With the world increasingly in lockdown how can we continue to work and to provide a service to the people who may really need it? This blog provides encouragement, some practical ideas and resources, including a brief, low cost online course to help you move your practice online. For this blog we’re ditching the numbers: this is Therapy Meets COVID-19.
I can scarcely believe it’s only a week ago that we released the last blog on the differences in interactional features of psychotherapeutic encounters conducted face-to-face vs. by telephone. At that point it felt like those differences were an interesting but rather abstract topic. Coronavirus hadn’t quite arrived here in the UK in the same way as for other countries, and it still didn’t really feel like my problem.
It does now. One the EAP’s for whom I work has mandated phone/video contact only, and others are urging caution and suggesting I offer clients the option of working remotely. The mediation that I was supposed to be running today was cancelled yesterday because one of the participants had to self-isolate. All of a sudden it feels like the normal rules by which we work no longer apply.
Are you ready for this? Even if you are able to continue to see clients face-to-face, assuming that’s what you do, this time next week that ‘luxury’ might be a thing of the past. This is almost certain to come, and if we are to develop new ways of working with clients that don’t involve face-to-face contact, some of us will need more preparation than others.
As I mentioned in the last blog I’ve been working using the phone for the best part of 25 years and video for almost half that time, so the transition is one that holds few fears for me, though I have some misgivings about how my existing clients may respond (more on how we might manage that transition later).
For anyone who feels like the transition is more of a step into the unknown, below are, first, details of a new brief course on moving your practice online from the wonderful Kate Anthony of the Online Therapy Institute. Second, some very personal thoughts, based on my own experience, on how we might (to paraphrase Dr Strangelove) stop worrying and learn to love the online space. Lastly, some additional guidance and resources from BACP and the new PCP Therapist Hub.
Dr Kate Anthony, FBACP, is providing a short transition course for the duration of the crisis. The course is entirely FREE, or you can contribute to costs. CPD evidence supplied. The main learning is:
Welcome and Introduction (How to take the course; reasons for course)
Rapid setup of secure communication methods Plan your service; Supervision issues; Insurance issues)
Intake and re-Contracting (Additional information required: between session contact; social media policy; crisis intervention; financial implications)
Reading and Resources (References, Further Reading, Social Media Links)
You can find out more here. Please contribute if you can to recognise the work that has gone into the creation of this resource for us all. ?
Please note that this course has been created explicitly for the Covid-19 Crisis and is not intended to replace a full training of 80 hours minimum.
Drawing on 25 years of experience
If the prospect of moving from face to face to phone or video I hope the following brief thoughts will provide both reassurance and guidance.
1. Question your assumptions and the stories you tell yourself
Do you hold a belief that therapy requires eyeballs on the client, or that therapy by phone or video is somehow not quite the real thing or less effective? If so, please read our last blog and be assured of two things. First, the evidence to date seems clear that face to face and phone counselling are broadly comparable in their outcomes. Second, the research shows there is no statistically significant difference between the two modes for key interactional/relational factors including therapeutic alliance, disclosure, empathy, attentiveness and participation.
2. Look for the exceptions
In speaking to friends and family by phone, are you able to pick up nuances of feeling and mood? Of course you are. So why should clients be any different? Phone a friend, family member or fellow therapist and consciously listen. To listen without the usual visuals try listening on a slightly different bandwidth.
3. Remember how amazingly adaptable you and your clients are
Leave your assumptions and stories at the door and challenge yourself. Yesterday I had a session scheduled with a couple that I was expecting to see face-to-face. A few minutes before they were due, I received a call from one of the couple, saying that she was needing to self-isolate for a period and could I please run the session with she and her partner on WhatsApp?
Before yesterday I hadn’t used either WhatsApp or the screen on my phone to run a remote session, so I entered into the session with some trepidation about how this was going to work. By the end of the session it felt little different in quality from our face-to-face sessions, for me and also them. Note to self; I am more adaptable than I sometimes give myself credit for.
4. Work collaboratively on the transition
Switching from face to face to phone or video is a change of the basic contract of understanding we have with our clients. Although I dislike the term rupture, it can be viewed as one. As such it’s important that we address this directly with the client. Even if you know it can work, it’s critical to explore the client’s concerns and respond honestly. Don’t be afraid to express a sense of not knowing if it will work for you and this client. They are going to pick up any phony self-confidence.
5. Re-contract as required
Working together with your client, you may be surprised at how much therapeutic work you can achieve without having the client in the room. Please don’t assume, however, that you can just do business as usual. Maybe you can, and maybe you can’t. For some clients the work may need to be more holding and containing than therapeutic. Our sacred therapeutic hour may need to be sacrificed for something more appropriate to the situation. If in doubt, call on your supervisor or colleagues.
Some additional resources
BACP has a web page dedicated to all things virus related. This includes a Q + A about COVID-19 and its impact on your practice, working online and managing our own anxiety as therapists.
Partners for Counselling and Psychotherapy has created The Therapist Hub to keep all therapists up to date with the latest COVID-19 developments. Links to free, daily online meetings for therapists to discuss their concerns, information on upcoming events and more information and advice than you can shake a stick at.
ACTO, the association for therapists and counselling working online therapeutically also has a dedicated web page with information for clients and non-ACTO therapists with general guidance and links to further resources.
Finally, keep an open mind, question your assumptions and stories, and be prepared to be surprised. Think of this as one unplanned but nonetheless very interesting CPD opportunity!
As a postscript to this blog, between the start and end of the couple session an email dropped into my inbox from another of my EAP’s stating that new clients would only be offered via phone or online and recommending the switch for existing clients.
The world is changing, and it’s changing more rapidly than many of us still appreciate. By tomorrow, the UK lockdown may be with us. If you need to prepare, now is a good time to start. A good place we can all start from is to stop telling ourselves stories about what we must have in place (including eyeballs on the client) for our work to be therapeutic. The evidence simply doesn’t support these stories anymore.
My thanks to Kate Anthony for the above content about her new course. I’ll also borrow her email sign off……. to you all, keep in touch, keep safe and keep your distance.
Take a moment to tell us what’s going on for you. Keep heading south for the comments box!
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