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

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:

  1. 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.
  2. 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.
  3. 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.
  4. Hand sanitisers should be available at the entrances and exits, and clients and staff should be encouraged to use them.
  5. Reception and other areas where staff work on a regular basis may need to be protected by screens or temporary walls.
  6. 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.
  7. 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).
  8. 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.
  9. 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.
  10. Each practice should identify the procedure for appointing a professional antiviral cleaning company if required.
  11. Rubbish should be removed more frequently during the crisis.
  12. Some facilities, e.g. water cooler may not be available.
  13. Practices need a good stock of single used gloves, aprons, antiviral sprays, wipes, and paper towels.
  14. 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.
  15. 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.

COVID-19 poster for 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.

Marketing for counsellors: How writing counselling profiles may be similar to tinder?

Marketing for counsellors is an underexplored subject within our profession and even less explored when it comes to advertising online. Most of us search for services online, and even though there are more differences than similarities between buying services and using social media, this article is a playful invitation to compare dating apps to writing professional profiles for self-employed professionals. As controversial as this comparison may sound, both professionals and users of dating apps look for a match through building a profile that includes text and photographs. They hope that the algorithm (mechanism working behind the scenes of an app or directory) will link them to people who are looking for similar things.
For this purpose, let’s imagine James, who is going through a break-up and does not feel good about this. He looks for support in various places, but he also wants to boost his self-confidence, so he decided to start dating. He signed up to Tinder and made his profile from carefully selected pictures writing a rather honest description of himself. It turns out he has absolutely no interest in his profile and have not been liked back in any of the apps for a good few weeks. Why?
In Tinder or online marketing for psychotherapists, there are three factors that one needs to consider: algorithm, profile and readiness of the subject (e.g. psychotherapist to see clients or James to date someone new).

How do directories work?

The algorithm is how the application connects you with the other person (be it your love on Tinder or a client on Google). Tinder has an algorithm that is also based on a geographical location. Is James seen by the application in the right areas i.e. was his profile adequate to these areas? Is James more Chelsea or Peckham? This is an important consideration in advertising. Who is a certain application or directory made for? Is the application attracting the right audience? Is this an app for people who are looking for a long-term relationship, one-night stand or anything else? Which one does James want at this stage? By algorithm, I mean all the aspects that are related to the medium that we chose to use for advertising. Similarily in the marketing for counsellors, we need to make sure that a directory we are considering has the best potential to attract the clients we are looking for. An easy way to do it is to google phrases that we hope to be found at and see where that directory appears in the search results.

How to write a profile?

The profile is the main way we communicate. Our pictures and text provide a message on which people need to make an important decision. Nobody likes to waste their time and money either or dates or counselling. Returning to dating, since James is looking for a long term relationship, his profile must show him both as someone confident and approachable. Showing own strong points could be an attractor but may scare people who do not look for perfectionism in their lives. Would a picture of him playing with a child show that he wants to have a family or that he is co-parenting? Is it worth to put an airbrushed photo on the profile, knowing that it may attract people who don’t like him in the real-life and only add to the frustration?

Does a therapist has a capacity for clients?

Having supported about a hundred therapists starting their private practice and miserably failing on Tinder, I have realised that one of the most important and either overstated or understated issues is own readiness. According to the field theory, all of our situations are interconnected. Wheeler (1997) writes that clients do not select us accidentally, so why would people on the dating sites? Is James ready for a relationship or just to build his self-confidence by having some likes and movement in the area love? In my experience of working with counsellors and psychotherapists at the different stages of their career, I believe the readiness or capacity (a term that I prefer) is the most crucial part in attracting clients to our practices. No matter they invest in marketing their counselling practices, their capacity will be the decisive factor.

The self-belief that we can make it

Apart from the algorithm, profile and readiness, although closely linked with readiness is our shame. Am I not handsome enough to have a date? Am I not interesting or do not know how to present myself? Perhaps I am not made for a relationship, or there is something intrinsically wrong with me that will doom me for eternal loneliness? Not only when we start being therapists, but also when we get more experienced, we may be asking similar questions about our ability to do this profession. Although these questions are necessary for self-development and ability to be critical towards the work that we do, I think that the intensity and viciousness with which we may be asking them to ourselves may be related to lack of support, connection or sensitivity to our feelings.
In other posts in this blog, I will share my thoughts and experience of online marketing for counsellors focusing on the algorithm, profiles, capacity (readiness), shame and contracts. I discuss how the algorithm works for Google search engines, directories and other forms of marketing for counsellors including offline, I make some suggestions about how to write own profiles and contain often difficult feelings that arise in this process. I focus on the capacity as our readiness for seeing clients is usually not binary (yes or no), but involves capacity – for example at this time of my life, I have the capacity for five clients. Shame will come in a separate section to describe how we may undermine ourselves in this process after which I will explore various strategies and mistakes beginning counsellor and psychotherapists do when negotiating or not negotiating contracts with clients.
Of course, James had some more work to do. His dating history showed him that he needs to wait and grieve first. His dating app gave very different results a few months later.

How to calculate counselling fees? A guide for counsellors.

Ways of calculating counselling fees

There are various ways businesses decide what the price should be. Some companies check the competition to see how much others charge, some calculate their counselling fees by costs and add a profit margin on the top, some like many big businesses nowadays are prepared to offer services and products for less than it costs to produce them as they want to grow before they start making a profit. The lack of discussion on calculating counselling fees led to a vacuum filled by own attitudes to money, generational gap and a fixed idea that if you have graduated you should charge around £45 per session.

The minimal discussion on the financial matters in psychotherapy may be rooted in our uncertainty and shame of talking about money. Some of us may feel uneasy charging for our services as helping others may feel natural. The generational divide is between generations of therapists who were trained during a more supporting housing situation, they usually own home and often work from it, while the new generation has to pay the high fees for therapeutic room rental and marketing that does not concern most established psychotherapists and supervisors.

This article is an invitation to a more robust discussion on psychotherapeutic financial matters and includes an alternative to calculating the counselling fees psychotherapists may charge. It is an invitation to rethink various aspects of our work that contribute to how we set our prices. All of the questions are based on personal beliefs and decisions; no two therapists should come with the same outcome.

In this article, I will ask you four questions and then propose a calculator with a formula that may be a way to calculate your counselling fees. I suggest you note down an answer to each question on a sheet of paper.

What is a decent salary for the work you do?

Let’s start with a question what a decent salary for the counselling or psychotherapy is? We are looking here for a full-time salary of psychotherapists or counsellor in the NHS or other organisations plus-minus what you believe you should earn? We are coming from different social and economic backgrounds, and at different times of our lives we may value ourselves or the therapy differently, so after you research the salary in the NHS in your area, check if you feel comfortable with this as your salary? Please note down that salary per annum with all taxes as you will need it for the counselling fees formula calculator below.

What are annual expenses in a psychotherapeutic private practice?

Having found the salary, let’s move to consider the annual expenses. If you are a seasoned therapist you can check your last year self-assessment or limited company statement, but please do remember that we are calculating the full-time salary, so for example, if you only work three days make sure that you increase your expenses to a five-day simulation.

For people who need to figure out their counselling fees for the first time, I have prepared a prompt list of some possible expenses people

  • Expenses:
    • Room rental – this is probably the most significant expense if you work in a large city such as London, the final price depends on how many clients you plan to see as a full time professional (see below)
    • Continuous professional development – with a minimum of fifty hours (UKCP standards) and the reality that most of us completes even more hours each year this is usually the second biggest expense. Please add here the cost of travel to the workshops and conferences, hotels and food if permitted by your accountant
    • Clinical supervision including travel to and from the destination of your supervisor
    • Personal therapy including travel (see above) – as most of the guidelines for psychotherapists suggests that we should be in personal therapy, I have included this as a business rather than a personal cost
    • Books and subscriptions
    • Registrations, insurance and other professional costs
    • Advertising (website, directories – e.g. Counselling Directory or Psychology Today, Google Ads, business cards, ads, etc.) – this expense will differ if you work long term or short term as in general short term therapists need to invest more in advertising
    • Accounting and banking
    • Mobile phone, emails, etc. (consider that the percentage of your mobile phone use if you don’t own a separate phone for your business purposes
    • Stationery
    • Equipment, e.g. computer, printer, scanner, shredder (you will not buy them each year, so consider how often you plan to exchange)

How many hours a week is full time for a psychotherapist?

This is a personal question and in order to provide a diversity of opinions. While the United Kingdom Council for Psychotherapists suggests that full time for psychotherapists is anything more than 20 hours, I have asked three senior therapists from our practices in Kensington and Pimlico to share their experience. Please note the number of hours that you think constitute the full time for you. This number may change as depends on our capacity for clients, support and work-life balance.

Cristina Durigon:

That’s an interesting question and of course, this can vary from practitioner to practitioner. In my personal experience, a full-time psychotherapist would be seeing a range between 18 and 22 clients or supervisees per week. This would mean offering more or less 4 to 5 hours of clinical contacts per day. The rest of the day would be dedicated to writing notes, attending supervision or undertaking other administrative tasks. Of course, this varies depending on a number of situations such as time of the year and workload, so, therefore, these are not fixed number. I hope this helps to give you an idea of what a typical week for a full-time psychotherapist would look like.

Gilead Yeffett:

My experience of a full-time practice is working five days a week, my average week includes 26-28 clinical hours.  I predominantly work with couples and parents-children; two- or three-person sessions last an hour and a half so I plan each day to cover no more than six and a half clinical hours.  I find the work highly rewarding and find that with the right weekly supervision I can maintain a solid and viable psychotherapy business.

Emily Cavendish:

What constitutes full-time is not just about clinical hours, it is also about how you manage your resources and the extent to which your work with clients can expand to fit the time and the space you have available. I did not set out to see 30 clients a week and, in truth, I would prefer a slightly smaller caseload. However, as for so many professionals who are self-employed, there can be a ‘feast or famine’ aspect to setting up a business. I am very familiar both with intense anxiety about how I can possibly see everyone and give them the attention they deserve, as well as a gut-churning fear of all my clients abruptly ending therapy and no new referrals coming in. This unpredictably is one of the features of private practice which makes it hardly to regulate the number of clients you take on. Perhaps one answer to the question of ‘what constitutes a full-time clinical practice?’ is that it is the number of hours you can work and simultaneously honour the needs of your clients alongside your own. This is a tricky balance to strike and one that must be subject to ongoing review.

How many weeks will you work on average with a client in a year?

To understand the salary of a psychotherapist over a year, therapists need to be clear how many times in a year they may see a client. Although this can be a simple question based on therapists availability, it includes essential considerations about holiday plans, time saved for sick leave, continuous professional development as well as the therapeutic boundaries. Does your contract with your clients protect you and the therapy from them taking too many holidays? For example, a therapist may plan 4 weeks of holidays, include time for 2 weeks of sick leave, 1 week conference and offer up to 5 cancellations for their clients – this equals to 40 working weeks in a year. Another example would be a therapist who expect to be paid during all of the clients' absences, travelling once for a conference, not working over 4 weeks in August and 2 weeks of Christmas and allowing only one week off due to sickness – their working year is 44 weeks. I am suggesting here only models where therapists charge for missed clients sessions with a short notice such as sickness, train cancellations, etc.

Counselling fees formula:

In the above paragraphs, you were guided through ways of figuring different amounts that now can be put into the calculator below:

 

The counselling fee that you calculated above is an average fee for a session, but you may consider increasing your price to offer some charitable work.

Social responsibility and offering discounts

A lot of my supervisees, especially those who just begun, offer discounts to clients almost automatically. As we (therapist) often had helping roles in our families, the offer of help and work for little money may seem natural to us. Others may feel that they have not qualified enough yet, so their counselling is not worth the full fee anyway. Both of the above reasons are unfortunately related to therapists own lives and have little to do with the reality of the client’s situation; they also may not support therapists in their long term relationship with their clients. A therapeutic relationship lasts for years and it is vital that the therapists prevent a situation when they may feel resentful towards clients, especially if they think they don’t value the work.

If it comes to the requests for discounts, it is important to consider if the client is not devaluing a therapy as they may devalue their own emotions and psychological health. Some of the clients may come from affluent backgrounds where money has always been a point of negotiations; they may bring these skills to the therapy too, expecting that the price we offer is a starting price of negotiations.

Having warned about all ways how it may be wrong, I think that therapy should be and isn’t at the moment accessible, and would encourage therapists to offer part of their time to people who cannot afford it. This can be done on a fixed fee basis where therapists increase their average fee (see above) by the amount they want to reinvest supporting low-cost clients or a sliding scale basis. If you choose to make it on a fixed fee basis, you need to find a discreet way of informing your clients about the low-cost places for example by writing on your website that you offer a small number of concessionary places. The sliding scale system is described below.

Sliding scale

The sliding scale system is a fair and transparent way of offering prices relevant to clients incomes. Therapists prepare the sliding scale considering the average calculated above and link it with the average salary in the area or of the group of clients that they already have in their practice. When clients come to the first session or even in the discussion over the phone, the therapist presents the scale. In most of the cases, clients are asked to self-identify the place on the scale, and we would not usually ask for evidence of their salary.

The problem is that your practice may become an attractive option to the people on low income only and you may need at some point not to accept clients who earn below a certain amount as you will earn below the calculated average.

I hope that the above system and counselling fees calculator will stimulate some discussion on how to calculate fees for psychotherapists and counsellors.