COVID-19 Reopening Your Private Practice To In-Person Therapy

As states begin to reopen, many therapists are asking, “Should I return to in-person therapy sessions?” and “How do I set up my practice to re-open safely?"

First, remember that while states are gradually re-opening, the American Psychological Association (APA) recommends that practitioners use teletherapy as much as possible. While you may be eager to return to in-person sessions, if you get sick, this virus can leave you feeling unwell for weeks — which means an even longer-term impact on your practice and income — and poses the risk of coronavirus transmission to your clients. Please think through these factors carefully as you weigh the option of returning to in-person sessions, and continue to follow your state’s guidelines.

That said, when the time does come to return to the office, it can be helpful to know what steps to take; preparation is key, and will set you up for a successful transition back! Below is our extensive guide on transitioning back to in-person sessions, with advice compiled from official sources and tailored to therapy private practices. We encourage you to take the time to review these steps, and give yourself a week to implement them. Having your practice set up before your transition back will help reduce concern about hygiene and safety, and instead focus fully on your clients.

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Set up your office for success

1. Deep clean your office

According to guidelines by the Centers for Disease Control and Prevention (CDC), if you haven’t been in your office for more than a week, a routine cleaning of the space should suffice before reopening; coronaviruses naturally die in hours to days in typical indoor environments.

That said, you might also see this as a good opportunity to conduct a deep cleaning of your office. You can hire a professional cleaning service by finding one on Yelp or use a service such as Handy. Alternatively, you could also conduct your own deep cleaning, but remember that there can be a lot of costs associated with cleaning supplies, in addition to your own time.

The CDC’s guide on “How to Clean and Disinfect” is a good place to start for recommendations on how to conduct deep cleaning during COVID-19:

As you clean or hire a company to clean, make note of all the sanitizing steps taken; these will be a key point you can include in your communication to clients about reopening, as well.

2. Set your seat 6 feet or more away from the client

Make sure that your seat is set at least 6 feet away from where your clients typically sit, or ideally farther, if your office allows for it. Create a distance comfortable enough for you so that if your client sneezes or moves around during session, you can still focus on what they’re saying, rather than worrying about the potential health implications.

Some therapists have considered installing plexiglass partitions to increase this barrier; while OSHA has released guidelines that suggest the use of plexiglass for manufacturing, restaurants, and retail businesses, this has not been suggested for healthcare professionals yet to date. The agency has indicated they will continue releasing industry-specific alerts designed to keep workplaces safe, so you can stay updated on their alerts here. (Are you using plexiglass partitions in therapy? We’d love to hear from you about your experience!)

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3. Use easily cleanable furniture and no-touch products

You may love your comfy couch, but fabric is one of the hardest surfaces to clean. Consider removing or placing a “no-use” poster on furniture with soft and porous materials, and temporarily using more easily cleanable items. Good alternatives include, chairs with vinyl cushioning (like these) or plastic chair covers (like this) that you can wipe down after every session. If you see couples or families, make sure to prepare chairs for each individual.

Here is a list of office goods that you may want to consider to make cleaning and disinfection easier for you:

4. Review your building’s protocols

While you may have full control of your personal office, clients also need to enter and exit the building, use the bathrooms, and wait in common areas if you’re using a shared space. Get in touch with your building manager to confirm the following:

5. Prepare cleaning, disinfecting, and protective supplies

You’ve heard it repeatedly — clean, clean, clean! In addition to your own cleaning, disinfecting, and protective supplies, have separate materials accessible for your clients, so you aren’t both reaching for the same bottle of hand sanitizer.

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6. Post reminders on your office door

Put a checklist up on the outside of your suite or office door so that clients are reminded at every session to go through it before entering your office. Ideally, try to print these in large font so that it’s eye-catching and easy to read.

Your checklist may include items like:

Build practice policies

7. Avoid using your waiting room

If possible, close off your waiting area during the transition back. Instead, have clients wait in their car until the time of their appointment, or only arrive at the office 5min prior to the appointment, not any earlier. This will allow you to enforce social distancing between clients and minimize interactions.

If you absolutely need to have a waiting room (for example if you are at a group practice or share a suite), place easily cleanable chairs 6 feet apart, or put markings on the ground to indicate where clients can stand to wait for you to call them in.

8. Limit non-clients from entering the office

If your client is typically accompanied by a parent, spouse, or other family member, ask them to wait outside the building, rather than coming into the office or sitting in the waiting area. Limit office visitors to clients only to reduce the amount of social interactions you have.

9. Require and prepare extra masks

For yours, your client’s, and other clients’ safety, require that anyone entering your office wear a face mask; this is CDC guidance that is reiterated by the NASW and APA. Post this requirement on your office door, your suite door, and waiting area, so that it’s absolutely clear to clients that this is a requirement.

Just in case clients forget, prepare extra masks for your clients so you can continue with the session regardless. If a client shows up for session without a mask and you don’t have extras for them to use, have a plan in place to reroute them to teletherapy on the spot; for example, you might conduct a walking phone session instead.

If you are using cloth masks, consider always having multiple masks available in a ziploc bag or hygienic box at the office so you can switch to a clean one at any time. By having multiple ready, you can use a few each day and wash them daily back at home. The CDC’s guidelines indicate that washing cloth masks in a washing machine should suffice.

If you don’t have a cloth mask, you can create one on your own or purchase them via websites such as:

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10. Prevent clients from touching objects in your office

Think of all the objects that clients touch in your office, and consider what you can do without or move online for now.

Here are some examples to get you started:

11. Keep as much as possible online

Wherever possible, keep your systems online. For example, continue sending intake forms via your practice management tool, and collect payments via online credit card processors.

If you need to give clients a handout, consider sending it to them electronically as a PDF after session instead.

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12. Get creative in scheduling appointments

Leave more buffer time between appointments than you typically would (such as 20min instead of 10min) to avoid clients coming in contact with one another. Add in extra time in case appointments run late or you have to deal with unexpected client emergencies.

This extra buffer can give you time to disinfect the office (such as wiping down the chair and doorknob) and open the window for air ventilation. It can also give you a few minutes to reset, sneak in a short meditation, or review notes prior to your next session.

You can also get creative with scheduling, such as alternately scheduling in-person and remote sessions back-to-back so that there isn’t a concern of clients bumping into each other in-person.

13. Clean, clean, clean!

Here’s a list of areas you may want to clean after each session. Consider printing this out and posting it on your desk as a reminder!

14. Keep your office ventilated

The Occupational Safety and Health Administration (OSHA) recommends increasing ventilation rates in the work environment. You can easily do this by opening your window after each session.

As for high efficiency air filters, the National Air Filtration Association indicates that “in most buildings and in most situations, filters may be considerably less effective than other infection control measures including social distancing, isolation of known cases, and hand-washing.”

Per CDC guidance, reiterated by the NASW and APA, clients and clinicians must wear masks in the office.

Your practice is reopening with new policies, and it’s important to share these with clients upfront!

Informed Consent Forms: Similar to creating an informed consent form for teletherapy, you may wish to develop a similar form to address the transmission of coronavirus and any additional protocols you’re putting in place for transitioning to in-person sessions. The informed consent form should have clients verify that the new office procedures have been discussed and communicated with them. Please consult your legal counsel as you develop a form that is unique to you.

Updated Policies and Procedures: Consider developing an “Updated Policies and Procedures” document that addresses changes to your practice such as the following:

Post these on your door, waiting room, website, and share with clients via email. Consider reviewing them in-person at the beginning of your first in-person session, or at the end of your last remote session with them, as well.

16. Contact your malpractice and liability insurance

As is the case when any major change occurs in your practice, contact your malpractice and general liability insurance carriers to discuss if any additional coverage may be warranted during practice reopening.

While Congress has shielded clinicians from certain types of liability to protect them from medical malpractice litigation, most of these apply to physicians and volunteers directly treating COVID-19 diagnoses. Reopening increases pandemic-related risk that may not fall under these protections, so it’s important to ensure your practice is protected from any potential liabilities.

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17. Have a plan for a COVID-19 diagnosis

Build a plan in case one of your clients shares that they are suspected or confirmed to have a COVID-19 infection.

Applying the CDC’s employee guidelines to clients, below are some things you need to know.

If it has been less than 7 days since the client has been in your office:

If it has been 7 days or more since the client was in your office:

Determine which clients may have been exposed to the virus and communicate this risk:

If you have had prolonged* close contact** with a client:

* “Prolonged” is defined as a “time period of 15 or more minutes,” which applies to most therapy sessions.
** “Close contact” is defined as “being within 6 feet of a person with confirmed COVID-19.” If you are able to strictly ensure you stay 6 feet away from clients, this is less applicable.
*** Cloth face coverings are not considered PPE because their capability to protect HCP is unknown.

If your bathroom doesn't have a reminder for washing hands, post one up!

Communicate with clients

18. Send an email in advance to set expectations

Your clients are likely experiencing a range of feelings, from relief that they can see you in-person, to concern around hygiene and safety. Clear communication and sufficient advance notice prior to reopening will help set the right expectations upfront.

Here are some notices to include in your reopening email:

19. Ask screening questions

Following the American Medical Association’s (AMA) guidelines, screen clients for COVID-19 symptoms 24 hours prior to the office visit and prior to entering the office. The AMA’s pre-visit screening script (page 4) is a template you or your intake coordinator can use.

Any accompanying individual (such as parents for child therapy) should be screened in the same manner as well.

20. Ease into it with a soft reopening

There’s no need to switch your clients to in-person sessions all at once; this can be a gradual process that you ease into and “soft reopening” where you reopen incrementally is generally recommended. A soft reopening allows you to identify any improvements you can make to avoid contact, keep the space clean, and give your clients comfort around safety. Given many clients may be out-of-town (such as back home with parents), this may already work in your favor.

If you are conducting couples or family sessions, consider if you can continue with these clients remotely during the slow reopening period as you get into the rhythm with individual clients.

Look at your calendar, chart out when you might reopen, and budget enough time in advance to prepare.

Bonus: Keep up to date on telehealth policies

21. Keep up to date with health insurance policies

For now, most health insurance companies have stated they will reimburse for teletherapy sessions during COVID-19 through around mid-June (please check specific dates and policies by health insurance company). However, most health insurances published these changes in their press releases in March 2020 and have not released any new statements since.

We are hoping for additional guidelines towards the end of May or early June as to whether they will extend these waivers and coverage beyond the current end date, and will continue to monitor the situation for our readers as well!

22. Keep up to date with cross-state telehealth policies

The American Psychological Association and American Psychiatric Association have great resources specifically geared towards therapists. Consider signing up for their alerts and your specific professional association as well!

The process of reopening takes a lot of thought and consideration for your and your client’s health.

There’s no need to rush it, and many therapists are continuing teletherapy in the short-term, while others are deciding to stay completely remote for the foreseeable future. For support around making the switch to teletherapy, read our guide to transitioning to teletherapy.

Additional resources

American Psychological Association (APA)
Guidelines for when it’s okay to resume in-person services

American Psychiatric Association (APA)
Practice Guidance for COVID-19

American Medical Association (AMA)
Guide to reopening physician practices for non-COVID care

National Association of Social Workers (NASW)
Guide on how to reopen social work practices

Occupational Safety and Health Administration (OSHA)
Guide for businesses preparing to reopen

Centers for Disease Control (CDC)
Coronavirus reopening guidelines

Grow Your Practice With Zencare!

We're looking for clinically excellent and compassionate therapists and psychiatrists to refer clients to. We'd love to learn about your practice!