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In February, Ashley Stauber spent most of her biweekly therapy sessions discussing the upcoming election. Stauber, a 33-year-old stay-at-home mom, was volunteering for Elizabeth Warren’s campaign in Los Angeles and found that her political work dominated her conversations. But by early March, her concerns had shifted to the mysterious infectious disease inching its way toward the United States.
“My anxiety is a lot about health and dying and sickness, so a deadly virus isn’t great,” Stauber says. “The next session I had it felt like all I could talk about was that, because I was afraid of it.”
Since the pandemic hit, surveys have shown its impact on Americans’ mental health: In March, the Disaster Distress Helpline, a disaster-specific counseling hotline, saw a 328 percent increase in monthly call volume. In a Healthline and YouGov survey from April, a few weeks into various state lockdowns, nearly half of Americans reported high levels of anxiety and depression. And according to a June 23 survey from the National Center for Health Statistics and Census Bureau, over 30 percent of American adults experienced pandemic-related symptoms of anxiety and depression within the previous week.
The coronavirus has altered life in mundane and major ways. Millions of Americans are unemployed; countless more are dealing with financial instability, loneliness, canceled weddings and upended living situations, not to mention the disease itself. As early COVID-19 hotspots like New York navigate the reopening process, Sun Belt states face a surge in new infections. It’s only natural to bring up these anxieties with our therapists.
Michael Gotlib, a clinical psychologist at the Center for Emotional Health of Greater Philadelphia, has spent the last three-plus months discussing the pandemic. At the outbreak’s onset, as face-to-face sessions moved to virtual appointments, many clients were in “crisis mode,” he says, and he worked to help de-escalate the sharp rise in anxiety. As the weeks under quarantine piled up, Gotlib guided clients through job furloughs, childcare woes and disagreements among friends and family on who to allow inside their COVID bubbles. “While we are all under the roof of pandemic,” he says, “we’re all experiencing it very differently with our experiences, our finances, our culture.”
Mass emergencies frequently find their way into therapists’ offices. From singular events like the September 11 attacks to the ongoing climate crisis, mental health professionals are well-versed in the ways in which current events intersect with their patients’ personal lives. Following the 2016 presidential election, Kathleen Smith, a therapist in Washington, DC, and author of Everything Isn’t Terrible: Conquer Your Insecurities, Interrupt Your Anxiety and Finally Calm Down, noticed common themes throughout her sessions. “It threaded [through] people’s thoughts, people’s conversations; it affected people’s relationships similarly,” she says of the election.
Gotlib, who worked as a college counselor during the 2016 election and through the beginning of 2020, says the DACA students he counseled felt the weight of uncertainty and insecurity long after Trump took office. But while Trump’s presidency has affected a large swath of people, experts say the anxieties spurred by the pandemic have taken hold quicker, among a wider population. “This hit fast and the crisis was immediate and it’s been ongoing — versus something like climate change,” says Gotlib, “which you might not notice on a daily basis if you’re not looking for it.”
For some groups of Americans, these concerns were always prevalent. But the playbook for how to help patients cope has changed, now that unemployment is rampant and physical isolation is encouraged as a health precaution. “Because I work with queer people, because I work with people of color, there’s always a common thread of some sort of trauma; there’s always a common thread of marginalization, there’s always a common thread of historical oppression,” says Courtney Watson, a licensed marriage and family therapist based in Oakland, California. “So that aspect isn’t necessarily new. I think it’s the fact that we don’t have tools for right now. The unknown makes it really hard to say anything but ‘Yeah, this shit is crazy’.”
With patients voicing novel concerns (I’m afraid of leaving my house and getting sick), as well as common concerns under novel circumstances (When will I get my job back?), therapists must recalibrate how they approach treatment. While Smith usually encourages her clients to turn to friends and family amid mental health challenges, she now understands the health risks of in-person meetups and the logistical hoops of coordinating Zoom calls. Since social coping mechanisms aren’t as readily available, Smith is on heightened alert for patients expressing suicidal ideation or considering self-injury. She asks clients about suspected self-harm more frequently, and more directly, than she used to.
For Watson, their methodology means simply acknowledging and validating clients’ anxieties. “People are so used to being OK or having these go-to tools that they utilize, and with those go-to tools not working, you have to remind them that there is a global pandemic, this shit is wild,” they say. “It makes sense that you have a day where you want to drink margaritas and watch Netflix.”
Gotlib uses a psychological approach called acceptance and commitment therapy, which asks clients to accept their emotions as rightful responses to stressors. He’s adapted his therapy techniques to the present moment. For example, when mentioning his own reactions to the pandemic, he says, “I made a list of all the unhelpful thoughts my mind was giving me. Things like, What if I die? What if my wife dies? What if some other worse-case scenario would happen? That’s my way of getting it out.” While Gotlib’s clients might be experiencing newfound struggles, he still uses the same framework to help them move forward: Clients learn to accept fears as they materialize and focus on the parts of life they value most.
Despite the various stages of societal reopening across the country, Smith doesn’t believe the pandemic’s effect on therapy will wane any time soon. The upcoming election and current social unrest have only compounded the panic set off by COVID.
Watson sees this moment as a breaking point. Out of the tumult, they feel, a new history can be written. Many of their clients have expressed hope borne from the Black Lives Matter protests. Returning to “normal” — both in therapy and daily life — means taking a step backwards, away from progress, they say.
“It’s been good and hard,” Watson says. “Good for me as a therapist because I feel like we’re really getting into the meat of a lot of things we couldn’t do when people have the distractions of life and work or going out. But with all of the stuff that’s coming up, there’s an ability to clear it out. That’s something that feels really good.”