Over the years, I’ve worked with many individuals who come to therapy fearing they have herpes — even after negative tests and reassurances from medical providers. Often, symptoms involve subtle sensations on or under the skin that can't easily be seen or assessed, leaving individuals feeling misunderstood or worried that something is being missed. For those who struggle with this, the worry can be consuming and isolating. But there is hope.

Most of the people I work with do not develop serious clinical depression but many of them do struggle with a period of sadness and shame. Reading this tells me that you have hope and there is good reason to have hope.

I have noticed an increase in feelings of loneliness among patients lately. Life has changed so much since COVID. If you are feeling isolated and down, here is a way to start feeling more connected.

What were some of the most important moments for you this year?

Revisiting experiences you’ve had during a period of time, making a point to think of them in the context of a year, can help build stronger memories about your life and help you feel grounded in space and time.

Maybe you’re reading this because another new relationship with someone you really liked just ended or perhaps you are worried it is ending. You feel confused as to what went wrong because you thought you had such great chemistry. Maybe you noticed a shift, not long ago, that alerted you that something was amiss, that this person was pulling away. Maybe they didn’t text as often, plan dates, or seemed distant. Perhaps there was a conflict or you’ve felt some tension between the two of you.

Anxiety can feel crippling. It can interfere with sleep, your ability to focus at work, or doing things you enjoy because your mind is worrying. Anxiety can make everything on the inside feel so confusing. You might find it difficult to figure out how to create steps to address the problem or decide where to put your focus so you can move forward. You might feel “all over the place” mentally or you can’t think about anything else because of how worried you are about something you may have no control over.

If you’ve been wondering if virtual or in-person therapy would be right for you, I have some thoughts for you to consider. I almost exclusively offer in-person therapy, with only some exceptions.

Here’s why.

Some people are so good at avoiding their anxiety that it doesn’t appear they are anxious at all. Others show signs of being panicky. Some people are anxious about a very specific thing (such as a health issue) and others are anxious about their place in the world, how they are doing in life, the security of their relationships, or when the next disaster is going to happen and how they will cope. Some people are able to function well despite their anxiety and others feel frequently distracted, distressed, and can’t sleep well. Some repeatedly seek reassurance from others while others become more introverted and avoidant.

Anxiety is definitely not one size fits all.

Over the years, many people with no history of herpes symptoms have called me to begin counseling or group therapy after receiving a herpes diagnosis from a blood test screening alone. It is true that you can have herpes and not be aware of symptoms. However, if someone tells me they have never recognized any symptoms, I think it’s worth exploring a little further to make sure the diagnosis is accurate.

If you’re feeling depressed or anxious, it can be hard to find the energy to do things that are rewarding or that bring you joy. Even some people who would not identify as anxious or depressed are finding themselves feeling a bit lost as they transition out of the pandemic and back into a semi-normal life. If this is you, you might have forgotten how good certain things you used to enjoy can feel.

Maybe it’s hard to believe right now, but it’s going to be ok. I have been working with people diagnosed with genital herpes for a lot of years, so I am not saying this from some naive belief. It comes from my experience with my patients. Life really can go on after a herpes diagnosis. Many of my clients say that herpes actually forced them to deal with issues that were present before their diagnosis, such as with self-esteem or how they engaged with relationships, and that they ended up better than they were before their diagnosis.

So here’s what I suggest:

It may seem a bit cliché, but I love to close each year with a reflection about what was good and what I want to change. It’s a time of year that I often challenge clients to think about these things, and this year I provided a worksheet that received a positive response from many of those I work with. Clients said it was helpful and some of them reflected at length on the questions.

Not always, but often, I find that many of the struggles that lead people to therapy, such as depression or anxiety, are associated with not getting needs met in relationships. This is most often apparent in romantic experiences or family dynamics but can also be seen in friendships and in problems with professional relationships. For this post, I will use romantic relationships as the primary example.

Longing for a relationship but having a pattern in which you are always attracted to partners who are wrong for you or partners who aren't interested in a relationship with you can be really painful.

This is especially true when you meet someone you really like. Maybe you've had some deep, satisfying talks with them and really fun times together. It feels like there is so much potential! You can't get them out of your head and find yourself anxiously waiting in anticipation for a text from them or hoping that they will soon make plans to get together with you. But they always seem out of reach, leaving you longing. Ultimately, you learn they don't feel the same or they don't want a relationship. This really hurts and can make you feel like something is wrong with you, like something keeps you from being good enough for someone like this to love you back.

Many people diagnosed with herpes feel betrayed by the medical system when they learn that they have never been tested and their partner likely was not either. If you didn't know before now, herpes is generally not included in a standard STD panel. That means all those screens that you so diligently obtained since becoming sexually active and the one you may have asked your partner to get as well, probably did not screen for herpes. 

Walking around New York City, I often see emergency preparedness signs, the ones that tell you to make sure you have a plan and working supplies, such as flashlights, batteries, water, etc. 

I especially love the poster of one family's strategy, where under each family member's photo there is text describing what that individual will do. Under the dog, it says, "Grab the cat."

Emergency preparedness is important. But what about being prepared for emotional "emergencies"? Discouragement, loss, let-downs, and grief are no fun. So why not do something in advance to help make those times easier for yourself when they happen?

I recently connected with Lori Fauquier, a nurse practitioner who used to practice at Callen-Lorde, here in New York City. She now has a tele-medicine practice focusing on women's health issues. I've found Lori to be knowledgeable and passionate and a provider that is comfortable talking about sex and sexual health.

Do you know what it's like to go to school and be picked on, to always be worried about what the next insult will be and when it will be thrown at you?

to sometimes be unsure if people are being nice or trying to trick you? 

to not be included and to know that you are purposefully not being included?

to wish you belonged?

Do you remember those experiences as if they were yesterday?

Some experiences of anxious or depressed feelings are normal. You notice the feeling but have a sense of being in control of it; it doesn’t interfere with your ability to take action, handle your responsibilities, or participate in activities you enjoy--at least not for long. You might even see the sadness or nervousness as a natural part of the circumstances, of healing, moving forward, or being challenged. You cry it out or give yourself a pep talk and then find yourself moving on.

But sometimes anxiety and depression can become more significant, either in intensity, frequency, or duration.

I’ve recently had an increase of clients and loved ones in my life with autoimmune conditions, like Fybromyalgia, Hashimoto’s disease (which causes hypothyroid), or other chronic pain conditions like migraine. These are all individuals who are young, mostly in their 30s, and in the prime of their lives.