These Are The Most Common Issues People Discuss In Therapy

Experts share the stressful problems that affected most of their patients in 2019, from social media to politics.

It’s an increasingly challenging time to thrive in the world, and therapists hear it all.

They listen to the most personal internal conflicts, and they also counsel clients on broader, more common issues, like political anxiety, that plague a ton of people. Especially in this era, when global problems seem to weigh heavily on all of us personally, it’s sometimes important to remember that we’re not alone.

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Below, therapists, psychologists and counsellors tell HuffPost what their patients were struggling with most in 2019. Did you feel it, too?

Comparing your life to someone else’s on social media

“The most common thing people brought up this year was a fear of not being who they think they are supposed to be, and the imposter syndrome. Because people are so used to seeing ‘the success of others’ on social media, they perceive others to be the real deal and question their own skills. It really revolves around our feeling of inadequacy; social media has made comparison and contrast the new norm.” Karla Ivankovich, clinical counsellor at North Shore Counseling in Northbrook, Illinois

“This year, many of my clients were dealing with impostor syndrome and perfectionism. I think a huge factor in why these concerns are predominating in people’s lives is the amount of exposure we have to everyone’s ‘highlight reel’ through social media and the web. By highlight reel, I mean the peak moments with none of the difficulties or failures shown. Impostor syndrome and perfectionism come up a lot for people who are high-functioning and were used to being at the top of their class or group but now find themselves not measuring up to what they see online.” ― Heidi Cox, licensed clinical psychologist in New York City

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Dealing with online dating

“Relational dynamics have shifted in the wake of online dating. The ubiquity of matches creates a consumer mentality and leads people to experience dissatisfaction with their options. This is a demonstration of the psychological process called ‘over choice.’ The more choices we have, the more difficult it is to choose and the less satisfied we are with our decisions.

“Ghosting is rampant, as well, and it often leads people to feel rejected and disappointed even when they haven’t done anything wrong. Often clients personalise when someone doesn’t reply even in instances where it has nothing to do with them.” ― Brooke Sprowl, clinical director and owner of My LA Therapy in Los Angeles

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Setting boundaries in relationships

“The most common issue clients have brought into our sessions this year has been difficulty maintaining and enforcing boundaries in their relationships. Relationships with others require balance between your needs and theirs; however, poor boundaries and care taking are the comfortable norm, so it takes a while to develop a healthy equilibrium that ensures respect and love.” ― Averry Cox, therapist based in Seattle

“Often, I saw clients having difficulty saying no to other people. They tell me that they don’t want family or friends disappointed in them, even if it’s at the expense of their energy. I see this as a struggle because they’ve walked on eggshells for most of their life in order to please those nearest to them, and aren’t sure how to assert themselves. So, assertiveness training has been helpful as a good starting point.” ― Jacob Kountz, associate marriage and family therapist at Kern Wellness Counseling in Bakersfield, California

Living with symptoms caused by work burnout

“Anxiety, worry, stress and insomnia around work is one of the most frequent difficulties I hear. People are struggling with pressure around work success and its impact on self-worth, as well as balancing work with relationships and self-care. Work has really become the end all, be all for us, consuming so much of our time and identity that there is little room for much else. This creates a context in which the ups and downs of work are deeply impactful on emotions and self-esteem.” ― Rebekah Montgomery, clinical psychologist in private practice in Washington, D.C.

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Issues with sex and pleasure

“I saw more men coming in to discuss their decreased sexual desire and open up about the stress, emotional challenges and vulnerable parts of their emotional worlds and how it pertains to their sexual interest and performance. We are slowly creating more space which allows men to feel more comfortable opening up about parts of themselves that don’t fall within that more traditionally narrow idea of masculinity.

“On the flip side, I also saw more women hoping to increase their desire and sexual pleasure. Instead of wondering, ‘What’s wrong with my low libido?’ they wanted to maximise their sexual pleasure. An increased attention on the ‘orgasm gap’ has helped move women’s sexual pleasure from the background to the forefront.” ― Sarah Hunter Murray, therapist and author of “Not Always in the Mood

Experiencing loss or uncertainty in some capacity

“One of the biggest diagnoses were adjustment disorders. In the past, major causes for this have been issues such as divorce, death of a family member and loss of job. However, the cause has somewhat shifted. Many people are now having trouble adjusting due to the cultural changes within our society, which has caused feelings of instability, and political issues both domestic and worldwide, which has brought about feelings of uncertainty in regards to the future.” ― Christopher Ryan Jones, clinical psychologist and sex therapist serving clients nationwide

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Managing fear of mass shootings or other violent trauma

“Many people came to therapy because they struggled with current events and handling how to process what’s happening in the world ― from shootings to politics. Also, many people came to therapy realising they were suffering from PTSD watching the news or not dealing with past traumas. There was a fear of ending up on social media and feeling embarrassed, fear of dying or getting hurt due to the mass shootings. And social anxiety of acceptance among others is at an all-time high.” ― Patrice N. Douglas, owner of Empire Counseling & Consultation in New York, California and Texas

Gender dynamics in relationships

“Another common presenting problem this year is this: heterosexual couples in which the wife is out-earning or outperforming the husband [at work]. There is nothing inherently problematic or wrong about this situation, but because it challenges the heteronormative script, it can trigger feelings of shame in the husband and resentment in the wife.” ― Alexandra Solomon, clinical psychologist and author of “Taking Sexy Back

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Dealing with triggering reports about sexual assault

“With the Brett Kavanaugh hearings at the end of last year and the release of ‘Surviving R. Kelley’ at the beginning of this year, many of my patients with sexual abuse and sexual assault histories found themselves triggered. When conversations about sexual assault become part of the public discourse, it’s harder to turn the switch on and off.” ― Heather Z. Lyons, licensed psychologist and owner of the Baltimore Therapy Group

Anxiety over being in public spaces

“Among the most common presenting struggles we have seen this year is anxiety. However, this year has been unique in that we are seeing anxiety around school safety and gun safety much more frequently. Anxiety disorders such as generalised anxiety disorder and [obsessive-compulsive disorder] have involved intrusive thoughts and worries about these issues, as undoubtedly influenced by the increased occurrence of and awareness of mass shooting, including those that have taken place in schools and in other public places.” ― Marla W. Deibler, licensed clinical psychologist and executive director at The Center for Emotional Health of Greater Philadelphia

Navigating anxiety and depression at the same time

“Unfortunately, the trend in skyrocketing anxiety and depression rates appears to continue. Most of the clients I see struggle with either of these two issues, and many times both.

The research is beginning to show that depression may be caused by inflammation of the brain, and studies are linking anxiety, depression and pain together in brain structures. This means that depression and anxiety may not be distinct disorders but two sides of the same inflamed coin. Research shows that disconnection from three key aspects of our lives drives anxiety and depression: ourselves, others and nature. Reconnecting to these three aspects is, I think, the best way to decrease stress and increase wellbeing.” ― Liz Shuler, licensed professional counselor at Inner Evolution Counseling, an online service

Responses lightly edited for length and clarity.

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