Privilege and Disrupting Our Comfort Zones
A week ago I wrote about how to navigate your practice during a public health crisis. Many of my colleagues were practicing business as usual and planning to continue seeing clients in person. It seemed to me that there was a reluctance to think that what was already an apparent pandemic would reach us. By “us” I mean the world that we know and it’s relative privilege. The kind of privilege we have as a culture when we don’t relate to anything disrupting our lives. The kind where we can’t conceive of disruption to our incomes or to our comfortable offices and spaces. A lot has changed in a short period of time.
Responding vs. Reacting
There has been a lot of dialogue on email listservs, on social media platforms and anywhere that therapists gather and communicate about what to do about the advisement from public health officials and government officials. Many on social media in particular debated whether or not COVID-19 virus was a real concern and whether or not it should be taken seriously. Others were reluctant to give in to what was being described as “panic.” It seems to me that many therapists, like most people, struggle with change. It seems to me that the willingness to take this virus seriously is directly connected to ones ability to both imagine being adversely impacted and by having the flexibility and will to respond to the crisis. That being said, some folks were taking the issue seriously from the outset and started planning accordingly. Others were forced to react as they started to receive what for them was adequate confirmation that the threat of the COVID-19 virus is real and that it requires a response from everyone.
Today -just 7 days later- almost everyone is trying to transition at least temporarily to distance work. Some, I am sure, are waiting for a national quarantine which I expect will come any day now. I am not immune to understanding why people don’t want to disrupt their lives as they know it. They don’t want anything to change despite the fact that things are changing. As therapists we are not immune to denial or rigid thinking. We want to reason that both we and our clients can’t “afford” to not meet in person. After all, the therapists’ work is not just about serving their clients…it is also about how they are putting food on the table. Clients are being let go from their jobs in service industries or other jobs where companies are cutting back because the economy is stalling. Some therapists are facing their first recession during a time when maybe they were only just earning what they needed to get by anyway.
We are living in the ultimate ethical dilemma… how to meet the client’s needs when those needs might conflict with our own and vice versa? How to meet our needs when the client has needs as well? Many therapists are worried about clients who will not have adequate resources during this crisis. As clients lose jobs and insurance and others were under insured to begin with; therapists worry about being able to get paid for telemental health sessions based on whether or not their client’s plans cover it. But also other concerns like what are the billing codes? What about client’s being able to still prioritize therapy when they now need to stock up on supplies and they may not have adequate resources. How do therapists adapt to working at home while their children are home from school and also need to be monitored? The problems are broad and they require solutions that are bigger than us and outside of our control. Fortunately or unfortunately because of the pandemic everything is flux. Just today the Department of Health and Human Services issued a statement relaxing the requirements surrounding HIPAA HITECH and having a BAA agreement….while paving the way for health care providers to use Facetime and other accessible video communication resources to provide services.
Faith & Humanity
The truth is that during this crisis a lot is going to change. We don’t know where this is heading and for how long. A lot of people are struggling with how to live with this uncertainty. Some people of faith are putting out messages that suggest that their religious belief/faith is going to protect them. Rather than a more nuanced representation that faith can bring peace and an understanding that all will be well. But it is our collective efforts as a community, as citizens and as human beings that will help us reduce the impact of the COVID-19 virus.
Licensing Boards and Professional Associations are Separate Entities
In times of uncertainty, therapists have been questioning their ability to do their work and to know how to do their work. A lot of people are questioning what is allowed and they are seeking reassurance from the licensing board and from professional associations on what to do. The licensing board governs our practice by way of writing rules and enforcing them by addressing complaints against licensees. They also of course issue licenses, revoke licenses and restrict practice. They monitor our license renewal and audit to make sure that we obtain our continuing education. They accept correspondence in writing via email or in a letter to the board. The administrative staff that answers the phone can answer rudimentary questions abut submitting an application to the board. The board does not generally tell us how to interpret rules; instead they point to the rules that are in place and we can interpret what they mean by them based on how they rule on issues that come before the board. While we have ethical guidelines from the licensing board, they do not in fact tell us how to practice in the sense of our day-to-day clinical actions. At their best, our professional associations advocate for us and help us organize as groups of professionals. They can assist with interpreting board rules and they also support continuing education by approving continuing education and also providing it. Professional associations during a time like this are likely fielding questions and providing information as best they can. However, professional associations are not responsible for you or your choices as a professional.
Someone Tell Me What to Do
It is not wrong to ask questions and to seek support. We should be doing that. However, it is very clear that many people are stepping forward and it becomes difficult to discern what information and advice is “correct?” What’s valid? Who is the authority? With the underlying reasoning being…”I need an authority to tell me what to do” even though I am licensed and even though I have access to training and information. These observations are not to shame those who feel uncertain. This statement is to acknowledge the inherent vulnerability in our professional networks. People who are not independently licensed should be talking to their supervisors. People who are independently licensed should be talking to their colleagues with whom they consult on a regular basis. If you don’t have this, then get it ASAP. If you are a supervisor and/or a consultant and you don’t know what to do then you should be consulting with someone who does. That is in fact what you should have been doing before COVID-19. If others do not consider you to be an expert in professional ethics and our professional licensing and regulations then you probably are not and you should refrain from giving advice no matter how well meaning.
Telemental Health Guidelines in GA
In the state of GA we have had telemental health guidelines from our state licensing board for Counselors, Social Workers and MFT’s since September 2015. These guidelines require every licensee to have 6 hours of telemental health training prior to providing telemental health services. I wrote about it at the time the rule was passed. I urged colleagues to seek training and as far as I know, many if not most of us who are licensed by the composite board did. The problem is that not everyone put very much of what was learned into practice. Because at the time many could not see how it related to their very traditional practices. The truth is comprehensive telemental health training probably bought to their awareness how much teletherapy intersectionality already exists in a modern practice from having a website to using a smart phone to communicate with clients to having an electronic health record. It’s not too late to adapt, to learn, to get re-trained…and to put what you have learned and are learning into practice.
Next Steps….What now?
- Monitor the insurance companies websites and communications. Contact them if they are not already letting providers know how they are accommodating during the pandemic.
- Monitor the licensing board and professional associations websites and notifications.
- Pay attention to relevant training opportunities and talk to people you trust for recommendations.
- Search for information. You will be amazed by what you can find if you look for it.
- Put your client’s well-being first.
- Trust that doing the next right thing will ultimately lead to the best outcomes for as many of us as possible.
In the meantime, I wish everyone the best. The best of health and well-being. The best in stress reduction during this time of social distancing. Be well.
Copyright © 2020 Ruby Blow. All rights reserved.
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