New Year News – different yet familiar

Some things are changing snd some things are staying the same. Read on to find out what’s happening in the coming months…

Currently I share the consulting room with a colleague. We split the time available in the week where I am able to work Tuesday, Wednesday and Thursdays half day and a full day on Fridays and my colleague has the whole day Monday and the other half of the mid week days. As my caseload has grown, however, I find I don’t have much wiggle room for rescheduling and don’t actually have enough time to have a full caseload. This is largely due to the space between clients. I used to work on the basis of 10 minutes between the end of one appointment and the start of the next but this proved inadequate when working by phone or video, I needed more time between appointments and adjusted appointment times accordingly, which sometimes meant working later into the evening.

Since starting to see clients in person over the summer, with the measures laid out in this blog post to minimise transmission risk, I am finding the room a bit small.

The usual maximum number of clients a therapist sees is around 20 per week. In some services it can be more than this – when I worked in prisons with people with addiction issues I was seeing 30 to 40 prisoners a week to offer support. In social work it wasn’t uncommon for caseworkers to have 60-80+ clients on their caseloads (which perhaps meant seeing them once a month at best) but the recommended limit within therapy registration bodies is 20; this is to ensure quality and safety of service. At the lowest this year I have seen 3 clients, at most 16. I have space for 17 currently. I now feel able to expand this to around 20. This means moving office.

So in March I’ll be moving to a slightly larger office within a 2 minute walk of my current location. There will be several advantages for clients: more flexibility in being able to reschedule appointments; more flexibility in appointment availability for new or returning clients and much lower risk in terms of covid-19 transmission (which was low anyway but will now be close to zero using current modelling).

As an aside, on covid-19, I have had only two clients who had been in close proximity to covid-19 positive people, but who themselves isolated appropriately and tested negative. Another two have isolated after having to travel abroad for family reasons.  There has been one instance of a new client who tested positive a week after initial appointment and they did not return to therapy. It’s not possible to say if they were positive and asymptotic when they visited but I got no alert on the NHS Scotland covid app and the room was empty for 72 hours after their visit. If they had been positive the risk of transmission to me was less than 5%, given the measures in place, and no risk to any other client except via me.

Therapy is still classed as an essential service by the Scottish Government and as such we continue to be allowed to work in person during tier 4 restrictions. The majority of therapists I know continue to work remotely. I will continue to work in person (and for short periods remotely with existing clients). Clients still have the option for us both to wear masks if attending in person.

I will continue to offer outdoor sessions for clients who are shielding. I have a route round Kelvingrove park which takes around 50 minutes. Outdoor sessions are weather dependant, of course.

Currently I have one space on a Thursday afternoon and one on a Friday evening. A Friday morning appointment may become free in January, as will a second Thursday appointment, however up to four clients may be returning in the next few weeks. Once the new office becomes available Monday appointments will be possible and more slots on a Thursday and one extra on a Tuesday.

Of course my caseload may fall significantly as a result of Brexit related economic impacts. Steady growth during a global pandemic gives me some optimism, however.

I will continue to be with people, possibly you, in the same way during a therapy session but there are now opportunities to work in additional ways. The new space will have things out in the open that were previously in a cupboard, only mentioned and never taken up by anyone over the past year. The furniture will change slightly, mostly the same but with additions, same goes for the pictures. It will feel different but familiar. I will be able to be more me in the new space and this will undoubtedly mean you will be more you, which is kind of the point of therapy – to be more like yourself. Plus ça change, plus c’est pareil.