COVID-19 Is A Lot Of Things, But It Isn’t A Reason To Put Off Therapy

You can search for your new therapist, schedule the appointment, and complete the session all while sheltering in place.

There have been countless social media posts over the past couple of weeks expressing gratitude for telehealth, including praise for therapists who have been able to provide virtual counseling sessions in lieu of office visits. In my community of fellow therapists, I’m so happy to see most of them embracing technology and quickly shifting their scheduled sessions to one of the secure, HIPAA-compliant online counseling platforms. 

What I haven’t heard much about in this climate of social distancing is making the decision to start therapy right now. Finding a therapist is already an intimidating experience for most people, so adding the crisis of a global pandemic to the mix could be paralyzing to say the least. Perhaps it’s time to dispel a few myths about starting therapy online during the coronavirus outbreak and addres the reasons why you may be considering COVID-19 to be the perfect excuse to hold off on contacting a therapist. (Psst, it isn’t.)

1. The first visit has to be in person.

I’m here to tell you that you don’t have to have an existing relationship with a therapist in order to get some professional support right now. Yes, that’s right. You can find a therapist today who will schedule a free introductory phone call to determine if they can help you and then schedule your first appointment online. Many people think the first visit must be face to face in an office. While meeting initially in person may be ideal for many situations, there are therapists who have 100% online practices and have been operating in this mode for quite some time now. Online therapy isn’t new. I’ve been offering virtual sessions for several years now, mainly for my clients who moved to another city within the state and as a backup method for meeting during inclement weather, when childcare falls through, or travel. Until COVID-19 changed the way we do, um, well, everything, I insisted that a client’s first appointment be in the office, but now that face-to-face simply isn’t an option, I’ve accepted that perhaps a virtual first session can be just as beneficial as an office visit. An online first session is definitely better than no therapy at all! Can I get a virtual elbow bump?

2. Online therapy isn’t as effective as in-person. 

I’ve been guilty myself of expressing skepticism that online therapy “isn’t as effective,” “will only do as a backup,” or, as discussed above, “should never be used for a first session with a brand new client.” But I no longer view online counseling as inferior to traditional office sessions. Let’s be honest, there are downsides to everything. There are body language cues that you can easily miss when you are communicating via video. I can’t assure that a client’s family isn’t listening in on our conversations (a particular worry in our current stay-at-home environment). There are sometimes technological hiccups to deal with, video freezing up, audio dropping out, that kind of stuff. The dynamic is different when you aren’t physically present with the person you’re talking to. So, no, I do not believe that virtual counseling is right for everyone 100% of the time. But that is not a reason to not give it a shot. You and your therapist can determine if it’s appropriate for you right now.  

3. I’m not tech savvy / I don’t have time to learn a bunch of new technology.

It’s natural to be intimidated by anything new. That’s just your trusty lizard brain trying to protect you. If you have an internet connection and a smartphone, you can do this. Therapists are using all kinds of different communication methods to do telehealth. You may have to download an app for your phone or computer at no cost to you. In my practice, I use TherapyPortal, an all-in-one EHR and telehealth platform that’s user-friendly and simple to use. Accept the fear you’re experiencing and be willing to give it a try anyway. If you have any problems, your therapist will help you figure it out. You and your therapist will have already discussed a backup plan in case of any technological mishaps anyway. Worst case is you aren’t able to get the video call to work, and you decide to talk by phone or try again later. Best case is you log right on and have a very helpful therapy session that validates your feelings, leaving you feeling heard and seen with some tools you can use to manage your symptoms. Yeah, I think it’s worth pushing through some trepidation, don’t you?

Quick tips for setting yourself up for a successful online counseling session: 

• Use headphones or earbuds, if possible, to cut down on background noise for both you and your therapist and to ensure a little more privacy. The other people around you won’t be able to hear what your therapist is saying, at least. By the way, in terms of privacy and acoustics, your bedroom closet can often be an ideal location. 

• Spend a few minutes locating a spot where your internet connection is strongest. Depending on where you are, your cell phone may work just fine. I’ve even had people do sessions from their car in the driveway or parking lot using their cell phone’s data connection.

• Most telehealth platforms offer the option to do a test call to try out your audio and video settings. It’s usually an automated interaction, not with a live human.

• Turn off notifications or put your phone or computer on Do Not Disturb.

4. I shouldn’t be spending money on non-essentials right now.

Well, this little piece of internet real estate right here certainly isn’t the place to debate whether mental health should be considered essential (OF COURSE IT IS. IT’S A THERAPIST’S BLOG. AND YES, MENTAL HEALTHCARE IS ESSENTIAL. IT’S YOUR MENTAL HEALTH!!!).

We are all feeling some anxiety about finances right now, and I would never try to scare you into spending money you don’t have or pressure you into trying therapy if you aren’t ready. You know your financial situation better than anyone else. There is a ton of uncertainty about just about everything, and keeping a close eye on your budget makes you feel like you have some control. You know what else makes you feel like you have some control? Intentionally deciding to set aside some funds for something that is helpful. It’s difficult to make your mental healthcare a priority. It isn’t a big gaping physical wound begging for attention. It’s more like that dull headache that starts throbbing when life gets stressful but subsides a little at night when you have some time to yourself. Then the cycle starts over when you wake up to face the next morning. 

Establishing a relationship with a trusted therapist is one of the most beneficial and impactful steps you can take for yourself right now that will not only serve you during this present crisis but will equip you with the tools you need to manage future stressors. 

Yes, therapy is an investment. If you are looking for an in-network provider who is contracted with your insurance carrier, check your specific healthcare plan’s directory. When you contact a therapist listed there, always confirm that they are currently in-network and that tele-mental-health is covered. Paying out-of-pocket may be more expensive, but it gives you and your therapist a lot more freedom to decide how to best work together:

Insurance = The insurance company controls your care, as in number of visits, frequency of sessions, whether your treatment is “medically necessary,” which of your symptoms meet the criteria for a mental health disorder diagnosis (which is, by the way, a requirement in order for an in-network therapist to get paid).

Out-of-Pocket =  You and your therapist control your care, deciding on how often to meet, where to meet (I even offer Walk & Talk therapy, in non-pandemic times, of course, and insurance would never cover such a thing!), whether or not you need a mental health diagnosis (FYI, you don’t need a diagnosis in order to benefit from counseling, but insurance companies aren’t in the business of paying for something that they don’t deem medically necessary), how long your sessions last, what you talk about, etc.

Whether you opt for an in-network provider or go out-of-network, keep in mind that you can probably use your health spending/flex spending account to pay for your therapy visits. Most therapists accept credit cards, including HSA/FSA benefit cards, so just remember that the money you’ve set aside in your HSA/FSA account could be well spent on counseling. If you aren’t sure if you have this kind of benefit, check with your employer’s Human Resources department.

5. Fill in the blank:________________

All the same pre-pandemic worries still apply: What if I don’t know what to say? What if I don’t like the therapist? What if it makes me feel uncomfortable? Where do I even start? Fill in the blank with any excuses you can come up with. Be sure to check my FAQs for more answers to common But-What-If? concerns.

Your brain will present all kinds of worries to talk you out of doing anything new. Thank it for its amazing life-saving skills, and then reassure it that just because something feels threatening doesn’t mean it is threatening. Do some research by checking out a few different therapists in your area. (Typically, your therapist must be licensed in the state where you reside, even if the services are conducted online.) Ask trusted friends if they have any recommendations. Talk to your OB/GYN or primary care doctor about a referral. (Don’t worry. This doesn’t have to be a formal complicated referral process. Most of the time, they just provide a list of trusted local therapists they know.) You can always just Google “therapist near me,” but for a less overwhelming experience, try one of the online directories. Two of my favorites are TherapyDen and the Secular TherapyProject. Both are inclusive and progressive, screening its participants thoroughly to make sure you’re in good hands.

Your pup may not understand why you’d choose to talk to a human on a screen over taking him for a walk, but he wants what’s best for you.

Review therapists’ websites to see what kinds of issues they specialize in, their communication style, photos, etc. You don’t have to go overboard with your search, but the more information you have, the more confident you will feel reaching out. Schedule a couple of consultation calls so you can get a feel for what it’s like to speak to a counselor. These brief interactions (usually between 15 and 30 minutes) can be very helpful for determining if someone is a good fit for you. You can discuss what you’re looking for help with (for example, feeling overwhelmed, extreme sadness, having a hard time turning off your brain, difficulty sleeping, overly worried, etc.), fees, how payment is processed, and you can ask any other questions you may have about what to expect. 

Take a deep breath and remember that if you decide the therapist you selected is not the right match, it’s ok. There are other wonderful professionals out there you can try. On the other hand, you might discover that you instantly connect and feel immediate relief upon being seen, heard, and supported. Or you might be feeling somewhere in the middle. This is perfectly normal and just means you’re getting to know your therapist and adjusting to a new experience. Give it a few sessions, and you just might find that you’re grateful you took this opportunity to find the kind of comforting validation and trust that only comes from this kind of professional support. And the best part is you got all this accomplished without leaving your house while wearing your fuzzy slippers! Yay for social distancing! Way to get what you need AND flatten that curve!

Hey, I’d love to know what you think about this article. Leave a comment to share publicly,, or send me a message using my secure contact form. Either way, I can’t wait to hear from you! Of course, if you’re in North Carolina or South Carolina and looking for a therapist who specializes in mental health in pregnancy and postpartum, schedule a free consultation call today.

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Coping With The In-Between

In a heartbreaking scene in the film, Bohemian Rhapsody, Freddie Mercury, played so beautifully by Rami Malek, speaks of needing distractions from them:

“The in-between moments, I suppose. I find them intolerable. All of the darkness you thought you left behind comes creeping back in.”

Ah, yes, the in-between: that grey and murky place you find yourself in when you aren’t quite sure of yourself or what to do next. This time of year (January-March) is definitely one of the most in-betweenish periods of them all, spinning you around in a fight to keep treading water in between waves of illnesses, severe weather, and holiday Mondays. Christmas has come and gone, the weather is dark and cold (depending on where you live, of course), and you feel kind of lost, like, “Now how can I make it until spring?” Frankly, life is one long series of in-betweens punctuated with intense moments. Growing up, you’re stuck waiting to be old enough, tall enough, mature enough. You finally become a grownup and find that what awaits you is more waiting . . . To meet the right person, find the right job, make enough money, and at some point, you begin to realize that John Lennon had it spot on when he sang, “life is what happens to you while you’re busy making other plans.”

Laughing our way through one of many in-betweens.

Motherhood is full of in-betweens. There’s the huge moment when you find out you’re expecting. You plan, plan, plan, take your vitamins, go to all the appointments, plan some more, research and register for all the gear, and then wait. Finally, the baby arrives. And it’s the most intense and sleep-deprived time of your life. You promptly become overwhelmed with decisions and tasks you never imagined would be so taxing. Your new life is thrust upon you, and you try to keep up with the demands. You kind of get the hang of feeding, figure out how to swaddle, determine which diapers work best, avoid thinking about how expensive kids are, and work out a sort-of team schedule with your partner so you both can get a little sleep. You soon realize that there is no point where you completely feel like you’ve mastered this new skillset, precisely because it is ALWAYS CHANGING. New developmental milestones to look out for, appointments to book, challenges to meet, discussions to have, and childproofing purchases to make. It feels like there should be some goal somewhere, but the only thing you can come up with is SURVIVE. That’s how I looked at the first year, for sure. Waves of change kept crashing on the shore, and as I struggled to stay afloat, I decided that I had to just take one day at a time and find joy (or at least contentment and gratitude) in the present. When you are feeling anxious, discouraged, and stuck in the in-betweens, give the following tips a go:

• Focus on what’s good about the in-between.

There are definite perks to having one big moment all wrapped up. Revel in how fun, exciting, rewarding, fulfilling, etc. this moment/project/occasion/event was. Treat yourself with a reward for getting through it. Look at photos of the experience and allow yourself to fully embrace the joy of it. Be mindful of both the recent excitement and the here and now. Use all your senses to reflect on what was special about it and how the present moment is just as special even if it isn’t as dramatic or intense. Take some time to notice what you love about your every day life and the right-this-very-second, your home or whatever your current surroundings may be, the solitude. What do you smell, hear, and see around you? Is your environment cozy and warm? Would it feel better to have a soft blanket wrapped around you and fuzzy socks on your feet? Simple pleasures are best appreciated during the in-between.

• Enjoy the downtime.

For me, the in-between is where it’s at.

Turn the FOMO into JOMO. Since becoming a mother, I have really developed a major appreciation for the experiences I would have referred to in my younger days as boring. Routines are MY JAM. I adore schedules and knowing what to expect (yes, I do realize I have no control and that part of being a parent means being ready to answer the phone at any second so the school nurse can tell you your child has a fever or is vomiting and needs to be picked up right now, dashing all your hopes and dreams of accomplishing anything). The structure of waking up early, getting my kid off to school, exercising, working, going to pick up my kid from school, homework time, making dinner, getting kid bathed and into bed, and (finally) watching TV or having quiet time with my husband brings me incredible joy. Sure, I love hanging out with my family on the weekends, but I confess, as Sunday afternoon rolls around, I work very hard to hide the giddy anticipation I feel as we approach yet another regular old Monday when everyone gets back to “normal.”

• Use the in-between to plan your next big thing.

Last family trip to the Great Smoky Mountains

Chances are, during the stressful time you were just in, you thought of a million things you’d do differently next time, if you had more time, if you had more money, etc. Make a list of how you envision the next go ‘round. Or where you’d like to go on vacation next year/season/whatever. My husband and I have a little ritual that we do when we’re on a trip. As the end of our getaway together draws near, we start dreaming of the next. We talk about whether we want it to be a family trip that includes our son, a grown-ups only vacation with friends, or sometimes if the budget doesn’t allow planning another vacation for awhile, it might be a date night to see a movie that’s coming out soon. Having something to look forward to can be super effective at helping ease that weird in-between time.

• Get sh*t done while you’re in the in-between.

Sometimes you just wait it out.

Start a list of Things To Do While In Between. It could be recipes you’ve wanted to try, local shops you’ve been meaning to check out, topics you want to research, home projects you’ve wanted to start, TED Talk by that smart chick you heard about, or any of the stuff that just somehow you never get around to. When you find yourself feeling like you don’t know what to do with yourself, pull out this list and see if you feel like taking steps towards crossing any off. If not, that’s fine, too. Take a nap instead!

• When all else fails, simply breathe and be grateful.

Write about what makes you happy, three things you’re grateful for, or the people who make you smile most. Give your pet some pats on the head. Kiss your partner. Hug your kid(s). Hug yourself. Use the in-between for a little no-cost high-impact loving kindness.

If you are a new mom in the Wake Forest, NC, area and would like some professional support or are wondering if you may be suffering from postpartum depression or anxiety, click here to send me a secure message. Virtual sessions are also available for NC residents.

How To Survive Baby's First Christmas

Photo by Tim Gouw on Unsplash

News flash: The holidays are stressful. Why do you think I’m just now publishing this article on surviving them? We feel like we’re getting a head start when we start ordering from everyone's Amazon wish list in October and collecting recipes for homemade goodies we can give as presents, and then we wake up and it’s December 15th, and our to-do list is still a mile long. How does anyone get through it? And what if you’re a new mom with a tiny human to keep alive? Well, the short answer is just breathe and take care of yourself, but I’m sure you expect more from a therapist who specializes in perinatal mental health, so here we go:

1. Say no.

I bet you saw this coming and were thinking, “Please don’t tell me I have to disappoint my entire extended family by saying the baby will not be at Grandma’s for Christmas dinner!” Yep, I kinda am. But only if that seems like it would be helpful. We can not make everyone happy and get the baby on a good sleep schedule and buy all the presents and get enough rest ourselves and breastfeed and pump and breastfeed and pump or mix formula and wash bottles . . . Think about what feels most difficult in your day to day routine (or whatever you’re doing to keep it together at this point) and what helps you get through those moments. Does the following example of a typical outing sound like how you want to spend your time?

Dressing baby in the adorable but impractical Christmas ensemble that will most certainly end up covered in pee, poop, spit up, or all three; restocking the diaper bag with enough diapers, wipes, bottles, and ice packs; packing up all the presents; getting yourself dressed; driving to the family gathering; passing baby around (and worrying about who didn’t get their flu shot); and pretending that you’re having a great time and definitely would not rather be home sleeping while your husband takes over for awhile.

If you answered with a “yes, please,” then by all means, go be festive. If you feel overwhelmed and anxious (and relieved to know I’m giving you permission to say, “no, thanks”), then you can say, “I don’t really feel up to going to Grandma’s this year. We’ll miss seeing everyone, but we’re looking forward to spending Christmas at home.”

2. Ask people to come to you.

If you actually do love spending time with your relatives, friends, and other loved ones, and you really want to make it happen but also manage the stress level, then you can ask people to stop by your house for a holiday visit. This option gives you a little more control (baby can sleep where they are comfortable, you can place hand sanitizer throughout as you see fit, you can feed baby where you like, you decide what food to serve, etc.). You could even call it a “drop-in” to send the message that you don’t expect people to stay very long.

3. Accept that this holiday season will not look like holidays of pre-baby life.

Your life has changed forever, so depending on where you are in your child's life, developmental stages can dictate much of what your days and nights look like. If your baby is still eating every two to four hours, you and your partner may still be feeling sleep-deprived. If you’re six months in and baby is sleeping for five to six hour stretches, you may be up to celebrating a little. Whatever your unique situation, know that your holiday experience will not look like it did last year, and next year (and the year after that . . .) will be different still. Lean into the uncertainty and focus on the both/and. This season is what it is and will be both joyful and exhausting, both exciting and draining, both fun and overwhelming.

4. Know that traditions evolve over time.

11 months into motherhood and still sleep-deprived, I have only a very fuzzy memory of this photo shoot.

You don’t have to have it all figured out this Christmas. Decide with your partner what is important to you now (baby’s sleep and feeding schedule, getting rest yourself, visiting family, etc) and discuss how to manage the holidays together. Try not to worry about getting the perfect family photo for the Christmas card. So what if the cards arrive after Christmas, just in time for Valentine’s, or not at all? You have life’s biggest adjustment on your hands, so think about what you envision for next year, but don’t allow your future wishes to turn into present-day anxiety.

5. Just do your best.

Your best probably looks vastly different each day, depending on a number of factors, most of which are beyond your control. Take care of you, knowing that if you get a little more sleep tonight, you can feel a little less anxious. You can take a walk, get some fresh air, hand off baby to someone in your support network (or take baby with you), and do some little things that help you feel more confident in your new role. Decide with your partner what your little family needs from each other, be patient with each other, show love to each other, and move forward into the unknown of 2019 together as a team.

If you are a new mom in North Carolina or South Carolina and would like some professional support or are wondering if you may be suffering from postpartum depression or anxiety, schedule your free consultation call here, and let’s chat to see if we’re a good fit.