Paging Dr. Hamblin: Is It Safe to See My Therapist in Person?

Julian Montague

Editor’s Note: On Wednesdays, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at paging.dr.hamblin@theatlantic.com.


Dear Dr. Hamblin,

I need to see my therapist, but she isn’t doing teletherapy due to her hearing. She says she’s opening windows on both sides of her office, leaving one hour between appointments, requiring masks, and swapping the nylon cover on the couch between clients. I still don’t feel comfortable. Plus, she herself is elderly. Am I overreacting?

Anonymous

San Francisco, California


San Francisco,

You are overreacting. Because I’m not a therapist, I’ll tell you that directly, even though I understand it would be more effective to let you discover it yourself.

It’s good to be cautious. About 1,700 Americans are dying from COVID-19 every day. The number is climbing quickly. Our collective problem is that most people aren’t being cautious enough. At the same time, it remains possible to be too cautious. At a certain point, caution becomes self-defeating, especially if it means missing things like important medical appointments.

When in-person visits can reasonably be delayed until vaccination is widespread, that may be the safest choice, especially in places where health-care systems are overwhelmed. Many people who are young and healthy, for example, could be fine without an annual primary-care check-up this year. But keeping up with therapy is extremely important, more like a root canal than a wart removal, and even more so at a moment when the United States is seeing a surge in mental-health issues.

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In your case, it sounds like your therapist is doing almost everything right. She’s set up good airflow (assuming these are big windows, seriously open) and required people to wear masks (assuming these are good masks, worn well). Clinicians around the world have managed to see patients safely under similar circumstances, and even to treat people who have COVID-19 (which neither of you should knowingly have). I’m not sure about the necessity of changing the couch cover or waiting a full hour between appointments, but the measures she’s taking suggest meticulousness, which itself is a reassuring sign.

The basic principle to keep in mind—for this sort of appointment and others like it—is that you want to make sure you’re in a space where the coronavirus can’t accumulate in the air. If one person is infected and talking in an enclosed space, the air in the room can gradually fill with virus. Masks help this happen more slowly, and airflow helps dilute the buildup of virus (though neither totally prevents it). Taken together, effective masks and high airflow make it extremely unlikely that you’ll be exposed to enough virus to infect you (or that you’ll infect your therapist). If her office is enormous, like an airplane hangar, then the risk is essentially zero. In a small office, a similar effect can be achieved with an air purifier that has a HEPA filter, which can clean the air of any virus every few minutes.

All of that said, I know the futility of telling someone who’s nervous not to be nervous. Anxiety isn’t mitigated by a barrage of facts about airflow and viral doses. If you feel uncomfortable in the office, your sessions will be less effective. The whole process requires you to feel at ease in the setting and to focus on your thoughts and emotions.

So if I’ve failed to reassure you here, and you’re not going to be able to comfortably see this therapist, then please try to find some help online. If you have a long-standing relationship with this therapist, seeing someone new may feel daunting, like starting from scratch. Establishing a relationship with a new therapist—especially one you’ve only ever met online—can take time. They need to get to know you, and to see how your thinking and moods fluctuate from week to week, to be maximally effective. Even if your situation doesn’t feel urgent at the moment, we’re on the cusp of a long, dark winter. Ideally everyone would have access to affordable therapy at the ready. If you’re one of the fortunate who does, don’t wait until it’s an emergency to get started.


“Paging Dr. Hamblin” is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.