Checking References

In today’s psychologically savvy world, though, many people don’t turn to a rav first, and instead head straight for the mental health professionals in their search for a referral.

Devorah Levinson has been a referral specialist at Relief Resources for 13 years and knows a thing or two about finding a therapist. A caller who approaches Relief will typically get three suggestions of therapists who are potentially good fits for the presenting issue.

With their referrals in hand, it’s time for the client to do some screening. Most mental health professionals don’t have secretaries and will answer phones or return calls themselves. In order to use the initial phone call to get a feel or the therapist, Mrs. Levinson advises clients to prepare a short presentation of their problem as a phone intro and to listen carefully to the therapist’s response.

The two key words to bear in mind, she says, are “relief” and “quick.” Since the professionals’ commodity is their time, and it isn’t unlimited, they will spend more time with someone they know is a targeted referral, and with someone who keeps the initial conversation succinct and to the point.

“Therapists don’t have time to hear about your kindergarten experiences over the phone. Try to keep it short: ‘I’m struggling with anxiety, as well as parenting and shalom bayis. Is this something you can help with?’ ”

Of course, says Mrs. Levinson, just like a shidduch reference who’s been asked if the young lady is kind, just about every therapist will say yes. But also just like with a shidduch call, a successful therapist interview is about listening to what else they say. Does the therapist mention previous experience in similar cases? Does she discuss the tools at her disposal that are relevant to the issue? Is she clear about what you can expect?

Therapists often have favorite tools, and as the saying goes, when you have a hammer, everything looks like a nail. Listen for subtle clues that the therapist has heard the specifics of your situation and is tailoring her response to your needs, rather than shoehorning you into the box most comfortable for her.

Tzivy Reiter, LCSW, Director of Children’s Services at OHEL, points out that there is a difference between being trained and being certified in a particular modality; a training might last as little as a few hours, while certification tells you the therapist has actually practiced the technique under supervision and demonstrated competence.

Feel free to ask questions about the therapist’s credentials, supervision, approach, and her administrative policies.

“You’re the consumer,” emphasizes Mrs. Levinson. “They’re not doing you a chesed — they’re selling you a service, just like your plumber or cleaning lady. The more information you have, the better you’re able to navigate the system.”

After Session

If the initial phone call leaves you feeling hopeful, schedule a session to meet the therapist in person.

Keep your eyes and ears open, and absorb everything. How does she make you feel? Are you comfortable speaking up? Does she answer your questions clearly and respectfully and seem interested in what you have to say? Is she professional and respectful of your time? If your answers are positive, it may be a shidduch.

Bassie Rosenblatt, LCSW, a social worker in private practice in Brooklyn and Lakewood, suggests that her clients not schedule their next appointment on the first visit. Instead, she encourages them to reflect on the session on their own turf, without her being present, so they can evaluate whether she’s a good fit for their needs.

Even when you’re feeling confused and vulnerable, your instincts are still important. Aidy, who was struggling with feeling low and anxious, visited several therapists recommended by friends. She didn’t feel great about any of them, but assumed the problem was on her end.

“One therapist was too aggressive,” she recalls. “Not only did she not recognize my constant, almost manic pacing as a symptom of depression, she demanded, very forcefully, that I stop pacing and sit still, as my pacing made her uncomfortable. One therapist clearly wasn’t comfortable talking about intimate subjects, using euphemisms and stilted word choices, making her sound like an uncomfortable mother trying to explain the facts of life to her equally uncomfortable teenage daughter. One felt self-righteous, almost with a savior mentality about herself as a therapist.”

Only in hindsight, after seeing a credentialed psychologist who spotted the signs of depression that the others had missed, did Aidy realize that her intuition had been steering her correctly.

“All three were poorly trained, if at all,” she says. “No degrees, just some ‘programs.’ I bargain hunted, and it backfired.”

Still, with all the best advice in the world, you’ll never find the best therapist, because there is no single best therapist for everyone.

“You can’t say, ‘This is your solution, this is your yeshuah,’” says Rabbi Goldwasser. “Therapy is highly individualized, and at times someone will need multiple referrals.”

Due diligence before beginning therapy can help you find the best help available, but after that, it’s up to you. If something doesn’t feel right, or you’re not progressing, don’t dismiss your concern, no matter how well recommended the therapist was. Therapy is about you.

Lone Ranger or Supervised?

In order to earn a license, every therapist is required to have thousands of hours of supervised practice. What’s less well known is that supervision is recommended after qualifying as an LCSW as well, for ethical and professional reasons.

The therapist’s supervisor will help her talk through any of her own emotions or biases that may be impeding progress and will answer questions, provide guidance, and ensure that the methods being used are appropriate.

While some people prefer private practitioners to clinic therapists because they assume that any excellent therapist will open her own practice, Tzivy Reiter, LCSW, Director of Children’s Services at OHEL, notes that clinics actually have an advantage in that quality supervision is built into the institutional structure. In addition, the care is often identical, since many private therapists still work part-time in clinics in order to benefit from the supervision, training, and camaraderie.

Clarifying the Alphabet Soup

There are numerous career paths in the field of mental health, which can be bewildering for a client trying to sort them out. However, the acronyms after someone’s name don’t need to play a major role in your choice.

“The letters are a starting point, not an ending point,” says Mrs. Reiter. “There’s no substitute for experience.”

All state board licenses guarantee that the professionals underwent a specified amount of education and supervised practice and are required to adhere to a professional standard of ethics and confidentiality. Titles that aren’t regulated by any government board, such as therapists or coaches, have no objective criteria or minimum standard of education and aren’t bound by any defined set of ethical guidelines. Anyone can call herself a life coach, and it tells you little to nothing about her qualifications or what she does.

Check that the therapist has a recognized, regulated license, and is authorized to be treating your concern, and then focus on her personal qualifications. Experience, empathy, and good personal fit can matter as much as the specific educational track she chose.

MSW: The individual with a Master of Social Work has completed a graduate degree program in the field of social work, but has not completed the licensing requirements, including 2,000 to 3,000 hours of supervised clinical practice, in order to meet state board requirements to practice independently.

LCSW: A Licensed Clinical Social Worker has a master’s degree, has completed extensively supervised clinical training, and is qualified to offer therapy for a wide range of issues as well as offer case management.

LGSW/LMSW: This is a preliminary license given to those who have graduated from social work school and taken the licensing test but might not have sufficient hours of supervision to reach the next level of licensure. These therapists are legally qualified to provide individual therapy but must do so in a clinical setting and be followed by a supervisor. The names of these licenses may vary from state to state.

LPC & LMHC: Like an LCSW, a Licensed Professional Counselor or Licensed Mental Health Counselor has a master’s degree and extensive supervised experience, but specializes exclusively in counseling, as opposed to crisis management or case management.

LMFT: Similar to the LPC, the LMFT has extensive training in counseling, but practices exclusively in areas of marriage and family therapy.

PhD/PsyD: With their more extensive graduate training, doctors of psychology can provide therapy for a broad range of issues, as well as administer psychological tests and diagnose mental and emotional disorders. A PsyD has likely spent more of his training in clinical settings, as opposed to the more research-oriented PhD.

MD: A psychiatrist has completed medical training with a specialty in mental health. Today, most psychiatrists do little talk therapy and mostly focus on prescribing medication.

Outgrowing My Therapist

It hurt that I had no one to turn to when things were hard. Sometimes it hurt bad. And so three-plus years ago, I decided to enter therapy.

I didn’t realize that much of therapy meant baring your heart and soul, and the process came as something of a surprise. At first, I was paralyzed by the precept that my therapist cared about me and wanted to get to know me better, but with time, her patience and nurture began to touch me inside, and I started to thaw.

Slowly, I learned to trust. Slowly, I learned that it was okay to experiment with different topics, to be unsure about what exactly I came to address, or to be so overwhelmed that even when I knew what I wanted to talk about, it was too hard.

We explored my resistance and used that material to build our sessions. We explored some of my previous relationships and drew connections. A whole world opened up.

For two years, therapy ran its course.

Then — slowly, subtly — our relationship began to derail. Both of our schedules tightened; mine because I gave birth to my first, and hers because she chose to cut back on her work hours. We were no longer available at the same times. It felt like a blow. I wasn’t ready to end therapy, and so I pushed myself to work my schedule around hers. We were constantly trying to reschedule, and while my therapist did her best to accommodate me, I sensed a certain impatience or resentment in her, which I interpreted as disinterest, even rejection.

It was a difficult time for me. On multiple fronts, I struggled to manage life with a child, and the fear and anxiety over losing a relationship I relied on was excruciating. I brought this up several times with my therapist. While it seemed like she got it, for the most part, there was a certain defensiveness in her attitude, subtle shades of blame that I was the problem here. She refused to apologize for not being available for me when I requested, claiming it was her prerogative and that I had to be more consistent with my requests.

Looking back, she may have been right — but she was also missing the point. I was hurt. I was in pain. I felt alone. I didn’t expect her to be available every time I asked, but what I did crave was empathy, understanding — maybe even an apology.

When I felt like our conversations were running in circles, I gathered the courage to write my thoughts in an email to her. The final straw came when my therapist refused to even read the email. If I could write my thoughts, she reasoned, then why couldn’t I speak them? I tried speaking them, I screamed inwardly. How I tried. But you didn’t listen like I wanted, and it didn’t get me what I wanted.

With the guidance of another therapist, I realized that I needed to end our therapy sessions. There was no terminating session — I realized that (paradoxically) it would leave me with too many open wounds. It was one of the most painful decisions I’d ever made.

I cannot say I’ve completely recovered from that experience. It’s been months and I still talk about it in therapy with my new therapist, whom I’ve learned to trust on a whole new level. Together, we’ve been taking apart and processing the entire experience.

I’ve also since learned that outgrowing a therapist is not a terrible thing. While it’s unfortunate that my therapy ended on a painful note, sometimes you need one round of therapy to lay the groundwork for another, deeper round. Not every therapist is capable of taking every client as deep and as far as they want to go. It may hurt to end with one and move on to another, but it’s also the reality, and I’m learning to own it — and even embrace it.

Malka Berkowitz

This Isn’t Our Son

Our son Dov has always been high-strung. He was a difficult baby and a moody toddler, and when he was five, we realized that Dov is hypersensitive to all kinds of sensory input. This realization was a real game changer: We took him for occupational therapy, we learned how to better manage his environment. After six months, Dov had finished OT, but his therapist recommended we take him for play therapy. He’d made a lot of progress, she said, but he still needed to learn to better regulate his emotions.

We took him to Talia Sherman*, an art therapist recommended by a local referral agency. A good friend of mine — a special-ed teacher with excellent judgment — had also used her and been very impressed.

But something felt strange. Dov’s evaluation — and I’d been through a number of them at this point — was much quieter than I expected. With minimal talking, and not much back and forth. Instead, Talia had Dov select his favorite colors, draw a picture of our family, incorporate geometric shapes into drawings.

The next week, my husband and I met with Talia. She asked us to briefly describe Dov before explaining her analysis of him, which was based entirely on his drawings and the color-selection test.

His drawings were extremely unusual, perhaps even alarming, Talia told us. She asked if he’d undergone any recent trauma. His drawings showed a child completely disconnected from his emotions, she said; Dov seemed to be harboring a large secret burden of guilt or shame. When I told her that he didn’t strike me as disconnected from his emotions — that we frequently discussed his feelings, that he was a dramatic, emotive kid — Talia suggested that that was very superficial. Gently, she told us that we should consider the fact that he may have been molested.

My breath caught. This was every mother’s worst nightmare. And I couldn’t say — in our cautious, fear-fraught society — that I’d never considered the possibility.

Yet while I didn’t want to push anything under the rug, something about this just didn’t sit right with us. Dov wasn’t a kid who hid things from me: He was the one who’d seek me out the minute he got back from school to give a blow-by-blow account of his day. And the behaviors that had brought us here, I pointed out, were nothing new — they had quite literally been present since his infancy.

Talia shook her head. She’d shown his drawings to a mentor, she said, who shared her concerns. She walked us through his pictures: the playground slide that showed he felt his life was sliding out of control; the tree he drew where the branches ended before the leaves, indicating a disconnect. And then there was his color-selection test, which didn’t align with the feelings displayed in his drawings.

Talia was gentle, soft-spoken — and clearly concerned. Therapy could help, she told us; together, they’d explore Dov’s emotions and discover the cause of his upheaval.

We left her office shaken and scared. We wanted to get to the bottom of Dov’s issues, we didn’t want to refuse help because we were mired in denial. But this just didn’t feel right.

After mulling this over, I called a family friend who’s a child psychologist. She offered to review my notes and Dov’s evaluations.

“This is absurd,” she told me. Talia’s methods were not research-based, her conclusions concocted out of thin air. She read the evaluation aloud. “A slide means his life is sliding out of control? He drew a playground because he’s a kid!” Point by point, she debunked Talia’s findings. Then she asked about Dov’s history, his routine, his behaviors. Nothing we’d seen, none of his behaviors, pointed to molestation. While she cautioned us that she hadn’t met with my son in person, she completely disagreed with Talia’s methods and analysis, and felt that Dov’s behaviors were simply an outgrowth of the sensory issues we’d seen since birth. She suggested we continue therapy elsewhere.

And that’s what we did. Three years later — with the help of a warm and qualified art therapist — Dov is thriving. She’s helped him refine his strengths and learn to regulate his intense emotions. He’s happy.

And we are, too. We’re so grateful for her work — and grateful that we didn’t ignore the instinct that told us: This isn’t your son.

Sara J.

Seeking a Safe Space

When I entered therapy ten years ago for depression caused by childhood trauma, I denied a large portion of my trauma story. It was deeply hidden in my mind, but it played itself out in life through various pathological behaviors. I kept things secret, I was spaced out, I had a lot of anxiety.

My therapist, a licensed social worker and middle-aged woman, wanted me to use the various bits and pieces of my trauma history that I remembered and collate them into a coherent story. The more she pushed me to remember my story, the more anxious I became. I stopped sleeping and became even more spaced out. I was overwhelmed with emotion. I cried to my husband that I wanted to go home to my parents.

My husband wanted me to stop therapy. But by that time, I was so entrenched in the process that I couldn’t extradite myself from it. To me, therapy had almost become a cult. Anything my therapist said made so much sense that I didn’t want to think on my own.

I only ended therapy when my anxiety rose to such high levels that I landed in the emergency room. I was treated with clonazepam, an anxiety medication, and I was sent home. The recovery process took a year, with frequent ER follow-up visits to a psychiatric doctor. She told me that I needed therapy, and recommended a social worker. The day of my appointment I remained in bed. I could not reenter a room, any room, where the threat of having another anxiety attack lurked.

But I needed help, I knew I did, so I did the next best thing. I devoured textbooks on mental health and read professional journals on depression, anxiety, and trauma. I learned about social work, psychology, and a little psychiatry from podcasts and videos. The only thing I was missing was that diploma nailed to the wall.

Most of all, I figured out what my therapist did wrong. She did not give me the skills to tolerate and accept my feelings, she didn’t form an alliance with me, she didn’t support or “hold” my emotions in therapy. She forced her agenda on me and did not abide by the ethical standards of social work.

All of my new knowledge helped. Things got better. But then, two years ago, my sister played a prank on me. My house of cards tumbled. I started bingeing like I’ve never done before, I was weepy, and I was so spaced out that my teens started mumbling, “Ma, what’s going on?” I refused to enter therapy. For me, it was a trap. But my mommy services were needed. Not all therapy is the same, my husband reminded me. And now that I was stronger and more knowledgeable, I was better equipped. I could do this.

This time too I went to a licensed social worker. She was younger than I was, which helped me feel more in control. From the get-go she was empathic, warm, and attuned, as therapists are meant to be. Regardless, I kept my finger on the trigger, waiting to pounce at any “misconduct” on her part. And when I did pounce, her response was an acknowledgment that she could be more sensitive.

I started keeping a journal of therapy sessions to help me judge how therapy was going. As I wrote, I realized that my therapist maintained her professional boundaries and didn’t allow me to develop dependence on her. She used good exploration and reflection skills and presented herself as an authority while still giving me the upper hand. She recognized when I was getting overwhelmed, reflected my feelings back to me, and provided a safe holding environment. Her refrains: It matters more what you think than what I think. What’s on your agenda for today? Which therapeutic modality do you want to work from? It’s normal to feel this way. And the one I loved the most: It’s not helpful or therapeutic for you to share what you don’t want to.

Because I didn’t have to share, and my therapist gave me a safe place to do so, I opened up. I stopped pretending everything was fine, and started telling my story in the fragmented way I remembered it. Slowly, I started to make sense of my trauma history. And finally, two years into therapy, I let go of my denial and owned the story of trauma that had been haunting me most of my life. Most of my pathological behaviors melted.

If I learned one thing from this experience, it’s that trauma can be healed by talking about it when one is ready to talk about it, and one can be ready to talk about it only if there is a safe environment to hold the pain, shame, and anger.

But today, thanks to that safe environment, I can finally be the person I always wanted to be.

Oversight Overlooked?

Unfortunately, I related to almost everything “Malka” in your recent article “Can You Help Me?” experienced with her therapist. But as life often has it, my experiences were so much more subtle and harder to pinpoint.

Many people blame the client for failed therapy — you should have known better, acted differently, done your research. In my experience (and I have lots), this is one of the most common pitfalls that mental health professionals fall into.

I don’t know anyone who chooses to make themselves miserable. We all make mistakes, but the goal in therapy should be to explore why and what we can do about it.

Therapists make their fair share of mistakes, maybe more than anyone, due to the delicacy of their job. It’s all too easy for a therapist to (very subtly) blame the client for their own issues, to self-righteously get upset “for the clients sake.”

Therapists should be able to handle the stuff we throw at them so we can learn that we’re okay, we’re good enough. Then we can begin to explore what we may want to change in our behaviors.

I’ve seen numerous therapists, all who’ve come highly recommended, who either completely didn’t know how to treat me, who hurt me and yelled at me, who inappropriately blamed me.

Something has to change. This isn’t just about helping people figure out relationships: There are lives at stake. I know, I’ve been dangerously close to the edge, particularly when I was hurt by the one person who should have been helping me more than anyone.

Referral agencies are a good first step, but they’re not enough. The therapeutic world needs more oversight. Yes, most therapists have supervision, but the supervisors only get to hear what and when the therapist chooses. There needs to be more communication between therapists, clients, supervisors, and mentors. Rabbanim should be more involved. Therapists need to answer to someone so that clients have a safety net before they hand their souls over to complete strangers.

If anyone would like to help me or join, you can reach me at safeandsupervised@gmail.com.

Your friend/neighbor/coworker

Not the Sponga Type

I was very intrigued by your article about bad therapists. When I was dating and became very anxious about the responsibility of making a decision whether to continue a relationship or not, I sought advice from a well-known therapist. After the first few sessions, I began to dread seeing him. I left his office feeling more stressed and confused than when I went in. It was only a few months in when I had the thought, “How stupid am I? I’m paying to see someone I don’t want to see? Why am I doing this to myself?” and decided to stop the therapy.

With hindsight, I realize he treated me like a daughter, not like a client. Instead of building up my confidence in my decision-making ability and helping me to trust my own voice, he gave his opinions, taking over the decision-making process for me. I was very conflicted about whether or not I wanted to marry a boy who wanted to stay in Israel in learning, and he criticized the whole kollel system and asked me how I could possibly take on responsibility for parnassah if I only had an arts degree. He told me that when he made aliyah, he experienced financial difficulties, and his wife had to clean shuls for a living.

“You don’t look like the sponga-doing type,” he said. (Actually, I do a very nice sponga, thank you very much!)

Well, I ended up doing bibliotherapy, reading The Feeling Good Handbook by Dr. David Burns, every second of which was a pleasure. And that empowered me to take the risk of marrying a boy in learning and staying in Israel. (And finding a well-enough-paid position that we were able to stay for six years before my husband started working!)

Bottom line: You should leave a therapy session feeling empowered, not confused, dreading the experience. And if you feel that way, your therapist isn’t right for you.

Name Withheld

(Originally featured in Family First, Issue 739)