'My Coping Skills As A Therapist in 2020: Fail, Fail Again And Then Keep Trying'

Over and over again in recent weeks I have found myself incessantly scrolling through social media. Each time, I knew I needed to stop and each time, I simply couldn't. News and social media commentary haven't been especially helpful to my emotional state for a long time, but the anticipation and uncertainty ahead of the 2020 presidential election, the delayed announcement of President-elect Joe Biden as the winner and the alarming recent rise again in coronavirus cases in the U.S., recently it has been more anxiety inducing than ever. There has even been some teeth grinding and a dash of anger. Yet, like a moth to a flame, I haven't been able to look away.

"Take a break."

"Put it down."

"Turn it off."

"Watch stupid television instead."

My inner voice has been talking to me like I would to any of my patients, but to my own detriment, I have ignored it. Truthfully, I am a bad patient and I already knew that. Most doctors are.

Losing sleep from remaining glued to social media has been just one tiny part of the ever-compounding stress of being a psychiatrist in 2020. It has also been one of many lessons in trying and failing to cope with the challenges of this year. I believe many of us, whatever our jobs or situations, may be experiencing a similar emotional rollercoaster.

Typically, I work in St Louis in the U.S. in an outpatient psychiatric clinic, as the months of 2020 pass I deeply miss human patients and have become tired of telehealth appointments. At the same time, I have noticed I can almost tangibly feel the sadness, anxiety and trauma seep out of the screen with each session. Sometimes at the end of the day I have to take a nap. I think it is the only way for my body to unload it all.

As we approached the election, like other mental health professionals, I was afraid that no matter what the outcome, people didn't have the reserves to manage any mental health effects of it. Our patients were holding on by a thread anyway—dealing with the pandemic, job loss, grief, parenting at home and systemic racism—and couldn't afford even the slightest break.

I had also been hearing many of the healthcare workers who are patients of mine using words like "exhausted" and "overwhelmed." This is all they can muster to describe how they are feeling. Quickly, this year, those words became ones I used to describe myself and my day-to-day experience, too.

With my friend and fellow therapist, Dr. Stephanie Zerwas, I wrote about how the pandemic was pushing mental health professionals to the brink a few months ago—not much has changed from that perspective. But, I have learned that my own coping mechanisms might not be adequate.

Therapists, Therapy, Coping, Failing
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Truthfully, I am not a person who often thinks about how I cope. I used to simply manage to do my work, relax with friends and television and go to sleep at night. This is not a structure a therapist can rely on in 2020.

So, the pandemic has encouraged me to broaden my own self-care and survival tools. But the results have been mixed—I have not always won in my personal battles to cope.

Despite being convinced I hated it for years, I decided to retry mindfulness instead of reacting to my anxiety by becoming fixated on thoughts or physical reactions. I also tried meditation apps again and, again, couldn't get into it. Not wanting to admit defeat, I dove a bit too far into this attempt and booked a three-day mindfulness retreat. Unfortunately, the retreat reminded me why I do not like mindfulness, and I cynically characterized the experience as too "woo woo" for me. So, I gave up on mindfulness completely.

As a way to avoid social media before bed, I attempted to read a chapter (see: the multiple half finished books by my bed) or listen to half a podcast. But after a few weeks, and with coronavirus cases on the rise, I wound up reaching for my phone anyway.

I have also tried, and failed, to erect boundaries around my work and private time. As an expert in the mental health of college students and health professionals, I found that at the beginning of the pandemic, I began to get many more requests to speak, write and assist people on the topics, as both groups have been greatly affected.

I would normally be happy to assist, but they all came at once and during a stressful time emotionally. I found myself having a visceral reaction to the emails; an increased heart rate, my anger rising. I noticed that, to cope, I would stop responding to anyone. I would even avoid my emails entirely for a day or so. The reality was that I was using an ineffective and not very mature tool, avoidance, to essentially fail to cope.

I have had to learn to say "no" more often and accept that saying no does not make me a bad person in some way. When I noticed I somehow still had a full month of engagements even though I was certain I had been saying "no" more, I had to reassess how and why I said "yes," and try to say "no" more often moving forward. I also turned off email notifications on my phone and computer as both were making me increasingly anxious. This stopped me from wanting to throw my phone against the wall and stopped me from being distracted during telehealth appointments with patients.

Therapists, Therapy, Coping, Failing
Dr. Jessi Gold has been learning through trying to cope, failing and trying again during 2020. Dr. Jessi Gold

Additionally, perhaps somewhat surprisingly given my profession, I often fail to ask myself: "How are you doing?" A tool that can help center one's own feelings. During 2020, I have rarely taken inventory of my own emotions or allowed the space or time to process them. I only did if my emotions were heightened to a point that they interfered with work directly or made me less productive in some way.

So, although I am trying to make a habit of taking the time and space to ask myself, without judgement: "How are you feeling?", I often don't make time for it or simply forget. This is one of a few coping strategies I have tried, failed at, slightly modified and then tried and failed at again. But, sometimes I get it right. I am a work in progress, after all.

I have heard that other therapists are having to take more of an inventory of themselves this year and figure out how to factor themselves into the equation, too. They feel burned out, but are busy and in demand, trying to balance the need to be there for their patients, but also be there for themselves. This sometimes means employers have to point it out or even nudge them to take the time off (I know mine did).

Working can actually feel like you are using a coping technique and trick you into believing it. You stay busy helping others and don't allow time for feelings to get in the way. You are also getting things done, and that feels like a positive, and like you are helping people. Altruism is a mature coping mechanism, is it not?

But, the reality is, just because you are present does not mean you are actually doing your best work. And not acknowledging your emotions does not mean they don't exist. It is easy to get distracted or miss part of the conversation with a patient if you are exhausted, and it is much harder to feel empathetic. Going through the motions when you need a break does not help your patients. Taking time off and recalibrating is critical, especially right now.

Therapists need to relax when we can, find the coping skills that do work for us and not beat ourselves up if we fail to implement those tools all the time. And, we need to go to our own therapy. I have tried and failed at many coping skills during 2020, but weekly therapy is one tool I absolutely swear by. I find it incredibly beneficial and, in reality, every single one of the coping skills I have tried were initiated because of conversations I had in therapy.

My therapist has observed my self-care throughout the pandemic and often points out that we are all interconnected trains of support. I agree. If my patient needs me and I might be struggling a bit, it is OK, because I have my therapist to lean on for support. And if I need her, it is OK, because she has her own support, too.

It is OK for all of us, therapists or not, to acknowledge out loud and normalize that 2020 has really been hard and different. There is no baseline emotional response to the pandemic, just like there is no one coping skill to manage it. It's OK to say that we have not always coped with our feelings in a way we would have liked, or that our traditional mechanisms failed us. It is also OK to be nice to ourselves for persevering anyway.

In a way, through all the trial and error, fatigue and sadness, the pandemic has actually strengthened my understanding and belief in the power of my own profession as a coping mechanism. After trying many coping skills, I am not sure that is the outcome I would have predicted. But, it is a pretty beautiful realization nonetheless.

Dr. Jessi Gold (@drjessigold), MD MS is an Assistant Professor and the Director of Wellness, Engagement, and Outreach in the Department of Psychiatry at Washington University in St Louis.

All views expressed in this piece are the writer's own.