What do therapists do when they’re sick?
2022 update - So much has changed since I wrote this in 2013.
Telehealth is now mainstream rather than “this weird thing I do with tech clients sometimes.” Our concerns about transmissibility of diseases has become much greater after COVID-19 as well. I’ve transitioned to an almost-all-virtual practice at this point. Oh and the world is on fire and so both me and my clients want to drive as little as possible. Telehealth is a great option when we’re sick but not sick enough to be unable to function. (I got COVID and worked through it as boredom was the worse symptom for me).
Industry thinking around self-disclosure has loosened up a bit. There are fewer therapists operating as “blank slates” and more who are willing to show up as fully human, with faults (although hopefully not client-damaging) on display. Check out this awesome podcast from yesterday from Curt and Katie about this very subject.
I now have three kids and so I feel like I’m saving all my sick time for THEIR sicknesses (especially the 3yo - the other two can rest in another room while I’m in my office). I’m much more likely to push through discomfort and work when “not 100%” but I also am a more experienced counselor who can make that decision with more nuance.
Much of the original article holds up though, so please read!
In counselor-land there is an often repeated metaphor, "Secure your own mask first, before helping others." This is a reference to airline safety demonstrations where passengers are instructed to put their oxygen mask on prior to helping those around them, since they will think more clearly to be of use to others if oxygen is flowing. In other words, you can't help others if you are a mess.
There is no shortage of advice on blogs and in articles directed at mental health practitioners, to call in sick and take care of yourself when feeling ill. The reality is not quite as simple.
Certainly, I think most counselors would agree that if a counselor is bed-ridden, throwing up, infectious, or otherwise extremely ill, they should call their clients and cancel. But we all know, there are plenty of degrees of "not well" that a counselor might be that aren't so black and white. My personal experience as a counselor and the experiences I've heard about from other colleagues have demonstrated to me that the decision to call in sick can sometimes be agonizing. For example, what should a counselor do if they...
recently broke up with a significant other and are having a tough day?
have a lingering cold that seems to flare into a mild fever an hour before their first client is scheduled?
are learning to cope with some type of chronic pain that will not go away anytime soon?
are pregnant and coping with normal but very distracting symptoms that will continue for many months?
have a sick child at home and this is the third time in as many months that this child has turned up sick on a day the counselor is scheduled to see clients?
Sometimes, like our clients, counselors can be in a mild to moderate amount of discomfort that may impact therapy. Yet the counselor may know that the discomfort is either unpredictable or long-term and cannot reliably reschedule clients for a time when they will feel better. Although I have not experienced all of the situations listed above, I have certainly agonized about how to balance self-care with client-care and left those situations having no idea if I did the right thing by either canceling or by attending the appointment.
Here is a sampling of the things I consider when deciding whether to cancel:
Who is on my schedule today? Is the safety of any of these individuals at risk, if I cannot attend the appointment?
Do I have opportunities to reschedule this week or would I have to call and request that we skip the entire week? Can I offer a phone appointment instead?
Will I be able to do a competent job of conducting therapy in my current state? Am I simply going to be less comfortable than I would usually be or is there a risk that I will do a truly bad job at my job?
If I am unable to hide the source of my discomfort, do I feel comfortable explaining to my clients what's going on?
Am I putting my clients at any risk in terms of giving them a bug I may have?
Even with all of these considerations, I can't say that I always feel confident that I've made the "right" decision. I have called to cancel and later regretted it, thinking "oh I didn't end up feeling THAT bad." I've also gone into work and thought afterward, "wow... that was probably not the best thing for me or my client..."
Whether in a client role or a therapist role, how do you feel about therapists calling in sick?