if using Zoom. T erapists and families might want to put together a therapy-session box where they keep their own materials, like toys and drawing tools.


How refl ecting team


conversations might be managed Family therapists are used to working in


teams, whether the team is in the room or behind the screen. Working over video aff ords the same environment. Social distancing can be achieved by the team each joining via separate screens, and sit ing with microphones muted while the family talk with the lead therapist. T en, the refl ecting team can talk while the family are muted and listening. Using Whatsapp to communicate between


team members has emerged as helpful. As we sit with microphones and cameras muted, watching and listening to the therapist talk to the family, we have been sending messages via Whatsapp – make short comments on what has been noticed and what we have wondered. We’ve played around with whether the therapist in the room should read the Whatsapp chain, a bit like having an old fashioned bug in the ear to know something of what is going on from behind the screen.


Topics that have been common in systemic sessions as the pandemic unfolds


• How to address children’s worries about the virus – being realistic and hopeful, utilising the many videos, social stories and guides that have been published in recent days


• How to manage when it gets emotionally hot at home


• Building safety and at achment at a time full of fear, loss and disconnection


• Managing teens who don’t want to stay in • Having life and death conversations and talking about advance decision-making.


• What people want to happen if they get very sick


• Get ing children to work now that schools are closed


• Enjoying family time (dealing with feelings of guilt about enjoying this time)


• Keeping safe in family situations that are not safe


• Managing issues to do with alcohol and drug consumption, access to illicit drugs or sex


• Dealing with illness in those far away – ways of keeping connected


• Activities outside the house taking account of physical distancing – for example, walking, running or having picnics


• Reset ing family rules about chores, screen time etc.


• Contact between parents and non- resident children


• Supporting the facilitation of contact between children in care and families: most contact centres have shut and local authorities are working very hard to fi nd ways of maintaining contact between children and parents.


• Addressing the let er and the spirit of the government lockdown instructions – is it OK to leave the house twice a day if that means a family are less likely to collapse? Or can an older person only walk for ten minutes?


• Giving each other a break, being kind. Recordings sessions


Recording our work when communicating


via video needs ongoing discussion. We are in the most part used to being in control of making the recording, and now families might have the possibility to record. Diff erent video platforms have diff erent set ings regarding who can record. Even if there has been careful prior agreement about why the sessions are to be recorded, this can oſt en be forgot en about and needs further discussion about how and why the recording is being made (this will diff er for diff erent actors), how the recording will be stored and who it will be shared with. T e benefi ts of having a recording are many.


Having a recording of the session might be very helpful for patients with additional needs, those who want or need time to process the information discussed or who want to share a session with a person who could not join. It will of course also help if the therapist, whether trainee or qualifi ed, has naturally occurring material that they can discuss during supervision. Sending therapeutic let ers by email has so


far proven useful and well received as a way of recording some refl ections and ideas for sessions. It also serves to show that we are keeping people in mind between the contacts. Some teenagers have asked for a list of questions in advance of a video conversation,


Context 170, August 2020


Ways of working during the COVID-19 crisis


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