‘We are in trauma together’: Americans need therapy – but psychologists are reserved

In a time when it feels like the world is perpetually on fire, we all need a therapist – but trying to find one these days can be a nightmare.

A study by the American Psychological Association (APA) published this week found that six in 10 psychologists “no longer have openings for new patients.” The shortage comes as demand for therapy explodes: since the start of the pandemic, about three-quarters of practitioners have seen their waiting lists grow. Over the same period, almost 80% of practitioners report an increase in the number of patients with anxiety disorders and 66% have seen an increase in the number of those requiring treatment for depression.

“I started my private practice just before Covid hit, and it was definitely filling up by then,” says Dr. Jennifer Reid, a psychiatrist, writer and podcast host in Philadelphia. “But the numbers have grown exponentially since that time.” She has stopped advertising her practice on sites like Psychology Today, a key place where people can find therapists.

woman with coffee
Dr. Jennifer Reid Photography: Grace Woolslayer

Reid focuses on anxiety and insomnia, which have been “major players” in the pandemic. At first, people with germ-related anxiety, phobias or obsessive-compulsive disorder had particular difficulty, she says. Then there was isolation and doomscrolling. And now, she says, people find it difficult to reintegrate into the world. “People are discovering that they experience anxiety trying to re-engage in social settings in situations that were previously not so safe” during the height of Covid, she says. “Now they have to kind of retrain their brains.”

Often, she says, people may need to go back to their primary care doctor for a while, “or they end up going without and waiting on waiting lists, unfortunately.” The APA study found that the average psychologist reported being contacted by 15 potential patients each month; Reid, who combines therapy and medical approaches, says she usually has room for about one new patient every few weeks.

Dr. Elinor Bock, founder and director of Therapists of New York, found a similar increase. “Since the pandemic, I think the demand has exploded,” she says. “We were all in trauma together.” During the confinements, “people were isolated, they lost people they loved, they were afraid”. They also had a lot more free time to ask for help.

Every stage of the pandemic, from lockdowns to delta to omicron to easing restrictions, has brought major stressors, says Dr. Brett Marroquín, a clinical psychologist in Los Angeles and associate professor of psychological sciences at the Loyola Marymount University. Even in a reopened world, there is a lot of loneliness, says Marroquín. “I see more people coming in who are like, ‘OK, I’m sort of coming out of the pandemic. I have lost my ties with my friends, haven’t dated, or have a lot of tension with my partner and experience life as very lonely and isolated.

The problem has been compounded because people have been unable to access care, Reid says. “Maybe when I start seeing them, they’ve really been struggling for months or even a year or two with growing anxiety,” she says. “And then here they are with higher levels of depression and anxiety, worse sleep, more symptoms. So that makes things even more difficult.

Healthcare workers in particular have struggled as Covid rages and precautions taper off, Reid says. Then there are the “dramatic consequences of what they experienced during the peak of Covid, which I believe will continue to be a problem in our healthcare community for years to come”.

Portrait of Dr. Elinor Bock
Dr Elinor Bock. Photography: Tricia Suriani/NY Therapists

Bock has seen a particular increase in demand in a few areas. “I have never received so many calls for couples therapy,” she says. “Couples have really struggled during the pandemic – they have gone from parallel lives to being in a small apartment together.” As for individuals, Bock saw people struggling with “existential anxiety, climate change, political issues, oppression, loneliness,” she says.

Lockdowns have forced many people to take a moment to reflect and ask themselves, “Who am I? What do I want to do? Where do I want to be? What job do I want? Is it meaningful enough? said Bock. “It’s almost like we have a little window to think about ourselves more than ever.”

This period also brought another change for the better. “All of a sudden it didn’t seem stigmatizing anymore about needing help during the pandemic, because no one was doing well,” Bock says, describing “a huge shift in the stigma around therapy.” “Every Netflix show I see now has a therapist. In the media, everyone sees a therapist – athletes, musicians – so it’s more part of our culture.

This is, of course, a double-edged sword: while stigma mitigation has fueled demand, the APA study suggests that supply has fallen short. So what can be done to remedy the shortage?

Portrait of Dr. Brett Marroquin
Doctor Brett Marroquin. Photography: Courtesy of Brett Marroquín

Changes in insurance practices could help. Therapists say it can be difficult to accept insurance because company reimbursement rates are too low for them to support their practices. This means that patients may have to pay out of pocket, putting some therapists out of financial reach for many people.

Bock would like to see a better system for patients to find care. “One of the biggest obstacles to entering therapy is the real: how do you find someone?” Online searches can bring up countless profiles to sift through, “and it’s really hard to tell what someone looks like from a photo and a three-paragraph bio,” says Bock. Silicon Valley, take note: “I think someone could come up with some kind of awesome matchmaking algorithm to help connect people with therapists, because that’s a big part of the connection.”

Such efforts are ongoing. Reid works with a platform for Philadelphia therapists that lets them see everyone’s availability. “We really feel responsible for trying to give patients good options if we can, if we can’t see them,” she says. And Dr. Brad Brenner, a Washington DC-based psychologist who co-founded the Therapy Group of NYC, works on a platform called WithTherapy, which helps match patients with providers. “It’s almost impossible to know if a therapist is even accepting new patients. Or whether your schedules line up,” Brenner wrote via email.

In the meantime, seeking a therapist by word of mouth — asking friends or calling practitioners even if they’re full — is a good first step. The growing use of telehealth can also help, especially under programs such as PsyPact, a legal framework that allows practitioners to work in multiple states.

And while many therapists don’t take out insurance, Marroquín recommends potential patients investigate those who do. Insurance company websites often provide a list of network providers; “Just contact them – blast them all,” he says.

If therapists are inaccessible, their work may not be. Reid says she started her podcast and started writing to reach those she wouldn’t otherwise be able to work with. “I can’t see everyone one-on-one and there’s all this news” about the shortage, she says. “You feel responsible for having the necessary training to disseminate the information.”

“We went into this business to try to improve as many people as possible. And so we’re trying to find different ways to do that.

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