We are joining the conversation about Coronavirus with the intention of providing something useful to us all in private practice.
In online forums, I have observed multiple worldwide discussions these last few weeks and gathered relevant questions on the topics of self care, cancellation and privacy. I have summarised the aspects I believe are important for us to consider below:
I spoke with several medical colleagues, including an infectious disease specialist to answer my own questions that the mainstream media had not addressed.
They directed me to these sites for reliable, official, up to date information concerning the virus itself, symptoms, treatment and outcomes.
This will vary based on which country and region you are in, so please do send me any relevant links to add to this article if you have them to hand.
What procedure should I put in place now to protect myself and my clients?
[Please note this commentary is relevant at time of publishing and requirements and regulations will evolve as the pandemic continues.]
Originally, there was no official obligation to make any changes. The British Association for Counselling and Psychotherapy published this advice about how to address anxieties therapists may have. Some practical measures included opening a conversation about Covid-19 with clients and make them aware of the nearest restroom to wash their hands, supply antibacterial hand wash, tissues, hand sanitiser gel and use disinfectant on door handles.
If a client travelled to a country with higher prevalence of the virus or had been exposed to the virus, online therapy would be appropriate.
You may wish to supply spare masks in case a client develops a cough in session, or you may wish to cut a session short and reschedule.
It is important to implement any measures carefully and sensitively, because so many people are experiencing an uptick in xenophobia and we do not want to perpetuate racism and blame in our practices.
Should I send my clients a letter?
We have produced a template for you to adapt based on your chosen procedures if you would like to display a letter at your clinic or send it to clients.
People may be receiving a deluge of Corona-related correspondence so you might prefer not to add to their inbox influx. Whether you send something in writing or not, it would be appropriate to discuss your updated practice procedures in session.
How can we best respond when clients bring their anxieties, triggers and fears to session on the topic?
Firstly, we must examine our own reactions. For those with health anxiety, it may be a confusing and stressful time. Can you focus in your own therapy on how you take care of your fears? Can you increase your self care and structural care? Journaling, meditation, movement and social connection may help. We should be aware of our own feelings and avoid projecting our own fears or dismissal in sessions. By spending time processing for ourselves, we will be in a better position to support clients.
Therapists who follow the news may find themselves “reporting” or relaying the news in session. I recommend a pause. Just before jumping in with “yes, and did you see that…” or expressing our own reactions, taking a moment to pause can give us space to listen to what the client is asking for. Is it reassurance? Is it a safe place to express their shock? Is it that they need to read official health ministry recommendations with you and create a safety plan?
There is one reaction that is important to avoid, and that is dismissal. I have seen so many comments in discussions that dismiss, perhaps unintentionally, and therefore invalidate peoples’ concerns. “The common ‘flu is worse”, “don’t fear monger”, “the mortality rate is lower than SARS”… memes and jokes and humour at the expense of those in panic.. if you believe the media is blowing things out of proportion, that is valid and possibly true depending on what you read. However, if your client is panicking, that is also valid. Telling someone not to worry, as we know, generally does not relieve worry and may cause a rupture if the client feels unheard or invalidated. Answering a concern with a joke, or “it’s not as bad as the common ‘flu” is unlikely to reassure a patient.
If our reaction is naturally to make a joke or write a statistic, this is a good time to slow down and draw deeply on our training and experience.
What procedure should I follow if a client tests positive for Covid-19?
If a client informs you that they have tested positive, you may wish to switch to online therapy after your exposure.
If you share your office space, you will want to advise the practice members and landlord that a client has contracted the virus.
You may have group practice procedures to fulfil and you will likely have to inform other clients that you have been exposed.
Our template provides email wordings for this eventuality.
Should I update my cancellation policy?
To avoid clients coming into therapy ill, some therapists are updating their cancellation policies to waive late cancellation fees for illness. Others are unwavering in their policies. Some maintain their cancellation terms,and suggest switching to online therapy if a client is symptomatic.
I sent out my illness policy in early winter and am comfortable with my terms continuing. I love working online and am more than happy to see everyone online. For the wording I sent my clients, check out my free course “How to Write Your Cancellation Policy” which also includes a lawyer approved cancellation policy template.
Should I consider expanding my practice online?
Short answer, yes.
There are various platforms such as VSee, Zoom and Doxy which provide secure video conferencing. For a platform that includes everything you need for an online practice, check out iTherapy which is pretty much the gold standard as far as telehealth goes.
If you have not yet done any training, I recommend doing a course. Amber Lyda’s Step by Step starts in June and she covers everything. Amber is a brilliant teacher, coach and mentor.
For those who would like to expand their practice to include online work with clients in the UK and Europe, my experiential group programme begins in April 2020. We cover research, ethics, legal aspects, contracting and best of all, we practice and give feedback, just like an in-person counselling course does. The first cohort will be small, collaborative and heavily discounted, so if you would like to join in, add your name to the waiting list and I will let you know when we are ready to start.
Our Invitation to You
If you have any thoughts on this blog, recommendations, wordings or just want to share how you are affected by Covid-19, pop into the new Facebook group focused on providing support for Covid-related concerns and share with our community.
Updated Practice Policies (Covid-19)
This bundle includes:
1. a customisable template for a letter to clients regarding updated policies
2. group practice/landlord’s letter for shared clinics
3. A letter advising clients that you will be working online and via telephone
4. Several email wordings for various eventualities including advising clients and colleagues of self isolation
We are offering this template free of charge. Please add your email below to receive the documents straight to your inbox.