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Local mental health care workers talk virtual therapy and when to get help

Monadnock Ledger-Transcript
Published: 6/2/2020 3:44:16 PM

Locally practicing mental health professionals are seeing new patterns associated with the COVID-19 pandemic and are experiencing the new realities and limitations of online services. The MLT interviewed therapist Winter Keeler, a licensed independent clinical social worker who works out of The Grapevine’s building in Antrim, and Rebecca Sartor, LICSW and Executive Director of the Counseling Center of New England. They described the realities of helping clients through existing or new mental health issues during a global crisis, and what they expect treatment to look like in the Monadnock region going forward.

Usually, “we have the ability to distract ourselves from our stress by engaging in work, or doing things with friends or the day-to-day life of grocery shopping and taking care of children,” Keeler said. The pandemic took many regular distractions away, and in that absence, many of her clients who had long been struggling with an issue found themselves experiencing heightened symptoms. “The things they kept pushing away are really rising to the surface and they need to address them,” she said. “It’s really kind of blowing up because of the added stress and not having the same social outlets,” she said.

The pandemic situation can trigger panic, anxiety, and depression in trauma survivors. “When you have trauma, your sense of safety and trust is really rattled. There’s almost like a sense of paranoia, what can I trust,” Sartor said, and that can make the new uncertainties of the pandemic especially destabilizing for people with more significant trauma history.

Clients and clinicians alike were afraid of conducting sessions over videoconferencing, Sartor said, but after they “ripped the Band-Aid off,” most have said they see the merit in incorporating virtual services into everyday practice, she said.

Practitioners are also focusing more on facial expressions in lieu of seeing the whole person in their office, Sartor said. The remote format even allows for the clinician to understand some parts of a client’s life they wouldn’t otherwise see, she said. For example, a child client who always talks about their room, or their dog, can now show those things to their clinician.

There are drawbacks too: It can also be harder to maintain a private, distraction-free environment with remote sessions, Sartor said. Keeler holds some appointments very early or late in the day so clients can speak in their home while other household members are sleeping. In-office visits allow adolescents a sense of privacy, and they may not feel as comfortable speaking to a counselor at home where their parents might hear, Sartor said. Visits with younger children have changed as well, Keeler said. When meeting virtually with young children, the format requires parents to be more involved than they would during in-person visits, and that changes the dynamic, she said, and play therapy sessions with her youngest clients have gone by the wayside.

In-person visits are still going on for some clients, Keeler said.  Some of her clients were ready to process a significant trauma when the Stay At Home order began, she said, and for some, “the thought of doing it through telehealth [was] even more scary than having to address it at all,” she said. It’s also better to assess the status of clients who engage in self harming behavior in person, she said. Each in-person visit is conducted with strict sanitary protocol that both parties agree to, she said.

The current boom in virtual mental health care could result in more service for the Peterborough area, Sartor said. The Counseling Center of New England has historically had a hard time recruiting clinicians for their Peterborough branch, she said, and, although they are looking to expand in-house services, virtual services could allow a resident to see a specialist in Manchester or Bedford from home after a couple in-person visits, she said.

Working in pandemic conditions can wear on the therapists, too. Some of Keeler’s colleagues told her they were feeling more worn out since they were having so many of the same conversations as their clients processed the uncertainties and anxieties associated with the pandemic. Visiting clinicians associated with the Monadnock Region System of Care used their drives between clients to decompress, and are now experiencing fatigue with back to back appointments, Project Director Dennis Calcutt said.

Clinics are bracing for traffic and caseloads to change as the pandemic continues and subsides. There was an immediate dip in new referrals to the Counseling Center of New England when schools and businesses first closed down at the end of March, Sartor said, around 30 or 40 percent. “I don’t think people initially prioritized their mental health while worrying about kids and money,” she said, although her organization truncated their screening process to make it easier for people to seek help.

Now, people with no history of mental health issues are beginning to reach out, Sartor said. She anticipates a future need for partner and family work as families experience the stressors of lockdown. Substance use disorders are likely to increase, she said. As the facilitator of a court-ordered group of domestic violence perpetrators, Sartor anticipates eventually fielding the needs of people currently being abused or neglected once emergency orders lift and there are more opportunities for them to be in safe, confidential spaces. “If you’re trapped at home with your perpetrator, there’s... not even an opportunity to reach out to one of those hotlines,” she said.

Many people are experiencing anxiety, disturbances in sleep patterns or bad dreams, and feeling isolated, Sartor said, but a person should consider seeking mental health care if they notice a marked increase in any of those symptoms, a reluctance to reach out to others about their problems, or any decline in functioning: getting out of bed, eating, or caring for yourself and children. “People who haven’t experienced it before might just not feel like themselves, and can’t pinpoint what it is,” she said.

Substance intake should be monitored, too. “If that 5 p.m. cocktail is sliding to 3 p.m.,” Sartor said, it could be a sign that mental health conditions are worsening. Ask yourself about the reasons you’re doing it, and if it’s functioning as a coping mechanism for anxious thoughts, Keeler said.

Keeler is currently taking clients, as is the Counseling Center of New England.

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