Sue Cristol, LMFT



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Therapy in the
Age of COVID-19


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May-June 2020

Member Contributor — Sue Cristol, LMFT

Therapy in the Age of COVID-19

This is a particularly challenging time for everyone, but especially for our more seriously impacted clients. The pandemic may exacerbate symptoms of those with any number of acute or chronic anxiety disorders. It can also heighten symptoms of depression.

I was thinking on this quite a bit during the last week or so, trying to cajole myself into writing this article. Every task just seems more of an ordeal, even when I’m engaged in some activity I previously enjoyed. It’s like all my focus and available energy is being utilized to handle the COVID-19 situation. Honestly, it’s emotionally and physically exhausting.

But there are two paths that this could follow. Here is one of them. As a client said to me when we were discussing the surreal nature of this time, “I’ve always been miserable. This is no big deal.” Another commented,” this will force me to finish some home projects that I’ve started but never had time to complete.”

It was then I realized that these are the clients who will rise to the occasion, who will remember the coping strategies we’ve reviewed over and over again. These clients may realize that they are not as impaired as they thought they were. They’ll remember about thought-stopping and externalizing the problem. They’ll remember that this is a temporary state of “crazy” and there is an end to it. After all, those that have dealt with anxiety and depression for most of their lives might just be more skilled at enduring hard times than those of us who haven’t struggled as much.

This leads to the other path. It goes like this. “This is gonna put me over the edge. I was barely managing with life before this pandemic.” “Why do horrible things always happen to me?” These are the clients that we may need to be more concerned about. For them, this time may be triggering, cause panic attacks, dysregulation, angry outbursts and insomnia, to name a few.

For these clients, we need to be that reassuring, non-judgmental voice reminding them that the pandemic is a global event that is impacting everyone. We need to use reality testing and encourage control of catastrophic and obsessive thinking. We need to encourage these clients to seek the support and love of understanding friends and family members, regulate food and substances intake and advocate for maintaining some sort of daily schedule for hygiene and sleep.

For most of us, clients and therapists included, this time will be a test of our resiliency and spirit. I wish all of you out there reading this a safe and healthy future. This is not the time for platitudes. It’s a time of authenticity and transparency. It’s ok that our clients know if we are struggling, confused and scared. We will not, however, abandon them. We won’t meet face to face but we will continue to stay connected by whatever means available.

Susan Cristol, LMFT, is a licensed marriage and family therapist. She works with children, adolescents, couples or adults. Susan stays current on research in the field of special education, as well as research and the many writings in the areas of psychology, sociology and marriage and family therapy. Her specialized training includes (but not limited to) cognitive behavioral therapy, trauma and abuse, domestic violence and play therapy. She may be reached 818.426.5546 or at

San Fernando Valley Chapter – California Marriage and Family Therapists