Face to Face Counselling During Covid

As England commences a national lockdown in November, is it possible to continue counselling face to face? The UK is now experiencing a second wave with warnings it may be more deadly than the first wave in March.    The following factors may help you decide whether to go back to online working or continue to see clients face to face (it is written for practitioners in private practice).

What does the Government say?

The latest guidelines can be found here: Government Guidelines

The Government states that:

To help contain the virus, everyone who can work effectively from home must do so.

Where this is not possible, you are allowed to travel to your workplace and this includes visiting people in their homes.

So can you work effectively from home?  This is a question to consider.

The Government encourages the public to attend their medical appointments and states additionally that:

Support groups that are essential to deliver in person can continue with up to 15 participants where formally organised to provide mutual aid, therapy or any other form of support.

This has been used as an argument for the continuation of face to face counselling.  It certainly indicates the government’s willingness to consider mental health needs during the pandemic.

The Government’s regulations also state that businesses that can remain open include:

other medical or health services, including services relating to mental health

See Health Protections (Coronovirus Restrictions) (England) (No 4) Restrictions

It is unlikely the Government will outlaw face to face counselling, especially given the quoted paragraph above.

What does your insurer say?

Remember that you should have adequate insurance to cover your work.  To practise without insurance means you and your client will be unprotected should anything go wrong.  Check with your insurer to see if there are any up to date guidelines.

What does your professional association say?

BACP, UKCP and NCS all give clear advice to their members.  As the government advises working from home, online practice is recommended.

National Counselling Society

“The UK Government advises that we work from home where possible. This remains the case when in a Tiered system, as well as during a National Lockdown.

The Society’s advice to members is to continue to offer services remotely where it is possible to do so.

Members may make individual decisions to work in the room with a client if it is not possible to work remotely due to a risk to the client”.

You can read the NCS guidance here: NCS Guidance to Members

BACP

Given the Government’s guidance to stay at home unless absolutely necessary along with the closure of close-contact services we advise that, wherever possible, you do not continue to see clients face-to-face if other options are available. 

You can read the BACP guidance here: BACP

UKCP

Official guidance urges people to work from home if they can do so effectively. For therapists working independently, there may be some instances where, in their professional judgement, they feel they cannot work effectively remotely. In this situation, therapists should give careful consideration to the consequences of in-person work – including whether they or their clients are at higher risk from COVID-19…

Guidance in England lists ‘medical appointments’ as a justifiable reason to leave home and travel. We await clarity from the government as to the precise definition of this, but one could reasonably interpret this as inclusive of therapy. However, as with other medical appointments (such as many GP appointments), therapy should be delivered remotely if it is possible to do so effectively

You can read the UKCP guidance here: UKCP Guidance

So the advice from professional associations is clear – to work remotely from home whenever possible.  So how do you make the decision whether or not to return to remote working?

What Do Your Ethics Say?

As an independent practitioner, ethics can inform your decision making when the answer is unclear.

So what ethics can be applied in this situation?  I use the BACP Ethical Framework as a reference here.

1. Beneficence, non maleficence, and autonomy

   Can you balance the need to do no harm – i.e., reducing the risk of virus transmission – with promoting your client’s wellbeing? The client may wish to exercise their autonomy and continue face to face, but you may need non-maleficence to take precedence here. Individual ethical principles may conflict and so each practitioner has to complete their own assessment of priorities according to individual client circumstances.

2. Our commitment to put our clients first

   When considering face to face work, are you making your clients’ needs the priority? Is it essential for them to see you face to face? If there is a conflict between your client and your own needs, you have a duty to discuss this with a supervisor or an experienced colleague.  For example, taking a risk with your own health in order to support a client who is at risk.

3. Being trustworthy, having integrity, acting with courage

   Your clients trust you to take decisions with their interests at heart.  Your ethics require you to be honest with yourself about your motivation.  It may be more convenient to work face to face but is it safe?  It may be difficult to face the prospect of turning clients away but courage enables you to do so.  Equally, you may need courage to continue to work face to face if that is required.

4. Self-Respect

   It is important for you to take your own needs into consideration. By working face to face you are increasing your own risk of contracting the virus.  What are your needs?  There is an ethical duty to protect your own physical safety.  At the very least this calls attention as to how you make your workplace covid secure.

5. Candour

   The duty of candour means an open and frank discussion with the clients about the risks inherent in working face to face. BACP say: “Working indoors over a sustained period of time increases the risk of transmitting the virus” (click here) Clients need to know that confidentiality may be affected if it is necessary to disclose their details to the track and trace service.

The BACP say:

A decision or course of action does not necessarily become unethical merely because it is controversial or because other practitioners would have reached different conclusions in similar circumstances

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