By: Erik Karff, LMFT

Over the past year, I have been facilitating restorative circles for LGBTQIA2S+-affirming clinicians in the Bay Area. I initially imagined them as a way to create community during a difficult sociopolitical period. What I did not expect was the level of connectivity and insight into my own process they would bring.  

I began noticing an increase in fear and fatigue, along with a harsher internal voice. Old patterns I thought I had put largely to rest were coming out and becoming louder again. None of this was entirely disconnected from what was happening around me, but I had not fully understood the degree to which this was the case. The circles did not resolve the conditions creating the distress. They did something more basic and, in its own way, powerful: they created a space of mutuality where this weight can be held in community.

That experience made me curious about what other therapists were noticing and experiencing.

Were we seeing the effects of the current sociopolitical climate in our clients? Were we feeling those effects ourselves? And perhaps most importantly, were there ways this distress was entering the therapy room without being immediately recognized as sociopolitical at all?

Those questions eventually became an anonymous survey of clinicians and, later, a longer paper, The Invisible Toll of the Current Sociopolitical Climate.

Asking Clinicians What They Were Seeing

The survey was small and informal. Twenty-one clinicians responded, many working in private practice and with LGBTQIA2S+, immigrant, first-generation, and other marginalized communities. It was not designed as formal academic research, and the sample was self-selected. My aim was more modest: to take a snapshot of what clinicians were noticing across their work and within themselves.

Even with those limitations, the responses were clear and cohesive.

Eighty-six percent of clinicians said they had noticed an increase in clients presenting with symptoms that seemed indirectly related to the sociopolitical environment. No respondent answered no; the remaining respondents were unsure.

The strongest finding was exhaustion. Ninety-one percent reported often or very often seeing exhaustion, fatigue, or shutdown in clients. Every clinician surveyed reported seeing it at least sometimes.

That finding stayed with me because fear is often easier to recognize. When someone is panicked or visibly anxious, we tend to understand that something has activated the nervous system. Exhaustion can be more insidious. It can look less like a crisis and more like diminished capacity: a person withdrawing, a particular flatness, having difficulty engaging, struggling to imagine the future, or simply finding it harder to keep doing what ordinarily keeps life moving.

The clinicians themselves were also being affected. Eighty-six percent rated the impact of the sociopolitical climate as a 4 or 5 on a five-point scale. Eighty-one percent endorsed exhaustion or burnout, the same percentage reported increased hypervigilance around news and social media, and 81% described a pull toward withdrawal or isolation. At the same time, 76% felt a pull toward activism or advocacy.

That simultaneous movement toward engagement and retreat became one of the more interesting findings for me. Many clinicians seemed to be living inside both impulses: wanting to respond while also feeling depleted by what they were responding to.

When We Don't Know What Is Triggering Us

As I reviewed the quantitative results alongside clinicians' written responses, another theme began to come into focus.

Sometimes people know exactly what they are responding to. A particular event, policy, news story, public statement, or threat creates a recognizable shift. The connection between what happened and what the person feels is relatively visible.

Other times however, these vital connections are harder to make.

Distress might look personal or intrapsychic at first. Often, an individual’s inner critic becomes harsher. Other times, anxiety that was once quelled begins to return. A person may begin to notice this and become confused as to why. Further, some people may isolate with more frequency while old patterns of shame start arising again. Here you have examples of real nervous system responses (or, as the DSM may say “symptoms) but, in these moments, with no clear, traceable cause or trigger

From this, I began using the term “invisible trigger” to describe this phenomenon: being affected before we fully understand what we are responding to. Giving it a name has been useful because it helps place apparently private distress in a wider context.

The sociopolitical environment does not remain so neatly outside the therapy room. Public hostility, uncertainty, scapegoating, instability, and repeated exposure to threatening and dehumanizing messages can become part of a person's internal environment. The nervous system may register that atmosphere before the conscious mind has organized it into a coherent story.

This is particularly important when working with people whose identities or communities are being publicly targeted. Survey respondents described the psychological effects of hostile messaging toward trans and nonbinary people, as well as significant fear and stress among immigrants, first-generation people, BIPOC communities, and neurodivergent people. The consequences are not distributed equally.

At the same time, one of the clinical questions raised by the survey is broader: what happens when a person experiences the effects of a social environment as though the problem exists entirely inside them?

Understanding Distress in Context

This question led me toward the emerging literature on sociopolitical grief. Darcy Harris uses the term to describe grief associated with political, social, structural, and symbolic losses. We tend to associate grief with death, but people can also grieve changes in their sense of safety, bodily autonomy, expected futures, social trust, and assumptions about how institutions or other people will behave.

That framework helped me think differently about some of the exhaustion clinicians were reporting. Exhaustion may sometimes be more than an individual wellness problem. It may reflect prolonged contact with instability.

It also changes the way we might understand symptoms clinically.

In the paper, I use the word symptoms carefully. Hypervigilance, shutdown, avoidance, exhaustion, or fear can also be understood as nervous-system responses to the environment. Naming the social context does not mean assuming that every psychological difficulty is political in origin. It means remaining curious about the relationship between the person's inner world and the conditions in which that inner world is developing.

For therapists, that can involve helping someone differentiate between what they have learned about themselves and what has been repeatedly communicated to them about themselves.

When devaluing messages have been present long enough, they may cease to feel like messages at all. They can start to feel like self-knowledge. Therapy offers a place to examine how a person's sense of worth, safety, visibility, and belonging has been shaped by the environments around them without reducing their experience to either psychology or politics alone.

Agency, Withdrawal, and Community

Another finding I keep returning to is the movement between powerlessness and agency.

Sixty-two percent of clinicians reported often or very often seeing clients move between empowerment or community-building and powerlessness. Among clinicians themselves, the strong pull toward advocacy existed alongside an even slightly stronger pull toward withdrawal.

I do not think the answer is to demand more engagement from already exhausted people. Nor is withdrawal always a problem. Conscious distance from news, social media, or political material can be an important way of restoring capacity.

What seems to matter is whether we retain some sense of choice.

When people experience themselves as having no meaningful way to respond, fear can begin to collapse into despair. Agency does not have to mean doing something enormous. Sometimes it is local and relational. It may involve making one decision, finding one place where participation feels possible, or allowing another person to help carry what has become too much to hold alone.

This brings me back to where the project began: community.

The word appears throughout the paper, and I am still thinking about what exactly I mean by it. I do not want to use community as a vague stand-in for belonging or assume it means the same thing across identities and cultures. I am interested in what makes community something lived and sustained rather than simply an ideal.

What does community provide that helps people cope and thrive? What does an individual offer back to it? What creates mutual responsibility alongside belonging? What makes community capable of carrying something that one person cannot metabolize alone?

I do not yet have a tidy definition, and I am increasingly comfortable leaving that question open.

What I do know is that the restorative circles at the beginning of this project changed my own relationship to what I was experiencing. The circumstances had not changed. I was simply no longer alone with them.

What This Means for Our Work

Therapists are being asked to practice inside the same social environment as our clients. We are not observing this period from outside it.

That does not require abandoning clinical boundaries or making therapy about ourselves. It does ask for a groundedness that is steady, receptive, and honest enough to recognize that the world outside the therapy room is already present inside it.

For me, one implication of this project is relatively simple: when someone's distress intensifies and the source is difficult to locate, our curiosity may need to extend beyond the individual.

What is happening psychologically matters. So does what is happening relationally, socially, economically, and politically around us. Sometimes making those connections allows an experience that felt confusing or deeply personal to become more understandable.

The survey of 21 clinicians cannot tell us how widespread these patterns are. That would require larger and more rigorous research. But it does provide a window into what a group of clinicians are seeing repeatedly across their work, and what many are experiencing themselves.

It also leaves me with a question I hope we continue asking together: how do we create clinical and professional communities capable of helping people remain connected to themselves and one another during periods that exert so much pressure toward fear, isolation, and disconnection?

The full paper, including the survey findings, clinical reflections, and references, is available here:

[Read The Invisible Toll of the Current Sociopolitical Climate]

About the Author

Erik Karff, LMFT is a San Francisco psychotherapist and founder of Eureka Center for Psychotherapy (Now accepting Blue Shield, CA). His work is relational, depth-oriented, trauma-informed, and attentive to the ways attachment, identity, social context, and community shape psychological life. He works with individuals and relationships and facilitates restorative spaces for LGBTQIA2S+-affirming clinicians in the Bay area.