Resilient, resourceful and adaptable, but struggling to stay afloat. Apprehensive about the future of our profession and practices. Still retaining some optimism, but under no illusions about the challenges that face us. That’s what you told us in response to our survey about how COVID-19 is affecting private practice therapy.
As I write, it is now just over four weeks since I saw my last face to face client. It feels much longer. The chairs in my counselling room feel like a reminder of a bygone age. Long ago, far away.
My practice comprises clients who self-refer and who also come via Employee Assistance Programmes (EAP’s). Some clients are face to face, some I work with via phone, others online. As the COVID-19 pandemic started to make itself felt in the UK, I had a fantasy that in working in this way, I might find myself more insulated from its worst impacts than colleagues who work only in private practice and/or face to face.
Twitter and Facebook started to hum with tales of practices shutting up shop overnight, and client referrals evaporating. The level of distress has been palpable, and it’s not going away any time soon.
We will have to maintain some level of social distancing, significant level of social distancing, probably indefinitely, until we have a vaccine available.Professor Neil Ferguson, Imperial College, UK Government advisor on the coronavirus outbreak. Today programme, BBC Radio 4, 16 April 2020
Trying to figure out a way of trying to be useful in this crisis, and having a little more time than usual on our hands, we set out to try and find out more about how COVID-19 is impacting our community. In particular, we were keen to know how private practitioners have been affected.
Our survey went live on 4 April, and these are the results to date. It will be open for a further short period. If you haven’t already responded, you can find it here.
About the survey
The survey explores how the COVID-19 pandemic is currently impacting on therapists in private practice. Given the rules in force on social distancing, maintaining any level of ongoing contact with clients is requiring those of us ‘non-essential’ practitioners to find alternatives to seeing clients face to face. This development is one that some of us may be better prepared than others to face. Hence, our questions focused on three main areas:
1. Before the pandemic
How have practitioners been providing therapy, specifically in face to face (F2F), phone and online modes? What are practitioners views of the relative effectiveness of each of these modes, and what are their attitudes towards them?
2. Since the pandemic
Are respondents continuing to practice, and if so, in what ways? What proportions of F2F clients have they been successful in migrating to phone or online modes? How have they and their clients experienced the transition, and has it been more or less challenging that they anticipated? Having made the transition, to what extent have attitudes towards non-F2F working changed?
3. In the future
What has happened to new client enquiries and referrals, both private and via EAP’s? To what extent have referrals via each channel increased or decreased? Are respondents now more or less optimistic about their professional futures than previously, and what informs this view?
Thus far, we’ve received 61 responses to the survey, 57 of which have been from practitioners within the UK. The results are summarised below.
Before the pandemic
Question: Before the arrival of COVID-19 which best describes your view of the effectiveness of face to face v. phone/online working?
In response to which mode they considered more effective, 72.1% of respondents stated their belief that therapy delivered F2F is more effective than phone or online interventions. 26% believed F2F and phone/online interventions to be equally effective, and just one respondent ventured that F2F working is less effective.
It would appear that this sample of therapists are broadly holding firm to the view that F2F is more effective, despite a significant body of evidence, previously outlined, that phone and F2F working can be equally effective. Not all, however, and a selection of respondents’ comments highlights the range of views:
Phone work is not the same as online work. Both are not as effective as f2f work.
I would prefer F2F-contacts for better interaction and more fine tuning to the client
Ineffective compared to face to face
It wasn’t my preferred method and would avoid if I could however for some people it may be the only support they can get, and this is I believe better than no support.
I am happy to work online as I believe it can be an effective and useful way of working depending on the needs of the client but am led by my clients who predominantly prefer F2F
While I am new to telephone counselling, I have been really inspired by the effectiveness of this medium
I’ve been doing both for years, so they feel as natural to me as breathing
Question: Before the arrival of COVID-19 which modes were you using for your client work?
Given the high proportion of respondents who expressed the view that therapy F2F is more effective than the other modes, a surprisingly high proportion (47.5%) offer a mixture of F2F and phone or online contact. None, however, work exclusively by phone or online.
Current state of practice
Question: Since the arrival of COVID-19, which best describes the current status of your practice?
Of the 52.5% (n=32) of respondents who have been working only face to face, almost all have migrated some or all of their clients to phone or online contact. Just one stated the intention not to resume till they are able to meet in person once again.
Question: What proportion of your face to face clients have you switched to phone or video?
Across all respondents, both those working F2F only and those offering a mix of F2F and phone or online, the proportion of F2F clients that have switched to phone or online varies considerably, as shown below.
More than a third of respondents have been able to migrate most or all of their clients to phone or online working, with nearly a further fifth achieving a migration of between 60 – 80%. This suggests that significantly more than half of respondents have been able to maintain the larger part of their active caseload in the short term. As we’ll see in a moment, however, the picture moving forward becomes less clear.
Question: What were your biggest fears about the transition from face to face to phone or online working?
Respondents biggest concerns about the transition from F2F to phone or online working focused the impact of the transition on the relationship and the ability to remain effective, as well as how well clients might adapt, and whether clients would be lost. The five most commonly expressed concerns, in order, were:
Experience of the transition
Question: To what extent has the transition been harder or easier than you feared or expected?
Almost half of respondents (46.7%) experienced the transition in migrating from F2F to phone or online as moderately or significantly easier than anticipated.
A similar figure (45%) found the transition about as difficult as they had feared or expected. Only 8.4% experienced it as either moderately or significantly harder than expected.
Asked about who had found the transition more difficult, they or their clients, 74.6% said that they and their clients had experienced about the same level of difficulty.
Question: Which best describes your current attitude towards working by phone or online?
The survey sought to establish respondents’ attitudes to working by phone or online in the light of their recent experiences. Their responses seem to indicate that many feel more favourably disposed to working by phone or online that might previously have been the case.
44.3% indicated being more favourably disposed to working by phone or online should the need arise. 23.0% went further, suggesting that they might positively embrace this new way of working. Only three (less than 5%) selected the option Phone or online work is not for me and that’s unlikely to change.
What’s happened to referrals?
We set out look at the impact of the pandemic on client referrals via the two channels of private practice and EAP’s. Responses show that whatever else may be happening in the world, it’s abundantly clear that the distress evident in our populations is not yet showing up in our therapy rooms.
Private client referrals
Of the 60 people who responded to the question of whether private client referrals have increased or decreased, 58 indicated a decrease.
The scale of the reductions in private practice referrals is stark. Of respondents who indicated that referrals have decreased, and excluding missing data and null values, the reduction on average is estimated at 71%.
A total of 25 people responded to the question of whether referrals from EAP’s have increased or decreased. Of those, all but one indicated that referrals had decreased.
The scale of reduction in EAP referrals is even more stark than that in private practice referrals. Excluding missing data and null values, the average decrease in referrals across respondents stands at 85%.
Question: Do you feel more or less optimistic than before about your professional future?
How have recent developments impacted on our sense of optimism regarding our professional futures? Quite considerably, it would appear. Slightly more than half of us feel marginally or considerably less optimistic, with the latter category accounting for almost one in five of us.
On a more positive note, however, nearly a third feel much as before, at least for now. There remain some optimists among us still: those who are either marginally or considerably more optimistic than before account for almost one in five (18%) respondents.
Below is a selection of the views, beliefs and hopes that inform these responses:
I am down to 1 client. Feels like i will have to start over again
Lack of new referrals and looming serious financial crisis
As I am struggling to recover from COVID-19, I haven’t been able to generate enough income to pay my bills. I am going to have to give notice on my office and I don’t know what the future will hold as far as having my own business concerns.
Therapy is not a priority in people’s hierarchy of needs right now. Money, and lack of privacy (for calling therapist), also huge problems. Likely to be significantly reduced business as long as lockdown is in place.
I’ve always felt optimistic about the place of counselling and therapy in the world, so this pandemic has confirmed this position but not bolstered it massively.
Gut feeling based on my belief I am adaptive.
Having gained experience in telephone counselling with effective outcomes for clients I envision an increase in referrals in the very near future – particularly as I work with health care staff
The need for counselling is only going to increase so hopefully this will have a positive impact on the counselling profession and mean it is respected more highly.
We will adapt to new ways of working as appropriate. Life goes on so people will need to access therapy as before
I think this is a lull before the storm
We asked people to share any closing thoughts they might have. In response to the question Please share any closing thoughts (for example, how this period has been for you; how it has impacted on your practice; what you have learned; is it a threat or opportunity?) 41 left us with closing thoughts.
We will in due course produce a fuller report than is possible in this blog. Sadly, while we’d love to do justice to all those who responded by including their closing thoughts, we are limited by space.
Given that, we’re leaving you with two comments which seem to capture a spirit of resilience, realism and optimism:
First two weeks – almost a trauma reaction in the rush to adapt whilst keeping clients held and seeming to be business as usual for them. Incorporating the feelings around lockdown and self-isolation into all aspects of therapy: relationships, self-value, comparing self with others in terms of experience and gov support received. Working hard to keep line between my own feelings around this and that of clients. It helps to look ahead. A little self-agency goes a long way.
V exhausting period, hope it gets better as we all get used to the situation; never have me and all my clients suffered through the exact same thing 😊
To all of you who responded – thank you. And if your comments are not reflected here, be assured that they will appear in a fuller report/blog in the near future.
To those of you who haven’t yet taken the survey – we’ll hold it open for a few more days. Should you wish to add your perspective, you’ll find it here. Alternatively, you can leave a comment below.
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