With COVID-19 set to be a permanent fixture in our lives for the coming weeks and months, Happiful is sharing personal perspectives and professional responses to the virus, in the hope of providing actionable advice, alternative viewpoints and normalising the wide-range of human behaviours that emerge in response to uncertainty

Counselling Directory member Pam Custers, MA Pg/Dip (RELATE) Accredited MBACP, explores the conversations and recent agreements that have taken place at her London practice, and the steps her associates will be taking to support and safeguard their clients.

As I finish up my associates meeting about managing the coronavirus, I sit down at my desk and ask myself so many questions. Are the measures we’ve agreed on enough? Are they too much? Have we found the balance at such an unpredictable time? As a busy psychotherapy practice, I’m all too aware that we need to have clear protocols in place to keep both our clients and ourselves safe.

In the face of so much uncertainty I acknowledge that I am, in some ways, reflecting the kinds of feelings that my associates and clients are presenting by asking myself these questions. There’s a mixture of anxiety, pragmatism and frustration that we haven’t yet got clear guidelines from the government.

Coronavirus has had an impact on all of our clients. Every single one has raised the issue as a concern or in passing

Coronavirus: The impact on our clients

Coronavirus has impacted all of our clients. Every single one has raised the issue as a concern or in passing. Many clients have spoken about how it may change their families, livelihoods or their health.

Major life decisions have been put on hold or indeed sped up. Couples considering separation are either deciding to postpone or some have decided to do so quickly, as the idea of isolating themselves in an already tension-filled environment is something they don’t wish to face.

Many clients discuss health, which is at the front of their minds; concerns about their own health or the health of their loved ones. There is an acute concern for those who have underlying health issues and many fear for their elderly parents, about not being able to work or losing the ability to provide for their families. Parents talk about children becoming hypervigilant.

As a group of counsellors and therapists, we have to be the keel holding the ship steady in the storm

I share this because the truth is that coronavirus doesn’t just impact us physically as a virus - it has a huge psychological impact. And, as a group of counsellors and therapists, we have to be the keel holding the ship steady in the storm.

We agreed we would support our clients by suggesting that they (and we):

  • Keep up to date with information from a reliable source, only once a day as too much checking and following only increases anxiety.
  • Sanitise their environment once a day.
  • Wash hands with soap for the required amount of time, no more (chafed hands are a health hazard).
  • Work with challenging thoughts that may become intrusive.
  • Put in place supportive measures around self-isolating, including indoor exercise, eating sensibly and talking to family and friends about worries. Having a supportive network is vital.
  • Keep a sensible amount in the store cupboard to feed yourself for a few days.

We’ll also suggest that our clients set up an online video conferencing and normalise the notion of having a virtual cup of coffee with a friend.

Online offerings

Online sessions have always been on offer at our practice but we’ve now made it clear to all our clients that, if they wish to work online, we will be able to offer them this. This may be the only way that we can carry on working as social isolation may well be the next step.

We know that with social distancing or self-isolation, one of the key factors for keeping mentally well is to still feel connected. So, having online sessions is a good way to keep our clients supported and connected.

Taking steps to protect our clients and practice

Our practice meeting to put measures around coronavirus in place was highly focused, though at times, we were conflicted. We did, however, formulate a protocol to take our practice forward in the most ethical way possible as it’s vital for all practitioners to set up and maintain boundaries that make us safe. This is something that we do automatically in terms of a client-therapist relationship but now we need to do the same in terms of the virus.

We, as a practice, are clear about what we can do for clients to reduce their anxiety. But, it’s also important that we provide our clients with a secure base, and that requires clarity and boundaries.

This is what we have formulated going forward, that other practices and practitioners may find useful

  • Counsellors are going to be mindful of who they come into contact with and are going to be socially responsible and self-isolate if there is any doubt.
  • We all agreed that washing hands before we start seeing clients and between each client is going to be done as a matter of course. No shaking hands. Keeping at least one metre away.
  • Separate tissues are placed out in the room so there's no neccesity for touching a tissue box.
  • The entire office is going to be disinfected every morning before the day starts. This includes keyboards, phones, door handles, work surfaces, bathroom facilities and handrails. Bathroom towels are being replaced by tissues that are easily disposed of.
  • We are also using fabric disinfectant on the upholstery, particularly where hands are placed. (There was a lot of debate around this but, after testing, we found the smell is reassuringly clean and not overpowering.)
  • All windows are opened and fresh air is allowed to pass through all the consulting rooms. This is done first thing in the morning and again in the afternoon.
  • We agreed (after much debate) for each associate and their clients to be responsible for their own used tissues. Waste paper bins have been removed. We have made small nappy bags available for these which are placed in the outside bin at the end of each session by the client. Tissues that catch tears, sneezes and coughs can’t be touched by counsellors
  • As my practice runs on lots of tea,we are all using our own mugs that get taken home and washed.

We consciously empowered ourselves whilst managing a situation that we are powerless to change

There was no easy way around this and we have all had to adapt but we have had to be clear about our aim to keep our clients and ourselves safe. Key here is a level of trust that we have in each other; trust that we will each be diligent about managing the issues, so that the possibility of coronavirus does not impact on their next client, themselves or the next user of the room. We also agreed to keep a watching brief and protocols will change if required.

By the end of our meeting, we all went away with clear protocols that went beyond just washing hands. There was a sense that we had managed to provide ourselves with a clear way to respond that made us and our clients feel safe.

We consciously empowered ourselves whilst managing a situation that we are powerless to change.

The reality of the current situation and next steps

This is a difficult time for our clients and for our practice. Having a clear protocol enables us as counsellors to manage how we operate in an ethical way. In my practice, now we’ve decided on those protocols, it’s freed us up to provide the psychological support that is required around the outbreak - and I will keep asking myself if we can do more to support our clients for many months to come.

Having concerns about coronavirus is reasonable, but when it starts to impact your mental health, seeking support can help you formulate a way forward that makes life manageable.

Find a local therapist through Counselling Directory or speak to a charity specialising in mental health support.