Face to face counselling

[Granolaslice]

Does anyone who works in the field know when it might resume? I’m on the waiting list and really struggle with talking on the phone. I’m thinking surely it’ll be possible if we’re sat two meters apart?

[Gutterton]

And the same option applies to the therapists as some have their own health issues or are shielding relatives so have chosen to remain online.

[Gutterton]

I am working for a service (adults) and we are starting back F2F on Monday using bigger rooms with SD and hygiene measures in place. We have asked current clients and new clients what they want to do - and it is a mixed response so we are offering both options.

[applesandoranges221]

I’ve had face to face therapy throughout lockdown - my counsellor works from home and has made more than adequate arrangements ( not involving masks) and we have both used our common sense! That is really different though from counselling in schools and other spaces where there isn’t that level of control, and I feel very sorry for anyone trying to work through those issues just now...

[Jellycatspyjamas]

It’s also worth remembering that CAMHS services have been massively struggling long before lockdown with ridiculous waiting lists - it was never going to improve with so many people unable to work. It’s awful - my DD is waiting to be seen by CAMHS, who at referral had a 25 week waiting list. It’ll be longer now.

[Jellycatspyjamas]

I work in private practice at home, at the moment if offer phone and online work - I honestly don’t know when I’ll see clients face to face because a) I work from a dedicated space at home so while cleaning etc isn’t an issue, being in someone’s home still is (in Scotland at least) and keeping 2m away at all times would be difficult in my work space b) I work when my kids are at school and schooling is going be 10 hours a week come August and I have no other childcare available. I can do remote sessions when my DH is home to care for the DC but that’s just 1 day a week.

Therapists have the same challenges and limitations as everyone else at the moment, I’d love to get fully back to work but can’t see it happening any time soon.

[buytheworldacoke]

As others have said, majority of counsellors have to abide by rules of wherever they're working. I'm in an educational setting and working privately through a hired space, neither of which are currently permitting me to see clients face to face. There's also the impact of indemnity insurance etc which needs to be considered.

It may be that if you have an entire team to come in and clean the room / space between clients for you that it would be more likely (as you've mentioned can happen in your school). However, both spaces I use are small, and it is just me who would be responsible for cleaning it. This would mean that the time between clients (usually taken for case notes and putting any necessary things into action, including safeguarding issues or communicating with other professionals involved) would be gone, which then leads to a less thorough service for each client. Furthermore, both my settings have soft furnishings, which aren't possible to clean to the standards suggested by public health.

Video calls are not recorded - it's pretty clear if anyone presses record during a session and I've put it into contracts during this time that this isn't to happen.

All that being said, I am incredibly frustrated that there's no ability to do face to face work, and it's distressing for clients (I work primarily with young people and can see how this will be damaging long term) that we can't support them in the way they are used to or deserve.

[time4anothername]

sorry but you don't know how deprioritised mental health is in the NHS, whatever the outward messages say and that is the fault of the budget holders and commissioners, not those working in it. Accommodation for mental health clinicians has been a big problem for a number of years. Therapists etc are the first to get kicked out when space is needed for other things, including commercial ventures like mobile ultrasound.
Whatever is said, physical health continually takes priority over mental health. At the moment health centres etc are making half the usual staff work at home let alone those rooms are sublet to.

A lot of therapists etc have to work in broom cupboard type rooms that you cannot air between patients. Patients will be coming in and sitting in the fog of the previous people who have been in and out of the chair all day. There is still no evidence that the virus is not passed in microdroplets in the air expelled when people talk, droplets that fall to the ground more slowly than those expelled from coughing.

So far there have been no statements from the government about how to manage return to face to face work for psyc therapists. Some in the private sector have been writing to their MPs for it to be raised in parliament.

Video sessions are not recorded anywhere so not sure where that fear comes from? Some mental health Trusts and services are not even allowing them because they haven't got the IT in place but where they are, the only time the sessions are recorded are either because it is a trainee therapist who has asked permission because they need it for their assessments or where it is part of the therapy and the patient is asked to record it to look at between sessions.

[Mittens030869]

@F1n1gans

I do understand, as I have 2 adopted DDs who need therapy and are missing out. My DD2 in particular has struggled so much, as she's missed her friends, and has been so anxious because of my illness. But I also see it from the other side, as I've been very unwell with long-term COVID, which obviously also impacts on my DDs.

So there are no easy answers. As I said, I think therapists should be allowed to do sessions, if they're not in a vulnerable group. Schools and GP practices should be open to therapists seeing clients there. But a lot of the rooms are very stuffy and ideal for the spread of germs.

Last year, my DD1's therapist came back to work too soon after flu, and I ended up catching it from her. It led to me developing pneumonia and being left with CFS (which is why I ended up with COVID-19).

I agree that MH issues are very important, and the NHS has a history of not giving people the help they need. I have PTSD and my DDs are adopted and have been through a lot. But there are risks and this is why face to face therapy isn't happening. It isn't the fault of the therapists themselves.

Hopefully, it won't be too long until our children's lives can get to normal. I've felt so awful about how it's been for my DDs. So I really do understand the frustration.

[F1n1gans]

My child has spiralled dramatically and I hold CAMHs to blame for some of that. It could have been avoided.

[F1n1gans]

Sharken the service we have received has been appalling, just awful. The phone call was the final straw. I had taken time off work and it was the end of the day. I am just very that having waited a long time for contact they got somebody else to ring to cancel then were miraculously able to ring a few minutes later after I burst into tears with frustration. We then had a call without all the notes.

Previous to this we had to ring the crisis team and are desperate.They know all this.

Is this seriously all we can offer children who have been through a really shitty time and are suffering hugely? If it is then it is incredibly sad.

[MajesticWol]

Even counsellors working privately still have to follow government rules on social distancing for businesses, make sure their insurance covers them for F2F etc. It’s not all up to the individual counsellor, and some of the requirements for F2F are not possible to meet right now (for instance, because of physical room size, building layout, disabilities etc).

Counsellors really really want to help, but can be held back by the various systems and legislation in place - legislation that is meant to protect people and is really important. It’s a no-win situation, but everyone is doing their best.

[Sharkerr]

You sound extremely angry and resentful towards counsellors, F1n1gans.

People are doing the best they can.

Most counsellors, unless they work privately, are having to follow the rules of their employer, such as the NHS. Not shirking or deliberately refusing to see people face to face when they’re allowed to.

Due to so many people working from home, the NHS IT systems have been under incredible strain, not designed to have so many people online at once. They’ve been working flat out to try accommodate but systems go down regularly, email becomes inaccessible, or things won’t load. That’s not the fault of a counsellor.

You sound very snide about the counsellor who had tech problems but managed to carry out the appointment 20m later: they probably thought as it wasn’t working you’d rather be cancelled with 20m notice than waiting 20m to see if it was back on (which it was). As for the puppy noises many people are having to work from home under difficult circumstances. I agree it’s not ideal for therapeutic discussions so perhaps you’d have preferred them to cancel it altogether and wait several weeks/months until people are back working in their usual environments.

[NotABeliever]

I work in mental health and I'm not allowed to see anyone face to face yet. I could sit 2 metres away easily in the room that I normally use. I've talked to my boss about keeping windows open, wearing face mask and gloves and 5 minutes to wipe surfaces between appointments but have been categorically told I can't. I asked for extenuating circumstances for a couple of people who are not engaging on the phone and again been told it's a no. Very frustrating.

[FondantPud]

I really need F2F to return. My therapist has a massive room and we probably sit 2.5m apart anyway. I only go to see him every once in a while anyway and really need that proper time.

Same with my other MH practitioner. A doctor won't do video calls and is being vague about when they might come back to the office. I am fed up with calls. It's a complete waste of time and feels like a admin exercise not a helpful discussion.

I get there are rules etc but it's so open ended it's not good for MH patients.

[LaurieFairyCake]

I've been doing face to face all the way through. It has always been fine to go out for mental health appointments.

[weaselwords]

I’m an NHS Occupational therapist that works in adult mental health speciality. We have been using phone and video calls throughout but are still getting mixed messages about when to resume face to face. We are under a lot of pressure from the universities to have students, so I’ve got one coming soon, but still no patients face to face. Like someone else said, our waiting lists were bad enough to start with, so this isn’t helping.

[Morningtviscrap]

I don't think any profession where the work involves sharing a small space for 50 minutes with a number of different people should be returning right now. Regardless of the exact technicalities of the rules that does not sound wise.

That doesn't help your child though. Is it worth trying a different therapist by telephone/video. It sounds like it was badly managed. I hope you can get some help.

[Mittens030869]

It's all very well saying that childcare isn't an excuse, but it is an impediment. We're not able to ask grandparents or friends to step in so a lot of parents are finding it hard, hence the number of people who have been furloughed.

Some people are shielding or vulnerable. My DH has asthma and I have CFS, which in my case led to me catching COVID-19, which I'm still not well with 3 months later. So it can really impact upon the life of a vulnerable person. This isn't an excuse, it's reality.

I can see the other side of it, too, however. My DDs are adopted and both are waiting for therapy. I discovered that DD2 (8) was being groomed online a month before lockdown and our adoption support worker was going to refer her for therapy. She's finally looking into it now, but she's been in limbo and she's also suffered from seeing me unwell, as has DD1 (11).

So yes, it's shit. But because of my own experience of this virus, I understand why a lot of therapists aren't able to do face to face therapy.

There will be some therapists who can do it, if they don't have an underlying health issue. I do think that should start again now. It will mean a long waiting list, though.

There are very vulnerable people in this sector, as this thread has shown. I was in therapy myself for my PTSD from childhood SA, but thankfully I've now been discharged so I haven't faced this problem myself. (I wouldn't have been able to, of course, having been ill.)

I don't see why therapists can't be given rooms at schools and GP practices now. That is very poor indeed.

I'm sorry to hear about what so many of you are going through.

[F1n1gans]

Rooms don’t need to be sterile.

You need to be able to sit 2 metres apart maybe only 1 soon and any surface touched needs to be cleaned. Get rid of soft furnishings like schools have. Most sessions my dd has been to has involved zero touching other than sitting on a chair and touching a door handle.

Bleach spray, disposable cloths, gloves and a bin. A wipe down after each patient. Not hard.

[F1n1gans]

So we need to badger secondary schools and government, the little rooms used in schools aren’t likely to be needed for the rest of the school. Gov need to give out guidelines for face to face and really those in the field should be proving why they don’t think their office spaces are safe. As I said offices up and down the land are being used and deemed safe. Strange only the mental health sector which can’t come up with safe spaces.

[Craftycorvid]

Outdoor therapy is one option for resuming face to face work, but it wouldn’t be suitable for every client’s needs. I’ve been working with people via phone and video call but it does change the dynamics - not always negatively. Sometimes people like the fact they can’t be seen and they find it easier to get to the essentials of what’s troubling them more quickly. I suspect remote therapy is going to be with us for a while yet. I couldn’t guarantee a sterile therapy room (and yes, some are like cupboards with no windows).

[Nikki078]

Unless the 2m and face mask rules are relaxed I don't think face to face counselling is likely to resume, at least on the NHS. I genuinly hate the phrase 'being creative' but I think this is the only thing we can do just now for accessing support - taking phone calls in a car or on secluded walk if you've no quiet space at home, video calls when family's out on walk, walk and talk counselling sounds like a good option if available. I was suprised video counselling did work for me as a client - I've always dismissed it as not as good as face to face until I had no other option. Yes it was different - but after a few sessions felt normal.

[TheWildRumpyPumpus]

What don’t you buy?

That the secondary schools haven’t allowed us back in?

Or that we don’t consider our therapy rooms Covid safe?

[F1n1gans]

Senior management, office staff, teachers..... we all do it.

[F1n1gans]

Do

Schools are doing this day in and day out. Not seen many spikes.