Credit: Taken from the Art of Social Work, https://kristinamarcelli.wordpress.com/contact/

Containment in Telehealth

“Containment is a powerful skill for all of us. Containment allows us to give our nervous systems a break from distress and choose what and when we want to think about certain things.

1) Collect some boxes! Show your boxes to the child through the video. Allow the child to choose a box. ( shoeboxes, shipping boxes, boxes are everywhere when you look!)

2) Show the child your collection of paints. Of course if this were a face to face session, you could allow the child to paint it on their own. For telehealth, I am painting the box with the child’s instruction. The child can choose to mix the paints, which size brushes to use, how to blend, etc.

3) Talk about containment while painting. Ask the child to visualize what they want the box to look like at the end and add any imaginary elements that help the box feel strong too (a lock, a guard, a surrounding fortress). Practice having the child think of something minimally distressing and visualize putting it in the box. Practice noticing the stress leaving the body (take a baseline of body sensations before and after the stressor is contained). Explain the container gives us breaks from stress and worries and helps us remember we are not what upsets us, it is separate from us. Talk about how we often do need to come back to what is in the box when we choose to and then we deal with things one at a time.

Create a routine! Practice using the box to put leftover material from session inside at the end of session. You can even hold the box up to the child on the screen while they do this. Remind the child you will come back to this next session and the child can choose to take things out before then to address with supportive adults or other safe expression activities. Some things stay in the box only for therapy, examples could be EMDR material or children who do not have an emotionally safe environment at home to express certain things.”

• Sample Progress Note: The focus of the session was to (tailor based on tx plan). The therapist and Ct created a Container Box to help teach the skills of containment, emotion identification, and self-soothing. Ct identified (name emotions) that they would like to put in their container.