"I didn’t know how to tell her that her life coach just wasn’t helping anymore”

Ruchy had first come to my office shortly after the birth of her second baby. She had never seen a psychiatrist before and had a general fear of doctors.

She was one of those patients who laughed nervously at things that weren’t particularly funny and teared up at things that weren’t all that horrible. As we spoke, she squeezed the armrests of her chair so hard her knuckles practically turned white.

With her husband, Heshy, at her side, though, she was able to push herself forward in what was obviously an uncomfortable situation.

They were a sweet European chassidish couple, true erliche Yidden with good yichus on both sides, more than enough parnassah from his father’s diamond trade to live comfortably, and a respected standing within their kehillah. On the outside, a perfect life.

But Ruchy’s symptoms were quite classic and so was her history. She’d been a bit picky as a child and had always dressed with a flair for perfection. In seminary she was known to have a bit of a nervous streak, the girl who always asked a few extra questions in the halachah shiur, “just to be 100 percent sure.” After she and Heshy got married, she nearly drove him bananas with all her sh’eilos about basar v’chalav until he learned how to calm her down by telling her he’d asked the Rebbe himself. After their first baby was born, she would wake little Shia up throughout the night “to make sure he was breathing” until the anxiety of crib death went away.

And now she was sitting in my office after the birth of their second son, telling me that she was having horrible thoughts of dropping their new baby on the floor and watching his head crack on the ground.

“Is that something you think could happen to your baby, Rebbetzin?” I asked her as Heshy looked on a bit helplessly.

“Chas v’shalom, Dr. Freedman!” she answered emphatically. “I am a very conscientious mother and I take good care of my babies.”

“Of course you do,” I said honestly. “So you’re telling me that there is no chance that could happen.”

“Well, not no chance, because accidents happen. But for sure I’m a very responsible mother, so definitely it wouldn’t be something that would happen like it might for an irresponsible family. Right, Heshy?”

Heshy nodded his head in affirmation, but looked a little confused.

“So it’s highly unlikely that this would happen, and yet it keeps popping into your head?” I asked.

“Exactly! That’s why I’m going crazy, Dr. Freedman!”

As Ruchy burst into tears, I took a moment before explaining to them that she was most probably experiencing a type of obsessive-compulsive disorder.

“Well,” she said, wiping her eyes, “then why did Suri tell me that this isn’t OCD at all, and that I just need to work a bit more on my emunah? She’s been such an amazing life coach these past few years.”

Oh, so this was a story about another well-meaning life coach playing the role of a psychologist.

“I mean, I don’t have any of the hand-washing stuff that people with OCD have and I don’t have any of the cleaning things where I need to stay up all night doing sponja,” Ruchy practically pleaded.

On a superficial level, Ruchy might have been right. But a significant percentage of people with OCD have only obsessive symptoms and not the classic compulsions that books and the media often sensationalize. And yet the way that Ruchy had described her approach to halachah, and other things in her background, it did seem as though she had experienced compulsions as well as obsessive thoughts.

It was quite concerning that Ruchy had been experiencing these painful symptoms for the past three months, and the emotional toll it had taken on Heshy was clear as well. Yet the treatment guidelines were clear: A combination of an antidepressant medication and cognitive behavioral therapy would help Ruchy to get through her current situation and return to be the loving mother she was underneath the anxiety of her OCD.

They were both on board with medication treatment, given how her obsessive thoughts had disrupted her day in such a profound way. But when I brought up the need for a specialized CBT therapist, Ruchy balked.

“I already have a great therapist, Dr. Freedman. Suri is the best. She’s really helped me,” she said sincerely.

“Really. In what way?” I answered as nonjudgmentally as I could.

“I mean, she’s like my best friend and she loves listening to me.”

Luckily Heshy jumped in to save me from doing my own dirty work. “That’s because we pay her a fortune, Ruchy. Listen, your life coach was great when we moved here and you needed to adjust to a new country, but today it seems all the two of you do is schmooze and go out to lunch. How is that any different from a friend, besides the fact that you pay her for it?”

Ruchy was quiet as Heshy continued. “Look, Ruchy, what kind of professional is she if she’s telling you that you don’t have OCD and the doctor here is telling you that it’s a classic case?”

We were silent as Ruchy thought it over and then spoke up. “Look, she’s a special lady and has really helped me out, especially in the beginning.”

“There doesn’t have to be a conflict here. You can keep your coach,” I commented. “But OCD is an illness that requires specialized treatment. Honestly, it’s out of her league.”

Ruchy was smart enough to realize the current setup wasn’t working, and agreed to meet with a top-tier frum therapist, with a plan to follow up in a few weeks.

As I walked them out, Heshy hung back for a minute. “Dr. Freedman, I really want to thank you. I knew there were real problems, but I didn’t know how to tell her that her coach just wasn’t helping anymore.”

A few days later, I got a phone call from Suri, the life coach, herself. As soon as she introduced herself, a few choice epithets nearly exited my mouth: Don’t you know you’re playing with fire? Do you know many cases I’ve seen of people with serious mental illness who have been completely mismanaged by life coaches who simply don’t have the training for real-deal problems?

But as I took a deep breath to regain my professional equilibrium, Suri cut to the chase.

“Dr. Freedman, thank goodness you’ve been able to help Ruchy. She’s become completely enmeshed with me and has ignored my pleading with her to see a psychiatrist and get professional help. She’s a great woman, but she definitely has an anxiety problem and I don’t know enough about diagnosis and treatment to help sufficiently at this point. I’m just so glad that she’s seeing a professional like you.”

(Originally featured in Mishpacha, Issue 821)