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Emphasizes that even without physical toys or office comforts, playful engagement remains essential. Examines stresses of teletherapy and highlights identifying and mobilizing children’s initiative and agency. Argues that shared imaginative empathy can foster connection, reduce isolation, and enable spontaneity and forward movement in virtual sessions, while also addressing communication and attention challenges.",{"@graph":69,"@context":113},[70,84,104],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/imagination-and-play-in-teletherapy-with-children/591868/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":98,"encodingFormat":97,"isAccessibleForFree":99,"interactionStatistic":100},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/imagination-and-play-in-teletherapy-with-children/591868.png","ImageObject",300,407,{"name":92,"@type":93},"Mabel","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-15",true,{"@type":101,"interactionType":102,"userInteractionCount":4},"InteractionCounter",{"@type":103},"ViewAction",{"@type":105,"mainEntity":106},"FAQPage",[107],{"name":108,"@type":109,"acceptedAnswer":110},"Why does the pandemic increase stress and reduce play for children?","Question",{"text":111,"@type":112},"COVID-19 changed routines and introduced new rules such as masking and avoiding groups. 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She suggests that generating playful engagement, however difficult without the toys and comforts of the traditional office, remains crucial. She discusses the stresses of the telehealth experience and the importance of identifying and mobilizing a child’s initiative and agency in this setting. She asserts that, when clinicians maintain empathy and share how they imagine children’s experiences, a joining can occur that lessens the children’s sense of isolation and emotional hurdles.  \nShe then conculdes that, if a clinician’s imaginative self becomes engaged with that of a child, spontaneity and forward movement are possible even when employing the medium of telehealth. Key words: clinician’s empathy;  \nimaginative play; sense of agency; telehealth.  \nIntroduction  \nWith the onset of the COVID-19 pandemic, telehealth suddenly became the safe place to offer therapy to children, a space devoid of the requirements to mask, sanitize, and socially distance. For children previously seen in the therapist’s office, telehealth offered to bridge physical distance and enable continuity of care. For new patients with access to the required technology, telehealth offered the possibility of receiving treatment during a perilous time.  \nAlthough new to many, telehealth has been used for mental health care for over twenty years, both in the United States and globally, typically for psychotherapy with those unable or unwilling to meet with a clinician in person. Veterans suffering from postraumatic stress disorder (PTSD) have used telehealth services when they are alone, allowing them to access help (Chen 2019) . Rural families without local services have been able to access care. Even when face-  \n13  \nAmerican Journal of Play, Volume 14, number 1 © 2022 by The Strong [Contact Lynn Borenstein at borneo00@comcast.net](Contact Lynn Borenstein at borneo00@comcast.net)  \nto-face therapy is available, some individuals in rural areas prefer teletherapy with a distant clinician because they worry about confidentiality or encountering their therapist out of session (Nelson 2010) . In both urban and rural areas, parents have found that the time and travel connected with the press of everyday concerns have made teletherapy a desirable choice. Telehealth allows patients access to experts when specialized diagnostic or treatment skills are required. For example, Wade and her colleagues (Wade et al. 2020) found telehealth tobe effective in teaching problem solving and parenting skills to parents of neurologically impaired children.  \nFor the practitioner, telehealth offers the opportunity to broaden practice geographically without the inconvenience and expense of travel. Indeed, clinicians sometimes use both in-person and teletherapy sessions with the same patient. Video sessions are facilitated by “residual trust and understanding when the patient has been seen face to face”(Russell 2018, 156) .  \nAlthough embraced by many, telehealth is not without its critics. Hoffnung and colleagues (Hoffnung et al. 2020), in their study of forty thousand children served through telehealth, noted that many of them struggled with communicating and sustaining attention in this medium. Children using e-learning for school and then in telehealth were especially challenged. As Russell (2018) emphasized,“What is important here is the necessity to understand exactly what is taking place when we treat another human being via technology: what succeeds in getting through, what gets transformed into something different, and what is degraded or lost along the way”(154) . Lemma (2017) noted that“body language, facial expression, and the pheromones [chemicals released during in-person interactions] fundamental to establishing human ","cbCaio9ICL11fltR","https://ap.wps.com/l/cbCaio9ICL11fltR","pdf",146364,"English","# Introduction\n## Stressed Children and Diminished Play in the Pandemic\n## (Telehealth criticisms and clinical challenges)\n## (Play as communication in teletherapy)","[{\"question\":\"Why does the pandemic increase stress and reduce play for children?\",\"answer\":\"COVID-19 changed routines and introduced new rules such as masking and avoiding groups. Children were exposed to illness and death talk beyond their ability to integrate, leaving them with fewer normal play and social opportunities.\"}]","Imagination and Play in Teletherapy with Children | PDF"]