March 13th, 2020

Coronavirus – Advice for Therapists & Yoga Teachers

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Following a lot of questions from clients and conversations with colleagues this week, I’ve put together this blog post regarding the current situation with Covid-19 (coronavirus) and how it affects us as therapists, practitioners and yoga teachers. As wellness professionals, it’s our responsibility to be up-to-date with the most current scientific and government advice. This will change often, and I recommend that you follow the latest Public Health England advice if you’re UK based. The information below isn’t an alternative to this, but includes some further suggestions specific to our field of work that you might find helpful. This advice may change as we move into the weeks ahead, so always follow the latest government advice or contact your professional association to find out what is recommended.

I believe that it’s also our responsibility as therapists to take a leadership role in the sense of being honest, transparent and communicating clearly with our clients at this time. We will all have concerns about the potential effects this situation could have on our lives and our businesses (more on this below), and the number one priority has to be safety – our own, and the safety of our clients, of the most vulnerable members of our society, and of our healthcare workers who will be putting themselves at risk for us.

So, if you are currently treating clients or patients in a one-to-one setting, or holding in-person yoga or other group classes, these are my best recommendations at this time:

 

1 Safety first

Now is the time to make sure we continue to maintain the highest standards of safety and hygiene and even to go above and beyond them. Because there is the risk, even if it may be low, of unknowingly passing on a virus with no symptoms initially, we need to be extra-vigilant and take extra care.

This includes:

Wash your hands thoroughly with soap and water (at least 20 seconds) immediately before and after every treatment or session. Ask your clients to kindly do the same, and explain that it’s part of your current practice guidelines to ensure the highest standards of hygiene for all. Most will be reassured and happy to know that these standards are in place. Also, wash your hands when you arrive at your treatment space/place of work, and as soon as you arrive home.

Don’t touch your eyes, nose or mouth unless you have just washed your hands. In general, get really used to not touching your face at all. This is harder than it sounds and it’s only when you ban yourself from touching your face that you realise how often we do it! If you get something in your eye or your hair is getting in the way etc, wash your hands first.

Maintain all of your usual hygiene practices as regards changing and laundering all towelling, sheets, cushion and face cradle covers between sessions, and ideally if you are a massage therapist working on unclothed parts of the body, changing your top between treatments.

Disinfect all touched surfaces (mats, props or equipment, chair arms, door handles, credit card machines, massage oil bottles/dispensers, heating pads, hot stones, phone/ipad screens if used for touch signatures, etc) after every session, and again at the end of the day. This includes waiting areas outside your treatment space, shared bathroom facilities and all surfaces. It may seem like a lot to do or to remember now, but after a few times it will become automatic and doesn’t take long at all.

The aim of your usual hygiene practices combined with additional sanitising practices in these times is to ensure that any surfaces or fabrics touched by one client are cleaned or replaced before your next client arrives.

You may wish to provide clients with hand sanitiser in the treatment room, and in the waiting area, if it is available. If not, hand washing is always best before and after treatments in any case. If you work in a muliti-disciplinary clinic or treatment space, ask your manager or receptionist about these provisions, and what other hygiene practices they have in place if it’s not obvious.

Change your greeting style. If you have some clients who you might usually greet with a hug, avoid doing this at this time, and let your clients know that this is because you’re following current guidelines. Alternatives to hugs or handshakes include the traditional greeting in some Asian/Buddhist cultures of palms together or prayer-like with a nod of the head, or you can welcome someone or say goodbye with a hand over your heart and a smile. Your clients may be unsure about what’s appropriate or wondering what needs to change – rather than avoiding the topic or being awkward, simply let them know what you’re doing instead at the moment, so they understand and feel equally welcomed.

 

2 Communication

Communication is everything, don’t avoid the topic with your clients – do the opposite! Let your clients or students know the things you’re doing to ensure their safety and wellbeing. Don’t feel that you have to hide your hygiene practices or worry that they will be worried if they see you doing things differently from usual. For example, let clients see that you are washing your hands extra-thoroughly before their appointments and using a disinfectant wipe to clean credit card machines after use, as part of a new standard routine – this is reassuring, not the opposite. If you employ other therapists, rent out room space to therapists, or are part of a therapy practice or yoga studio, reach out to each other to discuss how you are working and what your plans are.

I also recommend:

  • Sending out an email or message to clients ahead of their appointments or classes this week, acknowledging the situation, being both honest and reassuring about the things you can be reassuring about. Included in this, ask all clients who have any symptoms of cold/flu, no matter how mild, or who feel even slightly unwell, not to come to their appointment but to contact you to reschedule. Recognise as part of your email that this may be inconvenient or disappointing, but that it is for everyone’s safety and wellbeing. I am currently waiving all late-notice cancellation fees as part of my craniosacral therapy practice, to ensure that people can easily cancel if they wake up feeling unwell on the day, without having to worry about the cost.
  • If you use social media, consider doing a post with the same information as above.
  • Ask all clients who arrive for their appointments if they or anyone in their household has recently travelled from the most coronavirus affected countries (Italy, South Korea, China, etc). Also, ask again if they have any symptoms, even if you previously emailed them. If they have recently travelled from the most affected areas and/or if they have symptoms, however mild, even if they’re sure it’s ‘just a cold’ or ‘nothing serious’, it’s important that you reschedule out of an abundance of caution. It is your responsibility to decide when it is safe to treat – not your client’s. Most people will understand, even if they are disappointed. 
  • You may want to start thinking now or soon about suggesting that those clients who are in the most at-risk groups (aged over 65, or with chronic underyling health conditions like heart disease, diabetes, those with compromised immune systems, etc) to postpone their appointments at this time and to reschedule for a later date / be in touch to discuss when it is best to reschedule.
  • You may wish to offer clients the option of bringing their own towelling, blankets, props or yoga mats to their sessions, but be aware that they may then be bringing pathogens into your treatment space – otherwise, expect to be changing and/or disinfecting all surfaces including mats between classes.
  • Be prepared to answer any questions your clients or students have, around their concerns about coming for treatments or to classes, and about how you are ensuring their safety. Always be reassuring and honest, and encourage them to make whatever choice feels right for them. If they decide to cancel their sessions for the time being, be understanding, support them in their choice and let them know you are here for them whenever it’s right for them to come back.
  • Remind your clients and students that apart from following all the recommended safety advice, the best way to take care of their immune systems is by taking care of their health even more than usual, making sure they get a good night’s sleep, eating healthily, making sure any health conditions are well managed (diabetes, etc).

 

3 Start thinking ahead about the health of your business, too

I know that a lot of people are really worried about this. Your practice – if it involves one-to-one treatments, or face-to-face classes or workshops – is going to be impacted. I know it’s daunting think about the next few months, but this is the best time time to think ahead. It’s likely that there will be more cancellations than usual and fewer new bookings, the need to cancel group workshops or classes of a certain size. We may be advised not to treat in certain circumstances, or even not be able to go to work due to travel restrictions, the need to care for children or familiy members, being unwell ourselves etc.

It is much better to take a deep breath and start thinking about this now, rather than avoiding the topic, hoping/worrying, and being caught by surprise later. Even if you practice the most stringent hygiene standards and communicate clearly, it’s not possible to predict or control what will happen, or to avoid being affected in some way. Social distancing, and measures such as those introduced in Italy for example, will clearly have a huge impact on how we work if they are implemented here. What we can do is start thinking and having conversations with our clients, colleagues and practice managers about how to prepare for and manage in the weeks and months ahead.

Here are some things to start to think about. Ask yourself:

  • Is there a way that you can switch some or all of your sessions to an online format? For those of us who offer primarily hands-on treatments, this may not be possible. But it is absolutely worth looking at for talking therapists, as well as for any of you who could hold consultations online (even if you wouldn’t usually do this); this includes homeopaths, naturopaths, herbalists, nutritional therapists, health coaches, etc. If you’re daunted by the ‘tech’ side of this, don’t be. You can use Skype or Zoom to hold one-to-one sessions – I recommend Zoom for high quality online meetings, it’s easy to use, you can sign up for a free trial for ‘meetings’ (online video calls) of up to 40 minutes, and there is a monthly paid subscription for longer sessions. Why not try it out now, before you need to switch to it? Host a few practice calls with a colleague or friend, and get comfortable with it so you can offer it to your clients in a glitch-free, professional manner as soon as you need to.
  • If you’re switching to online sessions and wondering how best to take payment, while you can give your bank details to clients to make a transfer, the most secure and professional way of doing this is to be able to send them a clickable payment link so that they can pay you online from via their phone and laptop. Why not look into getting set up on iZettle or Square so your clients can pay you easily in this way – their customer service and support is really helpful, or ask someone you know to help if you’re not sure.
  • If your work involves hands-on treatment (massage, craniosacral, acupuncture etc) as an integral part of managing your clients’ health issues, and if it is no longer possible to offer these treatments for a time, could you offer an online consultation session now or in the near future, to offer them guidance, self-care advice or a home-managment plan in the event that they don’t have the same access to their usual treatments?
  • Start to think about how you will manage if the income from your practice starts to drop off in the short term. Is there some other work that you can line up alongside your practice to make up for the shortfall? Can you offer extra treatment sessions to clients now, letting them know that availability may change in the weeks ahead, and that this is an opportunity to have their regular sessions while it is still possible? On a personal level, now is the time to have conversations with your partner or family members about how to manage financially and with schedules if there is a sudden change in income levels or the need to take care of children if the schools close, as well as thinking about any savings you can draw on, if you are eligible for any benefits if you are self-employed and how to apply for them should you need to. I know that for some people this might seem dramatic, but it’s really not. It’s important to be mentally and emotionally prepared, as part of being resilient over the months ahead.

4 Holding space, and taking care of ourselves and each other

People are understandably very concerned about what is happening. As wellness practitioners, we will be (are already) holding space for that worry, stress and fear as people come for treatments and yoga classes. It’s good to acknowledge it, not only for safety/hygiene practices above, but also so your clients know they can talk about it if they want to. Setting even more of an intention than usual to create a safe, calm space feels important right now.

I’ve noticed a real mixture of reactions this week from the people I’ve spoken with – from a sense of panic, to not wanting to think about it at all, to being annoyed about how seriously people are taking it, to being super-informed and proactive, to experiencing a growing anxiety that is having a knock-on effect on their current state of health. We need to remember that everyone handles things differently. Everyone takes actions to protect themselves in different ways, ways that may not make sense to others. Be compassionate and understanding about how your clients (and colleagues, friends and family members) may be reacting.

In your treatment room or yoga studio, some people will want to voice their concerns and feelings as part of their sessions. Some people will want some respite from the bombardment of news about the coronavirus, and your treatment space may be the only chance they have to find that. Take your cue from your clients, and what they need on the day. If they ask your advice, take care to offer simple, empowering, science-based recommendations around following the latest guidelines, maintaining good hygiene (always hand washing), and perhaps encouraging them to have conversations about all of this with their loved ones and neighbours – especially older relatives and those with pre-existing conditions, as part of planning how we can best support each other. Many people are overwhelmed and fearful – be understanding, and reassure them about doing the best they can, with what it’s in their power to do.

At a time when people are probably more in need than ever of therapeutic, compassionate touch, it will be hard not to always be able to provide it if there are restrictions placed on how we work. But remember that you are always holding space for your clients, at every stage of connection with them – before, during and after treatments, and when communicating about changes to your practice. Be clear, kind and compassionate always, whatever information you’re sharing, and however your practice may need to change in the short-term.

Practice self-care. Take some time at the start of each day to breathe, to allow your feelings and your body to settle ahead of a day of treatments or classes. Check in with yourself at the end of the day – you might find you feel more tired than usual or unsettled, and need a listening ear if some of your own worries and fears have been triggered, or you might need to do some yoga, go for a run, or just zone out for a couple of hours and watch Netflix to unwind. Whatever your self-care looks like is okay – just make sure you’re self-caring.

 

And finally…

Trust your intuition and don’t put yourself or your clients at risk – if you’re in doubt, don’t treat.

If you have any flu-like symptoms yourself, do not treat clients or teach classes. In the UK, go to NHS 111 online for further advice, or if you feel so unwell that you would normally contact your doctor, call NHS 111.  If you’re not feeling well yourself in any way, don’t go to work – you need to take care of your health, and you absolutely need to make sure you don’t risk passing anything on to your clients, even if you’re sure it’s ‘probably nothing’. These aren’t ordinary times. If you feel unwell then staying at home is the best course of action, hard as it may be to cancel work when you are already worried about future income loss.

Things will change with each week that passes, and we’re all going to have to adapt how we work and live. It’s essential that we make decisions based on the available science and out of a sense of care and responsabilty towards the most vulnerable members of our communities.

For sure, panic and fear won’t help anyone. But the quote I have often had in my mind this week is from Mike Leavitt, US Department of Health and Human Services:

“Everything we do before a pandemic will seem alarmist. Everything we do after a pandemic will seem inadequate.”

The choices we make need to come from a place of being thoughtful, prepared, extra cautious, compassionate and socially responsible.

Clean hands. Clear communication. Open heart. Deep breaths.