COVID-19 has changed all our lives… our freedoms, our habits, how we spend our free time and how we interact with our clients. As therapists, we always discuss change with our clients. It is one of things that is constant and predictable. As my (non-clinical but very wise) mother-in-law often reminds me, “Time marches on and change happens.” To be sure, social distancing has contributed to our need, or perhaps mandate, to adapt and exercise creativity as we figure ways to work around the newly imposed restrictions.

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One of the most dramatic and life-changing adaptations many of us have had to embrace is the transition towards telehealth. Some important professional standards of care must continue as each of us “marches on” with our new telehealth practitioner label.

Professional boundaries must be adhered to. While these may have been firmly established in your “on-ground” practices, it becomes equally, if not more important, to create your own time/space boundaries when you are connecting with your client by telephone or over the internet. Recreating this within your remote office will be a valuable tool prior to stepping into this realm. It is important that you be aware of seeing what your client will see, which includes what you are wearing, what is in your background, where your children are as you speak with your clients. We are, in a sense, inviting our clients into our personal space, especially if you don’t have the luxury of a dedicated office space within your home.

Just yesterday, as I was walking a client through our final session, this came up from my client: “Can I ask if you’re willing to send me a pic of you in your backyard so I can remember you with a photo?” For some reason this surprised me. The fact is we did have a live video session while I was outside. I thought little of this fact at the time. It got me thinking about boundaries and what I was willing to share. Was this a boundary crossing? Allowing a window into my private beautiful garden… well, after some thought, I decided that sending a photo of a lovely Heliconia Rostrata would be acceptably within my professional comfort zone, and hopefully useful to my client, for whom our relationship and this small glimpse into my world was important.

Know your limitations with the technology that you are using or planning to use. Maybe it’s time to get back to role-playing; first practice your technology with a non-client. You may become aware of small, seemingly inconsequential mannerisms or facial expressions that you use when communicating with someone remotely. If you initiated counseling with a particular client in person, it may take some getting used to on their (and your) part as you transition to a small screen. Your clients may feel more or less open to sharing as the relationship transitions to the virtual space. Expect that you might feel a bit “off balance” with this remote therapeutic work. Be aware and adjust/adapt as needed. If you need more knowledge and training, there are many webinars (both free and not) and certifications available to help you in the transition. Chatting, commiserating, and practicing with colleagues may be another asset to help support you through this time.

Prior to each video session I check out the view as I would in the mirror prior to leaving the house in the morning. Lipstick is a must for me. I also check out the view of me that the client will see. Being aware of my professional dress (of course I want to stay in my workout clothes), is respectful.

Time and energy during the transition is another important consideration. That this “new” way of working may take a bit more time and energy than you initially imagined is inescapable. Creating clear personal boundaries around what schedule is best for you as well as for your family and friends will help you to arrive at a new balance between work and play/family/health. Flexibility, planning and self-care are critical.

With telehealth, the flow of sessions is different. Last week, a client and I were on a scheduled live video session. I say scheduled because I prepare by reading the entire case, which allows me to be in my “work mode.” Time invested prior to the session is considerably different than for on-ground office sessions. This client must not have informed their housemates about the anticipated need for privacy. Six times different people interrupted, and that drastically interrupted the flow. Monitoring and adapting the progression of my thoughts was a challenge and frustrating. It took more energy than usual to pause and return to the flow of my ideas and our conversation. It is important to be mindful of balancing expectations and reality as sessions like this unfold.

Documentation and record-keeping are going to be different as you make the transition to telehealth. In the on-ground therapy office, notes are taken and stored… left behind when you close the door. Certainly, we internalize some of the impressions and thoughts evoked during therapy, but for the most part, they remain safely behind. But once we transition to emailing, texting, and video or voice recording, all information is “out there” forever. Be aware, perhaps even doubly so, about how and what you write and say. Checking in and returning to clarify your message before pushing “send” is extremely important with remote therapy.

A client recently messaged me, “You know everything.” I worried that I was creating the wrong impression with this client… something I said or something I didn’t. And I wrote that in the next message, noting how I had years of experience but by no means knew everything. My message continued with questions around what I could do to ensure a more helpful experience for this client. The client wrote back to let me know that this wasn’t directed at me but was based upon what friends had told her and what she heard on a TED talk. We both got a good laugh out of that one. As you march on, be keenly aware of clarifying, validating and helping clients to identify feelings… since it may be more of a challenge to see and feel these in your virtual office.

All of us feel the impact of the stay-at-home order. While this pandemic has the potential to connect us, it can and will invariably throw us all off balance. And for me the key word is and has been balance, both professionally and personally. As I say to my clients, good, healthy food, adequate rest, movement and fresh air are essentials for positive health, both mental and physical. As clinicians we should adhere to the same need for a new equilibrium as we march on.

File under: Musings and Reflections, COVID-19 Blogs