The Clinical Implications of Climate Change

[memedoctor]

A friend of mine recently related an interaction she had with her therapist, where she mentioned to her therapist that she's been struggling with the impending consequences of climate change and our society's profoundly insufficient measures to address what is coming. She told me that her therapist's response was essentially to ignore the news and focus on her life. Of course, I can't know what the therapist really said, but I think we all have heard plenty atrocious therapy stories in our lives to believe that this is entirely plausible. Besides it being awful therapy (and the issue of how we deal with bad therapists is a whole other can of worms), it highlights an area that, to me, seems to be critically under-addressed in our field.

Just going by the recent Intergovernmental Panel on Climate Change (IPCC) report, the implications for mental health providers should be self-evident. For those who may not be aware of the report and what it says, this article gives a good overview:
What the IPCC report means for the Earth and how you can help beat climate change

The following is a brief snippet to highlight the impending massive, global trauma that we face:

Things are not looking good. We are on track to reach 1.5C between 2030 and 2052 if temperatures continues to increase at the current rate, and 3C by the end of the century.

Once we hit 2C warming, the world will be a profoundly different place. There will be almost no coral reefs remaining, the Arctic will be completely devoid of ice during summer at least once a decade, and huge numbers of animals and plants will become extinct as their habitat becomes smaller and smaller.

The impact for humans will be enormous, particularly in areas already vulnerable such as the low-lying coastal regions of Bangladesh and Vietnam, and island territories like Kiribati and the Maldives. Sea level rise will drive millions from their homes, and crop yields will fall dramatically in sub-Saharan Africa, Southeast Asia, and Central and South America.

The IPCC report is notable for a few reasons. Chief among them is that due to its political nature, it is a very conservative report; so even by some of the most conservative measures, we are in an alarmingly bad situation. I don't highlight this to indulge in nihilistic doom and gloom -- my main point here is that massive large-scale trauma is inevitable.

We are already experiencing the consequences of climate change (e.g. the fires in California, record breaking heat-waves, draughts, etc.). It may not be as directly obvious in terms of weather in some places for a while, but even those places will begin to start feeling the social effects; we'll be seeing increases in climate change refugees (likely resulting in increasingly draconian policies), loved ones in other parts of the world will be impacted, and even just vicariously witnessing these catastrophic events through the news will psychologically impact us (regardless of whether or not we consciously acknowledge it) -- just to name a few examples.

Our society needs to engage in radical transformation to mitigate some of the impending devastating consequences. This includes our field.
At this point, a lack of meaningful response is tantamount to denialism. If we are not thinking and talking about the clinical implications of climate change to some degree, we are not being responsible clinicians. This is not to say that everyone has to focus all of their energy on this, because of course, we already have plenty to deal with on our plates! But I am concerned at what, in my experience, seems to be an underwhelming response to this growing behemoth of a problem that we face.

So with all that being said, I am curious what other peoples' experience are when it comes to confronting the implications of climate change in their programs/workplaces, etc. I'm not looking for any specific feedback, I'm more interested in a general discussion - whatever comes up for you, I'm curious to hear.
But the following are some general areas of interested I'd like to hear from people about:
- Are you having more clients talking about the existential anxiety/dread that it provokes? Are you thinking/talking about what it means to integrate social responsibility into your treatment plans?
- Do you get the sense from your colleagues that this is something to be concerned about? Are you concerned?
- Have these issues even been touched on in any of your classes, trainings, seminars, etc.?

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[StellaB]

I work in a forensic setting, so in my experience patients aren’t cognizant of this, but I have wondered the same things, thank you for bringing up this topic. I have not experienced any training on the issue at all, and I doubt many others have. I do recall reading in a Sonoma-local paper that following the fires in CA last year, there was a critical shortage of mental health professionals available to address the needs of displaced and traumatized survivors.

 

[deleted480308]

Your premise is that doubts in the immediately impending doom claimed by climate change promoters makes someone a bad mental health provider?

 

[StellaB]

Your premise is that doubts in the immediately impending doom claimed by climate change promoters makes someone a bad mental health provider?

This doesn’t make sense. We at least should have a branch of our field working on this - even though some people still manage to doubt catastrophic climate change, it appears to be happening, so we should probably be prepared. That doesn’t mean every psychologist has to specialize in it.

 

[memedoctor]

Your premise is that doubts in the immediately impending doom claimed by climate change promoters makes someone a bad mental health provider?

If that was the main take-away that you got from my post and aren't interested in engaging with questions I put forward, then I think we are on entirely different pages. You can focus on whatever it is you think is more important, I'm not interested in arguing about whether climate change is a real problem, or to what degree of a problem it is.

 

[deleted480308]

This doesn’t make sense. We at least should have a branch of our field working on this - even though some people still manage to doubt catastrophic climate change, it appears to be happening, so we should probably be prepared. That doesn’t mean every psychologist has to specialize in it.

I don’t think it appears to be happening

If that was the main take-away that you got from my post and aren't interested in engaging with questions I put forward, then I think we are on entirely different pages. You can focus on whatever it is you think is more important, I'm not interested in arguing about whether climate change is a real problem, or to what degree of a problem it is.

To specifically answer your prior questions, I have never had a patient nor heard of a patient ask about climate change. I don’t think “social responsibility” is a specific enough phrase to answer but using context if you mean have I ever considered climate change activism as a treatment component...absolutely not.

None of my colleagues have ever expressed concern about this, I am not concerned. It has not come up in training

 

[memedoctor]

This doesn’t make sense. We at least should have a branch of our field working on this - even though some people still manage to doubt catastrophic climate change, it appears to be happening, so we should probably be prepared. That doesn’t mean every psychologist has to specialize in it.

This is a good point, and something I've been trying to look into a bit. I was recently looking at some programs to see what kinds of options were out there. The only program I found specifically thinking about ecopsychology was Pacifica, as well as some Community Psychology programs, but not much in clinical psych. I haven't really seen much in terms of specialization, CEs, or anything along those lines, but I'd love to hear about some if people know or have heard of them.

 

[memedoctor]

Actually, having thought more about it, if the reaction to my original post was in any coming from defensiveness surrounding me calling the therapist in the anecdote a bad therapist - I'd like to revise my answer.

If a client brings up anxieties around climate change to you as their therapist, and your response is to instruct them to ignore it, tell them they shouldn't worry about it, or in any manner attempt to minimize it or convince them that it is not a real problem, etc. - then yes, I absolutely, unequivocally think you are a bad clinician. Even just by the most general theoretical treatment standards.

 

[deleted480308]

Actually, having thought more about it, if the reaction to my original post was in any coming from defensiveness surrounding me calling the therapist in the anecdote a bad therapist - I'd like to revise my answer.

If a client brings up anxieties around climate change to you as their therapist, and your response is to instruct them to ignore it, tell them they shouldn't worry about it, or in any manner attempt to minimize it or convince them that it is not a real problem, etc. - then yes, I absolutely, unequivocally think you are a bad clinician. Even just by the most general theoretical treatment standards.

"Doc, I'm having anxiety around my fears that a unicorn is going to murder me"

 

[StellaB]

"Doc, I'm having anxiety around my fears that a unicorn is going to murder me"

You might not believe it, but if a client said they had anxiety about a genuinely scary situation something like 97% of the relevant researchers believe in, and you treated it like they were talking about unicorns, then yes, bad therapist.

 

[memedoctor]

First off, if your response to someone who is genuinely scared of being murdered by a unicorn is to tell them to ignore the unicorn, then I think you have poor clinical insight into what is helpful for people who are scared of being murdered by a unicorn, and I stand by my assertion that you are a bad clinician.

Secondly, say you are correct (you're not) and this is all fake (isn't), the fact that a ****load of people are all going to be terrified about this one specific thing and will only get more scared about it as time goes on makes it seem like it's sort of... still a problem psychology needs a systematic way of dealing with.

Lastly, you know that "person who believes their niche expertise gives them superior, dismissive knowledge of the consensus in other fields" stereotype is meant to be limited to old physicists and engineers, right?

 

[Ollie123]

I have some patients who explicitly work in the environmental field who discuss it at arms-length, but I can honestly say I have never had a patient raise it as a substantive clinical concern.

I would likely address it as I do most other manifestations of anxiety. Challenge catastrophizations or obvious distortions. Encourage agency and mitigation of avoidance behavior around the issue, which could range in intensity from a concerted effort to recycle to attempting to become the head of the EPA depending on the patient. Mindfulness/acceptance-based approaches when helpful. Probably a couple other things interwoven depending on the exact presentation. The exact balance of these depends on the patient and where the "art" comes into the field.

We do have growing sects of social psychology around these topics, which I strongly encourage. I do not really see much need for a specialty on the clinical side. I do personally believe it is a crisis that is likely to grow. I am equally confident if we solve it there will be another and I rarely see anxious folks whose anxiety is limited to a certain topic. I imagine if it appeared an adaptive and well-handled response, I would likely consider it as a value and try to harness the motivating elements. If I think this is just a person prone to panic about the topic of the day and today it is climate change and tomorrow it is gun violence and the next day it is their boss giving them a funny look...I think it is a disservice to focus on climate change itself.

I am in a pretty progressive social circle. I think we all think about it. Among my patients, it is likely quite a mix but like I said, I have never really had it raised as a clinical issue. Some of this may be location-based or cultural, I imagine it is a more salient issue near the wildfires or in a low-lying coastal region.

I am 4 years our from school at this point. We did discuss environmental psychology, but not in much depth. I have friends doing work in political psychology who I wouls be surprised if they were not directly working on this issue. I truly do not see much need in the clinical world based on both limited need and the fact that it seems readily bucketed into existing categories. Perhaps I am misunderstanding your point though.

 

[memedoctor]

I have some patients who explicitly work in the environmental field who discuss it at arms-length, but I can honestly say I have never had a patient raise it as a substantive clinical concern.

I would likely address it as I do most other manifestations of anxiety. Challenge catastrophizations or obvious distortions. Encourage agency and mitigation of avoidance behavior around the issue, which could range in intensity from a concerted effort to recycle to attempting to become the head of the EPA depending on the patient. Mindfulness/acceptance-based approaches when helpful. Probably a couple other things interwoven depending on the exact presentation. The exact balance of these depends on the patient and where the "art" comes into the field.

We do have growing sects of social psychology around these topics, which I strongly encourage. I do not really see much need for a specialty on the clinical side. I do personally believe it is a crisis that is likely to grow. I am equally confident if we solve it there will be another and I rarely see anxious folks whose anxiety is limited to a certain topic. I imagine if it appeared an adaptive and well-handled response, I would likely consider it as a value and try to harness the motivating elements. If I think this is just a person prone to panic about the topic of the day and today it is climate change and tomorrow it is gun violence and the next day it is their boss giving them a funny look...I think it is a disservice to focus on climate change itself.

I am in a pretty progressive social circle. I think we all think about it. Among my patients, it is likely quite a mix but like I said, I have never really had it raised as a clinical issue. Some of this may be location-based or cultural, I imagine it is a more salient issue near the wildfires or in a low-lying coastal region.

I am 4 years our from school at this point. We did discuss environmental psychology, but not in much depth. I have friends doing work in political psychology who I wouls be surprised if they were not directly working on this issue. I truly do not see much need in the clinical world based on both limited need and the fact that it seems readily bucketed into existing categories. Perhaps I am misunderstanding your point though.

Thanks for your thoughtful engagement.
I think you raise a reasonable point that it doesn't require specific expertise in terms of treatment versus any other form of anxiety. Though I guess I am a little concerned about how some clinicians might approach their framing or assumptions about what does or doesn't count as obvious distortions (e.g. see earlier in this thread with another poster equating it with fear of being murdered by a unicorn).

I think your other point about there being specialization in other psychological fields that aren't specifically clinical is also good, though the fragmentation and lack of communication/collaboration across social science fields is an endless frustration to me. I think, for example, that clinical psychology might have a really important perspective with regards to denialism that ought to be more in conversation with those fields.

At any rate, thanks for your input. And you didn't misunderstand - I did not have a more specific point than trying to open up a broader conversation about this as a growing problem and exploring how we are thinking about what this means for our training/work.

 

[StellaB]

Speaking as someone with several close family members recently involved in two different climate-related disasters (fire, hurricane), there is one thing I think is going to be clinically distinct for climate disasters. Our patients will be having to adapt to a new culture of nihilism - this won’t be a problem facing our patient alone; everyone they know and everyone the therapist knows could be affected simultaneously.

 

[Ollie123]

I agree some clinicians might struggle not to interject their own beliefs on the matter. I also agree it is generally difficult to draw a clear line between accurate and distorted thinking on topics like this. To me, these fall under general clinical skills and I just do not see any reason this topic warrants elevation to a special category.

I have had black patients who worry about racism and police encounters.

I have had LGBT patients who worry about being assaulted or ostracized from theor families.

I have had older patients worry about unemployment and age discrimination.

I have had BOTH liberal and conservative patients worry about how people they care about and complete strangers will respond when they find out their political leanings.

None of these things have clear lines in what is rational/irrational. We all do the best we can in those circumstances. And the best of us likely still screw it up regularly.

I just so not see any benefit to creating a subspecialty for any, let alone each of these things. It seems like it would fracture us further. Perhaps even worse, it could become an excuse not to learn those general clinical skills.

 

[memedoctor]

I agree some clinicians might struggle not to interject their own beliefs on the matter. I also agree it is generally difficult to draw a clear line between accurate and distorted thinking on topics like this. To me, these fall under general clinical skills and I just do not see any reason this topic warrants elevation to a special category.

I have had black patients who worry about racism and police encounters.

I have had LGBT patients who worry about being assaulted or ostracized from theor families.

I have had older patients worry about unemployment and age discrimination.

I have had BOTH liberal and conservative patients worry about how people they care about and complete strangers will respond when they find out their political leanings.

None of these things have clear lines in what is rational/irrational. We all do the best we can in those circumstances. And the best of us likely still screw it up regularly.

I just so not see any benefit to creating a subspecialty for any, let alone each of these things. It seems like it would fracture us further. Perhaps even worse, it could become an excuse not to learn those general clinical skills.

Yeah, all of these things make sense and I agree with you about their ambiguous nature. To be clear, I'm not advocating for a subspecialty, but trying to get more information about what peoples' clinical and training experiences surrounding these topics is like, and how they're thinking about what it means for their work.

Though I think as StellaB rightfully pointed to, there probably are some unique challenges that will arise in working with climate survivors/refugees, just as there are with groups you mentioned. But we typically GET some specialized training for dealing with many of those aforementioned populations - or at least I did - and that education/training has been invaluable in fostering working relationships with them.

 

[Ollie123]

Well...not to put too fine a point to it, but there is a clear distinction between what Stella mentioned and what you seemed to be getting at.

Natural disasters are not new, nor are they unique to climate change. It is already "sorta" its own sub-field within trauma. The real question is...how do we change our approach due to climate change beyond perhaps preparing for gradually increasing demand?

 

[StellaB]

Well...not to put too fine a point to it, but there is a clear distinction between what Stella mentioned and what you seemed to be getting at.

Natural disasters are not new, nor are they unique to climate change. It is already "sorta" its own sub-field within trauma. The real question is...how do we change our approach due to climate change beyond perhaps preparing for gradually increasing demand?

It’s a legitimate question. I think what we will need to figure out will include counseling people who aren’t sure whether to have children due to worries about the future, people who are not singularly feeling like their life isn’t worth living, but whose whole social network feels that way too. It’s especialy devastating for older people who are often less resilient, economically and physically. It’s a lot like natural disaster work, except the trauma doesn’t stop. Maybe it’s more like what war psychologists are doing.

 

[memedoctor]

Well...not to put too fine a point to it, but there is a clear distinction between what Stella mentioned and what you seemed to be getting at.

Natural disasters are not new, nor are they unique to climate change. It is already "sorta" its own sub-field within trauma. The real question is...how do we change our approach due to climate change beyond perhaps preparing for gradually increasing demand?

Okay sure, yes. I'm still not sure what you thought I was getting at before, but yes, I agree that is a deeply important question, and I am interested to hear your thoughts on it.

 

[StellaB]

To be more specific about what I’m trying to say: therapies that assume the patient’s issues are internal might not work when the crisis is external, widespread, ongoing - an existential threat probably not to most of us directly, but to our lineage. I do think exploration of whether established interventions are effective for climate anxiety is probably warranted.

 

[LadyHalcyon]

I don't think it's too different from addressing current events that cause a patient distress. Obviously climate change is a specific issue, but at the core it seems to trigger an existential crisis of sorts, which psychologists should be comfortable working with. I received two referrals around the time of the Kavanaugh hearings; both women with sexual trauma histories experiencing an increase in trauma-related symptoms as a result of the media exposure/responses of others on social media. I guess my point is that I expect issues pertaining to the president, racism, sexism, and climate change will more frequently find their way into sessions. As clinicians, we need to be extremely aware how our own political views will impact interventions.

 

[memedoctor]

I came across a really interesting article that some folks here might appreciate. I haven't finished it yet but I am hoping to get through it tonight, and would love to get thoughts from everyone who has engaged so far:
https://www.liebertpub.com/doi/full/10.1089/eco.2018.0021

An excerpt:

 

[deleted343839]

I came across a really interesting article that some folks here might appreciate. I haven't finished it yet but I am hoping to get through it tonight, and would love to get thoughts from everyone who has engaged so far:
https://www.liebertpub.com/doi/full/10.1089/eco.2018.0021

An excerpt:
View attachment 250683

I missed the part where reframing an ongoing problem as “trauma” facilitates activation of an adaptive response. This is a claim that lacks plausibility or evidence.

The author’s assertion that the use of the term “climate change” is itself a form of denial is pretty self-indulgent. The idea that the entire field of traumatology should be realigned to fit this concept is preposterous.

 

[cara susanna]

I'd probably take a DBT-ish approach - yeah, this is likely going to happen someday, and also balancing working for change as much as you can with also accepting your limitations and not dwelling on it. Worrying about it isn't going to stop it and it's just making you miserable.

I use the same approach with people who are distressed by our political situation in general right now. Be involved to the extent that it's productive and helpful, and maybe turn off the news once in a while if it's only riling you up.