The current pandemic has impacted various areas of our lives including how and where we access counselling. Although initially, the majority of sessions moved to the online domain, clients and therapists are more often considering restarting face to face sessions. This guide is an outcome of a study that Kensington Counselling Rooms along with Pimlico Counsellors and Psychotherapists did to ensure our practices offer the highest standard of virus control.

In preparation, we have reviewed the governmental requirements, Counselling and Psychotherapy Union guidelines, undertaken the coronavirus risk assessment, and spoken to our colleagues in Italy and Poland that are already working face to face.

Is it safe to see a counsellor face to face?

We are confident that following these guidelines, the risk of passing the coronavirus in the counselling practices will be low. However, there are specific steps that each private practice needs to take to enable working in the same physical space. Please check with the practice management if there is a coronavirus risk assessment in place. Even though the infection may be minimised within the counselling practice, a higher risk may appear on the way to get there. Clients and counsellors should consider their own safety before deciding to work face to face.

When to start working face to face?

The government has not explicitly prohibited offering face to face therapy, and in fact, some of the most emotionally vulnerable clients were seen face to face during the lockdown. Even though most of the shops and hair salons are now operational, each therapist and client will need to make an individual decision based on the risk. Therapists and clients who are in more vulnerable groups or who cannot easily access the practice may carry on working online for longer.

To make sure that a private practice is ready for working offline, it needs to have rigorous procedures in place including a specific cleaning schedule.

How to increase the safety of a counselling practice during the coronavirus epidemic?

Each counselling practice will have to go through a rigorous assessment of what needs to be changed to enable safer working during the epidemic.

Below are the most frequent considerations:

Waiting areas may need to be closed. Waiting areas used to be meditative for some clients while for others offered nothing more than a rain shelter, now they may need to remain closed and clients may be requested to come on time of their appointment.
If working in a larger practice, therapists may be requested to change the time of their appointments to make sure that clients arrive at different times.
If possible, a one-way system should be developed to enable clients to stay away from each other and use different doors for accessing and leaving the practice.
Hand sanitisers should be available at the entrances and exits, and clients and staff should be encouraged to use them.
Reception and other areas where staff work on a regular basis may need to be protected by screens or temporary walls.
Therapists should have discussions with their clients about what to do if either of them is diagnosed. The government was not able to deliver the application that could have made the tracing clearer for our clients. Since contact application cannot be used, we need to discuss if, how and when can we disclose the client’s names and contact details to the infection contact tracers or our will executor. I think that calling our clients when having high fever and covid anxiety should be out of the question, so I suggest you get in touch with you will executor to make sure you have a procedure for when this happens.
Clients and therapists must have procedures in place to quickly move sessions online if any of them develops symptoms. I would suggest that each therapist carries with them a charged device ready for online work even though they scheduled a face to face meeting. E.g. our coronavirus poster encourages clients to check their temperature before leaving for the appointment (see poster below).
Cleaning rotas and schedules. Therapists may be requested to ventilate the space and use an antiviral wipe or spray to clean surfaces after each client. Furthermore, each private practice needs a cleaning rota for common areas that include door handles, bathrooms, etc. How often the practice is cleaned should be determined by the number of clients and therapists using the practice.
If a therapy room does not offer a comfortable two-meter distance or appropriate ventilation, it may not be suitable for face to face counselling and should be dedicated to teleconferencing only.
Each practice should identify the procedure for appointing a professional antiviral cleaning company if required.
Rubbish should be removed more frequently during the crisis.
Some facilities, e.g. water cooler may not be available.
Practices need a good stock of single used gloves, aprons, antiviral sprays, wipes, and paper towels.
Soft furnishing would need either to be protected (we used cat scratch plastic covers on the arms) or regularly disinfected using a spray that can be applied to soft furnishing, e.g. Dettol All-in-one.
Communication with clients and therapists will be crucial during this time. Practices may use posters, stickers, emails and telephone to prepare both therapists and clients for the new normal. We have designed our own floor stickers showing 2-meter distance and a poster with info for clients (see below). Feel free to download the poster and send it to your clients.

Implementing the above steps require consultations and training. Each counsellor and staff working at the practice must be aware and have agreed to these changes. With the influx of counselling clients that are expected after the coronavirus pandemic, counselling and psychotherapy practices must have procedures in place to minimise the possibility of infections.

If you are looking for a counselling room to rent that is coronavirus ready, please find more info here.

Self-care is important in every day-to-day life, but especially when we find ourselves in isolation. With the Coronavirus spreading, isolation is becoming the norm for the elderly and vulnerable. You can also feel isolated if you have had a recent bereavement of a partner or parent. A person who has been a big part of your life suddenly not being there can trigger feelings of being alone. Or, if you are feeling depressed and you cannot face the outside world physically or mentally, you can shut down and avoid connection as it can feel too overwhelming.

We have been asked to self-isolate and most of us, more or less reluctantly complied. Most of us went through a phase of disbelief or even denial of the severity of the problem. It is hard to accept the need for isolation if we are in good health or young age, yet the virus reminds us that nobody is immune. We may also pass it on other people, so why it’s so difficult to accept it? It’s hard to recognise and accept our vulnerability in a society that on day to day basis teaches us to ignore it, we may also resist desperately the isolation that is against most of our human, social instincts. Isolation is difficult.

For some of us, coronavirus isolation will trigger a sense of abandonment. Even though rationally we know that we have to stay separated, in our feelings, we may be reminded of the times when we lost connection with someone or got rejected. Being in a state of anxiety can also feel hugely isolating, as a person can feel nobody else can understand how they feel. They believe that avoiding connection or any social contact is easier than having to reach out and explain how they are feeling. When in a fight/flight mode it is hard to communicate how we are feeling, as the part of the brain that helps us communicate shuts down - so reaching out can feel particularly hard. Having a self-care plan for these moments of isolation, as well as long term self-care, can be immensely valuable and healing. In times of isolation, it can be a time to ground, be present and set goals for the future and recharge. It can also be a time of feeling alone, overwhelmed and mentally unstable. Having self-care in place can help with this.

The most important thing is that our self-care pattern doesn’t become another burden. Coronavirus isolation and fear can make us overactive too and we can even use this article as a new project for ourselves, rather than a resource and support. Please treat every piece of advice in this article as a possible invitation and start from pausing and sensing what is good for you. For example, healthy food is good for us, but turning ourselves into nutritionists in the next few weeks is a rather challenging task.
Self-care means being kind to yourself and taking responsibility for your emotional and physical wellbeing. There are many types of self-care, I will mention just a few - physical, emotional/mental and social.

Physical self-care during coronavirus isolation

Good Sleep

Getting enough sleep is paramount for mental wellbeing. When we sleep, we produce serotonin which is our happy hormone, so if we are not getting enough sleep on a regular basis, our serotonin will be low.
Tips for good sleep:

turn off all electronics a couple of hours before bed,
do something to help switch off the thinking mind before trying to sleep (e.g. a hot bath, reading, mediation, yin yoga) - read out article on Mindfulness for more info.
If you have had a stressful day and your mind is racing, it can be helpful to write down how you are feeling in a journal or even on a piece of paper
Keep a journal of your dreams.

Also, often when we feel tired can be the best time to connect to our emotions as we do not have the energy to suppress them. You often hear people say “I am feeling sad because I am tired”, but the truth is the feelings you have when you’re tired are what need to be connected and expressed. So it can be useful to check in with oneself when tired to see what feelings are there that we might be unaware of.

Moving/Exercise

When we move, it helps move our energy and process our emotions. When feeling isolated, we can get stuck in the thought loop of “I am alone”. Moving can help move through this. Exercise also makes you feel good physically and emotionally.
Some ways to move if stuck at home: put music on and dance round the kitchen (how many times have you done that after a few wines!). This is a great thing to do first thing in the morning. Music is also uplifting or can help you have a good cry/release of anger if you feel you need to express that.
Shaking – literally shaking things off. Our bodies do this naturally when we are in shock or trauma.
Walking in nature – leave your phone at home and be present in the moment, connecting to nature is healing.
Yoga and stretching are amazing for the mind and body. Yoga can help you breathe deeply and tune out of thinking and become present, not lost. Stretches feel great in the body.

Healthy food

Soul food! Food that we enjoy and that is good for us is nurturing. It can also be great to spend time cooking for yourself (an act of self-love).

Expressing

Being able to express emotions is vital for self-care - having a good cry if feeling sad, having a good shout (not at someone) if you need to express anger. Often when we do this, we end up laughing, which is a great physical release too. Own your feelings, though, don’t blame someone else.

Emotional self-care

One of the most important areas of emotional self-care and stress management is our relationship with social media. Designed to cause a sensation, Facebook, Twitter, Instagram, and so on, need to be assessed in connection to your own wellbeing. What news is necessary during coronavirus isolation? How much in a day can you take? Which sources of information nourish you and provide you with an adequate connection with the situation outside of your home and which cause you unnecessary stress?

Connecting to people, you feel safe with to be able to express how you feel is important. Perhaps have a couple of friends on speed dial that know sometimes you are isolated so need to speak to someone or even have a check-in text.

What things can make you feel grounded?

Feeling grounded in a state of relaxation when we feel in touch with the ground underneath or just aware of our breath. You can achieve this through mediation but also deep belly breaths, listening to music, reading listening to a podcast, cooking or gardening. We are all different, so finding our unique way to de-stress is vital. Some of us can benefit from belly breathing. When we feel stressed, our breathing tends to go shallow, fast and into the chest, not the whole body.

Compassion and kindness to self

Watching your inner dialogue with yourself. If you find yourself thinking negative thoughts about yourself, ask yourself: “would I talk to someone else like that?” If you tend to have negative thoughts towards yourself, perhaps you could try starting the day with three things, you are grateful for or like about yourself.

Social self-care

That’s not a surprise, we are inherently social beings, and lack of interactions may be detrimental to our mental health. Many of us started reaching out to friends, either via the telephone, zoom or other apps, and some of us may choose to have additional support seeing a counsellor. Zoom dinners, book clubs or birthdays quickly became a reality, and it’s important that we schedule some of them. However, we may also need to have good boundaries. If you don’t have a strong “No”, your “Yes “means nothing. It’s important to not people-please. Check-in with your needs first don’t do something just to please someone else.
Sometimes someone can feel too overwhelmed or stuck in a place where it’s hard to reach out. However isolated you are feeling, please remember you are not alone; there is always someone you can connect to and support you.

If you’re feeling isolated, depressed, anxious or in a place where you need some support from professionals, please reach out to a counsellor or, if urgent, here are some useful places to call and connect with.

Samaritans call 116 123 or email.
Sane: 0300 304 700
The Mix If you are under 25: 0808 808 494
Calm if you identify yourself as male: 0800 585858
Nightline if you are a student.

For online counselling, if in isolation, please contact our online counsellors.

Category: COVID-19

Are counselling and psychotherapy practices safe for face to face work after the pandemic?