What It’s Like to Be a Therapist in Boston during COVID-19

Dr. Monica O'Neal, the Boston-based cast member of a new Bravo reality show, explains how she's caring for patients—and herself—during dark days for mental health.

Getty Images

Throughout this pandemic, we’ve been inundated with reminders to protect our physical health by donning face masks, dousing ourselves in hand sanitizer, and wiping down groceries. Fair enough. But even after several weeks of social distancing, self-isolation, and existential anxiety that may not abate anytime soon, most of us are still not hearing enough about the toll that this global emergency may take on mental health.

Unless, of course, you’re a professional—like clinical psychologist Monica O’Neal. Every day, O’Neal hears from patients who are struggling under the heavy weight of COVID-19, and all the compounding stressors that the situation has introduced to their lives. Through her private practice, she’s used to helping folks make their way through troubled waters. But as a clinician on the front lines of a growing mental health crisis, O’Neal is working hard to support patients during an unprecedented period when our caregivers need to take good care, too.

Like all of us, O’Neal is trying to stay focused on the bright spots in her future: For one thing, she’s about to star in Camp Getaway, a Bravo reality show premiering next month that’s set at an adult summer camp in the Berkshires. And of course, as any new fan of Tiger King can attest, vegging out with the small screen is indeed a very acceptable form of self-care. But we asked O’Neal to share more serious thoughts on what it’s like to counsel people through the coronavirus era—and the challenges of doing this work without becoming dispirited.

I tend to wake up with the sun, for the most part. I try to take some time every morning to just stop and breathe. The first people I think about these days are my parents, because they’re kind of far away. Especially nowadays, I’ll say my own prayer: “Thank you for letting me see another day.”  I’ve been trying really hard to read what I’d call modernly relevant devotionals, versus traditional Christian devotionals. I’m not someone who is going to be able to sit down and meditate for half an hour. But I can at least take a moment in time that feels meditative, to put things into perspective every morning.

I’m taking all my patients via telehealth, and everyone is feeling way more intense these days. There are recurring themes, but it also shows up different for everybody. I worry about some of my patients with compromised health situations. Instead of just launching in to asking my patients “what’s on the top of your mind today?” I have to do a health check-in. I ask them, “How are you feeling today? Are you taking care of yourself? Setting limits with who comes around and how often you go out? Are you talking about it with your partner?” All that stuff I wouldn’t necessarily have to do. It feels more intense, carrying the worries of all my patients, which in some ways mirror my own.

There’s a sense of urgency. For instance, I treat people who have binge eating disorders; I have to check more carefully to see how people are coping, and that they haven’t reverted back to their more primitive, less healthy means of coping. I don’t even have a history of eating disorders, but the first couple of weeks we were dealing with this thing, I was eating chocolate and cheese every day. Imagine if I was a person with a history of eating disorders? That could easily go from comfort-food eating to, potentially, binging and purging. The conscientiousness around that kind of stuff is much higher.

There’s a level of tension that feels much more profound than I’ve ever experienced, and I was doing my training during the period of 9/11. I was in Washington, DC at that time, and it had a profound impact on me. I had such profound PTSD, I couldn’t concentrate and wasn’t even sure I’d be able to finish the semester. But I was able to, because I was able to talk about it and do something about it. The difference now is that, even though 9/11 led to war, it was a discrete thing. It felt finite: something happened, and we responded. With this [COVID-19], we don’t know what is happening, we just know that people are getting sick. It’s like a tiger is jumping out of the woods at every single minute. You can never get people on stable footing. That’s the biggest issue: no firm ground to stand on.

When I talk to people about therapy, sometimes I explain it this way: Imagine you’re in a raft. Even if you know where you’re going, you don’t know the terrain—so you have to be okay with someone who knows a bit of the terrain leading you through. Even though you’re telling them where you want to go, they can recognize the pitfalls sooner. Right now, though, I’m trying to navigate people through terrain that I don’t even know myself.

The big thing I hear from people is a sense of ambiguous loss. We don’t know what’s in front of us, we just know what we’re not doing on a day-to-day basis. Ambiguous loss is hard for people to put their finger on, because they can rationalize: “Why should I feel sad about this? I still see my friend. We’re still doing virtual happy hours.” But it’s not the same. There’s also the loss of a sense of security: “I have my job now, but what if this goes through the end of the year? Am I going to have my job then?”

There’s also a loss of identity, especially for women—working mothers who are now around their kids 24/7. Work is a bit of a refuge, a boundary you have for yourself, and that has to go away because the needs of your kids come before anything else. I have patients who are in quarantine with a significant other, and some people are recognizing challenges that may cause their relationship to be called into question. Others are finding it to be a pleasant experience—but that is scary too, because it means, “I’m that much more dependent on this person.” It’s really a massive shift in people’s identities.

The risk of domestic violence is so much more substantial. We’re all stressed out, and abusers are people who don’t cope very well—they externalize through violence. Unfortunately, their victims tend to take on the responsibility of that, so the pattern deepens. Part of the abuser-victim dynamic is that the victim starts to blame themselves, or thinks that they have some modus of control. That pattern is only going to become deepened and more entrenched in a situation like this.

I’ve told people to limit their intake of media because it really will make you feel worse. That’s one thing that we have found in scientific studies from other countries: too much exposure to the media’s coverage of this is making people more depressed. I tell people, if they need to get information daily, to get it from the CDC or an actual scientific body, as opposed to CNN or the president’s briefings—because all that does is create more questions. In an already-ambiguous situation where nobody quite knows what’s happening, you’re creating a powder keg of anxiety ready to go off at any point in time.

I think the thing that is hurting people the most is all these different statements about the best mode of treatment. I think that is the most hurtful thing. It’s like, imagine setting someone up that their rescuer is on the way, and then at the last minute, it’s “sorry, my schedule got too busy.” It’s the ultimate disappointment. And when you go through that level of disappointment it creates a deeper level of hopelessness and despair. I wish they would stop speculating what is the best mode of treatment when we just don’t know—because people are really clinging, looking for something to give them hope, and there’s profound disappointment when something turns out to not be true.

I have a therapist as well, but I haven’t felt the need to see her yet. I know how to cope with the anxiety. If anything, what I feel most is guilt when I need to put up boundaries—as if I’m not doing enough. Not with my patients: I feel like I’m available enough to my patients, and I was surprised by how seamlessly we transitioned to telehealth. We didn’t skip a beat. But when it comes to the rest of my life, I just don’t have the bandwidth. After spending five hours doing therapy calls, I’m not going to want to talk to anyone else socially. My bandwidth for those kinds of connections is much lower.

It can be hard for me to communicate that I need a little bit of space and time for myself. I’m the quintessential extroverted introvert: Once I hit a wall, I need time for myself. I need the space to be able to feel like I can breathe, do things on my own, and come to people when I need help. But I’m also recognizing that sometimes that comes across as more rejecting than just a request for space. I think there’s something in that for me to learn, that I’ll continue to explore and look at for myself. I need space, but I know it can feel rejecting—and people who want to help me are not sure how they can. That’s something that has come up throughout my life, but this has given me more opportunity to explore my own dynamics and patterns.

Right now everybody is feeling a bigger pinch to be productive. People are experiencing more work stress than before. Instead of thinking, “I’m at home and I have to work at home because of what’s going on,” there’s still the idea of, “I’m working from home so I have to prove I’m being productive.” It’s important to stop for a moment and recognize that you’re going through a very challenging time and need more self-care. Watching television and having fun, thinking about the plans you’ll have for summer, is still a good way to cope. It’s important to not lose sight that this is going to come to an end, and to stay connected to those things you enjoy. I think doing something like watching our show will be an easy, good time for people to connect with those parts of themselves that just want to be free to play, and to not worry about stuff for a little bit.