RECOGNIZE THIS AS A SWIFT AND RAPID CHANGE. This is a TEMPORARY change during a very critical time in history. At some point, in office therapy will return. Whenever a monumental change like this happens, there are likely to be huge impacts. Some practices may move completely online.Some will have to shift specialties or areas of competence to meet the post-pandemic needs. At present, therapists may need to shift interventions. However, if clients are stable and not significantly impacted by the pandemic, the therapist may decide to continue on as planned with therapy goals. As the pandemic begins to impact people, interventions will most likely need to shift. This is a normal part of providing services during a crisis.
RECOGNIZE THE LIMITATIONS OF TELEHEALTH. Some clients aren’t appropriate for telehealth and that isn’t going to change in a pandemic…in fact it may heighten the limitation. The limitations may be related to the following: lack of knowledge of technology; lack of appropriate internet service; or lack of appropriate privacy. In addition, certain disorders or characteristics may not transition well to telehealth including: paranoia, particularly involving technology; psychosis; extreme impulsivity and dangerous behavior; and potential for violence. During a pandemic some therapists aren’t able to move to telehealth if they lack of tech experience and require additional training, lack of privacy at home, and lack of stable, high speed internet. Even through we are in a pandemic, therapists are required to practice ethically. Most importantly, know your requirements regarding personal health information and which platforms meet your specific requirements. DO NOT THINK THAT A REGULATORY COLLEGE OR LICENSING BOARD WILL LET YOU OFF THE HOOK BECAUSE OF AN EMERGENCY!! Be aware that some interventions may be harder to implement…harder but not impossible. Most of these interventions can be used online but there may be some training requirements to transition the skills to the online space. Telehealth does lend itself well to more directive approaches like DBT, CBT, and resilience interventions. As long as you stay within your scope of practice, the interventions can be transitioned to online with different shifts or adaptations. You may be pleasantly surprised how well children transition and find telehealth a pretty cool way to meet. Clients may also just be grateful for the support during the stressful time of a pandemic.
SHIFT SESSIONS TO CRISIS RESPONSE AND SUPPORT There are three phases of crisis intervention including prevention, intervention, and postvention. During prevention therapists may take steps to build capacity prior to the crisis However, with this pandemic we weren’t offered too much time to do prevention work. During the intervention phase, the main tasks are to assess, stabilize and prevent further emotional deterioration. When the crisis is over, the postvention phase starts and the following questions are top of mind: What will be needed for follow up? What will be needed for healing after the crisis is over? What services or referrals will be needed after the fact? This phase can more difficult work and emotionally draining particularly if you have been involved in the intervention stages too. However, this is an area that therapists can be STARTING to think about and prepare in advance. The benefits of preparing in advance include the feeling of being in CONTROL…which is the opposite of a crisis which typically has some type of loss of control. We are also in a much better position to serve our clients after this is over if we have focused on providing the support after.
In summary, when doing crisis intervention work it is important to go back to the basics. These basics include the first phase Judith Herman’s three phases of intervention for trauma (Stage 1: Safety & Stabilization; Stage 2: Coming to terms with memories; Stage 3: Integration of experience & Meaning). In crisis response intervention the main part of this that we are focused on is SAFETY & STABILIZATION and the most important aspect of this is to NORMALIZE their responses. Rely on the therapy relationship & trust it by being present, consistent and allow clients to feel safe seen, heard & understood.
Most of all, practice good self-care, trust your clinical intuition, and seek your own support if needed.