The Bad Virus: The First Incidence of COVID-19 in a Psychology Training Clinic
It was Monday. March 9, 2020. Kirkland, WA. A typical Monday, almost. I had come to our NUhope group supervision armed with hand sanitizer, alcohol wipes, and a new directive for everyone to start taking precautions. The Corona Virus, soon to be renamed COVID-19, had recently hit the news. Twenty miles north in Everett, WA, a man was diagnosed with the virus after returning from China on January 20. Subsequently, the LifeCare Center in Kirkland suddenly became the epicenter. Two cases on February 28 with the first death on February 29, and then this novel disease spread like wildfire through the facility. My colleague’s father was a resident there; she was in quarantine. Quarantine—what does that mean? A word so foreign back then, yet so familiar now.
Sitting side-by-side, six inches apart, nine NUhope therapists, one graduate assistant and I sat in a circle for two hours, like we always did on Monday mornings for group supervision. As part of our routine, we began with a few moments of deep breathing, exhaling with mouths open into the air around us. We were talking and laughing. No social distancing—we had never heard that term—and definitely no masks. I doubt that any of us owned one. A typical Monday, except for a few new rituals metamorphosing our routine: we sterilized everything after our meeting and opened the windows. Little did we know that despite these efforts, an uninvited guest had already joined us.
After group supervision, I made some coffee, as usual, with the communal Keurig, then spent an hour in an enclosed room with the person who unknowingly carried the stowaway; it was her individual supervision time. She was feeling fine, casually commenting as she blew her nose, that she had allergies that always acted up at this time of the year. I didn’t give it a second thought; neither did she.
Student therapists were getting a little nervous, but we were still open and operating business as usual, just more OCD about sanitizing, hand washing, and keeping windows open. However, our hand-washed, ceramic, environmentally friendly coffee mugs that we had provided for clients who loved the Keurig were closeted away, replaced by hopefully recyclable, poorly crafted paper imitations. We were building a fortress of alcohol wipes, hand sanitizer pumps (soon to be a coveted possession), cleaning rituals, and untouchable surfaces, but we were not impenetrable. We had the “It will never happen to me” attitude, but it did.
The next day, March 10, the student therapist I had supervised the day before called me. I was at my private practice that day. I saw her missed call come up on my phone between patients and something told me I needed to call her immediately. Her voice was strained. Her anxiety expelled her words too fast. She said she had a fever and cough, and thought I should know that I and the others at NUhope had potentially been exposed to “the bad virus.” I had no idea what to do. My mind was racing, searching my memory for a protocol that it did not have. This was something new. After thinking for a few moments, I started making phone calls.
I contacted my Dean and our wellness coordinator. This was the first potential case at our university, so there were no procedures in place. Our wellness coordinator suggested calling the state coronavirus hotline. I did. The helpful, yet clearly overwhelmed woman on the line said we all had to quarantine for 2 weeks unless the student’s test came back negative. I acted robotically, calling all the students at NUhope, informing them that their lives were about to change dramatically. They were stunned. None of us had ever experienced quarantine before. This was so early in the testing process that we had to hold our breath for nine days, waiting for the results. Those nine days felt like an eternity. Every little symptom–runny nose, sneeze, cough, headache–any of us experienced raising the hair on the back of our necks. The student’s test was positive. As it turns out, no one else developed symptoms of the virus- at least we do not think we did, but no one really knows for sure.
On March 11, the World Health Organization declared COVID-19 a pandemic (Hames et al., 2020). No one understood what that meant back then. It was still early. This was before the U.S. declared a national emergency on March 13 or before Washington’s Governor Inslee instituted his stay at home order on March 23. It was way before March 26, when we heard that there were 81,000 confirmed infections and 1,000 deaths in the United States. These numbers, so horrifying then, seem so insignificant now.
Fortunately, we had all been trained in the provision of telemental health and had practiced using it. NUhope had embraced the vision of becoming a telemental health resource long before COVID appeared. Some student therapists had already been “seeing” clients using this modality, but in the clinic. So, a few weeks before others would follow suit, we informed our clients we would be using telemental health and instantly began the process of adapting this “viable and elegant solution” (Inchausti et al., 2020) to the problem of how to provide quality mental health care during a worldwide physical health crisis. It actually was a surprisingly smooth transition (Hames et al, 2020). Most clients were amenable and willing to give it a try. Of the few that declined, most came around within a few weeks. Working from home became the norm and continuing the sessions worked well. Our supervisors adapted quickly and under the circumstances of quarantine, soon to be followed by sheltering in place, welcomed the online option. What took time to organize was using a VPN to access Titanium and having our IT department establish a method for billing. The latter took about six weeks to accomplish.
What have we learned?
Our student recovered. She had a rough time of it, but regained health and recuperated without hospitalization. Our clinic survived as well. Survival required being flexible, adaptable, creative, and innovative (Bell et al., 2020; Inchausti et al., 2020; Rosen et al., 2020). It is interesting to note that historically, it is the therapists, not the clients, who have been reluctant to utilize telemental health due to lack of knowledge of and comfort with this mode of therapy (Rosen et al., 2020).
There is no question that the changes implemented during quarantine and sheltering in place will last long past COVID19. Telemental health, already an option before COVID at NUhope, will likely be a much larger presence as will telesupervision. Supervisors can take a leadership role by modeling the effective implementation of telemental health (Inchausti et al., 2020). It appears that our field will be reevaluating supervision and be much more open to telesupervision options, thereby allowing for diversity in supervision made possible with access to a wider variety of supervisors to train our students (Bell et al., 2020; Hames et al., 2020; Ichausti et al, 2020). In the near future, when in-person supervision is an option for some, allowances will need to be made for supervisors who are in highrisk groups who prefer to continue remote supervision for health reasons.
As so aptly stated by Bell and colleagues (2020, p. 12), “What was unquestionably an unwelcome and incredibly challenging occurrence, the COVID-19 pandemic also brings the opportunity to advance and even transform HSP education and training.” There is no question that telemental health can benefit clients and open doors for people who may not otherwise have access to care including those whose past trauma makes driving or even leaving home an impossible obstacle to overcome (Bennett et al., 2020; Rosen et al., 2020). Bennet et al. (2020) reported that telemental health is effective in treating depression, anxiety, alcohol- related problems, and general mental health, as well as PTSD (Rosen et al., 2020). In addition, it allows for continuity of care when a therapist or client is in quarantine or under a shelter in place order in the future (Rosen et al., 2020).
Students need to be trained to help people who have been traumatized by the pandemic itself. It is thought that the majority of people will not have mental disorders as a consequence of the pandemic, but some will develop symptoms due to prolonged quarantine, death of loved ones, serious COVID illness, intubation, or social adversity (Inchausti et al., 2020). Health care professionals providing direct care to COVID patients are also at high risk for subsequent mental health consequences (Inchausti et al., 2020).
As a training clinic director, I felt the weight of making decisions for the well-being of my student therapists, my graduate assistants, my supervisors and the clients. At times, it seemed like the weight of the world was on my shoulders. The support of colleagues at my university and through the Association of Psychology Training Clinics (APTC) listserv was invaluable. Balancing the needs of my students with the needs of clients for continuity of care was delicate and I could feel the internal struggle (Inchausti et al., 2020). The day before we stopped in person sessions, one student therapist expressed concern about seeing clients and I encouraged her to try it for one more day as we waited to see how things evolved in the community. In retrospect, I think it would have been better for me to tell her to not see clients in the clinic if she was concerned about the health risks. I am aware of the power differential between me and the students, and knew some might be reluctant to advocate for themselves (Bell et al., 2020). The quarantine made that decision for us and the shelter in place order sealed the deal, but I learned something from this experience. In WA state, mental health providers are considered essential workers, so sorting out what that meant for student workers was a new challenge faced by many of us (Bell et al., 2020). I guess this complexity in decision-making and level of responsibility has always been part of my job, but never before did the reality of it impact me like it did on March 10, 2020. Although this sounds cliché, our training clinic will never be the same, nor will I. We joke about how we will tell our grandchildren stories of this time and how intolerant we will be when, long past this pandemic, student therapists of the future will complain about having to share office space or a computer, and we will say, “You think you have it bad. Well……let me tell you about the spring of 2020….”
Bell, D.J., Self, M.M., Davis, C. III, Conway, F., Washburn, J.J., & Crepeau-Hobson, F. (2020). Health service psychology education and training in the time of COVID-19: Challenges and opportunities. American Psychologist, 1-14. http://dx.doi.org/10.1037/amp0000673
Bennett, C.B., Sever, A.C., Yanouri, L. (2020). eHealth to redress psychotherapy access barriers both new and old: A review of reviews and meta-analysis. Journal of Psychotherapy Integration 30(2), 188-207. http://dx.doi.org/10.1037/int0000217
Hames, J.L., Bell, D.J., Perez-Lima, L.M., Holm-Denoma, J.M., Rooney, T., Charles, N.E., Thompson, S.M., Mehlenbeck, R.S., Tawfik, S.H., Fondacaro, K.M., Simmons, K. T., & Hoersting, R. C. (2020). Navigating uncharted waters: Considerations for training clinics in the rapid transition to telepsychology and telesupervision during COVID-19. Journal of Psychotherapy Integration 30 (2), 348-365. http://dx.doi.org/10.1037/int0000224
Inchausti, F., MacBeth, A., Hasson-Ohayon, I., & Dimaggio, G. (2020). Telepsychotherapy in the age of COVID-19: A commentary. Journal of Psychotherapy Integration 30(2), 394-405. http://dx.doi.org/10.1037/int0000222
Rosen, C.S., Glassman, L.H., & Morland, L.A. (2020). Telepsychotherapy during a pandemic: A traumatic stress perspective. Journal of Psychotherapy Integration 30(2), 174-187. http://dx.doi.org/10.1037/int0000221