| Family First Feature |

Can You Help Me? 

How to ascertain if your therapist is competent, caring, and the right match for you

Narrative by Malka Jacobs

 

"I see your nose. What kind of device are you using?”

“A tablet. With a stand.”

“You have to position it straighter. Do you have a tabletop stand?”

The heat rose to my face as I fiddled with the device to get a good view.

“I’ll just close my eyes,” Rachel said. “I’m getting dizzy. Let me know when you’re set.”

I adjusted the tablet as I watched Rachel doing deep breathing, her eyes indulgently closed.

“I’m ready.”

“Okay.” A smile. “So, Malka, how are you?” The start to our weekly session.

It was during the first wave of coronavirus and I’d met Rachel, my therapist, in her office only once, for my intake session. Then the country had closed down.

With Zoom new to me, I hadn’t yet been ready to meet face to face over a device. I opted for telephone calls for the following sessions. Until the previous week, when I’d left the session unsettled after feeling vibes of exasperation flowing through the wires.

“Why are you going so fast?” Rachel had asked me, when my anxiety reared its fearful head and I bombarded her with questions. Her voice was hard.

See? I chastised myself, writing in my journal that night. Everyone gets exasperated with you. Even the person you’re paying 250 bucks an hour to listen to you. The mighty Rachel also finds you annoying. You are annoying. That’s the fact.

Tiny seeds of doubt were starting to surface. But, I wrote, it’s probably because I’m not seeing her face to face. It’s only because I can’t see the compassion and care she probably shows while she delivers these words.

Because I knew Rachel was supportive, helpful, and cared for me — she was a therapist! And anything she said was surely therapeutic and premeditated, aimed to help me heal and become a better person.

So even though Rachel tried to dissuade me from switching to facetime (“Anxious and avoidant people usually prefer the phone,” she’d said), I insisted. Surely this faceless talking was why I was feeling so uneasy about my therapy.

During our first Zoom session, I unleashed my anxiety. I was so tense after our sessions, I explained. I was in turmoil all week. Therapy was taking over my life and overwhelming me.

She ran with it, explaining that anxiety of this intensity is not something therapy alone can deal with. “Do you want my advice?” she asked.

I nodded. Of course I did.

“Medication,” she said, nodding knowingly.

I blanched, but I was going to be mature about this.

“Look,” I said after a pause, “it’s not like I’ve never entertained the thought, but can we back up? Discuss this?”

“I’m very practical,” she said, her face inscrutable. “I’m brilliant—” a laugh — “but also very practical.” She gave me a psychiatric nurse’s number. And then sipped slowly from her 20-ounce tumbler of infused water, giving me a view of lime slices and her chin.

I tried returning to the topic.

“I need to digest this. It’s a lot to absorb. Just a few weeks ago I didn’t think I was dealing with anxiety at all. I’m starting to break away from that denial, but can we take this more slowly?”

“Yes,” she said with a grin. “I won’t forget how you sat at the edge of your chair that first session, coat on, vehemently denying that you had anxiety at all.”

I laughed along but I was not amused. I was hurt. But I was there to hear the hard truths, to be whipped into shape, so I continued.

The deep breathing was so hard for me, I confided. There were tears in my eyes at this point. “Can you guide me? Also, I need help leaving the session a little more settled.”

“YouTube,” she said. “There are hundreds of breathing tutorials.”

But I didn’t do YouTube.

“Well, we can send you to a physical therapist.” A shrug.

I’d already been to physical therapy. And had told her so more than once.

I looked at the clock. Fifty-seven minutes into our session. My hands started getting clammy.

“So you have three minutes now,” I said jokingly, but there was panic lacing my laugh, “to prepare me for handling the coming week.”

A look of shock crossed Rachel’s face as she slammed her hand on her desk, suddenly looming large on the screen. “What? Do you think this is even fair?! To pull this on me just as the hour is up?”

I chuckled as I waved goodbye, thinking she was just raising her voice for theatrical effect.

But she was back on the screen after a flicker.

“And I’m fine! Fine! Okay? I came back to tell this to you because I know you. Otherwise you’ll feel bad all week.” The screen went blank.

Oh, so she’d been serious. I hung my head, mortified. What had I done? I guess I really can be totally exasperating.

***

“It’s not about her, it’s about you? You know that, right?” Shoshi is several years younger than me, but she’s one of my most astute advisors. I filled her in on the medication bombshell via email. She was pro. (“Not a bad idea. I’ll come nosh some.”)

She saw where my husband was coming from when I shared his reaction: “You are not going back to her,” he’d said. “This is the beginning of the end! First you take meds, and then you get addicted, then you get hospitalized, and then they blame the husband.” That’s my man, the biggest opponent of all things mental health.

But about Rachel’s reaction, Shoshi was less cool. It didn’t sound good, she emailed, but therapists were human too. Do your research, she suggested. See if the organizations recommend her. And ask if she’s supervised. Tell her your husband is freaking out and insists on speaking to someone who can vouch for her. If she’s good, she’ll be cool and give you the info.

I also had a half a mind to ask some people about Rachel. I’d seen her work experience on her profile and had some ties to the organization she’d worked at. But oh, the shame. How could I admit I was seeing a therapist?

So I called Relief Resources, but chickened out before leaving a message. And I never had the guts to ask Rachel if she’s supervised.

 

Really, I should’ve done my research before I’d started.

But I sort of fell into the whole thing. I hadn’t even been looking for a therapist when I’d made the initial appointment. I was simply going to figure out how to relate to my daughter better. After long months of her seeing a variety of therapists, and with her treatment stagnating, I wondered if her behavior was tied to my mishandling of it.

So when Gitti, my daughter’s trusted therapist, referred me to Rachel, I didn’t blink. When Rachel quoted her inflated price, I agreed. After all, I was just going for two or three sessions of coaching to learn how to handle my challenging daughter.

But my presenting problem was pushed to the side at my intake session, and Rachel only wanted to hear about me. Suddenly, I felt so seen. I liked the idea of sorting through my many issues. And I was taken by her realness; she didn’t beat around the bush.

I didn’t have anything to compare the experience to, so I didn’t realize that asking intrusive questions ten minutes after meeting a person is not the accepted thing, even in therapy (especially in therapy). And I didn’t pay attention to the fact that she professed to know everything — even when her subsequent questions proved how clueless she actually was about the issue at hand. I just saw this as a special place to take care of myself.

Emotional Scalpel

Just a few short decades ago, therapy was only for extreme cases of mental illness, and would be spoken about in hushed whispers.

Today, books and magazines talk matter-of-factly about therapy, everyone and her sister has seen a therapist at some point, and social work is a popular career choice.

Even as therapy has become a welcome staple in our communal lives, awareness is growing that therapy is a scalpel — potentially lifesaving, but dangerous when mishandled. If talking can heal emotional wounds, it can also inflict them.

Poor therapy can cause clients to blame themselves for emotional problems they never truly had, exacerbate the symptoms of existing disorders, or cultivate a codependent relationship with a therapist.

While studies examining the risks of therapy are far less common or rigorous than those studying side effects of psychotropic drugs, existing evidence suggests that approximately ten percent of patients fare worse after starting therapy, and five percent report lasting adverse effects.

Though the research doesn’t adequately explain why some individuals suffer, we need to ask: What goes wrong for some people? And how can we prevent it?

Someone in acute emotional distress is unlikely to be in the optimal frame of mind to evaluate the quality of her care. And unlike the biological sciences, where blood tests or EKGs can measure health, there are few concrete goalposts that can give an accurate picture of someone’s mental health. A practitioner’s competence or a client’s success, therefore, can be subjective and difficult to measure.

Given the intensely personal nature of therapy, and the lack of objective markers of success, how are you to know if you’re getting the best possible service? How can you assess when it’s time to move on from your current therapist, or graduate from the entire therapeutic process?

Therapy at Work

You can buy the most expensive drill in the world, but if you don’t know how to use it, you’ll make holes in the wrong places. Therapy is also a tool, says Mrs. Devorah Levinson, referral specialist and Director of Eating Disorders Division at Relief Resources, and clients need to learn how to use it.

First, you need to figure out what you plan to build, which is where goal setting comes in. From the very first session, it’s important to establish goals for the therapeutic process. What would success look like? How do we intend to get there?

Esti, who tried numerous therapists before finding the right fit, learned the hard way to be upfront about her expectations. When she wanted acute short-term help dealing with her broken engagement, she found herself mired instead in lots of talk about her childhood, until she realized she had the right to set the parameters.

“If you don’t know where you’re going, you’ll get lost,” she says. “If you hire a tutor for the MCATs, you have a right to say, ‘This is what I’m hiring you for.’ In therapy, you can say, ‘This is my issue, this is my timeframe, this is my goal. By the end of this time period, I want to be better at dating, or at managing what I eat.’ ”

But what if your expectations are unrealistic? A client may underestimate the time needed to work through certain issues, or may hamper her progress by being unwilling to discuss issues that, to her, seem unrelated. Indeed, what may seem off-topic to a lay person may prove critical, says Bassie Rosenblatt, LCSW, a social worker in private practice in Brooklyn and Lakewood.

“Often, people say, ‘I’m not here to talk about my past,’ but they’re shortchanging themselves,” she relates. “If they understood how their behaviors stem from the parenting they received, they’d have a keener understanding of their problems.”

That’s why being comfortable communicating openly with your therapist is critical. If she thinks your goals are overly optimistic, she can explain why, and recommend how to adjust your expectations.

If you’re still unconvinced, use a trusted resource to provide an objective reality check. If more than one person thinks you’re being unrealistic, it may be time to reassess.

Of course, people’s lives rarely fit textbook narratives. “People don’t always know what they want,” says Mrs. Rosenblatt. “They just want things to be good. There’s not always a clear path.” In such cases, a competent therapist will guide the conversation to goal setting, isolating the key problems the client is facing and defining what success could look like. If you’ve had more than two sessions and still don’t have a clear picture of how the therapist intends to help you improve your life, it’s time for a pointed conversation.

This Doesn’t Feel Right

Is therapy comfortable?

No.

Facing fears, flaws, and shadows of the past can be frightening, even painful.

But when is discomfort normal and when is it troubling?

There’s one surefire prescription for any unease you experience during therapy: Talk about it. If a therapist does something that causes discomfort, if you feel hurt or confused, therapy doesn’t seem to be progressing or if your issues seem to be worsening — talk about it.

“No one should be afraid to say something to her therapist,” explains Mrs. Levinson. “If it doesn’t feel right, don’t follow blindly — discuss it.”

Perhaps you were so shaken up by discussing your childhood trauma that you couldn’t work for the rest of the day; perhaps you felt the session veered off-topic. Maybe it bothered you that she wrongly answered a text during a session. Your therapist needs that information.

Having frank conversations about therapy should be expected, explains Mrs. Levinson. “When I first started, I thought my job was only about finding the magical right therapist. Now, thirteen years later, I find I spend a lot more time educating people to better utilize the help they’re getting.” In her experience, some clients can even do better with average therapists with whom they feel comfortable communicating than with top-tier experts with whom they’re hesitant to air concerns or discomfort.

“If you want a new therapist, I’ll give you one,” she says, “but once you’ve already spent time, effort, and money — go back and have the difficult conversation. Many times,people are surprised by how beneficial that can be.”

If you’re unsatisfied with her answers, or something still doesn’t seem right, talk to an objective third party, such as a rav or Relief, who can confirm whether you have grounds for concern.

 

I was in a worse position than ever before, and I hid in my walk-in closet writing furiously in my journal. Everything was escalating. My fuse was short, my anxiety had reached new heights. My internal turmoil was only compounded by the virus, the deaths, the racking cough consuming my family, the kids underfoot 24 hours a day.

Every time a car beeped outside, I froze, expecting tragedy, envisioning one of my own under a tire. Every siren sent me into a panic. My body was so tense, even lying in bed hurt.

Sadness draped itself like a black cloak around me. I was crying incessantly, alternating between the waves of pain stirred up by the intense probing in session, and the crushing feeling of rejection. There was a record playing in my mind. “You Tube. We’ll get you a physical therapist.”

I was stewing with resentment. Okay, okay, I wrote. So I’m insecurely attached and ruining my kids, I’m avoidant, I’m anxious, I’m guilty of binary thinking, I have boundary issues. Okay, and you, Rachel, are the picture of emotional health.

But after I vented all of that in blue ink, I was hit by a realization. My brilliant therapist was just trying to get me out of the agony the dependency on her was causing. She was cutting ties, showing me how I couldn’t rely on her for relief.

Hmmm. That gave me pause, and my mind calmed a bit. I was in good hands.

Yes, she agreed at the next session. I had been “dysregulated.” I’d been “acting out.” What choice had she had but to deal with me that way?

 

Several weeks later I once again broached The Topic. I was in so much pain. I was anxious. I was sad. Therapy was just so, so hard and painful. I was opening so many wounds and bleeding all over.

“You don’t have boundaries,” Rachel told me smoothly. “You don’t know where to stop.”

She paused. “When things get too heavy, all you have to do is say, ‘Malka, Stop!’ and you won’t get so worked up.

“Without boundaries you hurt yourself, and then you become the victim,” she looked me in the eye. “And I, the perpetrator.”

A dramatic pause.

I made a face. I wasn’t going to take this sitting down.

“But I’m not victimizing myself, nor do I think you’re the perpetrator. I’m not blaming. You’re not hurting me. Therapy is hard. Didn’t we discuss that therapy causes pain back at the beginning? This isn’t about you; it’s the reality of therapy.”

This debate went on for the next session, with us splitting hairs over what’s pain and what’s discomfort, and whether she’d said to expect pain or discomfort. After two weeks, I came around and humbly apologized. She accepted the apology, still with a woebegone expression on her face. I was even granted forgiveness.

But it didn’t end there. She then discussed my cruelty and complete disregard to her feelings. How I’d attacked her and kept “shooting her down.” And she told me, lowering her voice, it wasn’t about her at all. It was just that the therapeutic relationship mirrors my life. If I did it here, I did it elsewhere. We had to figure that out and work on it.

And, furthermore, she said, I was expecting to accomplish in one hour enough to last the other 167 hours of the week, and that wasn’t realistic. She suggested I sign up for a DBT group, since I was feeling overwhelmed by my issues. There I’d gain tools to manage my emotions and intense reactions.

I was researching again. I’d already researched to death the modalities Rachel listed in her email signature, trying to figure out what methods she was implementing, trying to make sense of what was going on. I’d researched all the tools she’d introduced to me and never followed up on. And, of course, I’d read up on all the diagnoses she had flung my way.

Now I was looking up what “idealizing” and “devaluing” are in a therapeutic sense. Rachel said that was what I was doing to her. I had put her on a pedestal and as soon as I saw something that didn’t sit well with me, I entirely devalued her.

Borderline personality disorder? I read, horrified.

Was she trying to imply that I had a personality disorder? I read, took some tests, and suddenly, in some lines, I found myself. At least a little bit.

I guessed that could corroborate the cruelty I’d spent pages dissecting, wracking my brain to find real-life parallels to my cruel behavior toward Rachel. Now I tried to find where I was idealizing and devaluing others. After much effort, I suddenly realized perhaps she was right. I saw vague echoes of the behavior in the way I was annoyed at my neighbor, probably because I was envious of her housekeeping abilities and discipline and idealized her for it. I saw it in the way I expected too much of my husband, driving him away.

Was I cruel? Did I have borderline personality disorder? For the next week, my mind churned with the parallels I’d eked out.

 

I was in turmoil as my feet pounded the asphalt of the forest trail near my home. One loop, two loops. It was an early summer morning and the place was still on lockdown, so I had the bike path to myself.

I was still smarting from the words said to me in session two days before.

There were several things that had bothered me, but one retort in particular had sent a dagger to my heart. I’d come around, apologized for another misconduct Rachel had called me out on. And then submissively, wanting to see her view, I asked, “Can you explain to me once more where you see my binary thinking? I’m still trying to wrap my brain around that one.” Granted, I’d asked several times, but only because I had never understood how it manifested in my views and what to do with the information.

“I’m not a tape recorder,” came her curt response. And I — open, vulnerable, apologetic — flinched, apologized, then shut down.

Somehow I managed to engage on some level until the end of the session, but two days later I hadn’t yet calmed down.

I mulled over it now as I did my third loop around the bike path, tasting the intensity of the pain in the fog my brain had become. By the time I headed home to wake my sleeping family, I finally knew that she was wrong. I didn’t have a personality issue. I’m far from perfect, but I’m not cruel. Rachel had issues far greater than mine ever were.

A half hour later I had an appointment with Relief scheduled for the following week, a day after my next session with Rachel, the session I now knew would be my final one.

Darkest Before Dawn

Common wisdom maintains that problems often get worse before they get better. If a client’s issue appears to be worsening, is that a sign she needs to switch therapists — or that she’s on the road to healing?

Rabbi Dovid Goldwasser, rav of Khal Bnei Yitzchok in Flatbush, has spent years helping people navigate the world of mental health, and authored more than a dozen books on related subjects. He agrees that just as with physical medicine, where the body needs time to acclimate to new medication and symptoms may worsen despite treatment, a mental or emotional problem may continue to escalate despite effective treatment. However, just like in the physical realm, this needs careful monitoring. After an initial period ofadjustment, progress should be charted and reviewed by the client, the therapist, and a supervising doctor. “Of course one always has to be mispallel to Hashem that he/she finds the right shaliach,” says Rabbi Goldwasser.

Ilana, who was seeing a social worker to unravel issues related to her parenting, experienced this when the therapist’s suggestion seemed to cause a downward spiral in her relationship with her teenage son. She brought up her concern in subsequent sessions, and they talked through the issue. The therapist explained that the increased negativity from her child was a desperate attempt to restore the status quo, but that consistent application of the new strategy would soon lead to a healthier dynamic.

Because the therapist heard out her concern, and provided a measurable time frame and a logical explanation for the expected trajectory, Ilana felt able to stay the course. Time proved the therapist right.

A competent therapist, explains Mrs. Levinson, should never leave a client in turmoil. Mrs. Levinson likens best practice to airline safety measures — you make sure the client is buckled up, has an air sickness bag, and knows what to expect in case of emergency — and only then do you tackle the really difficult work.

While powerful and painful emotions are to be expected, an effective therapist won’t leave the client to deal with them alone. “It’s up to the clinician not to let the client walk out of the office bleeding. She needs to suture the wound, by setting up the session with enough time to decompress, preparing a safe holding environment, and teaching self-soothing exercises,” adds Mrs. Rosenblatt. Additionally, she always alerts clients that they might continue to feel strong emotions after the session, and they can let her know if something feels wrong. Sometimes she will reach out herself if it was a particularly hard or emotionally taxing session.

Just as exercise might be painful if you’re unused to it, the early stages of therapy can awaken painful feelings. But as you become more used to the exertion, the pain should lessen, and you should rebound more quickly. Over time, the general trajectory should be upward, the lows not as low, and the highs more sustained. If therapy consistently sends you into a tailspin, if your therapist doesn’t enable you to return to an even keel, or if there’s no clear positive trajectory, it may be time to re-think your goals, the intervention being used, and the therapist-client fit.

Roadmap for Success

Once you know where you’re headed, it’s easier to ascertain if you’re on the way.

Chana, who has been in therapy for two decades, dealing with complex trauma and related issues, recommends maximizing the benefit of your therapy by taking notes both during and between sessions. During sessions, information will come up that you may later forget, or may want to reflect on further; notes allow you to mine the trove of insight that constitute effective therapy. Between sessions, make note of any incidents or thoughts you’d like to bring up at your next session. When you’re paying hundreds of dollars, it makes sense to come prepared instead of floundering about trying to think of examples to talk about.

Mrs. Rosenblatt takes a few minutes every two to three sessions to review the progress the client is making. Together, they evaluate if they’ve made progress, and whether the goals or the process need to be adjusted in light of the work they’ve done.

Other therapists may do this at more infrequent intervals, but make sure it happens periodically. Knowing where you stand can help you answer an important question: When is it time to leave?

Unless you enjoy spending hundreds of dollars weekly on a listening ear — and there are those who do, considering it their “me time” — a key skill is identifying when to graduate from therapy. By assessing progress frequently, you get a sense of where you’re holding.

“I get the ‘I don’t know if it’s helping,’ call all the time,” says Mrs. Levinson. “Depending on the issue, there should be markers. For example, for OCD, if you’re not noticing some sort of symptom reduction within six to ten weeks, something else might be going on.”

Challenges like OCD, where a client can set an objective functional goal, such as not checking the oven more than twice, can be easier; generalized emotional problems can be more difficult to assess. Still, it’s worthwhile to take periodic stock of whether the problem is improving, or at least heading in the right direction.

“Use a whole session if you have to,” says Mrs. Levinson, but talk about where you’d hoped to be, where you’re at, and if there’s anything that can be done to optimize your success.

If therapy plateaus, and there’s no discernable progress toward a specific goal, it’s important to discuss why that’s happening, says Mrs. Rosenblatt. While it can be caused by a client who is finding the necessary work challenging, a mismatch between client and therapist can also be a factor.

Therapy, like many industries, tends to have a flavor of the month, but a therapist who uses the wrong modality to treat a problem is unlikely to see much progress. A quick check with an objective party, such as Relief or the therapist’s supervisor, can confirm if the right modality is being used.

Less easy to spot is a personality mismatch. If a client is intimidated by the therapist, or finds her pushy or unsympathetic, she’s unlikely to work hard. No matter how credentialed a therapist is, or how successful her track record, if you don’t feel comfortable and safe around her, you need a new practitioner.

“Malka’s story was disturbing on multiple levels,” says Mrs. Levinson. “She sounds like she was on an out-of-control amusement ride, holding on for dear life, and praying the therapist knew where she was going.”

Even when clients do things that are objective mistakes — for example, forgetting a checkbook three weeks in a row — a compassionate therapist will analyze it with gentle curiosity, never in a way that is blaming or critical.

“Malka felt like every issue was thrown back at her, but discussing problems should never be done in a punitive way,” says Mrs. Levinson. “Therapy should feel like an exploration with a smart, wise person who will hold your hand. You may travel through difficult terrain, but the feeling should be that you’re in this together. Noone should ever feel like Malka did — criticized, punished, out of control.”

Rabbi Goldwasser explains that effective therapy gives the client skills to achieve a level of independence on her own. If the therapist acts as a crutch, encouraging calls or texts whenever the going gets a little rough, then when the crutch is no longer available the client will fall. “It is of paramount importance that a therapist-client relationship remains professional at all times,” he explains. “A therapist has to encourage, inspire, enable, and at times enbolden. It is also critical that the chizuk of Torah should be incorporated within the therapeutic process.”

Simon Says

Cut off ties…. Leave kollel…. This marriage is not worth saving…. A common theme in Therapy Horror Stories is the therapist who gave bad advice, which the client followed to disastrous effect.

The first problem in that storyline, says Mrs. Rosenblatt, is that a therapist is not supposed to be giving advice. The professional’s job is to help the client come to their own conclusions, by laying out options and discussing the possible ramifications. “Clients have all the answers,” she maintains. If a therapist insists on a particular course of action, without room for discussion or acknowledgment of your objections, that’s a red flag.

Torah sources confirm this. Rabbi Goldwasser quotes the Rashba, who states that a patient knows where his salvation is going to come from. “Listen to your inner voice,” he says, “and — if a therapist recommends drastic or potentially harmful steps, consult daas Torah immediately.”

At a later point in Esti’s long and circuitous route to finding the right therapist, one particular incident taught her to trust her intuition. One therapist she tried was a secondhand referral, a sister-in-law of the first therapist she’d approached (though she only learned that years later). After sharing her deepest fears and vulnerabilities, Esti explained her dilemma about whether to quit her toxic job. Instead of listening to the various considerations, the therapist bulldozed in and instructed her in specific cognitive techniques to force her to power through.

“Though she was missing all the context I was trying to convey, she was the expert, and very authoritative.” Esti recalls. “I continued seeing her for several months despite my misgivings.” One night, she dreamed the therapist knocked on her apartment door as she was getting ready for bed. “Sorry, it’s not a good time,” Esti said in her dream. “It’s okay, it’s me,” the therapist answered, and barged in, disregarding Esti’s protests.

Waking with a start, Esti knew it was time to trust what her gut had been telling her: “She was peering into the most vulnerable parts of my life, but without any clear path to help me forward. When I left her a message to tell her I was quitting therapy with her, she called me back to let me know how disturbing she found this and that there was probably something wrong with me.” Esti didn’t look back.

Rabbi Goldwasser was once approached at a mental health conference by an older, leading psychiatrist who was seeking the Torah perspective on a particular addiction. “Let me be honest,” the psychiatrist told the rav. “If you think that with all my psychiatric knowledge I have the answer, I don’t.” That humility, the ability to acknowledge not having all the answers, is a trait Rabbi Goldwasser prizes in health professionals.

Not everyone can solve every problem. And that’s okay. If the therapist respects you, and you respect your own wisdom, you’ll find a way forward.

 

I turned off Zoom at 18 minutes flat. I’d spent more than $13 per minute, but this time it was worth every penny. I made a face to the camera. I gave myself a thumbs up.

I felt so liberated.

I’d stuttered a lot, complimented Rachel way too freely, and took far too much blame for the dynamics. I was still under her spell at that point and the doubts lingered.

But I made my point. I knew it had hit its mark when I saw the flush rise up her face. When I saw her grasping at straws and explaining my unwillingness to continue therapy as resistance to hard work. When she explained the cruelty I denied as an “introject” — more therapeutic jargon. When she asked for examples of when I didn’t feel safe — despite having refused to give me an example of my “cruelty” when I’d asked the previous week. When she retorted, “I wouldn’t have said that. It’s not grammatically correct,” when she made me quote what had bothered me.

I knew that I’d left off like a mensch, despite having been treated like anything but.

When I got some distance I learned a lot. I learned that while most therapists are wonderful, fulfilling a lofty calling that saves lives and families, some are damaging. I learned what emotional manipulation is. I learned that a red flag is a red flag, and it only gets worse when ignored.

I later learned that so many others had fallen for Rachel’s manipulation; I was lucky to have terminated before I got entirely entrenched. My biggest issue — the inability to accept help — had stood me in good stead, because I never took her up on the free 15-minute phone-call and texting session offers that had cultivated dependency in so many other clients.

 

Despite my telling Rachel that she’d broken my trust in people, just a few weeks later I found myself sitting on the edge of a gorgeous fabric chair, my foot pinned to the ground to keep it from shaking.

Like a volcano burst open, I posed my presenting problem: I was overwhelmed with my children. I was uptight all the time. I couldn’t get my act together. I was burnt out at home and burnt out at work. And I’d had a very disturbing therapy experience.

Across from me, my new therapist listened, face open, curious, unfazed by anything I told her.

She didn’t tell me I was going too fast even though I didn’t pause to catch my breath and didn’t let her get in a word edgewise. She didn’t counter my “Is it normal?” with “You tell me, is it normal?” Her eyes were peaceful and accepting; her demeanor nonjudgmental, eager to understand me.

And in the confines of this tastefully furnished oasis — a cozy fur rug, tender shoots of greenery and encouraging decals sprucing up this calming blue space — I would learn that trust isn’t attained with probing, but with patience and, sometimes, gentle prodding.

Over the next six months, I’d learn that therapy isn’t administered with psychobabble, but with presence. I’d learn that in this space, the focus is me and not the therapist. I’d learn that blunt “realness” doesn’t hold a candle to sincerity; that medication is sometimes a great option, but the decision can be reached with calm, clarity, and compassionate understanding; and that if someone cares, you feel it, you don’t have to search for it between the lines.

I know I’ll still learn many more things.

But most of all I’ve learned how drastically a life can change in less than one hour a week.

 

Questions? Comments? Experiences you want to share? Please join the conversation! Coming in future installments: how to find a skilled therapist, readers and professsionals share their reactions, more women tell their stories.

 

 

 

Advice for My Earlier Self

Woman who had a difficult journey in their quest for the right therapist share what they learned along the way:

> My grandfather always said, “Buy cheap, pay double.” If I needed heart surgery, I wouldn’t hire the first-year resident because he was cheaper. I’d get the best doctor possible, because it’s a matter of life and death. Well, therapy is often life and death, too.

> I’d tell myself to listen to my gut. It doesn’t matter how much experience a therapist has, or how good they were for your friend, or what a “name” they are — you have to feel comfortable and safe.

> Any time someone is restarting therapy after a break, or if there’s a significant change in their life circumstances, they should evaluate whether the one they’d been seeing is the right match for their new reality. Switching therapists doesn’t negate the value of the previous work, it just means acknowledging a new reality.

> If something feels off, trust that intuition and speak up. My best therapists wouldn’t get defensive, they’d discuss why I was having a strong reaction to something they’d said.

 

“But She’s the Expert!”

We learn from an early age to respect authority, but it’s important to evaluate the therapeutic relationship critically. What are some red flags that warrant further investigation?

  • Rigid communication policies, or none. It’s fine if a therapist doesn’t want to be constantly on call, but if her rules about an occasional quick text are very inflexible, consider if that offers you sufficient support. Conversely, if there are no limits and you have 24/6 access to your therapist, you might become overly dependent on her.
  • Leaving a session too shaken to function well. Effective therapy might be painful, but a good therapist will have sufficient safety measures in place to ensure you cope. If you find therapy debilitating, that’s concerning.
  • Oversharing. A personal example here or there might be enlightening, but therapy is about you. If the therapist shares too much personal information, or the relationship begins to feel like a friendship, she may be losing focus and crossing professional boundaries.
  • Having all the answers. Any therapist who claims to specialize in everything, or uses the same tool to treat all types of concerns, is probably not the expert she purports to be.
  • Anything that makes you feel uncomfortable. “That warning is our gift from Hashem,” says Mrs. Levinson. Not every discomfort will point to a true problem, but it always warrants a conversation and possibly some research. And even if there’s no objective concern, if something about the therapist continues to bother you, there’s a good chance she’s not the right fit for you.

 

(Originally featured in Family First, Issue 736)

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