Less than two weeks before the first COVID-19 cases showed up in New Mexico, 22-year-old Sevía Gonzales went looking for a therapist to cope with the effects of an unhealthy relationship she recently ended.
Before she could make an appointment for a face-to-face session, Gov. Michelle Lujan Grisham issued a stay at home order, thrusting Gonzales “…into an equally unbelievable situation.”
She looked for therapists offering remote services covered by her insurance and found a few practices, but each had long waitlists.
“The system is just so overwhelmed it’s not even worth it to try to get an appointment at this point,” she said.
In an effort to continue serving clients during the pandemic, many therapists and counselors across New Mexico have shifted to therapy online or over the phone.
It’s a solution, but one that fundamentally changes the way therapists normally interact with clients, those in the industry say. Usually, therapy is done in the same room sitting face to face, a more intimate setting where therapists not only listen to what a client is saying but can pick up on nonverbal cues.
“It’s better than nothing,” said Patsy Romero, CEO of Santa Maria El Mirador, an adult behavior and intellectual disability care center in Santa Fe. But online or over the phone therapy doesn’t replace face to face treatment, she said.
Clients “express fear that the phones are not secure, or they’re not as forthcoming with how they’re really feeling,” Romero said, adding that body language is sometimes more important in therapeutic treatment than verbal communication.
Face to face processes are much more effective than online therapy, she said. “My therapists feel like they have to check in a little more often to make sure that clients are okay.”
Nonetheless, public officials have been getting the word out to New Mexicans that such telehealth treatment for anxiety, stress and other mental health problems is available as the need to socially distance takes precedence over in-person sessions.
The move to online and phone therapy was facilitated by a bulletin New Mexico’s superintendent of insurance issued last month reminding insurers to treat telemedicine visits equal to in-person visits, and that cost sharing or prior authorization are not required in cases involving COVID-19. The state agency weighed in after numerous “consumer and provider” calls that complained of obstacles to telemedicine that resulted in “patients forgoing necessary care, or continuing with in-person provider visits when a telemedicine visit would have sufficed.”
Large demand for such telehealth services has caused virtual waiting lines for many.
“There are definitely people reaching out for services right now because of anxiety being higher,” said Roslyn Pursley, a licensed professional mental health counselor who works for the Attachment Healing Center in Albuquerque. The Center has seen an increase in people calling for appointments, she said, and now has a waitlist.
As a student at the University of New Mexico, Gonzales would normally have access to free services on campus like the Agora Crisis Center, but the “skeleton crew” of volunteers still working is stretched thin, and the phone is not always answered.
A free statewide crisis hotline is trying to fill treatment gaps created by waitlists and limited services. The New Mexico Crisis and Access Line gets around 150 calls per day on average from people struggling with suicidal thoughts, substance use, grief, or other problems. Since the first positive COVID-19 cases were announced in New Mexico last month, 35% of those calls have focused on the novel coronavirus outbreak, according to program manager Wendy Linebrink-Allison.
In an effort to close coverage “gaps” across the state and connect with more people, the crisis line has partnered with the New Mexico Behavioral Health Collaborative to create and release an app that connects users with mental health providers.
Bryce Pittenger, CEO of the New Mexico Behavioral Health Collaborative, described the app as “a one stop shop for any and all behavioral health resources across the state of New Mexico.”
All 200 crisis line staff are now taking calls from home, Linebrink-Allison said.
Mental health providers trained to respond to crises answer the calls and determine what the caller needs immediately. The staff try to talk people through whatever issue they are having by trying to validate and normalize the caller’s feelings, reminding them everyone is being affected by the pandemic, and offering the caller local resources. Crisis line staff can also refer callers to a mental health provider in their community if they want continued treatment.
Because of the stay-at-home order, those referrals are being made to mental health providers who have already or are in the process of moving to telehealth services.
The statewide crisis line hasn’t yet seen an increase in the number of daily calls it receives, but Linebrink-Allison said based on historical reaction to disasters in a community, she expects that to change.
Moving to telehealth; therapy is changing, too
Stefanie Juliano is a licensed mental health provider who owns a practice in Rio Rancho. She works mostly with teens 14 and up and new or postpartum moms.
Most of her clients are asking to see her more often, Juliano said, even some who were almost done with their treatment and only seeing her once a month.
“People who were on their way out the door have been retriggered, from things from childhood to just stressors, and so making sure they stay on whatever path that they’re on has been really difficult but really important,” Juliano said. “So it is kind of a crisis situation and not a vacation.”
Juliano stopped all in person visits with her clients and now talks with them over the phone, through video chat services like Zoom, and even texts them if they need immediate help.
It’s been a big adjustment, she said, but most of her clients have adapted.
In some cases, Juliano gets to learn more about her clients and their home life than she would during an office visit.
“Some of the teens think it’s really cool they’re like I’m in my pajamas right now in my room this is awesome. They’re like ‘look here’s my cat here’s my fish…’ It’s like oh here’s this other little part of my world that you don’t get to see,” she said. “Moms, too, they’re like ‘did you see that my husband came in and he doesn’t care that I am on the phone? So it is kind of a real life glimpse and so it’s good.”
Her practice hasn’t changed much. She isn’t engaging with or working through past trauma with her clients because she can’t offer them physical support, but she said that hasn’t had a huge impact. They mostly talk about the novel coronavirus, like a high school senior Juliano treats who won’t get to graduate with her peers.
“She feels like everything has been taken from her at this point,” she said. “She’s worked 18 years for this and it is just gone.”
Larrissa Campbell, a medical assistant currently working to screen staff and others at Presbyterian hospital in downtown Albuquerque, started seeing Juliano two months ago for reasons unrelated to the pandemic. Her sessions focus on stressors brought on by her job and the pandemic in general.
Campbell worries she isn’t being given the proper protective gear she needs to work with COVID-19 patients. Family members who would normally help care for her children also work in healthcare and are exposed to COVID-19 patients. That adds more stress and anxiety to her already full plate because she worries it puts her child at a higher exposure risk.
Being able to use telehealth sessions for therapy has helped, she said.
“It’s a little more convenient now that she’s able to call me, I am able to be at home with my little one,” Campbell said.
And she can schedule more frequent sessions because her and Juliano’s schedules are more flexible.
“It’s helpful to be able to converse with her, she talks to me about what alternatives I can do to ease anxiety… it helps me along my weekday,” she said.
But the transition to telehealth hasn’t been easy for everyone.
Pursley with the Attachment Healing Center works with children from Albuquerque Public schools. She said only 75% of her clients have the technology to continue sessions remotely, and some have put their treatment on hold until the stay at home order is lifted.
For those clients she can see over the phone or through video, Pursley often encounters technical difficulties.
“There’s been a learning curve that not everybody is comfortable with,” she said. “The biggest problem, even for the adults, is talking over each other – that nuanced way of communicating and turn taking, and there is a little bit of a lag so there’s that… It’s very frustrating.”
Without being in the room with her clients, Pursley can’t see their body language as easily, which limits non-verbal communication.
Pursley has seen her younger clients transition more easily than their parents. Like Juliano, Pursley said some of her “kiddos” love the camera, and show her things from their home that are important, or introduce her to their pet.
“They just think it’s funny and are very open in some ways because they’re in their home,” she said.
Pursley has also changed the way she practices because she can’t do things physically with her clients.
“There’s differences in providing the services for them… I do a lot of play therapy and sand tray, so I don’t have those tools,” she said, adding that she has been talking with colleagues about how to find and use online tools to do the same things she would normally do in person.
Like Juliano, she has stopped processing trauma with her clients because she can’t be in the room with them to support them.
“It’s more about maintaining normalcy and their daily routines at this point, because they’re home and I am not there to support them as much emotionally,” she said.
Not all therapists have transitioned completely to online services. Some, like Jerilyn Silver, have continued in-person visits.
A Licensed Independent Social Worker, Silver said her office is large, allowing her to keep six feet of distance between anyone there.
Some clients have asked to be seen online, and Silver has tried to accommodate them, but she prefers seeing clients face-to-face.
Online visits are “not as effective,” she said, adding that she also runs into technical difficulties.
Silver’s two offices are in Nambe and Los Alamos, where she sees people who work in classified areas and are subjected to higher levels of anxiety. Many don’t have the option to work from home.
“Some people are particularly frustrated. They relayed tremendous anxiety, disappointment, anger, mourning — all part of the grieving process,” she said.
The stay at home order has created stressors for many, Silver said. Couples who usually get to spend some time away from each other while at work, running errands or out with friends but are now being “forced to spend time together 24/7.”
“They’re left with themselves, the television, other family members that are showing signs of anxiety and stress…” Silver said. “Healthy models for conflict resolution are not being employed as much as they should.”
To try and keep some normalcy, Juliano suggests trying to stick to a routine as often as possible, and set a loose schedule for yourself and children especially. She has a three and a half year old who used to go to school on Tuesdays and Thursdays, so now Juliano tries to build learning time into their lives on those days, even if it doesn’t feel like school.
“Some of my clients tell me ‘my kids don’t want to sit down for four hours a day,’ and I tell them of course not, would you?” she said.
Her daughter loves the library and since they can’t go now, Juliano created a home library.
“We go to her playroom and we check out her own books, so she gives me her little library card, and it normalizes everything,” she said.
Juliano recommends taking part in activities that connect people, like a regular
Friday night movie and pizza, or family walks around the neighborhood.
Such advice mirrors that of the Centers for Disease Control and Prevention, which recommends people take frequent breaks from watching, listening to or reading news stories, and from social media. Take care of your body by stretching, doing yoga, meditating or practicing deep breathing. Exercise, eat well, and get plenty of sleep and avoid drugs and alcohol. Connect with others. Talk with people you trust about your concerns and how you are feeling.
Gonzales, the UNM student, is trying to do all of those things. “I’m really grateful that I got out of that [relationship] before all of this went down because I don’t know what I would have done if I was in it and under quarantine,” she said. “But I haven’t been able to deal with things as I normally would have, I can’t see a therapist in person which is what I think would work best for me.”
She’s been participating in online yoga classes, staying in touch with friends, and eating dinner with her family every night.
“I have just been trying to find ways to deal with that anxiety and stress and overall unease on my own and without any real professional guidance,” she said.
If you are having trouble finding a therapist near you, call the New Mexico Crisis and Access Line at 1-855-662-7474.