8-21-2020 update

IMPACT OF CORONA VIRUS ON THERAPY SESSIONS

As of this writing, all work with my private practice clients are still conducted in the virtual setting through the end of September 2020. In these stressful time, change and exceptions are afoot. For one thing, restrictions on insurance coverage for therapy sessions has been lifted. You may even be able to count phone calls for some insurance-covered sessions (although most insurance is requiring video to be included.)

Here is info on this from the US Dept of Health and Human Services for therapists for example on being able to use virtual services / solutions that are not usually approved of for telehealth (please check your individual situations to be sure of getting paid / being covered). That means providers should check which insurance companies are covering virtual sessions, and whether specific video solutions need to be used. Clients should call your insurance company to make sure they are covering video or phone sessions, and again, if it’s OK to use any system, or if it must be certain ones.

Many are not quite concerned with limiting contacts and following “social isolation” precautions. But as we see the inevitable progression of Covid19 cases (and the US follows about two weeks behind Italy’s situation), it’s become more critical in my mind, to be cautious. This is having a huge impact on many businesses and many support services. The impact of corona virus on therapy sessions does not have to be negative though, if you can work with the virtual arena.

HOW VIRTUAL SUPPORT WORKS

As usual, therapists will want to check with your billing manager or insurance companies, and clients will want to check with their insurance plans on how the coverage works.

Logistically, a session can use any number of virtual solutions – you probably have used Facetime or Skype for example. Many professionals use Gotomeeting, or Zoom for business or group meetings. For HIPPA compliant (privacy protected/secure) meetings, there are free solutions by doxy.me or vsee.com for example. My therapy group Sondermind has set up their own virtual session system which is working well. Go To Meeting also offers a HIPPA compliant virtual setting.

I worked in a telephone counseling position for 19 years. Although initially everyone said they preferred face to face sessions, after one ten-month program, most clients I worked with changed their view. In the end, they preferred the phone setting for it’s convenience, it’s easy intimacy and depth over time, and the way the lack of distractions helped us get to the heart of the matter.

Today’s virtual solutions provide video capacity, so you can also see each other. You can also choose to block your video from your end, if you’d just like audio and if it feels distracting (insurance concerns are relevant). Right now in a national emergency, it’s clear that adding this format helps our safety and well being. It can be more convenient, and even more supportive of intimate sharing of  feelings and deep expression, versus the face to face setting. Everyone’s different; I’d suggest you honor your preferences and be willing to experiment.

Do check with your providers and arrange to have the support you need in such a crisis/opportunity time. It’s important not to lose ALL of our support systems right now, as many of our usual support systems are needing to close doors. Massage therapy anyone? : (

STRESS and COPING challenges

As you might see, the Corona virus is testing everyone’s stress and coping practices. Quick notes: Coping with what we can’t control? Very very different than coping with challenges where we have control. If we need to get toilet paper for example ; ) we may have to get there when the stores opens these days.That’s taking control. If we’re more anxious and distracted, having a good supply of TP won’t quite be enough to calm our nerves or help us stay grounded. That’s where we need practices that regularly help us lower stress levels and release the tension that builds up. This tames the ever present fight or flight instinct, and keeps chronic stress, the real health-derailer-side of stress, at bay.

See the 4 Steps for Stress for the full stress management approach we use. For now I’ll suggest a few steps based on this model, the Transactional Model of Stress and Coping.

Get a piece of paper and write these steps out – it helps the brain learn to do it on auto-pilot later.

  1. Define what about the virus most stresses you out
  2. Make two columns under that –
    What’s in your control – and – What is not in your control
    about the situation. The problem – how corona virus impacts your world.

Although it may seem like everything’s out of control, that’s never true. After the first glance, you can start to come up with other things you can control. For example, diet, exercise, stress management, communication – all huge areas you usually control. Coping here is pretty straightforward and tends to follow a type of problem solving approach. You feel empowered when you take actions, even small steps. However, not taking care of steps that are in your control that are waiting for attention – can drain you. Procrastination causes more stress, usually, though you think you might have sidestepped it.

Now, that stuff on the side we can’t control is often the most nerve wracking. Here you just need to do things that reduce your stress level – anything helps. But obsessing here can mess you up. You can catastrophize. These days, you can watch too much news for example. Unchecked, anxiety, frustration and depression can spiral and grow without regular stress reduction (meditation, pets, creativity, play, social contact).

Instead, you might list 5 things that – though they won’t change the situation – tend to comfort you, lower your stress, inspire you. For me that’s walking in the woods. For many, exercise is a key stress reducer and perspective booster. Small self care steps, like baths, or foot care, are often cited. Reading, movies – netflix now has a way for people to stream together and share comments/chat. (Note: binge-watching may work for a time, but then doesn’t help anxiety lessen when you’re procrastinating about what needs doing.) Staying in touch with friends via facetime, phone, email, letters, is another good technique to use to help the stress of what you’ve no power to change.

Another thing to mention is the boost that helping others can provide. We all know people who are more vulnerable right now, whether physically or mentally. Random acts of kindness can boost both your health hormones, and theirs. Plus, don’t be shy if  you need help or support – your helpers get helped by helping you too – if you follow me.

See the 4 Steps for Stress – step 4 on the first worksheet/page, for a list of things that can help with the stuff we can’t control. Make your list of 5 things that would most help you in this area.

“SOCIAL DISTANCING” reframing

I heard this rephrased as Physical distancing. Much better.

On a webinar I heard today from ProductiveFlourishing.com, Charlie Gilkey and Angela Wheeler had some great suggestions. The above rephrase, for example, that the isolation now is only in the physical realm. The suggestion to name 2-5 of your key support people is another good one they name. Also, to figure out what you might need, what they need, and how you’ll do it together. I knew I’d be needing to schedule phone time with friends – and set that up. Maybe a regular time.

If you have a work setting to stay in touch with if working from home, you can stay in touch through daily check ins, text messaging, team and project mgmt software, etc. There is some good info on the webinar below about how to stay productive together, and how to minimize distracting each other.

RESOURCES

4 steps for stress 

Good article from my colleague and Reiki master Meg Sullivan on Dealing with Fear: Being Practical

CO-VID 19 Resources from Productive Flourishing

What parts of this pandemic are the most stressful in your world? What is helping you most with these stressful times? I’m wishing you well as we navigate this together and rise up stronger.