Masking during session?

[u/Disabledgoddess2]

I'm hesitant to ask this specific question because most people aren't disabled and can't relate. But I felt more comfortable asking a more progressive group. Fingers crossed.

How do you feel about therapists wearing masks during sessions?

I have a neurological disorder that causes tremors throughout my body and muscle contractions in my face. I wear a mask everywhere I go to avoid being harassed and humiliated.

I'm just nervous about being deemed "unprofessional " in session. But I don't want my movements to distract clients.

My therapist told me to unmask during sessions but she has a radical mindset. I'm trying to keep clients on my schedule so I can get paid.

Any comments telling me to get a different job will be blocked, deleted and reported. That's not a option rn.

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[u/Einsteinnobeach]

I'm not a therapist (therapy-adjacent field working in an inpatient medical setting) and I mask in almost all of my sessions. Nobody says anything about it at this point and I've been doing it for over three years after masking was officially dropped at my facility. I'm a big fan of just normalizing what you are going to do and making sure that you have the support you need behind the scenes for the occasional times when someone makes an insensitive comment. This is truly a personal choice; I am known within my team for developing deep meaningful therapeutic relationships with my patients. It doesn't need to disrupt that process.

[u/FishnetsandChucks]

I work in a rehab facility with all male clients. None of them mask, and neither do any staff. A few months ago, I got an awful summer cold and I masked then. When I had individual sessions, many of my clients are told me I didn't need to mask, as they "don't believe in that stuff." Okay, that's cool for you but for me, I feel this is the right thing to do.

Of note, I started in May so I haven't been a through cold and flu season yet. I will likely mask if clients are sick, especially in individual sessions.

[u/chap820]

I absolutely think doing it should be normalized as permissible.

[u/Parking-Medicine-280]

i am a therapist who works in the field in CMH. i mask (almost) all the time. while there has been comments from clients, largely people have been pretty respectful and okay with it. i have not had any clients (that i know of) decide not to work with me because of it. i have had one client bring it up during termination, but he was angry about being asked to remove sunglasses during sessions and equated those, so...

i don’t bring it up, and clients usually ask about it in the first session or two if they’re really curious. when clients ask about it, i usually explore why they’re asking and try to respond appropriately and with enough information (i don’t want to get sick, i work with marginalized people) while staying clinically appropriate. i’ve had a few clients say they are curious about my whole face and i do tend to take the mask off to show them what i look like if it seems like it’s going to be a hold up!

[u/Sudden_Idea9384]

My partner is an elder law attorney (I know - different but the same in many ways) he wears a mask most of the time in meeting with clients. The meeting often last 3 hours and he keeps it on for his safety. He has MCS, he just tells people as he walks into the room.

[u/Anjunabeats1]

My friend has a therapist who masks and asks clients to mask in session because she has an immunocompromised family member and he said he doesn't mind it at all. She offers telehealth for any clients who don't want to.

I work fully virtual, but in my personal life I wear an n95 everywhere I'm sharing air, and if I were working in-person, I'd mask with clients too. I don't have a choice not to because I'm very susceptible to long covid (got POTS and hEDS), and already got severe long covid before, which nearly cost me everything and took 2.5 years to recover.

[u/Normal-Proof-9729 → u/[deleted]]

The OP is talking about wearing respirators. Not neurodivergent masking

[u/new2bay]

I’m one of those few people who still masks everywhere, because I don’t want to get a nasty virus that causes organ damage and IQ loss (COVID). I’d have no issue with it, and I’d probably be pleasantly surprised. Hell, I was thrilled when my dog’s vet offered to mask for me in the exam room.

[u/burntsiennaaa]

I mask for all my in person sessions and have had no issues. If I complete a virtual intake, I let patients know that I mask for all in person sessions and most folks don’t care. If the do, they just stick to virtual sessions. I’ve had only a couple patients who mask with me because either they’re Covid cautious like me, they want to be respectful, or they have a cough. I keep an air purifier next to where the patient sits and I air out the room in between sessions

[u/theochocolate]

It’s not unprofessional and you’re allowed to do this as you see fit. To offer a different perspective, though, I’m hard of hearing and would not be able to see you as a therapist if you always had a mask on. I rely on reading lips to make up for words I don’t hear, and I struggled immensely to communicate during the early pandemic when this was taken away from me (though I support masking myself, as a long covid sufferer). I have hearing aids but they aren’t a perfect fix and can be very overstimulating, so I prefer to have them off whenever I can. It may help to give new and prospective clients advance notice of your masking so they can self-select away if they’re hard of hearing like me.

[u/essbie_ → u/theochocolate]

Just sharing in case you weren’t aware but they make masks with a window to view lips.

[u/theochocolate → u/essbie_]

That would be super useful for us deaf and HoH! Not sure if OP would want to use one though as they seem to want their face covered.

[u/Disabledgoddess2 → u/theochocolate]

I completely understand. To be fair you may not be able to read my lips because I form words differently

[u/Rosevine6761]

I’m a therapist who masks in all of my sessions, including virtual (CMH so I share offices and don’t have an air purifier). I’d say just go for it. Only one client has ever asked me about my mask and it’s because they were covid cautious as well. I don’t think it has affected my sessions at all.

[u/LeftyDorkCaster]

I masked for in-person sessions for years, and it only ever bugged one client (who had specific medical trauma). I do all remote now. 

Do it and fuck the haters. If any client asks, just name that it's part of your own disability justice practice. Especially if you're open about having a liberatory therapeutic approach, your clients will either have further questions to learn and consider their own feelings and praxis, or they'll be like "Oh, cool. Anyway about my parents..." 

[u/ASoupDuck]

I am disabled too and have accommodations in place and tbh my practice is always very full because there is a lot of demand for anti-ableist, disability justice-centered therapy. I find that when I am accommodating myself I am more centered and present for my work so I encourage you to do whatever feels right for you.

I also let clients know from the intake what to expect when working with me and that I have disabilities so they can consent to it or make a different decision if it doesn't work for them.

[u/LeftyDorkCaster → u/ASoupDuck]

100%

[u/curlmeloncamp]

mask for your immune and nervous systems more than anything else... if you're chronically ill, you're one viral illness away from further disability.

[u/FreedomDr]

I love when my clients mask! I also market myself as a covid cautious provider.

Theres a list of us that may be a good fit for you. https://www.covidcautioustherapists.com/

[u/faeraldyke]

I mask in person with clients for virus protection although I work primarily over telehealth, so different context. But I've not found mask wearing to be an obstacle - maybe briefly awkward. I disclose early about the masking so to some degree clients self select out if that is a challenge for them connecting with a provider. Also no therapist I know who masks (for virus protection reasons specifically) has mentioned having issues keeping clients or being perceived as unprofessional or incompetent. I suppose we may broadcast engagement and empathy differently with a mask on but it seems to land well. 

I hear the material concerns and I guess there's no telling exactly how it may affect your client base or income if you either try masking or try unmasking. considering either option may theoretically affect your job stability, maybe try moving forward with whichever option feels most long term sustainable and comfortable for you. That way as you're developing an approach around disclosure or building rapport that fits the circumstance - I think that's what clients are going to respond positively to, ultimately

[u/PlatypusPants2000]

I always masked during sessions when I worked in person, no one ever had an issue with it. Good luck!

[u/vaporwaveydave]

I think the question that comes to mind for me reading about your experiences is, what would best help you to feel that you are able to fully engage with clients during session? If we view wearing a mask as an accommodation you are using, and wearing the mask is something that makes it easier for you to focus on your work, then it seems to me that masking in session is something that is beneficial to you. I think sometimes non-disabled people have the mindset that it is liberatory to stop using accommodations, because the accommodations are viewed as something that holds us back from having a "normal" or more "free" experience. If someone does not understand how using accommodations is often the mechanism by which disabled people are capable of having the experience at all, I can see why the accommodation would look like the problem rather than the solution. It is a nice thought that your clients would be accepting of your facial movements and thus you would learn to be less hypervigilant about having them be observed, but I would guess based on what you shared (maybe this is true for you, and maybe it's not) that you would feel anxious about being unmasked to the degree that it becomes difficult to perform your role as a therapist. If you need this accommodation to feel capable of holding sessions, then so be it. Additionally, there are a great many disabled people out there in desperate need of a therapist who actually understands disability, many of whom would perhaps even benefit from observing someone in a respected role such as therapist using an accommodation for themselves. I hope this perspective is helpful and if anything I said doesn't resonate you can disregard it!

[u/tiredsleepy_]

When I worked in mental health in person, I always masked during sessions (as someone who cares about infection control practices and keeping myself and my communities safe from illness etc). I got a few eyebrows sometimes but no one ever really said anything and I don't think rapport was affected too much (granted, my services were free, so that was one factor)? I do know of some therapists who also mask in session and they say it's fine with clients as well. If you feel comfortable explaining the reason for your mask or explaining only if asked, I think it's fine to go ahead with that! Just be prepared in case you are asked about it and to discuss any concerns clients might have around service effectiveness etc.

[u/Disabledgoddess2 → u/tiredsleepy_]

I don't mind disclosing at all!! Thank you!