Lockdown and Tier 4 Restrictions - to Offer Therapy Remotely or Face to Face - that is the question!

What a trying time it has been for us all, since the pandemic hit. To different degrees, we are all contending with worries regards our health and wellbeing, together with that of our loved ones. The usual buffers of social gatherings, family get togethers, down-time at the gym or visits to the pub or restaurant have all been severely curtailed - in many cases, lost altogether. Even in work, we are more isolated than ever before as we busy ourselves remotely, find ourselves on furlough or manage demands of being a care worker, at the coal face. Those more unfortunate still, may have lost their livelihoods altogether.

Saving physical life is of course the priority - but mental health severely impacts quality of life, and in some cases we know it can lead to life-limiting health consequences too. Heart disease and cancer are just two conditions we know can be exacerbated by psychological stress. It is more obvious that eating disorders, suicide and drug or alcohol dependance may lead to actual loss of life, or alternatively, significant and enduring medical needs. Loneliness and isolation are already known to be the silent killers, the world over. How is it then, that Psychologists, Counsellors and Psychotherapists are not seen more definitively as front line workers, in this troubling time?

The Importance of Talking Therapies

The uncertainty and loss of normal routines and support networks during the lockdown period is laying siege to our emotional health. There are issues of complex grief to manage, after the death through Covid of loved ones. Stress levels for students and teachers is debilitating, as they limp between constantly changing sets of demands and expectations. In households characterised by domestic abuse, poverty or conflictual relationships, the world feels less safe or fulfilling than ever before. And, there is also the psychological fall out of long Covid for those in recovery from the virus. Dr Adrian James, President of the Royal College of Psychiatrists. points to the cumulative impact of the disease itself, together with the social consequences and economic fall out that follows an epidemic of these proportions. He is right to do so.

Continuing with Talking Therapies, Face to Face

It has been difficult for many people to access talking therapies, for a number of reasons. Whilst remote therapy has been possible, we know intuitively that some presenting needs and personal considerations cannot be managed through working practices at a distance. Fortunately, there is clear provision for in-person, face to face meetings if this is deemed necessary or reasonable, as per advice and guidance from the Government across all 4 nations of the UK. As the guidance is complex, this has been summarised in the first article of this series, available at https://www.solihullwellbeingclinic.com/single-post/offering-talking-therapies-safely-during-lockdown-and-tier-4-restrictions

Helpful Advice from the

British Association for Counselling and Psychotherapy (BACP)

BACP advises members to read the Government guidance before providing face to face therapy, and recommends working remotely where possible to reduce the risk of Covid-19 infection. What is really helpful about the BACP document is that it offers a decision-making process, which counsellors and psychotherapists are encouraged to adopt for each of their cases/clients, before agreeing in-person / face to face appointments. The decision making should include a review of the following factors:

  • the client's need and safety

  • your need and safety

  • the context of the service

  • the premises you practise from

  • whether other options are possible and the ethical and practical risks of any decision

  • the known risk factors of age and any pre-existing health conditions for both yourself and your client

  • particular needs of clients who may not be able to engage using online platforms or by phone

  • whether any risk to the client, either from others or from themselves. can be managed remotely

  • your supervisor’s feedback

  • your insurance cover

Working Remotely

There is some very helpful additional guidance from BACP if you do choose to offer services remotely;

  • you should seek and receive dedicated training before working online, to manage the many practical issues that need to be considered, as well as significant implications around how people may (and do) present differently online, communicating and responding in ways that may not be expected.

  • telephone or online counselling might be an acceptable option if you consider the following points:

  1. that the reason for doing so is to prevent the spread of the virus. If either party is experiencing symptoms of coronavirus the best option may be to take a break from therapy until fully recovered

  2. you are competent to deliver remote therapy

  3. remote working is suited to the needs of the client and the material being discussed, with the proviso that telephone or online therapy may not be suitable for all clients or certain issues

  4. your supervisor is competent to supervise online practice

  5. for older clients who do not have access to, or experience of, video-calling, continuing sessions by telephone may be the best alternative to face to face sessions.

  6. data protection and confidentiality obligations need to be managed, including provision of a safe and confidential space to work from where you can’t be overheard or overlooked during sessions. You'll also need to ensure that you have all the necessary equipment and that the solution you're using is secure

  7. approval from your insurer, after you have informed them of the planned changes to your practice, including working online

  8. consideration of being registered with the ICO (Information Commissioner’s Office)