When we collectively decided, late last year that we wanted to start our own psychology and psychiatry practice, we did not factor ‘global pandemic’ into the ‘potential risks’ section of our business plan. Just a mere three weeks after opening our newly kitted out clinic rooms…we closed them again. It would be untruthful to say this hasn’t been somewhat disappointing. However we, like many others, are adapting to new ways of working.

A media article recently reported that Health Secretary Matt Hancock advised that NHS Mental Health Services would “soon resume”. We can assure Mr Hancock that mental health services never closed down. They have continued to provide vital care and treatment to the population by whatever means they can. Although we do not provide a crisis service at The St Andrews Practice, we have continued to provide consistent online support and treatment to our clients where it is sought. We have also paused treatment for a number of clients who have opted to wait until face-to-face sessions can resume.

We will admit that until March 2020, none of us had ever provided online therapy. We have taken this chance to educate ourselves on the application of different therapeutic modalities using Zoom and Skype. This type of therapy works well for some individuals – some even prefer it. We have noticed that a number of our clients are more open in their sessions, perhaps feeling less vulnerable within their safe and familiar surroundings. Many of our clients are continuing to work towards planned treatment goals, and have had more time to pause and reflect than they might have had in a pre-COVID world. For some, the impact of the pandemic has been overwhelming, requiring considerable psychological re-adjustment. Some clients may be sharing a living space with people who trigger a dysfunctional belief system and overwhelming emotions. We in turn are providing a therapeutic space in which to process the losses, contain the anxieties, reflect on the family dynamics, and to cultivate a sense of hope for the future. We are adapting to try to meet our clients individual needs as best we can. Herein lies one of our most valuable skills as psychologists…that of re-formulation – the process of bringing new information to the pre-existing understanding of a person’s psychological process, and accommodating this new understanding into their individualised treatment plan.

For us personally, and perhaps for some of our colleagues, there is an undeniable sense of loss for what we now refer to as face-to-face therapy. There is little that compares to being in the room with someone, bearing witness to their fears and traumas, reacting to subtle non-verbal cues and using silence to draw out emotion and reflection. Yet the therapeutic efficacy of silence is perhaps diluted when there is the perpetual anxiety that your client will wonder if your screen has, in fact, frozen. We miss the physical act of passing the tissue box, hanging a coat for someone, making sure they don’t have the sun in their eyes. Even these small acts of caring contribute to the sense of safety in the therapeutic relationship.

Yet even in the face of the stress and disruption of this pandemic, and often with many physical miles between clinician and client, there is still significant and observable therapeutic progress being made. There is huge meaning and value in travelling this unknown path with our clients and in supporting them to ride out the many unexpected waves of anxiety that are currently impacting on all of our lives. Whilst our method of delivery may have changed, our fundamental role has not – be the steady ship in the storm. The remote access treatment gains we have observed have led us to decide to offer the option of online treatment on an ongoing basis. So just as we re-formulate our clients’ psychological processes (and our own), we are also re-formulating The St Andrews Practice.

We hope to use this space to discuss a range of pertinent issues in mental health and clinical practice, focussing on a different subject for each post. We will also discuss how we are developing and further informing our online practice and adjusting our approaches in light of the current pandemic. We hope this will be both informative and reassuring that we are here to support you now as much as ever.

You can find more details of the therapies that we offer on our services page.

The St Andrews Practice Team