‘We’re in a trauma together’: Americans need therapy – but psychologists are booked
"At a time when it feels like the world’s perpetually on fire, we all need a therapist – but trying to land one these days can be a nightmare.
A study from 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 soars: since the beginning of the pandemic, about three-quarters of practitioners have seen their waiting lists expand. In the same period, almost 80% of practitioners report an increase in patients with anxiety disorders and 66% have seen an increase in those needing treatment for depression.
“I started my private practice just before Covid hit, and it was certainly filling up then,” says Dr Jennifer Reid, a psychiatrist, writer and podcast host in Philadelphia. “But the numbers have exponentially risen since that time.” She has stopped advertising her practice on sites like Psychology Today, a key place where people can find therapists.
Reid focuses on anxiety and insomnia, which have been “major players” in the pandemic. Early on, people with anxiety, phobias or obsessive-compulsive disorder related to germs had particular trouble, she says. Then there was the isolation and the doomscrolling. And now, she says, people are struggling to re-enter the world. “People are finding they’re having anxiety trying to re-engage in social settings in situations that were previously not as safe” at Covid’s peak, she says. “Now they’re having to kind of retrain their brains.”
Often, she says, people may need to return to their primary care doctor for a period of time, “or they just end up going without and waiting on waitlists, unfortunately”. The APA study found that the average psychologist reported being contacted by 15 potential patients every month; Reid, who combines therapy and medical approaches, says she generally has space for about one new patient every few weeks.
Dr Elinor Bock, founder and director of Therapists of New York, has seen a similar increase. “Since the pandemic, I think the demand has skyrocketed,” she says. “We were all in a trauma together.” During lockdowns, “people were isolated, they were losing people they loved, they were scared.” They also had a lot more time on their hands to seek help.
Each stage of the pandemic, from lockdowns to delta to omicron to the easing of restrictions, has brought major stressors, says Dr Brett Marroquín, a clinical psychologist in Los Angeles and associate professor of psychological science at Loyola Marymount University. Even in a reopened world, there’s a great deal of loneliness, Marroquín says. “I’m seeing more people coming in who are like: ‘OK, I’m kind of emerging from the pandemic. I’ve lost my connection with friends, I haven’t been dating, or I have a lot of tension with my partner and I’m experiencing life as just very lonely and isolated.’”
The problem has been compounded as 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 increasing anxiety,” she says. “And then here they are with higher levels of depression and anxiety, worse sleep, more symptoms. So it just is making it that much harder.”
Healthcare workers especially have struggled as Covid rages on and precautions wane, Reid says. Then there’s the “dramatic aftermath of what they experienced during the peak of Covid, which is something I think is going to continue to be an issue in our healthcare community for years”.
Bock has seen a particular increase in demand in a few areas. “I’ve never had so many calls for couples therapy,” she says. “Couples really struggled during the pandemic – they went from living parallel lives to being in a small apartment together.” As for individuals, Bock has seen people grappling with “existential anxiety, climate change, political issues, oppression, loneliness”, she says.
The lockdowns forced many 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 this meaningful enough?” Bock says. “It’s almost like we got a little window to think about ourselves more than we ever did.”
That period also brought another change for the better. “All of a sudden it didn’t feel stigmatizing to need help during the pandemic, because nobody was doing well,” Bock says, describing “a huge shift in the stigma around therapy”. “Every Netflix show I see now has a therapist in it. In the media, everybody’s seeing a therapist – athletes, musicians – so it’s become more part of our culture.”
That is, of course, a double-edged sword: if the easing of stigma has fueled demand, the APA study suggests supply hasn’t matched it. So what can be done to rectify the shortage?
Changes to insurance practices could help. Therapists say it can be difficult to accept insurance because the reimbursement rates from companies are too low for them to support their practices. That means patients may have to pay out of pocket, putting certain 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 hurdles to getting into therapy is the actual: how do you find someone?” Online searches can turn up countless profiles to scroll through, “and it’s really hard to tell what someone’s like from a picture and a three-paragraph bio,” Bock says. Silicon Valley, take note: “I think somebody could come up with some sort of great matchmaking algorithm to help connect people with therapists, because so much of it is about the connection.”
Such efforts are under way. Reid works with a platform for Philadelphia therapists that allows them to see each other’s availability. “We really feel a sense of responsibility to try and get patients some good options if we can, if we’re not able to see them,” she says. And Dr Brad Brenner, a Washington DC-based psychologist who co-founded the Therapy Group of NYC, is working on a platform called WithTherapy, which helps pair patients with providers. “It’s almost impossible to know if a therapist is even accepting new patients. Or knowing if your schedules align,” Brenner wrote over email.
In the meantime, seeking a therapist through word of mouth – asking friends or calling practitioners even if they’re full booked – is a good first step. The increasing use of telehealth may also help, particularly under programs such as PsyPact, a legal framework that allows practitioners to work in multiple states.
And though many therapists don’t take insurance, Marroquín recommends prospective patients investigate those who do. Insurance company websites often provide a list of in-network providers; “just contact them – blast them all,” he says.
If therapists are inaccessible, their work may not be. Reid says she launched her podcast and started writing as a means of reaching those she might not otherwise be able to work with. “I can’t see everyone one to one and there’s all this news” about the shortage, she says. “You feel a sense of responsibility, having the training, to get the information out there.”
“We came into this business to try and get as many people better as we can. And so we’re trying to find different ways to do that.”