Compassionate Decision Making for Counselors and COVID-19

For many Licensed Professional Counselors, the pandemic put us in a position to quickly change our business model, moving from in office sessions to distance counseling with little time to plan or consider the long term effects for ourselves or our clients. We recognized a risk, and quickly moved to protect all of those involved; after all, our first consideration as therapists is do no harm. When I made the decision on March 13 to close our offices, I was wise enough to model for my clients and associates how to resist the urge to exit or suspend services until “we can get back into the office” but I never could have imagined 10 weeks later we would still be doing therapy in spaces and places that I teach other clinicians are less than desirable for sound clinical practices for telemental health. 

As clinicians we are tired, physically and emotionally. We are questioning the effectiveness of our services. Determining how to best address the needs of young children, family and relationship counseling when we have chosen to move our practices solely to distance counseling. From a trauma informed stages of change perspective, many of us are sitting in a contemplative stage of how to return to a healthy state of emotional, physical and financial well being. 

Each week, as I contemplate this decision for myself and those who work for me I ask myself the following questions:

• What recommendations are being made by the CDC related to social distancing and essential healthcare workers?

• Can each member of our team implement these recommendations consistently and effectively? 

• Can that be done without impacting the cost of services, to the business, the clinician or the client?

• Do I and each member of the team feel emotionally and physically prepared to provide effective therapy while incorporating safety precautions at an effectiveness rate higher than the services we are providing via distance counseling platforms?

• Am I as a business owner and the members of my team willing to take on the emotional and financial liability risk associated with infecting someone else or their family members when we don't know our health status as we enter the office each day? (keeping in mind asymptomatic carriers)

• How will our clients react to any decision we make based on their values and how will that reaction impact our credibility in the therapy room and in the community we serve?

Answering these questions is a very introspective, vulnerable and brave exercise. It is not a process where anyone can or should tell you what to do or pressure you to make a decision based on their experience. I specifically use this framework weekly because new external data is made available to me as a decision maker and I am developing resources and resilience as each day passes to strengthen my ability to thrive as a business therapist in this new environment. 

Being mindful that exhaustion will cloud our ability to make informed decisions, there are some small and affordable changes you can consider:

• Be transparent with your clients. Openly discuss the physical and emotional impact this situation poses to the therapeutic relationship. This level of transparency, when done through a humanistic lens with sound boundaries, will role model self care and respect for the relationship.

• Adjust session patterns, times and prorate/adjust fees accordingly

• Use 

  • blue light glasses or screen covers to reduce eye strain

  • topical anti inflammatory products on neck, shoulders, temple/forehead (under medical supervision where indicated)

  • heating or cooling pad or weighted blanket on lap to assist with therapist (or client) grounding and presence

  • chair with a footrest and proper support

• Use your  breaks between session for walks, sitting under a tree when weather permits, or petting the dogs when it doesn't (this is my routine, set up your own that permits a dispelling of energy and regrounding for your next session)

• Join a consultation, supervision or community group, there are many free groups meeting across the state and country or make one with folks you know, as Bill W would say it only takes two to make a group

This pandemic is exhausting on so many levels. We all long for normalcy. I keep reminding myself we aren't going to "go back to the way it was". The way it was is in the past, just like we tell our clients. Instead I have to find the path through and that will be uncomfortable for an unknown period of time. I hope by sharing my lens you find ways to persevere.

Wishing you emotional, physical and financial health,

Nick Fuentes, MS LPC, LMHC, CST, CPCS, NCC, CCMHC

Pronouns: he/him/none

All identities. All genders. All relationships. All people.