How to ascertain if your therapist is competent, caring, and the right match for you

Narrative by Malka Jacobs

"I see your nose. What kind of device are you using?”

“A tablet. With a stand.”

“You have to position it straighter. Do you have a tabletop stand?”

The heat rose to my face as I fiddled with the device to get a good view.

“I’ll just close my eyes,” Rachel said. “I’m getting dizzy. Let me know when you’re set.”

I adjusted the tablet as I watched Rachel doing deep breathing, her eyes indulgently closed.

“I’m ready.”

“Okay.” A smile. “So, Malka, how are you?” The start to our weekly session.

It was during the first wave of coronavirus and I’d met Rachel, my therapist, in her office only once, for my intake session. Then the country had closed down.

With Zoom new to me, I hadn’t yet been ready to meet face to face over a device. I opted for telephone calls for the following sessions. Until the previous week, when I’d left the session unsettled after feeling vibes of exasperation flowing through the wires.

“Why are you going so fast?” Rachel had asked me, when my anxiety reared its fearful head and I bombarded her with questions. Her voice was hard.

See? I chastised myself, writing in my journal that night. Everyone gets exasperated with you. Even the person you’re paying 250 bucks an hour to listen to you. The mighty Rachel also finds you annoying. You are annoying. That’s the fact.

Tiny seeds of doubt were starting to surface. But, I wrote, it’s probably because I’m not seeing her face to face. It’s only because I can’t see the compassion and care she probably shows while she delivers these words.

Because I knew Rachel was supportive, helpful, and cared for me — she was a therapist! And anything she said was surely therapeutic and premeditated, aimed to help me heal and become a better person.

So even though Rachel tried to dissuade me from switching to facetime (“Anxious and avoidant people usually prefer the phone,” she’d said), I insisted. Surely this faceless talking was why I was feeling so uneasy about my therapy.

During our first Zoom session, I unleashed my anxiety. I was so tense after our sessions, I explained. I was in turmoil all week. Therapy was taking over my life and overwhelming me.

She ran with it, explaining that anxiety of this intensity is not something therapy alone can deal with. “Do you want my advice?” she asked.

I nodded. Of course I did.

“Medication,” she said, nodding knowingly.

I blanched, but I was going to be mature about this.

“Look,” I said after a pause, “it’s not like I’ve never entertained the thought, but can we back up? Discuss this?”

“I’m very practical,” she said, her face inscrutable. “I’m brilliant—” a laugh — “but also very practical.” She gave me a psychiatric nurse’s number. And then sipped slowly from her 20-ounce tumbler of infused water, giving me a view of lime slices and her chin.

I tried returning to the topic.

“I need to digest this. It’s a lot to absorb. Just a few weeks ago I didn’t think I was dealing with anxiety at all. I’m starting to break away from that denial, but can we take this more slowly?”

“Yes,” she said with a grin. “I won’t forget how you sat at the edge of your chair that first session, coat on, vehemently denying that you had anxiety at all.”

I laughed along but I was not amused. I was hurt. But I was there to hear the hard truths, to be whipped into shape, so I continued.

The deep breathing was so hard for me, I confided. There were tears in my eyes at this point. “Can you guide me? Also, I need help leaving the session a little more settled.”

“YouTube,” she said. “There are hundreds of breathing tutorials.”

But I didn’t do YouTube.

“Well, we can send you to a physical therapist.” A shrug.

I’d already been to physical therapy. And had told her so more than once.

I looked at the clock. Fifty-seven minutes into our session. My hands started getting clammy.

“So you have three minutes now,” I said jokingly, but there was panic lacing my laugh, “to prepare me for handling the coming week.”

A look of shock crossed Rachel’s face as she slammed her hand on her desk, suddenly looming large on the screen. “What? Do you think this is even fair?! To pull this on me just as the hour is up?”

I chuckled as I waved goodbye, thinking she was just raising her voice for theatrical effect.

But she was back on the screen after a flicker.

“And I’m fine! Fine! Okay? I came back to tell this to you because I know you. Otherwise you’ll feel bad all week.” The screen went blank.

Oh, so she’d been serious. I hung my head, mortified. What had I done? I guess I really can be totally exasperating.