Guidance for counsellors and psychotherapists

The government has not provided any guidance specific to counselling or psychotherapy, but please refer to the resource on keeping workers and clients safe in close contact services.

This contains extensive guidance on risk mitigation applicable to a range of working environments. While primarily written for employers, you can adapt the guidance if you’re self-employed and working from your own home or rented premises. 

The face to face conversational element of therapy, combined with the length of exposure during a typical therapy session, puts you and your clients at particular risk. We recommend you read the guidance in full, especially:

• how will you comply with the social distancing guidelines or considering and setting out the mitigations you will introduce in your risk assessments (p8)
• if people can safely must work face-to-face for a sustained period with more than a small group of fixed partners, whether the activity can safely go ahead. The closer someone is to the source of the virus, the greater the risk of transmission. Pay particular attention to avoiding contact with surfaces near to the client and thoroughly cleaning those surfaces after each client (p9)

Devolved nations

The devolved governments in Northern Ireland, Wales and Scotland are lifting restrictions at a different pace – please see our latest information on returning to face to face work. Our previous guidance still applies and we advise working with clients remotely wherever possible.

Before returning to face to face work

If you’re thinking about returning to face to face work, you will need to:

• consider whether the space you plan to work from allows for social distancing of two metres or at least one metre with mitigation – this includes any areas such as entrances, exits, corridors and waiting areas?
• decide whether you need protective equipment such as masks or visors
• conduct and publish a risk assessment of your premises and create a procedure checklist to mitigate the risk of contamination before, between and after seeing clients. This is a legal requirement. 
• if you work with others from a shared space, ensure they’re also applying appropriate measures and there’s no risk that any of these will be compromised
• if you work from rented premises, check whether your landlord has any risk assessment or sanitisation process you need to follow?
• check if your indemnity policy covers you for face to face work
• ensure your supervisor supports your decision
• check whether you need to make any amendments to your contract with clients and asked them about the possibility of returning to or starting face to face work

Carrying out risk assessments

It is a legal requirement for all businesses to complete a risk assessment before resuming trade. If you have fewer than five workers, or are self-employed, you don’t legally have to produce a written risk assessment. However, this may be a helpful exercise and a useful document to have if asked by insurers or concerned clients.

Wearing face coverings

Should my client wear a face covering?

The UK Government has announced that it is extending the areas where face coverings are mandatory from 8 August in England, which includes a range of indoor settings when providing personal services to clients.

This does not apply to members in the other nations of the UK. Please refer to the specific guidance for Northern Ireland, Scotland and Wales.

While the list of settings issued by the Government doesn’t specifically include counselling and psychotherapy, given the extent of the settings covered and following discussions with the DHSC, to ensure the safety of the client and the therapist, at this stage we’re encouraging the use of face coverings for clients receiving therapy face to face, where appropriate.

It’s important to note that there are some circumstances, for health, age or equality reasons, where people are not expected to wear face coverings. You’ll need to take these into account before meeting with the client.

People are not required to prove they’re exempt from a face covering. Those who have an age, health or disability reason for not wearing one should not be routinely asked to give any written evidence of this.

If you practice within a service setting or from a rented space, you should also consult with your employer or landlord’s COVID-19 risk assessment and associated procedures. Face coverings are also not required in schools.

What exceptions are in place for wearing a face covering?

The Government has issued the following exceptions in relation to wearing face masks, which may be relevant to your clients:

You do not need to wear a face covering if you have a legitimate reason not to. This includes (but is not limited to):

• young children under the age of 11 (Public Health England do not recommend face coverings for children under the age of 3 for health and safety reasons)
• not being able to put on, wear or remove a face covering because of a physical or mental illness or impairment, or disability
• if putting on, wearing or removing a face covering will cause you severe distress
• if you are travelling with or providing assistance to someone who relies on lip reading to communicate

See the full list of exceptions.

Other potential scenarios where a face covering may be removed include:

• if speaking with people who rely on lip reading, facial expressions and clear sound. Some may ask you, either verbally or in writing, to remove a covering to help with communication.

You would need to agree if an exception should be applied with a client.

We accept this may raise questions about the possible effect on the therapeutic relationship of wearing a face covering. You may wish to consider whether working online would be a suitable alternative option.

We’ll continue to liaise directly with the Government to ensure we can provide members with the clearest possible guidance around the use of face coverings.

Do I need to wear a face covering?

Members should still continue to consider their own risk mitigation when returning to face to face work, including risk assessments and wearing face coverings.

The Government guidance states that where a distance of two metres, or one metre with risk mitigation, is not possible, the use of visors is advisable.

How this works in the therapy room depends on individual circumstances. Even if you can maintain the two metre distance, you and your client are at increased risk due to the face to face position and prolonged exposure during a therapy session. This is particularly important where the client is exempt from wearing face coverings themselves. We suggest you consider:

• can you maintain the recommended social distance?
• if you can maintain social distancing, do you feel the risk to you and your client could be reduced through the use of face coverings?
• if you can’t maintain social distancing, would continuing to work online be the safest option for you and your client?

Informing clients of changes to your practice and re-contracting

As the lockdown guidance changes, you should revisit any amendments you made to your contracts at the beginning of the outbreak to check whether they are still relevant or need updating. You may also want to consider whether it would be helpful to  provide your clients with any additional information relating to any changes to your practice, for example:

General practice:

• any practical changes to your practice, such as location, access, sanitisation procedures, reduced access to facilities
• any requests of your clients – for example do they need to bring their own hand sanitizer, face masks or visors. What should they do if they have symptoms of COVID-19, or have been in contact with someone who has the virus?
• what actions you would take if you have symptoms of COVID-19 or have been in contact with someone who has the virus?
• what would happen if there was a local lockdown?

Re-contracting:

• any changes to your method of payment and cancellation fees
• any potential implications to confidentiality, for example contact tracing, trusted others contacting them in your absence

Breaks and endings

If you contract the virus and can’t continue working with clients, the Ethical Framework states:

“Any unplanned breaks due to illness or other causes will be managed in ways to minimise inconveniencing clients and, for extended breaks, may include offering to put clients in touch with other practitioners.” (Good Practice, point 41)

It also commits members to make plans for who will contact their clients if they are unable to because of serious illness. This is also known as a making a clinical will.

Practitioners need to ensure that their “wellbeing is sufficient to sustain the quality of their work” (Commitment 2d). So you need to pay attention to self-care and take steps to ensure that, if you have to take breaks from practice, your clients are informed, supported and referred to other appropriate services if needed.

Contact tracing

If you test positive for coronavirus, the NHS test and trace service will ask you about people you’ve been in contact with. The NHS will then contact them to provide support and testing. This has raised concerns about whether you can identify your clients to the NHS.

The government recommends that businesses keep a temporary record of clients and visitors that they have had in the last 21 days. See the guidance for information on what this record should include and how to keep it in accordance with GDPR.

You may need to revisit your contract with your clients. Your existing contract may refer to the limits of confidentiality relating to the balance of public interest. Public interest is the general welfare and rights of the public that must be recognised, protected and advanced. Disclosures in the public interest, based on the common law, are made where this is essential to prevent a serious and imminent threat to public health, national security, the life of the individual or a third party, or to prevent or detect serious crime.

You could explain to your clients that, under this clause, you may need to share their name and contact details with the NHS if you or another client contract the virus. If you want to make it clearer to clients, you could add a separate coronavirus contingency clause, stating that confidentiality will be broken if necessary for reasons of public interest in the area of public health.

Insurance

We’ve received confirmation from several insurance providers that they are providing policy cover in relation to claims arising from COVID-19.

However, we recommend speaking with your indemnity insurance company to specifically check whether you’re covered under your existing policy.

If you’re reviewing your insurance cover and considering switching to another provider, check:

• the cancellation policy of your current provider – some insurers will not cover claims made against you for past practice if you don’t follow their cancellation procedure
• any associated cancellation costs
• whether your potential new insurer covers you for claims against COVID-19 as well as your general practice needs

The government is implementing localised lockdowns in response to spikes in the spread of COVID-19. This may have a particular impact on those of us who work close to county or country borders, where you or your clients travel to another area.

The government will be issuing further guidance on managing regional lockdowns, but in the meantime, there are several considerations regarding the potential for changes between online or telephone and face to face contact with clients:

• what are the ethical implications of potentially changing the format of therapy more than once?
• what is in the best interest of the client regarding a potential for frequent changes in the format of sessions?
• how can contracts be managed to reflect any varying nature of the session format?
• can clients access therapy online again if needed?

Due to the potential varying nature of regional lockdowns, you may decide to maintain online working until the virus is under more control and to ensure safety of yourself and clients.

Members will be returning to face to face working at different stages depending on your concerns, risk assessments, organisational policy, region and context or setting. If you can’t work remotely with clients at any stage of the lockdown, we recommend you consider the following factors on a case by case basis:

• the client’s need and safety
• your needs and safety
• the context of the service
• whether other options are possible and the ethical and practical risks of any decision
• the known risk factors of age and any pre-existing health conditions for both yourself and your client
• advice on social distancing and face coverings 
• clients with particular needs who may not be able to engage using online platforms
• whether your clients could be putting themselves at risk during the journey to and from your premises

We’d encourage you to work through the ethical decision-making process with your supervisor to make a personal decision that takes these factors into account.

If you’re in Northern Ireland, Wales and Scotland, our previous guidance still stands. Our advice is that you should continue working remotely with clients wherever possible.