psychotherapy

Each of us will decide when we feel confident enough to begin in-person contact with others. Like many, psychotherapists must weigh the risk to their clients, families, and themselves.

As you consider this question for yourself, the article in the link below will be very useful:
https://erinbromage.wixsite.com/covid19/post/the-risks-know-them-avoid-them.

In his article, Erin Bromage has given a sobering, detailed analysis of the primary ways that people have gotten infected. Some of the main behavioral sources of transmission are toilet flushes, sneezing, coughing, yelling, speaking, and simply breathing. As most are aware and Bromage notes, actions such as touching contaminated surfaces and then touching your face can also transmit the virus.

The most common locations for the transfer of the virus have been in private homes, prisons, religious ceremonies, choirs, indoor sports facilities, and workplaces. Restaurants, parties, and funerals have also been high-risk settings. Curiously, Bromage did not mention hospitals, nursing homes, doctors' offices, and other health care facilities.

Basically, as the work closures are loosened, and we start to venture out more, possibly even resuming in-office activities, you need to look at your environment and make judgments. How many people are here, how much airflow is there around me, and how long will I be in this environment. If you are in an open floor-plan office, you really need critically assess the risk (volume, people, and airflow). If you are in a job that requires face-to-face talking or even worse, yelling, you need to assess the risk.

https://erinbromage.wixsite.com/covid19/post/the-risks-know-them-avoid-them

There is a lot we do not know yet, but it is clear that the risk of contracting COVID-19 will be on-going. For many of my clients and their families, this risk could be life-ending.

I do not believe we will be able to meet safely in an enclosed office for many more months.

It is possible that some therapists will opt for providing talk therapy in outdoor sessions, such as while walking in a park. I will be considering the use of outdoor sessions, although that would require additional safeguards for safety and privacy.

The good news is that teletherapy via video-conferencing is possible and works very well with most forms of psychotherapy. I will continue offering teletherapy.

Neurofeedback conducted in the office with both therapist and client present will likely be impossible for an extended period of time. Clients who wish to purchase or rent a neurofeedback system will be able to do neurofeedback in their own homes with my supervision via video conferencing.

I hope that you and your family are safe and remain healthy. If you, like many of us, have lost family members to COVID-19, I am deeply sorry for your loss. If you have suffered with COVID-19, my heart goes out to you and I wish you a speedy and full recovery.

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I've been thinking this past week about how a large-scale infectious disease outbreak, such as appears likely with our current Coronavirus, might affect psychotherapists' private practices.

I've been surprised by how many clients come into my office with sniffles and worse. It is cold and flu season, but now many clients nervously mention their sniffles and some are much more careful to not infect others in the office.

It strikes me that teletherapy would be fine for most (70%) of the work I do. Getting ready now to provide teletherapy may make sense.

There are a number of articles about how the general population can prepare for the increase in COVID-19 cases, such as this article: https://www.nytimes.com/article/prepare-for-coronavirus.html.

Synthesizing what I've read, here are what I'm seeing as the key points for private practice folks:

  • Wash your hands with soap and water frequently. You can use hand sanitizer if your hands aren't dirty.
  • Cover your nose and mouth when you cough or sneeze with the crook of your arm.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • If you are sick, stay home unless you are leaving to see a medical doctor.
  • Get a flu shot, if you haven't already.
  • You may not want to use face masks unless you are already sick, have a compromised immune system, or are in regular contact with sick people.  (Good quality masks appear to now be very expensive and in short supply.)
  • Keep at a distance from sick people. (The safe distance is often described as 3 to 6 feet, which is how far large droplets travel. This article -- https://universityhealthnews.com/daily/eyes-ears-nose-throat/how-far-does-a-sneeze-travel/ -- suggests that fine droplets may travel 19 to 26 feet, or even 200 feet, and at great speed. So, the advice to stand away from sick people may not be realistic.)
  • Prepare a plan and communicate it to your clients.
  • Stock up on any supplies your business might need in the event that shopping or supply chains are interrupted. (This may also apply to essential food and water. Already, an office device I had ordered is on indefinite delay because COVID-19 has caused manufacturing and supply problems in China. Face masks, hand sanitizer, and toilet paper may also be in short supply.)
  • Realize that only about 2% of people who catch COVID-19 die, but be especially careful if you or any your clients likely have weakened immune systems.

I'm very aware that a post like this could be viewed as fear-mongering. That's not my intention. Our goal should be to be able to offer ongoing psychotherapy services while also doing what we can to help our clients and ourselves remain healthy.

Please send me an email if you have comments or additional suggestions!

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Mental health providers and other professionals often talk about a child or adult's "dysregulation" and "self-regulation," but these terms are often left undefined. A 2017 summary and the 2015 report from the U.S. Department of Health and Human Services help define self-regulation and show the complex social, biological, and environmental factors involved in development of self-regulation.

The summary defines self-regulation as "the act of managing one’s thoughts and feelings to engage in goal-directed actions such as organizing behavior, controlling impulses, and solving problems constructively."

Components of self-regulation
Self-regulation is a term that refers to a number of essential capabilities for successful human functioning.

Being able to self-regulate helps us succeed in many aspects of life, including creating satisfying relationships, tolerating difficulty, prospering in school and work, managing finances, and maintaining physical and mental health. Self-regulation is a critical life skill. ...continue reading

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TIME article on increased rates of teen depression and anxiety

An article in Time Magazine by Susanna Schrobsdorff, Anxiety, Depression, and the American Adolescent, explores the causes of the recent significant increase in teen mental health issues.
http://time.com/magazine/us/4547305/november-7th-2016-vol-188-no-19-u-s/

Schrobsdorff identifies a number of potential causes for the increased rates of depression, anxiety, and other mental health problems ...continue reading

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Neurofeedback is a type of psychotherapy that helps you return your brain to the way it was designed to work. It has been used successfully to help people with a wide variety of problems, including depression, anxiety, ADHD, serious behavior issues, addictions, sleep issues, epilepsy, PTSD, and brain damage from head injuries.

The "neuro" in neurofeedback refers to nerves and the nervous system because neurofeedback measures the electrical activity of the nerves in your brain. "Feedback" refers to the visual, auditory, or tactile information (in other words, feedback) that a neurofeedback system gives your brain to help it shift its brainwave patterns.

Neurofeedback is a form of biofeedback applied to the brain itself. It uses the brain’s natural abilities to learn in order to help it function more efficiently. ...continue reading

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