What to do when a therapy client obviously has a cold.
August 2, 2015 3:37 AM   Subscribe

You're a psychotherapist, your client comes in for a scheduled appointment and seems to have a cold (runny nose, coughing, blowing their nose, sneezing). The client says "It's just allergies."

You guessed it, two days later you've got the mother of all head colds and will probably end up having to cancel two or three days of paying clients as a result (not a wonderful thing, as a contractual therapist you only get paid if you see clients).

What would you do?

1. If the client shows up, hope it isn't contagious and spend an hour in a small office with their symptoms.

2. Tell the client that, since they seem to have an illness that may be contagious, they will need to reschedule when they are feeling better?

Keep in mind that the client may have driven 20 miles to come to the appointment and it will probably be at least a week before there will be another opening.

Also, if you were the client, how would you feel about your therapist canceling in this situation.

Thanks in advance for your thoughts and please pass the tissues.
posted by HuronBob to Work & Money (32 answers total) 1 user marked this as a favorite
Maybe set up an explicit policy in which you offer a phone session to clients if they are not feeling well?

I would be put out to be turned away from a session for a reason I didn't have foreknowledge of, but totally happy to work with a known policy, and frankly relieved to not have to haul myself 40 miles while sick.
posted by apparently at 4:13 AM on August 2, 2015 [47 favorites]

As a (part-time) counsellor I accept this as par for the course. It's possible to catch a cold from any number of people and no different than catching it from a fellow office worker. It sucks to have to cancel paid work but it's not possible to never catch anything from your clients so I'd just file it under "things which may happen when you work closely with other humans". As a client I'd be very upset to be turned away from a session that I might have plucked up considerable courage to attend.
posted by billiebee at 4:14 AM on August 2, 2015 [40 favorites]

I'd do 1. +
- ensure the office has good ventilation
- use good hand hygiene myself (wash my hands after the fact, avoid touching my face)
- protect my own immune health, if it's in question (for me this would probably involve getting the flu shot and taking Vit C [even though Vit C may or may not help])
- perhaps (very politely and gently) ask the client to use a tissue when sneezing if they forget, and make Kleenex and a waste basket available [beforehand]
- wipe down surfaces after the client leaves with an appropriate cleaning agent
- be glad I don't work at a nursery or similar.

If I were seeing the therapist for anxiety or depression, I would probably comply and not complain, and experience a range of negative emotions (like humiliation) that would probably lead me to avoid or feel bad in the presence of this therapist in future.
posted by cotton dress sock at 4:15 AM on August 2, 2015 [27 favorites]

Many medical offices supply masks, and I would supply them and ask a sick person to use one. A person may think it's allergies and not a cold.
posted by theora55 at 4:19 AM on August 2, 2015

I was a therapist in a former life, and frankly, it would have never occurred to me to cancel a session under these conditions, unless it appeared the client felt too badly to get the work of the session done. I honestly don't remember it often occurring. The majority of my caseload was children, FWIW.
posted by thebrokedown at 4:27 AM on August 2, 2015 [12 favorites]

On preview, I would never ask a client to wear a mask. It is REALLY not a thing that happens where I live (Deep South) and would be seen as Very Weird and off-putting for me to do so.
posted by thebrokedown at 4:29 AM on August 2, 2015 [9 favorites]

This is just part of the joy of living in a society. People around us are sick all the time, we just don't necessarily know that. Maybe you were served yesterday at the supermarket by someone in the most contagious stage of the flu? Just because you didn't see the person showing symptoms of the flu, doesn't mean they couldn't make you sick just as easily. It seems pretty silly to send a client home when the only difference is that you actually know they are sick. As long as they are well enough that they feel okay being there, I think you just need to put up with this.

All you can really do is protect yourself by washing your hands regularly, not touching your face, and supporting your immune system. I used to get colds all the time but I've started taking vitamin c daily (and zinc when I feel like something could be starting) and I haven't had a cold in months and months. I guess there could be other explanations for that, but I feel like at least I'm doing something.

Cotton dress sock's list is great. I'd add:

- Have a somewhat flexible cancellation policy if you can. Usually cancellation policies allow people to cancel 24 or 48 hours in advance. But I went to one practice where it was possible to cancel on the day as long as you scheduled (and then kept) a new appointment within a certain period of time. YMMV whether that works for your practice.

Also, yes, good God, do not ask a client to wear a mask. How are you supposed to have a successful session when you feel like the therapist thinks you are so diseased that you need a mask?
posted by kinddieserzeit at 4:33 AM on August 2, 2015 [15 favorites]

Voice (singing) teachers have to deal with this, and since they are singers themselves, they are very vigilant about health matters.

I know one teacher who would make sure the sick/symptomatic students faced away from her during the lesson, as a precaution. Maybe this would work for some kinds of talk therapy, too.
posted by amtho at 4:52 AM on August 2, 2015

I asked my family doctor how she deals with being constantly exposed to colds and she said that as soon as she has any symptom, (eg tingling sore throat) she uses a neti pot. Maybe that might work for you?
posted by girlpublisher at 5:05 AM on August 2, 2015 [1 favorite]

As someone who regularly has allergies with all those symptoms I'd be really upset about being called a liar by any professional I was seeing and they'd immediately lose my business. To be blunt.

You can catch colds anywhere. Use good personal hygiene, (e.g. antibacterial hand wash etc), provide disposable tissues and an easily-accessible plastic bag lined rubbish bin, have a good cancellation policy, and realise that working with the public comes with some risks. But don't kick out your customers because you've diagnosed them with something despite not being that kind of doctor.
posted by shelleycat at 5:17 AM on August 2, 2015 [24 favorites]

As another person who has allergies with these symptoms occurring frequently, I'd be very upset at a cancellation. You'd be effectively calling me a liar - that's hardly a good relationship to have with your therapist.

What's more, it's very likely that I'd still have the exact same symptoms at any rescheduled appointment - I'd probably be looking for another therapist.
posted by Ashlyth at 5:31 AM on August 2, 2015 [6 favorites]

As one who maintained a private practice for 25 + years I can't remember ever even thinking of this. As other have said--take reasonable precautions and see your client. If either the client or therapist has a known compromised immune system perhaps some special procedures could be used. As was well said--this is the price for living in a community and having relationships--personal and professional
posted by rmhsinc at 5:59 AM on August 2, 2015 [3 favorites]

Err, yeah, it's part of living in society that we all have to deal with. The person on the train coughing and sneezing, the person who opened the door handle before you at the local store... etc etc Perhaps you could isolate yourself completely from the world and try to make a living doing phone-only consultations?

Besides, from my limited knowledge, people are most contagious BEFORE the symptoms start to show, so you'd better look out for those seemingly physically healthy people!
posted by Diag at 6:14 AM on August 2, 2015 [2 favorites]

In addition to the risk of being part of society (which i agree with), even further, clients think of therapists as caregivers. This relationship, I believe, somewhat increases the burden of risk the therapist has to take on in that role for something as relatively benign as being exposed to a cold. It's not like meeting up with a friend and saying "You know what, I really don't want to catch that, sorry, can we take a rain check?" Being asked to leave because of the (really pretty slight) chance that my caregiver might catch my cold would be inseparable from my feelings about the therapeutic relationship and I'd probably not have the same level of trust in the therapist as a caregiver.
posted by flourpot at 6:21 AM on August 2, 2015 [2 favorites]

My therapist has a no show policy where I would pay for the hour even if I don't show for my appointment. It makes me feel like I have to go even if I'm sick. Do you have a similar policy encouraging people to show up sick?
posted by cecic at 6:27 AM on August 2, 2015 [18 favorites]

Here's a tip: Don't have a big, cushycomfy sofa with a million smooshy pillows and afghans that all the clients Eeyore all over and in the process jampack full of multiple strains of rhinovirus and the deadly MRSA. Maybe therapists' offices should have a bank of lockers in the lobby and create a ritual where each client goes and gets their own MRSA'd-to-hell, smallpox-blanket comfort items out of their own locker and puts them back at the end of the sesh. A nice transition ritual.
posted by Don Pepino at 6:30 AM on August 2, 2015 [1 favorite]

IOW, unless you have a really nontraditional setup, you will be fine over there in the immaculate therapist zone: nobody sits in your chair and nobody touches anything you touch. Your clients, however are going to catch the cold. This is a problem and cecic has the solution to it.
posted by Don Pepino at 6:43 AM on August 2, 2015 [1 favorite]

You can't prove that you got the cold from the allergic client. You could have picked it up anywhere. It isn't reasonable to isolate yourself from the people that you are supposed to be helping, just because they might get you sick. It is acceptable to not shake hands with someone who appears to be sick. It is also acceptable to ask if the session can be held in an outside patio area but, since this is someone with allergies, that might not work out either. You can purchase a hepa filter and keep it running to help with a small space (something that your allergic clients would greatly appreciate, btw).

If I were you, I would notice that my client has trouble taking care of herself to the point that she can't even acknowledge that she might be sick and might need rest. Self care is certainly something to address in a therapy session, not because she got you sick but because it indicates that she has disconnected from her body and her needs.
posted by myselfasme at 6:43 AM on August 2, 2015 [2 favorites]

As someone who's worked in one "helping profession" and training in another...this is just par for the course. I used to be a special needs teacher aide and the only time someone was sent home was if they had a fever or were really ill. You're going to be exposed to people who aren't symtomatic yet but still contagious, people with colds, those still coughing like crazy 2 weeks later. I've had students with diseases that can be transmissed if you don't take the proper precautions - so you take the proper precautions.

Also my allergy symptoms very closely resemble colds, I can't always differentiate them at first so an outsider would be completely clueless.
posted by Aranquis at 7:38 AM on August 2, 2015 [2 favorites]

I'm a private language tutor who works one-on-one with elementary school age children. I have to be a lot physically closer to the kids than a therapist (reading from the same book, physically helping them write, etc.) I've found a couple things to be helpful in reducing the number of sick kids I have to work with:

1. It's been helpful to simply let the parents know upfront that I PREFER they cancel when their kid is sick and wear a mask (normal in my Asian country, probably a weird thing to request in America) for allergy related coughing or sneezing. Often times the parents assume I'd prefer to have any kind of paid work rather than a cancellation, so letting them know the way I'd like that situation to be handled beforehand has gotten results.

2. I make the cancelation policy very lenient for younger students to encourage parents to cancel. There's no fee for them to cancel more than 2 hours before the class and even with under two hours of notice I charge a pretty small penalty (about $25.)

So that's what's worked for me doing one-on-one work with kids. But I agree with most of the above posters - as a person who's been in a lot of therapy, I think you're being too uptight and I wouldn't say anything (other than perhaps a reminder when you first start working with someone that you prefer they cancel if sick.)
posted by horizons at 7:40 AM on August 2, 2015 [2 favorites]

Same as everyone else in contact with other humans -- if you're in contact with someone who appears to have a cold wash your hands after. Luck of the draw. You probably have more chance of getting something from a grocery cart or elevator.

Also, if you were the client, how would you feel about your therapist canceling in this situation.

I'd never return.

Not that I'm not sympathetic. I wish my coworkers would stay home when they're sick, but they don't, and when they don't I just try to be a bit more vigilant about handwashing. People have all kinds of invisible constraints and needs. I'm pretty sure my worst offending coworker shows up when he's sick to avoid staying home with his wife.
posted by A Terrible Llama at 7:45 AM on August 2, 2015 [3 favorites]

My physical therapist has a sign up in the office that says something like: If you are sick, please call us and let us know. We will be happy to reschedule your appointment. (In other words, no cancellation fee.) I wish this were a social norm, but unfortunately, I don't think it is in the US.

I work one-on-one with people sometimes, and yeah, I get colds. People come in when they're contagious and aren't showing symptoms, so it's hard to avoid. I've gotten a lot better about washing my hands, not touching my face, and keeping zinc lozenges on hand.
posted by wintersweet at 8:19 AM on August 2, 2015 [5 favorites]

I'm a primary care doctor, so I see people with contagious minor illnesses all the time. I just use moisturizing hand sanitizer after seeing them (also before but this is less important in the non-medical setting. If you have non-fabric seating you could also wipe things down (arms of chair, doorknob) with a Clorox wipe or something after they've been in your office.

I get way more illnesses from my preschool aged kids than I do from patients.
posted by The Elusive Architeuthis at 8:22 AM on August 2, 2015 [3 favorites]

Very few colds are so virulently airborne that you're going to catch them from sharing air with them. And most viruses are most contagious right as initial symptoms appear, so it's actually your client who sneezed once or asked if it was a smidge too warm in the room that gave it to you, IF you didn't actually get the cold that's already going around from a doorknob or shopping cart or something else that you touched and then touched your face.

Keep hand sanitizer out unless you think it will trigger your patients, in which case keep some in a drawer to use between clients, and bleach-wipe your touchable surfaces after a suspicious character has visited (and, honestly, just do it at least daily anyway). If you're customarily a hand-shaker, either stop or avoid it during cold season or train yourself not to touch your face.

I would suggest implementing a limited phone session policy, and make an especially big deal about it during flu season, but don't expect that to keep people away when they don't know they're sick yet.
posted by Lyn Never at 8:23 AM on August 2, 2015

My therapist explained in my first appt that because she deals with so many people, if I were sick I should not come in to my appointment. She made it clear right from the get go she had boundaries and it was so nice to know as a client that she has that policy and stuck to it for everyone. No charge if you call enough in advance to reschedule the appt for later that week.
posted by HMSSM at 8:56 AM on August 2, 2015 [4 favorites]

Spicy food is your friend. I've been doing massage therapy for almost 2 years and I make conscious efforts to supplement my immune system with my dietary choices - of all of the things I have tried, spicy is the thing that gets it done.

Ditto on finding a new therapist if I showed up with allergies and was accused of being the therapist sick. Your own immune system is just that - yours. Own it. Master it before the sickness does.
posted by thebotanyofsouls at 8:57 AM on August 2, 2015 [3 favorites]

I have severe allergies that present as a cold all of the time. Coughing, sneezing, runny nose, the works. If I say to someone, "It's just allergies" and they come back later and call me a liar because they caught a cold, I'll tell them they didn't catch it from me because I've had these allergies for ages and no one's gotten sick off me yet. If you were my therapist and this happened, you'd lose my business. Point blank.
posted by patheral at 9:05 AM on August 2, 2015 [3 favorites]

I primarily work with disabled adults and those impacted by HIV/AIDS.

If you have a client showing symptoms the best thing to do is reflect and model self care: wow you look sick, are you really up to a session? It is okay to cancel and rest, that is taking care of yourself. In if you feel you may have a cold, encourage clients to wash their hands after seeing you. With clients with allergies asking what they have explored with a PCP to minimize symptoms.

In your space, washing pillows or blankets regularly, wiping down surfaces and providing accessible trashcans for clients to dispose of tissues is a good idea.

Offer phone check ins. With my therapist if I have to cancel due to illness, she will call and do a phone session if I'm up to it. She bills and I pay my copay next time I see her.

Good luck, catching a cold always messes up my schedule. I think of it as part of the risks I take in this line of work.
posted by AlexiaSky at 9:50 AM on August 2, 2015 [2 favorites]

To be okay with this as the client, I would need to know (clearly, and in advance!) that I could cancel without harm to myself, even at the last minute (i.e., no 24 or 48 hour notice required!), based on cold symptoms. So, one, I can reschedule, not just pay for the hour as if I were there. And, two, you would work with me to find another appointment. If this meant finding a way to squeeze me in the same week, so be it, you need to find a way to do that -- if it's important for my care that I see you soon.

What I'm saying is, I want you to make it pain-free for me to move my appointment if I'm sick. The upside of that is both that I don't have anything to complain about, and that I will probably call and suggest this on my own. Because honestly, why would I want to get dressed and drive in and sit through an appointment if I were sick and feeling like crap, if it were basically just as good for me to reschedule?
posted by J. Wilson at 9:53 AM on August 2, 2015 [9 favorites]

Thanks, all, for your thoughts. You've pretty much confirmed what my feeling was on this (and the approach that I've always used). I do need to step up my game on disinfecting and being careful about who touches what in the office, thanks for the reminders on that....

I've marked a few answers as best, but rest assured they were all useful... thanks for taking the time to respond...
posted by HuronBob at 12:11 PM on August 2, 2015 [1 favorite]

In addition to allowing us to cancel when we're sick, our therapist also gives us the option of meeting with her when she's ill - not desperately sick, of course, but when she has a cold that doesn't require bed rest. This might be an option for you, rather than having to cancel appointments. Some people are less risk-averse than others!
posted by VioletU at 12:15 PM on August 2, 2015 [1 favorite]

I would do #1 but make sure that you tell clients ahead of time that if they aren't feeling well, you'll happily reschedule their appointments without any fee. Expect that 1/3 of the people having last minute "colds" are not actually sick, figure it is part of the cost of doing business.
posted by arnicae at 1:58 PM on August 2, 2015

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