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My therapy in college was interrupted by COVID-19 and I still need it – now what?

The stay-at-home restrictions and social distancing necessitated by COVID-19 have had sudden ripple effects on mental health services for everyone who counts on these supports and treatments. 

College students have faced their own unique effects, as campuses have emptied requiring students to relocate to their respective homes. Although psychological treatment is included amongst essential services, social-distancing has created a widespread prohibition on in-person therapy. An added wrinkle for out-of-state students who’ve been mandated to leave college housing is that their therapist is most likely not licensed in the students’ home states (not to mention the situation faced by international students returning to their home countries).

Dealing with uncertainty is the core underlying theme of stress and anxiety. Hence, the quick switch to all online classes, its effects on graded assignments, and trying to figure out where and when to study without distraction in the home that now serves as a makeshift, all-in-one school and workplace all produce a state of flux. Not the least of these issues is questions about how to reconnect with or find a therapist for remote treatment – or if this is even possible.

A first proactive coping step is to identify the specific questions you are facing and take stock of your automatic thoughts about them – “What am I going to do about therapy?” Such rhetorical questions are usually veiled negative thoughts – “I’m not going to be able to have therapy sessions.” For a different approach, the next step is to consider actual information – what you know and what you do not know (yet) – and decide on a course of action. In the case of this sort of rhetorical question – “What am I going to do about [fill-in-the-blank]” – the task is constructing a literal answer to it and a realistic, attainable action plan. 

So, let’s focus on what we know about how to access therapy services during the COVID restrictions.

1) First and foremost, remember that psychological emergencies, such as suicidal thoughts, plans, and intentions warrant a trip to or at least contact with a hospital emergency department, urgent care center, or crisis response center, which are still open and accessible. Calling 911 for emergency response is also still the correct response to an imminent risk to one’s life due to suicidal thoughts and actions. Other resources include: 1-800-273-TALK (8255) / https://suicidepreventionlifeline.org (online chat available) / via Twitter @800273TALK

2) Don’t assume that your college counseling services are not available, as many institutions have transferred all of their services to telehealth. Reach out to your therapist and the college counseling center for information about how they are handling established (or new) clients, including out-of-state students.

3) Even before COVID-19, increasing numbers of therapists were using remote video platforms that allow for secure video-therapy sessions. With remote sessions now mandated, even therapists who might have been skeptical are utilizing such options. There has also been a loosening of privacy regulations to allow the use of some popular video platforms for remote sessions, such as Skype and Facetime, to meet the current need for accessibility to services during the emergency.

4) With the stay-at-home mandate, though, you will not have the same privacy of your therapist’s office, as household members are ever-present. The video-therapy platforms mentioned above are accessible by computer, tablet, and smartphone, which allow for portability. If you are open about your sessions with family, you can coordinate sufficient privacy for sessions; otherwise, it will require creativity, such as going outside for a walk, or driving your car and parking somewhere for a session on your phone, or other ideas for safeguarding your privacy that adhere to social distancing standards.

5) Many students live in different home states from where they attend college. Thus, a remote session would be with a now-out-of-state college therapist, which typically violates state licensing laws for the practice of psychology. However, many states have modified these licensing restrictions to address the need for continued, remote psychological services with established clients during the COVID-19 emergency. Although your therapist will be kept abreast of any new changes, you can check The Association of State and Provincial Psychology Boards for daily updates of states’ interjurisdictional remote practice status for COVID-19. See updates at:  https://www.asppb.net/page/covid19

6) Difficulties refilling psychiatric medication prescriptions is another issue that runs up against cross-state practice issues. As with therapy, reach out to your prescriber to collaboratively work out a solution. A complicating factor is that some classes of medications have specific restrictions in being prescribed through telehealth, most notably stimulants for ADHD. In some cases, out-of-state physicians have remotely consulted with students’ home-state primary care physicians to take over specific prescriptions until a return to treatment-as-usual.

7) Money is a common stressor that will span pre- and post-COVID life. Most insurance companies will reimburse for remote sessions during COVID-19 restrictions, even if they had not previously done so. Some are even waiving co-pays during this time and permitting coverage for a 90-day supply of medications. However, you cannot talk about insurance coverage without the time-worn but necessary caveat – contact your carrier as to how it is handling services and reimbursement during COVID.

One of the goals of psychological treatment itself is to better manage the ups-and-downs of life. Current circumstances will put these skills to the test as you reconnect with your therapist, not to mention all the sudden changes thrown at you and other students. Facing the discomfort is what advances not just resilience but anti-fragility, the newfound strength and skills gained by muddling through and getting to the other side of difficult times.