What It’s Like To Be A Therapist During COVID-19

Photographed by Jessica Garcia.
During the pandemic, many of us are feeling on edge. There’s a laundry list of worries that run through our heads every day: Is that tickle in my throat coronavirus? What if my parents get COVID-19? Am I going to get laid off? You get the point.  
Many people, whether they were seeing a mental health specialist prior to the pandemic or not, are turning to therapy to help them cope with the uncertainty and anxieties of life right now. But therapy, like everything else in our lives, looks different than it ever has before. Psychologists, psychiatrists, and other professionals are having to navigate heavier-than-usual workloads, devastating levels of grief and stress, and virtual sessions. 
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Refinery29 spoke to Mary K. Alvord, Ph.D., psychologist, director of Alvord, Baker & Associates in Maryland, and co-author of Conquer Negative Thinking For Teens. She’s been working with patients for 35 years, but has never seen anything like the coronavirus. We asked her for the advice she finds herself repeating to her patients — and herself, as she works to balance her own mental health with her desire to help as many people as possible during this time. 
Refinery29: How are you seeing patients during the pandemic? 
Mary K. Alvord: “I’d say that my business was 10 to 15 percent telehealth prior to the coronavirus. That was our norm. And now it’s basically 98 percent of all services. I’m not licensed in Washington DC, so normally they’d have to come to me. But right now, the laws [around practicing in states other than the one you’re licensed in] are relaxed, and I can continue services with my DC patients, even though I’m based in Maryland. 
What’s the other two percent? 
“We can’t do comprehensive psychological testing with children online. You really need to do that in person. Then, a minority of people want to wait and do their therapy in person, so they’re not coming in right now.”
Can you have the same connection with a patient via telehealth? 
“I have been advocating for telehealth therapy for a long time. If you have limited mobility, or if you live far away from a therapist clinic, or in a variety of other circumstances, telehealth is a wonderful way to access services when you might not otherwise be able to. 
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Mary Alvord
Mary Alvord
“That said, it’s maybe not 100 percent as intimate as in person, but it’s pretty close. You lose some nonverbal cues, since you can’t quite see [the patient’s] whole body. I also talk to my patients about lighting; I need to see their face and their expressions, so I don’t like backlighting. 
“Because of that, it’s more tiring for the therapist to be sitting in front of the computer — you have to work really hard to make sure you really notice everything. 
“There’s a risk of being disconnected, too. My patients and I agree they have a phone right next to them in case the connection goes out, and I have my phone near me too. You need to be prepared.” 
Have your patients found it hard to make the switch to virtual sessions? 
“Some of my patients were reluctant to try telehealth during coronavirus. I said, ‘Let’s just try it out for five minutes. If you hate it, fine, but let’s just try it.’ [For the most part], they’ve been okay with it. For a couple of patients who were reluctant, we just scheduled short sessions at first until they were comfortable. We also talk about privacy — I send a secure link and have them test it.
“I do cognitive behavioural therapy, and, with kids, I will email worksheets — to their parents or to the teens if they have email — that we might do together during the session. I also share a white board on my screen where we talk about how thoughts and feelings and actions are related. We can set goals on it in real-time, and write down strategies. Overall, clients seem to be taking to the transition to virtual sessions quite well. ” 
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Are you seeing any general trends in your patients’ concerns in the midst of the pandemic? 
“Yes. There’s a lot more anxiety. At the beginning of this, my adult patients were concerned. Many have autoimmune diseases or heart conditions, or they were concerned about getting sick because of their age. Then there was a wave of sadness — and I’m worried it’s turning into depression for a lot of people — as they are in their homes and can’t really go anywhere. And then there are family dynamics that create difficulty and added stress. On top of that, there’s economic stress. 
“I started my virtual sessions with kids on March 14. When I first started working with them, they were worried about their grandparents. Then there was a shift two weeks later because we learned it’s not just older people. They started to worry about themselves.” 
What kind of advice are you giving people who are anxious about coronavirus? 
“Most of the work I’m doing right now emphasises resilience building. I’m encouraging people to focus on what they can control, and let go of what they can’t. So with adults, that looks like encouraging them to create routines and structures — for their kids or just for themselves. Set up boundaries around work time, meal time, sleep time, play time. 
“I also encourage patients to ask themselves: ‘What can I do to make this easier?’ For example, I can take precautions. I can eat well. I can sleep well. I can think of things in a realistic manner — how likely is it I'm going to get sick? I teach adults how to do what I call ‘reality checks’ in response to catastrophising. If they start fixating on the worst-case scenarios in their heads, I teach them to ask themselves, ‘What’s really the likelihood of that happening?’
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“Right now, the only thing we’re certain of is that there’s a lot of uncertainty. That uncertainty feeds anxiety. We’re sort of learning to accept that we don’t like all this but that it is what it is. 
“For some people who have someone they love who’s tested positive for coronavirus or who’s been hospitalised, I work with them through those difficulties. 
“But for most people, a lot of the work we do is focusing on how they can structure their days, and how they can turn their attention toward what is going well — and whether they can use this time as an opportunity to do something they haven’t done before. Like a hobby or catching up on reading. They can hike or walk or run around the block.” 
What do you tell someone if they’re doing all the “right things” to combat the virus, but they’re still feeling a lot of anxiety?
“I would say, what we choose to focus on determines our memory and our reality. If you focus today on all the things that went wrong, tomorrow you will remember that you had a bad day yesterday. But if you focus on what you accomplished, what went well, that you asked for help when something was difficult — the next day you remember having an okay day. 
“Instead of focusing on how many people are sick or overthinking the fact that you got closer than six feet to a neighbour that one time during a social distancing walk, think about the good things going on in your life — the extra time you have now or the fact that technology can connect you with loved ones during this time. Practicing gratitude for even the small, so-so moments helps us keep perspective.”
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How do you help people through the guilt and shame that comes with coronavirus? For example, if you think you passed on coronavirus onto someone, or you’re an essential worker who’s coming home every night to your family after having contact with people. 
“When your thoughts go to, ‘What if they got it from me?’ know that most likely, you have taken all the precautions that were known at the time, to the best you were able. In other words,  challenge those thoughts and feelings of guilt with a heavy dose of reality. Know that you can’t control everything about this virus. With each day comes new information for each of us to absorb and implement. What we know today is not what we knew eight weeks ago, for example. Remember that.”
As a psychologist, how do you manage your own mental health during this time?

“For me, the number one thing I do to manage my mental health is making sure that I get enough sleep at night. Because I find that if I’m fresh, and my brain is clear, then I can start the new day. It takes a lot of energy as a psychologist to be supporting so many people. For me, it’s both supporting patients and my staff. I make sure that I stay as healthy as I can.
“I have those routines I talked about. I get up around the same time each morning. I limit my news in the morning, and avoid it for the hour before I go to bed, so that I can go to sleep without being upset by something I read. I take breaks. I take a walk around the block a few times a day. Once a week I take a long hike with a good friend, and we keep our physical distance. I make sure that I’m socially connected. I speak to my kids, who are all out of state. We have a Zoom family meeting every Sunday. 
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“My daughter-in-law is an ICU nurse and it’s rough — they’ve got a one-year-old — so I try to support her and my son, who’s trying to work and is with the baby.”
What else can people do during the pandemic to look after their mental health? 
“Nature, mindfulness, gratitude, and appreciation — they’re all things I integrate for myself as well as for my patients. What are you grateful for right now? Remember that life is not joyous every day, most days are just okay. But be grateful for the okay.”
This interview has been condensed for clarity and length.
The coronavirus pandemic, and resulting economic downturn, has disproportionately affected some professions — doctors, nurses, teachers, small business owners, cashiers, and food industry workers are just some of the folks on the front lines. Checking In is an ongoing series where we pass the microphone to workers in industries most impacted, and ask them what they want us to know about their hopes, fears, and needs right now. Click here if you want to participate.
The World Health Organization has declared COVID-19 a global pandemic. It says you can protect yourself by washing your hands, covering your mouth when sneezing or coughing (ideally with a tissue), avoid touching your eyes, nose and mouth and don't get too close to people who are coughing, sneezing or with a fever.
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