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Doing therapy with masks and other considerations as we all face the “new normal.”

Posted By Karen J. Hardin, Wednesday, May 6, 2020

Written by: Kelly Martincin, Ph.D., Co-chair of OPA Communications and Technology Committee, Chair of OPA Public Sector Interests Committee

As with all CTC blog postings, this column is not intended for medical, legal, or ethical advice; it is purely for information sharing and is the experience of one psychologist attempting to be useful to her peers in a very difficult time.  To share a bit about my background, I’m a health psychologist working in interdisciplinary care environments. I have been working from home only part time, spending 60% of my time in the medical clinic working  with the medical team whom I’ve grown to love as family and who don’t have the option of working from home.  I work for a large hospital system where many decisions about masks and other personal protective equipment (PPE) are out of my hands, so I realize I don’t have to make many of the decisions that colleagues in private practice might be making.  I’ve spoken with friends who wonder “Should I wear a mask when my patients come back to the office?” or similarly “Should I ask patients to be wearing masks in my office?” and “How often should I be sanitizing surfaces?” and “When should I be transitioning from mostly telepsychology back to regular appointments?” and “How long can I delay testing appointments?”  All of these are obviously complex questions with no easy answers.  Even then, the answers might vary widely from person to person and practice to practice.  Here I’ll provide some resources and considerations that  myself and some other practitioners  will be doing in the coming months to give others food for thought as you decide what is right for you, your patients, and your individual practice.  

Recently, the listserv was very active with the “to mask or not to mask” question.  I come down on the “wear a mask” side of the argument.  The CDC has recommended we all wear masks due to the risk that we all may be carrying COVID 19 for weeks before showing symptoms.  I am still doing mostly phone or video appointments and will be for at least another month, if not longer per the guidance of leadership at the hospital where I work, but on the rare occasion when I do see a patient in person right now, I always wear a mask (it has recently become mandatory in my facility, but this is consistent with my values on this subject).  We also wear masks around the office when it’s just staff to avoid possible employee to employee transmission of the virus, and patients are asked to wear masks when they are in the clinic.  I have frank and open conversations with patients about this experience.  What typically starts out as “this is weird that we’re both wearing masks'' often quickly turns into “I’m afraid of…(insert health/finances/future)” and becomes a very deep and meaningful conversation.  Having worked in medical settings, this was not the first time I had done a therapy session wearing a mask and my concern is always that I am less able to convey non-verbal information.  This is a similar concern during the many telephone sessions that I’ve been doing lately.  When wearing a mask or doing telephone sessions, I’ve begun sharing “I’m smiling” or “that makes me feel very sad” when I know my face is less able to express what I would prefer to share.  It’s not a perfect solution, but it’s one thing I’m able to do.  An additional worry I have is for individuals who have sensory impairments.  I have yet to come across this, but I worry that masks will get in the way if a person is hearing impaired and relies on lip reading and facial expressions.  I look forward to hearing what colleagues who work closely with this population might be doing to help with this while still taking precautions.  One thing I’m noticing though is that the mask conversations are becoming less frequent.  Wearing masks in public is quickly becoming the norm.  Major store chains are now requiring masks for both employees and shoppers, so I think many people are coming to expect this in healthcare settings as well.  I will personally continue to invite the conversations with patients I see in person, but I have a feeling that it will become less and less of an issue.

I was recently discussing sanitation in the office with a colleague and how to keep everyone as safe as possible in the office.  Presently, I am wiping down my office with hospital approved sanitizing wipes once a day or before and after I see a patient in person in my office (which is rare, as the majority of my appointments are presently phone and video). The staff in the clinic where I work continue wiping down the rest of the clinic multiple times a day.  My office will also almost permit me to sit nearly six feet from another person.   I’ve spoken with colleagues who are coming up with great creative solutions for situations where sitting six feet apart is impossible, such as assessment.  There are products on the market such as clear acrylic barriers that sit on stands and have cut outs in the bottom, so you can sit closely at a table and administer assessments with some protection between you and your patient (these cost roughly $150).  I’m sure others will be coming up with other great ideas for sanitation when the time is right to transition back to mostly in-person services. 

Speaking of the time being right to transition back to in person services, when will that be?  As I said earlier in the post, for my location, my leadership has indicated that we will continue providing primarily telehealth services for a while yet, but this is what they have determined is right for our location.  I have had some great opportunities to talk to psychologists around the state of Ohio who work in many different settings with many different populations and they are doing many different things.  This is a highly personal decision that each psychologist will have to make for him and herself and the patients.  Each practice is far too different to offer any kind of blanket thoughts on the subject.  Luckily, we have some great resources to help you as you make that decision:  

  • If you are looking for general information on COVID 19, national policy, or keeping yourself and others safe, the Center for Disease Control is the place to start.  They have a wealth of information ranging from highly technical info geared at physicians to symptom checklists and suggestions for coping that is meant for all audiences.  
  • For concerns more specific to Ohio, OPA’s Pandemic Resource page has a wealth of information!  Info on inter-state telepsychology laws, the latest insurance info from Dr. Jim Broyles, and so much more is available on this page.  It’s updated regularly so check back often.  
  • American Psychological Association also has a great resource page on a very wide variety of topics.  They also have been offering free seminars on topics such as telepsychology, but these have been filling up fast so keep an eye out for these offerings! 
  • The Suicide Prevention Resouce Center has info specifically on treating patients via telehealth during COVID 19.  This is a great reminder of best practices for some of our highest risk patients.   
  • You’ve likely heard that domestic violence has been on the rise due to COVID 19.  If your patient or someone else in your life needs resources, check out the National Coalition Against Domestic Violence website. 

Some extras: 

  • Headspace is offering free meditation during COVID 19. 
  • For a cool distraction, the National Park Service website has “virtual getaways.”  This one honors Asian American and Pacific Islander Month, featuring Minidoka National Historic Site.  If you or your patients are missing travel, there is a lot of really neat content online for “virtual travel.”   
  • If outdoor distractions aren’t your thing, The Metropolitan Museum of Art in New York has an excellent Art at Home section on their website full of awesome content.  

Have questions or an idea for a future CTC blog post?  Email Kelly Martincin.

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