(Republished with permission of Mishpacha magazine)

Meira was seeing her therapist Malka because she was having trouble making decisions. She had a promising career that paid well and had potential for growth, but she wasn’t sure that she wanted to spend her life working in front of a screen. She was dating a charming young man who was interested in marriage, but she wasn’t sure he was the right one and didn’t feel ready to commit. The first two therapy sessions seemed helpful, but at the third session, Meira told Malka, “I’m not sure you’re the right therapist for me.”

When Reuven was a teenager, his mother passed away after a long illness. His father remarried soon after, and Reuven was left feeling very alone. Reuven kept mostly to himself and felt no one could be trusted. He got by with adequate grades and was accepted into a small yeshiva in Israel after high school. The Rosh Yeshiva was concerned about Reuven and suggested therapy, but Reuven refused. A number of years later, Reuven married. A few months into marriage, his wife told him she was so frustrated trying to communicate with him that if he didn’t see a therapist, she would file for a divorce.

Reuven began seeing Dovid for therapy, but had a hard time speaking openly with him. In the second session, Reuven forced himself to share something a little more personal, but as soon as he returned home, he regretted what he had said. He was afraid that community members might hear aboutwhat he had shared. The next week, he got a terrible migraine and missed his appointment. The following week something else “came up.” He felt terribly stuck; he didn’t want to ruin his marriage, but he couldn’t bring himself to go back to therapy.

Miriam was a perfectionist. As a teen she prided herself on being at the top of her class, holding a prestigious chesed position, and running production. Now married with three small kids, she was starting to understand that the perfectionism was getting in her way. She wanted the kids to always be clean, well dressed, eat balanced meals, and her home to always be neat and tidy and have “that look.” She wanted to stay trim and fit, and of course maintain her respected professional standing in her part-time job. But when she simply wasn’t able to succeed on all fronts, she found herself snapping at her husband and children. She had trouble falling asleep before she felt that the day’s work was done and was often up until the wee hours of the morning. Then she was so tired during the day that she ate chocolate just to keep going, which was affecting her figure and making her more distressed. The stress was building and something had to change; she felt she was crumbling inside. Her husband begged her to go to therapy, but she said that she wasn’t “the therapy type.”

One day she overheard a conversation between her six-year-old daughter and her friend.

“I like coming over to play because your house is very pretty and you have lots of toys,” the friend said.

“Your house is a lot more fun because your mommy is a nice mommy,” Miriam’s daughter replied. “She smiles, plays with us, and doesn’t yell all the time.”

After a good cry into her crisply ironed bed linens, Miriam decided it was time for therapy. But when she arrived at the office, she wasn’t impressed with the décor and didn’t feel the therapist made a good first impression. The therapist, Eliana, had been highly recommended, but she just didn’t seem to be her type. Still Miriam felt a need to impress her, and she didn’t share the full extent of her obsessive behavior. The sessions dragged on, and after three weeks she felt that she wasn’t getting anywhere.

The Therapy Roundabout

Meira, Reuven, and Miriam all came to therapy with some degree of hope that it would change their lives for the better, but the very issues that brought them to therapy ended up sabotaging their progress. Meira’s difficulty in making decisions made her unsure if the therapist was the right one for her. Reuven’s lack of trust made it hard for him to trust his therapist, and Miriam’s critical eye was turned against her therapist.

This “Therapy Roundabout Trap” is a challenging phenomenon. Every experienced therapist has dealt with it, and many clients are in danger of falling in, but surprisingly, it is rarely discussed.

People go to therapy because something hurts. That “something” is usually an issue that has been affecting their lives for a while, possibly in various areas: at work, with family, and with friends. Often the issues that cause so much trouble in people’s lives cause the same type of trouble in therapy. If the client and therapist are not aware of what is going on and committed to working on it, the same issue that brought the client to therapy can be the very issue that makes them walk away.

Not all therapists take the time to orient clients to therapy and explain how they can make the most of their experience. By understanding and applying these tips, you can avoid sabotaging your therapy experience and get the best bang for your buck.

1. Ways To Maximize the Bang for your Buck in Therapy:

2. If you know what kind of help you need, find a specialist. The sweet, supportive therapist your neighbor saw after her miscarriage may not be helpful in sorting out your shalom bayis problems. If there is violence and abuse in the marriage, not every certified marriage counselor will have the appropriate training. If you aren’t sure who to turn to, try referral sources like Shalom Task Force, Yitty Leibel Helpline, and Relief in the U.S. In Israel, Tahel—the Crisis Center for Religious Women and Children is a wonderful resource for finding the right professional, or the Neve Family Institute which offers subsidized therapy and make referrals to specialists throughout Israel. On the initial phone call, ask for a therapist with specific training and experience dealing with issues such as stepparenting, special needs children, trauma, social anxiety, addiction, infertility, or whatever else you are dealing with.

Seeing the wrong therapist can sometimes be worse than doing nothing at all. Sadly, victims of trauma who come to therapy to deal with post-traumatic stress can be re-traumatized in therapy if they are not seeing someone trained in the nuances of traumatic stress. If a couple is having trouble because one spouse is suffering from an addiction or mental illness, the types of interventions used in regular couple’s counseling may be more problematic than helpful.

1. Share previous experiences in therapy. A good mechanic can use his expert technique to fix engines and get good results each time. Human beings aren’t like that! Not every type of therapy is right for every client. If you have ever been to any form of psychotherapy, tell the new therapist about it, especially what was helpful and what wasn’t. You can save time, money, and frustration by helping your therapist understand what works for you.

For instance, your last therapy experience may have taught you that it’s very hard for you to verbalize your emotions; your new therapist may therefore suggest some sort of expressive tool such as art, writing, drama, or music. Likewise, if your previous therapist did something that was uncomfortable, inappropriate, or unethical, it is vital for the new therapist to know, as it is only natural that you will need time to build trust and may remain wary well into the treatment.

1. Get comfortable with meta-talk. One of the things that makes therapy different from talking to a friend is that in therapy we talk about the talk (sometimes called meta-talk). Therapists will sometimes comment about the process of the session—not just the content being discussed, but also the way things are being discussed. For example, “I notice that when I asked you that question you looked away from me and shifted your posture. Did you notice that?” or “We talked about some very personal issues today. How are you feeling about that right now?” These types of questions help steer the discussion where it needs to go.

Meta-talk may feel uncomfortable at first; it’s not the kind of social or even family conversation style we are used to, but it is essential for successful therapy as it builds a sense of alliance, openness, and trust. Basically, it helps you and your therapist stay on the same page. Don’t hesitate to talk about how you are feeling about the conversation at any point in your therapy.

1. Offer feedback. At the end of a session, many therapists ask clients how they felt about the session. To make the most of your therapy, answer in a real and honest way, even if it isn’t polite. A good therapist will be happy to get honest feedback, both because it will guide the therapy to where it needs to go, and because it shows a certain amount of honesty, growth, and health on the part of the client.

I get excited when clients give me feedback that they want something to be different. It means they are giving the therapy thought and consideration and that they trust me and the therapeutic relationship enough to bring in things that are important to them. Here’s one example. I typically find it helpful for clients to focus on their strengths and reflect them back to them. I might comment, “Wow, how did you have the to do that?” or “It sounds like you managed that with ” With one client however, whenever I said something nice about her, she would disagree. When I asked her about it, she told me that she didn’t like having anyone “editorialize her selfhood” – she was the only one who should decide who and what she is. She preferred not to receive compliments which felt like a slight on her autonomy. This was helpful and significant information which led to an important conversation about her family of origin. I never could have known this if she hadn’t told me, and I was pleased she felt empowered to share it.If your therapist responds to feedback by getting defensive, annoyed or offended, or tells you that you are wrong, look for someone else.

1. Be honest. If you are a people-pleaser, or have a hard time connecting to your emotions or trusting others, tell the therapist! As well-trained or experienced as we may be, we cannot read minds. If the therapist asks a question that is difficult or painful to answer, say so. If you feel you can’t trust the therapist, say so. If you feel you are looking for the answer the therapist wants to hear – guess what? Yes, say so! Often what you are experiencing in the moment reflects your core issues and is therefore more important than the original question that the therapist asked. Addressing those feelings will get the therapy process where it needs to go faster.

If you don’t share honestly, you are likely to fall into the Therapy Roundabout, and you’ll carry your emotional baggage right out the door with you.

Irvin Yalom, a well-known therapist and author, wrote that when something important needs to be discussed in a session and the therapist or client avoids bringing it up, it is unlikely that anything else of importance will get accomplished. If you’re hesitant to bring something up, start by talking about your discomfort or reluctance and see where that takes you.

1. Discuss the parameters of Confidentiality. All therapists are bound by confidentiality – morally, legally, and halachically. Therapists know that a leak of confidentiality can end their professional careers. That said, the Jewish world is small, and uncomfortable situations may arise where your relationship with the therapist may cause you discomfort. For instance, how would you like your therapist to respond if you bump into each other at a wedding, tzedakah event or supermarket? In a small community these coincidental meetings are almost inevitable. Discussing these issues in advance can avoid a lot of discomfort and increase your sense of security.

There may be times you want your therapist to discuss your case with a rabbi, teacher, or someone else involved. The therapist will ask you to sign a confidentiality waiver that legally allows them to speak to that specific party. Be sure to clarify which topics you want discussed, and what information should not be disclosed.

(There are important exceptions to confidentiality. If the therapist has reason to believe that someone—particularly a child under age 18—is in danger, they may be legally bound to report the situation to the authorities.)

1. Take it slow. Therapy needs to touch on core issues in order to lead to progress. However, if you open up too quickly, you may feel uncomfortably emotionally exposed. Pace yourself. Think of a bottle of soda that’s been shaken up—it needs to be opened slowly and carefully. Our emotional issues can make us feel very vulnerable. Take time to get to know your therapist and build trust. Your therapist should respect your need to pace yourself and to feel comfortable with the process. The goal in therapy, as in many other important endeavors, is slow and steady.

1. Do your homework. Some therapists give assignments between sessions which are important to make the most of your process. If you are in CBT (cognitive behavioral therapy) or DBT (dialectical behavior therapy), homework is an essential part of therapy.

Even if you don’t have homework, you can increase the power of your sessions by giving them some thought between sessions. One client would sit in the garden outside my office after each session and draw a picture expressing how she felt. This helped her feel more contained after discussing vulnerable issues. She would bring the picture to the next session to help with her sense of continuity. Another client sometimes had a hard time talking about difficult things, but would write me letters between sessions which she would bring in and read to me. Writing in a journal can be helpful to your process of growth and self-understanding, regardless of whether you share what you wrote with your therapist.

1. Check your alignment. According to research, a key factor influencing the outcome of therapy is that therapist and client agree on what needs to be covered during the session. Imagine visiting a dermatologist because of a painful rash. You show the doctor the rash, but instead of taking a close look, asking detailed questions, and prescribing treatment, she asks you many questions about a birthmark you’ve had your whole life that never bothered you. Would you go back? No. If the doctor looked at the rash and started poking, prodding, and pinching, causing you great pain, would you go back? Also no. You want the doctor to take a good look at what is ailing you and approach the pain gently while maintaining your personal dignity.

It is your job to tell the therapist what ails you. You want the therapist to focus on issues that are important to you, gently and not pushing you too far too fast. If you feel like you are becoming more vulnerable in the session than feels safe, tell the therapist. You may agree to slow down or talk about other approaches that would ensure your emotional safety.

1. Be prepared to work. This isn’t a manicure where you just show up and pay for the service. You need to do most of the work in therapy; your therapist is there as a guide and witness. If you come to therapy expecting the therapist to do most of the work, you will be disappointed.

1. Set goals—and a timeline. They may change at some point, but having goals and a timeline will help you avoid procrastinating any discussions that need to happen. Commit to continue even if it gets tough. One difficult session is not a reason to leave therapy. Unless it becomes absolutely clear that something is very wrong, stick to your commitment and follow through to meet your goals. Share your goals and time frame with your therapist so together you can make a realistic plan to meet them.

1. Book an exit session. This crucial part of therapy is, unfortunately, often overlooked. If you have decided not to continue, see the therapist for a final session. It is worth paying for that last session for several reasons: Discussing what you gained from your sessions helps consolidate those gains; it is worthwhile to give the therapist honest feedback about what was helpful and what was not; it will empower you in your own growth and give you clarity about your own needs—which is essential if you will be looking for another therapist. Also, it is a chesed for the therapist and the future clients who will benefit from your feedback.

Sometimes it isn’t the healthiest part of you that tells you to discontinue therapy. In each of our introductory examples, the desire to discontinue therapy was coming from the very issues that brought the clients to therapy in the first place. By openly discussing your desire to end the therapy, you may be able to take the therapy to a whole new level.

I have found that the process of ending therapy can be one of the most meaningful aspects of therapy. Many of us have experienced endings that were painful, sudden, and unresolved. Taking the time to end therapy in a wholesome and healing way can be very empowering and meaningful.

If you have only met for a couple sessions, it is possible that a short phone session will provide enough closure. If it has been months or years, give yourself weeks or even months to talk about what the ending means to you.

Let’s go back to Meira, Reuven, and Miriam. By following these 12 tips, they could each salvage their therapy process and avoid leaving therapy with the same issues that brought them there in the first place.

Meira could discuss her difficulties in making decisions and commitments with Malka. By carefully looking at her decision-making process, Meira could use her difficulty in committing to therapy with Malka as an analogy for other difficulties she has in making important life decisions.

If Reuven would tell Dovid how terribly frightened he is to trust anyone, he would take a huge step forward in his life. They could talk about how trust is built and the damage that occurs when it is broken. Dovid could focus on the trust issue, going slowly and steadily to help Reuven understand its source, and they could work together to find a therapeutic pace that was both safe and challenging. This sort of corrective experience could eventually help Reuven build trust in his relationship with his wife and save their marriage.

Miriam the perfectionist has a harsh critical inner voice that is causing her and her family a lot of pain. If she honestly shares the reality of her harsh inner critic with her therapist, they will be able to work together to oust it from the driver’s seat of her life.

Many more issues bring people into therapy and could potentially make them exit at the same place they entered. The client who comes to therapy because of low self-esteem feels he doesn’t deserve the therapist’s time and attention and that he shouldn’t be wasting money on himself. The depressed client feels that therapy is hopeless and she doesn’t have the strength or emotional resources to get out of bed to make it to the session. The client who is so overwhelmed by the stressful circumstances of her life has a hard time fitting anything else into her over-packed schedule and doesn’t keep appointments. The client with an anxiety disorder may find that talking about his anxiety triggers is too anxiety-provoking for him to continue. The nature of therapy is such that people come in because something is ailing them. Unfortunately, the very things that ail can make therapy fail.

It’s true that a skilled therapist may be able to safely guide a client out of the “Therapy Roundabout.” Still, being an educated and savvy customer gives you an advantage, ensuring that the time and money you invested in therapy is well-spent.

(Originally published in Mishpacha magazine - reprinted with permission)