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Blog posted by: Zoe Hargreaves, 22 May 2020.

Zoe Hargreaves,
Psychosexual therapy service lead for Blackburn with Darwen, Lancashire and South Cumbria NHS FT

I am a psychosexual therapist working part time for the NHS and also independently for privately referred clients. I am service lead in Blackburn with Darwen and am also supervising a registered nurse, Rachel, who is undertaking a Master’s in psychosexual therapy.

Since lockdown I have been working from home but recently I have been going into clinic on Wednesdays so that my student Rachel can see clients to deliver a half-day session. I also go in for that half day to provide her with supervision and it’s good to catch up with colleagues as that’s the one thing I miss while working from home.

I have got Skype at home but because of professional boundaries, I can’t give clients my private contact details. Instead, I use WhatsApp video on a secure work phone and I can see all my clients this way.

Setting up the tech and the space

At first, the tech side of things was a real stresser! I have got blinkers on when it comes to technology and I panicked about having to connect things up and make it work but my daughter calmed me down and once she had set it up and shown me how to do it, I was fine.

I chose a non-descript part of the house in which to conduct my therapy, secure and confidential without interruptions, but formal enough for me to feel safe in a therapeutic setting.

Since I was continuing with clients who I had already got to know, seeing them online was not very different to seeing them in person.

It was important for me to maintain professionalism so I did my hair, put on make-up and dressed accordingly. I’ve stuck to the security of a regular routine, from the way I see the clients, to writing my notes up and all the admin that goes along with seeing clients face to face. 

Of our 35 clients, three have not wanted video calls and say they will wait until they can meet face to face. In the meantime, I have check in calls to see if they want to reconsider having video sessions.

I’ve previously worked in a different team with a group of other psychosexual therapists and saw my clients in non-descript clinics.  Around three years ago, I came over to the sexual health department for Blackburn with Darwen and now have one of my clinics in the contraception and sexual health (CASH) clinic. A lot of people worry what friends and family will say if they’re seen going into a sexual health clinic.

Video is ‘not very different’

I thought it would be very different giving therapy by video, but with mainstream psychosexual clients, as long as I’ve got a good wifi connection, it’s not that different. Of course with most of the clients I’m seeing, I already have a relationship with them which makes it easier.

Some of my clients have got autistic spectrum disorder (ASD) symptoms and sometimes I find it difficult to read them but more often than not, it’s okay.

Some of my ASD clients experience communication problems so I might use objects to help them express feelings and emotions. I have a box of things like various crystals, a little lion – very often chosen for anger; a little lady in a snowstorm globe which can represent confusion when it’s shook up, and calm when it’s settled. I’ve collected about 20 of these over the years. There’s also a small spirit level which can show they are feeling off-kilter, a monkey for feeling playful and a plumber’s copper bend for when they feel they are going round the bend. I’ve also got a box of words so if they can’t express themselves, they can dig into that too. I hold up the objects and the words to the screen for the client to pick out the right one.

Why I love my job

I have used video sessions for some time in my private practice as I have clients from different areas and some clients who live abroad, so video sessions are something I’m used to, but never with the NHS until the last five weeks. Relatively speaking, psychosexual therapy is quite a small specialism; I am also trained in CBT (Cognitive Behaviour Therapy), EMDR (Eye Movement Desensitization and Reprocessing) and sex addiction therapy so quite an unusual mix.

All the problems that come to me are psychological and impact on a client’s ability to enjoy and have sex. They include erectile dysfunction, premature ejaculation, delayed ejaculation, vaginismus, dyspareunia and loss of desire. Someone might perceive sex as negative after being abused as a child or had trauma in childbirth, have sexual phobias or be confused about their sexuality or gender.

My job is what I was meant to do, I will never get bored with it and will probably never want to retire.

I love the feeling I get when someone gets better and I love the fascination of the different stories and meeting different people.

More than anything I love making a difference in people’s lives – it’s not altruistic, it makes me feel good about myself.

Waving ‘I’m with you’

I very rarely touch clients during the therapy and although I am a great believer in therapeutic touch, we are discouraged from touching clients - particularly in this type of therapy though occasionally a client will hug me at the end.

But what I’ve found myself doing at the end of a video call, is say “I’ll see you soon, look after yourself” – and give them a wave! I have laughed at myself at that but actually it just feels right, it’s a little sentimental and makes people smile and demonstrates that I’m with them and I’m caring. I wouldn’t wave to them in a session would I, so why do I do it in a video? I’m going to carry on doing it, it feels like an appropriate end to a session and within boundaries.

The future

I will definitely be offering clients the opportunity of video sessions in the future. Not every time as I want to see clients face to face in the first instance, but for some clients it will be very helpful. I have a couple of clients who can see me in their lunch hour but haven’t got enough time to travel and have the session. With video, they can sit in their car for a session, which takes 50 minutes. There have been times when a client couldn’t come to a session because they had shingles and didn’t want to risk coming out and another didn’t have transport so having a video session was ideal for them.

Video has never been considered before for my NHS clients - it would never have been allowed, mainly because it had never been done before; because it might have skewed the boundaries; and because there was an expectation that you come to work in a building.

COVID has taught us it is actually fine to work from home with some adjustments and there are many benefits for staff and patients. For those of us motivated to do a good job we will continue to do a good job, or even better, because we don’t have to break off to beat the rush hour or pick up kids, there is no time wasted in commuting and no parking expenses.

Now, I just carry on working till I get my work done because it’s easier than breaking off and picking it up again the next day, which can sometimes take longer.

I think my productivity has increased by at least 15-20 per cent by working from home – and there is no reason why I can’t continue like this.

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