DULUTH -- Feelings of anxiety have become familiar to a lot more people thanks to the COVID-19 pandemic. This has been apparent to therapists, counselors and psychologists, who have been seeing more clients than ever before.

“We are experiencing very traumatic events in a short amount of time with a lot of unknowns about where we’re going,” said Dina Clabaugh, a psychotherapist and founder and CEO of Insight Counseling in Duluth. “That has just increased anxiety, depression, isolation, trauma and grief.”

This isn’t necessarily bad news. Katie Erickson, clinical director of Duluth Counseling Center, said many clients will come in seeking help with pandemic-related stress, but will end up unpacking lifelong trauma that was hidden underneath.

Katie Erickson (Courtesy photo)
Katie Erickson (Courtesy photo)

“I think what we’ve found is for a lot of these people, COVID made them get help, but now they are really seeing the benefits of therapy and I think a lot of them like it,” Erickson said. “This was the little nudge to get them to go to therapy. And we don’t just work on COVID anxiety. We work on anxiety in the rest of their lives.”

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Common reasons people have sought therapy recently have been anxiety; depression; stress about the pandemic, parenting or job stability; loneliness; or increased substance use. Clabaugh said many clients are also grieving, whether it be the loss of friends or family to the pandemic or the loss of a job or stability in life. People also have been stressed about political events like the 2020 presidential election, or worry about various conspiracy theories online regarding politics and the pandemic.

To meet the increased demand, counseling centers have hired more clinicians in the last year, and some continue to add more therapists to take on new patients. Erickson said the appointment openings for new clinicians will fill within a week or two, and then will have a three- to four-week waiting list like the rest of the clinicians. Clabaugh said when she opened Insight Counseling almost four years ago, she planned to have two or three therapists, but now she has 20 because the demand has always been so high.

Thanks to telehealth services, they are able to refer clients to other therapists, both in the area and across the state, to see if they can get an appointment sooner.

“When people call for help, they usually need it now,” Erickson said.

Although Erickson worried that the demand would decline as vaccines became more widespread and places began to reopen safely, she hasn't seen any decrease in scheduling yet.

At Arrowhead Psychological Clinic, psychologist Dave Plude sees clients from Sandstone to Ely, and from Brainerd to Grand Marais. For many clients, the use of video or phone sessions has been a more convenient option in many ways. Plude said once clients overcame the learning curve of the technology, many people would rather call in from home or their cars than drive up to four hours round-trip for an hourlong session.

“It’s been kind of fun,” he said. “It’s enjoyable to be able to offer good clinical care to people in smaller towns who might not have as much access to it historically.”

Dave Plude (Courtesy photo)
Dave Plude (Courtesy photo)

Telehealth surges

While telehealth has been offered at many clinics for a while now, it’s never been used as much as it has been in the pandemic. At Arrowhead, Plude said last summer, 80% of their sessions were via video or phone, and they went to 100% virtual last fall during the surge of COVID-19 cases. While many are now returning to in-person sessions, Plude said quite a few are fine with staying virtual. Some will start sessions in person, then switch to telehealth after they get comfortable with their therapist.

For family sessions, it's easier to fit a virtual session into multiple people's schedules, Plude said, because they don't have to factor in travel time. Telehealth has also made winter scheduling easier.

“If your car won’t start on a cold winter Minnesota morning, it might not need to make it to therapy,” Plude said.

Erickson said the telehealth visits have helped therapists stay in touch with area students when they return home for breaks. They've even been able to serve clients in northern Wisconsin and Michigan's Upper Peninsula if they're licensed in those states.

At Insight, Clabaugh hosts group therapy and support groups that help her meet with more clients at once to lessen the caseload. She also said it's been a good time for therapists to consider whether a client needs to meet less frequently to make room for other sessions. She's seen far fewer no-shows than pre-pandemic, which is good because clients aren't missing sessions, but it makes it less likely she can fit in a last-minute appointment.

Other downsides of telehealth, Clabaugh said, include dangers of breaching confidentiality if a client doesn't call from a private or safe space. Therapists aren't able to intervene if a client experiences dissociation or other unsafe situations that normally could be helped in an office setting.

Plude said sometimes, video sessions are preferred to masked sessions in person.

"If you can only see from their eyes down, you miss out on so much nonverbal communication," Plude said. "Even smiles, or different facial expressions people have, are quite complicated.”

Phone sessions are least ideal because therapists can't assess any body language at all, but sometimes, especially for less tech-savvy clients, Plude said they can make a big impact on a client's mental healing.

U.S. senators introduced a bill at the beginning of May to continue access to telehealth services with Medicare after the pandemic. CONNECT for Health is one of more than 20 bills introduced this Congress about the future of telehealth.

But regardless of the specifics of insurance coverage or other future rules related to telehealth therapy services, all three therapists said they plan to continue offering video sessions at their clinics.

“It reduced so many barriers to care for people and it offered more flexibility so people could get services, so there is an effort underway to be able to sustain some of these modifications on the government level,” Plude said.