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.”
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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.
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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.
“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.