Dear Therapists, It's Been a Long Ten Years

While doing my 5Rhythms practice tonight, I was what my teachers affectionately call, “danced.” Getting “danced” is that transcendent encounter with the body, the letting in and letting go of something deep within the soul’s favorite hiding spots. Inside the living tissue of these corporeal meat sacks we live in lingers the stories of infinite generations waiting to be told. Tonight, as chaos yielded to lyrical, my body found space, but the space it found was not the joyful lifting of the spirit letting go of letting go. Rather, it was the breaking of a psychospiritual dam, the destruction of a levy of professionalism I could not hold up or hold back from the water.

I cried. It was not the beautiful shedding of twin rivulets down rosy cheeks, but the ugly, raw force of nature I have held at bay far too long. It was the kind of crying that winds itself up from your feet, coils through your guts, and hides behind hands tented over your nose and mouth so no one could hear you screaming. Underneath the mucus and salt, lived the festering grief of hopelessness and the bitter edge of heartbreak.

I am not okay.

I haven’t been for a while.

In fact, ten years ago, the day after the 2016 election, I was flying to Las Vegas to run the half-marathon for cancer research. In the airport, the faces of the dejected and tearful were all around me, staring blankly at newspapers and television screens. I cried to my mother on the phone. She told me it was going to be fine, that I needed to focus on the race. I got sick during that race, my body responding to the stress with a reaction rooted in MCAS (Mast Cell Activation Syndrome). It was my worst, and my last, race.

I was a new therapist then. I had just graduated a year earlier and was earning my license at an agency which adamantly insisted it was not, in fact, an agency. I was full of energy and creativity, braver than I am now in my interventions and twice as nervous about them. At the same time, I was drowning under the pressures of productivity. My caseload was so intense, a utlization review manager from one of the insurance companies called me directly to express concerns about potential burnout. She declared with no small amount of certainty, that I had the hardest caseload in their books. Under this terrific weight, I was constantly afraid of not being good enough, suffering a hearty bout of imposter syndrome exacerbated by no small dose of corporate gaslighting which convinced me I could, in fact, do the impossible with almost nothing and that that was somehow a good thing.

It wasn’t.

Four years later, there was a bit of a reprieve from the constant chaos of that first political term. I should be clear that I have spent most of my career involved, in one way or another, with social justice and trauma-focused treatment.  I do not apologize for my politics, nor that my politics are part of the way I do therapy. I believe, wholeheartedly and no doubt a little naively, that the greatest gift a healer can give to their clients is authenticity. I will not pretend to know something I don’t or pretend not to care. I think one of the greatest disservices we can do is to keep up the “therapeutic neutrality face,” as if we aren’t impacted by the horrific stories we hear every day of the terrible things people do to one another. Therapeutic neutrality face is simply a mask of professional detachment and imperviousness. It doesn’t stop our clients from getting to know us. They read us as readily as we read them. Or, as one client so aptly told me all those years ago, “Honey, you wear it on your face.”

In case you are wondering, that’s the moment I surrendered said therapeutic neutrality face.

Following the 2020 election, the world turned grimly towards the Covid-19 epidemic. The global mental health tanked precipitously, my clients spiraling with existential dread, boredom, and fear. Jobs were lost and with that, homes. Children couldn’t go to school and their social and academic growth stalled. In some cases, indefinitely. When wearing a mask was politicized, family holidays and get togethers became war zones. At the center of it, therapists, who aren’t recognized as first responders, held the hands and hearts of the families of the dying. I spent the first months of the pandemic working in primary care mental health. I counseled family members in one room while members in other rooms joined in, helping them to navigate the grief of lost loved ones while they suffered, unable to breathe, from the OG Covid strain. I saw my client’s charts marked “deceased” when their bodies were unable to fight off that terrible disease, particularly in the early days. There are times now, when it feels as if we have forgotten those that died during the Covid pandemic. Politics would have us think it “mismanaged” and would tell us it was “just a bad flu,” but millions died even with our modern technology and medications. That’s not a flex; that’s tragedy.

And still, therapists held the other side of the couch. I wondered then, in those pandemic years, how long before the therapists, counselors, social workers, school psychologists, and others within our field would be able to hold on in the face of such deep grief. I wondered if the loss of healers would be the next pandemic. I often joked of a “grand” therapist, the “therapist of all therapists” who would be at the end of the interlocking spirals of therapists needing other therapists. During that time, many of my colleagues burned out, leaving the field for other opportunities. For profit fly by night organizations came on board, paying abysmally low wages and offering therapy on the cheap and easy, increasing stress on small practices. Artificial intelligence, of which I have plenty to say, also rose up. Ostensibly the therapist of the future, it’s apparently destined to help humankind without possessing a shred of humanity. In Oregon, the state removed the right of Registered Associates, post-graduation but pre-licensed therapists, to bill Oregon Health Plan, the state’s version of Medicaid. This closed practices, stalled careers indefinitely, took therapy away from clients in already established therapeutic relationships, and forced Associates into community mental health where they will be exploited and drained until they, too, burnout and the next crop of nubile new graduates replace them.

In short, the blows just keep coming.

In 2020, I moved on from my job in primary care, retreating into group practice and private practice, re-establishing a sense of control and normalcy over my career. Meanwhile, the world spun again into chaos in 2024. There’s a lot I could say about that political election, about the close calls in Oregon, and the shitshow of the presidency, but I only have so much space for a blog post. To make things worse, by the end of 2026, the federal subsidies for the ACA will be terminated, creating a health insurance death spiral that has already caused the mass exodus of smaller, regional insurances across the country. Here in Oregon, two regional providers, of which one insures half a million state workers, have announced that they are closing their individual plan networks. Thousands of individuals will no longer have coverage, or will have to change their doctors and health networks completely. For someone like me with complex health needs, changing my treatment team is not viable; it's taken me thirty years to find a team that finally understands how to keep me functional. The threat of losing that is, frankly, terrifying. Thousands of therapists, myself included, are facing the grim reality that we may not be able to afford to keep our doors open. For neurodivergent weirdos like me, going back to agency is akin to a death sentence. My health will literally not survive it (the doctors told me so).

Moreover, my clients’ mental states have deteriorated, their acuity at an intensity I haven’t seen since those early days of Covid. The existential dread is so high, I have to remind them to eat, to sleep, to exercise, and to cry. Not the pretty crying either. The real shit. That self-same ugly crying I did myself today. The same ugly crying I've been doing for months when no one else is looking.

And still, my friends, we hold the other side of the couch. We hold the grief and fear of our clients as much as we hold our own, our family’s, our loved ones’, and our children’s. The last ten years have been hard. The endless days and nights of suffering, of one bad news story after another, have taken their toll. They still are. I tell my clients every.single.day that it is okay to not be okay, that after the last ten years, our nervous systems are overwrought with overwhelm, unable to process the chaos of events as they flicker in and out of the public consciousness with the rapacious appetite of the 24/7 news cycle.

It’s impossible to hold it all.

And still, my therapist colleagues, we try.

I see you. I hear you.

You are the best of us.

And it’s okay not to be okay.

The etymology of farewell comes from the Middle English to “journey well” or “go safely.”

May you go safely and journey well.

Until next time,

Sharon