It’s July 2020 and the UK is slowly starting to emerge from the lockdown caused by the Covid-19 pandemic which has changed the way we all live our lives and which has brought suffering and misery to thousands. With the virus still out there in the community, people still becoming ill and many continuing to die every day from it, the powers that be deem it all right for certain businesses and services in England to open up and resume trading albeit in a careful and restricted way.

​Among those itching to restart will be Face to Face Counsellors, Psychotherapists and many other types of practitioners who have been unable to work over the last few months. Those of us who already delivered therapy through other mediums like Skype, Zoom or even the humble telephone, were able to continue with client sessions while the remainder had the choice to move across into the new electronic world or just not practice at all.

So what are the implications of returning to face to face client sessions and what thoughts and feelings are going to be thrown up?

Firstly let’s look at the practicalities of resuming sessions and the measures that we can put in place to help client and therapist stay safe. To kick off here’s a few ideas I’ve had for my own counselling room: 

• Complete honesty by the counsellor and client as to whether either is ill or has been ill recently and a promise to cancel the session if this is so.   
• Copious amounts of hand sanitizer available on entry and exiting of the therapy room
• Hot water, soap, paper towels and hand sanitizer available in the client loo.
• Client and counsellor to stay at 1metre plus apart throughout the session.
• No shaking of hands at beginning or end
• Water glasses replaced by disposable plastic cups.
• At least an hour between clients for wiping down of chairs and surfaces and a change of air.
• Many of the counselling aids and ornaments put away to aid easier cleaning. 
• New room layout has a coffee table between the client and counsellor‘s chairs to create distance. (Barriers like this have always been discouraged)
• Weather permitting; windows will be opened to allow fresh air to enter.
• Payment: If the client pays by cash or cheque they will place it in a small plastic basket located near to the client and not handed directly to the counsellor. Having the correct money will help this.

So the practical side of resuming face to face work is relatively straight forward to put together and maintain, but what of the psychological aspect of it? 

As we all know in counselling a key skill is active listening and this means really hearing what the client is saying, not just the words but the tone, inflections, the silences, the little nuances and of course body language. It’s hard work and to keep focused during the whole of the counselling hour can sometimes be a challenge. Most of us in our training will have worked with `blocks to communication` and high on the list of these is `distraction`. This can be the man outside with the pneumatic drill, the circling helicopter, the need to go to the loo, or illness among countless others. But we have a duty of care to our clients and the BACP code of ethics requires it’s members to put the wellbeing of their clients first by:‘making clients our primary concern while we are working with them.` The code also requires that members look after themselves and ensure `that our wellbeing is sufficient to sustain the quality of the work`. So there can be a balancing act going on between the client and therapist. 

But we are all in unchartered territory with this pandemic which has killed thousands in the UK alone and it would be unusual not to have concerns about it. As therapists we usually strive for transparency and genuineness in our work with clients but how will this authenticity be affected or compromised if we have worries and concerns about the health of our clients? Furthermore will our underlying anxiety collide head on with any unease that our clients have for being there with us? Honesty and self disclosure will play a big part here. If we discover our client has fears and worries about coming back to face to face therapy and we have similar thoughts then share those concerns, after all you are both on this journey together.

No one has the definitive answer to how best to go back to face to face therapy – it’s just theories and guesswork with rules and advice changing almost daily. It’s likely that this will be one of those occasions when we must go with our instincts and examine the evidence. How well do we know our client? Is it likely they are being completely honest with us over their health? Are we confident that the measures that we have put in place to reduce the risk are adequate?  We then need to balance all this with the evidence: How does the South West compare to other areas of the UK regarding the number of cases of Covid-19. What is the current `R` number for the region? Is this number rising or falling?  While juggling all these ideas, facts and figures we still have to consider asymptomatic transmission where an infected person, who has not yet developed symptoms, is still able to transmit the virus. So in essence we have to make a judgement based on a whole raft of variables, many of which are out of our control. However, despite the bizarre old saying `ignorance is bliss`  gen up on the virus and how it’s spread by visiting a reliable website like https://www.nhs.uk/conditions/coronavirus-covid-19/  and use facts and evidence in making your decision.

David Trott © 2020 Council Member of Taunton Association for Psychotherapy (TAP)

On January 24th TAP welcomed their council member Ian Stevenson to talk about the Context of Management and the impact on therapy in clients referred through Employee Assistant Programmes (EAPs). He spoke about common concerns these clients present with, concerns that leave him wondering about the influence of constant changes in management and economics. With key performance indicators, management by target, as well as fear and loss of work stability for employees, it is more difficult to prevent mental health issues.  

The main pressures on clients are constant change to zero hour and/or short term contracts which cause anxiety. Micro management with constant auditing, fear of sanctions and less creativity, build resentment and this fear can affect self-esteem. An increased workload with reduced staffing and a lack of dialogue with management at all levels leads to increased stress levels and an impact on home life, so people learn to stay silent or risk losing their job.

Richard Murphy’s book The Joy of Tax highlights how some large well-known companies avoid tax, a subject which has recently been in the media. These companies’ actions increase the sense of unfairness for the majority of the workforce.  Paul Hogget writes of the increased paperwork, care plans, assessments and standardisation in all areas of life that lead to lack of personal encounter between two separate people. For client work this may mean being shown how to be ‘bullet proof’ to survive. Our dilemma is ‘What should our response be?’ do we ‘patch ‘em up and send ‘em back’, trying to cope in this ever changing world; or should we challenge the pathology of the system rather than the person?  We are left to debate this statement.

Our next talk is 19th February 2016 when Matthew Appleton will talk about the Life Long Consequences of Obstetric Interventions at Birth. The talk will start at 7.45pm at Taunton United Reform Church, Paul Street. All welcome