Results from our recent survey suggest that as lockdown in the UK continues, we are actually becoming more optimistic about our professional futures. Is this optimism merited, or are we engaging in wishful thinking? We explore some possible futures.

On Tuesday 7 April we launched our survey to establish how the current pandemic is impacting on the professional lives of therapists. Three weeks later, on Monday 26 April, we stopped taking submissions. Over that time, we seem to have become more optimistic about what the future may hold for us, at least in a professional sense.

We received a total of 161 responses, of which 156 were from practitioners within the UK. We published a blog summarising the early responses on 16 April and we will publish full results of the survey in a further blog in the coming days.

This blog, however, focuses on one aspect of the survey findings: our level of optimism about our professional futures.

What has surprised us from the responses is the degree to which our optimism has actually grown in the three-week life of the survey. We outline the findings below and ask to what extent this optimism is justified, or whether we might be indulging in some wishful thinking.

The survey question and responses

The survey asked: Do you feel more or less optimistic than before about your professional future? A five-item scale offered options which ranged from Considerably less optimistic than before to Considerably more optimistic than before.

The lockdown has obliged many therapists to move from face to face to phone or online working. For many it has been a painful process. As the lockdown has gone on, however, it appears that many who were reticent about this way of working have found the process less onerous that they had expected. Both the results of our survey, and comments in online media forums have borne this out. Overall, we are adapting.

I have managed to maintain an acceptable level of clients, I’m still getting a small amount of referrals. I’m now looking at additional training regarding working online to now develop that side of my practice when things return to face to face.

The view of one survey respondent

We wanted to establish whether, over the three-week period that the survey was open, respondents’ level of optimism had changed. In order to establish this, we looked separately at the first 50 responses (submitted between 7 – 8 April) and last 50 respondents (24 – 26 April) separately.

The chart above reflects the responses of the first 50 respondents to the survey who submitted their responses between 7 – 8 April 2020. It shows that almost half (48%) were marginally or considerably less optimistic than before the pandemic. Nearly a third had about the same level of optimism, and just one in five were either marginally or considerably more optimistic.

Jump to the last 50 responses, made two and a half weeks later, and we see a significantly different picture (below). Now, just a third of us are less optimistic, those equally optimistic have risen to 42%, and the proportion feeling marginally or considerably more optimistic has risen from one in five to one in three.

CAVEAT ALERT: The sample should in no way be seen as representative of the professional therapy body, nor should the first and last 50 respondents be assumed to share the same or similar characteristics. Still, it is rather curious, don’t you think?

Self-disclosure spoiler

If you are in line with the survey trend toward increasing optimism, I’m delighted for you. I, however, seem to be bucking that trend. I normally think of myself as an optimist. As the lockdown has progressed, however, I’ve been gazing more and more into my crystal ball, and liking less and less what I think I see. Hence, feel free to leave encouraging comments below.


Are you feeling the surge yet?

As we highlighted in the last survey related blog, some of you are telling us that you still have healthy levels of referral, whether from private clients or EAP’s. The vast majority, however, have experienced a calamitous reduction in demand.

Many of you also anticipate a surge in demand for your services once ‘normal service’ is resumed. This is a sentiment I’ve seen echoed on Twitter and in online forums. The demand will come. If not now, then soon. When lockdown ends, the pent-up anxiety, depression and trauma will start to manifest itself. I’ve  seen it suggested that we might even start to experience our own sense of overwhelm.

Maybe we will, and it will be a nice problem to have. But I’ve been thinking a lot about this in the past week, and I’m beginning to have my doubts. We are in this for the long haul. Social distancing will be with us till at least the end of the year. The world is going to look different on the other side of this, whenever that comes. At this point it seems unwise to make too many assumptions about its shape.

That said, I think it well worth playing with some possible futures, focusing on the two areas from which the majority of referrals to private practitioners tend to come: private practice, and the world of workplace counselling.

1. The future for private counselling work

First, the best-case scenario. People slowly emerge from this lockdown and start to do more than just survive. As they do, they start to seek help with the emotional fallout they have been holding. Referrals, at least for a time, far exceed their pre-pandemic levels. Private practice enjoys a new renaissance.

Alternatively, they emerge traumatised and continuing to fear for their security, their jobs and their finances. In this scenario, their needs are significant, but they will not jeopardise any remaining security they may enjoy for fear that this, too, may be taken away from them. For the foreseeable future, committing resources to therapy will be unthinkable.

I don’t know which of these two scenarios is the more likely. What I do believe is that the longer we are required to work remotely, the more difficult things will become. While I have no evidence to support it, my sense is that most potential clients still view therapy as a face to face activity. For as long as we are available only online, we will face the challenge of persuading those potential clients to consider this as a viable alternative. This is not a challenge of evidence but one of marketing.

2. The future for workplace counselling

Reports have put the proportion of organisations providing EAP’s for their staff at 71%, and estimated the EAP  coverage of the UK workforce at 47%. While those levels of coverage may seem high, however, at times of economic scarcity their stability cannot be assumed.

The Employee Assistance Professionals Association (EAPA) highlighted that EAP’s are “most commonly being used by employers for ‘soft’ business reasons, as part of broader health and wellbeing offerings, and in order to be perceived as a ‘good’ employer.” The EAPA  go on to highlight that only 9% of HR manager respondents in their research had attempted a ‘hard’ evaluation of implementing an EAP in terms of a cost utility benefit or return on investment. That may be about to change.

What are the chances that organisations which survive this period emerge with a renewed commitment to invest in the psychological wellbeing of their workforces? If EAP’s are indeed viewed primarily as a ‘nice to have’, then I wouldn’t stake my house on it.

In the end the service was retained. The deciding factor was our service’s commitment, over many years, to evidencing our impact. We already had the data.

In the early 00’s the Royal College of Nursing undertook a root and branch examination of activities in response to a major deficit in its pension fund. I suspect that the economic fallout from the pandemic will make that problem look like a little local difficulty. The RCN’s Counselling Service, of which I was Head of Service at the time, went through a lengthy period of internal, then external, independent review. it almost broke me, and I wouldn’t wish the process on anyone.

The choices were simple: retain the service; axe the service; contract provision out to an EAP. In the end the service was retained. The deciding factor was our service’s commitment, over many years, to evidencing our impact. We already had the data. You can find the story here.

To conclude

I hope my worst fears aren’t confirmed, and I’m sorry if I’ve rained on your parade. Other futures are available, and we’d love to read yours in the comment section below.

I hope our collective increased optimism is justified. I will feel more secure, however, when I feel that we’re not just assuming our impact, but actually evidencing it. That takes me back to what TMN is really all about, and that seems a fitting place to close.

Travel well, but travel small. ?

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Posted by:Barry McInnes

8 replies on “Post COVID: The future of private practice

  1. I think your assessment is fair. I started to take clients online for sessions mid March, just before the beginning of lockdown. At the beginning of this I had quite a few clients, I had also received a few new EAP referrals. The transition to working online was a success.
    Whereas I wouldn’t say I was confidently optimistic I did hope my practice might survive, this gentle optimism was probably reflected in my initial response to your survey. However, economic concerns such as job losses and furloughing have now impacted sessions. I have reduced fees where I can but when an individual is faced with ‘Pay the mortgage or have counselling’ I completely understand why Counselling is not a priority. Currently my practice is limping along at a much reduced rate and I’ve seen a downturn in both EAP and new private client referrals which has started to concern me. I’m very loyal to those I work with and value the work but do wonder how long I can realistically keep this up before I have to look for another job myself. I can see huge demand for counselling services in the near future but based on what I’m seeing currently, feel economics will pay a huge part in the take up of sessions.

      1. Thank you Barry, I don’t know whether you are planning this already but it would be good to revisit your original questions in a couple of months time. Just to see how things have worked out. Like David I’ve got real concerns on how we will work as well as getting the work. For me working with a screen in the room wouldn’t feel right at all, neither does counselling in a mask. To me therapy is all about connection whereas a screen screams separation. Even if it were put there for health reasons I am not sure how it would effect the clients or the process.

        1. Thanks Heidi, the more I reflect on this the more I agree with you about the possible challenges to face to face connection, and thinking I might experience more of a connection by seeing them via video. Still, we’ve proven adaptive so far, who know where we’ll be in a couple of months. Thanks for the idea of a follow up. I do like the idea of tracking some of this over time!

  2. I’m 69, so don’t expect to be released into the wild soon, and like you I think most clients regard therapy as a face-to-face activity.
    There is also the matter of shielding my wife – how can I do that with a home office?
    The short answer is that it isn’t clear yet. I suspect that some form of screen, like in banks and now many supermarkets and shops, together with air filtration, may be an answer, and I won’t be able to accommodate that at home, so will be looking for some kind of office space with these facilities built in.
    EAPs may look at the outcome research comparing face-to-face and online therapy and decide that online therapy is the way to go. There is absolutely no doubt that face to face contact with clients in the short term will be expensive to safeguard. I do not want to have to break the news to Towergate that a client is suing me for coughing Covid over him/her, true or not.
    You asked for good news. Well, I don’t know how to break it to you, but I see my clients after bad news! – and there has certainly been enough of that. And I would hope that the experience of online contact that many (most?) people are getting used to now will make their acceptance of online therapy easier.

    1. Thanks David. It sounds like you are already starting to think very realistically about what (y)our post-COVID therapy will look like. I suspect that if someone had said, three months ago, that in six months we’ll be seeing clients ‘face to face’ behind a screen, or wearing a mask, and disinfecting our doorbells and door handles, we’d probably have said ‘Yeah, right…..’ and moved the conversation?

      How much do we have to take for granted to be able to just live day to day in the world, and at what possible cost?

      May you and your loved ones stay well.

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