The Most Common Issues People Brought Up In Therapy In 2020

Experts share the problems that affected most of their patients during the pandemic and offer advice on how to cope if you're struggling, too.
Mental health professionals addressed a range of unique concerns this year.
Mental health professionals addressed a range of unique concerns this year.

For many people, 2020 has been the most difficult year in recent history. The coronavirus pandemic continues to rage on while taking away loved ones, disrupting daily life and causing increased worry.

Mental health professionals addressed a range of concerns from patients who experienced challenges and setbacks throughout this year. And while the current public health crisis was a conversation topic in many sessions, other general worries and concerns continued to appear as well.

Robin Gurwitch, a psychologist at Duke University Medical Center, said that the reasons people go to therapy have not changed this year ― instead they’re magnified as a result of the coronavirus pandemic and the stress that comes with it.

Below, experts from across the country share what was brought up most in therapy this year, along with suggestions for how to deal with some of the most common struggles.

An increase in depression, anxiety and stress as a result of the coronavirus pandemic

“If you had asked me before the pandemic started, ‘If you could impose something on people that would create more depression, more anxiety and more stress, what would you do?’ I’d say, well, make everybody stuck at home ― so that’s what is happening here,” said Michael Stein, a psychologist in Denver and president of Anxiety Solutions.

Stein emphasized that there are both direct and indirect impacts of COVID-19 on his patients. But, overall, the pandemic is creating more anxiety and challenges for many of his clients who lost go-to coping mechanisms as a result of the necessary safety restrictions that are in place throughout most of the country.

For example, people who used to go to the gym to blow off steam may not be able to do so, or those who visited with friends to ease their depression can’t safely do that.

The pandemic has almost forced us into inactivity ― both physically and emotionally ― which can cause mental health issues, Stein noted.

The pressure to achieve personal goals during this time

Morgan McCain, a psychologist in Texas and the owner of McCain Psychological Services, said that a number of her patients put pressure on themselves to achieve unnecessary goals.

She added that performative productivity on social media ― especially in the beginning of the pandemic ― made people believe that they should be using any free time to pour into self-improvement hobbies like fitness, baking or learning a new language.

“I think that was an unfair expectation for people to set for themselves because we forget that this pandemic is stressful,” she said.

As a whole, people have additional things to manage as we go through this pandemic ― reduced work hours, child care changes and more ― but many of us have continued to put pressure on ourselves to come out richer, more rested or with new business ideas, McCain said.

Additionally, while we may have high expectations for ourselves, many of us also simultaneously struggled to meet basic needs this year, she said.

“We have this idea that we’re supposed to be operating at a 10 when our lives demand us to really focus on our basic needs,” McCain said, adding that “if your basic needs aren’t met — things like your safety, physiological needs ― it’s really hard to focus on those higher-level needs.”

In other words, how can we be expected to personally excel while we are worried about staying healthy during a global health crisis?

Instead of pushing ourselves to become a better baker by the time we’re vaccinated, McCain suggested practicing self-compassion while redefining our expectations.

Can we reset those expectations to match what our environment is demanding right now so we don’t feel as critical or like somehow we failed when things are just different?” McCain said.

The fear of uncertainty

Stein said that a lot of anxiety stems from the fear of the unknown, and he has seen many patients struggle with this in 2020. The pandemic itself is an enormous source of uncertainty ― we don’t know when life will go back to normal and we don’t know what that will look like.

To combat the fear of the unknown, which is an inevitable worry at this point, Stein recommended getting comfortable with uncertainty.

“It’s all about tolerating uncertainty and having a friendlier relationship with it,” he said. “The thing that maintains anxiety is short-term avoidance ― anything you do to avoid anxiety in the short-term keeps anxiety going in the long run.”

We often avoid uncertainty by trying to gain control or find answers, which often comes in the form of reassurance from loved ones, online research and doomscrolling. We also catastrophize or try to anticipate the outcome of the things we are uncertain about, which often ends up creating more worry since the answer doesn’t materialize right away.

“It’s all about cutting off any reassurance-seeking process, whether it’s external or in your own head, and coming back to what you’re doing right in front of you,” he said.

In other words, we need to focus on what we can control in the moment. We can do this by trying a mindfulness exercise, writing down a list of things we do have control over or making a plan for the day to help ease some anxiety around uncertainty.

Police brutality and racism against Black people

McCain said she experienced her busiest month as a clinician in June when the country was responding to systemic racism.

“Some of the biggest themes I’ve noticed this year involve this response to racism, particularly violence against Black bodies around police brutality,” she said.

Many of her clients were reeling from the accumulative pain of the deaths of Ahmaud Arbery, Breonna Taylor and George Floyd and what that represented in our society, she noted.

“That potential for racial trauma was very present, folks were really hurting,” McCain said.

She noted that as her clients are hurting, they are still living through a public health crisis, which limits necessary coping mechanisms. Many people weren’t able to go out and heal through protest out of fear of the virus’s spread and also weren’t able to grieve with family or co-workers in the way they’re used to.

“One of the best tools to cope when we’re experiencing these kinds of things is community,” she said. “How do I get community if I have to be 6 feet apart from everyone and at home?”

Financial concerns

Many people are struggling with paychecks, rent and more. Stein noted that financial worries have been a source of anxiety for many of his patients throughout this year.

“People have lost jobs, people have much more up-in-the-air money situations,” he said.

Additionally, even those who are not out of work or working reduced hours still have concerns around their financial stability as layoffs have become the norm in many industries.

Feelings of disappointment

In Gurwitch’s work with children and teenagers this year, she found that feelings of disappointment as a result of social changes and canceled plans are prevalent. We’re unable to celebrate events and gather in the ways we enjoy, which is a tough reality to face.

“People are more disappointed and more angry,” she said. And while patients understand why there are limitations, it still does not feel fair that they don’t get to see friends and family members.

To help fight feelings of disappointment during a disappointing year, Gurwitch recommended looking for ways to help others who have also been impacted by this pandemic.

“Is this a time where you cull out some gently used clothes or toys to donate? Or volunteer at the food bank?” Gurwitch said. “When we’re not doing well after disasters or horrific events, if we find a way to help others who have also been impacted, we actually do better.”

We likely will be dealing with the mental health effects of 2020 for some time to come. The emotional aftermath of this year cannot be understated. Speaking to a therapist can help sort through the trauma, grief and other issues that may arise. We all deserve to find some peace and calm ― especially now.