I'm pregnant and a mental health counselor. I've been meeting my clients in person during the pandemic despite the health risks — here's why

Kylie ChaffinKylie Chaffin, left, with her sister, right, sitting where Chaffin’s clients sit during their in-person sessions.
  • Kylie Chaffin is a 29-year-old licensed mental health counselor who lives in Spokane, Washington and is expecting a baby.
  • Despite the rising numbers of coronavirus cases in her area, Chaffin has been meeting with clients in person at her private practice since late April because she says it’s necessary for the type of therapy she offers, eye movement desensitization and reprocessing (EMDR).
  • Chaffin has a high-risk pregnancy with gestational diabetes, which has added to her stress of meeting clients face to face, but she takes steps to sanitize her office and prioritise safety.
  • “A lot of my EMDR clients are hesitant to wear face masks because they want to see my facial expression and I want to see theirs. EMDR is a very emotional process because you’re reprocessing trauma,” she says.
  • Here’s her story as told to Liesl Hammer, a freelance writer.
  • Visit Business Insider’s homepage for more stories.

I rent a suite in a building of medical offices. When I go to my office on the third floor, I have to pass by medical assistants who take temperatures and ask questions about my health. I call them the ‘hall monitors.’ Once I get past them, I can go to my office.

Usually I offer tea or snacks to clients, but I can’t offer them anymore. Instead, I have to wipe down all the handles and make sure everything is clean and sanitised. I have to make sure the sanitizing agent is out, along with masks I offer people in the waiting room.

Right now I’ve got face-to-face clients and telehealth clients. If it’s an in-person client, they come in and we talk about how things are going. The virus comes up every time: frustrations with the mask, frustrations with working at home – it’s the theme for every client.

In between my in-person clients, I’ll wipe down the handles and the seat they sat in. I wash my hands in between people. I also use this fog machine that has a safer chemical that kills the germs. It uses the stuff that’s in eye drops. The CDC says you can use these fog machines for sanitizing rooms, but you still have to wipe down handles.

Chaffin's cleaning and hand sanitizing station at her office. Kylie ChaffinKylie ChaffinThe cleaning and hand sanitizing station at Chaffin’s office.

I have less time for people because I have to quickly do the cleaning, so I’m always five minutes behind.

Helping clients over the computer can be exhausting and ineffective for clients working in EMDR

Some people have done really well with telehealth and even prefer it. Some absolutely hate it. It’s more exhausting than in-person because we wait for instinctive cues from people. I’m seeking an empathetic connection through the computer screen. You have to be “on” the whole time.

Eye movement desensitization and reprocessing (or EMDR for short) is a procedure for PTSD and trauma. When you process your memories through REM sleep, your eyes are going back and forth while sleeping. Turning that system on while you’re awake can help process those traumatic memories.

This method requires using equipment. One method is to look at a screen and follow a horizontal light back and forth with your eyes. There’s another method you follow by counting to eight while thinking of a targeted memory, which is supposed to desensitize that memory over time. I also use hand buzzer tools that buzz back and forth so the client can close their eyes and imagine the memory, as well as headphones that have sounds that go back and forth.

As you can imagine, although some therapists have attempted doing this online, it’s not very effective, so I’ve had to halt EMDR for a couple of months. I eventually started seeing the EMDR clients face-to-face again in late April.

A lot of my EMDR clients are hesitant to wear face masks because they want to see my facial expression and I want to see theirs. EMDR is a very emotional process because you’re reprocessing trauma. The mask complicates things, because in the world of therapy you need to be able to connect with each other and the mask covers a lot of that up.

Even though telehealth is a great tool, it was never meant to be used with someone who is suicidal or has had significant trauma. It’s harder to ascertain how they’re doing over the computer. It’s harder to ground them and there’s a lot of safety risks helping someone virtually versus in-person. I can’t see someone twitching or picking their skin. I can’t tell if someone hasn’t taken care of themselves. People will hide how they’re doing.

In late April, I had to commit one particular EMDR client to a psych ward. I hadn’t seen them for six weeks and they were telling me they felt unsafe, so I saw them in person at that time and did an evaluation.

This person was isolated and mentally fragile. They went into a downward depressive spiral during the first six weeks of quarantine when everything shut down. I could just see that something wasn’t right and they didn’t have anyone to make sure they were ok, so we needed to find a place for them to go.

I don’t know if I could have made that call over telehealth. Seeing them in person showed me more than I could have seen on video, so it was a necessary risk to make sure this person was ok.

Kylie ChaffinKylie ChaffinChaffin cleaning and sanitizing her office in between appointments.

I’m worried about contracting COVID-19 because of what it might mean for my patients

I would never want to test positive for the coronavirus because it would mean I’d have to call up all of my clients, and tell them I tested positive and that I might have given it to them.

In terms of offering in-person sessions with clients, I still don’t know what the right thing is to do and what my responsibility should be. I’m in a bunch of Facebook groups for therapists, and everyone fights over the most ethical way to support people during the crisis. People are vicious towards each other because opinions are so varied.

I have to keep people safe, but I know I also have to see them in person. I can’t disrupt their treatment forever. Part of keeping a client safe as their therapist is being able to meet with them face to face, but I know that also puts us both at a higher risk of contracting the virus. But there’s always that question: What is my ethical responsibility? It gets very complicated. There’s so many barriers to getting the care you need.

I took this oath to make sure people are ok, and telehealth just doesn’t cut it sometimes. It’s a paradox I can’t reconcile.

Editor’s note: After taking maternity leave on July 14, Chaffin had her baby on July 18, 2020.

Liesl Hammer is a health and travel writer in the Pacific Northwest. Her work has been featured in Thrive Global, The Financial Diet, and Matador Network. Learn more at her website: lieslhammer.com.

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