First person: Take the first step toward therapy – together | Wisconsin Jewish Chronicle

First person: Take the first step toward therapy – together


After 40 years in practice, I never really considered myself a Jewish family therapist. Maybe, just a therapist who was Jewish. And yet, it was an important segue for a potential client I will call Michael to be referred and come and talk to me. I periodically wondered whether I was being forthright in not perceiving myself as a Jewish therapist, but the issue tended to slip by the wayside as I focused on skill development and process. Even self-awareness seemed to have no place for it.

Come and sit with me and I will share my experiences with Michael. Michael is a very successful business executive.  He was referred to me by another therapist who is a friend of his and understandably didn’t want to cross boundary lines with him.  She also told Michael I was Jewish and since he was also, maybe we could “connect” easier. I didn’t want to go into this myth as I sensed it at the time, but put it in a metaphorical dusty drawer to be brought into the light at a later time.

The therapist described the presenting problem as one in which Michael was up for promotion and the deciding executive was not very impressed with him.

Michael came to the office looking and sounding bright and charming, but with a sadness streak that burned through his speech and manner. He denied being sad but admitted to great anxiety and a dread of failure if he should not be promoted. He perceived the other executive as out to show Michael’s weaknesses and that Michael would bring a great many problems to the business: problems that would not be there with another person to be chosen for the position.

I noticed he was looking around the office. He told me he was looking for something “Jewish.” I had none. When I asked why he was looking, he said his friend made a big deal about our sharing the Jewish faith. “Was it a big deal” I asked?  “Only to her” he said. Both of us sat for a moment or so in silence. I suggested we move on; for now.

I asked why he wanted the promotion and why was it so important to him. I had learned long ago that asking seemingly obvious questions frequently led to wonderful diagnostic information and a possible source of a pathway to some sort of healing. Michael became overtly anxious as he described the unfairness of the other man, the persecution he felt, and a litany of accusations against this man that would have filled my notebook if I had been taking copious notes.  I hadn’t.  And yet I still didn’t understand and asked him again.  This time he threatened to walk out if I wasn’t paying attention. I went to the door and asked the secretary to come into the room.  She already met Michael when he registered and I asked her if she thought I was the kind of therapist who didn’t pay attention to his clients. “Oh no,” she said, “The prof is extremely competent and gives all his clients his full attention.” I said thank you and she left. Michael was speechless and I asked the question again. This time, he began to sob and told me that he had been keeping a secret for all his professional years. That he was always afraid that someone would realize he is incompetent and not worthy of the success he had enjoyed. He would be found out; he was an imposter! The exec was absolutely correct and Michael wasn’t fit to be promoted.

A waterfall of pain and suffering and anxiety began to pour forth from him. Sometimes, it is best to let people express their feelings fully, and I thought this was the time. Michael then began quietly sobbing and said he was ashamed to reveal such emotions, such painful and sad emotions. I said nothing, giving him a chance to express even more emotion. I had a sense that I wanted to ask one question about losses in his life and he said the only loss he had was that of his father, but that was a long time ago. What happened? He replied his family wasn’t observant, and they ridiculed shiva as a foolish and outmoded action by Jews. I told him I disagreed, at least for me, for it was helpful when my folks passed because it successfully supported me to begin the painful process of deep grieving. I wondered if he had successfully grieved his father’s loss? “Now that I think about it, I don’t even know that. I can’t talk about it now.” Maybe at a later date, I suggested.

He repeated his words of shame and unworthiness, and then I shared my willingness to be there for him if he wanted to explore the why, the how, the history, and to seek some more positive skills and insights to replace the giving up of his great sadness and confusion about himself as a person.

Sometimes, but not always, a therapist will keep some rein on the expression of such feelings with a client. My instinct said that he would be OK and that his ego would not deteriorate by these expressions.  At other times, I will sense a breakdown of reality testing and ego strength and offer a tissue which is a clue for the client to bring the expression to a close, for now. Whether I let them continue or offer a tissue is always explained to the client later in terms of why I am doing what I am doing. It is not about my being uncomfortable with their pain or that what they are expressing is alien and inappropriate. No one wants to feel exposed and vulnerable, so I gauge my response on where they are emotionally and psychologically during these floods of affect and feelings. Of course, other therapists may deal with similar situations differently, and that is what makes each therapist unique and may appeal to different types of clients.

It was almost time to conclude the session and I offered Michael a plan to consider. Sometimes, I negotiate a plan and sometimes not. Not this time. I offered two more sessions with him alone, for there was much I did not yet understand, one session with Michael and his wife, Millie, one session with Millie and their four almost adult children, and a final session with Michael in which I would hope to present a treatment plan with goals and objectives and a time frame for us. Michael agreed to this plan and then asked for my fees. After I told him, he laughed and called it “pocket change.” “I spend more for dinner and a bottle of wine.”

“Uhm,” I said, “many folks would be in a financial disadvantage and ask for a discount.” He brushed aside my comment and extended his hand and agreed again to the pre-therapy and diagnostic phase of this work. Interesting that he agreed twice, which seemed to imply to me that he was relieved with the plan in that someone had gone beyond the intense emotionality of all this and  had taken the lead for a while: an experience he had not had in a long time.

What was behind this sense of failure and fear of being “found out,” how did he achieve so much already with these secrets behind his image, how much of this affected his role as partner and parent, what will he want from me, can I be of real therapeutic help to him? Questions like this filled my mind as I fluffed the cushions on the sofa, straightened the office, and awaited my next client. It was early in the evening and I had a full schedule of clients ahead of me.

Therapy is tough work; therapy is for courageous and brave people who are willing to make that special step into the unknown. To make a commitment to reveal their most intimate experiences and feelings and to partner and collaborate with a therapist. We have skills and abilities and a desire for those suffering and in pain to find a reduction in suffering and pain while seeking new pathways to being and becoming. It is also rigorous work for me and tests my deepest intentions and purpose as a healer.

I think about our “Jewish connection.” Well, it brought us together and gave me some excellent direction into Michael’s lack of grieving his father’s death. What other significant experiences had he not grieved and what might be the connection between this hypothesis and Michael’s sense of being an imposter and the dread of being found out? How much did an overly critical self-image play a role in all this? Most important was my being optimistic for Michael. He had taken that first anxious step. One can seldom appreciate how hard it is to appear at my door, or any therapists’ door for the first time. I believe he is a brave guy.

This article, revised here for a Jewish publication, is reprinted with permission from The New Social Worker magazine at Alan S. Wolkenstein of Mequon holds a master’s degree in social work from University of Wisconsin – Milwaukee and is a retired clinical professor of family medicine with the University of Wisconsin School of Medicine and Public Health. “Prof,” as his students and friends call him, is a native West-sider. He and wife Kathy are members of Chabad of Mequon.