A few weeks after the election, Science of Us sought out counselors, therapists, psychologists, and others in the mental-health field, posing two simple questions: Had they been seeing many patients with anxiety about the election result? And, if so, how had they managed their own concerns in sessions with their worried patients? The response was so overwhelming we had to stop taking calls. As a marriage and family therapist from the Bay Area glibly mused, “He says he’s the jobs president — well, he certainly is for me and my fellow therapists.”
But therapists have feelings, too, of course. As the news settled in, the psychologists we spoke to were weighing how much of their own anxieties they should divulge to their already vulnerable clients. Here’s how they coped. (Consider it free therapy.)
On patients who’ve regressed:
My patients were in a state of shock and grief, like at the funeral of someone you love and did not expect to die. And I felt the same way as my patients. As a psychologist, I was trying to help others deal with a negative event that affects us all. It is like the therapist is taking on a parent role — but in actuality, the patient wasn’t a child. My patient felt like a child due to overwhelming fear, so I had to take on the adult role and seek a solution.
In fact, in many of my patients I noticed signs of regression, which means turning into the child you were when overwhelmed by similar stress. A man whose family attempted to suppress any hint of his individuality spoke of killing himself after hearing of Donald Trump’s election. In his mind, he had returned to nonexistence.
I have a male patient whom I’ve known for years. I helped him get over a horribly traumatic childhood. He said he was going to laugh off the election result. It felt good to join him in denial for a moment. But then I asked if he was overwhelmed by the consequences the election would have on his children. He nodded. I said that the way to deal with something that frightening is to break it down into manageable portions and direct your focus on what you can do right now with that small piece. You only move onto the next when that one is completed. I told the man that loving your children and grandchildren requires that you care and fight back. I reminded him that as a child he was thrown out of his family by death and insanity so he accepted disempowerment and helplessness as his natural state. I said: “Powerlessness of the child is no longer your natural state. No one can take that from you.” —Dr. Elan Golomb, a licensed psychologist in private practice in New York
On struggling to relate to patients who aren’t upset:
I had a very personal response to the election. I had to do some soul-searching to find empathy for working with people who were not affected either way by gigantic tectonic shifts in the political landscape.
I come from a family that has had to escape countries when they became toxic to peaceful existence. (My grandparents are from Eastern Europe but migrated to Chile.) When our country experienced a coup, we chose America as the last bastion of relative safety from tyranny, fascism, and anarchy. The foundation we relied on to protect us provided by what is seen as the birthplace of democracy was shaken to the core a few weeks ago. It gave me a feeling that there is no real place of safety — nowhere to run. And I really did feel a stunning loss of confidence in a system that seemed poised to elect our first female president. Everything we had come to know as a democracy seemed to fail us. All of it failed.
As I got ready for work the day after the election, I knew I had to be armed with some kind of philosophy to lend my clients, and I relied on Elisabeth Kübler-Ross’s stages of grief, which include denial, anger, bargaining, depression, and acceptance. I did this because Trump’s election was a death of a sort to me and my clients — certainly a loss. I had to identify these feelings in myself that I would not be beholden to them and so I would be present for patients while they experienced the same.
I work with a lot of people in the LGBT community — those who have historically experienced trauma, which has been reignited by the violent rhetoric and actions of those emboldened by Trump’s election as tacit permission to bully and lack basic human empathy. They have come in with abject fear, the trauma of growing up LGBT reignited. The reinforcement of my client’s fears have grown as each appointment to this man’s cabinet points to just how much he is embracing backward, divisive individuals bent on turning back the clock on freedoms our society fought so hard for.
Every single one of my patients brought up the election as a significant source of stress in their lives, except for two who I would consider people for whom the election seemed insignificant. Those two have struggled to feel empathy for others in the past, which has impacted their ability to maintain relationships. They are in the demographic that would generally benefit from these election results so they saw no reason for concern and were baffled by all the hoopla. I don’t think either of these individuals voted. This further informed my understanding of their difficulty connecting with others people’s emotions and concerns and to participate in the idea of a collective, collaborative world, including these shifts that are surely to affect all of us profoundly. Then again, these difficulties are precisely why they came in to seek a professional’s help. —Michel Horvat, a psychotherapist in Los Angeles
On taking their own advice:
Therapists and (many) patients tend to be “porous” — that is, it is often hard to keep unwanted things from affecting us. And so — after some reflection and research — I decided it was okay to share my views with them as long as it was relevant and helpful to resolving their issues. In part, talking about politics as it surfaces in a session feels appropriate due to my being trained as a social worker, with roots in advocacy and social change as well as clinical treatment.
At the same time I’ve been trying to help clients, I’ve been struggling to compartmentalize my own considerable anxiety, sadness, helplessness, and hopelessness. But here’s what I’m doing to cope: I’ve come up with a nickname for you-know-who — I call him Donnie Boy. I avoid hearing his voice on the radio, and don’t watch him on TV. I can’t control much, but I can control my immediate environment. So I talk with clients, too, about what they can and cannot control. I’ve suggested that instead of steeping themselves in news, wade in gradually, if they are comfortable doing it. I also encourage them not to catastrophize, but to identify ways, if any, that the president-elect’s policies will specifically affect them. (And I use this practice to help myself, too.)
One of my clients grew up poor, neglected, and abused and now suffers from PTSD. She came in scared that she will lose her ACA insurance. We talked about how she could choose not to worry about that now because it may not happen and this led to discussing her finding a better job, maybe even one which provides health-care insurance. I alternated between validating her anxiety and helping her quell it.
I was crying frequently hearing news reports (such as one on NPR in which the head of a white-supremacist group touted that they are now “legitimate”). But last week I decided that while at first tears helped me to release feelings, now they are serving no purpose other than to make me feel more helpless. So I’ve stopped the crying. I’ve also been very careful to restrict my conversations to people who share my political views. Several weeks postelection I find that I don’t even want to commiserate.
But the type of patients especially triggered are, hands-down, those who’ve been abused, especially by sociopaths and psychopaths. In addition to having my own practice, I do volunteer counseling at a local women’s center, and nearly every client I saw right after the election was in serious distress. Many were dressed in black. One woman who’s in the midst of divorcing a psychopathic husband came for a 1 p.m. appointment on November 9 and said she didn’t know who’d won because she was afraid to be alone when she heard the news. When I told her, she burst into tears. I cried a bit, too.
So I’ve been listening to and validating my clients’ feelings. We’ve talked about how their current anxieties tie in with their clinical issues and, to some extent, the election has become more grist for the mill. Since I am still reeling from the election results, when it has been appropriate, I have shared some of my anxieties and ways of dealing with them. One is remembering that this too shall pass, and that we’ve survived other presidents we’ve been unhappy with. Another is not catastrophizing, but being crystal clear on if and how new policies might concretely affect each of us. In some cases, we’re talking serious potential repercussions and in others, barely any.
I am trying to see the bigger picture. I find solace in the fact that history goes in cycles. This is simply how the world works. I can only chip away to improve my corner of it. —An eating-disorder specialist in Florida
On being wrong:
Just four hours after Trump gave his acceptance speech, I started my day. As the hours went by, I listened to many patients express their Trump issues. A female patient felt extreme anger that a devaluing sexist would be our next president. A gay man was worried about social progress being repealed.
But for me, the most difficult client was an artist who eloquently described what I would have referred to before the Trump phenomenon as a “paranoid rant.” His apocalyptic prediction tapped into my own fears about a man with a proneness for narcissistic rage having the capability to unleash a nuclear weapon without restraint. I wondered: Is the world over? To soothe myself, I stopped trying to predict what would happen. I stopped trying to reassure myself or the patient. I told myself: “I don’t know what is going happen. But I do know, in this moment I am here. I will do what I can to fight for my beliefs, but I will also be present and appreciate my breath, my family, and the unity I feel with others.” As I reflected on this, while simultaneously listening to the patient, I felt calm. I think my acceptance gave him a model for how to cope with it. Anxiety is contagious, and the best thing you can do to help an anxious person is to remain calm and give them the space to express their fears without judgment or amplification. I showed my patient that I could survive his anxiety and my own. I believe that was very powerful. This patient still talks about his fears, but has taken action and started a political blog. He also laughs and jokes as he ponders the potential for great art and comedy that may emerge during these ambiguous times.
One of my patients with severe Trump anxiety started bringing it up regularly back in March. We connected his strong Trump anxiety and anger to his history of being bullied as a kid. As time went on, his relentless Trump preoccupation started to frustrate me. I was tired of talking about it. I was sure Trump was not going to win and wanted to do real work and move past his defenses. I did cognitive restructuring with him. The idea of this intervention is to modify irrational thoughts (Trump winning) to more balanced thoughts, such as Trump’s chances of winning are remote. When Trump won I felt shocked and embarrassed. I was the one who needed the reality check.
But I also have a couple of patients with social-anxiety disorder who are Trump enthusiasts. They wish they were fearless enough to say whatever is on their mind, just like Trump. —Michael Brustein, a clinical psychologist in New York City and New Jersey
The first few days after the election were chaos. Clients who I hadn’t seen in years were calling me for emergency appointments. Those who had moved across the country several years before were scheduling Skype sessions. I called all my therapist friends and said to them, “I don’t know how to make anyone feel better about this. I can’t make anyone feel better about this.” For the first two weeks after the election I stopped sleeping and stayed up all night.
Usually, when people are having panic and anxiety, it’s because they’ve focused in on a fear about something that might or might not happen in the unforeseen future. For that, we have to do a lot of reality checks — slowing down the mind, not running away with fear about something that might not happen. This fear was real. Our president-elect was someone who said he wanted to register all Muslims, take away the Affordable Care Act, deport undocumented people, and who seemed to think it was okay to grope women and pontificate on their looks, bodies, and age.
After he was elected, I saw a female professor at an elite school who said she was having anxiety attacks; I also saw a high-school teacher who is trying to recover from bulimia, who spent the whole night of November 8 awake, bingeing and purging, because she figured, “Well, what the fuck, we’re screwed anyway.” I also saw an Asian-American woman who fears that she is going to be discriminated against. Her Caucasian husband doesn’t share her concerns, which makes her feel alone and depressed. It’s messing with their marriage. Several clients of mine are in same-sex marriages and worry that their rights are going to be taken away. I can’t reassure them. I can’t tell them that it’s not going to happen. All I can do is validate their fears and tell them that we all have to fight together.
As therapists, many of us ascribe to the tabula rasa method of counseling clients — we are blank slates, so that we can allow our clients to have all of their feelings without our feelings or judgments interfering with their process. But I wanted my clients to see how upset I was — I wanted them to know that I was just as scared and anxious as they were because I wanted them to know that I was with them. So in the first few weeks, I allowed myself to be with my clients and to cry with them. I wanted them to know that we were all in it together, that racism, homophobia, and misogyny shake me to my core as it does for them. However, regarding my specific concerns about the possible way that the Trump presidency will affect my life (i.e., insurance and education for my 5-year-old son with disabilities), I do not share that with my clients.
And here’s the really embarrassing thing that will get me in trouble with eating-disorder specialists everywhere. It happened between a client and myself on Election Day. Said client is an active bulimic and in a place where she is unsure if she wants to recover. We’d been working on a cut-down plan for her (we were slowly reducing her behavior) and on that Tuesday she got angry when I told her that it was a non–binge/purge day. I looked at her and said, “I’ll make you a deal — if Trump wins, you can do it as much as you want.” I just didn’t think it was a possibility. When I saw what was happening I sent her a text saying, “Maybe don’t turn the television on tonight — just relax in bed with a good book.” Suffice it to say, she’s going into residential treatment for bulimia next week. I blame the election. —Leora, a marriage and family therapist who specializes in treating women with eating disorders, in the San Francisco Bay Area
On helping people use their anxiety in productive ways:
Treating this kind of anxiety is difficult. It’s hard to differentiate between fears that are irrational and fears that are an appropriate response. But what seems to be most beneficial is helping people find a way to use their anxiety in productive ways. Many of the folks I work with are finding it helpful to donate or volunteer with organizations that share their concerns. Seeking support from others who share their fears is helpful in combating isolation and alienation. Finding a balance between staying informed and avoiding media saturation is a concept most people see value in.
I try to reinforce that sometimes anxiety is appropriate — beneficial, even. When used correctly, fear can keep us safe. It can propel us forward to confront things that need to be confronted. It can empower us to take an active role in asserting our convictions and standing up for ourselves and others.
I get anxiety just thinking about considering a Trump quote or agenda item as possibly being reasonable even though the rational part of me knows that there’s probably something out there that I would agree with. It’s easier to just think of him as the most evil or incompetent person in the world and completely discount anything he says. In that way, my own “Trump anxiety” only shrinks my ability for perspective and forms a feedback loop that is really difficult to acknowledge and interrupt.
But I do think “Trump anxiety” can be useful. I know I’ve had more really genuine and heartfelt conversations with my kids, friends, and family about my own thoughts and fears around the election and current events than I might have had if Trump were not in the equation. —Michael Hilgers, a licensed professional counselor in Austin, Texas
On knowing when to keep quiet:
I tend to draw a fairly liberal group of clients, and since the election I’ve seen in them increased symptoms of depression and anxiety, difficulty sleeping, conflict with family and friends, nervous-system agitation, and fearfulness. Many of those in substance-abuse recovery have experienced an increase in urges and cravings for alcohol or drugs. Some have had suicidal thoughts.
One of my clients has been having frequent nightmares about nuclear war. His symptoms have made it hard for him to focus on school — it’s also interfering with his sleep, and causing an increase in urges and cravings for drugs as a way to self-medicate. He has a family member who loves to watch the news so we’ve had to enlist the support of the household to reduce the amount of time the news is on in the home, because it is one of the triggers for his panic attacks.
As a therapist, I know that I have to put myself first so I can look after my clients. For me, this includes daily meditation, yoga, spending time with people I love, playing with my dogs, and getting outside as much as possible. In challenging times where there is a lot of fear and uncertainty about the changes ahead, my self-care becomes an even more prominent focus in my life.
I’m personally worried, too. But I didn’t find it hard to compartmentalize during my sessions, something I attribute to own spiritual practice — for the first hour and a half of my day, I meditate, journal, and give myself Reiki (a Japanese form of energy healing). This creates space for me to process my own emotions, so I’m not distracted by my own feelings when I am with my clients.
I did not talk about my own personal feelings about the election with clients, but I did speak more collectively about my general observations of what they are going through, as a way to normalize their feelings. I showed empathy so I think they knew that I could relate to their fears on a personal level. But I didn’t openly discuss my own feelings. This would have taken the focus off of them and put it on to me and that is not what they are there for. —Mariel Diaz, a psychotherapist, yoga instructor, and meditation teacher in California
And knowing when to open up:
As the psychotherapist I have to be the neutral party. I have to listen to my patients and avoid delving deeply into my own emotions, because they’re paying me to help them with how they’re feeling. As professionals we are taught not to make it about what we have felt or done or thought. But, on the other hand, I think (from time to time) a good therapist knows it may be helpful to say something about their own feelings if that helps the other person.
So I will occasionally bring myself into session, maybe say something like: “I have a variety of things that I find helpful for me. What do you find helpful? Do you like to meditate, swim, take walks? That’s what you want to be doing.”
For women, I saw this particular sadness. Here was this issue that they were, of course, already aware of — that is, older women not being taken seriously — being acted out in the larger discourse of the country. They felt like this is another demonstration of how women of a certain age are dismissed. I work with people in Silicon Valley where the stereotype is, once you’re over 40, forget it. I think people have seen that there was some ability in most good organizations to recognize the value of someone who had been around the block a few times, whether it was a man or a woman. But on the other hand, this outcome raised women’s fears — “Uh-oh, there are more people out there who feel like an older woman isn’t capable even though an older man is.”
Many psychotherapists have formal or informal support groups with other psychotherapists. They can’t ask their clients to take care of them — they need other people to do that. It’s kind of a reminder to us: Do what’s right for you and find the right people to help you do that. I sat down with some friends yesterday and that was helpful.
When a client says “I feel horrible and angry” I can say things like: So do many others. So it’s an issue of normalizing strong feelings, because psychotherapists feel things, too. —Anna Ranieri, a psychotherapist and career coach in California