Dear Therapist:

Our son recently acknowledged that he has been experiencing extreme anxiety over the last 6-8 months. This has been something that his menahel had been concerned about and mentioned to him, but he denied anything was wrong. I think that finally it got so bad that he couldn’t push it away anymore and he is coming to us for help. The issue is he is supposed to go to learn in Eretz Yisroel next zman along with all his shiur. There is the option of him going and us finding the right therapist for him in E”Y but we are very concerned to send him in such a fragile state.  We are worried that such a significant transition (he has always had difficulty with change) may really just be too much for him to handle and could break him. Plus, who knows how long it will take for him to find the right therapist and get settled in. On the other hand, him staying in America for another zman would be devastating to him. I am not even sure that it would be an option for him to go back to his yeshiva. The question for the panel is how risky do you think it is to send him to E”Y like this? Do you think it is a non-starter? Do you have any ideas as to how to smooth the transition and how to make it work so he could still go, or do you think that as hard as it might be he needs to stay home next zman until we get this under control?  

Response:

I don’t know your son. Nor do I know the details of the situation. Therefore, I can respond only very generally, and speak only to the few factors that have been laid out.

It appears that your son is experiencing a pervasive, extended period of significant anxiety. Initially, he was reluctant to admit that he was anxious, despite his anxiety being a concern for others. He finally reached out for help. This possibly suggests that his anxiety has been increasing in intensity and frequency. It is possible that he was refusing to believe that he had a problem. It is possible that he assumed that the anxiety would abate on its own. It is also possible that your son has maturely identified a problem, is aware of its severity, and understands that he may need to make sacrifices to properly address it.

To state the obvious, the key word is “possible.” I don’t know to what extent these—or many other possibilities—are true. It seems that, to a large degree, you are in the dark as well. In fact, your son himself may very well be unclear as to the nature of his problem. This lack of clarity can be scary, can cause people to feel alone and feel like the only person with such an issue. It also will typically add to feelings of anxiety, thus continuing a vicious cycle. The more anxious someone is, the more unclear the understanding of their problem often is. And the more uncertain a person is, the more anxious they will typically feel.

You mentioned the menahel’s concerns. You discussed your fears and thoughts. I spoke to my thoughts and general sense of the situation. What hasn’t been mentioned are your son’s thoughts, feelings, beliefs, fears, and insecurities. How does he feel about the fact that he has anxiety? What does he think about seeing a therapist? What are his thoughts about going to Israel? Does he have a clear understanding of anxiety and its treatment? Does he understand the long-term implications of his anxiety not being appropriately treated? Does he recognize the possible impact of undergoing a significant life change (going to Israel) at the beginning of treatment?

These are just some of the questions that should be properly addressed before an impactful decision is made—largely by him. These are not closed-ended questions that should be asked point blank with the expectation of a clear and concise response. They are open-ended questions that will lead to other questions, all of which will hopefully lead to a better understanding of the situation, possible solutions, and appropriate decisions. Your son needs to be an integral part of this process, and a competent therapist can help him to achieve this clarity.

Regardless of the ultimate determination, I believe that it is imperative that your son see someone prior to leaving for Israel, so that a proper plan can be put in place. This can help the entire family to be more comfortable with the resultant decisions. It will likely also help your son to feel less anxious about his anxiety.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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