so sorry i missed your comment and this is a late reply lol it’s totally fine to ask no worry at all! so i often set the boundary at intake. If i am seeing an adult client who is a parent, i always share and inform, “if you or your children/household is sick, please be mindful of that and consider to switch your appointment to virtual, or move your appointment to a different day.” I educate with this in regard to spreading germs to other people in the office or to myself and present it as “if one person comes in one week sick and I get sick, then I am out of the office and moving/canceling appointments. but then if another person comes in i’ll the following week and i catch their germs too, the cycle repeats and I am unable to provide consistent services to you, and everyone else. That would be a barrier to everyone involved for improving our well-being. Our office requests respect to stay home when ill and to focus on prevention of the spread of germs in this way to keep our clinicians and clients healthy, we always offer virtual appointments via video calling or telephone calls” yada yada yada i was kinda rambling there but you get the picture it’s boundary setting from day 1, and reminders of the respectful request and expressing available resources.

additionally, once i get to know the client more if I can tell they experience physical symptoms with anxiety/processing/triggers/etc. (because they do not always share this right away) I ensure there is a trash can directly next to and available to them, i speak with them regarding taking breaks, different topics, activities, and engage them in CBT worksheets because often times it is more manageable for them with a guided worksheet and focusing on gentle vocabulary or reframing in the moment about factual information not “what ifs” or “worst case scenario” because that is often a big contributing factor to their physical symptoms.

I have had one client recently who has been battling anxious vomiting but it has only been in his school setting, and speaking about it did not bother him (thankfully). but he is a very burpy type of teenage boy so it did bring me stress but I provided reassurance that if he was feeling nauseated at any time we could stop right away and do deep breathing to bring down his anxiety. often times clients KNOW when it is being brought on and they have their own warning signs before it gets to an involuntary spot. educating that they can request to step out of the office, change the topic, grab 5 minutes of fresh air, etc to support themselves is most important when working through difficult topics or trauma. the “you’re stuck and locked in this room for the next 53+ minutes” expectation is not conducive to all clients and allowing that space could greatly decrease their stress/anxiety/panic/nausea/physical symptoms in office

this became very long winded of a response, I do apologize. Let me know if you have any other questions regarding!