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The Benefits of Online Behaviour Therapy for Tics & Why I'm Staying Remote After Lockdown.

What is Telehealth Therapy?

Telehealth is the use of technology to deliver therapy and other similar services remotely. Telehealth, also referred to as telemedicine or remote interventions have been forced upon many of us due to the Covid-19 pandemic.

How has the pandemic affected how interventions are delivered?

Many therapists had never used or even considered using Telehealth prior to the pandemic and it's been a learning curve for many of us.

My personal experience of remote therapy before the pandemic was scarce, only ever using it for clients who were too far away or in another country all together.

This accounted for maybe 25% of my caseload.

When the pandemic hit, we were all faced with either delivering therapy remotely or not at all. Some families were confident about this transition but there were many more who were apprehensive or full blown reluctant to engage in this new way of working.

The confident parents, were the ones with children who they knew would be able to keep their attention, and focus. The apprehensive parents were the ones which had children who had co-occurring conditions such as ADHD and the reluctant parents were the ones with children who had more complex needs such as Autism alongside their tic disorder.

I would be lying if I said, I wasn't apprehensive too, I enjoyed playing games with my clients during sessions and making them feel at ease during our sessions. I worried about how I would keep some of my younger clients engaged, how would I make it fun, how would I keep the focus of the one's who found it extremely hard to attend to sessions face to face let alone via a computer screen.

That said, I knew I had to deliver therapy to my clients, I to had to learn and adapt to the new 'norm' like I was expecting my clients to.

What are the benefits of Telehealth Therapy?

There are obvious, business benefits to delivering therapy remotely, for example, increased geographic reach of clients, less overheads, increase in clients, increase in profits etc however business aside there are an incredible amount of benefits to 'therapy users'.

For starters, by accessing therapy online, you may have no/ reduced outgoing costs, you may miss less time from work or school, you may be less anxious as no travel is involved, and you are less likely to miss an appointment as the variables that cause missed appointments are reduced.

Seeing an anxious child grow, and blossom for the first time after numerous attempts with other therapists (reported by family) is an incredible feeling, but I am pretty sure this has been down to the reduced pressure, safe environment and no change in stimuli, other than me as a therapist.

For each individual there will be pro's and con's to remote therapy but below I want to explain the benefits I have found and why I will be staying as an online therapist.

Why am I staying remote after lockdown?

As already mentioned I was nervous to start out with, one week I had an office full of clients, then boom over a weekend I had to prepare to deliver all interventions remotely, sitting in my office 'alone' all day. I felt like it would be less personal, less fun, and that delivering therapy all day via a computer could become a bit mundane. However, I was very wrong!

Confidence: I noticed very quickly that after the initial 10 minutes of the first remote session, my regular 'face to face' clients became more relaxed then I had ever seen them before, due to this new relaxed state, they were engaging more, they grew in confidence and their achievements within sessions was very evident. As my clients confidence grew, so did mine, we started to learn together what games worked remotely and which didn't and sessions were actually more fun than ever before.

Motivation: When clients come to the office, parents usually come into the sessions with the child, this is very beneficial to some but to others it can add pressure to the client. I have noticed that the majority of parents now set their child up on the zoom call and then leave them to the session. This has 2 benefits, one, the child engages more, and appears more resilient then when parents are not in the room. two, when they achieve a goal within the session they love to run off and tell heir parents, this results in them having a 2 minute break, huge reinforcement from their parent and an increase in motivation to continue with the session.

Generalisation of skills: Now this is the biggest pro for me, being able to work in different settings, engaging in different activities and targeting specific problematic situational triggers that can not be achieved in a clinic.

Many of my clients have specific settings/ environmental factors that either increase tics or make it harder for them to engage in behavioural techniques being taught.

Here you can see a client and I working on tic management whilst eating. He has struggled with tics at meal times for a while, so we spent a couple of sessions really workin on this together. Although, he does still tic during meal times, they are much more manageable now.

Next you can see a client who has amazing control over his tics when in full concentration and also when engaging in activities such as drawing. However activities such as running, playing computer games and sport can increase tics and make it harder to manage. Here we spent a session with him playing a computer game, with me being able to coach him throughout and increase his ability in tic management.

Lastly, I have been able to broaden my group work interventions. Prior to lockdown I ran group sessions so children with tics could meet others like them. This wasn't always easy as there are only a limited amount of children with tics in close enough proximity to run these regularly however I now run monthly virtual playdates which have had the post positive feedback from all the the events I run and sell out everytime.

What do my clients have to say?

Less pressure to ‘sit still’ in a ‘clinical’ (I have no idea whether your office feels ‘clinical’ as we haven’t been (there)!) environment and the pressure associated with this. She can move about, fiddle, have a break and come back, have her things around her... and actually I think learning in your own environment where you need to be able to implement your new skills and ideas is good practise... xx surprisingly it’s been brilliant doing sessions remotely!
We loved remote therapy for many reasons. With his anxiety, our son was more comfortable at home. It was more convenient for us parents to be able to be getting things done at home rather than driving our son around to appointments. And maybe the biggest benefit is that you can choose a therapist who isn’t necessarily in your town to work with - In our case it was a different country and continent. That allowed us to find the most perfect match we could imagine.
I feel more comfortable in my own home and can move more freely it saves a car journey 😃 no anxiety about ticking round others I would’ve met amen 🙏

Would like to know more about therapy for tics?

Behavioural Therapy for tics, also known as CBiT (Comprehensive Behavioural Intervention for Tics) is recommended as the first line Intervention for tics, before medication by the American Academy of Neurology AAN. CBiT is made up of 6 components with the main element being Habit Reversal Therapy HRT, where we implement a competing response to tics. To learn more visit or

Sign up for a free zoom consultation to learn more via

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