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New ways of working: Counselling during COVID-19

When lockdown fully took effect on 30 March, the Bereavement and Emotional Support Service was working with more than 100 clients in the community and in Jersey Hospice Care.
The response to COVID-19 varied across the psychotherapeutic sector. Many private practice therapists quickly went online; but other agencies suspended client work altogether.
Our team – administrator Nicky, and counsellors Maria, Mary, and Claire – was determined to find a way to continue supporting existing and new clients. We stayed on site at Clarkson House, and got to work to establish a safe and ethical online practice.
Initially this meant:
• Sourcing professional guidelines and training for counselling and psychotherapy during COVID-19
• Writing new JHC policies, forms and therapeutic contracts to reflect how phone and video counselling work differently
• Contacting all our current clients and everyone on our waiting list to ask what they’d like to do; wait until face to face counselling resumes or start Zoom or phone counselling
• Send new guidelines and training modules to our valued student and volunteer counsellors and advise them on safe practice and the best way to continue to either check-in with or support clients
A more complex issue was how to prepare for COVID-19 unknowns; the families who may sadly have been affected by COVID complications and the impact on grieving families affected by travel or care home restrictions.
Who and how many might need support and how should we manage this different kind of grief and loss? Our professional networks made all the difference. We worked closely with many other government and third sector agencies both in Jersey and in the UK. Mary liaised weekly with Jersey Bronze Command, and the National Bereavement Alliance COVID group.
Meanwhile, we continued to run a busy counselling service; the usual day-to-day referrals were coming in, we were still operating online peer supervision for our students and volunteers, and attending our own online clinical supervision.
Now, nearly three months in, where are we at? And what have we learnt?
• About half of existing clients opted for online or phone counselling. The rest wanted to wait until face to face restarts. They weren’t comfortable with the new approach, or struggled to find a device to use, or a private space to share their concerns. For some, it wasn’t comfortable to be in therapy with family around.

• Clients go therapeutically deeper more quickly on the phone or by video. It can work well, but it needs care and can be more tiring for both client and therapist – so we had to schedule fewer sessions a day than normal. And clients seem to prefer briefer and fewer sessions working this way.

• Working on the phone or online is not like being in a room together. It’s harder to pick up subtle shifts in mood or body language, especially when connections are poor quality. You also go straight in and out of a session with phone and video; there’s no pre or post-session chat about the stuff of everyday life that develops the relationship.

• We thought carefully about the quality of our emotional support to IPU families. Face to face work was suspended initially, but video support wasn’t always suitable. Some clients were too tired or unwell and the connection was sometimes unstable. Moving out of COVID Stage 4, we’ve been able to balance the risks and support patients face to face.

• A significant plus is that within two weeks of lockdown, we rolled out a safe, ethical service with new ways of working – this might have taken much longer in a pre-COVID age.

• And, by going online, we’ve increased accessibility for people who can’t visit JHC in person. Now, there’s no barrier to therapeutic support if you live in a residential home or have small children, or can’t use the bus, and that will continue in the future.
With restrictions easing, our referrals are increasing and we continue to offer a full counselling service by phone or video. To safeguard JHC patients, we won’t be moving to face to face counselling support imminently, but we look forward to welcoming all our clients in person when the time does come.

Mary Le Hegarat and Claire Stanley