Dovid was misbehaving. It got to the point that his mother was being asked to pick him up every day, and the school was ready to throw up their hands and expel the third grader. How could they take the responsibility for a boy who just wouldn’t do what was expected of him?
Panic stricken that he would really be thrown out of school, Mrs. Posner tried speaking to her son. She tried threatening him. She tried rewards and consequences; nothing seemed to make a difference. The teacher and the administration did not know how to improve the situation, either, so they advised Mrs. Posner to take her son to a therapist. Luckily, through the recommendation of a friend, she found a therapist who specialized in children and was able to help her son. “I can’t say that it was really magic,” says Mrs. Posner, “because it wasn’t instantaneous, but over a period of two years the therapist really helped my son learn to follow the rules. She worked with me, with him, and with the administration. He is now in seventh grade and doing very well.”
Many people today consult mental health professionals for themselves or their children to help them navigate life’s rough spots. It might seem obvious that – just as a person with a physical problem seeks out a doctor who has learned how to treat physical illnesses – someone suffering emotional distress would seek a psychiatrist, psychologist, or other psychotherapist who has been trained to help people deal with their emotional problems. Yet that does not always happen. In the past, psychological treatment was stigmatized, and although it is more accepted today, many people still hesitate. Even after admitting that there is a problem, a difficult step in itself, the process of finding the right therapist is not easy; it is hard to know what to look for or whom to choose. This article – along with the articles by various therapists in our community, elsewhere in this issue – seeks to answer these questions: Why would a person go to see a therapist? How can they find the right therapist for their problem? What are some of the methods therapists use to help their clients? Can a parent insist that a child see a therapist, or can a person only be helped if they seek help on their own accord? And finally, how long does therapy take?
Why Go to Therapy?
Bennet Pologe, Ph.D., on his website, About Psychotherapy, describes the purpose of therapy: “The less aware we are of our motives, feelings, thoughts, actions, perceptions, the more they control us, and the more we stay stuck in old patterns that don’t work anymore…. The good news is that this awareness is the one magic psychotherapy has to offer….I have seen it again and again in all kinds of patients, in friends, in myself…when you feel whatever it is you spend your energy trying not to feel, you feel better and you function better….”
Avraham Reich, a licensed clinical social worker in Baltimore, agrees: “Psychotherapy is the process of removing emotional obstacles which prevent people from reaching their goals,” he says. “Those who remain unaware of unconscious forces driving self-sabotaging behaviors may repeat such behaviors indefinitely and never attain their goals. In psychotherapy one gains an awareness of the meaning that memories have attached to prior experience, and this awareness liberates the individual to make better choices for the future. Some people consider having been in therapy a blemish indicating something wrong,” he adds, “but in reality it is a gold star, a sign that one is doing the work necessary to improve. It is a path of self-development for those wise enough to make use of the opportunity!”
People see therapists for many different reasons: According to Dr. Michael Freedman, a licensed social worker, “A person usually goes to see a therapist when they or their children have symptoms that interfere with daily living activities such as eating, sleeping, occupation or school, or if they feel so anxious or depressed that they have physical symptoms.”
“Most people have issues,” says Dr. Yoel Schwartz, a Silver Spring psychologist. “There is nothing embarrassing about getting help when you have a problem. If you can’t find a solution yourself, a therapist may be able to help you. As Albert Einstein said, insanity is doing the same thing over and over again and expecting to get a different result.”
People go to marriage counseling to help a good marriage get better or to help a faltering relationship. Some engaged couples go to counseling to prepare themselves for their future together. Some people just go to therapy because they find it helpful to have an ongoing relationship with a person who can help them figure out ways to deal with life. Moshe describes his relationship with his therapist: “In the past few years, I have found a therapist who is intelligent, empathetic, and wise. I now actually take the time to listen to the insight that he shares with me. I have the advantage of an objective stranger who listens to my personal problems and shares the benefit of his experience. I believe that this is therapy at its best.”
How to Find a Good Therapist
Our community has many mental health professionals. There are psychiatrists, psychologists, counselors, and social workers. How does a person sift through all the names and titles and find the right person? “The most important things are the expertise that the professional has in your problem and the rapport between the client and the professional,” says Dr. Ken Sachs, a psychologist with Psychology Consultants Associated. Those two things are more important than the letters after the person’s name. The client should feel understood, secure, and totally accepted by the therapist. In addition to one’s comfort level, patients should also feel stimulated and challenged in their therapy endeavor,” adds Dr. Sachs.
People in our community often speak to a Rav if they or their child are having a problem. Rabbanim are a good resource, because they have experience in recommending therapists. They advise so many people that they are familiar with therapists who have expertise in various areas.
“Sometimes you can get a recommendation from a friend with whom you have good rapport,” says Shlomo Schor, a licensed counselor. “If your friend finds a therapist helpful, perhaps that person will also be a good match for you. There has to be a rapport between the counselor and the client.
“You can ask for an informational interview, as well,” Mr. Schor continues. “You can speak to the counselor over the phone or in person and describe to him, briefly, your problem and your symptoms. Questions you might ask can include: How would you deal with a problem like mine? How do you help a client move from here to there? What kinds of techniques do you use? Have you seen other clients like me? How long do you think it will take to help me? During that meeting, you can see if you feel a rapport with the professional. Does it sound like he knows what he is talking about? You can also ask for references and speak to other clients who have used that counselor.”
Sometimes a person may choose a therapist and then find that he or she is not the right one. “Failed therapy” is not the end of the world, according to Dr. Pologe. He writes, “Psychotherapy is a relationship, and no relationship comes with a guarantee….There is no reason for failure to mean anything more than minimal lost time and money, if even that….This is not brain surgery, where one wrong move and there goes all sensation from the left side of your body. If you meet with a therapist for a few sessions and it is not working, you will hopefully have learned something from the experience, if only more precisely what you want in a therapist.”
What Kinds of Therapists Are There?
A psychiatrist is an M.D., a medical doctor, and the only mental health professional who can prescribe medication. Although psychiatrists used to provide talk therapy – in the early days, that’s all there was – in the past few decades of managed care, that is happening less and less. Insurance company rules have made it more cost-effective for people to go to psychiatrists for medication only and to counselors for talk therapy. However, since studies indicate that a variety of problems are best addressed with a combination of medication and talk therapy, psychiatrists and psychologists or social workers often work together.
Psychologists have earned a Ph.D., and can help people understand the underlying problems. They are qualified to do psychological evaluations, testing, and various types of therapy. Counselors and social workers are also trained to do psychotherapy but cannot do testing. “A psychologist has a big allegiance to evidence-based practice,” says Dr. Gail Goldberg, a practicing psychologist. “That means they understand in great depth the different methods that can be used to help a client, and have expertise in applying the right kind of therapy for each person.”
Most therapists have a specialty. Some specialize in marriage therapy and will only see couples; some specialize in children, and some in addictions. Some work with the senior population, and some work with teenagers. It is important to find a professional who has expertise and experience with the problems you are dealing with.
Paying for Therapy
Unfortunately, psychotherapy is expensive, which is a major roadblock for many people. If you are planning to use health insurance to pay for the therapy, you have to make sure the therapist will take your insurance, and also check your insurance policy’s coverage. Insurance companies often have limited coverage for mental health care and make it difficult for a person to see therapists who are out of network. Many therapists do not accept insurance, because of the paperwork involved. These therapists want to be paid up front; clients are then reimbursed by the insurance company.
Because therapy is usually for an extended period and can be expensive, some therapists are willing to charge people on a sliding scale. If the therapist you want to see charges more than you can afford, don’t assume it is impossible to see him,” says Mr. Schor. “Therapists want to work with motivated clients, and it is fine to ask if he would be willing to work with you on the price.” Social service agencies, like Jewish Community Services, also offer a sliding scale that makes therapy affordable for many people.
What Techniques Do Therapists Use?
Once the client has chosen a therapist, the therapist will usually discuss which modalities will be the best for this person’s situation. Therapists specialize in different techniques, and various techniques are more effective of certain problems. For example, according to Dr. Ken Sachs, therapies that focus on understanding the rationality of one’s thoughts, as they relate to feelings and actions, (cognitive behavioral therapy and rational emotive therapy) work best with phobias, panic disorder, depression, alcohol and substance abuse, and couples conflicts. Psychodynamic therapies focus on understanding how past issues in one’s life influence present situations. These approaches work best in addressing personality problems, relationship issues, and dysfunctional family concerns.
“Cognitive behavioral therapy is very popular and effective,” says Dr. Gail Goldberg. “In very simple terms, this means that, if you change the way you think, you can change the way you feel, which in turn will lead you to change the way you act. Cognitive behavioral therapy can also be approached from the other direction: If you change the way you act, you can change the way you feel, which will, in turn, change the way you think.”
“A therapeutic technique I often use is mindfulness,” says Esther Hackerman, a licensed counselor. “Mindfulness means learning to live in the moment, focusing on what is, instead of what was or should be. It means trusting that what Hashem has sent us is what is meant to be. It means learning emuna. Mindfulness, instead of teaching people to reduce stress, teaches them to tolerate stress. Learning acceptance takes time and patience. Yet every time we practice awareness, we strengthen our capacity to be open to life as it is – and to grow from it.”
Rabbi Shlomo Slatkin, MS, LCPC, an Imago therapist, says, “Imago is a form of relationship therapy that helps couples reconnect and restore love. In Imago therapy, they learn how to understand their conflict in a new way that brings them to greater connection. During a session, couples face each other and address each other, not the therapist,” continues Rabbi Slatkin. “They learn to curb their reactivity and begin to truly understand the other. Imago therapy has helped all kinds of couples, from those who are dating to newlyweds to couples who have been married for 40 years. Some couples use this process to make a good marriage great, and others come because their marriage is in trouble.”
Dr. Yehuda Bergman specializes in expressive therapy. When a client sees him, Dr. Bergman doesn’t use only talk therapy; he draws upon different forms of the arts to help the person express thoughts he may have difficulty expressing verbally. Sometimes, through drawing, music, drama, or poetry, a person can get in touch with how they really feel. The emphasis is not on the finished product but on the process of creating.
There are many other modalities and variations of modalities. Read what each contributor has written in his or her section.
Therapy and the Family
Just as there are various kinds of therapists and methods, there are various kinds of clients. Some people are motivated to go to therapy, while others are very reluctant, and only go if they are forced or if the situation is unbearable to them. Often, parents or the school insist that a child or teenager go to therapy, because of misbehavior or a problem like an eating disorder. Depending on the situation, the therapist will focus just on the child, or will want to see the whole family. Young children may enjoy getting special attention from the therapist. An older child is not so easily coerced, however. A teen is more concerned about the stigma of seeing a mental health professional, and parents may have to use their creative skills to get their child to go for the help that they need.
“I was very pleasantly surprised when my plan worked, said Mr. B. “I knew that it would be beneficial for my daughter to go to therapy, but she was not interested at all. You can’t force a grown-up to do anything. Once she wanted me to buy her something which she could not afford. I offered to buy it for her if she would see a therapist four times, the hope being that she would find it helpful and continue going. I was so happy when it really worked and she continued to go after our agreement was over.”
Even if parents get their very reluctant child or teenager to go to therapy, how does the therapist deal with someone who doesn’t want to be there? “I acknowledge to the client that I know it wasn’t their idea to come see me,” says Dr. Gail Goldberg. “I try to find a point of connection and try to find something positive to admire about them. I also reassure them that everything that is said is confidential. I tell them I won’t tell anyone about our conversation unless they give me permission, and I sometimes suggest that we meet three times and hope that by then the child won’t be so reluctant.”
Dr. Michael Freedman, who works with people with addictions, says, “It is very hard to work with someone who doesn’t want to be there,” he says. “Parents often bring their teenagers, because they want me to fix them, but the client has to be motivated to change in order to be helped. Part of the problem,” says Dr. Freedman, “is that addiction is a family disease. Every member of the family is affected by the addict’s addiction. In our community, there is the added burden of people being worried about the stigma and about others knowing that they have a problem. Once a parent wanted me to label their child ADD, rather than depressed, because they were worried that the word would leak out when it came the time for shidduchim.
“If a person is willing to get over the stigma and attend 12-step meetings, they can really improve. Some people are concerned that the 12-step program is not appropriate for Torah Jews, but that is not true. I heard from Rabbi Dr. Abraham Twerski that each of the 12-steps has a source in the Torah.”
How Long Does It Take?
The length of the treatment may depend on the goals of the therapy and the modality that is used. “Cognitive behavioral therapy is structured and shorter term,” Dr. Ken Sachs writes on his website. “Psychodynamic therapies…are less structured and may be longer in duration.”
Some therapists offer their clients a clear picture of how long successful therapy will take: “I can always promise patients that within 10 or 15 sessions they will see some change,” writes Dr. Pologe, “maybe not a cure but a clear difference in how they think, feel, and act, or in how things look to them. This has actually become a rather conservative estimate. Many patients see a change sooner, sometimes a big change.”
Other therapists rely on the client being aware of the changes in themselves as a guide to when to end therapy. Dr. Judith Levin, a Baltimore psychologist, considers it progress when her clients realize that they are ready to consider a range of options, instead of being stuck in their old way of doing things. “There is a greater sense of self-awareness and freedom and choice,” she says. “For example, if a person always reacts in a certain way when her boss makes her angry, and now she can consider other options, that is progress.”
Finding a competent therapist is quite a challenge. There is a lot to think about and research. Hopefully, this article and the ads and articles in this issue about the services available will be helpful to people who are exploring their options.
