The last time I had to stay home sick it occurred to me that people might be interested in some of what happens behind the scenes from the therapist’s perspective. Here’s a play-by-play:
- Early Saturday morning: Wake up in the wee hours of the morning with a fever. Feel miserable. Hope that I will feel better soon.
- Early Sunday morning: Remain feverish despite doing all the good self-care things of resting, drinking fluids, etc. Realize that I might not be able to see my clients the next day.
- A little later Sunday morning: Still feverish and exhausted. Contemplate contacting clients to cancel Monday client appointments, which I would really prefer not to do. Decide that I will wait a few more hours before contacting clients in hopes that the fever will lift and I will be able to go to work Monday after all.
- Sunday mid-afternoon: Fever and exhaustion are worse now. Decide that I have to tell clients I won’t be able to see them the next day. Think about clients I am scheduled to see, what we are working on, my schedule for the rest of the week. Assess level of crisis clients are in, if any. Contemplate what support I will be able to offer to those clients this week if they are in crisis and need to talk before next week. Really hope that I will feel better tomorrow so I don’t have to cancel more client sessions.
Contact clients, let them know I am sick and will not be able to see them tomorrow. Ask if they are OK to wait to meet until next week and say if not we can schedule a time to check in on the phone this week. All clients say they are fine not meeting this week and do not need to check in before next week.
- Monday afternoon: Temperature finally back to normal, still tired but feel confident I will be able to work tomorrow. Feel sad I couldn’t see my clients today but recognize that I made the right decision.
- A week later: Meet with clients whose appointments I had to cancel last week. Apologize for having to miss the session. If it seems like it will be helpful, inquire about what it was like for clients for me to cancel on them. Explore whatever comes up. Realize for the umpteenth time that my clients are good at taking care of themselves and I do not devastate them when I have to cancel an appointment. Feel appropriately humbled.
And in case you are wondering:
- Do I ever come to work when I am sick? If I’m only feeling a little sick, but doubt I am highly contagious and still feel capable of thinking clearly and working, I meet with clients as scheduled. If clients are particularly worried about getting sick due to their own health concerns or vulnerabilities, I will contact them and give them the choice of whether to meet or not.
- If a client says they are in crisis and absolutely needs to talk with me when scheduled, do I go into the office and meet with them even if I am sick enough to cancel? No, I don’t. If I feel able to do so, I may offer to talk on the phone, either for a full session or a brief check-in. If not, I reiterate that I cannot meet because I am sick but am happy to schedule a time to talk later in the week (in person if I have space in my schedule, or on the phone if I need to work around a full schedule).
- How much notice do I give clients of cancellations due to illness? I try to balance the need to give enough notice so clients don’t have to rearrange their schedules at the last minute while waiting long enough to make sure that I really, truly need to stay home that day. Sometimes if I think I might have to stay home, I contact clients to tell them that and then get back in touch to let them know.
- What about the financial aspect? I am in private practice and, therefore, have no paid sick time, holidays or vacation time. So when I stay home, I do not get paid.
- But what if a client is sick and cancels at the last minute? Don’t they have to pay a fee? Shouldn’t I be paying my clients a fee if I cancel? Generally, I waive my cancellation fee for situations beyond clients’ control. I try to offer the same understanding to clients that they offer to me when I am sick. If a client’s cancellations for illness become frequent, then I will talk with the client about what to do.
- Am I happy to have the day off when I am sick? Generally, no. First of all, I’m sick, so I can’t do anything fun anyhow. But mostly, I really like my work and feel sad when I don’t get to see my clients. I care about them and how they are doing.
- What if a client gets upset with me about it? It happens, although usually my clients are quite understanding. If a client gets upset with me for disappointing them or letting them down, then we talk about it and it becomes an opportunity for the client to explore what happens for them when someone disappoints them. If I have disappointed them enough and our therapy relationship isn’t strong enough yet, they might fire me. In that case, I offer to help them find another therapist in hopes they will be able to continue their work elsewhere. And then I feel sad.
So there you have it. Sick therapists demystified.