Working Face to Face in COVID times

working in covid times

On 23rd March 2020, High View – like the rest of the UK went into Lockdown.  The story of COVID-19 and its effect on the world is familiar to us all.  For us, this meant that we could no longer meet with our patients, supervises, and colleagues face-to-face in either of our clinic locations.  Like the rest of the country, we found ourselves working from home and trying to find ways in which we could continue to deliver the best possible psychological support to all those that we work with.  Our work is based around the importance of talking within the confines of a private and trusting human relationship.  Although we both had some experience of working using video connections such as Skype and Zoom it was initially hard to see how the whole of our work could be transferred to this medium.  Despite this – for those people who wanted to continue their treatment throughout the pandemic – and for our supervisees and professional colleagues – we took the leap into working via the internet.  Zoom seemed to offer us the best connectivity and confidentiality and it soon became our way of working.

For some this worked remarkably well.  Our colleagues – facing the same challenge in their own work – quickly adapted and our work with them carried on much as before.  There were some regrets about missing the shared cup of coffee and the chat but there were ways around that.  Teenagers, seemingly well used to a “life on-line” adapted quicker than us and seemed to value the added flexibility that meeting from their own home offered.  We played around with ideas that took us away from our one hour – once a week – appointment slots and many youngsters preferred shorter but more regular meetings.  Some preferred being able to type things that were difficult to say.

For others, it was more challenging.  Younger children – those that prefer to share their feeling whilst playing or drawing – were less engaged by their Zoom sessions.  But even here there have been good points.  There has been more of a need to engage parents as co-therapists and keep them involved in the work – which has had a knock-on effect in terms of family relationships and parent’s confidence in helping their children to find their ways through fears and anxiety.  PowerPoint has become a useful tool in providing psychoeducation – and Caleb the Cat’s online psychological quizzes (as well as his demands for food if a session is scheduled at his dinner time) have become the stuff of legends……….

As we have gradually “unlocked” parts of the service we have experimented with some outdoor “walk and talk” sessions – and although these face the challenges of protecting confidentiality and (sometimes) keeping warm and dry – most people have found these valuable as a way of feeling more connected.

So now we are approaching autumn, winter, Christmas, and the end of the year.  What now?  Children are going back to school; you can have your hair cut and go back to your favourite restaurant.  Many people seeing their world returning to something like the “old normal” are starting to ask us “will you be doing face to face sessions again soon?”  And you only need to pass a school at drop off or pick up time to understand why.  Lots of children moving into school together and parents meeting (still at a distance) in the playground – surely its okay to start meeting in the clinic again?

We have started to think about this question, talking to each other, to our colleagues, and consulting our professional bodies.  We have studied the way that the COVID-19 virus is transmitted, listened to the news, and the evidence shared by the epidemiologists.

Our overriding answer to the question is NO.  For now and for the foreseeable future we will remain working on-line.

The information about COVID-19 is emerging all the time but the basic information has not changed since the beginning of the year.  This is a highly infectious virus that can be transmitted between people in a number of ways.  The risks increase the closer you are to someone (less than 2m), in a confined space, indoors, for an extended period of time (over 15 mins), with poor ventilation.  This describes our consulting room environments almost perfectly making them ideal places for the virus to thrive.  The risks can be mitigated to some extent by the wearing of masks and other personal protective equipment (PPE) including aprons, gloves and visors and by extensive cleaning of consulting rooms between sessions.  Better still if we make waiting rooms and toilet facilities unavailable and ask people to make health declarations at each visit.  But that is still not risk free.

And then we have the winter months.  Parents are often unsure when to go to work and when to send children to school (and their psychology appointments) – “is this just a sniffle? A cold? Norovirus? Flu? Or COVID?”  This may not matter if you are safely at home on the other end of a Zoom connection.  But it can matter a lot in a consulting room…………………

At High View, we have a duty of care to ourselves, our colleagues, and our patients.  We are highly experienced at completing risk assessments and helping people to manage uncertainty.  And our assessment is that the risks of meeting in a consulting room are too high.  And that the benefits of being able to meet are outweighed by the barriers to communication posed by masks and PPE and the other measures we would need to take.