Mental Health 2020 in a Nutshell: A Psychiatrist Reflects on a Year of Therapy

From a professional standpoint, 2020 will always be remembered as the year that pandemic and political stress collided.

therapist virtual session
2020 was the most stressful year of some people's lives.iStock

Therapy sessions definitely changed a bit in 2020. Prior to the COVID-19 pandemic, feeling “meh” was, for many patients, an occasional thing, and reason to pause and unpack the preceding week in therapy.

Now feeling "meh" is more the status quo — almost expected. In fact, most of the people I see in therapy have experienced more change, grief, frustration, disappointment, and stress over the past year than in the last several years combined (for some, in their life so far).

The pandemic contributed to a lot of this. But that stress was compounded by political tension, including the heated, drawn-out election.

Political tension isn’t new to America. But in 2020, it peaked in ways that increased our collective stress to toxic levels. I saw — and am still seeing — the results of it in the (virtual) therapy room each week.

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What Did People Worry About in 2020?

This election and its aftermath was intense for clients to process for a number of reasons.

Throughout 2020, clients often complained that the future felt uncertain. They worried over the health of themselves and others. They stressed about the economy, and how it would affect their livelihood. And, come post-election, they stressed about effects of those questioning the election results.

In many ways, it seemed the decisions politicians were making affected their lives more than ever. This made all of the political uncertainly even more unnerving.

Many clients commented that they felt like they were living with a low level of tension all the time, and, because of this, all emotions felt more overwhelming to them.

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With everything so politicized, common ground among people also felt like it was shrinking. Depending on what news network a person tuned into or what they looked at on social media, the “facts” they read were different. It felt, to many, like they didn’t even share the same reality with many people.

The pandemic and the need to socially distance had already narrowed our social experience. Political tension, on top of this, caused additional strain on relationships for some.

I also saw that when people do not feel like there is any underlying truth or united front, they feel more hopeless. I heard a lot of “who knows” and “we’ll see,” said with a sense of confusion and lack of control.

On top of this collective stress, for the first time as a therapist, I also saw a kind of collective identity crisis for many Americans in 2020. For many of my clients, seeing clearly through the pandemic how America has failed BIPOC (Black, Indigenous, and People of Color) communities has created disappointment in the part of themselves that identifies as an American.

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A Coping Crisis: People Need New Tools

All that said, the number one thing people are taking about is not just the stress, but the limited ways they have of dealing with it.

Everyone feels that they do not have the same number of coping mechanisms available to them because many of the ways they used to release stress are unavailable to them now.

Also, all of the decisions people make now about how to spend their free time, just seem so big and exhausting.

They worry if any experience is worth the risk, even seemingly safe decisions like spending time outdoors with their own family.

This imbalance has made a lot of people feel less able to deal with the normal life stress of work and family life.

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2020: What Worked for People

I was also pleasantly surprised by how many people found meaningful lessons in these challenges.

Here are some of the big takeaways that have helped some cope:


Many people think acceptance is synonymous with giving up, but this could not be farther from the truth. The term acceptance can actually be replaced with the words “see clearly.” To accept a situation is to see it clearly, without judgment. In contrast to “giving up,” when you accept a situation, you are seeing the situation as it is and making choices based on this reality.

For the many that struggled with this term, 2020 helped them learn the meaning because it became so obvious that some things cannot be changed. We cannot change the pandemic. We cannot change the effects of the pandemic. The best we can do is see clearly the parts of the pandemic that are the most challenging for us — like not being able to do normal activities — and make the best decisions we can based on this reality.

Media Limits

Prior to 2020, most of my clients kind of recognized that too much exposure to social media and network news was not good for their mental health, but many didn’t change their behavior. But 2020 made it very clear that, from overly politicized presentation of news to misinformation spreading like wildfire, media can be divisive and damaging. As a result, I saw more people setting limits with timers or taking off days off from social media and the news entirely.


Boundaries has always been a wellness buzzword, but for some of my clients, it was also an important 2020 takeaway. Some set boundaries with spouses over which extra household tasks they would take on. Some needed to create boundaries with family or friends who were not taking the pandemic seriously about the types of activities they felt comfortable engaging in. Some set boundaries with family members about not having tolerance for certain words or phrases being used in reference to the Black community or Black Lives Matter. Although these discussions can be difficult, everyone felt more positive and more empowered after setting these limits.


2020 highlighted a lot of issues in the world. The wildfires highlighted our climate crisis. The potential relationship between COVID-19 and agriculture highlighted problematic animal agriculture practices. Many incidents — from the death of George Floyd and Breonna Taylor to the higher incidence of COVID-related death among Black Americans — emphasized ongoing racism. The election demonstrated how politically divided our country is becoming. All of these things risk making us feel small. But, I saw people feel empowered by the realization that small, individual acts, like speaking kindly to someone with a different perspective, learning how to be a good ally, and participating in meatless Monday made them feel more hopeful and more in control of the future.

I’m Not Alone

One of the most interesting parts of being a therapist in 2020 was hearing people say “Well, you know.” Meaning, I understood what they were going through. Being a therapist is often falsely associated with having everything figured out. But in 2020, people realized that I was probably having a tough time, just like them. Similarly, they realized that outside of the therapy room, they were having a somewhat shared experience with others. While not everyone who feels stressed has an anxiety disorder and not everyone who feels sad has depression, the recognition that most people struggle with their mental health at times has made many people feel less alone in their experience.

We’re not done, even in 2021, with what plagued us in 2020. We are, undeniably, still in the thick of things. But the rollout of the vaccine and the switch-up in administration has added a little light for many people. Let’s hope the light shines even brighter as the year progresses.

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