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Brian Lehrer: Brian Lehrer on WNYC, and we're going to end the show today with an invitation for you to call in. If you're a therapist or any kind of mental health professional, we will turn your usual question to clients around on you. How are you doing? Yes, how are you doing? 646-435-72-80. We ask because the demand for therapy has surged so much in the past year, as many of you know.

According to an American Psychological Association poll of nearly 1,800 psychologists published in November, 74% said they were seeing more patients with anxiety disorders compared with before the pandemic. Sixty percent said they were seeing more patients with depressive disorders, and nearly 30% said they were seeing more patients overall.

Therapists, would you call in, and tell the rest of us what you're seeing in your practice that reflects the pandemic times that we're in, and what you find most helpful to people? 646-435-72-80. 646-435-72-80, for therapists or anyone who is a mental health professional, whatever you call yourself. 646-435-72-80. What have you been seeing in your practice that is really of this pandemic moment or year now, and how have you been helping people? What works? 646-435-72-80, and with us to help take your calls and to answer some questions in her own right is Lori Gottlieb, psychotherapist, co-host of the Dear Therapists podcast, and author of the book, Maybe You Should Talk to Someone: A Therapist, Her Therapist, and Our Lives Revealed. Lori, thanks for coming on the show. Again, great to have you.

Lori Gottlieb: Oh, my pleasure. Thanks so much. Good to be here.

Brian: We wanted you to ride along with us for this because as you've discussed here before, you've written about both sides of therapy; being a therapist helping clients, and needing to see one yourself. Do you get the sense that more therapists are needing more therapy after this past year?

Lori: I think that a lot of therapists really are struggling because they feel a responsibility to help so many people who are coming to us in the last year, and I think that sometimes therapists forget to take care of themselves. Then the question is, are therapists going to make time given the obligations that they feel to help others right now in this crisis, to actually go and make sure that self-care is part of their day?

Brian: I know you've written about this idea of a hierarchy of pain, a belief that some pain is more worthy of help than others. I know you don't subscribe to that belief, but I think this past year, that idea has become even more acute. Some people are just stir crazy at home, while others have lost multiple family members to the virus, both sets of people deserve to talk to someone. How have you been thinking about the idea of a hierarchy of pain? It is obviously much worse to lose somebody than just to wish you could get out more, or is that wrong?

Lori: I think that people minimize what they're experiencing, if it's not, let's say during COVID, loss of life, loss of health, loss of financial stability, obviously, really big stressors and huge sources of loss and grief. I also think that what people do then is they say, "Well, what I'm experiencing this anxiety, this sadness, this insomnia, this loss of connection, it's not that bad so I'm not going to reach out to anybody," and we don't do that with our physical health. It's not like we say, "Look, I broke my arm, but I don't have cancer, so I'm not going to go get my arm set or get a cast." We don't do that, but we do that with our emotional health. We say, "Well, if we compare it, mine isn't that bad so I'm not going to do anything about it." The problem with that is that if you don't do anything about it, it could get worse.

Brian: Mark in Leonia. You're on WNYC with Lori Gottlieb. Hi, Mark.

Mark: Oh, hi. I am running my private practice. I'm continuing to run my private practice and also being a stay-at-home parent at the same time, so doing it virtually.

Brian: What are you seeing, and what do you find is helping people?

Mark: Oh. Well, I am seeing a lot of the same issues as we always have seen, like anxiety, stress, depression. It's exacerbated by the stress of the pandemic. I think it's an underlying stress that's either in the front ground or in the background of everybody's mind, and it's working behind the scenes. We work on practicing anxiety management. I use a lot of mindfulness, mindful-based cognitive therapy.

Brian: What do you need? Do you find you need support in a different way than before?

Mark: I don't think that I just pay attention to my own mental health and just continue the same routines, exercise, walking, but it's been okay. It's been relatively smooth. Virtual therapy has been very good, actually, and hasn't been too bad of a thing for my practice.

Brian: Good. Mark, thank you for checking in. Let's go next to Sonia, a clinical social worker. You're on WNYC, Sonia. Hi, thank you so much for calling.

Sonia: Oh, thank you. Thank you for doing this. It's really surprising to me as I'm sitting here. Are you going to ask me a question here?

Brain: Oh, I thought you were-- That's okay. I'll ask you a question, but I think I know that-- Well, I want to get right to the heart of the matter because you told our screener that people are painfully lonely and grieving the lives that they used to live in many cases so don't be afraid to talk about that.

Sonia: Then older people are thinking, "Wait a minute, this wasn't supposed to happen. I don't have so many years ahead of me and is this the way I'm going to live." There's a lot of questioning about the meaning of life. There's a lot of concern with just philosophical kind of questions of what is this about because what's been stripped away is that thin façade of what life is about. I think that a lot of people that I see are turning to spirituality trying to find deeper meaning.

Brian: Lori, you want to talk to Sonia?

Lori: Yes, I agree with that in terms of people really examining what matters to them, what is important, what are they going to prioritize, because they think that when you are faced with mortality, or you see so much mortality around you, and you don't have all of the normal distractions that we have of just keeping busy in the ways that we run around in our normal days, you start to really step back and say, "Am I doing the things that I want to do in my life? I do have a limited time here and who are the people who are important to me, and am I nurturing those relationships? Who are the people that I don't necessarily want to spend my time on, and what are the things that I don't want to spend my time on?"

I think there's been a real existential questioning going on, and also what Sonia was saying about the loneliness. I think people are realizing how important connection is in our daily lives. When you're stripped of it, you notice it's lost even more significantly. A lot of people are saying, "Wait a minute, I really need to focus on connection, not just now, but as we emerge from this."

Brian: Sonia, how do you help people with loneliness?

Sonia: I ask them to explore it and what it means to them, and when else have they been lonely in their lives and just revisiting because you know one's current loneliness triggers memories of past loneliness. Just to explore, and then very much to explore how did you cope with it then, and to try to remind people of their coping skills that they've gotten through it.

Brian: Thank you so much. Lori, would you elaborate on that or add to it because I think the loneliness and especially in a lot of older people might be some of the worst of it psychologically in numbers around the country?

Lori: Yes. The loneliness, I definitely see in people who are older and maybe living alone and more isolated but I also see it in kids. Kids who can't go to school, kids who can't see their friends. A year in the life of a child feels interminable to not have any social interaction and those years developmentally are so important. I think that it's really important to remember that I would say younger people and older people are probably hit the most hard by loneliness, but I think people in the middle are too. It really speaks to this question of how do we live our lives and I think one of the positive takeaways from this really horrible experience is going to be people are really examining their relationships and if they aren't connected enough in the world they're thinking very proactively about how they can get more connected.

Brian: Brynn in Massapequa. You're on WNYC. Hi, Brynn.

Brynn: Hi, Brian. How are you? It's great to talk to you. I listen to you all the time.

Brian: Thank you.

Brynn: I've been a social worker for 35 years and I am seeing a lot of decline in patients that had at one point been very stable. It seems like the one-year mark is getting to everybody. That's just people that I see in my practice. It's very symbolic of-- "How much longer can we take this?" That's a lot of what I'm hearing like, "I've had it. I want to go on vacation anyway. I don't care." That kind of thing.

Brian: People are hitting their wall, their pandemic wall?

Brynn: Exactly. I think we see it a lot. I've noticed if I'm just out of the grocery store, people aren't as nice as they were initially. We're all a little compassion fatigue, we've had it. That's a lot of what I see. I also--

Brian: Is it also--? Go ahead.

Brynn: Go ahead, I'm sorry.

Brian: Well, I was just going to ask you if you're also seeing more depression as time goes on. Like maybe at the beginning, it was more anxiety, people worried they were going to get the virus, and of course, a lot of people have. Now as it seems like it's going to drag on and drag on that that might more lean toward depression. That's just a theory. Is that what you're seeing?

Brynn: It hasn't been my experience really. Frustration, anger. I do see a lot of people who do have anxiety. The anxiety, they're having a hard time maintaining and stabilizing because they're just getting very frustrated. The capacity to tolerate another month, another three months of not being able to travel, not being able to see relatives, not being able to have their wedding. So many disappointing things.

Brian: Brynn, thank you so much for checking in. Miranda in Washington Heights, you're on WNYC. Hi, Miranda.

Miranda: Hi. So glad to be with you, guys. I love your show, Brian.

Brian: Thank you.

Miranda: I was telling the screener that for me, I work in a community-based health center as well as doing some private practice. It's been certainly challenging but also I will say that some of the positives have been that approaching things in terms of this collective experience and the solidarity that can be sometimes a comfort and this sense of we're not in this alone. Obviously, everyone has an individual experience in this and I want to validate and do validate that but at times I have found, it's really helpful in the way in which we connect in that way.

For me, to disclose in an appropriate way but to disclose that shared struggle and really we can relate and to bring that in I think to just we're really all going through this and that has been a helpful thing for me with my clients. I think the other thing that has been mentioned but just the loss, really acknowledging all the forms of loss and really I think for me it's been helpful to consider the grief on again, many layers of loss and really acknowledging and processing that together. As far as the ways of coping for me and for my clients, I think that people have mentioned mindfulness.

For me, that's been a really important part of this is really how do I really continue to work on going inward and figuring out how do I get a sense of control, because really inside is where- the inner world is where I have control and not the outer world. I often say to clients that's always true but right now, we're going through this time of feeling hit in the face with that over and over, that sense of we don't have control. We want control. That's a human thing. How do we keep getting and how do I help them to feel a sense of control inside?

Another last thing I'll say is just that I've been really exploring a lot more body psychotherapy, body-centered approaches, and how do we get movement, how do we stay attuned to our body, how do we move even micro-movements with our body when we're limited in our activities so that we're really again, just taking advantage of all the ways in which we tune into ourselves and how do we move to make ourselves feel better literally, feel better sometimes.

Brian: I'm so glad you brought up movement in this time and so many people are staying home and just not moving as much as they can and that's so necessary both the physical health and mental health. Miranda, thank you so much. Lori Gottlieb, we've got about two minutes left. Let me throw a couple of last things at you. One, have you had to bone up on your biology and virology in order to help answer people's questions in your psychotherapy practice like talking down people who think they have coronavirus but it's really a panic attack? What happens when people present to you with the kind of issues that lead them to not abide by the safety guidelines? Do you say something? On those to finish up.

Lori: First of all, I think on the first one, that's anxiety. I talk to people about the difference between productive anxiety and unproductive anxiety. Productive anxiety is when you are worried about something in a way that helps you to be productive to take action. If you're worried that you're going to get the coronavirus, you're going to wear a mask, you're going to social distance, you're going to do all those things. Unproductive anxiety is that obsessive rumination about something that hasn't happened yet and may never happen. Someone comes in or they're on my screen now and they say, "I'm really worried this is going to happen. I'm really worried that's going to happen,"

Or they're checking the news every few hours instead of maybe once a day. It doesn't help them take action or do something different because they're already doing what they need to be doing. When people come in with this free-floating anxiety, it's really important to help them, "Look, is this productive anxiety? Is this unproductive anxiety?" Then what can you do with the unproductive anxiety? Can you go take a walk? Can you call a friend?

Brian: 20 seconds. Go ahead and finish up.

Lori: What can you do? That's where really there are some practical things people can do like connecting with someone taking a walk, doing an activity where you're in concentration for 10 minutes to reset what you're thinking.

Brian: Lori Gottlieb, psychotherapist, co-host of the Dear Therapists podcast, and author of Maybe You Should Talk to Someone: A Therapist, Her Therapist, and Our Lives Revealed. Thank you so much. Thank you for talking to your fellow therapists in this segment. To all the listeners, it's been really helpful. Thank you very much.

Lori: My pleasure. Thanks so much, Brian.

Brian: Therapists, thank you so much for all your calls and your openness.

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