Practical Practice: Getting people the help they need

According to a study published in August by the Centers for Disease Control, U.S. adults have reported three times the prevalence of symptoms of anxiety disorder and four times the prevalence of symptoms of depressive disorder compared with the same time period in 2019.

Even if the figures cannot be compared directly, as the CDC report points out that the methodology was not identical, the numbers are alarming. One quarter of respondents reported symptoms of anxiety and depression, 13 percent reported an increase in substance use and 11 percent reported an increase in suicidal ideation.

Luckily, Americans are also reaching out for help more. Back in April, the Substance Abuse and Mental Health Services Administration reported a 1,000 percent increase in texts to a crisis counseling hotline compared to the previous April.

An online therapy company reported a 65 percent increase in clients by May. The problem, of course, is that the well-documented shortage of therapists in both rural and urban areas may keep many of those who are reaching out from finding the help they need.

For a psychologist, the question becomes: how do I help? Firstly, how does one add more clients to a busy schedule and secondly, how can psychologists help those who may be experiencing mental health issues but will not necessarily seek treatment?

For Thomas Cooper, Psy.D, president of the Maine Psychological Association and a clinical psychologist with a private practice in Portland, the increased need will take a multi-pronged approach that may require therapists to learn how to think outside the box.

“One of the biggest things I talk about with clients is the importance of being flexible,” he said, “and to notice how we can cling to patterns or views in a really rigid way. And like everyone else, psychologists can be guilty of that as well and resistant to change. This pandemic has forced a number of changes on us whether that means working non-traditional hours or being open to questions about how we can adjust, like maybe doing group therapy or shorter sessions. Those are important questions we should be asking ourselves.”

A smaller practice may not be set up to do group therapy and scheduling two clients to split one session can be tricky, Cooper said, but it is this type of creative brainstorming that may lead to other solutions like offering weekend or evening hours.

One option he has put in place to open up more therapy sessions is to offer clients less frequent visits where clinically appropriate.

While his practice and those of his colleagues are being stretched at the seams, one silver lining may be with the increased use of teletherapy.

“One of my biggest takeaways is that, frankly, telehealth is working,” Cooper said.  “It is not the same as being in the room but anecdotally, I can’t say I have noticed any treatment outcomes that are vastly different. Over the past six months, I have had several clients whom I met with, treated and terminated, all without ever meeting them in person. A number of clients have to drive over an hour to come see me so even post-pandemic they may choose telehealth so they can save 2.5 hours in the car.”

For Luana Bessa, Ph.D, who focuses on diversity and inclusion in her Boston-based practice, the demand for services has also outstripped her ability to treat everyone who reaches out. As a result, she is working to expand her practice to be able to provide more treatment. In addition, she recently decided to hire administrative help so that each person who contacts her can be responded to quickly.

“What I am doing as a solo practitioner is making every effort I can to be really ethical with folks I cannot take on,” she said. “In my experience, it is not unusual for folks to reach out to therapists and not hear back. I am trying to provide referrals and educating myself on possible options of places I can refer them to, and not just from a generic list but places that are specifically invested in cultural competence, that focus on providing high-quality care to folks from marginalized communities, and that offer sliding scale services.”

Beyond those who come looking for therapy, reaching out to people who have not asked for help should be a crucial role of the individual therapist and of the profession as well, she added.

Writing articles for local newspapers, providing talks to community groups, producing a podcast or appearing on a radio show are all ways to raise awareness of methods people can use to address the feelings of stress and isolation.

“Individually, as therapists, there is a lot we can do as far as building and providing value to the community beyond that one-on-one time in a clinical space,” she said. “Collectively, as a profession, there is a lot we can do to educate the public. It could look like having PSA’s; there are lots of commercials for medication but I would love to see commercials saying, ‘Go talk to someone if you are feeling overwhelmed.’”

While some may not seek treatment because they don’t feel it is necessary, there are others who don’t because they don’t feel validated by the profession, she added.

“In the context of Covid, where certain groups are disproportionately impacted, some folks may not come for treatment because they have been historically marginalized by our profession,” she said.

“There are ways we can grow as a profession in terms of how to serve folks with different identities and life experiences. We want to build our awareness and expertise so that when people come to us, we can actually help them. That is something we can do to heal those fractures.”