I didn’t know that Aharon was a fellow psychotherapist when he initially called to book the appointment. He’d gotten my number from a colleague of mine and called for a consultation, explaining that he was feeling out of sorts.

“I think I’m depressed,” he said. “I mean, work is getting to me, and I need another professional to talk it over with.”

After a few more questions, we scheduled an appointment and Aharon hung up the phone, only to call back a few moments later.

“I just thought I should tell you, I’m actually a social worker and therapist,” he blurted out nervously. “Is that okay, I mean, do you see fellow therapists as patients?”

“I’ll see anyone who isn’t a child abuser or an arsonist,” I said.

“I’m clean on both fronts,” Aharon laughed.

Some therapists shy away from seeing their colleagues as patients. There are lots of good reasons for this: difficulties with maintaining professional boundaries, increased odds of running into a patient in a social or an academic setting, and many others. For me, there was an added achrayus in being a doctor for patients who happened to be mental health professionals themselves: the duty to provide them with high-quality care, coupled with the duty to make sure that the patients of these professionals would have functional treatment providers themselves.

Aharon came to the office looking much like any of the other avreichim, professionals, and mainstream chareidi men I’d see over the course of the day. He was in his early thirties, was wearing the standard white shirt and black pants with a short beard that made him look as normal as could be. The fact that he arrived with a small sefer Tehillim made him even more inconspicuous.

He sat opposite me and began to tell me the story of his life. He came from a good family, had a mainstream yeshivah education, went on to Ner Israel in Baltimore, got married, and obtained his Master’s degree in social work from The University of Maryland while learning part-time in kollel. After a few years working with various local programs, he and his wife decided to join her parents who had moved to Israel after retirement.

Aharon had made a name for himself as a therapist for at-risk boys in the greater Anglo community. He’d developed relationships with a number of American yeshivos from Har Nof to Ramat Beit Shemesh, where his focus was OTD kids and substance abuse. Aharon was generally happy with the work-life balance he’d created for himself, including his unwavering nightly chavrusa.

They weren’t rich, but Aharon and his wife were happy with making ends meet in order to live in Eretz Yisrael and to live in a Torah community. But then Aharon’s wife left her teaching job due to the birth of their twins the previous year. They decided she would stay at home with the kids and that he’d pick up some extra work by seeing patients at night for a few months. It meant cancelling his chavrusa, but he rationalized that it was just for the summer. Yet when his wife’s job was given away for the rest of the school year and they suddenly needed a new minivan, Aharon felt forced to keep working overtime — and three months later was starting to break.

“I’ve been really stressed recently, Dr. Freedman,” Aharon lamented. “You joked with me about being willing to treat anyone besides arsonists and child abusers, but I’ve had both the past week. I had a long-term patient who was drinking Motzaei Shabbos and left a lit cigarette in his parent’s apartment, nearly causing the whole building to burn down.”

“That’s not exactly arson, you know,” I commented. “I’ve worked with real arsonists in the past, including a guy who had torched his boss’s car after being fired.”

Aharon gave me an irritated, quizzical look and said, “Well, it was still stressful to be involved in the family meeting afterward. And I held another family meeting after learning that one of my patients is in the second category. I’m telling you, I’m stressed.”

Aharon went on to describe many of the classic signs of burnout, or “provider-fatigue.” He felt tired and drained in the office despite getting more than enough sleep. And he was manifesting the psychosomatic back pain, muscle aches, and headaches of an overworked healthcare professional.

“Aharon, you don’t have many of the defining and classic signs of clinical depression or anxiety, but you’re certainly suffering and there is a definitive connection between your symptoms and the intensity of your work. You need to find a way to get your work-life balance back. There is some serious research out there suggesting that protecting family and personal time helps a person to beat this kind of impasse.”

Aharon nodded in agreement so I continued.

“Look, on one hand you need to pay the bills, but on the other hand you’ve given up a great chavrusa and the yishuv hadaas that comes with studying Torah. That’s the fuel that keeps you going the next day.”

“And working through Chol Hamoed didn’t help either,” he admitted, then rose apologetically. “I’m actually late for a meeting now. I need to run, Dr. Freedman.” And he did.

Aharon called to schedule a follow-up appointment a few days later. He arrived and looked even worse this time, with his shirt half-untucked and a wad of tissues in his hand.

“Not only am I burned out, Dr. Freedman, now I also have a cold.”

“Aharon, you probably have a cold because your immune system is taking a beating with all this stress.”

“You know, I’m starting to crack in the office, too. I yelled at a patient the other day,” he said dejectedly. “I know I’m not doing too great, but I need to pay the bills.”

“Aharon,” I said, “I’m gonna tell you a quick story. Dr. Carver ran the vascular surgery department when I was a medical student and was known for his surgical acumen as well as his temper. The man could kill you just as fast as he’d stitch you back together. Anyway, one time there was an obese Latina woman sitting in the waiting room for her appointment. When he called her name and she stood up, grabbing her soda and dusting the potato chips off of her lap, he couldn’t control himself and began screaming, ‘You have diabetes and need me to amputate your toes, and have the gall to bring junk food and Mountain Dew to my clinic! Get the heck out of here!’ ”

“Wow, what happened next?”

“She started crying and he stormed back into his office where he screamed at his helpless medical student — me — until he began to feel chest pains and I rushed him off to the emergency room where he was evaluated for a heart attack!”

“Oy vey,” said Aharon. “I gotta figure this out soon.”

“As your colleague, I’d say you’re at risk of being an ineffective therapist if you continue this way. As your therapist, I’d say that you need a vacation and to focus on learning some mindfulness and relaxation strategies as you get your work-life balance back in order. We’re going to aggressively help you to take care of yourself, or else you’re going to be unable to take care of your patients.”

“Hmm…” Aharon thought out loud. “You know, Dr. Freedman, this is going to be tough, but maybe I can start by getting my chavrusa going again.”

Originally featured in Mishpacha, Issue 731. Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman can be found learning Torah in The Old City or hiking the hills outside of Jerusalem.  Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.