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?

Mine has changed to webcam, I don't enjoy phone calls much so wasn't sure, but its been fine & still has the feel of a normal session. Of course there's some downsides like tech glitches and for me the usual therapy room with its separation feels more confidential than home.

Its been interesting as we're both home, relaxed in our natural habitats & although we'd already built a relationship, i have noticed its changed the dynamic slightly in a good way. It takes time to build trust with therapist and that room to become a safe place, I had to change therapy rooms once and was shocked how it effected me so being relaxed at home could help speed up that process.

Where I live (not UK), face to face counselling resumed alongside the other "non-urgent" medical services as soon as the very first phase of lockdown easing began.
Therapist sits several metres away from patient, handwashing required on entering/leaving. Chair disinfected between patients. No masks, unless patient requests it.

Some therapists will do social distancing walking therapy in good weather or sit in their garden, but that's no good for the winter obviously.

My brother is a CPN and does a mix of social-distancing home visits and video or phone visits.

It really does seem to vary a lot. Therapists are recommended to do online therapy if possible but it's not always possible, not for everyone.

I’m working online and on the phone from home with my adult clients. I do have kids at home but my husband is around to make sure they don’t disturb the sessions (also have a lock on my office door so they can’t barge in).

I normally do sessions in secondary schools as an NHS bereavement counsellor which we haven’t been able to get up and running again even though the demand is there - the schools won’t let us in to use the buildings even though they are open and the rooms are plenty big enough for 2 people to socially distance.

The future really is bleak for teens. No school, no exam provision, shite mental health provision and a broken economy to look forward to.

And it will be a fair while I think until my adult agency is doing face to face counselling because there’s just not enough time to ‘clean down’ the room in between clients as well as take notes.

We might be 2 metres apart, but we sit in small enclosed spaces together for 50 minutes, one client gets up and 10 minutes later another client comes and sits in the same stuffy room in the same armchair - it’s the perfect breeding ground for passing on any virus.

Sorry I don’t buy that Thewild we are cleaning down between bubbles very quickly. Our staff can do a whole corridor of touch surfaces with bleach spray very quickly. I could go a room in 5 minutes. Door handles, tables and chairs. Bring their own pen.Very little else would be touched. With children infection risk is minimal.

Too many excuses.

Do

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

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

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?

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.

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).

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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

@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.