This is the dilemma for many therapists: How can you safely practice talk therapy when just opening your mouth to greet a client could mean sharing the deadly coronavirus? To be clear, talking for an hour in a closed room falls squarely within the CDC’s description of how the virus is transmitted:
“The virus that causes COVID-19 is thought to spread mainly from person to person, mainly through respiratory droplets produced when an infected person coughs, sneezes, or talks. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs. Spread is more likely when people are in close contact with one another (within about 6 feet).”
If you are thinking about seeing clients in person again, you need to create a detailed plan before you unlock your office door. We’ve pulled together guidance from the major therapy-related associations and from government agencies:
Here are the key points for counselors to consider before reopening:
Do no harm Our first duty is to protect the welfare of our clients. Determine if an in-person session is necessary. Remember, your professional associations and the government are all recommending that you use Telemental Health if possible. If you decide to hold in-person sessions, document your decision and the steps you’re taking to protect client safety.
Laws, ethics and risk management Check with your state board and your liability insurance company to see if you can legally and ethically reopen your office. Talk to your liability insurance company to see if you need more coverage. Ask if you need to have clients complete a COVID-19 waiver. Work with a lawyer to make a plan for contact tracing if you or a client contracts COVID-19. Update your informed consent documents.
Clients Educate clients about the options for telehealth. They may get a false sense of security if you open your office. Make sure they know the risks of meeting in person and that you cannot guarantee their safety. Are your clients in a high risk group for getting severely ill if they contract COVID-19? Tell clients who are not feeling well to stay home. Make sure you give your clients a copy of safety protocols before their appointment. Post a copy of your protocols on your door so clients can read it before entering.
You, your employees and colleagues Make sure everyone in your office is well. Get tested for COVID-19. You can be a carrier even if you don’t have symptoms. Make sure everyone has been trained on your new COVID-19 protocols.
Hand sanitizer Keep plenty available and ask clients to use it as soon as they enter the office.
Masks Masks save lives. According to the CDC, “masks are recommended as a simple barrier to help prevent respiratory droplets from traveling into the air and onto other people when the person wearing the mask coughs, sneezes, talks, or raises their voice.”
Make sure you are comfortable wearing a mask during multiple therapy sessions. Make sure your staff is comfortable wearing masks all day. Remember, germs exhaled by your clients may end up all over the front of your mask. Don’t touch your mask. Don’t touch your face.
Require masks for your clients and make sure they know your policy before their appointment. Will you provide masks to your clients, or do you want your clients to bring their own? Keep extras on hand for clients that forget to bring masks to session (and some will). Do you want to charge them for the masks if you provide them? Remember, make sure you have told your clients about your policy on masks before their session.
Special notes on masks:
Clients who cannot or should not wear masks: Clients who are very young, or clients with intellectual and developmental disabilities may have challenges wearing a mask. The same goes for clients with PTSD, OCD, or clients who have suffered trauma. Think about how you will accommodate these clients if you reopen your office.
Clients who refuse to wear a mask: Masks are controversial. They have been politicized. Be prepared to offer telehealth for these clients.
Babies: The CDC does not recommend masks for infants, children under 2 years old, or anyone who has trouble breathing.
Clear masks: Consider a clear mask to help clients with hearing impairments read your lips.
Face shields: The CDC doesn’t know yet if face shields provide enough protection and the agency does not currently recommend using face shields as a substitute for masks.
Signs Add reminder signs to your front door so the clients know what to expect when they open the door. You can purchase professionally-made signs at many office supply stores.
Cleaning your office This isn’t your routine office dusting. You will need to make sure your counseling office has been thoroughly cleaned and disinfected before you open and that it stays clean. Follow the CDC safety guidelines for businesses and OSHA’s guidance for workplaces. The coronavirus can remain on surfaces for days and it can linger in the air for hours. It can be killed, but you have to use the right products. The EPA has compiled a list of disinfectants shown to be effective against the coronavirus. If you hire an outside cleaning agency, make sure the workers understand the extra cleaning that is required. You may want to share a printed version of the CDC’s cleaning guidelines.
Each time a client leaves your office, you need to clean before the next client arrives. Clean every surface the client touched including chair arms, door knobs, pens, clipboards and play therapy supplies. If you open your office restroom, you will need to wipe down all touchable surfaces after each use. Same goes for your break room. Be sure to wear gloves and a mask while you’re cleaning.
Ventilation Does your office share a ventilation system with other offices? Do you have a filtration system to keep the virus from spreading between those rooms? Check with your building manager to make sure your air conditioner and heater aren’t spreading the virus.
Social distancing You’ve heard this many times by now, but remember – the coronavirus spreads by talking, coughing, sneezing and by touch. Is your counseling office big enough for you to sit 6 feet away from your clients? How about your lobby? If you have clients waiting together, do you have enough space for the clients to sit 6 feet apart? If not, you can arrange for clients to wait outside and to be called in one at a time. Do you share an office with other therapists? If yes, consider alternating days so that you don’t overlap. Remove magazines and other shared objects.
Remember, Telemental Health still is your safest option. Above all, do no harm to your clients, your self or your staff.