As the pandemic continues to grow and isolation and anxiety take their toll, reports have shown a significant increase in text-based therapy requests, like Talkspace and BetterHelp. Since in-person appointments aren’t an option even for traditional therapists, patients are often turning to virtual sessions and phone calls, an adjustment that isn’t always easy.
We asked seven therapists to explain what it's like to provide clarity and solace during uneasy times, the barriers of being socially distanced from their patients, and how they’re coping with their own mental health.
For most therapists, the shift to social distancing hasn’t been smooth. But they agree that virtual sessions and phone calls continue to be the safest option for all involved.
Amy Morin, LCSW, Boston: It has been a challenge to shift everything so suddenly. During a time when people want to meet in-person more than ever, we're not able to do so.
Kathleen Smith, PhD, Washington, D.C.: It has been strange not to be in the same room with people. I think a lot about their unique challenges—financial difficulties, relationship challenges, anxiety problems. But I also think about how isolation could be an opportunity for them to work on managing anxiety and building stronger relationships, and I try to communicate this when we meet.
Vanessa Soleil, LCMHCA, NCC, Raleigh, NC: On the one hand, practicing distancing feels safe and like a relief, knowing that clients don't have to come into our office building and potentially come in contact with the virus on elevator buttons, door knobs, and shared seating areas. I also feel more at ease as some clients take this more seriously than others. Since I cannot control what distancing clients may be practicing in other areas of their lives, I can at least keep those clients of mine who are more vulnerable protected from those who may be less conscientious.
Ariel A. Friedman, M.A., Ed.M, Palo Alto, CA: Therapy by nature is dynamic and always evolving. As a therapist managing crisis and adapting quickly to ensure client's safety is part of business as usual. What makes this moment unique is that all of my clients and myself are facing the same crisis simultaneously.
Beyond glitchy internet connections and other tech issues, one of the greatest barriers for socially distanced therapy is maintaining a patient's privacy, especially if the person they want to talk about is nearby.
Morin: Some people are finding it difficult to be able to speak privately. Their kids or their partners are home and it's tough to have an hour-long conversation without being interrupted. Also, it's tough for some people to speak openly when they're at home. For many, there's something about being in a therapist's office that helps them open up. It's more difficult for them to address difficult issues when they're sitting at their kitchen table talking on the phone. Also, not being able to read one another's body language is definitely different. They can see me listening to them and I can't see their facial gestures when they're speaking.
Friedman: I work at a community mental health clinic. Many of our clients come to us because we offer sliding scale therapy that's affordable. For a lot of people accessing a private space with stable internet and a computer is just not a realistic expectation. So we have to be flexible and get creative about solutions. For some, that means taking a walk around the block and checking in via phone. For some, that means having a session while a child is napping.
Sam Pranger Silvaine, LCMHC, Chapel Hill, NC: Technological issues have no doubt been a reality. The internet breaks up pretty regularly; we can't really talk at the same time and still understand each other, so there are some moments of "Can you repeat that?" in many sessions. It's about what you'd expect.
Therapists also struggle when they can’t read facial expressions or gestures made by their patients. When they’re not in the room together, it’s harder to pick up on subtle cues.
Silvaine: So much of the work I do and how I do it is based on factors that happen "in the room." Perhaps there's a jittery movement in the leg or a clenching of the hands; there's also just the general "energetic field," so to speak. These things are much harder to notice and attend to virtually—sometimes quite literally invisible to me. It has made the work harder, and I generally feel more exhausted at the end of the day.
Rebecca Kronman, LCSW, Brooklyn: I can only see you from the neck up or from the torso up. I can’t see if your foot is shaking. I can’t see if you’re playing with your hands. I can’t tell if somebody has gained or lost weight, which gives me a lot of information.
[On the flip side], sometimes people are just more comfortable in their homes. That just came up in a session today with someone who normally I wouldn’t see her cry—she would cover her face. [But] she was in her own environment and I did [see her cry], for whatever reason, which may be attributable to this moment or her location.
Insurance companies are making it difficult to get teletherapy covered–and therapists are as frustrated by it as their patients.
Silvaine: Insurance companies are making this fairly hellish for many clinicians. Many companies have started covering teletherapy for the time being—nope, they didn't before—but that has a limit, and we aren't sure when they will decide to end that. More importantly, I've heard that some insurance companies are paying clinicians less than an in person session of the same type and duration. It's disgusting. More profit off of other people's pain and suffering, and less income for those of us who are working hard to help those folks in pain. It's wrong and unethical, and I really hope that something comes of it.
"I also have some worries about some messages out there about taking advantage of this time to focus on self-care. Of course that's not an option for everyone, but it's also another version of pressure to be productive."
COVID-19 is dominating their conversations with patients, and any existing anxiety among patients is intensified.
Soleil: Well, we are all talking about this pandemic, of course. It is all-consuming and touches all aspects of my clients' lives. Some are suddenly thrust into economic emergencies and are applying for unemployment. Clients with their own small businesses are feeling the economic pain and worried about paying their taxes suddenly, when their projected numbers have plummeted. Most are worried about parents, grandparents, and family members who have compromised health, especially those family members who listen to all of the misinformation about coronavirus put out by President Trump, and are continuing to put themselves at risk. I have clients who are single and live alone feeling an acute sense of isolation at times. Some clients are also talking more about getting creative, returning to old interests and spending time outside. Under all of this, however, is a sense of unease about what life will look like in a month or two from now, and feelings of helplessness and anxiety.
Karla Ivankovich, PhD, LCPC, NCC, BCPC, Chicago: Anxiety is at the heart of every session I have. It has made some of my clients see the importance for prioritizing what is really important, versus what is done to maintain a social media presence. Truthfully, the only other time I saw anxiety this high, across the board, was during the last election. Clients were struggling to make it through their days with a fear of the unknown. This situation is similar.
Smith: I think fears about COVID-19 and isolating tend to magnify the problems that are already there. So if a person has a conflict with their spouse, that's only going to become more pressing when they're stuck together at home all day. So I've found that people mostly want to talk about the same subjects. It's just that the anxiety is dialed up, so it can be even more difficult for them to problem solve and stay thoughtful.
Therapists aren’t immune from the anger, fear, anxiety, and overall mental health impact their patients are suffering from.
Ivankovich: I am sure after this is over, I will need time to decompress—but for now, I have a job to do and people to help. At the same time, it never escapes my thoughts that most all of my immediate family works in healthcare, so there are more days spent worrying about the health of my family. Checking in on them more often, remaining calm for them, and never forgetting to say “I love you” at the end of a call. Frankly, I’m reminded not to take any moment for granted.
Silvaine: It's relatively rare that so many of us are experiencing the same concerns that our clients are coming to us with, and that has its fair set of challenges. I am afraid for people broadly and specifically for the people I love. I am angry and disgusted by our nation's leaders who continue to put human lives at risk for their own political and financial gain. I am grieving at the loss of a world that will no longer be the same after this is "over." I sometimes think maybe the birds are a bit happier right now, with fewer airplanes in the sky; that brings me moments of joy. I also have some worries about some messages out there about taking advantage of this time to focus on self-care. Of course that's not an option for everyone, but it's also another version of pressure to be productive. Always must do, do, do. I've felt that pressure myself, for sure, watching people getting all sorts of reading done or playing instruments more or whatever it may be. But I'm truly exhausted and my mood in this fluctuates as regularly as any of the clients I see. I'm worried we will keep falling into that trap when that trap is part of the problem. I've been sharing a list of unproductive things I've done in a day with a friend of mine (I think my favorite so far was lying on the ground so I could experience the perspective of my dogs), and that has brought some lightness to my day.
Soleil: I have been working through my own feelings of fear, grief, helplessness, confusion, anger and anxiety. At times I am able hold space for all of these emotions and practice compassion towards myself and all of us feeling this right now, but I also have fallen into pits of despair and frozen into hopelessness and anxiety. I do have a sense of dread about what is to come, and it is very painful to connect with the sobering reality that reports from Italy show us and that is currently unfolding in New York. As I have kept up with epidemiologists and public health experts over the recent weeks, I had extreme anxiety and anger towards the inaction of our federal and state governments. The incompetence and inability to mobilize a centralized response is costing lives and putting the safety of healthcare staff in jeopardy. The lack of a clear, coherent, science-based message contributes to more confusion and anxiety. The helplessness I feel is in part from seeing a global power like the U.S. fail so abysmally at protecting its people. I feel shame that this is what we have allowed the U.S. to become. With decades of inaction on climate change, I have expected to experience disasters and crises and the like, but living through one is different than an intellectual understanding of the path we are on. I think we can take this as a warning of more pandemics and climate-related disasters in our future, take stock of our response and what it reveals about us as a nation, and organize to actualize our values and protect each other, most especially, the vulnerable.
The president has said ours is not a country that is designed to "shut down," and how true is that? We lack the basic need of universal healthcare, we lack safety nets and social programs to help people stay afloat. The solution is not to open back up for business, but to create those programs that would provide a buffer and ensure our basic needs are met while keeping people safe and alive.
Interviews have been edited and condensed for clarity.
Taking Care of Yourself During the Coronavirus Pandemic
Originally Appeared on GQ