Tamara Howell


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Coughs, sniffles, 'flu, headaches, period pain, viruses… all non-lethal physical ailments that affect us to varying degrees. So how do you decide whether you are well enough to work and how do you deal with scheduling issues that follow if you're not?

"I'm not that ill"

Many of us will struggle in with a hot water bottle and lemon tea spluttering into a tower of tissues. Why? When I ask therapists, the usual response is "I didn't think I was that bad" or "I thought I could get through the day and relax afterwards"

When I first wrote that, for an early version of this blog published a few years ago, we hadn't been through Covid yet. Now we are faced with the uncertainty of testing, waiting mode and worry as we juggle yet more questions about whether we should be at work. The increased practice of online therapy means that in person therapists can switch over without too much disruption usually, and although we might maintain our income, we could end up snivelling away between sessions, just about holding it together for 50 minutes.

The reality is that although most of us sit in chairs and listen, it is still physically demanding work. We listen with our bodies, we feel, we intuit. Working online is even more demanding, on our eyes and our ears, our brains making a multitude of tiny click-here-not-there decisions and our faces attempting to crumple with just the right amount of wrinkles to demonstrate compassion.

When we are faced with the question of whether we are well enough to work, maybe we can start by asking whether we have enough resources to care for ourselves and heal, as well as be available for our sessions.

The Impact of Covid

I can't speak from experience here, although I know therapists who have been able to work within a couple of weeks of testing positive and others who can't work months later. With illnesses where we aren't quite sure if we are better yet, I suggest easing slowly back into the work and balancing it with social reintegration. Financial responsibility plus emotional support and connection.

The Big (Financial) Picture

If we miss a whole week of sessions or even just a whole day, we not only lose income but the sick day costs us money too in the form of office rent [if you work in person], and time spent rescheduling. Some clients may lose momentum and find it difficult to return so there is a potential to lose clients too, especially if it is early in their therapy journey.

However, this day by day or session by session outlook misses a more holistic perspective. 

If we go to work in person sick and pass on our illness to our clients or offer a less professional service, they are less likely to get what they need, enjoy our work or recommend us. If we look like we need looking after, this may lead to clients feeling unable to share their concerns, consciously or not, putting them in the position of carer sometimes. I realise we are human, and we get sick and of course some of this is about how comfortable we are sharing and our therapeutic approach. 

For some of us it may feel ok to be ill and just say that. Maybe we differ on different kinds of pain... For me, coughing is an absolute bottom line. I can't listen when a cough is brewing. A headache that won't go away with painkillers... well I can struggle through a brief phone call but not a session. Period pain makes work impossible for some people, and for others it's enough to lean back on a hot water bottle or get a cosy blanket. We all have different limits... it's not that we have to share those same limits or rules but I am encouraging us to listen to ourselves and care for ourselves as a priority.

The tricky thing is that in private practice, we are the only people available to mitigate our own financial loss due to illness. The statutory minimum amount of paid leave in Europe is 20 days plus bank holidays. If we consider ourself to be our employees, let's plan for at least 20 days plus bank holidays! Let's factor in two to four weeks' sick leave. You can put funds aside each month in a savings account or average out the pay over the year and create a salary payment from your business bank account to your personal account.

Setting an Example

When I worked in person, I would ask my clients to switch to online sessions if they were too ill to come to the office but well enough for therapy. If they are too unwell for online sessions, I will always try to reschedule a few days later for them - I keep space in my calendar for this. I have an Illness policy, I had a Covid Policy before switching back to 100% online practice again and my email templates are prepared just in case I need to send a message.

Therapy is self care, but sometimes going to bed with soup and tea is better self care. I think about when I struggle through, coughing with red eyes and low energy, what message am I sending my clients about their own decisions to take time off for illness?

The Suggestion I received

A loving and thoughtful friend once told me that if we ask ourselves if we are well enough to go to work, we are not yet well enough, because on the days we ARE well enough, we do not question it at all. I have tried to follow this guideline enthusiastically, no matter the financial cost. I want my clients to know "I am here for you" and not the other way around. We have to first look after ourselves in order to take care of others, right?


Having said that, one aspect I didn't consider deeply enough when I first started supporting therapists with private practice was chronic illness. Some of us aren't operating at 100% every single day, and the grey area between well enough and a bit too sick is sometimes only clear in retrospect. Some therapists are able to remain present and focus when in pain or discomfort, so I don't want to declare a blanket "don't work if you feel a bit under the weather" statement. Lots of people, both therapists and clients feel under the weather a lot of the time.

The question then is, how can we adapt our practice to support ourselves in other ways? Taking time off sessions is not the only way we support ourselves.

Suggestions Other than Taking Time Off

✅ Scheduling 30 minute breaks instead of ten minutes might lengthen the day, but also means we aren't sweating and spluttering continuously if we have a cough or cold.

✅ Having some pre-cooked meals in the freezer, whether you batch cooked or bought them, means on days when your back pain is bothering you, you don't have to do too much on your lunch break and can lie on the floor and do some stretches.

✅ Staying at home instead of commuting, switching to telephone rather than video if you are able to work that way, changing chair, location, temperature of the room - all these small adjustments can improve your comfort level and make it slightly more possible to be present for clients without it costing your health.

✅ Publish or share an Illness Policy so clients know what to expect.

✅ I know this might feel impossible, but you CAN cancel some and not others.

✅ Pre-prepare your email templates and save them so that if you do feel unwell, you don't have to think of the right wording to explain you need to cancel.

✅ Complete a Covid risk assessment if you are working in person, pre-prepare your email templates for switching to online therapy or taking time off and consider your Covid related procedures ahead of time.

✅ Consider your cancellation policy. If you have clients with chronic illness, a flexible cancellation system is often appreciated. If we charge for late cancellations, consider offering a free late cancel in the bank when you need to cancel at short notice.

What other ideas do you have for preparing for short to medium term illness? Mild, acute or chronic.

What would help you feel more secure in your procedures?

Let me know in the comments, community or by email! 


Image description & Photo Credit

1. Person wrapped in blanket and hoodie lying on couch by Rex Pickar on Unsplash.

2. Slide from Learn to Love Online Therapy showing a quote from Tamara saying "We can be our best employers yet."

3. Photo of white mug with lemon tea and spoon by Pure Julia on Unsplash.

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