Interview with Annabelle, The Effects of the COVID-19 Pandemic on Therapy, Hist 150H Spring 2022, Conducted by Shayna Larrow, March 22, 2022.

Overview:

In March of 2020 a new type of coronavirus was introduced to the world: COVID-19. Because of its level of contagion and how fast it was spreading, the whole world shut down and people were forced to quarantine and stay in their homes (with the exception of grocery shopping and other essential jobs and tasks). For many, it was a very difficult adjustment. The isolation and lack of social interaction took a toll on people. People’s mental health was severely impacted, and there was a significant rise in mental health disorders.

Two years later, we are still dealing with the repercussions of the global COVID-19 pandemic. Annabelle has seen these consequences first hand through her work as a therapist, and she has graciously agreed to an interview regarding the effects of COVID-19 on therapy. In this interview, Annabelle speaks about the difficulties people have had accessing therapy over the past 2 years. She discusses the pros and cons of this new virus, and how its effects have impacted us in both good and bad ways. She also discusses how people’s views of mental health have changed due to the pandemic, and how there is a new level of awareness when talking about it.

Like everyone else, Annabelle had to drastically adjust her work in response to the pandemic. Because she couldn’t see people in person, she was forced to move completely to Telehealth and meet with her clients online. She speaks about her experience with this transition and how it became the new normal.

Biography

 Annabelle(she/her) was born in Freehold, New Jersey and lived there until she was 13 years old, when she moved to Sudbury, Massachusetts. She received her masters of Arts in Marriage and Family Therapy from Antioch University New England in 1998. She first worked at the Counseling Service of Addison County, then later in 2014 started her own private practice.

Research

Since the start of the global COVID-19 pandemic, we have seen many changes in our everyday lives. The stay-at-home order and quarantine procedures have affected our ability to go about our daily routines and interact with other people in our community. This increased isolation, for many, led to increased loneliness, anxiety, depression, substance abuse, and self-harm and/or suicidal behavior. There has also been a rise in cases of domestic abuse because people are stuck in their homes with nowhere else to go. A lot of people have experienced these negative effects, and the demand for therapists has been high. Because people were unable to meet in person, behavioral health treatment services were forced to adapt. Many service providers used telehealth, online platforms, to meet with patients. Because this was not as frequently used before the pandemic, insurance companies did not originally cover those types of services. However, because telehealth was one of few options for people to see therapists, they reimbursed appointments made through it.

This interview takes a look at these issues from the perspective of a therapist who has worked with many people dealing with the negative effects of a global pandemic.

Transcription

Shayna [0:05]: Today I’m going to be interviewing Annabelle, who is a marriage and family therapist. So if you’d like to just go ahead and introduce yourself a little bit or give us the history in your field of mental health, that’d be great.

Annabelle [0:16]: Hi, thanks for having me. It’s nice to be a part of this dialogue around mental health and COVID. I’ve been a therapist for- I’ve been in the mental health field for 25 years. I started out in community mental health, and I did that for about 15 years, doing family therapy and working with kids in various communities- low income communities, foster care placements- before transitioning to private practice. And I’ve been doing that for the last eight years focusing on a lot of couples work and individual therapy as well.

Shayna [1:00]: Nice. So how did you first discover you wanted to be a therapist?

Annabelle [1:06]: Ah, well, you know, it’s hard to kind of dissect that. But I think naturally, when I was in high school, I was always that friend that people came to talk to about things. And then it was either my junior or senior year in high school, I took a psychology class. And I don’t know if it was the class or the professor. She just inspired me more than any other teacher that I’d ever had, and I just loved the class and knew from that point on I was going to major in psychology in college. Going into college, I decided to be an RA because I wanted to have that level of influence on students to be able to be there for other students my age and younger, to support them emotionally in that way in the dorms. And then it kind of snowballed after that. I think a piece also was my childhood and things that happened in my childhood and watching my parents relationship influenced my desire to be a marriage and family therapist in particular.

Shayna [2:24]: That’s really interesting. I guess we’ll just jump right into it. So obviously, COVID has been very prevalent the past two years, I think now it’s been, in what ways that you’ve seen has COVID impacted mental health, both good and bad. Obviously, it’s impacted many different ways, but how have you seen this?

Annabelle [2:44]: I think that the first thing that really comes to my mind is anxiety, whether people have been diagnosed originally with anxiety, or just general anxiety that the average human being has about life and things that they encounter. And when COVID started, it created this high level of alert and, for lack of a better word, kind of paranoia, right? When it started, and we were told, okay, we can’t touch things, and we have to wipe down our groceries and not touching the mail for a few days and leaving it outside your doorstep. So I think a lot of those things really fed people’s anxiety about going out, their fear of germs. I think anybody who struggled with agoraphobia, I don’t know if you’re familiar with that term, but that fear of leaving the house, I think that was maybe even worse, during COVID, and then not being around people in the healthy ways that we need, the social aspect that was going down. I think the good part- did you ask me about the good part?

[Agoraphobia is an anxiety disorder that can include fear of leaving one’s home, entering crowded spaces, or being in a situation without an escape that might cause panic or embarrassment]

Shayna [4:08]: Yes.

Annabelle [4:09]: I think there were there were a lot of good parts. You know, whether you talk to people about their family time. You hear about even celebrities who were always traveling or musicians that were always on the road and didn’t have a normal life. Everybody kind of buckled down at home, had downtime with their families, families were playing games and doing puzzles and, you know I did really creative things with my family with, you know, specialty dinners and making it unique so that when we were kind of stuck in our house, it became this reframe of okay, let’s make the most of this. And so I think it kind of slowed things down and I think for some people, you know, not having to go to work, not having to go to an office and not have to travel. It gave people a lot of flexibility. And in that sense, I would say it almost decreased stress levels, and maybe lessened some of people’s busyness and, you know, the crazy routines that people had, it really slowed life down. So in that sense, it was a blessing, right, and people kind of looked at it as, okay, let’s make the most of this, let’s find all the silver linings in this.

Shayna [5:37]: That’s a really good point, I hadn’t really thought about how that could actually be a good aspect of it. Obviously, people focus on the bad parts of COVID a lot, but it really did kind of increase that family time that probably wasn’t there before.

Annabelle [5:50]: Yeah.

Shayna [5:54]: Given that it’s changed mental health, in what ways that you’ve seen, has COVID changed therapy, including settings, different methods of therapy, whether that be online or in person, or even just your clientele. How has all that changed due to the pandemic?

Annabelle [6:10]: Well, it’s changed a lot. It’s made therapy even more prevalent. It’s like, on the top of the list for a lot of people now, where maybe in the past they’ve thought about reaching out to a therapist to work on their own stuff, or their marriage or their relationship. And with COVID, everything was really magnified. And people- it was like they were under this microscope now of wow, now I really have to look at my relationship, or now I’m really suffering and now I need some help. So I think it increased the clientele and those who might not have reached out for therapy in the past, all of a sudden, were really pursuing it. Settings like telehealth; telehealth was kind of- it’s always been there. It’s interesting because prior to the pandemic it was on my radar of something that I was going to look into, for down the road for when I was, you know, planning on moving to another state, and I thought, let me see what telehealth options would be so that I can continue to work with clients. Now, all of a sudden, it was this big thing that everybody was doing. And everybody had to do it because we weren’t allowed to see patients or clients in the office. So yeah, the settings changed. Methods; I don’t know if- I wouldn’t say that my work in particular changed, like the way I do my work. It’s amazing, though, in the first year, every conversation, every hour of every appointment, I was talking about COVID. I was talking about the fear of going to a grocery store, I was talking about “how are your friends dealing with it?”, “are they following the guidelines?”, “how does that impact you?”, “how does that change your friendships?”. When you look- when you see people reacting to something big in the world in a different way than you are? So the focus of therapy certainly changed. I don’t know that I would say methods necessarily changed.

[Telehealth is healthcare that is provided online for both patients and healthcare providers]

Shayna [8:50]: Yeah. That makes sense. You sort of answered this before, but how has the need for mental health help increased since the onset of the pandemic? Not necessarily just in general, but maybe in terms of COVID? How has that increased?

Annabelle [9:13]: Like specifically around the virus?

Shayna [9:17]: Yeah, I think just the effects due to that, I guess, more focused on anxiety and all that. How has that increased specifically because of COVID?

Annabelle [9:31]: Well, I think mental health became- it’s almost like in the last five to 10 years, and maybe this is- I don’t know if this is another question you’re going to have, but like- in the last five to 10 years, mental health has become like a high topic, right? It’s always kind of been in the background. But I would say the last five to 10 years or maybe even a little bit longer, it’s become heightened, right, there are lots of- awareness around, you know, suicide awareness and their walks for things like that. And, you know, ribbons and people doing different fundraisers, and so I think it’s become more talked about and more socially acceptable and more in the media. But when COVID happened, like, oh, my God, it was like, twofold, like it became the number one thing, really.

Shayna [10:40]: Yeah.

Annabelle [10:42]: So it definitely impacted mental health. And the need for it increased, you know, 150% because of it. Yeah.

Shayna [10:56 ]:That actually answered my next question, so that was perfect. So building off of that, obviously, there have been a lot of changes in therapy because of the pandemic. Do you think these changes will stay in place after the pandemic mostly comes to an end? Or do you think they’ll go back to the way it was?

Annabelle [11:14]: I really think that they’re gonna stay the same. I think now that people have reached out for support, I think there’s a new level of awareness for individuals, for couples, for families, that once they see like, oh okay, this is really helpful now that we’re not talking about COVID, now I think there’s some other things I can focus on. So I don’t think that part is going to change. I don’t think telehealth is going to change. It’s interesting to kind of see how its transitioned into telehealth and now transitioning away as I look at my community and some of my colleagues and other professionals how they’ve started to transition back to an office and starting to see clients in person again. And then there are many people who are saying, no, you know what, telehealth is working really well. Myself included, I have decided. I gave up my office last spring and really took a poll of all my clients and asked them like, okay, what’s your feeling? Would you want to do in person? Is this online working for you? And these are people that I worked with, prior to the pandemic, so they had the experience of meeting me in the flesh, in person. And then some people who I’ve only ever seen over video. And I think the convenience, the being able to be in their own home or being able to do it from work and not having to add on the travel time, I think all of those things are probably going to keep some of those changes.

I think the the part that I don’t know if it’s going to continue, is where health insurance companies fit in. While they allowed certain things for a period of time, and they kept extending it while we were in a crisis, some of them are starting to back off saying, okay, we’re no longer going to cover telehealth, or if you’re out of network, we’re no longer going to cover it. Or now we’re not going to cover phone appointments. Whereas at the beginning of the pandemic, they did allow, you know, all along. Like everything was allowed, and now they’re starting to kind of reel it in a little bit. So I think there will be some changes, but I would say for the most part, I wouldn’t be surprised if things kind of stay the same.

Shayna [14:10]: Well, it seems to be a lot more accessible for everybody and easy to access, which is definitely a good thing. So, that seems to be positive. You mentioned earlier that, obviously, the first year of COVID, that was mostly the main topic of your sessions, and all anybody wanted to talk about. But now almost two years later, have you found that people have kind of shifted their focus away from that, or would you find that it’s still a common topic of discussion or just a theme that you’ve witnessed in your sessions with clients?

Annabelle [14:40]: It’s still there, it’s in the background. It’s not a focus, but I would say almost daily I could say I got off a call or session with somebody and there was at least one if not two appointments a day where somebody said, oh, I got COVID, or my son, or my daughter got COVID, or my friend got COVID, and now I’m nervous about it. So it’s still in the background, but it’s not the focus 100% the way it was in the first year,

Shayna [15:17]: Right. Do you think it’s always going to be a focus, or will it eventually kind of fade? Or do you think it’s going to be something that people reference in the future just kind of always be there?

Annabelle [15:25]: I think it’s- there will be a reference for a long time. You know, the effects of this pandemic just don’t stop overnight. The damage that was done to people’s mental health and their way of life doesn’t change overnight, just because now the rules are saying, okay, don’t wear a mask, or you can go here, or you can see your friends. But I think, you know, it takes a long time for that to go away. And I think also, at the same time, it’s never going to go away.

Shayna [16:06]: Right.

Annabelle [16:07]: You think about 9/11. And, you know, that was 21 years ago. And it’s still referenced, and it’s still talked about, and there are moments where, you know, people from my generation, we do something and it’s like, snap of the fingers, and we’re right back to that moment of remember where you were when you when you heard of the towers being hit? So I think for, especially your generation, 20 years from now it’ll be “where were you when the world shut down?”.

Shayna [16:42]: Right.

Annabelle [16:43]: You remember when schools closed and you thought, oh, it’s just going to be an extra week of vacation before spring break. But then you didn’t go back for a long time, and then everything’s different. So…

Shayna [16:57]: Yeah. That’s really interesting to think about. How has COVID affected you as a health care provider? Obviously, you deal with people and their anxieties around this pandemic for the past two years. But how has that affected your outlook on it? Has that taken a toll on you in any way having to kind of throw yourself into helping other people?

Annabelle [17:21]: Yeah, it was really interesting being in this role of giving advice to people, which I’m trained to do, and I feel like I have a lot of knowledge in a lot of areas, and I don’t tend to take on clients who have issues that I’ve not experienced, and I would then refer them elsewhere, right, because I want to only give advice that I feel like I know. And here I was at the beginning of the pandemic, helping people cope with this virus. And I was in the same shoes that they were in.

Shayna [18:01]: Right.

Annabelle [18:02]: And I was going through with them, and yet they were leaning on me for emotional support. So it was a whole different experience where I almost became, you know, a friend. Like, okay, we’re in this together, versus okay, let me help you. I could give the advice to help around the anxiety, because that’s a specialty; that’s my expertise. But in terms of the virus and how to proceed, and how to go to a grocery store, and what to do with your friends, it was all trial by error, like it was- and that was weird. I was very aware of it, and I vocalize that to each and every one of my clients, like, this is all new, we’re going through this together, so let’s figure that out. And that part was different.

The emotional toll of it, for me, came in waves. I think, for the most part, I tend to be resilient when it comes to crisis, except for when it’s like really personal and then you know, then I fall apart and I get [very emotional]. But I think with COVID, like, I jumped on the ship and I’m like, okay, what do we have to do? Let’s just figure it out. And then there were moments where it would hit me, like being caught by a wave at the ocean where you get sucked under. And there were moments that I just felt completely overwhelmed by it and I missed people and I missed my friends and I would cry and I would get sad and then I would kind of push through and work through that, because I had to be there for my family and my kids and my clients. But I think for the most part, I think I handled it well. And I continue to, and it still hits me even now, there are times, because I’m not doing everything that I would love to be doing, because I’m still so cautious, that I get angry, and I miss. And I miss doing the things and the freedom, feeling like, you know, being able to go now and walk into a store and not have to think, “wait, where’s my mask?” Like, just the fact that I worry about that now. And remembering the days, like, wow, that was once not a thing.

Shayna [20:55]: Right.

Annabelle [20:55]: But it’s gonna take a long time for that to go away.

Shayna [21:00]: Do you think that increased or decreased your passion for your work at all? Kind of that feeling of being overwhelmed with what, I’m assuming, you’ve always had a very strong passion for since your junior year of high school?

Annabelle [21:21]: I wouldn’t say it negatively impacted my passion. I don’t know that I would say increased my passion, although I did find that I wanted to help more and more people, because people were desperate for therapists. And when you heard people and, you know, I would get emails saying I’ve been looking for therapists for months. And even today, you know, I get emails from people saying I’ve been searching for a therapist for a year. And that breaks my heart. And I want to say, okay, I’ll add one more. But it’s me learning how to find that balance, because when you’re really passionate about wanting to help people, you also have to really focus on self care. And it’s hard to say no, it’s hard to turn people away.

Shayna [22:22]: I’m sure.

Annabelle [22:23]: So that part is hard. I will absolutely say I got more burnout than I’ve had in years and years of my work. And I wouldn’t even say it was compassion fatigue. That’s a term in mental health, where you just get exhausted from helping people. It was COVID fatigue, it was, oh, my God, how much more do I have to talk about COVID?

[Compassion fatigue is emotional and physical exhaustion that can lead to feeling less compassion or empathy for others]

Shayna [22:50]: Right.

Annabelle [22:51]: That was exhausting. Day in day out at the beginning. But that’s eased up a bit.

Shayna [23:02]: So just one last question for you. You mentioned earlier that, you know, the past 10 years or so obviously, mental health has been seen as more important, and definitely something we need to pay more attention to and COVID just really emphasized that. But do you think it had ever been taken into enough consideration, or made a priority as much as it should have been, during COVID? Or did you feel that it was still neglected more than it should have been?

Annabelle [23:31]: You mean, before?

Shayna [23:32]: After COVID. When a lot of people were struggling and maybe, you know, health insurance companies or people like that didn’t realize that this was a much bigger problem and we needed to pay a lot more attention to it. [More than just] focusing on, you know, not getting sick.

Annabelle [23:48]: Yeah, yeah, I think- I think it’s a, I would say it’s 50/50. I think there’s more focus on it and energy around it, but I think there’s probably not enough consideration when you hear people say, yeah, I’ve been trying to find a therapist for over a year. So then what’s missing there? Is it the lack of therapists? I mean, there are tons of therapists out there. So is it that therapists are just overloaded because now we have more people than ever inquiring about therapy? Or, you know, your question about like, health insurance companies; they don’t pay therapists what they’re worth and what they should be paid. And so you know, more and more therapists are dropping insurance companies, which then falls into that category then of, okay, then all those people who are going to rely on their insurance company to cover that cost, now they’re losing therapists who are saying, look, I’m going to just go off on my own because it’s not worth the headaches that the insurance companies put you through, and the lack of reimbursement for the work that we do. So, yeah. I think that’s a complicated question and more complicated answer, because there’s so many layers to mental health and how our society and our community supports them. Right? It’s kind of same with health care providers, like look at how nurses and doctors were finally seen in a different light for all that they did through the pandemic.

Shayna [25:49]: Right.

Annabelle [25:50]: Right? They were … recognition and like, oh, let’s praise these people. And let’s give them free coffee, and look how much they’re doing. And that’s wonderful, and I am so glad that they got that. But what about for all the things that they did before the pandemic?

Shayna [26:06]: Right.

Annabelle [26:06]: You think they didn’t do those things and shouldn’t have been recognized for all the years of their work before? And what goes on in hospitals? And so it’s the same with therapists too, right? It’s just all of a sudden, it’s like the spotlight has been on these professions in a different way, but we’ve always been doing this kind of work.

Shayna [26:33]: Yeah. That makes sense. Is there anything else you’d like to add?

Annabelle [26:43]: Hmm, I think this was a really nice conversation. I think it’s- it should be an ongoing one, right? Because we’re not we’re not done with this.

Shayna [26:55]: Absolutely.

Annabelle [26:56]: And maybe COVID is, well we know COVID is changing, but it doesn’t mean there’s not something else around the corner that’s going to impact our society again, in years. And what are we going to take from the last two and a half years and learn from and then apply for any future pandemics that we’re in, and the struggles that we’re in.

Shayna [27:23]: Right. All right. Thank you so much for taking the time to talk with me today. I really appreciate it.

Annabelle [27:33]: You’re welcome. It was nice to talk with you.

Shayna [27:36]: You too, thank you.

Bibliography

 Kumar, Anant, and K. Rajasekharan Nayar. “COVID 19 and Its Mental Health Consequences.” Journal of Mental Health (Abingdon, England), vol. 30, no. 1, Routledge, 2021, pp. 1–2, https://doi.org/10.1080/09638237.2020.1757052.

  Duff, Johnathan H., et al. Changes to Behavioral Health Treatment During the COVID-19 Pandemic. [Library of Congress public edition]., Congressional Research Service, 2020.

Recording and Transcription Process

This interview was recorded over Zoom, then converted into an MP3 file using an online audio converter. Otter.ai was used to transcribe the audio, and then later edited for better accuracy. After reading the citation guideline, I chose to remove repetitions that were not necessary for comprehension so it would be easier to read. I also removed filer words that I felt didn’t need to be included. I put brackets around words I added when the audio was muffled or cut out so that the reader would understand what was trying to be said. I did not fix run-on sentences because I felt that shortening them would lose their meaning. I included brackets underneath paragraphs where defining certain terms was important for comprehension.