“I know what the feeling is. It’s…” Batsheva took a deep, shuddering breath. “It’s like I can’t stand being in my own skin….”

Problem: Low self-esteem

Tools Used: Cognitive Behavioral Therapy

Her voice had started strong and confident on the phone, but when I asked Batsheva what she was seeking support for, she got stuck.

“I don’t really know what I need. I just feel low-level anxiety and bad about myself, and I don’t know why.”

We booked a Zoom appointment. I missed the energy of shared space with my clients, especially getting to see them in “real” for the first time. I let Batsheva in from my Zoom waiting room, and a young, stylish woman with a long, dark sheitel smiled back at me. After a brief hello, Batsheva launched right in.

“I feel unsettled most of the time. I have, and do, so much, but I’m always feeling… off.”

“Batsheva, it’s really good that you’re attuned to what you’re feeling, even if it’s difficult to identify exactly what that is. Can you tell me anything in general that you’d want me to know about you?”

“I’m 28 years old. Married for eight years to Akiva. We have three kids — all girls — and I’m expecting our fourth in a few months, iy”H. I used to work as a sheitelmacher, but as Akiva’s business has grown, and the girls are getting older, I don’t work that much anymore.”

We continued a general intake that included a genogram of Batsheva’s family and some general medical and personal questions. As our initial intake session was coming to a close, I asked Batsheva what she considers to be her strengths.

She froze.

“I, uh… I don’t know really. I try to be a good mother and wife. But sometimes, you know, I get really overwhelmed…” She trailed off hesitantly.

“Being a good mother and wife requires a lot of strengths and skills, Batsheva.”

“Well, I don’t think I actually pull it off most of the time. It always seems like everyone else does it more easily? Better?”

“Tell me more about that.”

“Let’s say I make a nice supper. I’m always missing an ingredient or don’t plate it well or don’t time it well, or something like that. The food is just an example, this happens with everything, and I just feel like…” Batsheva’s face clouded over. “Never mind. I’ll tell you another time.”

“Okay. I’m glad you stopped yourself if you didn’t want to share, Batsheva. If you say something you’re not ready to share, it might negatively impact treatment, so I’m so glad you drew that boundary.”

Batsheva’s face cleared in relief, and we wrapped up the session.

The following week, Batsheva described that she was feeling good albeit with that “off,” almost sad feeling in the background.

“How long have you been experiencing this feeling, Batsheva?” Batsheva was currently in the middle of her second trimester, and I wanted to rule out any peripartum depressive and anxious episodes, and see if I needed to refer her to a doctor.

“For as long as I remember, but sometimes it’s stronger than others. I think it never goes away completely. It’s just a lot of self-doubt. I remember it more at certain times, like when I started high school, or seminary, my first job in a salon, when I was dating.”

Batsheva paused thoughtfully. “When I was first married and we moved, it was bad, and I think also it gets worse around the time of being pregnant or giving birth. See?” Batsheva laughed, sweet and tinkling. “It’s like all the time.”

I smiled. “Actually, it sounds more like it’s during high stress times or times of transitions.” I paused to let that sink in.

“Yes! You’re right. Like new situations cause this feeling to flare up a lot. Like they — employers, family members — are going to find out I’m a big faker. I don’t remember it so much during the quiet day-to-day.”

“So you mentioned self-doubt. Would you also call this ‘off’ feeling ‘sadness’?”

“No. Not like a depression. More like… ugh. It’s this thing again. I, um, didn’t want to share it.” Batsheva blushed.