•  Developing a Virtual Therapeutic Space
•  Carol Rockhill, M.D., Ph.D., M.P.H., DFAACAP and Felissa Goldstein, M.D., DFAACAP, DFAPA

• Establishing virtual therapeutic space starts with the rooms at both the patient’s and psychiatrist's sites. The rooms should be set up to establish a typical clinical experience.
• The psychiatrist's room should be conservatively appointed both to facilitate the camera's focus and to not distract the patient.
• The patient's room should be of appropriate size to optimally conduct a mental status examination, including observation of gross motor and fine motor skills, affect and relatedness.
• Engaging youth entails the use of some toys or other implements. These items should be selected to provide the psychiatrist information about the youth's development, clinical status, and personality. They should not interfere with audio communication or make additional work for the staff at the patient sites.
• Telepsychiatrists working with children and adolescents typically use creative verbal and interactive techniques to ensure the youth and caregiver of their interest in the youth and his/her community and culture.
• The technology may be used to establish rapport, e.g. to give the youth a tour of the psychiatrist's office or for the psychiatrist to show the youth a close-up of his/her image on the monitor.

References

1. Gloff, NE, LeNoue, SR, Novins, DK, Myers, K. Telemental health for children and adolescents. International Review of Psychiatry, 2015; 27(6), 513-524.
2. Goldstein, F, Glueck, D. Developing rapport and therapeutic alliance during telemental health sessions with children and adolescents. Journal of Child and Adolescent Psychopharmacology. 2016; 26(3), 201-211.