by Jimmy Heags, MA, LSC, LPCC, LADC, ACS
Telehealth changed the field of mental health care by offering new ways to connect with families and provide therapy. As a therapist with over 20 years of related experience, I have personally witnessed how technology has created opportunities for families navigating complex interpersonal dynamics. While telehealth offers particular benefits, it also presents certain challenges that should be addressed compassionately, particularly when working with children who have experienced trauma. This article will explore telehealth’s strengths, limitations, and ethical considerations therapists are tasked with navigating to effectively support families.
Opportunities in Telehealth
Accessibility and Flexibility
Telehealth’s greatest strength is in its ability to overcome logistical barriers. Families who may struggle with transportation, work schedules, or geographic isolation can now attend therapy sessions from the comfort of their homes. For parents managing multiple responsibilities, this flexibility can reduce stress and improve attendance, which are critical for therapeutic progress and continuity.
For example, I’ve worked with families in rural Minnesota areas where in-person therapy services are limited. Telehealth allowed these families to receive consistent service, particularly for adoptive families, because it provides a way for parents to get guidance and support without disrupting the routines of their child(ren), many of whom thrive on structure and predictability.
Observing Family Dynamics in Real Time
Another unique advantage of telehealth is its ability to provide a window into the family’s whole house. Virtual sessions allow therapists to observe real-time interactions within the home, which offers valuable context for understanding family dynamics and the child’s lived experience.
For instance, when working with white parents raising Black children in transracial adoption scenarios, telehealth has provided an opportunity to see how parents are integrating their child’s cultural identity into daily life or their application of psychoeducation on implicit bias. This visibility of telehealth allows for meaningful conversations, thus increasing a sense of belonging and addressing potential gaps in cultural understanding. Observing these dynamics in real time helps therapists offer specific practical strategies, such as integrating elements of the child’s culture, family rituals or daily practices.
Trauma-Informed Practice in a Virtual Space
Telehealth also supports trauma-informed approaches by offering parents immediate, real-time coaching in moments of conflict or psychiatric dysregulation. Children who have experienced trauma—whether through instability in foster care, or attachment issues — require communal environments where they feel safe and validated. Telehealth allows therapists to counsel parents in responding empathetically during challenging moments which help them shift from reacting to their child’s behaviors to better understanding their needs. For example, I use concepts from the Nurtured Heart Approach, which focuses on highlighting the child’s strengths rather than their challenging behavior. In many cases, parents who were struggling with their child(ren)’s particular challenges were able to reframe their perspective during a telehealth session and start focusing on their resilience and adaptability as a starting point for change. Real-time moments like this can guide and foster emotional growth and resilience for both parents and children.
Limitations of Telehealth
Technical and Logistical Barriers
Despite its accessibility, telehealth has its challenges. Technical issues, such as poor internet connectivity or a lack of adequate devices, can disrupt sessions and impede client participation. Some families who are less familiar with technology may find it difficult and stressful to navigate virtual platforms, especially when they are also managing the emotional demands of therapy. These barriers can be especially difficult and stressful for families already dealing with systemic inequities and/or limited resources.
To address these challenges, I, sometimes, work to ensure that families are prepared for virtual sessions. This includes giving them or their children suggestions on setting up a quiet, distraction-free space, troubleshooting technical issues, and providing resources to improve digital know-how. These small steps can mitigate disruptions and create a more focused and productive therapeutic session.
Rapport and Connection in a Virtual Format
Building and leading with rapport and trust is a cornerstone of effective therapy. This can be more difficult in a virtual setting. Non-verbal cues, such as subtle expressions or body language, are harder to perceive through a screen, which can lead to misunderstandings or missed opportunities to address deeper emotional needs. For children, especially, the absence of physical presence can make it challenging to establish the sense of safety and connection needed for meaningful progress.
To address this issue, I use creative strategies to foster engagement and connection. For children, this might involve implementing interactive activities or developmentally appropriate play-based techniques (if applicable), even in a virtual format. For parents, I emphasize clear, compassionate communication and active listening, ensuring they feel challenged as well as heard and supported. These efforts help bridge the gap created by the screen and build a stronger therapeutic relationship.
Ethical Considerations in Transracial Adoption
When working with white parents raising Black children in transracial adoption scenarios, telehealth adds another layer of complexity to the therapeutic process. A primary ethical consideration is ensuring that the Black child is not viewed as the "identified problem" within the family system. Instead, therapy must address the broader dynamics at play, including societal influences and implicit biases that may shape the child’s experience.
Telehealth offers an opportunity to engage parents in discussions about race, privilege, and cultural identity in a way that feels less intimidating than traditional in-person settings. For example, I integrate principles of diversity, equity, and inclusion (DEI) into sessions, helping parents recognize their own biases and understand the unique challenges their children may face. These conversations are not always easy, but they are essential for fostering a supportive and nurturing environment where the child feels seen, valued, and understood. The goal is for the parents to strive to take themselves out of the equation as a precipitating factor.
At the same time, telehealth raises questions about what may be missed on a virtual platform. Subtle dynamics, such as microaggressions or unspoken tensions, can be harder to observe through a screen. Therapists must remain focused and reflective, ensuring they are attuned to the nuances of family interactions while also addressing the limitations of telehealth.
Broader Implications of Telehealth
Telehealth has expanded access to therapy while challenging therapists to adapt their practices in innovative ways. For adoptive families, it offers a bridge to support and guidance that might otherwise be unavailable. At the same time, it requires therapists to remain mindful of its limitations and ethical implications, particularly when supporting marginalized, vulnerable and exceptional populations.
As telehealth continues to evolve, it is essential to approach it with both curiosity and caution. How can we ensure that telehealth remains inclusive and accessible for all families? How do we balance its strengths with its limitations to create meaningful therapeutic experiences? These questions remind us that telehealth is not a one-size-fits-all solution but a tool that must be used thoughtfully, intentionally and continually rexamined.
Conclusion: A Call to Reflection
Telehealth has transformed the way families access mental health care, offering both opportunities and challenges. Its flexibility and accessibility make it a powerful tool for supporting families, particularly those navigating the complexities of trauma and transracial adoption. At the same time, it demands ongoing reflection and adaptation to ensure it meets the needs of diverse families.
As therapists, we must embrace telehealth with intention, using it to manufacture connection, understanding, and growth while remaining mindful of the limitations. By prioritizing trauma-informed care and ethical practices, we can create inclusive spaces where families feel supported and empowered to thrive—one virtual session at a time.
Jimmy Heags, MA, LSC, LPCC, LADC, ACS is a licensed counselor, educator, and consultant with 20+ years’ expertise in trauma, restorative practices, and culturally informed mental health services. Contact: [email protected]