So when can we see you in the office again, are you reopening soon?

I wanted to put out a special blog this week to the question that we are hearing most often, when will we be reopening to see our clients for their counseling sessions in the office? The answer is both simple and complicated: We will be very happy to go back to being able to see our clients in office just as soon as it makes scientific, medical and therapeutic sense to do so.

We know how frustrating it has been for everyone over these last few months. Our whole lives were turned upside down with limited notice and no sense of control. We have spent months hiding in our houses and avoiding all social contact and now, just as the sun is beginning to shine (literally and metaphorically), we are all starting to creep back out of our isolation. This gives us the urge to move ahead full speed and get everything ‘back to normal’ as fast as possible.

We understand that everyone has different views on the severity and importance of COVID-19 and the dramatic actions that have been taken in order to address this global pandemic. As a counseling office we are not qualified to make judgments on medical issues or infection dangers. Our training and specialty is based on the mental health spectrum and we follow the guidance of epidemiologists (professionals who study patterns of disease and health risks) regarding best practices and protocols during this pandemic.

In this ‘step down’ phase of social distancing we are seeing many things reopen and people rushing back into social elements at a fast pace. Please keep in mind that much of the protocols that are being adjusted are based on governmental and economic concerns and are not based on a decrease in medical threat. These are changes for places of business, entertainment, dining, and shopping centers area able to be more broad in their application (provided they stay within said guidelines).

What reopening as a counseling office means

Angelus is a counseling office, which falls under the category of a medical facility and has very different guidelines to follow. Our guidelines are based on current medical indications and protocols from the Center for Disease Control and various clinical licensing boards and are NOT directly controlled by political or economic policies. Our ability to ‘reopen’ does not follow the color coded system of our state, it follows the studied risk of transmission and current disease rates. We do not have the expertise to judge what the ‘actual’ risks are for in person sessions. It is our responsibility to ensure that we are bearing on the side of caution and taking no chances on the lives or health of those we are here to care for.  Our driving goal is to ensure that we are taking every safety measure we can to protect our clients, our clinicians and our community.

At Angelus we have 12 (soon to be 13) therapists/staff, all of which who have private lives and families that they need to be able to be there for as well. On an average day we may have all 5 therapy rooms busy for the majority of the day/evening, which could mean 50 different therapy sessions occurring within just our Wallace Ave location in New Castle. That is 50 or more clients that are coming in and out of the office and interacting with our staff throughout a single day. Some of these may work in healthcare and public sectors while others may only leave home to go to their appointments. Some may be carefully following all social distancing guidelines while others may have made no alterations to their current patterns of interaction.

Some of our clients are very vulnerable and immune compromised individuals; many times we are not even aware of their having underlying medical ailments until well into treatment. Which means they could easily be exposed during the short time in our office to something that could literally be the end of their life and the person who transmits it to them may never even know what happened. That is too great a chance for us to take. All of our clients are valuable and important people that we want to keep safe in any and every way that we can.

Many insurance plans previously covered this as a full benefit prior to COVID and Angelus has been using telehealth for multiple years. Always with a very secure and protected platform to ensure the same security and privacy that our clients receive in our office. In some ways the privacy is actually even higher with telehealth because there are no accidental meetings in the waiting room, no one seeing your car in the parking lot, and no need to make awkward conversation with someone who may be coming out of the therapists office as you are going in.

I want to clarity here that there is absolutely NOTHING wrong with going to a counselor or with being seen getting counseling, but for many they would prefer this to stay private.

The insurance, medical, and technology sectors have really pushed forward to offer an alternative to putting clients at risk during in person counseling sessions by dramatically increasing access to telehealth as policy add-ons when it has not previously been offered.

It is also very significant to note that many insurances are also providing waivers for copays and deductibles if their clients use virtual appointments rather than in person sessions.

This is because they see a greater value in minimizing unwanted potential transmission of COVID then in collecting copays. At present several have extended this benefit until the end of September.

Continuing to use Telehealth

As such, we have made the decision to ask any client whose insurance covers telehealth to continue to utilize it through the duration of this pandemic. Our therapists will continue to primarily work from their home based locations and only be in the office on a very limited basis and only with special approval and circumstances.

There are also very extensive protocols that are being put in place for those specific exemptions that limit the risk of transmission to anyone within our office. These protocols are not optional and must be followed strictly by staff and consumers.

But let’s step aside from the semantics of protocols and policies. Instead of a long list of what we have to have in place I want to run you through two separate scenarios that may best explain our decision to continue with telehealth as long as medically indicated and covered as a primary option for our clients.

Much of the success in counseling is based on the connection and communication you have with your therapist. With both you and your therapist learning each other’s body language, facial expressions and tone of voice.

A ‘normal’ counseling session before COVID

Pre-Covid it was normal practice for a client to come into the office early, stop by the restroom first, and then spend a few minutes relaxing in the waiting room to prepare themselves for their session. They would often pick up a book or magazine and unwind to get in the right mind space for counseling. Family or supports would frequently accompany them and wait for them in the waiting room while there are with their therapist.

Their therapist would be able to come out and greet them at the time of their appointment with a smile and often a handshake and lead them back to the therapy office. Once there the client would pick whichever chair they found most comfortable and settle in for an in depth counseling session addressing the myriad of factors that may have led them into counseling.

They would get to spend the next hour very interactively with their therapist, discussing plans for treatment, strategies, and practicing techniques to get the best benefits from counseling. This might include settling into a comfortable position for a breathing exercise, getting up and physically moving around for a grounding exercise, or using special equipment for processing past traumas.

               Notice here that the client is often moving around the space; touching things, breathing, coughing and at times crying (and blowing their nose) due to processing very sensitive and personal experiences.

At the end of the appointment the therapist would walk their client back to the waiting room where their family members or supports could be waiting for them and then they could stop by the restroom if needed on their way back to their car. The therapist would then likely have a quick 5 mins to then get prepared and ready for their next session.

How a counseling session is different during COVID

Now, I want to lay out how dramatically different an in-person counseling session would be if we were to have them now.

• The client must take their temperature before coming to their appointment and will be unable to be seen if they have a temp above 100 and may have their temp taken by their therapist once they arrive
• The client is asked to wait until 3 min or less before their appointment before entering the building. This is to minimize the amount of time that they would be in the waiting room and have the potential to spread or be exposed to any pathogens
• The bathrooms are now locked and unavailable for client use
• All reading materials and ‘touch’ based objects have been removed from the waiting space. Making it feel more bare and unwelcoming
• Chairs and seating has been altered to keep a 6 foot space between clients in both the waiting room and therapist’s office
• Appointment times would have to be altered and shortened to allow for a 15 min gap between appointments so that each therapy room can be fully sanitized between sessions (to the best of our ability with limited sanitation supplies available in the market right now).
• The therapist will come out and get the client and ask for them to use hand sanitizer just before entering the therapist office.
• The client and therapist must sit 6 feet apart within the therapy space, which greatly limits sitting options and can increase levels of discomfort (some of our offices are not able to accommodate this distance and are not able to be used at all during this time).

Wearing Masks in Counseling Appointments

• Masks must be worn by both the therapist and client for the duration of the counseling appointment.
  • This is the big factor of why we are holding off on in person sessions. It is difficult to wear a mask for the 15 min in and out of a grocery store. Imagine wearing one for a full hour, while talking, and experiencing heightened emotions. (Imagine you are the therapist and doing so for 8 hours a day)
  • Imagine not being able to touch your face or blow your nose while crying because you are wearing a mask
  • Now imagine exposing your vulnerabilities to your therapist and not being able to read any facial expressions as to what responses you may be getting.

• Wearing a mask during counseling may increase feelings of stress and anxiety and decrease the effectiveness by being a barrier to the therapeutic process.

There are lots of other small guidelines that need put in place as well that complicate the whole counseling process.

• Not being able to have a loved one come into your session or sit in the waiting room for emotional support.
• Children not being able to touch toy objects or art materials as they may have previously.
• The therapist having to stagger appointments to allow for proper sanitation between appointments, which then cuts down on the amount of people they can see and treat each day.
• And the ongoing worry for clients and therapists with potential exposure and sickness.

To return to the issue of dispute that we are frequently hearing from people who are upset with the idea of having to wear a mask and what it may or may do to prevent COVID.

Again, we are not doctors or scientists, but we do want to do any and everything we can to make sure our therapists and clients are safe.

Wearing a mask into our office protects our therapists and staff from being exposed to any potential contagions that you may or may not know you are carrying. They are wearing a mask to protect YOU from anything that they may have unknowingly contracted that could be a danger to you. This is not a decision based on any political spectrum. We simply and clearly want the safety of those we are here to serve to be our driving factor in how we move forward from here.

Finding our way forward

We will continue to monitor and assess the pandemic conditions and recommendations by the CDC and will update or alter our protocols accordingly. At this point we are planning to remain telehealth based for the remainder of the summer.  All of our therapists are available virtually, including our school based Compass program will remain active through the summer for our Laurel residents and Lori will be available virtually to work with you and your children/teens.