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 hasn’t 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 wasn’t like I was scared to get sick or worried about my family. It’s this grief … hearing everybody’s 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 people’s lives. People who can’t 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 don’t have the routine that we crave. We don’t have the human connection,” she said. “I have some rape victims that say they feel trapped, like they can’t get out.”
Piled on is the grief of loss from canceled proms, lost jobs, the death of a loved one from the virus. But it’s not just the big events that give rise to grief, Doyle said. It’s 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.
Bringing up past trauma
Doyle works from her home office. She’s 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 can’t be replicated, Doyle said.
“[A couple of weeks ago,] I was talking with a client about a volatile situation between her and her fiancé,” she said. “She tries to make sure he’s 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.
“There’s probably going to be fallout from alcohol later on,” Doyle said. “I can’t say that it’s abuse, but I definitely know there’s a higher use of alcohol.”
If someone’s 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 Doyle’s 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 she’d 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 she’s 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 can’t have your support system [with you],” Stiles said. “It’s totally gone.”
Doyle urges her clients to “talk to the brain.” She reminds them that they’re not alone and that the stresses they’re facing, though valid and real, aren’t past trauma making its way into the present.
Some of Doyle’s 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. “They’ve shown up for customers, and they showed up for us in being able to provide telehealth.”
But not everyone can afford counseling right now. Doyle’s 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. She’s 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 she’s seen a notable decline in calls from people looking to start therapy.
“There’s an aspect where people aren’t 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. She’s had people stop counseling because their kids need to be cared for or they don’t have the ability to talk freely at home. Some don’t want to look at themselves on camera.
Stiles, Doyle’s partner, says she has added four new clients during the pandemic, and she’s been surprised by how deeply she’s 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.
Trading heels for tennis shoes
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 she’d typically wear to her office, except for her shoes.
Doyle typically sports a pair of heels when she’s working in her Denton office. But working from home, more often than not, she trades in her heels for Rothy’s Sneakers or a pair of flats.
But she can’t replicate the camaraderie she’d 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 it’s 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.”
That’s not unusual during the pandemic. The state’s 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 she’s 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. “I’m not a believer in working alone. We all [in our office]. we’re 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.
Quality journalism doesn't come free
Perhaps it goes without saying — but producing quality journalism isn't cheap. At a time when newsroom resources and revenue across the country are declining, The Texas Tribune remains committed to sustaining our mission: creating a more engaged and informed Texas with every story we cover, every event we convene and every newsletter we send. As a nonprofit newsroom, we rely on members to help keep our stories free and our events open to the public. Do you value our journalism? Show us with your support.