“My caseload has gone up by about 40 per cent since the pandemic started”: Five therapists on what it’s like to treat patients over text, phone and Zoom

Darlene Cyrus-Blaize

Registered psychotherapist at Hasu and Fruits from the Roots

“Two years ago, when I started a family, I began offering psychotherapy online exclusively. Since the pandemic, I’ve noticed an increase in clients struggling with feelings of isolation, loneliness, grief, sadness and depression. Many people are grieving the loss of normalcy and life as they knew it pre-Covid. They have a tremendous amount of stress, whether it’s about disruption in schooling, financial strains or trouble balancing responsibilities while working from home.

“My husband is working on the Covid front lines in the emergency department, and, at the beginning of the pandemic, my two-year-old son no longer had access to daycare services. So I found myself in the same situation as many of my clients, trying to figure out how to care for myself and my family, all while meeting the demands of work. It was important to pace myself so I could deliver the best care for my clients. I limit counselling sessions to only four a day, I take walking breaks and I also participate in my own virtual therapy to prevent professional burnout.

“Over the past nine months, I’ve seen a significant uptick in women of colour, particularly Black women, reaching out for support. They’re dealing with the pandemic as well as the emotional distress of witnessing news coverage of BIPOC individuals dying at the actions of police officers.

“Racial trauma is a complex issue. It’s an emotional and psychological injury that can have symptoms similar to PTSD: hypervigilance, heightened anxiety, distrust, fear, social isolation and hostility. It’s important to address the wounds of racial trauma in a healthy way: to speak with caring family and friends, or to talk to a psychotherapist who can help you process intense and difficult emotions and turn it into purposeful action toward positive change.”

Shaun Ali

Registered social worker and clinical therapist at Maple

“I’ve been a practising registered social worker and therapist for 14 years. I’d already been doing online therapy for a couple of years before Covid. Online platforms have increased access to care for people with mobility difficulties, caregiving responsibilities or without easy access to transportation. For some clients, it’s also reduced the stigma of walking into the therapist’s office.

“I find that clients feel safe and comfortable sharing their feelings online because they’re doing so from the comfort of their home turf. Clients have shown me items in their home that are important to them and have introduced me to family members. It builds rapport and helps me get to know them better.

“My caseload has gone up by about 40 per cent since the pandemic started. I specialize in working with veterans, EMS and the police. I’ve also been seeing doctors, nurses, social workers, lawyers, dentists and other health care professionals. Many of my front-line worker clients expressed concerns about exposing their families to Covid. They’re often worried about their elderly parents while caring for someone else’s. As we head into winter, I’m seeing the effects of cumulative stress in these workers, which leads to burnout, emotional exhaustion, a depletion of empathy and a decreased sense of accomplishment. The world is thanking them, but inside they feel like they can never do enough. I often remind clients they need to take care of themselves—to put their oxygen mask on first before helping others.”

Thiviyan Sithganesan

E-therapist at MindBeacon

“I was hired at MindBeacon as an e-therapist when the pandemic started. We offer digital guided therapy through a messaging-based platform. Clients share their concerns via text, and I recommend readings and worksheets based on their needs. Because of Covid, MindBeacon’s digital therapy is currently being funded by the provincial government, so Ontario residents can access our therapy for free during the pandemic.

“There are advantages to guided digital therapy. I have time to read over my client’s responses and reflect on how to best address their concerns. Clients using our message-based platform often say they feel secure knowing that their personal matters won’t be overheard by others. Plus, they can ask questions as they come, knowing that their therapist will respond to it when they are back on the platform. “I work with a number of post-secondary students on MindBeacon. Younger clients feel especially comfortable with a platform like this, since they’re used to expressing themselves through online messaging. Some of my clients in college or university are worried that the pandemic has compromised their education, even though they’re paying the same tuition. And with limited in-person internship opportunities, they’re worried about getting enough experience to secure a job after graduation. Many students are also missing out on the social aspect of school. For students, I often recommend scheduling ‘worry time,’ a designated chunk of time that you spend thinking about your worries. Some of my clients have even found that they no longer feel the need to worry about the thing that was bothering them by the time their worry time comes around. It reinforces the idea that you are in control of your worrying, not the other way around.”

Valerie Tsang

Partner therapist at Layla

“I’ve worked in community mental health since 2008 and have been a registered psychotherapist since 2017. My practice moved to virtual care, through phone and video sessions, when Covid hit. I have noticed an increased demand for therapy since the beginning of the pandemic. But since I’ve been able to eliminate my commute time, I’m able to offer more session times to clients. I’m working an extra five to 10 hours a week now that I’ve gone virtual. And I find that clients appreciate being able to access care from their own space without having to commute to my office.

“The types of concerns my clients are sharing with me haven’t changed much since the pandemic. But the severity and intensity of concerns has increased. Issues like stress, burnout, anxiety, depression, suicidal ideation and domestic violence issues have magnified due to isolation and changes to their daily lives because of pandemic protocols. Clients have also told me that the pandemic has increased their worries about the future.

“I have a number of LGBT+ clients. Even prior to the pandemic, these clients experienced more difficulty finding supportive health care due to discrimination. LGBT+ clients facing financial hardships from job loss might have to seek assistance from unsupportive or unaccepting family members. There was already a lack of safe spaces for this community, and now they’re even more limited due to Covid closures and services moving virtual. Pandemic protocols have increased isolation from these supportive networks and communities which compounds their difficulty in navigating the world.”

Kerrin Daniels

Counsellor at private practice and Inkblot Therapy

“I’ve been working as a therapist for six years. I’ve been delivering therapy online for four years. With online therapy, I can reach non-local clients and I can usually adjust my hours to suit clients that prefer late-night or early-morning meetings. My clients can attend sessions from anywhere they can get an Internet connection. They can fit sessions into tight schedules, so it’s convenient for them. I have clients who do sessions from their office or cars so they can speak somewhere private and quiet. Some clients with young children often get interrupted by their kids, so we try to schedule our sessions later in the day after their children are asleep.

“Since Covid, my clients who are single have reported worrying more about isolation. Their lack of physical interaction became more difficult to cope with as time went on. I believe that more people were experiencing existential questioning as they had more free time and needed to explore the notion of purpose. For singles, a lot of relationship concerns around finding a partner and loneliness arose.

“I also work with many couples. Being in close proximity with a romantic partner for longer periods of time than ever before has brought up doubts around relationships. Couples have shorter fuses with each other as they experience withdrawal from external social activities. For those with children, having less alone time contributes to less intimacy. For the childless couples, there is also less intimacy and less sex despite having more physical time together. I recommend that couples revisit each others’ needs in their relationship and to schedule quality time together, especially common projects to encourage creativity like creating a photo album or working on a DIY renovation.”