Dr. Vivian Weatherby sees clients in a converted Victorian on Burlington's Hill Section, where the radiators clank and the windows frost over in patterns that arrive later each year. She moved here from Oakland in 2022, after the smoke seasons started blurring together and she realized she was prescribing Xanax to half her practice for air quality alerts.
Now she's part of a small but growing cohort of therapists who've added "climate-aware" to their credentials. A specialization that didn't exist when she finished her doctorate. One she's still figuring out how to practice.
The Climate Psychology Alliance directory lists over 300 providers now1. Weatherby laughs when I mention this. "That's 300 out of, what, 700,000 therapists in the country? We're basically making this up as we go."
She's 47, speaks with the measured cadence of someone trained to hold space for difficult emotions, but occasionally breaks into something more raw. Today she's drinking tea from a chipped mug that says "Keep Calm and Carry On."
"Deeply ironic given my patient load," she says.
What does climate-aware therapy actually mean?
Vivian: I wish I had a clean answer. The official line is that we're trained to recognize climate change as both a global threat and a deeply personal one. To help people process eco-anxiety, climate grief, all of that.
But in practice? I'm mostly trying not to pathologize perfectly rational responses to existential threat while also helping people function enough to go to work and feed their kids.
The training is minimal. I took a seven-week online course2. Seven weeks to prepare for treating the psychological fallout of planetary systems collapse. But it's something, which is more than most therapists have.
How did you end up specializing in this?
Vivian: I fled California and then realized I was treating climate refugees while becoming one myself.
I had a practice in Oakland. General anxiety and depression, some couples work. Around 2018, 2019, I started noticing this pattern. People coming in ostensibly for other things, but everything was tangled up with climate. Insomnia during fire season. Panic attacks when checking air quality apps. One woman spent every session talking about whether to have children, and we both knew what she was really asking.
By 2021, I was prescribing benzos for smoke-related anxiety more than anything else. And I was taking them too, honestly. You can't breathe through September and October and pretend you're fine.
So I left. Moved somewhere that still has winter, supposedly.
What's your patient mix like now?
Vivian: [Laughs] It's this weird bifurcation.
Half my practice is people like me. Climate migrants from California, Oregon, Arizona. Tech workers who can work remotely, retirees who sold their homes for absurd amounts and bought here for half. They're processing displacement, guilt about being able to leave, anxiety about whether Burlington is actually safe long-term or if they just bought themselves a decade.
The other half is locals who've been here forever and are watching their world transform. Maple syrup producers whose seasons are collapsing. Ski instructors at resorts that barely open anymore. People whose family farms are dealing with weather they don't recognize.
That group is angry in ways the migrants aren't. It's not abstract for them. It's their grandfather's orchard producing apples that taste wrong now.
Do you treat those groups differently?
Vivian: I try not to, but yes.
With the migrants, there's often this need to process privilege. They got out, they have resources, but they're also grieving places they loved. That's real. With the locals, it's more about witnessing. They don't need me to explain climate change. They need someone to acknowledge that what they're experiencing is loss, not just "change." Their emotional knowledge is ahead of the data.
The hard part is when I have them back-to-back. Last month I had a session with a tech guy from Palo Alto processing guilt about his carbon footprint, followed immediately by a dairy farmer whose herd is heat-stressed half the summer now.
The tonal whiplash is intense. And I'm sitting there thinking, should I be telling the tech guy that his guilt is less important than systemic change? Should I be validating the farmer's rage at people like my previous client?
Nobody trained me for this.
There's research showing 45% of young people said climate worry affected their daily functioning3. Are you seeing that?
Vivian: Oh, constantly.
I have several Gen Z clients who are just stuck. Paralyzed by the impossibility of planning for a future they don't believe exists. One woman, 23, brilliant, can't finish her master's thesis because she keeps thinking "what's the point?" She's not wrong to ask that question. But she also needs to pay rent.
The tricky thing with young people is distinguishing between climate anxiety and regular developmental anxiety about the future. Except you can't really distinguish them anymore. Climate is the future.
So we're back to: how do I help someone function in a world that might not function much longer?
What about your own climate grief?
Vivian: [Long pause]
I miss California in ways that feel embarrassing to articulate. I miss the specific quality of light in Oakland in October. I miss trails I used to hike that probably burned. I have dreams where I'm back there and the air is clear and it's 2015 and everything's fine, and then I wake up here where it's fine—for now—and I feel guilty for leaving and guilty for grieving and guilty for being able to afford to leave.
And then I have a session with someone processing almost identical feelings, and I have to be the stable one. The container.
It's a lot. I see my own therapist, obviously. She's not climate-aware, which is actually helpful. I need one space where I'm not thinking about this professionally.
Is climate therapy just for people who can afford therapy in general?
Vivian: Yes. Absolutely yes.
That's the crisis within the crisis. The directory of climate-aware therapists is 300 people, mostly in expensive cities, mostly charging $150-300 per session. Meanwhile, the people experiencing the most acute climate impacts—farmworkers, people in flood zones, communities near refineries—they're not getting specialized climate therapy. They're getting, if they're lucky, overworked social workers at community health centers.
I do some sliding scale work, but it's a drop in the bucket. The whole model is broken. We're treating individual anxiety about a collective problem, and only for people who can pay.
It's like offering meditation classes on the Titanic. Maybe helpful for the people who can access it, but not addressing the actual situation.
So why do it?
Vivian: Because people are suffering and I can sometimes help?
I know that sounds defensive. But when someone comes in completely undone—they can't sleep, they're having panic attacks, they're stuck in climate doomscrolling—and we work together and they get some capacity back, some ability to engage with the world again... that matters. Even if it's individual and insufficient and not solving the systemic problem.
Also, honestly, the work is interesting. I'm watching in real-time as people develop new psychological frameworks for living with uncertainty. Some of my clients are doing things I find genuinely moving. Building mutual aid networks, preparing their communities, grieving while still showing up. Others are making peace with not having children, or leaving careers, or radically changing their lives.
As a therapist, you're witnessing people navigate truly unprecedented territory. It's terrifying and fascinating.
What do you tell people who ask if Vermont is safe?
Vivian: [Laughs] I tell them I'm not a climate scientist and then I tell them anyway.
Vermont's relatively better positioned. Water access, cooler temperatures, though that's changing. But we're getting intense rainfall events, flash flooding. The 2023 floods were worse than Irene. And the social infrastructure is fragile. We're a small state. If we get a real influx of climate migrants, which we probably will, the systems might not handle it.
But people don't really want a risk analysis. They want me to say it's okay to stay, or okay to leave, or that there's a right answer. And there isn't.
There's just: What can you live with? What can you afford? Who do you want to be near?
Those are the only questions I can help with.
Do you think climate-aware therapy will become standard?
Vivian: It has to, right?
Climate change is already affecting mental health on a massive scale4, and it's going to get worse. Every therapist is going to be a climate therapist whether they want to be or not. The question is whether we'll get training and support, or whether we'll all just be winging it like I am.
I think about my colleagues who are still pretending this isn't their problem. Treating climate anxiety as an individual pathology to be managed rather than a rational response to reality. That position is becoming untenable. You can't do good therapy while ignoring the context people are living in.
And the context is: the planet is becoming less habitable and nobody's stopping it.
So yeah, we'll adapt. We always do. But I think we're going to be dealing with levels of collective grief and trauma that the profession isn't remotely prepared for.
I'm watching it happen in my practice already. The baseline anxiety level has shifted. What would have been a crisis response five years ago is now just... Tuesday. People are developing this low-grade chronic stress that never quite resolves because the threat never quite resolves.
We don't have good treatment protocols for that. We're improvising.
Dr. Weatherby is a composite character based on reporting about the emerging field of climate-aware therapy, representing authentic experiences from multiple practitioners navigating this new specialization.