Thoughts on Returning to the Office for the Mental Health Professionals

Last evening a new newly referred client asked when he could see me face to face in my office. He really wanted to be seen in person for his first session. I empathize with this wish because a few short months ago, I would have felt the same. But now there are multiple issues and concerns that I have to consider. Mental health professionals must make risk analyses and decisions based on factors regarding the health and safety for their clients, their colleagues and themselves. There are a many variables in a psychotherapy office that are not necessarily organic, as there are different practitioners, client subsets, and often limited budgets available for overhead. Given the uncertainty of these issues, I told him that to be honest, I do not yet have a clear timetable for returning to the office for my practice. I have yet to establish exactly when I can see my current or new clients back in the office as I am now seeing everyone through tele-health. I replied that my return to the office would really depend on the comfort and safety of both my clients and myself, and that at this point I could not ensure this.

My lack of eagerness to return to my office, surprises even me. The building and the neighborhood have always been great for my clients' and my own purposes. The building is a pristine Medical Plaza. The office is in a comfortable suite with an ocean view, in a serene neighborhood, with good parking and upscale shops and restaurants. What's not to like? Additionally, the building's Property Managers have worked very hard in their attempt to continually safeguard and sanitize the building and all the common areas. Many of the dentists in the building have no doubt returned to work. However, those in the medical and dental professions have experience dealing with infection control, unlike most psychotherapists. And with the health and safety issues, emotional comfort and liability concerns, I still have concerns, and am not ready yet. As of this writing, most if not almost all my colleagues are providing tele-health services to their clients. Some therapists I know, primarily those with month to month leases, have actually given up their offices, and are planning to continue working from home for the foreseeable future. Other colleagues have elected to provide tele-health by holding sessions from their offices remotely, in order to provide a calm and peaceful work environment for themselves...away from family and privacy concerns.

Even with social distancing, mask wearing, office sanitizing (including common areas), I am not confident that most of us can provide an acceptably safe and secure office-setting for our clients and ourselves. I am still unsure and uncertain. 

 Issues to consider include:

1. The building, parking, elevator and common areas are still unknown entities for, coordinated safety practices. Therapist's typically take up one office in a suite. There is minimal oversight of entire suites and a lack of centralized disinfection throughout the day.

2. Social distancing in the waiting room and office could be problematic given space and distance, since many of our offices are relatively small spaces, with a lack of open air ventilation. We also do not often have staff to receive texts from clients when they arrive and tell them when to come to the suite, to avoid traffic in the waiting room. Once they arrive, should we take our client's temperature and perform a health screening before they come to each appointment?

3.Therapists and clients wearing face masks could reduce the sense of intimacy and connection in therapy sessions.

4. Wiping down furniture in the office could be difficult, especially given many areas have upholstered sofas, throw pillows and floor time on the carpet with our youngest clients. 

5. Ensuring the safety of clients who may be at risk for COVID19, since therapists serve diverse client populations, and we do not normally screen for or know all the risk factors our clients may possess.

So at this time, given that all of the therapists in my suite and my consultation groups are continuing to practice solely tele-health services...I am going to wait. I can continue to provide professional, ethical and helpful treatment via tele-health to adults, adolescents and to children. With a bit of creativity and ingenuity I have even found inventive and engaging strategies for working with the younger children in my practice. 

I believe in safety first with my clients. I'm just going to wait.

The Lessons We Learned So Far

Winter 2020 certainly did not go as planned…for anyone. In a very short time, everyone in the world turned their attention to the first Pandemic in over 100 years. From the beginning, the news media anticipated the significant toll this experience would have on mental health. As mental health providers, we have had to become more technical, more strategic, and more creative in the delivery of mental health care. We are experiencing a crash course in fear caused by this Pandemic, altering the health, economic stability, and psychological well-being of individuals and families. As mental health clinicians/providers, we must understand the impact thus far as it affects ourselves, our clients, AND the world. We are still learning. Thus far some important lessons include: 

TELEHEALTH IS HERE TO STAY 

Zoom, Doxy.me, VSee, and other systems have proven a viable way of working with clients. Not only is it feasible for talk therapy but also effective for somatic experiencing, EMDR, Brainspotting, and group therapy. There are challenges but we in the psychotherapy community are working through them. Good work is being accomplished as we are invited into homes and living spaces and introduced to pets, family and the personal isolation precipitated the Pandemic. Healthcare will be forever modified to accept telehealth to reach those in need. 

PANDEMIC FEAR 

The psychological and emotional reactions to the pandemic are mixed and varied from client to client, family to family, crises to crises. For some, the Pandemic has brought about intense fear, anxiety, and panic, loneliness, depression, and grief. It may exacerbate an already difficult psychological issue and make matters worse. For others, it has meant losing your job or ability to make a living. For still others who are considered "essential,” it may mean great health risk(s), sacrifice, and even heroism. 

FAMILY LIFE 

For some people this experience has given rise to a more difficult time with spouses and family members, leading to estrangement from relatives and support systems. Additionally, not everyone is safer at home, as the United Nations reports a simultaneous surge in domestic violence globally. 

HOME ALONE 

In 2019, 36.58 million people were living in single-person households. For those who are not quarantining with family and friends, this can be an even more isolating experience. Zoom, Houseparty, and other technologies have stepped up as a virtual respite. Additionally, there are social distance walks or friends meeting in the driveway or yards to have a connection with another human beings offline. However, loneliness can be bitter and cruel...leading to extreme depression, anxiety, and even panic. 

WHO NEEDS HELP 

There is an important role for therapists in supporting and caring for all the "essential workers" in healthcare, food, transportation, and city/state/federal positions. Relief, respite, and hope needs to be in ample supply for all these workers. To meet some of these needs, organizations have emerged to offer crisis support and short term affordable therapeutic services.

 PREVENTING COMPASSION FATIGUE (self-care) 

As those of us who readily supply emotional and psychological support, it is necessary to provide and maintain self-care. Therapists are talking amongst each other about the adjustment to telehealth and the intensity of working in this way. Shifting schedules and investing in blue light protection are some of the self-care measures of the day. As we go through a very historic period, as therapists we have a chance to provide an invaluable service and make a difference, something akin to what we signed up for. To do this, however, we must make sure we are taking care of ourselves by honoring and addressing our own issues as we work towards alleviating the suffering of our clients. 

While this has been an unimaginably challenging time, our common humanity and resilience have emerged. Friends, relatives, and colleagues have become closer through more frequent, benevolent, and kindly contact. Shelters and rescues across the country are running out of available cats and dogs who are more than happy to lend emotional support to homebound humans. There are countless free support groups online and social media. One such group offers meal support on Instagram to people struggling with eating disorders. Neighbors are organizing on apps like Nextdoor to shop for those at higher risk. Skies are clearing, traffic is calming, and many businesses are discovering that telecommuting can be very effective. 

As we move through this time it is important that those who need our help can access it, are willing to reach for it, and can afford it. We must not only normalize the depression, anxiety, and trauma the public is facing but the need to seek help to process and work through it. Our role as mental health providers is essential as we continue to learn invaluable lessons from this Pandemic. We are the stewards of connection and resilience for our clients and ourselves, and we will emerge from these trying times stronger for it. 

A New Day

A New Day For Psychologists, Therapists and All Mental Health Professionals

With the Coronavirus Pandemic affecting all of our lives -- every one of us -- Psychologists and Therapists are needed more than ever. As we become, by definition, "Crisis Workers and Interventionists," we are called to duty to provide a modicum of calm in a sea of of anxiety, fear, change and uncertainty. This unprecedented experience affects people from every walk of life. Young children and older adults may be confused, mystified, worried and even terrified about the sheer scope of this situation. 

We are faced with a formidable responsibility and challenge for our profession: It is a New Day in that we must immediately implement and embrace an online format for our work. This sudden, yet experimental necessity will likely change the delivery of Psychotherapy and to some extent, Healthcare, forever. This will, of necessity, be a useful, reasonable change that allows people to find help and support that they would not otherwise be able to access. This Call of Duty to our existing clients and others who may need our assistance, provides a connection to those without other mentally healthy options. A soothing voice, some education and clarification, as well as sense of hope for those that are stressed, confused and lost will be available to those who are suffering. This is a tremendous responsibility for us. Unlike a hurricane, tornado, earthquake or fire, this is going on everywhere and affecting humanity across the globe. The time frame is uncertain. It is up to us to step up and provide what we are able to provide online. The technology is there… and we must embrace it. 

It is remarkable that all of my clients seem to be greatly receptive and appreciative of this support. The service we provide needs to be readily available to those who don't have easy access. NOW.

Be well, my friends.

Talking to Kids about Coronavirus

These are tough and trying times for everyone. Let’s think aboutour kids who are now home and out of school. It’s difficult enough for grown-ups to really understand the Coronavirus, let alone a young child. Here is a brief explanation for kids. I hope it helps.

TALKING TO KIDS ABOUT CORONAVIRUS (COVID-19)…

THE CORONAVIRUS (ALSO CALLED COVID-19) IS:

1) A sickness that people can catch much like a cold or the flu. It can be mild, like a normal cold but it can also be a very serious sickness that people have to be careful about. This is being seen in all countries throughout the world.

2) The sickness can cause a cough, a fever and some difficulty in being able to breathe.

3) While most people do not get really sick, some do. Older people and people with other sicknesses may get more sick. Not too many kids get really sick.

4) Everybody, including kids, have to careful STAYING SAFE FROM SICKNESSES that are contagious. This means: washing hands throughout the day, washing hands for 20 seconds (the time it takes to sing the Happy Birthday song), sneezing into your elbow and TRYING not to touch you face. This will make them less likely to get sick and they will be HELPING to keep other people from getting sick, especially older people and those with health issues.

5) There are many grown-ups who are here to keep kids safe.

THE CORONAVIRUS IS NOT:

1) Something that you can catch by being outside, by eating food or watching TV.

2) Something that WILL NOT go away. Many people are working hard to prevent people from getting the Coronavirus, and to help people to get better if they get it. 

3) Something that will keep schools closed forever. Schools, dance studios, teams and sports, and what we were doing before, will be back again. You can see your friends through FaceTime and online games (with adult supervision) and you will be able to see them and play with them in person when things settle down and the virus is under control.

4) Something that should stop you from laughing, playing, having fun and loving your family.

FOR PARENTS:

1) Help your kids to understand what is going on in the world in reaction to the Coronavirus from their point of view and context…closing of schools, canceling of events, people becoming worried/anxious.

2) Please explain to kids why people and places are being very careful and cautious about spreading and safety.

3) Be mindful of your child’s thoughts, ideas, fears and worries about this. Explain that grown-ups are taking steps to keep everyone SAFE. The world is full of people helping to make this situation better.

4) Use language that kids can understand. Kids also seem to have a much better reaction if they should get the virus than older or already sick people. Kids are safer.

5) Encourage your kids to ask questions and express thoughts, worries or fears. 

6) And try…really try to keep the news off as much as reasonably possible. And while it is fine to be honest about anxious feelings and concerns - you don’t have to pretend everything is perfect - be mindful of laying your worries on the shoulders of your children. Try to model healthy coping skills that include good nutrition, exercise to mitigate stress, talking honestly about feelings and avoiding unhealthy coping mechanisms such as taking your fears out on others by losing your temper, or using/abusing chemical substances to self-medicate your stressful feelings.