I
staggered into therapy with almost three decades of unresolved emotional baggage.

My collapse — years in the making, but sudden in its occurrence — brought me swiftly to my knees. The drama laced in these words is no hyperbole. The dread that gripped me had no mercy; it clawed its way into my thoughts, crumbling any visage of safety I’d once held dear. Anxiety, and its faithful attendant, depression, dogged my steps relentlessly, rapidly bleeding life of its color.

There was precious little that was more important to me than stilling the pain, and my desire to live wavered dangerously. But in a moment of G-d-granted clarity, it came to me: Wherever I ran to, I, and all of me, would still be there. My losses, my struggles, my pain, would follow me, always. With that, I lost the will to end my life, and began the battle to regain it.

Swallowing back bile and reservation, I stumbled into therapy with all the grace of a wary novice client. Week after week, I clenched and unclenched my jaw in mindfulness exercises, deep-breathed, and gave color, shape, and a name to my anxiety. I gave up rituals and reassurances, willingly exposed myself to the object of my fears, and finally tolerated uncertainty. I struggled to recognize my triggers and the accompanying flight, fight, or freeze responses.

Moving beneath my anxiety, I challenged long-held beliefs and cognitive distortions, held black and white in both hands, and allowed room for gray. My relationships, both the ones that anchored and rocked my life, reconfigured as I learned to repair ruptures, develop closure, and feel the light of emotional intimacy.

There is undeniably a mysterious and magical quality to what takes place in this enigmatic healing relationship called psychotherapy. While we tend to attribute this to the talent of the therapist, as we ought, considering their expertise and education, we often neglect the role of the client in the therapeutic process. Much has been written about the skill required by the therapist, but less has been said about the sheer grit a client must have to see success in therapy. Partly due to preconceived notions about what therapy is, whom it is for, why it’s necessary, and what success in therapy looks like, clients are often reluctant to take the driver’s seat in their treatment.

As the consumer receiving a service in this relationship, I learned that it’s essential for the client to take ownership of the process to see maximum success. And the rewards are many. For the client, treatment is more focused, goal-oriented, effective, faster, and economical. For the therapist, the process is more rewarding, productive, and efficient — all translating into a better prognosis for the client.

And with that, allow me to introduce you to therapy and all its exhilarating and exasperating moments. Let me show you what it looks like to take the reins in treatment — from the other side of the couch.

Redefining Normal

There’s an erroneous assumption that only unwell, unstable individuals are in therapy. It’s simply no longer true. In fact, a great number of clients in therapy are young, college-educated professionals with unspecified diagnoses. Therapy is for the emotionally healthy, those who are suffering the normal problems of the human experience.

Despite my almost two years in therapy, I’m still of the opinion that I’m normal. I’m a successful professional, wife of a talmid chacham, and mother of a band of precocious children — and I’m in therapy. I’m a social star, funny, and well liked — and I’m in therapy. I’m driven, conscientious, and active in my community — and I’m in therapy. I’ve never tried drugs, alcohol, dropped my Yiddishkeit, or succumbed to an addiction — and I’m in therapy.

I’m in therapy because I’m courageous and resilient and unwilling to stagnate. I’m in therapy because I’m emotionally healthy and self-aware and I can’t leave well enough alone. I’m in therapy because I want more — for myself, my family, and my relationship with Hashem. And I’m in therapy because when I was ready to tackle my inner-world demons, I wanted someone skilled and compassionate there with me.

A Safe Haven

One of the things I love about the therapeutic relationship is the transparency of the process and the freedom to question and explore the judgment calls the therapist makes. A good clinician invites criticism and feedback and has a ready answer for exactly what she is doing with your money.

Many clients hesitate to speak up or ask for clarification for fear of being rude or disrespectful, forgetting that they are the consumer and the therapist needs to answer to them. Disagree, express your needs, and feel free to question anything and everything. Don’t squelch that slightly weird remark you’re hesitating to make — it may lead to the most revealing conversation of all. Particularly if you walked into therapy with preconceived notions, not sharing will stifle your progress. The therapy room is one place where you can (almost) leave your social norms behind.

What if you aren’t made of bold, outspoken stuff? Not to worry, that’s why therapists went to school and earn nice money. They’re trained to help reluctant clients learn what drives and discourages them, to discover what rigid beliefs and cognitive distortions are preventing self-growth, and to learn how to move past their defense mechanisms. A good therapist can give even shy or naturally reserved clients the tools to express themselves and safely explore their issues.

During some sessions, I have a plethora of emotions and thoughts bottlenecking on the way out, which ends up entirely clogging me up. Often I find it easier to express myself in writing afterward without all that scrutiny and eye contact. Likewise, when I feel lost and flooded with emotions between sessions, I e-mail my therapist nice long letters to assimilate over the week.

When I write, it helps wear off the intensity of the feelings, containing it in an inbox for me so I know it’s there and waiting to be attended to without me ruminating over it. My therapist is not expected to respond to these e-mails between sessions, but she has a grasp of the waves I ride during the week. This is an invaluable tool for us both — I release, she has great material to work with and build on, and we neatly avoid preliminary warm-ups, allowing us to reach deeper places every session.

Here is just one example of the many exchanges I initiated with my therapist:

Mon, Sep 4, 2017 at 2:40 PM

To: Sarah Kahan>kahan.sarah@gmail.com

Me: Hi, if you could read the attached letter please. Maybe text me after you digested it — let me know if you’re kicking me out of therapy or not.

Sarah: I just read what you wrote and I really appreciate the effort you put into doing something that was so hard to do. I am very okay with what you wrote and your feelings and thoughts are very understandable. It shows a lot of progress. Therapy is hard work and we are getting to the really deep stuff so forward onward!! We are on this journey together and… I hope you will continue to come and stay with the process. Our relationship can handle it!

Laboratory or Lecture?

One of the biggest and earliest shocks I received in therapy was learning how deeply the therapist relies on herself and her relationship with the client to achieve healing. I had blithely thought I’d be attending a lovely weekly lecture, in which the topic was myself, and learn lots of helpful strategies to set me on my way. Not quite.

To use an academic analogy from Ryan Howes, PhD, a clinical psychologist and professor in Pasadena, California, therapy is both a lecture and a laboratory. You’re learning the tools of relationships and simultaneously playing them out in terms of your relationship with your therapist. Meaning, everything you do or say or feel in therapy is significant and becomes grist for the mill.

What then occurs, often early on in the relationship, is called transference: the client unwittingly and arbitrarily transfers feelings from prior relationships onto the therapist. And not just fleeting, insignificant feelings — there are surges of misplaced intense emotions and reactions like rage, rejection, attachment, affection, and loss. As emotionally provocative as transference might sound, dealing with the flood of emotions that arises is at the crux of healing since it gives you the opportunity to practice healthy coping and relational skills in a safe environment with your clinician.

So confront transference, turn it on its heels, and make it work for you. Talk about therapy in therapy. Perhaps your therapist angered or hurt you last week and all you want to do is run or fight back. Maybe you think you enjoy therapy too much and you’re scared of becoming dependent on it. Yes, it’s transference at work: Raise these concerns, challenge your therapist, and watch the therapeutic alliance strengthen and grow — translating into a more productive experience for you.

Set Goals and Stay on Track

Short of driving my therapist nuts, my goal is to make sure she’s on top of her game. I have her constantly referring back to my goals, assuring that my treatment is aligned with the therapy objectives. I don’t hesitate to point out discrepancies or blurred boundaries, and I expect her to prepare, research, and consult on my behalf.

When therapy is so goal oriented, the push to grow is phenomenal. Writing out checklists with established markers of positive growth and still unaccomplished goals helps both of us track progress and stay motivated. These markers include anything observable — behavioral, emotional, or attitudinal — and they work like signposts, indicating in which direction (positive or negative) change is flowing.

Goal setting can be as simple as a list or as sophisticated as objectives that follow realistic, measurable, and attainable goals. (See box.)

Already addressed in therapy:

• Anxiety, work, mindfulness
• Tolerating uncertainty
• Rupture and repair
• Parenting: active listening, validating, giving a name to feelings
• DBT: people don’t go into good and bad categories; splitting
• Getting needs met in general
• Communication in marriage

Still need to address:

• Fear of emotional intimacy
• Increase self-validation
• Pain and fear of abandonment
• Handling others’ dysfunction
• Triggers
• Transference
• Respecting others’ needs for protection, not exposing their fakeness and shortcomings

Goals

1. In one month’s time, Rivky will learn to how to reframe situations that have triggered feelings of fear.
2. In one month’s time, Rivky will use mindfulness and somatic awareness to ground herself in the present and reduce feelings of anxiety.

Testing Boundaries

A therapist who stays overtime in session, is limitlessly available during the week, who self-discloses indiscriminately, who waives payment — not only is she not being nice, she’s reflecting her incompetence, trifling with her mandated ethical standards, and is causing confusion and pain to her client. It’s the boundaries of space and time that provide the safety and space crucial for healing.

I know I’m healing because I pay my therapist to provide a consistent, weekly service for me that defines the therapist-client relationship (unlike an un-boundaried mentor whose time and patience are limited, conditional, and make you feel like you have to perform to gain attention). I’m healing because I trust her to end the session on time, not finish later when I’m more entertaining, or earlier when she’s had enough. I’m healing because she won’t disrupt the balance of the relationship and engage in ongoing conversations between sessions or reveal personal details about herself. And I’m healing because I know that she can never (and will never) discuss me with others without my knowledge — “even for my own good, just to help, and only l’toeles,” like others I’ve trusted before.

That said, here’s advice I can’t imagine you’ll ever hear from your therapist. Test those boundaries. It’s her business to make sure those boundaries are not violated and if she has unnerving patience like mine, she’ll take it in stride, and explain why these all-important limitations are in place to keep you safe.

So go ahead, ask personal details, bother her between sessions, and complain about the session length and price. When she produces the counterforce and structure you covertly crave, you’ll feel relieved and even protected.

But be forewarned: She’ll analyze why exactly you feel the need to violate boundaries, how it manifests itself in relationships outside therapy, and how it reflects other boundary violations in prior relationships.

Still, I think it’s worth it. I’ve gained immeasurably from putting her through the wringer, and you’ll learn something more about yourself in the process.

The Purpose in Pain

Therapy is an experience of real vulnerability. To quote Howes, “Being a ‘good client’ doesn’t mean being on your very best behavior, it means being the most authentic… version of yourself.” The extent to which the client is willing to emotionally expose herself determines her success. Successful clients are willing to tolerate pain for growth.

Besides the core issues that I worked on with my therapist, the very process of therapy brought on a host of lovely other unexpected feelings. These weren’t mere aftertastes — tackling most of these newly surfaced emotions proved to be the catalysts in my healing.

There was the opening of old traumas: “After last session, I spent most of my day in paroxysms of serious confusion and distress. I’m going to need trauma therapy for therapy. Seriously, what on earth am I supposed to do with myself over the week if I’m left hanging like that??” Boundary testing: “I thought boundaries are crucial in a therapist-client relationship. I unconsciously try to break them, but I thought you would be firm enough to maintain them… please make this process safe for me since I’m bound to unconsciously try it again….” And the transference: “After a week of wearing raw emotion on my sleeve, the fury has died down somewhat. Obviously it wasn’t only you I was really upset at — you just happened to have said things that were reminiscent of some of the most painful things ever said to me.”

It may be hard to believe that struggling through these issues actually brought me more relief and security, but it did. Confronting the initial triggers of discomfort was painful, but it was pain with a purpose. Use any allegory you want here — the wash cycle, the silver-wrought process, kur harbarzel — but heat and pressure, masterfully administered, cleared out much of a lifetime’s worth of slime and sludge.

Between Sessions

While therapy sessions are important, so are the client’s efforts to reflect on what has been discussed and explored. “Some clients seem to leave the session, get swept up in the busyness of the week, and then show up a week later having spent no time thinking about our work together,” Howes says. “Progress is slow to none at that rate.” Aside from my lengthy e-mails to my therapist, I often jot down thoughts, questions, and epiphanies that come to me during the week and bring them with me to session.

Perhaps most important is doing the homework your therapist assigns — even if it feels counterintuitive or even illogical. The advice you get from a good therapist (especially an anxiety or addictions counselor) may not always make complete sense. Every pore in your body may be resisting the assignment, but sometimes therapy requires that you make that leap of faith — and try. Eventually you’ll feel relief, and understanding and acceptance will dawn.

I fought hard with the concept of tolerating uncertainty, the premise that one doesn’t need immediate answers and reassurances to obsessive concerns, that real certainty is an illusion we attempt to chase. I had trouble coming to terms with the concept, and even more so in attempting the exercises that denied me certainty. Even as I struggled with her advice, my therapist recognized my need to understand the science behind the treatment, and with unnerving patience and calm (G-d bless her!) took the time to explain the rationale of the work we were doing. It was a long haul, but after really following through with the excruciatingly difficult exercises, relief was not long in coming.

Many clients go into therapy expecting some kind of procedure to be done to them. The role of a therapist is not that of a surgeon. Their job to show you how you can make yourself feel better. While your therapist should very clearly delineate exactly what you need to do to get better, much of the hard work and healing will come from within. They can teach, train, and practice with you, but they can’t go out on the field and play for you. To succeed, you have to step up to the plate.

Therapy has been a deeply transformative experience for me. I believe I’ve capitalized on what it has to offer and hope and pray for others to do the same. My greatest regret is that my voice is limited to this piece written under a pen name and I can’t personally unfurl for you the moments of therapy without expecting a nervous tinkle of laughter or reproachful silence in response. If I could, I’d yell it from the rooftops and watch the therapized emerge from the woodwork, telling their stories and receiving the standing ovations they deserve.

One day I’ll be able to look my student, my sister, my colleague in the eye and say, “I’m in therapy, and I love it. Try it, you’ll thank me.”

(Originally featured in Family First, Issue 641)