Counseling After COVID-19: What Should Providers Do?

Do we dig in the trenches or stay behind a screen?

Posted May 13, 2020

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Source: Unsplash

At the beginning of the pandemic, life began shifting in ways that the majority of people could have never anticipated. Now, several months into a global quarantine, debates have arisen around the re-opening of everyday life.

At the same time, the need for mental health services has become an increasingly pressing issue, as the COVID-19 pandemic, as well as the resulting social isolation and overwhelming uncertainty, have all led to significant spikes in mental health issues like anxiety, depression, traumatic stress, and more (Torales, et al., 2020). To battle this increasing need, telehealth options like Zoom, Facetime, texting and email, or therapy apps like Better Help have become more and more available to try and connect people to the necessary mental health treatment (Zhou, et al., 2020).

Still, clients and counselors may be itching to return to face-to-face therapy for any number of reasons; clients or counselors might be battling technical difficulties, clients might not have access to the means for teletherapy, or clients might not be able to find a safe/private space for their sessions. Regardless, whether counselors are thinking about bringing a client back into the office or buckling down for long term teletherapy, it is crucial to consider the inevitable gray area that either option presents. That being said, as businesses like restaurants and gyms debate their reopening, a similar question has been posed within the mental health community: When and how should counselors start seeing clients face to face?

Worth the Risk?

Given the state of the world, resuming face-to-face meetings with clients means weighing out the potential risks that come with it. Some pieces to think about might include:

Client health: In a pandemic, client mental health is not the only concern for counselors. Is your client part of a population that is at higher risk for COVID-19? Do they feel comfortable leaving home to come and see you face-to-face? Does your office allow for a session that adheres to the CDC's recommended safety guidelines? Are you and your client comfortable wearing a mask during a session? (i.e., space to keep six feet apart, easy access to hand sanitizer or a bathroom to wash hands?)

Your health: While client health is critical when considering in-person therapy, your own health is also essential. Does seeing a client in person put you at risk? What about others at your office?

State guidelines: Even with the health of yourself and clients taken into account, the guidelines in your state are a necessary piece of the puzzle. What are the recommendations around leaving home? Are you located in a COVID-19 hotspot, where movement is more restricted?

Staying Online: What to Look Out For

To some, it may be easier to consider the pros and cons of returning to in-person therapy. This is only half of the equation; for those aiming to remain digital, there are important questions that need to be asked to ensure the safety of your client, even if they are through a screen:

Abusive situations: An unfortunate consequence of COVID-19 is where many individuals have been forced to shelter-in-place. If a client is in a home where there is abuse, or where they cannot find a private place to engage in therapy, it creates a roadblock for both the client and the counselor. Navigating this scenario is important for counselors who are planning to stick with teletherapy.

Suicidal risk: The distance created by using teletherapy presents a problem that some counselors might have already encountered: a client who is at immediate risk for self-harm/committing suicide. In-person, whether it is a private practice, hospital, or school counselor’s office, you may have guidelines for when this situation occurs. But what about when you are no longer right in front of the client? Having a plan in place for how to keep clients safe if this comes up should be a primary concern for counselors staying online.

Client is unhappy with telehealth: Although research has found telehealth to be just as successful—and in some cases, more convenient—in relation to in-person therapy, that does not mean that every client will be content with the transition. Technical difficulties, wi-fi lag, or simply the difference socially between a virtual person and a real one, could create barriers for clients in their progress. Having frequent dialogue early on with clients and how you can address those barriers will help to make the sessions as effective as possible.

When and How Do We Go Back?

With all of the above considered, businesses will eventually re-open and the restrictions will eventually lift, so the original question remains: when and how should counselors return to in-person therapy? Truthfully, this process will likely be unique to each counselor, client, or practice. This still means that there are a few steps to evaluate before that jump can happen:

  1. Stay up-to-date on recommendations. As mentioned above, individual opinions become somewhat moot when state regulations are taken into account. Always be aware of restrictions and recommendations at the state and federal level. Professional organizations have also begun to compile tips and tricks for counselors having this debate. The American Psychological Association and the American Psychiatric Association have begun pulling together such lists, so be sure to check in with your affiliated organization as you go.
  2. Your and your clients’ health. Again, as mentioned above, the health of you, your clients, their families, and the others in your office are of primary importance. Can you reduce the risk for your client, or are they safer staying at home? Know the risk factors surrounding all necessary parties before deciding to return to in-person or stay online.
  3. What are others doing? A good rule of thumb for any ethical or practical dilemma in counseling is to look to peers for advice. Are other mental health professionals bringing clients back into the office? If not, it may be best to consider utilizing teletherapy a bit longer. If so, what are they doing to make it most effective?
  4. Have a conversation with your clients. Above all, the best way to proceed is to be open and transparent with your clients. Voice your thoughts and concerns and encourage them to do the same. What are the risks, benefits, fears, goals, etc. for each of you that would lead toward one decision or the other?

No matter how counselors choose to proceed with clients, there must be a willingness to examine the various gray areas involved in the decision. Gathering as much information as possible and having honest conversations with clients and colleagues will help mental health professionals to provide the best services possible to those in their care.

To find a therapist, please visit the Psychology Today Therapy Directory

References

Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry, 0020764020915212.

Zhou, X., Snoswell, C. L., Harding, L. E., Bambling, M., Edirippulige, S., Bai, X., & Smith, A. C. (2020). The role of telehealth in reducing the mental health burden from COVID-19. Telemedicine and e-Health, 26(4), 377-379.

Mohr, D. C., Ho, J., Duffecy, J., Reifler, D., Sokol, L., Burns, M. N., Ling, J., & Siddique, J. (2012). Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients: a randomized trial. Jama, 307(21), 2278-2285.