Returning to Providing Psychotherapy In-Person During a Pandemic After Providing Online Services
Musing from an Early Career Psychologist
Clinical Impact Statement: Resuming providing in-person treatment during an on-going pandemic can present several challenges for psychotherapists. The presentation of some practical and clinical issues involved in this process could allow ECPs to better prepare for this transition.
It has been over a year since psychologists worldwide adapted to provide clinical services during the global pandemic. As we know, clinicians, among many other professionals, rapidly learned the nuances of working with clients online. For those whose jobs demanded to continue meeting in-person, masks became essential, a needed barrier that created some protection and made possible to share physical space with others.
The development of vaccines brought new hope, and as people started to get vaccinated and began to experience some sense of security, new possibilities opened up. Several colleges and universities are making vaccinations a requirement, and more recently, several agencies and companies have reported that they will also ask their employees for proof of vaccination. For many who have been providing services online, the consideration of providing therapy in-person became more of a reality.
In several clinical professional spaces (e.g., listservs, consultation groups), there have been ongoing discussions about returning to in-person work or continuing working on-line; however, the number of people considering providing in-person services during the upcoming Fall semester seems much larger than it was at the same time last year. Furthermore, several clinicians have already returned to providing in-person services without masks, which for many has gone hand-in hand with a greater sense of “normalcy.” However, the COVID situation continues to evolve. Recent information released by the CDC regarding the Delta variant and vaccinated individuals (Centers for Disease Control and Prevention [CDC], 2021) brought up once again the precautions that individuals need to take regarding in-person contact, including recommendations about mask usage indoors. As we consider providing in-person services, and in line with the general principles of beneficence and nonmaleficence (American Psychological Association [APA], 2017), it seems central for us clinicians to ponder what conditions could help to do no harm and increase welfare.
There are several aspects that might be relevant to contemplate regarding returning to providing in-person services in a time of a pandemic, which I will introduce below. For clarity and practical purposes, I am presenting some considerations related to clients as separate from considerations related to therapists; however, some of these might be interconnected. Additionally, I am separating some practical aspects from clinical aspects, yet in clinical work, these two might be quite related (e.g., examples of clients arriving late to session).
Considerations Related to Clients
- Recently, the CDC once again recommended masks usage under certain indoors conditions. Will you ask your clients to wear a mask? Will you wear a mask while meeting with clients?
- Will you consider asking for proof of vaccination for your clients? Will you see clients who are not vaccinated? What potential ethical challenges might be related to such considerations?
- Will you leave time in between appointments to ventilate the space where you are meeting with clients?
- If you decide to return to providing in-person services, would you offer online therapy to (a) clients with medical conditions that might put them at higher risk of COVID or (b) clients who do not want to expose members of their household who might be at higher risk (e.g., due to medical conditions, having unvaccinated children)?
- How will you manage physical distance and/or decrease the amount of clients in the waiting room (e.g., will you leave more time between clients)?
- If you are providing in-person group therapy, what guidelines will you follow if one of the group members was exposed to COVID or has COVID (e.g., will you then transition to online group work)?
- For many, meeting for therapy in-person might be one of the few times in when they are indoors with someone who is not from their household. For others, this might not be as rare; however, they can still be wary about it. It would be important to explore, process, and address a client’s feelings (e.g., fears, concerns, anxieties) regarding meeting in person, as they could affect the therapy process. How and when in the session might you consider this?
- If one of your clients starts manifesting any potential signs of disease during your session (e.g., coughing frequently and profusely, has visible signs of not feeling well, etc.) how would you ask about it and/or address this?
- If you are meeting with a client in person and they share having been recently exposed to COVID, or they share about frequently engaging in activities that might expose them (e.g., attending large group gatherings indoors without masks), will you address it, and if yes, how?
- If you are providing in-person group therapy, how will you open up discussion and address clinically if one group member exposes other group members to COVID (e.g., process and address feelings such as guilt, anger, etc.)?
Considerations Related to Clinicians
- Many early career psychologists (ECPs) might not be directly involved in decisions regarding returning to work in-person and conditions related to it (e.g., mask use, vaccination requirements). What might be some factors that might help you better engage in your clinical work in spite of such predetermined conditions (e.g., open windows between clients, use an air purifier, engage in frequent COVID testing)?
- If you have younger children who have not been vaccinated yet, or you or someone in your household has medical conditions that put you/them at higher risk related to COVID, what measures can you take to decrease potential risk for you and your household?
- What potential biases might you have towards clients who are vaccinated, clients who are unvaccinated, and clients who expose themselves or others to COVID, and how might these affect you and your work?
- As a clinician, will you disclose that you are vaccinated/unvaccinated to your clients? How will you address this if clients ask you about it?
- As therapists, we need to feel safe enough to provide the best services we can for our clients. If you decide to see clients in-person, what are some aspects that you would need to feel safe during the session or to restore safety if needed (e.g., if an unmasked client starts coughing)?
- If you have COVID or are exposed to someone with COVID, how will you process this with clients who might have been affected due to meeting with you in person? How might this affect the therapeutic relationship and the therapeutic work?
- If you know that one of the colleagues at your office tends to be less careful than you are regarding COVID related measures, how will you navigate in-office interactions?
- If you are providing group therapy in person, how will you manage your own reactions if one group member during the session discloses having recently being exposed to COVID or discloses behaviors that might put other group participants at risk of exposure? How would you explore the experience of the different participants, including the person disclosing this information?
The questions and points presented by no means are an exhaustive list of aspects to ponder when resuming in-person services. Additionally, one cannot anticipate all possible scenarios related to returning to in-person work. However, this is an invitation for ECPs to contemplate some aspects that might affect in-person clinical services. Finally, consultation and collaboration with our peers are essential as we continue to navigate the clinical world during the ongoing COVID-19 pandemic.
Cite This Article
Palma, B. (2021). Returning to providing psychotherapy in-person during a pandemic After providing online services: Musing from an early career psychologist. Psychotherapy Bulletin, 56(3), 11-13.
American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct. https://www.apa.org/ethics/code
Centers for Disease Control and Prevention. (2021, July 28). Interim Public Health
Recommendations for Fully Vaccinated People. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html