There will be risk in working with clients in the same physical space – we cannot remove all risk, and it would drive us crazy to try to do so!
It’s worth bearing in mind that therapeutic work necessarily involves risk, as does breathing.
…and as Eisenstein reminds us – we are all going to die, we cannot ‘prevent death’, so maybe we can relax from that impossible demand. At the same time, it makes sense to reduce covid-19 transmission for a number of good reasons.
Navigating all this will bring up material, both for us and our clients – for example: safety and danger, contamination, contact as risky or as denied, what is reality, whose worldview to trust. It’s worth pausing to offer the opportunity to explore the emotional and relational implications of our practical arrangements.
Circumstances and context
I think it’s our responsibility to take account of our own particular circumstances, and those of our clients, in deciding when, where and how to start working with clients in the same physical space again. I would suggest that this includes (at least):
-The details of the place(s) that we work
-Our own health vulnerability, and that of those we live with or support
-Our preferences and aversions
-Our lung and gut feeling, our intuition and dreaming
-The restrictions of organisations we work for, belong to, or which have power and influence in relation to us
-Our beliefs and values in relation to the work we do, life and death, viruses, wellness etc
-The effect on our clients of our availability or non-availability to them in different channels
-The technical detail that continues to emerge about how virus spread can be minimised
-Our clients’ health vulnerability and that of those they have contact with, their preferences and aversions, beliefs and values, gut feelings, thoughts, beliefs, wisdoms etc
-Your own and your clients’ particular abilities and capacities to maintain distance and work more safely
In all of this, it seems fundamental to me that we give ourselves full permission to stick to ways that work for us, and to avoid ways that don’t work for us, regardless of their relationship to guidance from outside bodies – it is absolutely ok to continue to not work in the same physical space if we are not comfortable doing so, and it is worth keeping in mind that guidance, permissions and restrictions are generalised, and may not fit our particular circumstances. I found Nick Totton’s advice helpful: “whatever you do, don’t listen to the government, they’re just confusing everybody!”
The situation I’m in has considerable privilege, in relation to working with clients in the flesh:
– I work in private practice, in a large room used only by my clients and I
– Clients come straight into the room from the outside via an unused kitchenette with handwashing facility.
– I am able to negotiate client appointment times, and to work with a relatively small number of clients
-I have easy access to outdoor space to work in, and the confidence and capacity to work outdoors
-I have the odd ability to avoid touching my face for an hour at a time
My thought in reducing covid-19 virus spread in client work
I am no expert, not a medic or a scientist – just trying to find my way through the muddle.
My current understanding is informed by Erin Bromage’s writing, the Sage committee’s advice to the UK government, various articles from the BBC and the Guardian, and to a limited extent, the UK government guidance. My attitude and behaviour is informed by listening to my body, conversations with colleagues, friends and family, and Eisenstein’s very helpful essay.
It seems that an ideal situation to transmit the virus is to sit in a small room together, facing each other and talking for an extended period of time!
“In order to get infected you need to get exposed to an infectious dose of the virus”
Bromage 2020
“Remember the formula: Successful Infection = Exposure to Virus x Time” Bromage
“If you are sitting in a well ventilated space, with few people, the risk is low.” Bromage 2020
“Importantly, of the countries performing contact tracing properly, only a single outbreak has been reported from an outdoor environment (less than 0.3% of traced infections)” Bromage 2020
What helps to avoid infection passing
Lots of airflow
– ideally work outdoors, use larger rooms, open windows and other ventilation
-Distance: The further away you are, the fewer virus particles are likely to reach you (though in a small unventilated space this won’t make as much difference)
-Direction: Better to sit side by side at distance, or even better, back to back (see UK Gov advice to businesses)
-Time:The shorter time your client is exposed to you, the less likely they are to pick up sufficient dose to be infected
-Surfaces and hands:Clean all surfaces and hands before and after sessions
-Avoid face touching: This will minimise infection going from the environment to you, and from you to the environment
-Avoid breathing towards your clients – this may include wearing a face covering of some kind. I do wonder whether a transparent face shield from the nose downwards would be the way to go? – both keeping the face visible, and having no barrier between our eyes and those of our clients
-Keep numbers small: Work with as few people as possible, avoid groups or keep them as small as possible
Have lots of time between clients. Ideally leave the room yourself and ventilate it.
What to avoid
-Being in a small unventilated space with people shouting or singing, especially if there are lots of them!
-Spending time with people who have symptoms
What I actually do
My practice in regard to covid-19 is, I think, a combination of rational thought, intuition, wishful thinking, ungrounded fear, and insufficient information – I think this is likely to be true for most of us!
I meet with a small number of clients individually, where we are in the same physical space. This includes:
-Meeting clients for walks outdoors, which I regard as safest, taking due account of hand washing or sanitising before and after, maintaining distance, working side-by-side and not facing. I also think about walking routes – wideness of paths, and strategies for safely passing other walkers.
-Meeting clients in the therapy room. This includes keeping some distance, not meeting if either have symptoms, cleaning surfaces and hands before and after sessions, my avoiding any face-touching, my moving more slowly and consciously if we’re moving round the room, letting my client know of my movements, ventilating the room before and after sessions, if loud expression is likely to be needed then looking at moving outdoors or apologising for not offering this opportunity. I tend to change my clothes before and after meeting with clients. At the moment I am only offering 1 client session per day in the room.
I provide handwashing to clients on arrival, but I don’t require it. my thinking on this is that clients tend to touch their faces numerous times during sessions, making handwashing on arrival somewhat redundant.
I will offer physical touch, paying attention to direction and distance. I will, for example; sit back to back with a client, or offer contact from my foot to their back. I tend to heighten my awareness of potential virus transmission at this time, and negotiate slowly on safer ways to work. I don’t wear a face covering or gloves. Gloves can give a false sense of security, and my body just wants to run away if I consider wearing a mask with clients!
I welcome any feedback on these thoughts: http://www.stephentame.com/2020/06/working-with-clients-in-the-flesh-some-viral-thoughts/
Updated 17/7/20
Web Resources
I really recommend reading this blog post, and anything else from Erin Bromage – sensible science based advice, and he seems to have a good sense of the limits of his knowledge. North American but translates well to UK conditions:
https://www.erinbromage.com/post/the-risks-know-them-avoid-them
The Coronation – an essay from Charles Eisenstein – highly recommended to either read or listen to this:
https://charleseisenstein.org/voice-recordings/the-coronation/
https://charleseisenstein.org/essays/the-coronation/
Scientific advice to the UK government:
scroll down to the link: View the scientific evidence supporting the government response to Covid-19
UK government advice to businesses:
https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19
and in particular, this section: https://www.gov.uk/guidance/working-safely-during-coronavirus-covid-19/close-contact-services
Other web resources
Some clinician info from the NHS you might find relevant to your work:
https://www.england.nhs.uk/coronavirus/
An overview of deaths in the UK from Covid-19 This gives a delayed impression of what is happening with virus transmission more widely – scroll down to total announced deaths:
https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/