Therapists Are Seeing More Patients Struggle With Climate Anxiety

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Covering Climate Now

Andrew Bryant, a therapist based in Tacoma, Washington, felt helpless the first time climate change came up in his office. It was 2016, and a client was agonizing over whether to have a baby. His partner wanted one, but the young man couldn’t stop envisioning this hypothetical child growing up in an apocalyptic, climate-changed world.

Bryant was used to guiding people through their relationship conflicts, anxieties about the future, and life-changing decisions. But this felt different — personal. Bryant had long felt concerned about climate change, but in a distant, theoretical way. The patient’s despair faced him with an entirely new reality: that climate change would directly impact his life and the lives of future generations.

“I had never considered the possibility,” Bryant said. In that moment, his fear was a dense fog. All he could think about in response to his client’s anxiety was his own young children: What world would they inherit? Should he feel guilty for bringing them into it?

“I didn’t know what to do, I didn’t know what to say,” Bryant said. He did know that nothing in his years of training and experience had equipped him to deal with climate change. Bryant has since spent years studying the mental health effects of climate change. Today, he is well equipped for these situations. But that first experience marked the beginning of a reckoning — one he sees happening in the field at large.

The American Psychiatric Association (APA) recognizes climate change as a growing threat to mental health, but many mental health professionals feel unequipped to handle the growing number of people anxious and grieving over the state of the planet.

Therapists in a few subspecialties, such as eco-therapy, train specifically to integrate environmental awareness into their work with clients. But these therapists make up a small percentage of the field, and the vast majority of people don’t have access to climate-informed therapy. A 2016 study found that more than half of therapists interviewed felt that their training had not adequately prepared them to deal with the mental health impacts of the climate crisis. Moreover, the same study found that although most respondents recognized the importance of climate change in the mental health profession at large, nearly half saw climate change as irrelevant to their own work specifically.

The reality is that climate change is impacting everyone in the therapist’s office; it’s the background — and increasingly the foreground — of life on Earth. But for a therapist who is themself barely coming to terms with climate change, offering non-judgmental counsel to a patient can be particularly challenging.

“I think a lot of therapists do recognize that these issues have clinical relevance,” said Susan Clayton, a psychologist at the University of Wooster who researches climate anxiety, “but at this point, hardly anybody has received any training specifically in addressing this.”

With climate-related anxiety, stress, and post-traumatic stress disorder on the rise, a contingent of mental health professionals are developing a new standard of mental healthcare for our climate-changed world. Their profession faces a steep learning curve.

There’s growing recognition in the field of psychology that people are experiencing distress over climate change. More than 40% of Americans felt “disgusted” or “helpless” about climate change, according to a survey published by researchers at Yale University. A 2020 poll from the APA found that more than half of respondents were somewhat or extremely anxious about the effects of climate change on their own mental health. Though not officially classified in the DSM-5, the tome therapists use to classify and treat mental illnesses, there’s a name for this state of despair that has emerged from academic texts and media since as recently as 2007: eco-anxiety.

It’s only natural to feel anxious in the face of a melting planet and the sixth mass extinction, both wrought by human actions. But while humanity may be responsible for the carbon pollution warming our planet, the reality is that just a few large corporations — and complicit politicians — have set us on this path. As individuals, it’s easy to feel helpless to stop the destruction of the biosphere.

That was my experience. I grew up in a region of Oregon heavily impacted by drought and wildfire. Over the past 10 years, my grief has steadily intensified as lack of snow closed the mountain where I learned to ski, as smoke blanketed my hometown each summer. Though I was in therapy for five years, I didn’t speak about my yearly dread of triple-digit temperatures, or my obsession over local snowpack reports. I assumed that therapy couldn’t ease my sadness, because I was there to deal with internal problems. In contrast, climate change seemed like the ultimate external problem. If I had no control over climate change, how could I begin to tackle my own despair?

Climate anxiety is awkward in this way. In some ways, it’s a rational response, said Leslie Davenport, a therapist based in Tacoma, Washington, and the author of the book Emotional Resiliency in the Era of Climate Change: A Clinician’s Guide. “Eco-anxiety is a natural response to a threat. And this is a very real threat,” Davenport said. Yet it can also debilitate. In college, I began a campaign to shut down fracking in Los Angeles County. Within months, I burned out. Constantly contemplating the impact of fracking on our atmosphere and communities was making it difficult for me to function at a basic level.

Because of this tension between eco-anxiety’s role as a rational but potentially debilitating response, there’s no clear, standard definition as to when eco-anxiety is unhealthy, if it ever is. “That’s one of the questions we really need to be asking,” Clayton said. “Anxiety is not pleasant to experience, but it’s not necessarily a bad thing. It’s an emotional signal that we need to be paying attention.”

But a lack of clear guidelines around eco-anxiety and climate change means that many therapists pathologize their clients’ anxiety, or treat it as an unhealthy response. Others simply feel uncertain about how to treat it. In response to a 2016 survey, nearly one in five therapists described their clients’ responses as inappropriate. Several participants said that their clients’ beliefs about climate change were “delusional” or “exaggerated.” Another quarter gave mixed responses.

One mental health professional told me about an experience with her own therapist, when she divulged her anguish over the increasing severity of drought. In response, her therapist asked “OK, but what is this really about?” The otherwise highly competent, trusted therapist couldn’t comprehend that climate change was the sole cause of her distress.

While eco-anxiety is a natural response, it can also become unhealthy when it becomes paralyzing, Clayton said. But that doesn’t make it exaggerated or misplaced. When a therapist dismisses a client’s distress as so, it can be profoundly damaging, Davenport said. “The client becomes the problem and the source of dysfunction,” Davenport said of this scenario. “Anytime a person is wrongfully blamed it can be painful, but coming from a mental health professional, an expert where a power differential is also in play, it can be disorienting for the client, causing them to question their own reality.” This dynamic harms the foundation of trust between client and therapist, and can drive the anxious client into further isolation, Davenport said.

Caroline Hickman, a psychotherapist and climate psychologist at the University of Bath, has spent years leading training sessions and presenting lectures on climate change. But lately, the field’s inadequacy in the face of a mounting problem has struck her as particularly stark. Increasingly, people have reached out to her after confusing or disappointing experiences trying to articulate their climate anxiety to trusted therapists. “Suddenly there’s this disconnect. And suddenly you realize you’re living in different worlds,” Hickman said.

When a therapist dismisses a client’s eco-anxiety or grief, the response doesn’t necessarily come from a lack of empathy or concern for the climate crisis, Hickman said. Oftentimes, the reaction occurs because therapists themselves feel unable to cope with their own feelings about environmental destruction—much less those of the client. “Therapists are only human — but have a duty and responsibility, I believe, to face this stuff and reflect on their own vulnerability in order to help their clients,” Hickman added.

For John Burton, a psychoanalyst based in New York City, there’s rarely a day when he doesn’t think about climate change. When a client brings up the topic — even in a passing comment about air travel or Greta Thunberg — he immediately feels a jolt of anxiety.

“It stirs up such feelings of helplessness,” he said. “That’s what comes up for me. It shouldn’t.”

When a therapist hasn’t begun to come to terms with their own emotions around climate change, it can add to the emotional turmoil of clients coping with overwhelming grief and anxiety, said Tree Staunton, a climate psychotherapist in Bath, England. For example, a therapist’s own grief, anxiety or guilt might come off as defensiveness or withdrawal.

“In therapy, we need to stay with that person’s reality and that person’s response. And the worst thing we can do as a therapist is bring in our own defenses,” Staunton said. “We don’t want to really experience the distress or the anxiety, so we can’t hear the other person’s.”

Climate change is the reality we all live in now. Between 2009 and 2020, the proportion of Americans who said they had personally experienced the effects of global warming increased from 32% to 42%, according to the aforementioned 2020 survey from the Yale Program on Climate Change Communication. And in some cases, these effects are directly impacting mental health. Researchers followed more than 1,700 children who lived through four major hurricanes: Ike, Charley, Katrina, and Andrew. Their results, published earlier this year, found that up to half of the children went on to experience symptoms of post-traumatic stress disorder. For 10% of the children, these symptoms became chronic. In another study published in 2018, researchers gathered data on the mental health of nearly 2 million people between 2002 and 2012 and local climates during that time period. Their results show that over five years, 1.8 degrees Fahrenheit (1 degree Celsius) of warming was linked to a 2% increase in all reported mental health issues.

While the world has a choice when it comes to limiting climate change, magically stopping all carbon pollution tomorrow would still leave decades of warming baked into the system. That means, presumably, the mental health impacts could worsen into the future. Society will have to adapt to many changes, including how we treat the attendant grief and anxiety of life on a less stable planet.

Therapists differ in how they help clients cope with the mental effects of climate change when they become unmanageable. Mindfulness-based approaches can help people cope with the intense emotions associated with climate anxiety and grief. For example, Davenport might walk clients through a guided meditation, in which they imagine themselves in a peaceful setting or have them tune into the specific sensations their body experiences as they think about climate change. Cognitive behavioral therapy, which focuses on addressing unhealthy ways of thinking, can help clients paralyzed by distressing thoughts about climate change. Climate-informed therapists also encourage activism and time in nature as a way to cope with the helplessness often associated with eco-anxiety and grief.

These tools aren’t just for clients; they’re for therapists as well, who need to bear witness to the distress people are already experiencing over climate change. “Therapists need to be able to sit with that feeling, whatever that feeling is with their client,” Staunton said.

Davenport, Staunton, and Hickman all lead training sessions where other therapists can learn to develop a climate-aware practice. At a recent training, Hickman spent the first 40 minutes of a training session helping students “recreate their connection” with the environment. Each went around and talked about their personal relationship to the planet, before learning about the relationship between climate change, grief, and loss.

The goal of these sessions isn’t to become a specialist in climate change. The goal isn’t even to develop a discrete set of skills to use when a client expresses their anxiety about the environment, Hickman said. The goal is to help therapists view their entire practice through a new lens.

“We look at every aspect of a person’s life through that therapeutic climate lens,” Hickman said. “People are existing and dealing with personal problems in the context of this global crisis now. And the global crisis will impact on the way you deal with personal problems.”

For Hickman, that means looking at the environments clients inhabit, at the planet as other relationships in clients’ lives, just as therapists would examine clients’ relationships to their parents or significant others.

“The reason we’re in this mess with the climate emergency is because we look at it as separate to ourselves,” Hickman said. She helps clients explore anxiety and grief about climate change by exploring their relationship to their local environment. For Hickman, her relationship to the planet is embodied by two trees in her childhood backyard, an oak and an ash, which she used to sit under when things were difficult in her home.

By bringing this lens to the mental health profession, climate-informed therapists hope that it’ll encourage more people to speak out about their emotions around climate change. Although 27% of people say that they’re “very worried” about global warming, according to Yale’s 2020 survey, therapists say that emotionally significant conversations about climate change rarely come up in therapy, but that the topic does come up in passing comments — a finding supported by the 2016 survey on climate change and therapy. This might simply be because people aren’t paying attention to their emotions about climate change, or don’t think to bring the topic up, Burton said.

“We feel like it’s something we can’t do anything about,” he said.

Climate anxiety and grief are what Davenport called “disenfranchised” emotions. As a society, we don’t yet make space for it as a valid emotional response; not in the same ways that we would for, say, grief over the death of a family member. “It’s prevalent, but no one’s allowed to speak up,” she said.

Under a climate-informed model of therapy, therapists encourage these people, who otherwise might remain silent, to bring their grief and anxiety into the open. They might help clients tease out passing comments about climate change, or even include climate change-related questions on intake forms.

It sometimes takes a crisis to provoke change. In the wake of the 9/11 attacks, the Council for Accreditation for Counseling and Related Standards, which accredits master’s and doctoral degree programs in counseling and its specialties, began requiring programs to include crisis, disaster, and trauma response as core counseling curricula.

“Before 9/11, no one ever thought about the role of therapy for disasters, ever,” Burton said. He hopes that climate change will force a similar change sooner, rather than later.

For Bryant, that first experience working with an eco-anxious client was a reckoning. Since then, Bryant has devoted years to learning about the psychology of climate change. He facilitates study groups on Zoom, posts detailed guidelines for leading a climate-change support group, and gathers articles on climate science and psychology. Today, others consider him a leader in the field of climate-change informed psychotherapy. He’s seen these changes mirrored in the field at large.

“I’ve seen a huge shift in discourse,” Bryant said.

In England, Staunton has been advocating for more systemic changes. Recently, her advocacy led to the addition of new training standards in the UK’s Humanistic and Integrative Psychotherapy College, one of 10 subsections of the UK Council for Psychotherapy. New therapists will be required to learn about the environmental and climate crises and the unconscious defenses we’re all employing when we think about this crisis. They’ll have to learn when to support those defenses in clients — and how to help clients overcome them.

In the coming years, the number of people on the frontlines of climate change is going to grow. Widespread training promises more widespread access to necessary mental healthcare, Staunton said.