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What It’s Like to Be a Teenager Now: The Winners of Our Coming of Age in 2022 Contest

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24 comics, paintings, photos, drawings and collages tell a nuanced story.

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Doctors do not appear to be bouncing back from the pandemic's early days - their happiness at and away from work continues to be significantly lower than before the pandemic. Physicians reported similar levels of unhappiness last year too.

Nearly half of physicians said they were somewhat or very unhappy at work, compared with 75% before the pandemic, the new Medscape Physician Lifestyle & Happiness Report 2023 shows.

"I am not surprised that we're less happy now," said Amaryllis Sánchez, MD, a board-certified family medicine physician and a certified physician coach.

"I speak to physicians around the country and I hear that their workplaces are understaffed, they're overworked and they don't feel safe. Although we're in a different phase of the pandemic, doctors feel that the ground beneath them is still shaky," said Sánchez, the author of Recapturing Joy in Medicine.

Most doctors are seeing more patients than they can handle and are expected to do that consistently. "When you no longer have the capacity to give of yourself, that becomes a nearly impossible task," said Sánchez.

Also, physicians in understaffed workplaces often must take on additional work such as administrative or nursing duties, said Katie Cole, DO, a board-certified psychiatrist and a physician coach.

While health systems are aware that physicians need time to rest and recharge, staffing shortages prevent doctors from taking time off because they can't find coverage, said Cole.

"While we know that it's important for physicians to take vacations, more than one third of doctors still take 2 weeks or less of vacation annually," said Cole.

Physicians also tend to have less compassion for themselves and sacrifice self-care compared to other healthcare workers, she said. "When a patient dies, nurses get together, debrief, and hug each other, whereas doctors have another patient to see. The culture of medicine doesn't support self-compassion for physicians," said Cole.

Physicians also felt less safe at work during the pandemic due to shortages of personal protective equipment, said Sánchez. They have also witnessed or experienced an increase in abusive behavior, violence and threats of violence, she said.

Physicians' Personal Life Suffers

Doctors maintain their mental health primarily by spending time with family members and friends, according to last year's Medscape's Physician Lifestyle & Happiness Report. Yet half of doctors reported in a survey by the Physicians Foundation that they withdrew from family, friends or co-workers last year, said Sánchez.

"When you exceed your mental, emotional, and physical capacity at work, you have no reserve left for your personal life," said Cole.

That may explain why only 58% of doctors reported feeling somewhat or very happy outside of work, compared with 84% who felt that way before the pandemic.

More women doctors said they deal with stronger feelings of conflict in trying to balance parenting responsibilities with a highly demanding job. Nearly 1 in 2 female physician-parents reported feeling very conflicted at work, compared to about 1 in 4 male physician-parents.

When physicians go home, they may be emotionally drained and tired mentally from making a lot of decisions at work, said Cole.

"As a woman, if you have children and a husband and you're responsible for dinner, picking up the kids at daycare or helping them with homework, and making all these decisions when you get home, it's overwhelming," said Cole.

Prioritize Your Well-Being

Doctors need to prioritize their own well-being, said Sánchez. "That's not being selfish, that's doing what's necessary to stay well and be able to take care of patients. If doctors don't take care of themselves, no one else will."

Sánchez recommends that doctors regularly interact with relatives, friends, trusted colleagues, or clergy to help maintain their well-being, rather than waiting until a crisis to reach out.

A good coach, mentor or counselor can help physicians gain enough self-awareness to handle their emotions and gain more clarity about what changes need to be made, she said.

Cole suggests that doctors figure out what makes them happy and fulfilled at work and try to spend more time on that activity. "Knowing what makes you happy and your strengths are foundational for creating a life you love."

She urges doctors to "start thinking now about what you love about medicine and what is going right at home, and what areas you want to change. Then, start advocating for your needs."

Christine Lehmann, MA, is a senior editor and writer for Medscape Business of Medicine based in the Washington, DC area. She has been published in WebMD News, Psychiatric News, and The Washington Post. Contact Christine at clehmann@medscape or via Twitter @writing_health

For more news, follow Medscape on Facebook, Twitter, Instagram, YouTube, and LinkedIn

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balancing personal and professional life

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Doctors' Happiness Has Not Rebounded as Pandemic Drags On

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Doctors do not appear to be bouncing back from the pandemic's early days - their happiness at and away from work continues to be significantly lower than before the pandemic. Physicians reported similar levels of unhappiness last year too.

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Gabor Mate: The Power of Connection & The Myth of Normal

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Gabor Mate: The Power of Connection & The Myth of Normal

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Dr. Gabor Maté: The Power of Connection & The Myth of Normal | Wholehearted

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Health Panel Recommends Universal Anxiety Screening

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Health Panel Recommends Universal Anxiety Screening

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The guidance comes as Americans are coping with illness, isolation and loss from the pandemic, as well as other stressors like inflation and rising crime.

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The U.S. Preventive Services Task Force recommendation is intended to help identify warning signs during routine examinations. Credit... iStock/Getty

A panel of medical experts on Tuesday recommended for the first time that doctors screen all adult patients under 65 for anxiety, guidance that highlights the extraordinary stress levels that have plagued the United States since the start of the pandemic.

The advisory group, called the U.S. Preventive Services Task Force, said the guidance was intended to help prevent mental health disorders from going undetected and untreated for years or even decades. It made a similar recommendation for children and teenagers earlier this year.

The panel, appointed by an arm of the federal Department of Health and Human Services, has been preparing the guidance since before the pandemic. The recommendations come at a time of "critical need," said Lori Pbert, a clinical psychologist and professor at the University of Massachusetts Chan Medical School, who serves on the task force. Americans have been reporting outsize anxiety levels in response to a confluence of stressors, including inflation and crime rates, fear of illness and loss of loved ones from Covid-19.

"It's a crisis in this country," Dr. Pbert said. "Our only hope is that our recommendations throw a spotlight on the need to create greater access to mental health care - and urgently."

From August 2020 to February 2021, the percentage of adults with recent symptoms of an anxiety or a depressive disorder increased to 41.5 percent from 36.4 percent, according to one study cited by the task force.

The guidance was issued in draft form. The panel will finalize it in the coming months after reviewing public comments. While the panel's recommendations are not compulsory, they heavily influence the standard of care among primary care physicians across the country.

In response to the recommendations, mental health care providers emphasized that screening programs are useful only if they lead patients to effective solutions. At a time when the country is "short on mental health resources on all levels - psychiatrists, psychologists, and therapists - that's a real concern," said Dr. Jeffrey Staab, a psychiatrist and chair of the department of psychiatry and psychology at Mayo Clinic in Rochester, Minn.

"We can screen lots of people, but if that's all that happens, it's a waste of time," said Dr. Staab, who is not on the task force.

Psychiatrists, while pleased with the attention on mental health, also underscored that a standardized screening is only the first step toward a diagnosis, and that providers will need to guard against assuming that a positive screening result indicates a clinical disorder.

For many Americans, the screening could simply reveal a temporary period of distress and a need for extra support.

"When providers say, 'You must have a disorder, here, take this,' we could face an overprescribing problem," Dr. Staab said. "But the opposite scenario is that we have lots of people suffering who shouldn't be. Both outcomes are possible."

Rising mental health issues are not unique to the United States. Anxiety and depression increased by 25 percent globally during the first year of the pandemic, according to the World Health Organization, and has only partially improved since.

About a quarter of men and about 40 percent of women in the United States face an anxiety disorder in their lifetimes, according to the task force, though much of the data is outdated. Women have nearly double the risk of depression compared with men, studies show, and the recommendation paid special attention to screenings for pregnant and postpartum patients.

Physicians typically use questionnaires and scales to survey for mental health disorders. According to the recommendations, positive screening results would lead to additional assessments at the provider's discretion, depending on underlying health conditions and other life events.

Some primary care physicians expressed concern that adding an additional responsibility to their wide-ranging checklist for brief patient appointments is implausible.

Dr. Pbert of the task force said that those providers should "do what they already do on a daily basis: Juggle and prioritize."

She also said the task force's rigorous review of available studies revealed that people of color are often underrepresented in mental health research, which, if not addressed, could contribute to a cycle of inequity.

Mental health disparities are rampant in the United States, where Black patients are less likely to be treated for mental health conditions than are white patients, and Black and Hispanic patients are both more frequently misdiagnosed. From 2014 to 2019, the suicide rate among Black Americans increased by 30 percent, data shows.

Standardizing screening for all patients could help combat the effects of racism, implicit bias and other systemic issues in the medical field, Dr. Pbert said.

The task force panel did not extend its screening recommendations to patients 65 and older. It said there was no clear evidence regarding the effectiveness of screening tools in older adults because anxiety symptoms are similar to normal signs of aging, such as fatigue and generalized pain. The panel also said it lacked evidence on whether depression screening among adults who do not show clear signs of the disorder would ultimately prevent suicides.

The task force will accept public comments on the draft recommendation through Oct. 17.

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Health Panel Recommends Anxiety Screening for All Adults Under 65

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The guidance comes as Americans are coping with illness, isolation and loss from the pandemic, as well as other stressors like inflation and rising crime. Send any friend a story As a subscriber, you have 10 gift articles to give each month. Anyone can read what you share.

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When Victoria Vial's Miami middle school shut down last spring and her classes went online, it felt like the beginning of an adventure. "I was in my pajamas, sitting in my comfy chair," the 13-year-old recalled. "I was texting my friends during class."

Then she received her academic progress report. An A and B student before the pandemic, she was failing three classes. The academic slide left her mother, Carola Mengolini, in tears. She insisted her daughter create to-do lists and moved the girl's workspace into the guest bedroom to pull up her grades.

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Andrea Petersen | Photographs by Maria Alejandra Cardona for The Wall Street Journal 

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Loneliness, Anxiety and Loss: the Covid Pandemic's Terrible Toll on Kids

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When Victoria Vial's Miami middle school shut down last spring and her classes went online, it felt like the beginning of an adventure. "I was in my pajamas, sitting in my comfy chair," the 13-year-old recalled. "I was texting my friends during class." Then she received her academic progress report.

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After multiple lockdowns, three vaccines, and one bout of COVID, I want my life back.

I got my COVID-19 booster shot last week, on the first day I was eligible. My shot was delayed because I caught COVID in early December, an experience that was low-key grim: two days of shotgun sneezing, no taste or smell for a week, and a constant fatigue that didn't abate until the holidays. I was very glad to face the coronavirus with two Pfizer doses already in my arm, and even more grateful that my parents and 91 percent of Britons in their age group are triple-jabbed.

Immunity builds to a peak in the fortnight after vaccination, and so next week I will be about the most protected a human can realistically expect to be against COVID. That reflection has inevitably led to another one: I want my life back. Thank you, coronavirus. Next.

Avoiding the virus is no longer an option; Omicron has seen to that. Almost everyone is likely to catch the variant eventually. Over Christmas, one in 10 of my fellow Londoners- one in 10!-had COVID. Thanks to Britain's solid vaccination rates, particularly among vulnerable groups, this tsunami of infections has so far led to a daily death toll less than a fifth the size of the one we had last winter. In the United States, the picture looks bleaker, with overwhelmed hospitals and 1,500 deaths a day. Because the vaccinated can still spread the disease, Americans should probably lie low for a few more weeks, until this wave subsides. Personally, I don't need an immediate license to party like it's February 2020, but I want some indication from lawmakers and medical experts that restrictions won't last forever. For any country without the discipline, collectivism, and surveillance technology of China, the zero-COVID dream is over. Two years is long enough to put our lives on hold.
Read: Omicron is forcing us to rethink mild COVID
And that really is how it feels here in a big city like London. Prime Minister Boris Johnson's government wants to slow the spread of Omicron in England, but not enough to impose a new lockdown or provide the financial support that goes with that. (Tougher restrictions are in place in Wales and Scotland, which have more left-leaning administrations.) The English are expected "merely" to work from home if possible, and to wear masks in shops, restaurants, and other indoor spaces. Nonetheless, on a weeknight last week, the center of Soho was eerily quiet. Many of the big theater shows have suffered closures because of the self-isolation rules. As soon as the news of Omicron reached Britain, Tube journeys fell by 38 percent. No one I know had an office Christmas party.

In Britain, the era of formal business closures has been supplanted by something equally stressful: a nationwide guilt trip designed to ensure that we regulate our own behavior without the state handing out more cash. It reminds me of the constant nagging advice given to pregnant women. Of course you could have a drink, but why risk it? You could have some soft cheese, but why risk it? Why not just stay indoors, forever, until you die of old age and no one can say "I told you so"? In the pandemic, too, moral judgments are being passed off as medical ones. Why put the National Health Service in danger for the sake of your social life? (In America, the likelihood of a guilt trip varies by geography. You might not get dirty looks for shopping maskless in Florida, but the story is different in the bluest cities.)

When I caught COVID at a completely legal restaurant dinner, I was surprised that I felt ashamed. Where did that sensation come from? Some leftish pundits seem to think that demanding anything beyond the essentials of life is immoral, and that any willingness to tolerate some risk (personal and society-wide) is reckless. Recently, a prominent San Francisco doctor wrote a long Twitter thread about his otherwise healthy, triple-vaccinated 28-year-old son, whose case of COVID was no worse than a nasty cold and was apparently caught from watching a movie with a vaccinated friend. To me, his apprehensive rundown of potential treatments and his admonishment that "even low risk stuff-things that were safe last [month]-may now be risky" felt like a dispatch from an alternate universe. How can people live with this level of fear?

Yet to publicly question the current level of restrictions is to invite accusations from your more COVID-averse friends, or even strangers on social media, that you hate doctors, reject science, and actively want people to die. I am not anti-lockdown; I lived through three of them without a single illicit wine-and-cheese party or Christmas quiz, unlike senior members of the British government. I got my vaccines the minute I was allowed to. I wear a mask whenever doing so is mandated. But I'm done, profoundly done. Or at least I'm what my colleague Derek Thompson has called "Vaxxed and Cautious Until Omicron Burns Through and Then Prepared to Be Done."

And that's because I am desperate for a party. So desperate I would attend an enemy's book launch. So desperate I would attend an improv-comedy night. So desperate I would see an amateur production of Shakespeare. All of these things are technically legal and available in Britain, but the hassle of masks and the worry of last-minute dropouts mean that, in practice, most of my friends have cleared their diary indefinitely. And so I work and binge-watch, and work and doomscroll, and work and see the occasional friend for coffee or dinner, when what I really want to do is freely move about in the world again-even if that means plotting my escape from a man with mild halitosis telling me his plan to reinvigorate the great American novel, or standing in line for the ladies' room and feeling annoyed. I want to see the people I see only twice a year in normal times. I want to gossip about acquaintances. I want to wear something with a real waistband.

Perhaps you think this is shallow. You are right! Life should be shallow sometimes. I used the first lockdown to create a perfect cross-stitch replica of Hokusai's Great Wave Off Kanagawa, and the third to read and discuss several of Shakespeare's history plays with like-minded friends on Zoom. I cannot honestly say whether these activities made me a better person.
Read: Omicron is pushing America into soft lockdown
If the health-care system needs more investment to deal with future winter COVID waves, hit me up for the taxes needed. In the meantime, we should simplify our public-health rules and wean ourselves off hygiene theater. Outdoor masking-which is still mandated in some European countries, such as Spain-is absurd. End it. The recent travel bans effectively punished South Africa for responsibly monitoring new variants, and should not be repeated. Because " 'post-vax COVID' is a new disease," isolation periods should be shortened to five days for the vaccinated, which would help hospitals and schools struggling with staff absences. Politicians should explain their planned endgame: Will we test and isolate forever, or will COVID one day be treated like the flu? Oh, and people should stop terrifying their children. Your kids will get COVID, if they haven't had it already. Statistically, they will be fine. They are in more danger on the drive to school than from COVID once they get there.

As for the vaccine-hesitant, I sympathize with those who are afraid of needles and with pregnant and breastfeeding women, for whom the advice has been inconsistent, but less so with those who think that the vaccines are untested or "experimental"-a plausible concern last year but not now-and those who object to "putting chemicals in their body," unless they eat only homegrown food and wash their hair with soap nuts. Public policy should make life more irritating for the unvaxxed-or rather, consistently irritating for the vaxxed. (Ten years of writing about technology and privacy has shown me that most people value convenience more highly than principles, although they won't admit it.) On vaccines for health workers, I am implacable: You have no business working in medicine if you don't believe in science. The American and European COVID vaccines went through rigorous clinical trials, before being used on hundreds of millions of people. If you can't accept that evidence, no other evidence will sway you.

The past two years have been tough, but the world has emerged from them with a formidable medical arsenal, as well as the knowledge that humanity has to live with COVID. Putting normal life into suspended animation back in the spring of 2020 was the right decision, but now I want to hear more about the thaw. There will be trade-offs, and there will be casualties, but you can't remove all risk from human existence. Like most of us, I've followed the rules. I will continue to do so. But I really do want my life back.

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prime minister boris johnson’s government

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apprehensive rundown of potential treatments

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After multiple lockdowns, three vaccines, and one bout of COVID, I want my life back. I got my COVID-19 booster shot last week, on the first day I was eligible. My shot was delayed because I caught COVID in early December, an experience that was low-key grim: two days of shotgun sneezing, no taste or smell for a week, and a constant fatigue that didn't abate until the holidays.

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What Therapists are Hearing from their Patients

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What Therapists are Hearing from their Patients

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Tara Parker-Pope, Christina Caron and Mónica Cordero Sancho

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Why 1,320 Therapists Are Worried About Mental Health in America Right Now (Published 2021)

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Frontline mental health workers in every state say they can’t keep up with the demand from patients struggling with the disruptions of pandemic life.

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Three minutes. That's all the time Lanee Higgins, a Baltimore County Public Schools teacher, had to herself during a typical day of coronavirus-era remote learning. On her computer screen were middle-schoolers, scattered across the county, running through their lessons - while at home, Higgins, age 29, was trying to maintain her authority over her classroom and her life. Sometimes her potty-training toddler, refusing to nap, would wander into the frame when her entrepreneur husband wasn't there to corral him. When she just couldn't hold on anymore, Higgins would announce a three-minute break. She'd leave her students staring at the screen while she scurried off to use the bathroom or steal some time to just think.

The never-ending cycle of stress had started long before the pandemic. In her short teaching career, Higgins had already sat in a locked classroom as police officers forcibly restrained a middle-schooler in the hallway. She'd had to call Child Protective Services out of concern for a student, only to be told there wasn't anything to be done. And she'd joined her union's negotiation team in an attempt to address her and her fellow teachers' workplace frustrations.

But remote teaching demolished the boundaries between that tumult and home, threatening Higgins's sanity and her life. "I was suicidal. It was a lot of pressure," says Higgins, who went on leave under the Family and Medical Leave Act in February to seek therapy and treatment for the extreme demands of her job, resigning for good in May. "There is a lot of trauma in teaching. It's rewarding but also takes an emotional toll. ... I was already dealing with that, and the pandemic just broke me."

Higgins is not the only teacher to recently reach their breaking point. One in four American teachers reported considering leaving their job by the end of the last academic year, in a survey taken in January and February by the Rand Corp., a nonprofit, nonpartisan research organization. That's "more than in a typical prepandemic year and at a higher rate than employed adults nationally," the report explained. Teachers, in general, "were more likely to report experiencing frequent job-related stress and symptoms of depression than the general population." The study also noted that Black teachers were particularly affected. And a National Education Association survey of 2,690 members released in June found that 32 percent of respondents said the pandemic had led them to plan to leave the profession earlier than anticipated.

[Opinion: Florida teachers are quitting their jobs in droves - and who can blame them?]

Whoever said "those who can't do, teach" obviously never experienced the modern educational system, where teachers do everything. They're more than the people who give math and science lessons: They might find themselves makeshift social workers to troubled students, surrogate parents checking if children eat, security guards breaking up fights and funders of the most basic of classroom supplies from their own shallow pockets.

Teachers aren't the only American workers taking part in the so-called " Great Resignation," which has seen many people in many industries leavetheir jobs since the start of the pandemic to find better pay and satisfaction. But the sheer number of those contemplating an exit from the classroom raises the question: What's happening, and why? I recently interviewed seven public-school teachers from around the country who have left their jobs since March 2020 to understand what they faced. The overarching sentiment: Teaching was already too much - and with the increased stresses and demands introduced by the pandemic, they'dsimply had enough.

Their specific reasons for resigning vary. Fear for their health and that of their family. Juggling work and parenting from the literal confines of their homes. Existing frustrations with an education system that never quite seemed to meet the needs of its students and staff. Some struggled with remote learning; others didn't want to go back to the classroom. But whatever their particular motivations, these former teachers were ready to move on. While many of them have been isolated from their peers over the past year and a half, they are now united by the bold act of walking away.

Words like "heartbreak" and "guilt" come up a lot in conversations with these former teachers. "I [told] my therapist how much guilt I felt about leaving my students, and she said, 'They were gonna leave you at the end of the year anyway,' " Lanee Higgins says. And while there's remorse in leaving the job so many considered a calling, they say they're comforted in knowing they aren't alone, and that a tide of teachers leaving is a signal that things need to change.

"I was feeling like I've ditched my career," says Peggy McAloon, a 50-year-old former elementary school teacher in Lexington Park, Md., who chose not to return this school year after a leave of absence. "It helps knowing that there are other people out there feeling overwhelmed and anxious and unsure. There are so many kick-ass teachers out there. We care so much."

Jacqueline Wolfe thinks that conviction is why many people come to the classroom in the first place. "Teachers by nature are the type of people who are nurturers. We tend to carry the weight of the world on our shoulders," says the former central Florida teacher. In the summer of 2020, Wolfe struggled to decide whether she'd return to the classroom, waiting every day to see whether her state would, as she says, "do the right thing" and stay virtual during the height of the pandemic. Last fall, schools went back in-person, and this school year Gov. Ron DeSantis has continued to fight mask mandates, going so far as to threaten schools that require masks with financial penalties.

For years, Wolfe had felt vulnerable in her classroom - from a possible school shooting. She had even sought treatment for post-traumatic stress disorder after the 2018 mass shooting at Marjory Stoneman Douglas High School in Parkland. Though the shooting had not happened at her school, it triggered unarticulated fears in Wolfe. Now, she feels teachers are "bargaining chips" in the state's drive to get parents back to work and the economy going.

[A teacher lists 10 things school districts should do right now]

"It's just heartbreaking. The state government was saying they were short thousands of teachers, and 'What can we do to hire more teachers?' " explains Wolfe, 36, who resigned before the start of the 2020-21 school year and is currently home-schooling her kids at their new home in St. Augustine, in northern Florida. "Well, you're doing everything but what teachers want to feel safe, from covid and gun violence. You're not doing any of these things, and you're wondering what's going on here. I don't think 'betrayal' is too strong a word."

Wolfe's right about the shortages in her state: There were nearly 9,000 classroom and staff shortages in August, according to the Florida Education Association, an increase of more than 67 percent from the year before. Districts across the country, including in Texas, California and South Dakota, have also reported teacher shortages at the start of this academic year.

"Public schools were facing staffing shortages prior to covid, and the pandemic has only made those shortages more acute," wrote Randi Weingarten, president of the American Federation of Teachers, in an email. These former teachers' stories sound familiar to Weingarten: "Before the pandemic, teachers were facing a lack of respect on the job, routinely taking money out of their own pockets for children's supplies while at the same time paying student loans and cobbling together multiple jobs to make ends meet. Now, they're facing all that plus the exhaustion and burnout of the last few years."

"I'm a little angry," says Tracy O'Rourke, also a former Florida educator, who retired earlier than planned from the School District of Palm Beach County. As someone with severe asthma, she felt the risk of covid-19 was too great and lacked confidence in the state's mask policy. "I've taught 30-plus years, and I had intended to teach another 20 years. It's not a happy retirement. I'm sad I gave it up. I felt like I didn't have a choice."

This school year, Palm Beach County schools had initially proposed allowing families to opt out of wearing masks, then instituted a 90-day order requiring their use by staff and students, giving the 59-year-old teacher little reassurance. O'Rourke says that in Facebook groups she'd observed district parents declaring their intent to send their coronavirus-positive kids to school to make a statement. "To me, it's almost like psychological terror every day. Imagine listening to the parents of your own students posting, 'I'm gonna send my kid to school sick with covid'? I was having panic attacks going in every day," says O'Rourke. "I know that if I got it, I would at least wind up in the hospital." She officially retired in August.

Health was also the leading factor in Katy Ward-Crossan's decision to leave the District of Columbia Public Schools and the profession she had long dreamed of entering. As a kid she had difficulty learning and credits her academic success to her own dedicated teachers who worked with her one-on-one. She wanted to pay that forward as a teacher who got children "to understand that they can learn, no matter how they are struggling."

In the fall of 2020, Ward-Crossan, 29, who is asthmatic, found out she was pregnant. Having been through the pain of a previous miscarriage, she received a written recommendation from her doctor to remain teaching virtually. Her request was denied by the school. After mediation failed, she filed a complaint with the city's Office of Human Rights,alleging that she was refused reasonable accommodation; the complaint is currently under investigation. ("DCPS attempted to ensure that employees who wanted a virtual assignment for various personal health circumstances were prioritized as such," the school system said in a statement. "Where it was not possible to accommodate all requests for virtual assignments during the initial return to in-person learning during the 2020-2021 school year, staff were selected through a lottery system to return." The school system said, however, that it could not comment on specific personnel matters.)

In the meantime, Ward-Crossan is at home with her daughter, who was born in June. "I wanted to do anything I could to protect this pregnancy,"she says. While she'd hoped to realize her dream of becoming a mother and her dream of being a teacher, that is not currently possible. "I miss the classroom dearly," she says.

[Back in the classroom, teachers are finding pandemic tech has changed their jobs forever]

Life outside the classroom is also important to Calvert County, Md., band teacher Stephen Lane, and remote teaching made him recognize that he didn't really have one. Keeping the beat going remotely was not only a professional challenge ("I would often get the question 'How do you teach band online?' and I would say, 'When you figure it out, you let me know' ") but a personal one too.

"I realized that I was so dedicated to achieving success for my students that I was neglecting myself. I'd customized my life around it," says Lane, who left at the end of the 2020-21 school year. "When I was home ... I realized how much I had not been at home when I was teaching [in person]. I didn't realize how much I was missing."

Lexington Park's Peggy McAloon says that she had long realized something was missing, not in her life but in the lives of her students, who were facing obstacles not of their own making. And she, like other teachers, tried to bridge those gaps. "I always struggled with taking care of the whole child, of kids that were hungry, that didn't bring in school supplies, [that had] dirty clothes," she says. "I gravitated towards those kids, to try to make a connection, to lift them up and create some stability for them. It's nearly impossible to teach a child when they are hungry, tired or scared."

Though she credits schools and society for recently "paying a lot more attention to the mental and physical health of students," she says, "it's difficult for educators to wear all of the hats expected of us." The pandemic just kept adding new hats, and having taken a leave of absence from teaching in the fall of 2019 to deal with family health issues, she simply never returned.

"At this point I would want to focus on [students'] mental health. ... I don't want to go back to the classroom," says McAloon, who is interested in exploring positions in emotional support. "I'd rather help kids and families through the pandemic and not focus on academics."

Like McAloon, Aeriale N. Johnson, 45, thinks right now the best way for her to help students in the classroom is outside of it. Through her 23-year career teaching in schools from Florida to rural Alaska to San Jose, she says she observed a maze of inequities in the public education system, which the pandemic laid bare.

She had a "galvanizing" moment after spring break this past April, when her elementary school students in San Jose were "greeted" with standardized tests three days after their return to in-person classes. "That was a moment of reckoning for me. Yes, we had to give them, but I thought, 'This is not what we are supposed to be doing.' "

So after a life spent caring, spent answering their professional calling, what do former teachers do now? O'Rourke, who taught for more than 30 years, says she considered moving out of state to teach, but "Where am I gonna go? My house is here. I have a Florida teaching certificate. Where am I gonna go that there's no covid?"

At the end of the last school year, Johnson moved across the country to be a staff developer for the Teachers College Reading and Writing Project at Columbia University in New York, training teachers in reading, writing and racial literacy. In her new role, Johnson believes, she's helping eradicate problems from the ground up. "There was all this talk throughout the pandemic that 'Yes, we recognize the disparities that exist. ... We notice all of these things, and the system does not work for everyone, does not serve everyone, and has to change.' But there has been no change," she says. "Everyone who works for the school I taught at were all incredible, wonderful human beings. I believe in educators, but we work within a system that doesn't work." In the end, she says, "I had to live my truth, and my truth was that I can't sit here any longer and not do everything within my power to impact the system in a larger way."

For a change of pace and a chance at a social life, former band teacher Lane took a position as an instructional designer writing educational training curricula for a private company. Single and 33, he says he's looking forward to dating and perhaps meeting someone, and doing simple things like grilling with friends. He admits that he is young enough "that teaching will always be there."

But there's likely no going back for Higgins and others. "I was talking to other teachers who were like, 'Hey, I resigned, too, and I feel so much better.' Or 'I can go to the bathroom when I want to,' " she says. "Another said she could go for a walk and her brain isn't busy thinking of all the lesson plans she has to do."

Higgins is now focusing on writing and a comedy card game she created with her husband called Winsults (it's been endorsed by no less than rapper 2 Chainz). For the first time in her life, she doesn't know exactly where her career is going. But she's pretty sure where it's not. "Do I miss it? Absolutely," she says. "Would I go back? Probably not."
Leslie Gray Streeter is a journalist, speaker and author of "Photo editing by Annaliese Nurnberg. Design and art direction by Audrey Valbuena. Black Widow: A Sad-Funny Journey Through Grief for People Who Normally Avoid Books With Words Like 'Journey' in the Title."

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Why so many teachers are thinking of quitting

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Three minutes. That's all the time Lanee Higgins, a Baltimore County Public Schools teacher, had to herself during a typical day of coronavirus-era remote learning. On her computer screen were middle-schoolers, scattered across the county, running through their lessons - while at home, Higgins, age 29, was trying to maintain her authority over her classroom and her life.

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WHO: Impact of pandemic on mental health

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WHO: Impact of pandemic on mental health

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In the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by a massive 25%, according to a scientific brief released by the World Health Organization (WHO) today. The brief also highlights who has been most affected and summarizes the effect of the pandemic on the availability of mental health services and how this has changed during the pandemic.

Concerns about potential increases in mental health conditions had already prompted 90% of countries surveyed to include mental health and psychosocial support in their COVID-19 response plans, but major gaps and concerns remain.

"The information we have now about the impact of COVID-19 on the world's mental health is just the tip of the iceberg," said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "This is a wake-up call to all countries to pay more attention to mental health and do a better job of supporting their populations' mental health."
Multiple stress factors
One major explanation for the increase is the unprecedented stress caused by the social isolation resulting from the pandemic. Linked to this were constraints on people's ability to work, seek support from loved ones and engage in their communities.

Loneliness, fear of infection, suffering and death for oneself and for loved ones, grief after bereavement and financial worries have also all been cited as stressors leading to anxiety and depression. Among health workers, exhaustion has been a major trigger for suicidal thinking.
Young people and women worst hit
The brief, which is informed by a comprehensive review of existing evidence about the impact of COVID-19 on mental health and mental health services, and includes estimates from the latest Global Burden of Disease study, shows that the pandemic has affected the mental health of young people and that they are disproportionally at risk of suicidal and self-harming behaviours. It also indicates that women have been more severely impacted than men and that people with pre-existing physical health conditions, such as asthma, cancer and heart disease, were more likely to develop symptoms of mental disorders.

Data suggests that people with pre-existing mental disorders do not appear to be disproportionately vulnerable to COVID-19 infection. Yet, when these people do become infected, they are more likely to suffer hospitalization, severe illness and death compared with people without mental disorders. People with more severe mental disorders, such as psychoses, and young people with mental disorders, are particularly at risk.
Gaps in care
This increase in the prevalence of mental health problems has coincided with severe disruptions to mental health services, leaving huge gaps in care for those who need it most. For much of the pandemic, services for mental, neurological and substance use conditions were the most disrupted among all essential health services reported by WHO Member States. Many countries also reported major disruptions in life-saving services for mental health, including for suicide prevention.

By the end of 2021 the situation had somewhat improved but today too many people remain unable to get the care and support they need for both pre-existing and newly developed mental health conditions.

Unable to access face-to-face care, many people have sought support online, signaling an urgent need to make reliable and effective digital tools available and easily accessible. However, developing and deploying digital interventions remains a major challenge in resource-limited countries and settings.
WHO and country action
Since the early days of the pandemic, WHO and partners have worked to develop and disseminate resources in multiple languages and formats to help different groups cope with and respond to the mental health impacts of COVID-19. For example, WHO produced a story book for 6-11-year-olds, My Hero is You, now available in 142 languages and 61 multimedia adaptations, as well as a toolkit for supporting older adults available in 16 languages.

At the same time, the Organization has worked with partners, including other United Nations agencies, international nongovernmental organizations and the Red Cross and Red Crescent Societies, to lead an interagency mental health and psychosocial response to COVID-19. Throughout the pandemic, WHO has also worked to promote the integration of mental health and psychosocial support across and within all aspects of the global response.

WHO Member States have recognized the impact of COVID-19 on mental health and are taking action. WHO's most recent pulse survey on continuity of essential health services indicated that 90% of countries are working to provide mental health and psychosocial support to COVID-19 patients and responders alike. Moreover, at last year's World Health Assembly, countries emphasized the need to develop and strengthen mental health and psychosocial support services as part of strengthening preparedness, response and resilience to COVID-19 and future public health emergencies. They adopted the updated Comprehensive Mental Health Action Plan 2013-2030, which includes an indicator on preparedness for mental health and psychosocial support in public health emergencies.

Step up investment
However, this commitment to mental health needs to be accompanied by a global step up in investment. Unfortunately, the situation underscores a chronic global shortage of mental health resources that continues today. WHO's most recent Mental Health Atlas showed that in 2020, governments worldwide spent on average just over 2% of their health budgets on mental health and many low-income countries reported having fewer than 1 mental health worker per 100 000 people.

Dévora Kestel, Director of the Department of Mental Health and Substance Use at WHO, sums up the situation: "While the pandemic has generated interest in and concern for mental health, it has also revealed historical under-investment in mental health services. Countries must act urgently to ensure that mental health support is available to all."

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COVID-19 pandemic triggers 25% increase in prevalence of anxiety and depression worldwide

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In the first year of the COVID-19 pandemic, global prevalence of anxiety and depression increased by a massive 25%, according to a scientific brief released by the World Health Organization (WHO) today.

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Who is helping the mental health professional helpers?

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Who is helping the mental health professional helpers?

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When a world in pandemic shut down, the mental health professionals did not. They kept working, many more than ever, counseling patients on how to survive something they'd never seen before, something they feared themselves. They counseled while the virus ravaged their neighborhoods, with their children in the background, through months of racial unrest and a presidential election that was the most polarizing in many of our lifetimes.

"This has without a doubt been the toughest year of my life, let alone my career," said Michael Mandel, a licensed clinical professional counselor who works with adults and adolescents.

USA TODAY spoke with half a dozen mental health workers who told us the pandemic has been the most challenging year of their professional lives. Every one of them said they’d experienced symptoms of burnout.

Some are in therapy themselves, but most are not. These professionals are helping their patients cope with stress, anxiety and sometimes unimaginable loss while also managing their own suffering. Many have taken on heavier caseloads with more patients experiencing trauma and suicidal ideation. Most have transitioned to telehealth, which made therapy possible during the pandemic but reduced the intimacy many therapists count on to connect.

Yet despite how they have risen to the occasion, nearly all clinicians interviewed felt guilt – for the answers they could not give their patients, and for the many people they had to turn away.

"In grad school, they don't teach you how to provide therapy and help during a pandemic," said Janel Cubbage, a member of the American Association of Suicidology and a psychotherapist in private practice. "This is unprecedented and at times I feel really helpless. I feel like I don't know what to do other than be present with my client and validate what they're experiencing."

One of the most unique challenges of COVID-19 is the parallel experience for therapists and their patients who are experiencing many of the same fears and frustrations, brought on by many of the same external events.

"I'm going through the same things that they're going through," said psychologist Colleen Cummings, whose husband is a hospital physician and who spent months working from home with two small children. "A lot of us feel lonely and worried about coronavirus and are navigating work and kids."

Mandel said while he feels capable of helping his clients cope with a number of stressors, his initial fears about coronavirus sometimes left him at a loss for words.

"If someone comes to me and says, 'I had this panic attack for the first time,' I can go, 'OK, no problem.' I know exactly what to do.' But when someone comes in and says, 'I'm worried about the virus,' it's really hard for me to know what to say ... because this is new for me, too," Mandel said.

This spring, a client called to tell him her mother was in the hospital with COVID-19, and he said it "completely knocked me off my feet."

"I just remember repeating 'I'm so, so sorry. I'm so, so sorry,'" he said. "It was almost like, I couldn't think of what to say or what to do because it was so scary for me, too."

Therapists and their patients have lost many tools they would normally use to cope. Cubbage used to decompress on her drive home, but now she works from a second bedroom she converted to an office. Mandel said while he would normally suggest someone experiencing depression go see a movie with friends, that option is off the table.

"The main feeling is frustration," he said. "It definitely does feel very boxed in."

Physical warning signs: Your body is trying to tell you something

"One of the biggest challenges is how limited life is right now for everyone. So many of the things that I might suggest to people who are suffering with depression or anxiety, I can't," Michael Mandel said. handout

The shift to telehealth has been a massive change, lowering one barrier to care but bringing new therapeutic challenges.

Cubbage said assessing a suicidal patient, for example, is something she'd prefer to do in person, rather than over Zoom. Cummings said she's lost valuable connections with colleagues who she would stop in the hall to speak with after a difficult session.

Even providers well-versed in telehealth were overwhelmed because they took on the task of training others.

Mary Alvord runs a large psychotherapy practice in Maryland that was providing telehealth services 10% to 15% of the time pre-pandemic, she said. When her practice went exclusively remote, staff were able to adapt relatively quickly, but then she conducted telehealth training for more than 10,000 mental health providers.

"No wonder I am so exhausted," she said.

People were encouraged during the pandemic to reach for help when they needed it. And many more people needed it.

The Centers for Disease Control and Prevention has found elevated levels of symptoms of anxiety and depressive disorders, substance use and suicidal ideation among U.S. adults and identified populations at increased risk, including young people, racial and ethnic minorities, essential workers and caregivers of adults.

Am I OK?: How to do a mental health check

Mental health professionals have been flooded with new requests. Patients who stopped therapy asked to begin again. Some patients who had only been doing one counseling session a month requested to be seen weekly.

Sherry Burkhard, who co-founded the Texas nonprofit Mosaics of Mercy, which connects the community with mental health resources, recently surveyed local mental health professionals and found 84% had an increase in their caseload since COVID-19 started.

Many therapists currently at capacity are taking on new cases. Some are doing it pro bono when they already struggle to earn a living wage.

Sherry Burkhard, co-founder of Mosaics of Mercy

We’re helpers, we want to help everyone, we don’t want to turn people away. And so it’s really hard to say, ‘No, I can’t fit anyone else in.’ Or ‘I can’t help financially.’

"We're helpers, we want to help everyone, we don't want to turn people away," Burkhard said. "And so it's really hard to say, 'No, I can't fit anyone else in.' Or 'I can't help financially.'"

Many therapists are working more hours to accommodate demand. Those who face child care issues are opening up weekends.

"From a child care perspective it's been pretty stressful," Cummings said. "I can't have a baby in my lap when I'm doing direct client care. ... There was one morning where my daughter woke up and she had a bit of a cold and I knew I was counting how many patients I'd have to cancel that day."

'A culmination of crises': America is in turmoil, and a mental health crisis looms next

Psychologist Riley Benko has made an effort to keep his caseload manageable, which means he's watched his waitlist grow. Last year, Benko was diagnosed with Hodgkins Lymphoma and worked through his treatment. He said "he was looking forward to 2020 as a rebound year. Instead, the world changed."

In December, Benko and his wife, also a therapist, contracted COVID-19. Benko has recovered, though his wife has lingering health effects. He said the hardest part of being sick was worrying about his clients.

"There was guilt," he said. "I thought, 'Wow, I got sick and now I'm not able to provide therapy or services like I otherwise would,' which made it challenging to ... take care of myself."

Guilt was a common theme this past year, especially among therapists who turned prospective clients away. Cubbage said as a therapist of color, she recognizes her services are in high demand.

According to the U.S. Census Bureau, only 4% of psychologists in the U.S. workforce are Black.

Experts say burnout occurs when stress is prolonged, and there is no time to recover.  Mental health professionals are especially susceptible, and the pandemic has made them more vulnerable.

That feeling you can't name?: It's called emotional exhaustion

Tia Dole, a clinical psychologist in private practice and chief clinical operations officer at the Trevor Project, which works to prevent suicide in the LGBTQ community, said while mental health providers are used to working in an emergency state, the duration and scale of the COVID-19 emergency has been extraordinary.

"Personally, especially as a black woman, COVID was upsetting, All the events were upsetting but really the addition of what was happening over the summer with police brutality, that was actually what pushed me really hard," Tia Dole said. Lawrence Miner

"Before, when you'd have a patient in crisis, it's over in a couple of hours, you have a debrief, you huddle up, you go, 'Whew,' you go home. In this case, it is going on and on," she said. "I became numb, and then I became overwhelmed, and then I kind of went back to numb."

Dole, who in her private practice focuses on treating Black, Brown and queer people, said not only were many of her patients struggling with a virus that disproportionally affects people of color, but they were also traumatized by the death of George Floyd this summer and the ensuing racial unrest.

Patients are also coming to therapists with more acute symptoms. Kimberly Griffin, a substance use disorder counselor at Lionrock Recovery, an online drug and alcohol addiction rehab program, who also has a private practice, said she's seen an increase in substance use disorders as well as domestic violence.

"For the first time I believe in my life, I've experienced ... symptoms of burnout," she said. "The stress comes from trying to figure out how to help people who are experiencing something new at the same time that I'm experiencing something new."

The pandemic has been a traumatic experience for many people, she said. Before the coronavirus she had a couple of clients coping with trauma, now she says she's seeing trauma on "a mass scale."

“I think this past year was the most challenging in my career because it magnified how many people were really suffering mentally and emotionally," she said. "As a therapist,  I wish I could help everyone, but that thought becomes overwhelming and, of course, it's not realistic."

Study: Pandemic could push up suicides, drug deaths

Not all mental health professionals are providing care exclusively through telehealth. Some are working in hospital settings and continue to face health risks.

Dole, who works in New York City – once the epicenter of the COVID-19 crisis –  said when a patient having a psychotic episode comes into an emergency room, they are not likely to follow COVID-19 precautions.

"You have someone who's in a psychiatric crisis who is not thinking, who is not in their right self, who is not going to wear a mask, who is going to get too close," she said. "I know personally so many people who ended up getting sick because of that."

These professionals go to work each day not knowing whether they will be exposed to the virus, or whether they'll expose a loved one. Those who work in hospital settings also end up providing support to their medical colleagues who lose patients to COVID-19.

"Not only are you treating patients, you're also helping out your co-workers," Dole said. "They're trying to be strong, be present for their peers in the workplace environment. ... Everyone is just really broken down. You're watching people die who are 30 years old and it just doesn't make any sense."

The pandemic has been raging for nearly a year and has not abated. Experts say the negative mental health impacts will outlast the current crises. Research suggests the extreme and prolonged stress of the pandemic may lead to longer-term psychiatric disorders.

Many therapists said they are learning – or relearning – the importance of self-care during a crisis they know will not end for their profession with widespread vaccinations.

"Even though we are therapists and mental health professionals and we have training and understanding of things above what the average person does, it doesn't mean that we aren't susceptible to dealing with our own mental health challenges," Cubbage said. "As much as we show other people grace, we ask that people please extend that grace to us."

Mental health professionals say they need organizational support to help ward off burnout. That could look like granting a clinician their day off request or respecting when they say they can't take on another case. They also need better pay, Dole said, so more people can enter the field, stay in the field, and serve a greater share of the population.

In the immediate future, therapists also need to be able to continue to see patients remotely, Dole said, and they need insurance to continue to pay for it. Some insurance companies have already made moves to scale back coverage of telehealth services.

More: As virus rages, insurance companies look to scale back telehealth

Despite the myriad challenges, mental health professionals say people who are suffering should always seek help.

"We're challenged, we're stretched thin, we're finding higher acuity in stress levels in our patients but it's what we're here for," Benko said. "People should still reach out."

If you don't have access to the care you want right now, there is still help available:

You can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time day or night, or chat online.

The Crisis Text Line provides free, 24/7, confidential support via text message to people in crisis when they dial 741741.

The National Alliance on Mental Illness has support groups for people living with mental illness.

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Mental health professionals are the ones taking care of us: Who's taking care of them?

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When a world in pandemic shut down, the mental health professionals did not. They kept working, many more than ever, counseling patients on how to survive something they'd never seen before, something they feared themselves.

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Getting Serious About Teacher Burnout | NEA

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To avoid a “Great Resignation,” districts need to make substantive changes to reduce stress and improve morale in schools. Educators don’t need any more chair massages or Casual Fridays, says one expert. “This is about support and autonomy.”

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As professors of counselor education at three separate universities, we share a vested and common interest in counselor wellness. When COVID-19 hit, we began researching burnout in counselors. There is a consensus in the profession that burnout is the gradual onset of emotional, cognitive and physical exhaustion related to work. Often there is a sense of dread and avoidance with completing work-related tasks.

Our thinking was that due to the demands on counselors and the heightened health scare during COVID-19, counselors would begin to burn out. We wanted to understand the relationship between the new pandemic and counselors' levels of stress, burnout, resilience and self-compassion during this time. We asked ourselves how we could better understand this unprecedented phenomenon so that we could better support our students, our supervisees, our colleagues and ourselves.

After conducting three independent research studies over the past year, we discovered some surprising results that could help us define - and rule out - what issues counselors may be facing and what can help keep us well during our parallel experiences with clients during the continued evolution of COVID-19.
Surprising Evidence of low burnout rates
In the past year, we have been inundated with anecdotal information from online sources and peer-reviewed manuscripts that communicate how counselors are experiencing high rates of burnout while seeing clients during the pandemic. This is a fair and seemingly clinically sound assumption, except that our current research isn't supporting this claim. Three independent research studies that gathered data from counselors across the country in 2020 and 2021 indicate that burnout rates in counselors remain low, which is consistent with reports prior to the pandemic.

Three months into the pandemic, we sampled 211 counselors and found an average burnout rate of 20.85, which fits in the "low" category. According to Henry E. Stamm, developer of the Professional Quality of Life Scale, a score of 22 or less indicates low levels of burnout; a "moderate" score ranges from 23 to 41. Most participants in our first study scored low on burnout (67%), with the remainder displaying moderate levels (33%). No participants reported high levels of burnout. In this first study, we found self-compassion and resilience predictive of lower levels of burnout.

Eight months into the pandemic, we conducted two additional independent studies looking at other predictors of burnout. In the second study, 252 counselors reported an average burnout level of 20.99, again in the "low" category. This study found compassion for self and others predictive of resilience, whereas empathy was predictive of burnout.

The third study surveyed a national sample of 125 counselors who reported an average burnout level of 22.09, which again is consistent with that of the "low" burnout category. This study found that counselors' negative perceptions of their working conditions, maladaptive coping styles, decreased levels of compassion satisfaction, higher caseload volumes of clients with trauma-related concerns, and lower levels of resilience were predictive of burnout.

Low burnout rates are surprising and, again, seem counterintuitive, even when we take our own experiences into consideration. This isn't to say that counselors aren't experiencing burnout, however, because they are. They just don't seem to be experiencing it any more than they did before the COVID-19 pandemic.

Admittedly, it is hard to define an experience when it is one the current generation of counselors has yet to practice and live through completely. The trajectory of COVID-19 variants is still unknown, so further defining the struggle that counselors may be facing can be beneficial in increasing our ability to maintain personal wellness.

So, what is preventing counselors from experiencing higher burnout rates given the added stressors we have all faced this past year-plus, both at home and at work? Our research indicates that counselor resilience during the pandemic is moderately high. These findings suggest that counselors may be uniquely suited to cope with the additional pressures of a pandemic. By utilizing skills taught in counselor training programs and supervision - including maintaining adequate self-care, maintaining healthy boundaries, practicing ethical decision-making and responding to crises - counselors seem to be able to maintain enough resilience to keep burnout levels low.
Pandemic fatigue
If we aren't experiencing burnout, then what are we experiencing? Here's what we think: The phenomenon of providing counseling during a pandemic has produced an outcome unique to COVID-19 - pandemic fatigue. It is time that we talk about what this means for counselors.

The World Health Organization defines pandemic fatigue as "a reaction to sustained and unresolved adversity which may lead to complacency, alienation and hopelessness, emerging gradually over time and affected by a number of emotions, experiences and perceptions." Pandemic fatigue is dissimilar to burnout in that the exhaustion being experienced isn't related only to our work as counselors but is woven throughout the tapestry of our lives as a whole.

To us, this makes good sense. Counseling during a pandemic means that we cannot leave all of our clients' material at the office. Because we are all experiencing the pandemic - clients and counselors alike - we, as counselors, carry our own experiences of the pandemic home with us. Often, we are transitioning from holding space for our clients' concerns related to the pandemic to going home and doing the same for ourselves and our families. In this context, we can start to see that it's not necessarily the tasks related to counseling that are increasing burnout but rather the increasing demands on our personal lives that are leading to pandemic fatigue.

Fortunately, counselors are trained to respond in crisis situations. When the pandemic hit, we continued to provide care to the growing numbers and needs of clients, most likely by shifting to a new telehealth business model to safeguard our health and the health of our clients. We prepared for a sprint instead of pacing ourselves for a marathon. Although access to vaccinations has provided some health care workers an increase in psychological resilience, counselors are still in the race with no known finish line in sight for themselves or their clients.

When humans are confronted with a crisis, they draw on short-term survival instincts and systems. When circumstances drag on, new coping strategies need to be implemented to prevent or reduce behaviors that cause fatigue and demotivation.
Pacing ourselves
So, what can counselors do to pace themselves for the marathon we find ourselves in? Here are three suggestions:

1) Utilize parallel processes in supervision. Counselors shouldn't be afraid to discuss fatigue, lack of motivation or other symptoms of pandemic fatigue with a clinical supervisor or colleague. Regardless of years of experience, talking about the exhaustion of providing care during the ongoing pandemic can have a dual benefit.

First, counselors can work with their supervisors to identify and discuss any guilt, demotivation, and lack of energy with clients, and ways of improving resilience in these areas. In doing so, the counselor participates in a parallel process that may trickle down to how the counselor identifies and treats pandemic fatigue in clients. Using the parallel process may increase new coping strategies and resilience in both counselor and client.

2) Practice compassion more and empathy less. According to neuroscientists Olga Klimecki and Tania Singer, empathy activates the pain network within the brain. In contrast, compassion activates nonoverlapping brain regions. In a subsequent study of counselors, increases in compassion (compared to increases in empathy) were associated with increases in counselor resilience. This means that counselors may benefit from practicing compassion to self and others. It also means identifying causes of suffering and working to alleviate them.

This contrasts with our practice of empathy. Empathy requires the counselor to take the perspective of the client by "trying on" their pain. When we practice empathy by putting ourselves in our clients' shoes, our brains have difficulty distinguishing what is "ours" and what is "theirs." Taking the client perspective requires an additional process of emotional regulation to distinguish others' suffering from our own, which may add to counselor fatigue.

Practicing self-compassion may also aid in identifying and decreasing guilt associated with the counselor's inability to treat as many people in need as possible throughout the pandemic. Recent literature has captured the moral challenges of counselors when they are unable to provide more services to the increasing numbers (and overwhelming needs) of clients. When we practice self-compassion, we address our desire to help others and the guilt that arises when we cannot do so, while offering lovingkindness toward ourselves in the midst of that guilt.

By engaging in this self-compassionate process, counselors are better able to extend the same care and consideration to their clients. After all, we cannot effectively lead our clients to a place we have yet to discover or experience ourselves.

3) Define personal space and time. Remember, slow and steady wins the race. It looks like we are in a fluctuating pandemic that has the potential to affect us and our clients for some time to come. Intentionally carving out time and space to come back to center so that we can choose what we do with our time (instead of ceaselessly dedicating it to work) can provide balance.

No, this doesn't necessarily mean taking a spa day, getting our nails done or binge-watching reruns. Those coping strategies are good only in the short term to distract from stress. They might have been effective coping strategies during the first months of COVID-19, but they can quickly turn into maladaptive behaviors that prevent us from being in our feelings and really assessing what we truly need. Instead, we are asking counselors to pay attention to their thoughts, bodies and feelings and prescribe leisure time (and purposeful aloneness) accordingly. Healthier coping strategies may enable us to remain resilient for the long haul.
Summary
Why is this important? Yes, we have available vaccinations and boosters, businesses are back up and running for the most part, many children and adolescents have returned to school for in-person learning, and more counselors are seeing clients face-to-face. Even so, we have such little information about how professional counselors remained well during pandemics and crises prior to COVID-19. Because little can be gleaned from the past, we hope to provide additional context centered on counselors' experiences during global crises. Based on our research, we have a better understanding of what is keeping us well and what we may need to do to maintain that level of wellness.

As a profession, it is easy to focus on the needs of clients and not to focus on our own needs. The truth is that by keeping ourselves well, we are better positioned to help our clients reach and maintain their own wellness. Additionally, when we are well, we are more likely to make ethical decisions.

Our mental health is not separate from that of our clients. When they are suffering more, we are more likely to feel its effects, much like a shared experience. Conversely, when we are suffering more, our clients too are more likely to feel it. During the pandemic, when both counselors and clients are experiencing the same challenging phenomena, our symbiotic relationship needs to be addressed.

Given the ongoing nature of COVID-19, the unpredictability of its variants and an undetermined end point for the pandemic, understanding counselor wellness during this time is imperative. Counselors have described feeling burned out, and this is mirrored in current literature. When tested, however, we did not find counselors to have higher rates of burnout than before the pandemic. Instead, counselors may be experiencing pandemic fatigue marked by chronic stress that impacts perceptions of events, increased exhaustion and decreased motivation.

To mitigate these symptoms, counselors can use parallel processes in supervision to reinvigorate both the counselor and the client, practice compassion toward self and others, and carve out time for intentionally addressing needs. Using new coping strategies may help counselors to pace themselves during the COVID-19 marathon and mitigate pandemic fatigue.

Considering the gradual onset of burnout, it is plausible that counselor burnout rates will climb as the pandemic continues. However, many of the coping strategies we recommend using to reduce pandemic fatigue should also help prevent increases in burnout.
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Carrie L. Elder is a visiting assistant professor and clinical coordinator at Mercer University in Atlanta. She is a licensed professional counselor (LPC), national certified counselor (NCC), certified professional counselor supervisor and registered art therapist. Contact her at elder_cl@mercer.edu.

Elizabeth K. Norris is an assistant professor of counseling at Denver Seminary in Littleton, Colorado. She is an LPC, NCC and board certified telemental health provider (BC-TMH). Contact her at elizabeth.norris@denverseminary.edu.

Leann M. Morgan is core faculty in the School of Counseling at Walden University. She is an LPC, BC-TMH and certified career counselor educator. Contact her at leann.morgan@mail.waldenu.edu.

Counseling Todayreviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.
**** Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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Counselor burnout during COVID-19 - Counseling Today

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As professors of counselor education at three separate universities, we share a vested and common interest in counselor wellness. When COVID-19 hit, we began researching burnout in counselors. There is a consensus in the profession that burnout is the gradual onset of emotional, cognitive and physical exhaustion related to work.

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There's a Name for the Blah You're Feeling: It's Called Languishing (Published 2021)

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The neglected middle child of mental health can dull your motivation and focus - and it may be the dominant emotion of 2021.

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Credit... Manshen Lo

At first, I didn't recognize the symptoms that we all had in common. Friends mentioned that they were having trouble concentrating. Colleagues reported that even with vaccines on the horizon, they weren't excited about 2021. A family member was staying up late to watch "National Treasure " again even though she knows the movie by heart. And instead of bouncing out of bed at 6 a.m., I was lying there until 7, playing Words with Friends.

It wasn't burnout - we still had energy. It wasn't depression - we didn't feel hopeless. We just felt somewhat joyless and aimless. It turns out there's a name for that: languishing.

Languishing is a sense of stagnation and emptiness. It feels as if you're muddling through your days, looking at your life through a foggy windshield. And it might be the dominant emotion of 2021.

As scientists and physicians work to treat and cure the physical symptoms of long-haul Covid, many people are struggling with the emotional long-haul of the pandemic. It hit some of us unprepared as the intense fear and grief of last year faded.

In the early, uncertain days of the pandemic, it's likely that your brain's threat detection system - called the amygdala - was on high alert for fight-or-flight. As you learned that masks helped protect us - but package-scrubbing didn't - you probably developed routines that eased your sense of dread. But the pandemic has dragged on, and the acute state of anguish has given way to a chronic condition of languish.

In psychology, we think about mental health on a spectrum from depression to flourishing. Flourishing is the peak of well-being: You have a strong sense of meaning, mastery and mattering to others. Depression is the valley of ill-being: You feel despondent, drained and worthless.

Languishing is the neglected middle child of mental health. It's the void between depression and flourishing - the absence of well-being. You don't have symptoms of mental illness, but you're not the picture of mental health either. You're not functioning at full capacity. Languishing dulls your motivation, disrupts your ability to focus, and triples the odds that you'll cut back on work. It appears to be more common than major depression - and in some ways it may be a bigger risk factor for mental illness.

The term was coined by a sociologist named Corey Keyes, who was struck that many people who weren't depressed also weren't thriving. His research suggests that the people most likely to experience major depression and anxiety disorders in the next decade aren't the ones with those symptoms today. They're the people who are languishing right now. And new evidence from pandemic health care workers in Italy shows that those who were languishing in the spring of 2020 were three times more likely than their peers to be diagnosed with post-traumatic stress disorder.

Part of the danger is that when you're languishing, you might not notice the dulling of delight or the dwindling of drive. You don't catch yourself slipping slowly into solitude; you're indifferent to your indifference. When you can't see your own suffering, you don't seek help or even do much to help yourself.

Even if you're not languishing, you probably know people who are. Understanding it better can help you help them.

Psychologists find that one of the best strategies for managing emotions is to name them. Last spring, during the acute anguish of the pandemic, the most viral post in the history of Harvard Business Reviewwas an article describing our collective discomfort as grief. Along with the loss of loved ones, we were mourning the loss of normalcy. "Grief." It gave us a familiar vocabulary to understand what had felt like an unfamiliar experience. Although we hadn't faced a pandemic before, most of us had faced loss. It helped us crystallize lessons from our own past resilience - and gain confidence in our ability to face present adversity.

We still have a lot to learn about what causes languishing and how to cure it, but naming it might be a first step. It could help to defog our vision, giving us a clearer window into what had been a blurry experience. It could remind us that we aren't alone: languishing is common and shared.

And it could give us a socially acceptable response to "How are you?"

Instead of saying "Great!" or "Fine," imagine if we answered, "Honestly, I'm languishing." It would be a refreshing foil for toxic positivity - that quintessentially American pressure to be upbeat at all times.

When you add languishing to your lexicon, you start to notice it all around you. It shows up when you feel let down by your short afternoon walk. It's in your kids' voices when you ask how online school went. It's in "The Simpsons"every time a character says, "Meh."

Last summer, the journalist Daphne K. Lee tweeted about a Chinese expression that translates to " revenge bedtime procrastination." She described it as staying up late at night to reclaim the freedom we've missed during the day. I've started to wonder if it's not so much retaliation against a loss of control as an act of quiet defiance against languishing. It's a search for bliss in a bleak day, connection in a lonely week, or purpose in a perpetual pandemic.

So what can we do about it? A concept called "flow" may be an antidote to languishing. Flow is that elusive state of absorption in a meaningful challenge or a momentary bond, where your sense of time, place and self melts away. During the early days of the pandemic, the best predictor of well-being wasn't optimism or mindfulness - it was flow. People who became more immersed in their projects managed to avoid languishing and maintained their prepandemic happiness.

An early-morning word game catapults me into flow. A late-night Netflix binge sometimes does the trick too - it transports you into a story where you feel attached to the characters and concerned for their welfare.

While finding new challenges, enjoyable experiences and meaningful work are all possible remedies to languishing, it's hard to find flow when you can't focus. This was a problem long before the pandemic, when people were habitually checking email 74 times a day and switching tasks every 10 minutes. In the past year, many of us also have been struggling with interruptions from kids around the house, colleagues around the world, and bosses around the clock. Meh.

Fragmented attention is an enemy of engagement and excellence. In a group of 100 people, only two or three will even be capable of driving and memorizing information at the same time without their performance suffering on one or both tasks. Computers may be made for parallel processing, but humans are better off serial processing.

That means we need to set boundaries. Years ago, a Fortune 500 software company in India tested a simple policy: no interruptions Tuesday, Thursday and Friday before noon. When engineers managed the boundary themselves, 47 percent had above-average productivity. But when the company set quiet time as official policy, 65 percent achieved above-average productivity. Getting more done wasn't just good for performance at work: We now know that the most important factor in daily joy and motivation is a sense of progress.

I don't think there's anything magical about Tuesday, Thursday and Friday before noon. The lesson of this simple idea is to treat uninterrupted blocks of time as treasures to guard. It clears out constant distractions and gives us the freedom to focus. We can find solace in experiences that capture our full attention.

The pandemic was a big loss. To transcend languishing, try starting with small wins, like the tiny triumph of figuring out a whodunit or the rush of playing a seven-letter word. One of the clearest paths to flow is a just-manageable difficulty: a challenge that stretches your skills and heightens your resolve. That means carving out daily time to focus on a challenge that matters to you - an interesting project, a worthwhile goal, a meaningful conversation. Sometimes it's a small step toward rediscovering some of the energy and enthusiasm that you've missed during all these months.

Languishing is not merely in our heads - it's in our circumstances. You can't heal a sick culture with personal bandages. We still live in a world that normalizes physical health challenges but stigmatizes mental health challenges. As we head into a new post-pandemic reality, it's time to rethink our understanding of mental health and well-being. "Not depressed" doesn't mean you're not struggling. "Not burned out " doesn't mean you're fired up. By acknowledging that so many of us are languishing, we can start giving voice to quiet despair and lighting a path out of the void.
Adam Grant is an organizational psychologist at Wharton, the author of "Think Again: The Power of Knowing What You Don't Know" and the host of the TED podcast WorkLife.

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There's a Name for the Blah You're Feeling: It's Called Languishing (Published 2021)

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The neglected middle child of mental health can dull your motivation and focus - and it may be the dominant emotion of 2021. Send any friend a story As a subscriber, you have 10 gift articles to give each month. Anyone can read what you share.

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Therapy & Spiritual Care in a Shattered World

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Therapy & Spiritual Care in a Shattered World

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Conference

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What if Burnout is Less about Work & More about Isolation

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What if Burnout is Less about Work & More about Isolation

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Opinion | What if Burnout Is Less About Work and More About Isolation?

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Feeling burned out? Call your friends. Our real problem may be isolation.

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That Discomfort You are Feeling is Grief

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That Discomfort You are Feeling is Grief

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Scott Berinato

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In these difficult times, we've made a number of our coronavirus articles free for all readers. To get all of HBR's content delivered to your inbox, sign up for the Daily Alert newsletter.

Some of the HBR edit staff met virtually the other day - a screen full of faces in a scene becoming more common everywhere. We talked about the content we're commissioning in this harrowing time of a pandemic and how we can help people. But we also talked about how we were feeling. One colleague mentioned that what she felt was grief. Heads nodded in all the panes.

If we can name it, perhaps we can manage it. We turned to David Kessler for ideas on how to do that. Kessler is the world's foremost expert on grief. He co-wrote with Elisabeth Kübler-Ross On Grief and Grieving: Finding the Meaning of Grief through the Five Stages of Loss. His new book adds another stage to the process, Finding Meaning: The Sixth Stage of Grief. Kessler also has worked for a decade in a three-hospital system in Los Angeles. He served on their biohazards team. His volunteer work includes being an LAPD Specialist Reserve for traumatic events as well as having served on the Red Cross's disaster services team. He is the founder of www.grief.com, which has over 5 million visits yearly from 167 countries.

Kessler shared his thoughts on why it's important to acknowledge the grief you may be feeling, how to manage it, and how he believes we will find meaning in it. The conversation is lightly edited for clarity.
HBR: People are feeling any number of things right now. Is it right to call some of what they're feeling grief?
Kessler: Yes, and we're feeling a number of different griefs. We feel the world has changed, and it has. We know this is temporary, but it doesn't feel that way, and we realize things will be different. Just as going to the airport is forever different from how it was before 9/11, things will change and this is the point at which they changed. The loss of normalcy; the fear of economic toll; the loss of connection. This is hitting us and we're grieving. Collectively. We are not used to this kind of collective grief in the air.
You said we're feeling more than one kind of grief?
Yes, we're also feeling anticipatory grief. Anticipatory grief is that feeling we get about what the future holds when we're uncertain. Usually it centers on death. We feel it when someone gets a dire diagnosis or when we have the normal thought that we'll lose a parent someday. Anticipatory grief is also more broadly imagined futures. There is a storm coming. There's something bad out there. With a virus, this kind of grief is so confusing for people. Our primitive mind knows something bad is happening, but you can't see it. This breaks our sense of safety. We're feeling that loss of safety. I don't think we've collectively lost our sense of general safety like this. Individually or as smaller groups, people have felt this. But all together, this is new. We are grieving on a micro and a macro level.
What can individuals do to manage all this grief?
Understanding the stages of grief is a start. But whenever I talk about the stages of grief, I have to remind people that the stages aren't linear and may not happen in this order. It's not a map but it provides some scaffolding for this unknown world. There's denial, which we say a lot of early on: This virus won't affect us. There's anger: You're making me stay home and taking away my activities. There's bargaining: Okay, if I social distance for two weeks everything will be better, right? There's sadness: I don't know when this will end. And finally there's acceptance. This is happening; I have to figure out how to proceed.

Acceptance, as you might imagine, is where the power lies. We find control in acceptance. I can wash my hands. I can keep a safe distance. I can learn how to work virtually.
When we're feeling grief there's that physical pain. And the racing mind. Are there techniques to deal with that to make it less intense?
Let's go back to anticipatory grief. Unhealthy anticipatory grief is really anxiety, and that's the feeling you're talking about. Our mind begins to show us images. My parents getting sick. We see the worst scenarios. That's our minds being protective. Our goal is not to ignore those images or to try to make them go away - your mind won't let you do that and it can be painful to try and force it. The goal is to find balance in the things you're thinking. If you feel the worst image taking shape, make yourself think of the best image. We all get a little sick and the world continues. Not everyone I love dies. Maybe no one does because we're all taking the right steps. Neither scenario should be ignored but neither should dominate either.

Anticipatory grief is the mind going to the future and imagining the worst. To calm yourself, you want to come into the present. This will be familiar advice to anyone who has meditated or practiced mindfulness but people are always surprised at how prosaic this can be. You can name five things in the room. There's a computer, a chair, a picture of the dog, an old rug, and a coffee mug. It's that simple. Breathe. Realize that in the present moment, nothing you've anticipated has happened. In this moment, you're okay. You have food. You are not sick. Use your senses and think about what they feel. The desk is hard. The blanket is soft. I can feel the breath coming into my nose. This really will work to dampen some of that pain.

You can also think about how to let go of what you can't control. What your neighbor is doing is out of your control. What is in your control is staying six feet away from them and washing your hands. Focus on that.

Finally, it's a good time to stock up on compassion. Everyone will have different levels of fear and grief and it manifests in different ways. A coworker got very snippy with me the other day and I thought, That's not like this person; that's how they're dealing with this. I'm seeing their fear and anxiety. So be patient. Think about who someone usually is and not who they seem to be in this moment.
One particularly troubling aspect of this pandemic is the open-endedness of it.
This is a temporary state. It helps to say it. I worked for 10 years in the hospital system. I've been trained for situations like this. I've also studied the 1918 flu pandemic. The precautions we're taking are the right ones. History tells us that. This is survivable. We will survive. This is a time to overprotect but not overreact.

And, I believe we will find meaning in it. I've been honored that Elisabeth Kübler-Ross's family has given me permission to add a sixth stage to grief: Meaning. I had talked to Elisabeth quite a bit about what came after acceptance. I did not want to stop at acceptance when I experienced some personal grief. I wanted meaning in those darkest hours. And I do believe we find light in those times. Even now people are realizing they can connect through technology. They are not as remote as they thought. They are realizing they can use their phones for long conversations. They're appreciating walks. I believe we will continue to find meaning now and when this is over.
What do you say to someone who's read all this and is still feeling overwhelmed with grief?
Keep trying. There is something powerful about naming this as grief. It helps us feel what's inside of us. So many have told me in the past week, "I'm telling my coworkers I'm having a hard time," or "I cried last night." When you name it, you feel it and it moves through you. Emotions need motion. It's important we acknowledge what we go through. One unfortunate byproduct of the self-help movement is we're the first generation to have feelings about our feelings. We tell ourselves things like, I feel sad, but I shouldn't feel that; other people have it worse. We can - we should - stop at the first feeling. I feel sad. Let me go for five minutes to feel sad. Your work is to feel your sadness and fear and anger whether or not someone else is feeling something. Fighting it doesn't help because your body is producing the feeling. If we allow the feelings to happen, they'll happen in an orderly way, and it empowers us. Then we're not victims.
In an orderly way?
Yes. Sometimes we try not to feel what we're feeling because we have this image of a "gang of feelings." If I feel sad and let that in, it'll never go away. The gang of bad feelings will overrun me. The truth is a feeling that moves through us. We feel it and it goes and then we go to the next feeling. There's no gang out to get us. It's absurd to think we shouldn't feel grief right now. Let yourself feel the grief and keep going.

If our content helps you to contend with coronavirus and other challenges, please consider subscribing to HBR. A subscription purchase is the best way to support the creation of these resources.

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During the global pandemic, a palpable sense of collective grief has emerged. Grief expert David Kessler says that grief is actually multiple feelings that we must manage. In an interview with HBR, he explains how the classic five stages of grief (denial, anger, bargaining, sadness, acceptance) apply today, and the practical steps we can take to manage the anxiety.

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4 Podcasts

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Manshen Lo

The pandemic has resulted in complex emotions for many people. Some are thriving; others not so much. And still others are biking through foreign cities after dark to feel alive.

Here are four articles to listen to about our current moods →

Adam Grant, a psychologist, suggests that languishing might be the dominant emotion of 2021.

It is the forgotten middle child of mental health, he says, "the void between depression and flourishing."
Listen to the full article here.

In her piece, Dani Blum tells those who are languishing that the power to flourish is in their own hands - from savoring and celebrating the small things to doing good deeds. She provides practical tips on how to feel good post-pandemic.
Listen to the full article here.

Another, more heady, way of beating a feeling of stagnation is on the rise: A contingent of people are risking it all- their cushy jobs and stability - in search of a post-pandemic adventure.

Kevin Roose explains that if this movement had a rallying cry, it would be "YOLO."
Listen to the full article here.

In his "Letter of Recommendation" for The New York Times Magazine, Daniel Peña extols the virtues of biking through the Berlin streets at night.

It's one way he's felt present amid the disorientation of pandemic life.
Listen to the full article here.

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The pandemic has resulted in complex emotions for many people. Some are thriving; others not so much. And still others are biking through foreign cities after dark to feel alive. Here are four articles to listen to about our current moods → Adam Grant, a psychologist, suggests that languishing might be the dominant emotion of 2021.