As Americans head into a third year of pandemic living, therapists around the country are finding themselves on the front lines of a mental health crisis. Social workers, psychologists and counselors from every state say they can’t keep up with an unrelenting demand for their services, and many must turn away patients — including children — who are desperate for support.“All the therapists I know have experienced a demand for therapy that is like nothing they have experienced before,” said Tom Lachiusa, a licensed clinical social worker in Longmeadow, Mass. “Every available time slot I can offer is filled.”
The New York Times asked 1,320 mental health professionals to tell us how their patients were coping as pandemic restrictions eased.
General anxiety and depression are the most common reasons patients seek support, but family and relationship issues also dominate therapy conversations.
One in four providers said suicidal thoughts were among the top reasons clients were seeking therapy.
“I regularly wished aloud for a mental health version of Dr. Fauci to give daily briefings,” said Lakeasha Sullivan, a clinical psychologist in Atlanta. “I tried to normalize the wide range of intense emotions people felt; some thought they were truly going crazy.”
The responses to our survey, sent by Psychology Today to its professional members, offer insights into what frontline mental health workers around the country are hearing from their clients. We heard from mental health providers in all 50 states, as well as Washington, D.C., and Puerto Rico. (You can learn more about how we conducted our survey at the end of this article.)While there were moments of optimism about telemedicine and reduced stigma around therapy, the responses painted a mostly grim picture of a growing crisis, which several therapists described as a “second pandemic” of mental health problems.“There is so much grief and loss,” said Anne Compagna-Doll, a clinical psychologist in Burbank, Calif.
“One of my clients, who is usually patient, is experiencing road rage. Another client, who is a mom of two teens, is fearful and doesn’t want them to leave the house. My highly work-motivated client is considering leaving her career. There is an overwhelming sense of malaise and fatigue.”
Nine out of 10 therapists say the number of clients seeking care is on the rise, and most are experiencing a significant surge in calls for appointments, longer waiting lists and difficulty meeting patient demand.“I live in a rural town, but I still get approximately seven to 10 inquiries a week that I have to turn away,” said Amy Wagner, a marriage and family therapist in Carrollton, Ga. “I know the other therapists in my area are also full and have been since the pandemic started.”“Every single day there are new inquiries,” said Jacent Wamala, a marriage and family therapist in Las Vegas. “People are having to deal with the aftershock, emotionally and mentally, of what has happened.”Respondents said the higher demand was coming from both former patients who had returned for care and from new clients seeking therapy for the first time for anxiety, financial stress, substance use, job worries and other issues that have surfaced during the upheaval of the past 18 months.
Many therapists say they are counseling health care workers who have been traumatized by caring for Covid-19 patients.“The pandemic has functioned like a magnifying glass for vulnerabilities,” said Gabriela Sehinkman, a licensed clinical social worker in Shaker Heights, Ohio, who specializes in serving the Latino community.And while the pandemic has been polarizing, our analysis found that the higher demands for therapy are happening in every region, and at similar rates in red and blue states.“Even if some clients don’t recognize certain scientific aspects of the pandemic, they’re still feeling the isolation and separation,” said Nathan Staley, a licensed professional counselor in Kansas City, Mo. “Political disagreements are increasingly a source of distress.”
“I regularly wished aloud for a mental health version of Dr. Fauci to give daily briefings.”Lakeasha Sullivan, clinical psychologist, Atlanta “There is a general feeling of stuckness and stagnancy that is new.”
Michelle Slater, licensed mental health counselor, Jacksonville, Florida.
“Every available time slot I can offer is filled.
”Thomas Lachiusa, licensed clinical social worker, Longmeadow, Massachusetts.
Overall, 75 percent of respondents reported an increase in wait times. Nearly one in three clinicians said that it could take at least three months to get an appointment or that they didn’t have room for new patients at all.“I’ve never seen it like this before, where everybody is full, and everybody that I know has a wait list,” said David Goldberg, a clinical psychologist in Birmingham, Ala., who has 10 people on his waiting list. “I hate it that I have to turn so many people away.”
Although the survey wasn’t sent to psychiatrists, who often work with therapists to prescribe medication, we asked clinicians if they had seen an increase in patients’ use of or requests for antidepressants or anti-anxiety prescription drugs.
Six in 10 therapists said more patients were seeking medication. Some clinicians said waiting times for psychiatrists and practitioners who can prescribe medications had also increased.
“I’ve had a client who is suicidal and experiencing depression for the first time in his life have to wait three months to see a psychiatrist for medications,” said Kristin Mathes, a licensed clinical social worker in Bend, Oregon. “People don’t have that kind of time when their life is on the line.”
About 13 percent of the therapists surveyed said their practices focused primarily on children and adolescents. Their responses echoed a recent advisory from Dr. Vivek H. Murthy, the U.S. Surgeon General, who warned this month that the pandemic had intensified mental health issues among the young.“I don’t have room for anyone else right now, but the calls keep coming,” said Pooja Sharma, a clinical psychologist in Berkeley, Calif. “It might be some years before we have some sense of normalcy in mental health for children.”
“A 10-year-old boy I work with came up with ‘sad panic mode’ to describe his feeling of overwhelm,” said Georgie Gray, a licensed independent social worker in Cleveland Heights, Ohio. “I now use this phrase with other kids, and it resonates.”
“We’re seeing kids fist-fight, a lot of yelling at teachers. They don’t know how to be in a room with 25 other kids. They’re having difficulty relating to one another.” Pooja Sharma, clinical psychologist, Berkeley, California. “I believe I will be helping people navigate the effects of the pandemic for the rest of my career.”Leah Seeger, marriage and family therapist, Minneapolis.
Nearly 75 percent of respondents said much of their time was spent helping clients with family and relationship issues.
Couples are arguing more and coping with the aftereffects of lockdown isolation, financial and job stress and having children in online school.“There has been a significant increase in referrals from couples wishing to begin marriage/couples counseling,” said Florence Rosiello, a psychoanalyst in Sedona, Arizona. “Apparently, after being together in quarantine, couples have realized they don’t like their partner.”
Nate Sawyer, a marriage and family therapist in Durham, N.C., said even though things were opening up more, the couples he sees still don’t have enough time apart. “Couples are less attracted to each other,” he said. “They don’t have time to miss and desire each other.”
Many respondents said the pandemic had also highlighted existing relationship problems that could no longer be avoided, including differences in parenting styles and communication, the division of household chores and spending habits.
“It’s pretty difficult to find a therapist who does couples work who isn’t slammed,” said Chris Davis, a marriage and family therapist in Louisville, Ky. “It feels like more couples are on the brink of separating or divorcing. They’re fighting, their communication is negative, or it seems they’re just apathetic.”
“I’m already watching marriages crumble. None of the problems that they’re presenting with are new. It’s just their capacity to have resilience and compassion, and everyone is just so worn down. ”Patricia Garcia Mulligan, licensed mental health counselor, Port Orchard, Washington.
“While telemedicine can be effective and therapeutic, I think something is missed when not meeting in person. ”David Goldberg, clinical psychologist, Birmingham, Alabama. “Usually therapists don’t experience the same concerns and traumas as their patients at the same exact time. But during the pandemic,
everyone has been struggling to stay afloat. ”Cadmona Hall, marriage and family therapist, Chicago.
Although our survey did not ask about therapist burnout, about 10 percent of respondents raised the issue on their own. Nearly one in five therapists surveyed reported having had to cut back hours because of home and life demands during the pandemic.“Mental health professionals are drowning,” said Brooke Bendix, a licensed clinical social worker in West Bloomfield, Michigan. “Burnout and compassion fatigue is real — as well as the guilt we feel when we cannot see all of our patients, and the wait lists continue to grow.”
“We’re holding other people’s emotions, their sadness, their sorrow and their stress,” said Claudia Coenen, a certified grief counselor in Hudson, N.Y. “I saw four people today, and that’s about my limit. I’m on the edge of burnout, and I have to step back and trust that my clients will be OK.”Cadmona A. Hall, a marriage and family therapist in Chicago, said her brother had been in a coma after contracting Covid-19. “One thing many people are failing to acknowledge is the impact the pandemic has also had on therapists,” Dr. Hall said.
“Usually we are not dealing with the exact same thing as our clients.”More people of color are seeking support.
About one in seven of the respondents cited racial justice issues as a top reason that clients were seeking therapy. Therapists said people of color were reaching out following the murder of George Floyd and anti-Asian hate crimes, among other issues. They said interest in therapy had also increased after Simone Biles and Naomi Osaka spoke openly about their own mental health struggles in the sports world.“To have celebrities talking pretty openly about how they seek treatment has really broken through a big piece of the stigma that existed for a long time,” said Eldridge Greer, a clinical psychologist in Denver. “It has helped create a window of acceptance for therapy in the Black community.”
“There was a dramatic increase in requests for mental health services from Asian Americans, which is sad, because it was a reaction to the xenophobia and assaults we witnessed over the past year and a half,” said Jason Wu, a clinical psychologist in San Jose, Calif. “But I also hope that this openness to therapy becomes the norm.”
“Clients are seeking support for racial justice more than before,” agreed Montia Brock, a licensed professional counselor in Pittsburgh. “We can’t say the pandemic is the problem, but it has definitely amplified the problems.”“A lot more people who are Asian are looking for therapy who never did before. People are being more open about saying, ‘I’m feeling scared. I’m feeling anxious.’”Jason Wu, clinical psychologist, San Jose, California.
“Mental health is becoming more normalized, and people are not plagued with the same stigma as they have been in the past.”Steve Alexander Jr., licensed mental health counselor, Brooklyn, NY. The benefits of telemedicine are mixed. More than half of survey respondents said telemedicine had made their jobs easier, increasing access to therapy for clients and giving mental health professionals useful glimpses into a person’s home life, but 28 percent of respondents said virtual counseling had made caring for patients more difficult, in part because they missed important body language cues. Therapists described scenes of chaos in the background during online visits, and clients retreating to a closet, a bathroom or a stairwell for privacy.“You can see the toddlers running around; you can hear kids screaming in the background; they might still have their work screen up while they’re trying to talk to me,” said Christin Guretsky, a licensed professional counselor in Fredericksburg, Va. “An in-person office can help you slow down and provide a comfort that sometimes your home environment can’t.”
Six out of 10 therapists surveyed said the high demand for services would remain at current levels for some time. And nearly four in 10 therapists predicted that things would get much worse and that they would struggle to meet the mental health needs of their patients in the coming months.“These ripple effects are going to be affecting us for some time,” said Leah Seeger, a marriage and family therapist in Minneapolis. “I believe I will be helping people navigate the effects of the pandemic for the rest of my career.”
Several respondents said it will take state and federal intervention to address the growing crisis. Financial and insurance issues are among the biggest obstacles to patients finding care. Many therapists require cash payment and find it too difficult to work directly with insurance companies or Medicaid. Restrictive rules by state boards can prevent therapists in some states from offering telehealth sessions to clients who have moved to another state.
Our respondents said more federal and state funding is needed for public clinics, especially those for children. More educational support and training programs, including loans and scholarships, are needed to increase the number of trained counselors, particularly for people of color.“We can’t do it on our own,” said Shatangela Gibbs, a licensed professional counselor in Bloomfield, Mich. “We need assistance from people who have voices in high places.”Emily Fasten, a marriage and family therapist in San Francisco, said that she had tried to reframe the challenges of pandemic life for her clients as an opportunity to “grow and heal” but that she was not always successful.“It doesn’t feel hopeless, but as a person and a clinician, it is hard to always maintain that positive reframe in the face of all this,” Ms. Fasten said. “Therapists are tired."
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