Julie McIsaac
June 17, 2020

Kitchen Conversation: Mental Health Counseling at Home

Marcela Mota Aversa, clinician, Preschool Outreach Program, The Home for Little Wanderers (Boston, MA)Marcela Mota Aversa is a Clinician & Early Education Mental Health Consultant at The Home For Little Wanderers and a Gallery Educator at the Museum of Fine Arts.


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OK. I think we’ll get going. We have a short 30 minutes here. And it tends to fly by, so we’ll get started. 

Welcome, everybody. Some of you are familiar faces. You’ve been with us for prior webinars. And we’re happy to have you back. And some of you are new. So thank you for joining us and taking the time out. 

So today is our third session in Kitchen Conversations. And today, we’ll be talking about mental health with Marcela, who’s joining us from The Home for Little Wanderers in Boston. And we are thrilled to have Marcela here with us. And she’ll introduce herself a bit more in just a couple of minutes. 

But I just wanted to take a minute and go over some housekeeping items. So first off, we will be recording the session. So these videos will be up on our website. We will alert you through our newsletter, which you should be receiving. Or you can follow us on social media and we’ll put a note up there when it’s live and ready to be shared. 

Your audio during the presentation will be muted. We have a group here, so we just want to make sure that we get everything in our 30 minutes. So you’ll be muted. But there will be a chance to ask questions. We will be reserving time at the end for question and answer. 

And if everybody could now just pull up the Q&A box– so if you click on the Q&A icon there, it will pull up the box. And if you could just think of a question as you are listening, or if you have one now that you could type in, we’ll collect those over the course of the presentation. And then we’ll be asking Marcela at the end to share with us her answers and have a discussion at the end. 

If there are questions that go unanswered, then Marcela has offered to share her email so we can get back to everybody. And we also have the chat function, which many of you have already used to introduce yourself. But you’ll see that icon there on the bottom menu panel, as well. And if you have any technology questions, you can also go into there to ask for help. 

So just a– oh, I keep going through here very quickly. OK. So just a word about Exceptional Lives. If you came to the first webinar, I did speak a bit more about Exceptional Lives. So I’m not going to get into more here other than to say we work hard to find the resources and sift through the information to present it to you in an easy to understand way. 

So we do that through creating guides [Louisiana Guides/Massachusetts Guides], having a searchable resource directory [Louisiana RD/Massachusetts RD], writing blogs that we put out. And most recently, we’ve created a page for at home learning, now that we’re all learning to deal with life during a pandemic. So you can go to our website and check things out there. And let us know if you have any questions. 

A bit about me– I have three boys of my own, all of whom are accessing telehealth in one form or another. This is one of my kids during a speech therapy session. But the photo that I should have up there is my husband in our messy bedroom on his telehealth appointment this morning with my son’s mental health therapist. 

So that’s what it looks like for us. I think it’s different in every home. And sometimes, it’s different every week. 

So we’re looking forward to answering the questions we’ve heard from you, which are how does this happen, how do you do mental health with a child, or teletherapy with a child who isn’t sitting still for more than 30 seconds, is this something that’s even offered, and if so, how do I find out about it, and then what does it look like. And Marcela is here to really answer those questions and tell us more. 

So we have a quick survey here that we would love for you to just answer for us. And then when we see those results of how you are dealing with the current situation, then we can move on to Marcela’s presentation. So we’ll just give a minute to finish this. 

There we go. OK. Clinicians looking for more ideas? Excellent, that’s great to hear. And I think Marcela has some ideas for you. So let’s just turn it over to you, Marcela. 


Thank you. So my name is Marcela. I am a mental health consultant and a clinician at The Home for Little Wanderers. And before that, I’ve been in the field, in early childhood education field for 40 years. Only 20 in this country, and the other 20 in my country of origin, which is Mexico. 

At the beginning of this pandemic, immediately we migrated to everything digital, everything Zoom-wise. I think I had an unfair advantage. Because there are other groups that I coordinate through Zoom in 17 Spanish-speaking countries all over the world. So I sort of know that platform really well. And I also know ways to engage. 

Since most of us here are clinicians, the first thing that I’ll mention is that most people that engage in Zoom have their laptop on top of the table. And it makes a huge difference if you elevate the laptop to eye level. Because what you want to recreate is eye-to-eye contact, right? 

I do believe in telehealth. At the beginning of the pandemic, my husband was due to his medical appointment. He has high blood pressure. 

And I was just, like, curious. I mean, the nurse told us we are going to have your appointment, but it’ll be through Zoom. And I was, like, how is this going to fly, right? 

Well, to my endless surprise, not only the appointment happened and his medication was adjusted, the physician who was always– whenever we went face-to-face to the clinic, the physician was looking at the computer or taking notes. And he would never go and look at my husband. 

But now, he was making face-to-face contact and expanding his range of questioning. Right? He wanted to know about his general health, about his mental general health. He wanted to know if he was employed or not. 

He wanted to know how he spent his days. So it was not only about high blood pressure. It was about many other things. 

Just before this meeting, I had a session with family therapy. Before, back in the days when we met just face-to-face and were in the playroom, we used to meet with just our client, our designated patient. And it will take extra time and effort to connect with parents or siblings or larger systems, to get together with the educator, or a meaningful caretaker figure. 

And now, through Zoom, everything happens so quickly. You can switch from one-to-one to sibling subsystem or family subsystem. You can get together with teachers and other allies. 

Is it worth the trouble? Well, we had this town hall meeting with a commissioner. I really liked it, because she acknowledged that there is no human being in this world, in the whole planet– in the whole planet– that could not use a little bit of mental health consultation. 

All of us are under unprecedented stress. Nobody has the roadmap. We have zero clue how to be confined all the time in our houses. Now we have zero clue how to slowly start going out. Right? That’s just addressing the COVID-19 issue. 

Then we were hit with things that were, you know, brewing under the rug. But now it exploded right into our faces. And now nobody knows why. Everybody is full of questions. Nobody knows right ideas or answers. 

So what are we going to do? This is so inexpensive and so convenient and so immediate. So it is worth the trouble. Because we can learn together. 

So telehealth is not instead of play therapy. It is not while we get together again. It is real connection, real therapy, and a real encounter. 

Providers– it takes a few sessions to design– oh, yeah, the therapeutic space. Well, just back in the day when we went to the play therapy, you would you would set some timer– or in your office– you would spend some time and energy designing your space. As you can tell, I have designed my wall. All of these paintings, my husband painted them. 

So we need to take a little bit of a time to see what’s in your background, a little bit of time elevating your laptop so that you can make eye contact. Play a little bit with the light so that you don’t look too dark. And also, so because I’m doing play therapy and family therapy, this is my portable box of surprises. So I have hear all kinds of fancy toys that are relevant to the times that we’re living right now. 

I’ll just show you one, which is a very super cool toy. This is a picture of me. It was a gift that I got in Madrid when I was a speaker. Right? And she’s wearing her mask. And you can’t see her face right now. 

She’s not exactly my skin color. But I said thank you anyway because it was given to me with very good intentions. So I have all kinds of surprises in my portable play therapy box. 

Having access to relatives– yeah, what I was telling you. Right? You bring your laptop. And this is your play therapy. 

I set boundaries with my young clients. I say this is the space in which we’re going to meet. You are not going to be wandering around with the laptop all over your home. Because if you do, I am going to stop the video. I will still be listening to you. But now it is not OK to be wild with the computer, just to protect privacy of the rest of your people that are in your space. 

And this is the only thing that I’m going to show you. Because this is our office. This is our place where we meet. And if somebody can pop in and be part of our time together, that is a plus, because now I can address my client within their immediate context. 

For parents and caregivers, your child will connect with a therapist and learn how to– yeah, it is a learning curve at the very beginning. Well, I don’t know if you work with very young people. Very young people can pay attention to the screen for a few minutes at a time. 

But back there in the day we were obligated to meet with them for 50 minutes, because their parents have commute and park and wait in the waiting room. And then go to the playroom. And then come back. 

But now, it just takes a few seconds to meet with people. So you can have a few sessions. I’d much rather meet with my clients for 20 minutes at a time. It might take three sessions. But I can do that. 

So the flexibility in frequency and length of session it works into our advantage. So you will have more flexibility. So yeah, I really like that. 

How will it work if you’re a parent? Yeah. It’s like the same thing, right? Back in the day when we went to a physical spot, you agree on a schedule, and you keep the schedule. And then, of course, if you’re meeting with a minor, you will need the assistance of an adult. 

But little by little, and I have seen it. I have experienced it. At the beginning, the parent has to be there for a little while. And it is almost like a meeting with two people. 

But very, very soon, that parent, because that child knows what’s going to happen, that parent can go to the background. And then, even, she or he might leave the room completely, entirely. And then the child is just engaged with us. 

So the length of session can go from a few minutes, from 10 minutes, depending of the age of the child. A 3-year-old can be engaged for, like, 10 minutes at a time, half an hour tops. And then, as that bond of trust and predictability keeps growing, that child will definitely be engaged longer and longer and longer. 

Time with you matters– I forgot what I wrote that. I don’t have the slightest idea what I wrote it. 

Access to the rest of the family– yeah, what I was saying, like, more than ever we have access, not only to the immediate context of the child, but also we can do intersectionality. We can have the school system and the medical system and the therapeutic system, and everybody who’s engaged with the child in one way or the other. We can share information very, very quickly, very effectively. 

So yeah, new flexibility and new rhythms– I don’t know what it is. It is just like looking at each other in these little squares, Zoom squares. It does something to our brain. It really does. 

I don’t know what that means. Because I’m spending so much time in Zoom lately, I don’t know if it happens to you yet. But I have Zoom dreams. I do. 

I go into my bed. And I see the little squares. And I see myself in the little squares. And I’m one with the many. 

And I’m one of the many. I see myself much better within a context. I can be a better member of my team. I can be a peer with my peers. 

I can hold my power better. I am better understanding what is expected from me. So it is flexibility, not only in time and frequency of sessions, but it is also flexibility within myself and my own rhythms. So yeah, I’m liking it a lot, to tell you the truth. 

For parents– so you just tell your child you are going to meet somebody, a friend that is going to help you with your feelings. And we’re going to think together and we are going to have a little get together. And this is where the computer is going to stay. And it’s not going to move from here. 

We need that whole arrangement and protocol that includes adults involved if you want to show me something else. But you may not wander with a laptop all over your house. So to protect that privacy of each home, only adults can move it. And we need to have a previous understanding that that is going to happen and how it is going to happen, if it’s going to happen at all. Yes. 

Oh, this is the end of the session? OK. I always talk too much. Thank you. What’s next? 

I’m sorry, Marcela. That was not a cue for you to stop talking. You can keep going. 


This is if you have any tips for providers setting up their workplace or playroom. And then we’ll move to the questions after you wrap up. But you have a few more minutes if you have some more things to add. 

Other than designing your Zoom screen, make sure that the light is on your face from different sources. Right now, I have one lamp here and one lamp here. And my laptop is elevated to facilitate and recreate the eye contact. Right? 

I’m going to show you the difference between sound– it is a very different sound. I hope that you can appreciate the difference between this and now that I’m talking without the speakers. Having the speaker sound creates a much warmer, more intimate ambience. So that goes for sound and for connection, visual connection. 

So right now, because I’m looking at myself in the little window, but if I want to make eye contact with you, I look directly into the camera. So that’s another way. And if I want to catch a child’s attention, I’d talk directly into the camera. And I zoom in with my face. So that’s just for effect. 

And I love my team. We get together every Thursday. And everybody’s really, really generous, like, sharing all kinds of resources, all kinds of ideas, games that work, things that we can share, how to create a playful ambiance of what we lost in terms of toys. 

And so yeah, get a team and share with them. That’ll be my most useful tip. Belong to a group that helps you think together. 

And good luck. We’ll keep learning together. I don’t have any other bright ideas at the moment. 

I know you do. They’re in there. 


But we’ll move to the question and answer. OK. So here’s the first one here. Marcela, do you feel that there are benefits of telehealth that may not be present in face-to-face therapy? Is there anything that you would take from this telehealth world if, when we go back to face-to-face, that you might even miss? 

Oh, absolutely. Just like– where was it– it’ll be a week ago tomorrow, a very, very distressed adult, very distressed adult raised their voice in rage. It was righteous indignation. It was righteous indignation. 

And I’m not arguing there. She had a point. But she raised her voice so angrily. 

And I’m a coward. You don’t want to know these things about me. But I’m a brown mouse that runs and disappears. I reacted very well. Thank you, God. Thank you. 

I reacted so well. I kept my calm and my composure. Because this, of course, is safety. It goes both ways. It really goes both ways. 

I have heard things in Zoom that I would have never heard in the other ambience. And so that’s one, like, a physical screen of safety. The other one is the flexibility, that immediacy. 

I feel so nimble in Zoom. It took me forever back there in the day to go from client to client to client. For the first time in my life, I have enough time to do all my paperwork. 

Isn’t it nice? To write my notes, right? My mind is fresh. I can have my session and write my notes and be done with it. So I feel very nimble, very efficient. 

Of course, I can see many more clients than back in the day. I mean, if you’re asking me, I’ll do so Zoom for the rest of my life. Yeah. 

OK. Let’s move to the next one. Once the child is comfortable with video, is it better for the parent to leave them alone, one on one with the therapist, or should we listen in? 

I don’t think that there is a right answer for anything. Like, each family is a universe. Each child is a universe. 

I have both experiences. The child that says– I’m working right now with a pair, an eight-year-old and a 12-year-old. I mean, of course, they’re older. But they like their parents to be present for the first 3 minutes, and then they go. 

I am working with a four-year-old right now that wants very much her parents to be part of that [INAUDIBLE]. I don’t think that there is one answer for each family. Each family has to find their own. 

I like that. I like that. OK. You mentioned first when you have a parent that’s frustrated, or there’s frustration on the other end of the computer. So this next question is, how do you handle it when very frustrated parents are interacting with their kids in a negative way during the session? 

That is a really, really good question. I am going to say something very risky, very, very risky right now. But if it’s not today, then when, right? 

There is a gap of power between a child and a parent. There is a gap of power. There’s also a gap of power between clinicians and a parent. So I would say address the power. Right? 

Because we don’t want to talk about these things. But clinicians hold a lot of power. And then, if the skin color is different, it’s– [MAKES EXPLOSION NOISE]– much more of a gap, right? 

So what is in the best interest of the most vulnerable? How do we protect the most vulnerable? And that’s the way to go. And the most vulnerable in this equation– it’s never the clinician. The clinician is the one who holds the power. 

So of course, each equation will deliver a different formula. But how do we protect the most vulnerable? Because that’s our mission, right? Yeah. So where’s the power and how to use the power or lack of power to protect the most vulnerable. 

OK. I have a question that I’m sneaking in here. Because this came up during a previous conversation with you that I thought was important. And you were talking about mental health telehealth is not a “this is OK for now” type of therapy. But the quality is just as good as you would be getting in the room or in the playroom. So I just wondered if you could speak to that for a minute. 

Well, I would say that either we believe of all the neuroscience that is available to us, or we don’t. I don’t know if you have the experience of getting a phantom text message. That you don’t have your cell phone on you. And then suddenly, you feel in your skin that it’s buzzing. Right? 

And it seems like you’re getting a text. But your cellphone is not even on your body. You’re not carrying it in your pocket. But you still have the skin sensation of getting that message. 

So this thing is doing something to our brains. It’s really having an impact at the physiological level. So we can take that and hold it into our– like, twist it in order so that it can benefit us. Right? 

I believe that we’re playing with fire right now. We really don’t know what we’re doing. We’re just discovering these things, that immediacy, the flexibility, that frequency, that stretching of length, that opening intimately in our home, but not so much, that with no boundaries. We’re playing with fire. 

The books that we’re about to write are going to be so amazing. I want to fly in time, like, 10 years from now and look back. And I’ll say, holy cow, telemental health. Just think of integration, think of everybody [INAUDIBLE], of exchanging radical, different ideas and feelings and approaches to all kinds of things. 

Yeah. This is incredible. This is the dawn of a new way of thinking. 

It’s the dawn of a new way of thinking. And we’re pioneers. How exciting is this? 


I love that. OK. That is a great note to end on. If anybody does have more questions for Marcela, please feel free to get in touch with us. And if you would like some more information about telehealth or strategies for how to manage life at home right now, please check out our resources at Exceptional Lives. 

And join us for next week. We’ll be talking about speech therapy. Again, 2 o’clock on Wednesday or 1 o’clock Central time. OK. 

Thank you so much. And here’s a quick pull for you. And we will see you next week. 

Thank you. And thank you so much, Marcela. 

Thank you Julie. 

All right.


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