In previous interviews, we have highlighted the challenges of working during a global pandemic, including the fears and anxieties of ordinary workers. While many have continued to work with little protection, rearranging their lives to accommodate a deadly virus, some workers have decided enough is enough. In April of 2021, an estimated 4 million workers left their jobs, a phenomenon that has been dubbed “the great resignation.” We wanted to better understand the motivations of this mass exodus of workers, so we sat down with Alex, a social worker who quit her job at this time.
Can you tell us a little bit about what you do in general?
I am a social worker working as a psychotherapist. I quit my job back in April. That job was an outpatient mental health clinic that serves folks that rely on public health insurance programs. As some of your readers may be aware, therapy is very expensive and those in private practice often do not take health insurance. The clinic I worked in was a large nonprofit organization. There are psychiatrists on site and therapists on site. I initially got this job when I graduated from social work school and because I wasn’t fully licensed yet, I was under the supervision of other therapists and got paid only per session, what is called ‘fee for service.’ So, for instance, if someone doesn’t show up, I don’t get paid. I also don’t get vacation or sick days or healthcare benefits.
But I want to provide psychotherapy to poor and working-class people, so I stuck with it. Now because of the populations I was servicing, mental health issues like anxiety and depression are compounded by poverty, unstable housing, and racism. If you are rich, you can go on vacation to deal with your anxiety or depression. But when you are poor you are worried about access to the most basic things that wealthier people take for granted.
What did your day to day look like during the pandemic?
Once the pandemic hit in March, we were all asked to work remotely. They told us that the clinic was shutting down and overnight our sessions were transferred to phone and zoom. But we don’t have the infrastructure to work remotely. I didn’t have an office in my home, I was holding virtual therapy sessions in my bedroom. I was on zoom 10-12 hours a day seeing clients back-to-back, and it was really exhausting. Anxiety, depression, domestic violence, all these problems increased. During the pandemic clients that I previously saw biweekly or sometimes monthly became weekly clients because of how much people were struggling. At the same time my cancellation rate was lower. I would say that I had about 10 more appointments per week compared to pre-Covid times.
The pandemic clearly affected our clients. People were getting sick, many lost their jobs or relocated out of state. We saw an increase in hospitalizations as well as an increase in conflict with partners, roommates, and family members. It’s been very difficult because I couldn’t just do talk therapy. I mean how can I focus on talk therapy when someone is threatened with eviction? So, I found myself trying to get them any assistance and legal help I could find. This was a very common experience for many therapists I have spoken to.
What was the clinic’s reaction?
The clinic just expected us to keep working like this. Sure, we were thanked for our hard work but it didn’t translate into material benefits like a raise or more pay for instance. The situation just kept getting worse. Our waitlist kept getting bigger and bigger. to take extra cases. And on top of this we were told we had to fulfill extra requirements including more assessments.
Can you say more about the assessment aspect of your job? Other than seeing and supporting clients, are there other things expected of you?
Yes, our working day is not just spent on therapy sessions but most of it is consumed by paperwork, assessments and linking clients to services. The clinic I worked at was a non-profit and they are very strict about assessment and paperwork. You have to meet rigorous assessment requirements because they are often audited and you have to be able to explain the services you provided to clients. So, a lot of my time is spent filling out paperwork on clients. Otherwise, I am also dealing regularly with various crises my clients experience. For instance, if a client has a crisis and is hospitalized I need to call and coordinate with hospital workers, I speak with case managers regarding assistance with housing and benefits for clients and I do not get paid for any of this time.
Your job sounds very stressful and intense.
Yes, it is. I have colleagues that see ten clients a day just to make ends meet. Unlike private practice who deal with mostly wealthier clients, mental outpatient clinics focus on poor and working-class people. These are the people we want to work with but in order to make ends meet you need to see clients back-to-back and you end up being burned out. The quality of work ends up not being good and your clients do not get the treatment they deserve. It’s just how the system works, it’s exploitative and you are just locked in. It got to a point I realized that it’s not worth it and I am not supporting my clients the way I want to because I cannot under the circumstances.
Did you try to connect with your coworkers to share your experiences?
Yes, one of the positive things out of this entire experience has been the connections I have forged with my clients and my co-workers. I have been talking to many therapists because we need to talk with each other. It wasn’t just the pandemic. It was the pre-election period and the uprising also. Amid all these things we were asked to provide support while managing our own uncertainty about what’s happening in the world. I think what was helpful to me was to connect and find radical therapists with whom I shared similar values about the work. Honestly, I never felt so connected and there was a lot of solidarity among mental health workers and it was beautiful.
During the pandemic especially I got closer with other therapists. There was a lot of burnout and I saw a lot of people quitting and saying “screw this, I can’t deal with it anymore.” I have never experienced anything like the solidarity we forged. It kept us going. We found ways to connect outside of the office which was important. A few of us often chat, vent and support each other through it all. Sometimes someone quit and another person said “Oh you quit, oh you are right. These are terrible conditions, maybe I should quit too.” So, people influenced each other this way. We began to realize what is important and what is not.
I quit in late April of 2021 and since then it’s just one person after another quitting in the clinic. I am not sure about what the exact quitting rate is, but I have noticed a very high turnover in therapists leaving their jobs since the spring. We were being asked to go back to the office and people feel that it’s not safe to do that. Many of my co-workers are frustrated and scared about returning to the office. How will the clinic enforce social distancing? What does the Delta variant mean? There is too much uncertainty. Also, many don’t want to go back to how things were—to constantly being surveilled by our managers, to having to work long hours and not have time for other things that are important to us.
Was there a particular moment that pushed you to quit your job?
For me it was the moment that things started reopening and going back to ‘normal’, when we were asked to go back to the office and this was coupled with the expectation of getting more cases in an already very tight therapist schedule. Giving us extra clients in a moment that is unsustainable, and we are already dealing with so much. I remember thinking to myself that I needed to take a break because I was getting super burned out and that I would figure something else out.
How do you feel about quitting?
I am definitely less stressed, but I also miss my clients. It was a hard decision because I connected with my clients on a more human level than ever before, and it was meaningful and important. It was hard for me to leave my clients and they would be transferred to another therapist who would probably quit in three months. Unlike private practice, in clinics you have high turnovers, and this can be hard for people.
Were the folks you know that quit just consider leaving social work or was it just going to private practice?
Folks are taking a break trying to figure it all out and are not sure what is next. Some are trying to get jobs with benefits and others are going to private practice. It is not uncommon to see people charging $200+ in private practice. Most therapists are not on insurance panels and it creates a situation where therapy becomes inaccessible to folks. And there are so many people who need support and the ones that take insurance are backed up right now.
Any other last thoughts you want to share with our readers?
They say the pandemic was an accelerator for many things and we saw that with the George Floyd uprising of course and how it shed a light on all the inequalities of our society. But the pandemic also showed us how broken our mental health system is. I want to talk to everyone about this. Those of us who are providing mental health services we are burned out and overworked and as a result our clients who are poor, they don’t have access to quality services that they need and it’s a vicious cycle. This is how broken the system is. All of this has convinced me that we must really fight and struggle for a different world. And I hope more people can join that fight.
Over the next days and weeks we hope to publish more interviews like this. We want to highlights stories about quitting work and navigating everyday life in these very strange and difficult times. We want to hear from you! If you have a story that you want to share with us please email the editor at email@example.com.