Cyndi Doyle is an expert in holding space for her clients, putting aside her own emotions to support them through their anxiety, stress and trauma.
As a licensed professional counselor in Denton, Doyle typically works three days per week and sees between 24 and 27 clients.
But since mid-April, the coronavirus pandemic has brought a surge of new demand, and clients she hasnt worked with in more than a year have started reaching out for help. So she started working up to five days a week and seeing as many as 36 clients per week.
Before long, listening to so much trauma began taking a toll on Doyle.
Every day for two weeks, I would cry a little, Doyle said. It wasnt like I was scared to get sick or worried about my family. Its this grief hearing everybodys pain and not being able to do anything.
Working on the front lines of mental health care, Doyle has seen firsthand the way the new coronavirus has upended peoples lives. People who cant work from home fear exposing their loved ones to the virus, uncertainty about the future triggers anxiety and stay-at-home orders create feelings of isolation, Doyle said.
There are no events on the calendar. We dont have the routine that we crave. We dont have the human connection, she said. I have some rape victims that say they feel trapped, like they cant get out.
Piled on is the grief of loss from canceled proms, lost jobs, the death of a loved one from the virus. But its not just the big events that give rise to grief, Doyle said. Its also how the brain struggles to normalize something so enormous and life-changing.
All of our brains are like, What is going on? Doyle said. A lack of control is really what was triggering the brain.
Nearly half of American adults said their mental health has been negatively impacted because of the virus, according to a poll by the Kaiser Family Foundation, a national health policy think tank.
That has caused an increased need for mental health professionals like Doyle. NAMI Texas, the state affiliate of the National Alliance on Mental Illness, has seen a 500% increase in calls since the coronavirus pandemic took hold, said Grace Mansfield, outreach coordinator for the organization. Most callers are struggling to access the mental health support they need; NAMI Texas helps connect people with resources.
But the grief caused by the coronavirus pandemic is widespread, stretching even to counselors and therapists who have to take into account their own mental health while serving clients.
Doyle works from her home office. Shes done sessions remotely on her computer since mid-March to avoid the risk of infection.
Doyle tries to mimic the safe space her work office offers for many of her clients. But sometimes, the privacy and security cant be replicated, Doyle said.
[A couple of weeks ago,] I was talking with a client about a volatile situation between her and her fianc, she said. She tries to make sure hes gone, but he came home in the middle of our session. We both shut our computers.
Doyle said this new reality has been disempowering for some of her clients. Some turn to alcohol or other substances to cope with the uncertainty brought on by the virus, she said.
Theres probably going to be fallout from alcohol later on, Doyle said. I cant say that its abuse, but I definitely know theres a higher use of alcohol.
If someones past trauma includes feeling trapped or being in danger, Doyle said the stay-at-home mandates and event cancelations caused by the pandemic can mimic those traumas and trigger old feelings.
Doyle said she recently worked with a client who had been out of counseling for a year after going through a divorce. When she left Doyles office a year ago, she was feeling great about being single, Doyle said.
But after the pandemic took hold in Texas, the woman called Doyle in an awful state. The coping skills shed typically use to work through feelings of loneliness and isolation, like going out with friends or going to a workout class, were taken off the table. This allowed deep-seated feelings of worthlessness to rise up.
Brandy Stiles, a counselor who co-owns Pecan Branch Counseling with Doyle, said she has seen unique challenges arise in her clients lives.
A teenage client told Stiles that shes worried that her e-cigarette use will cause her to develop serious complications if she catches the virus. Another client, a teacher, lost her husband unexpectedly in late February, and the pandemic prevented those close to her from being with her when she needed them most.
The standard grieving process got totally messed up because you cant have your support system [with you], Stiles said. Its totally gone.
Doyle urges her clients to talk to the brain. She reminds them that theyre not alone and that the stresses theyre facing, though valid and real, arent past trauma making its way into the present.
The pandemic also has rendered many people vulnerable financially, as more than 1.5 million Texans filed for unemployment in six weeks. But even Doyles clients who have lost their jobs have continued to make therapy a priority, she said.
Some of Doyles clients pay out of pocket, and others bill through insurance. But Doyle said most insurance companies have been very generous, sometimes covering clients copays and deductibles.
The insurance company has said, We get it. Go get the help you need, Doyle said. Theyve shown up for customers, and they showed up for us in being able to provide telehealth.
But not everyone can afford counseling right now. Doyles office is less than a mile from the University of North Texas, so many of her clients are college students trying to make ends meet. Shes offered reduced rates or even pro bono services because of her commitment to providing therapy to the clients she has an established relationship with.
She said shes seen a notable decline in calls from people looking to start therapy.
Theres an aspect where people arent sure about starting a therapeutic relationship over telehealth, Doyle said. It takes courage to be vulnerable.
Doyle said the brain can tell the difference between telehealth and a face-to-face connection. Shes had people stop counseling because their kids need to be cared for or they dont have the ability to talk freely at home. Some dont want to look at themselves on camera.
Stiles, Doyles partner, says she has added four new clients during the pandemic, and shes been surprised by how deeply shes been able to connect with them remotely.
Once their office reopens to in-person sessions, Stiles said she plans to maintain a hybrid practice, giving her clients the choice between virtual and in-person counseling.
While Doyle and Stiles are eager to reopen their doors some clients have paused their counseling until it returns to in-person they are equally concerned about the safety of their clients and counselors. They tentatively plan to reopen June 1.
My whole existence as a professional is to create a safe space, Stiles said, adding that the possibility that their office could be unsafe for clients makes her anxious.
Every day, Doyle has a routine. She wakes up, pets her dog and grabs a fresh cup of coffee before soaking in a bit of morning air outside. She puts on what shed typically wear to her office, except for her shoes.
Doyle typically sports a pair of heels when shes working in her Denton office. But working from home, more often than not, she trades in her heels for Rothys Sneakers or a pair of flats.
But she cant replicate the camaraderie shed typically share with the six other counselors in her office. She said she misses the coveted time between sessions that served as an outlet to let out the air in the balloon and decompress after a particularly challenging hour spent with a client.
Doyle ensures she takes moments to process her own anxieties from the pandemic, even if its simply grabbing a glass of water between sessions or enjoying her lunch outside in her hammock.
The first two or three weeks were rough, Doyle said. I was grieving as well, having my own fears and anxieties, feeling trapped and stuck.
Thats not unusual during the pandemic. The states COVID-19 Mental Health Support Line has received calls from therapists feeling overwhelmed by their work with clients, said Sonja Gaines, commissioner for intellectual and developmental disabilities and behavioral health services for the Texas Health and Human Services Commission.
Stiles said she has completely restructured her day to ensure shes taking care of herself, too. She ends her workdays before 7 p.m., and she waits until 11 a.m. to log in on Mondays and Wednesdays so she can fit in a morning run.
And the counselors in their practice share group text messages to support one another after particularly tough sessions or send jokes to lighten the mood.
It has a cathartic effect, Stiles said.
The biggest toll is not having that outlet, Stiles said. Im not a believer in working alone. We all [in our office]. were a family.
People can reach the Texas COVID-19 Mental Health Support Line at 833-986-1919 and the National Suicide Prevention Lifeline at 800-273-8255. NAMI Texas also offers online support groups, which can be found here.
Disclosure: The University of North Texas has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
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