Therapy is complex, grueling — and rewarding
Not Done with Therapy
I don’t need a therapist.
Not me, nuh-uh, I’m totally okay, totally.
That’s what I tell my 11th grade mechaneches when she corners me shortly after my parents’ divorce. That’s what I tell my aunt, the only one I’d ever opened up to about what was going on at home. That’s what I tell my principal, my mother, my grandmother, myself.
But at some point, when I’m so worn down and things have reached new levels of unbearable, I give in. It takes fewer than ten minutes for Mrs. Green, the mechaneches, to hand me a pale green slip: Tuesday, third period.
The school social worker has an office with a separate entrance, no windows overlooking the school grounds, a noise machine humming in the background. It’s safe and private and I feel a tiny stirring of hope. Maybe this will help?
Mrs. Weiss takes notes as I speak. I talk and talk, she writes and writes. She barely says a word until the time is up, and she tells me to come back next week, same time. We can discuss solutions next time, she says. I leave feeling relieved. This was okay. Besides, Tuesday third period is social studies, my least favorite subject.
The next Tuesday, I’m outside the door, right on time. There is murmuring from inside… can that be the noise machine? It kind of sounds like voices. I knock hesitantly, and Mrs. Weiss swings the door open with a big smile. “Come inside, Leeba, come in.”
She’s too loud, too jovial. I step in, suddenly wary. There’s someone else in the room.
The room spins.
Mrs. Weiss tells me to sit. I want to run, run, run, but the door is closed and I feel trapped. Mrs. Weiss takes out her notebook, filled with my words, my secrets, all the pieces of my broken heart.
And she starts to read it out, word for word.
“It’s important that your mother knows,” she says, afterward. “It’s better this way.”
But it isn’t better. She’s made everything a thousand times worse.
I don’t go back to see Mrs. Weiss after that. I don’t reach out anymore. Professional help tastes of betrayal, sharp and painful.
It’s a few years and several major life changes later that I decide to try again. This time, it’s my own choice. My aunt recommends her friend, Mrs. Jacobs. I walk around the block six times before knocking on the door.
Mrs. Jacobs is warm and motherly and expressive. She oohs and aahs about my experiences. She tells me I should never have been treated like that, ever, and she teaches me breathing exercises. We talk about thoughts, feelings, and emotions, and she tells me everything’s just a matter of changing thought patterns. I see her for three months. It doesn’t help.
Later, I learn about the difference between cognitive-behavioral and experiential modalities. I learn that CBT isn’t going to help me access, process, and heal from deep-set traumas. I learn about attachment theory and ego states and transference and the role of the therapeutic relationship in the healing.
I learn this in Gila’s office, when I brave trying one more time. By now I’m juggling a family of three children, work, household, finances. But this is important. Therapy takes $10,000 and five years. It’s wrenching and healing and introspective and shockingly freeing. It’s grit and struggle and challenge and work, it’s light and revelation and connection and love.
My world begins to revolve around the weekly sessions. I crave the connection, the slice of time carved out just for me. For one hour, I’m the most important person in the world to someone who means the world to me.
The transformation isn’t magical or sudden. It’s a slow process, like an imperceptible dawning that you can’t quite pinpoint, night somehow turning into morning. I feel more confident, more whole. My attachment style shifts from anxious-ambivalent to secure. I try new things, leave my dead-end job with the critical boss, take the leap and open my own business. My relationships with my husband and children improve.
And then somehow, things start to plateau in therapy, and even slide downhill.
It starts small, a comment here and there. When I mention to Gila that I want to visit my father, who is hospitalized, she insinuates that I shouldn’t, I’m dealing with too much. Are you sure you want to? You have enough on your plate.
For the first time, I feel like she doesn’t really understand. She doesn’t realize my strengths, how far I’ve come.
I fly out to visit my father, taking my baby along for the trip. It’s the best — and the hardest — decision I’ve ever made. The visit is not pleasant, it’s tough and triggering and brings up a host of negative emotions. But I do it, and I’m proud of how far I’ve come. I fly home triumphant — and a little disturbed. Why did Gila think I couldn’t handle that?
I start to cancel appointments, schedule monthly instead of weekly. I try to be open and share, but it feels like Gila is stuck somewhere in my past. When I discuss my husband, she reminds me of things that we struggled with a few years back. But things are different. I’m different. She just can’t seem to un-see the me who walked into her office all those years ago.
I keep trying, because we’re so close. Gila knows me, my history, maybe even better than I do. She’s warm and loving and wise and perceptive and strong.
But after a few sessions that go completely awry, I realize: she doesn’t understand me anymore. I’ve changed too much. She’s insisting on treating the client I was, not the client I am.
So I take my leave. I smile and tell her things are busy, I’m doing great, I’ll be in touch if and when I need a session. I coward out of explaining what’s really happening, because I feel like she’ll throw it right back on me: You’re just saying that to avoid talking about the problems I’m pointing out. That means they really ARE issues.
Because I can’t argue with that unanswerable logic, I just leave. I’m grateful to Gila; she changed my life, I’m the person I am because of her. But she’s not the therapist I need now.
I’m done with Gila, but not with therapy. I have things to work through. I know what they are; I’m deeply self-aware, highly intuitive. I’m honest and bright and know more about therapy and the therapeutic process than most laypeople out there.
I don’t need someone to tell me about thoughts being the root of emotion and action. I need someone who knows more than me. Who can figure out the pieces of the puzzle I still haven’t cracked, five years into the process.
I do need a therapist. I need one, and I want one. I just don’t know where to find the one that I need.
Clinics Can Be the Answer
In your last installment, you asked: “Are clinics really the answer?” I’d like to respond with a resounding “YES!”
With over 20 years of experience as the Chief Clinical Officer of Achieve Behavioral Health, I’ve seen tens of thousands of patients treated at a clinic, and have a significantly divergent view than the ones you offered. I’m very proud of the amazing transformation in our community’s approach to mental health, and the role that clinics like Achieve have played in shaping that transformation.
Just as not all therapists are equal in expertise, commitment, and quality, so too, no two clinics are the same. But here are some pointers to keep in mind:
Clinics are the primary place where people receive behavioral health services. At Achieve, we currently serve over 5,000 people and provide over 110,000 sessions annually. If you multiply this across multiple clinics, we’re talking over 1 million sessions serving over approximately 50,000 people in our communities. All provided at low to no cost to those who need it.
And that’s exactly how it should be. Emotional health shouldn’t be a luxury. Access to quality care and preventive services should be available for everyone — for those in financial need and those who are “comfortable” and choose clinics because of their quality, outcomes and array of services.
Systems are good, not bad! Your article touts the benefits of boutique clinics, comparing them to the service received at a corner shop versus Walmart. But there’s a reason so many people shop Amazon — it’s developed systems that support the customer. Similarly, a clinic’s systems and oversight to support the work between therapist and client makes the work more accountable and the process stronger. It’s not unlike choosing a major medical center over a local hospital, despite its size and treatment by residents, because of the system of care.
Leadership and good management matter. As noted in the article, look to the clinic’s director and supervisors to get a sense of its worth. Good leadership leads to good outcomes. Many (though not all) clinics are led by serious leaders and experienced practitioners who build up a solid system.
Training is essential. Supervision, oversight, and training lie at the heart of the added value of clinics. Many experienced clinicians stay with us to benefit from the rich learning and growth opportunities that working in a clinic offers.
It’s not all about the paperwork. Supervision should never just be about paperwork. If it is, that’s bad practice. That said, it’s also untrue to state that paperwork is just a technicality and waste of time. Formulating a treatment plan — in writing, and evaluating what does and doesn’t work with the client — is an excellent clinical tool that clarifies the therapeutic process.
Who works at clinics? Your article claims that most therapists working in clinics are interns or those too fresh to work privately. That’s patently incorrect. While some of the therapists in clinics are interns or early in their careers, many of our clinicians and psychiatrists have years of experience, and yes, even thriving private practices. With competitive salaries, training and strong collegial support, there’s much less turnover and clinicians can make careers in clinics as clinicians, supervisors, and leaders.
Look at the data. How do you know that private practice leads to better outcomes? Do they have data to show it? We do! Systems allow for oversight and clinical measurements to assess client outcomes — because they’re systems that care about clients and have the scale to do it.
Clinics have the advantage of being able to provide fully integrated care across multiple services. In our case, this includes therapy, psychiatry, primary care, crisis services, case management, psychosocial rehabilitation, and peer support. Integrated care leads to greater cooperation, communication, and success for clients. This is particularly crucial for complex cases, and indeed, we’ve lowered the need for hospitalization, even in difficult situations, by well over 75 percent.
Mental health clinics offer incredible access to a wide range of services and high-quality care for all. It’s essential that leaders, providers, and clients take a fresh look at these services and appreciate their professionalism, contribution, and impact.
Isaac Schechter, PsyD is the Chief Clinical Officer of Achieve Behavioral Health (formerly CAPs) in Rockland and Orange Counties, NY. Achieve was one of the first Certified Community Behavioral Health Centers in the country — a federal designation bringing innovation, excellence, and a broad base of behavioral health services to the community.
Private Not Shameful
I recently had a conversation with a member of our community regarding the stigma associated with going to therapy. Since then, I’ve been wondering how it is that while the number of frum therapists has grown exponentially, there’s still a barrier to feeling comfortable with seeking help. I still hear from people who don’t want their spouses or children to seek help, people whose mentors have told them not to go to therapy.
I think there’s a mischaracterization that fuels this stigma. Generally, the way we destigmatize things is to publicize them, to shout them from the rooftops. We could ask people in therapy to talk about it publicly to take away the mystique and mystery that surrounds the therapist’s office — but this idea makes me profoundly uncomfortable.
One of the most important elements of therapy is confidentiality. The environment is private. The content is private. Even the relationship is private. If I see a patient in public, I don’t wave, I don’t even make meaningful eye contact, so they don’t have to explain to anyone how they know me. When I have patients who may know each other, I try to schedule them in a way that will avoid them possibly meeting each other. Federal statutes dictate very few circumstances under which one can disclose any information about an identifiable patient.
Is it possible we confuse privacy for shameful? Is it possible that when we do all we can to protect the privacy of those in therapy we feed the narrative that there’s something shameful or dirty about seeking help, that there is something broken in those that do?
The Navi Michah tells us, “Mah Hashem doresh mimcha? Hatznea leches im Elokecha. — What does Hashem require of you? Walk with tzniyus with your G-d.”
Although the word tzanua is often translated as “modest,” it can be more properly understood as “private” or “hidden.” We generally cover the private parts of ourselves — whether physical or emotional — as if to say, “This is special, this is not for public consumption.” It’s very easy, however, to mistake this idea for shame, embarrassment, or rejection of the thing or idea we are covering.
We’re spiritual beings in physical bodies. This presents a challenge to the simple understanding of things like privacy and modesty. However, that doesn’t absolve us of the responsibility to seek the nuance and true meaning of these ideas.
The question of how we, as a community, can allow this sacred space to be shared with someone who is not friend or family is an important one. It cannot, however, be used to feed the stigma that distorts what this important resource is really all about.
—Binyomin Yudin, LISW-S
Binyomin Yudin LISW-S is a psychotherapist in private practice in Cincinnati, OH
I Don’t Need Therapy — But It Helped
I grew up with the word “therapy” tossed around my house about as often as “potato kugel.” My father, who’d benefitted significantly from therapy, used to tell us all the time how beneficial therapy can be for everyone and anyone. I’d nod, thinking that obviously there was nothing wrong with therapy; people who were too embarrassed to go were just silly.
And then my father turned it on me. When he told me he thought I needed therapy, I suddenly realized that it wasn’t quite as simple as I’d thought. Did this mean I was out of control, dysfunctional? Did my father think I wasn’t normal? Of course therapy wasn’t embarrassing —but it wasn’t for me.
I’d had a very hard time coming home early from seminary. Seminary had been an incredible experience; I was able to spread my wings and make friends whom I connected with deeply. I thought a lot about who I was and grew tremendously in almost every way. I was definitely not ready to leave when the world suddenly shut down because of COVID-19, and we were sent home three months early amid an ocean of tears.
Adjusting to the sharp contrast of family, family, family after nothing but friends, friends, friends was very difficult for me. The suddenness and lack of mental preparation made the adjustment even harder. My seminary also told us repeatedly that they were trying to get us back in Israel before the end of the year. This kept me in denial for months — I thought I was going back and refused to let myself settle in at home. Then, of course, there was quarantine, which cut off any possibility of in-person social interaction.
So, okay, maybe I wasn’t perfectly fine. Maybe I was miserable. But with every passing day I was able to better appreciate my family and look forward to the future. With every week I regained a little more of my natural positivity. With every month I grew into a better person. I was proud of how far I’d come.
And then my father told me I needed therapy. Which felt like he was telling me that all my efforts, all that impossibly hard work, all that growth, wasn’t good enough. I was still a mess. I couldn’t handle my life. I needed therapy.
I eventually agreed to go when my father clarified that he didn’t think I needed therapy, he just thought it would give me important life skills. And six months later, I’m eternally grateful.
Grateful to my father, and grateful to my incredible therapist, who has helped me in countless ways. She’s made me feel normal about so many things I was self-conscious about and given me endless compassion and sympathy. But she didn’t just sit there and validate; she helped me figure out where my reactions were coming from, helped pinpoint some underlying mindsets. I’ve learned so much about myself and my relationships. Week after week, therapy has been eye-opening, enjoyable, and gratifying.
So why am I still embarrassed? I think back to the articles I’ve read about people in therapy. They’re about people who struggle to function in day-to-day life. They involve intense phobias, major crises, and sometimes even abuse. But how many articles are there about people who are functioning perfectly fine, who don’t really need therapy — but who still find it helpful?
I don’t remember seeing any of those articles — so I decided to write one. Self-discovery is a huge and essential part of life that many people completely ignore. Intellectually, I believe that going to therapy should be respected, a sign of a person who is well-developed, self-aware, and seeking to grow. In real life, though, I’m still embarrassed.
But someday, hopefully, I’ll be proud.
(Originally featured in Family First, Issue 748)
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