Colleen Cummings, a psychologist I’m going through the same things that they’re going through. A lot of us feel lonely and worried about coronavirus and are navigating work and kids.
Mandel said while he feels capable of helping his clients cope with a number of stressors, his initial fears about coronavirus sometimes left him at a loss for words.
"If someone comes to me and says, 'I had this panic attack for the first time,' I can go, 'OK, no problem.' I know exactly what to do.' But when someone comes in and says, 'I'm worried about the virus,' it's really hard for me to know what to say ... because this is new for me, too," Mandel said.
This spring, a client called to tell him her mother was in the hospital with COVID-19, and he said it "completely knocked me off my feet."
"I just remember repeating 'I'm so, so sorry. I'm so, so sorry,'" he said. "It was almost like, I couldn't think of what to say or what to do because it was so scary for me, too."
Therapists and their patients have lost many tools they would normally use to cope. Cubbage used to decompress on her drive home, but now she works from a second bedroom she converted to an office. Mandel said while he would normally suggest someone experiencing depression go see a movie with friends, that option is off the table.
"The main feeling is frustration," he said. "It definitely does feel very boxed in."
Physical warning signs: Your body is trying to tell you something "One of the biggest challenges is how limited life is right now for everyone. So many of the things that I might suggest to people who are suffering with depression or anxiety, I can't," Michael Mandel said. handout
The shift to telehealth has been a massive change, lowering one barrier to care but bringing new therapeutic challenges.
Cubbage said assessing a suicidal patient, for example, is something she'd prefer to do in person, rather than over Zoom. Cummings said she's lost valuable connections with colleagues who she would stop in the hall to speak with after a difficult session.
Even providers well-versed in telehealth were overwhelmed because they took on the task of training others.
Mary Alvord runs a large psychotherapy practice in Maryland that was providing telehealth services 10% to 15% of the time pre-pandemic, she said. When her practice went exclusively remote, staff were able to adapt relatively quickly, but then she conducted telehealth training for more than 10,000 mental health providers.
"No wonder I am so exhausted," she said.
People were encouraged during the pandemic to reach for help when they needed it. And many more people needed it.
The Centers for Disease Control and Prevention has found elevated levels of symptoms of anxiety and depressive disorders, substance use and suicidal ideation among U.S. adults and
identified populations at increased risk, including young people, racial and ethnic minorities, essential workers and caregivers of adults. Am I OK?: How to do a mental health check
Mental health professionals have been flooded with new requests. Patients who stopped therapy asked to begin again. Some patients who had only been doing one counseling session a month requested to be seen weekly.
Sherry Burkhard, who co-founded the Texas nonprofit Mosaics of Mercy, which connects the community with mental health resources, recently surveyed local mental health professionals and found 84% had an increase in their caseload since COVID-19 started.
Many therapists currently at capacity are taking on new cases. Some are doing it pro bono when they already struggle to earn a living wage.
Sherry Burkhard, co-founder of Mosaics of Mercy We’re helpers, we want to help everyone, we don’t want to turn people away. And so it’s really hard to say, ‘No, I can’t fit anyone else in.’ Or ‘I can’t help financially.’
"We're helpers, we want to help everyone, we don't want to turn people away," Burkhard said. "And so it's really hard to say, 'No, I can't fit anyone else in.' Or 'I can't help financially.'"
Many therapists are working more hours to accommodate demand. Those who face child care issues are opening up weekends.
"From a child care perspective it's been pretty stressful," Cummings said. "I can't have a baby in my lap when I'm doing direct client care. ... There was one morning where my daughter woke up and she had a bit of a cold and I knew I was counting how many patients I'd have to cancel that day."
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Psychologist Riley Benko has made an effort to keep his caseload manageable, which means he's watched his waitlist grow. Last year, Benko was diagnosed with Hodgkins Lymphoma and worked through his treatment. He said "he was looking forward to 2020 as a rebound year. Instead, the world changed."
In December, Benko and his wife, also a therapist, contracted COVID-19. Benko has recovered, though his wife has lingering health effects. He said the hardest part of being sick was worrying about his clients.
Riley Benko, a psychologist There was sort of a guilt. I thought, ‘Wow, I got sick and now I’m not able to provide therapy or services like I otherwise would,’ which made it challenging to rest and take it easy and take care of myself.
"There was guilt," he said. "I thought, 'Wow, I got sick and now I'm not able to provide therapy or services like I otherwise would,' which made it challenging to ... take care of myself."
Guilt was a common theme this past year, especially among therapists who turned prospective clients away. Cubbage said as a therapist of color, she recognizes her services are in high demand.
According to the U.S. Census Bureau,
only 4% of psychologists in the U.S. workforce are Black.
Experts say burnout occurs when stress is prolonged, and there is no time to recover. Mental health professionals are especially susceptible, and the pandemic has made them more vulnerable.
That feeling you can't name?: It's called emotional exhaustion
Tia Dole, a clinical psychologist in private practice and chief clinical operations officer at the Trevor Project, which works to prevent suicide in the LGBTQ community, said while mental health providers are used to working in an emergency state, the duration and scale of the COVID-19 emergency has been extraordinary.
"Personally, especially as a black woman, COVID was upsetting, All the events were upsetting but really the addition of what was happening over the summer with police brutality, that was actually what pushed me really hard," Tia Dole said. Lawrence Miner
"Before, when you'd have a patient in crisis, it's over in a couple of hours, you have a debrief, you huddle up, you go, 'Whew,' you go home. In this case, it is going on and on," she said. "I became numb, and then I became overwhelmed, and then I kind of went back to numb."
Dole, who in her private practice focuses on treating Black, Brown and queer people, said not only were many of her patients struggling with a virus that disproportionally affects
people of color, but they were also traumatized by the death of George Floyd this summer and the ensuing racial unrest.
Patients are also coming to therapists with more acute symptoms. Kimberly Griffin, a substance use disorder counselor at Lionrock Recovery, an online drug and alcohol addiction rehab program, who also has a private practice, said she's seen an increase in substance use disorders as well as domestic violence.
Kimberly Griffin, a substance use disorder counselor For the first time I believe in my life, I’ve experienced ... symptoms of burnout. The stress comes from trying to figure out how to help people who are experiencing something new at the same time that I’m experiencing something new.
"For the first time I believe in my life, I've experienced ... symptoms of burnout," she said. "The stress comes from trying to figure out how to help people who are experiencing something new at the same time that I'm experiencing something new."
The pandemic has been a traumatic experience for many people, she said. Before the coronavirus she had a couple of clients coping with trauma, now she says she's seeing trauma on "a mass scale."
“I think this past year was the most challenging in my career because it magnified how many people were really suffering mentally and emotionally," she said. "As a therapist, I wish I could help everyone, but that thought becomes overwhelming and, of course, it's not realistic."
Study: Pandemic could push up suicides, drug deaths
Not all mental health professionals are providing care exclusively through telehealth. Some are working in hospital settings and continue to face health risks.
Dole, who works in New York City – once the epicenter of the COVID-19 crisis – said when a patient having a psychotic episode comes into an emergency room, they are not likely to follow COVID-19 precautions.
"You have someone who's in a psychiatric crisis who is not thinking, who is not in their right self, who is not going to wear a mask, who is going to get too close," she said. "I know personally so many people who ended up getting sick because of that."
These professionals go to work each day not knowing whether they will be exposed to the virus, or whether they'll expose a loved one. Those who work in hospital settings also end up providing support to their medical colleagues who lose patients to COVID-19.
"Not only are you treating patients, you're also helping out your co-workers," Dole said. "They're trying to be strong, be present for their peers in the workplace environment. ... Everyone is just really broken down. You're watching people die who are 30 years old and it just doesn't make any sense."
The pandemic has been raging for nearly a year and has not abated. Experts say the negative mental health impacts will outlast the current crises. Research suggests the extreme and prolonged stress of the pandemic may lead to longer-term psychiatric disorders.
Many therapists said they are learning – or relearning – the importance of self-care during a crisis they know will not end for their profession with widespread vaccinations.
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"Even though we are therapists and mental health professionals and we have training and understanding of things above what the average person does, it doesn't mean that we aren't susceptible to dealing with our own mental health challenges," Cubbage said. "As much as we show other people grace, we ask that people please extend that grace to us."
Mental health professionals say they need organizational support to help ward off burnout. That could look like granting a clinician their day off request or respecting when they say they can't take on another case. They also need better pay, Dole said, so more people can enter the field, stay in the field, and serve a greater share of the population.
In the immediate future, therapists also need to be able to continue to see patients remotely, Dole said, and they need insurance to continue to pay for it. Some insurance companies have already made moves to scale back coverage of telehealth services.
More: As virus rages, insurance companies look to scale back telehealth
Despite the myriad challenges, mental health professionals say people who are suffering should always seek help.
"We're challenged, we're stretched thin, we're finding higher acuity in stress levels in our patients but it's what we're here for," Benko said. "People should still reach out."
If you don't have access to the care you want right now, there is still help available: You can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time day or night, or chat online. The Crisis Text Line provides free, 24/7, confidential support via text message to people in crisis when they dial 741741. The National Alliance on Mental Illness has support groups for people living with mental illness. Help support mental health journalism like this. Get news and insights sent to your inbox. Sign up for email newsletters.