At the Transformations Treatment Center in Delray Beach, Florida, resilience is the driving force behind treatment. The center caters to clients with mental health and substance use needs. “We have people coming from a variety of backgrounds and cultures, and a variety of struggles,” therapist Devora Shabtai, LCSW, PhD candidate says. The staff helps people who are suffering from depression, anxiety, bipolar disorder, obsessive-compulsive disorders, and trauma. “We focus on understanding an individual’s background and identity. It not only plays into their struggle but helps with their healing,” she adds. One major demographic that benefits from the program is veterans. “When many people come back from military service, due to trauma that is often unprocessed, they turn to addiction as a way to cope,” Shabtai explains.
Therapist Tamara Evans, MS, Shabtai’s coworker and an Army veteran herself, elaborates: “Veterans have this tendency to want to feel they need to be strong and mission oriented.” One big challenge that therapists address at Transformations is vulnerability. “Vets can have a difficult time getting in touch with their feelings or admitting that an experience hurt or changed them in any way,” Evans says. It can be especially hard for people with a military background because their “never surrender” training teaches them to think of vulnerability in a negative light. At the center, they learn to reframe vulnerability as a strength.
But the trauma is not only from the pain of what they went through—it can also be from a loss of identity after they leave. Evans experienced this herself. Before joining Transformations, she had served in the US Army for nine years, and was active duty for five. An injury changed everything. “I wanted to stay in but I was medically separated,” Evans says. Her mission and plans were destroyed, which impacted her self worth. Before, she had been regarded with reverence and respect for the uniform. Now everything was different. Going from soldier to civilian so quickly was hard for Evans. “I didn’t know what made me special,” she adds. She quickly found herself descending to a very low place, describing the experience as a “giant hit to the ego, my identity, my humanness.” But then she received treatment with an amazing counselor who did EMDR therapy (eye movement desensitization and reprocessing) which helped her heal. Evans elaborates that EMDR is an evidence-based approach toward helping individuals address unresolved trauma. “I got a new lease on life, and that’s when I decided to become a therapist,” she says. “It gave me a way to serve without wearing a uniform.”
For veterans, successful treatment involves resolving trauma and infusing their civilian life with positive vibes, replacing the aspects of service that they miss. The center enables veterans to accomplish this in a few ways. First they assign a primary trauma therapist to focus on trauma treatment, and a secondary therapist who is also a veteran. That way a veteran can talk about their military service to a mental health professional who understands their struggle firsthand.
They also get potent results from group therapy sessions, which give veterans a place to talk about reacclimating as a civilian. In that setting everyone hears each other’s stories and does lots of identity work, exploring who they are once they take off the uniform. For instance, as Evans explained, a uniform and title gives vets meaning, purpose, and direction. Once their service ends, however, this becomes a looming question. The center strives to help its veteran clientele regain a sense of purpose in addition to providing treatment. The ability to process their experiences with other vets is very healing as it fosters a deep sense of fellowship, camaraderie, and understanding.
Evans works with veterans and women in group settings and one-on-one. She leads group sessions and sees clients for trauma work, providing treatments like talk therapy as well as EMDR. The results from EMDR, Evans says, are incredible. One acute event usually takes one session to resolve while chronic, multi-faceted trauma can be resolved in two to three sessions. But in order to keep seeing results, Evans says it’s imperative for clients to continue some form of therapy after.
With individual traumatic events there tends to be a central theme of a negative or distorted belief: “I’m unworthy,” “I’m not good enough,” and “It was my fault” are the most common. This belief shows up in other parts of the person’s life and poisons the way they relate to themselves and other people. Processing the event helps the individual change the negative belief to something more realistic: “I am worthy,” “It’s in the past,” “I survived,” or “I did the best I could.” With EMDR there is a sense of relief and release. By the time these clients leave the office, Evans says, they feel lighter.
Treatment often addresses childhood or deployment traumas. For example, Evans had one recent case that involved a veteran. While this vet was on deployment, a fellow soldier committed suicide. This veteran was the one who found him, and the gruesome image was burned into his mind. He had nightmares and struggled with depression, survivor’s guilt, and a sense of helplessness. It impacted how he saw himself, and his beliefs spiraled until he felt like a complete failure. As he processed the trauma through EMDR therapy, not only did the images become neutral (think “that was really sad,” as opposed to his nervous system lighting on fire), he became desensitized to it. The reprocessing part focused on changing the belief. Instead of “I should have done more,” he turned it into, “I did the best I could.” The veteran stopped blaming himself and the horrific image stayed neutral, even when he tried to access the feelings of distress. That’s when the vet knew he had healed.
Transformations is unique because in addition to its specialty in assisting the veteran community, it also has a Jewish track designed to meet the unique needs of Jewish people from all walks of life, whether observant or not. In this track of rehabilitation, directed by Shabtai herself, clients can explore Jewish practice and connect with other Jews while in treatment. Shabtai says the 12-step program has become an important element for this group, especially because of its strong spiritual component. But, she stresses, recovery and treatment come before religion.
“A Jewish client often brings a unique set of spiritual beliefs and cultural experiences with them into our doors,” Devora explains. “Religion can be a complex and delicate topic for our Jewish clients on all ends of the spectrum.” Because of this, Transformations takes a highly nuanced approach in order to cater to each client’s needs. Shabtai adds, “Through this program we provide space for each client to harness those aspects of Jewish belief or practice that are personally meaningful, as well as an opportunity to work with a clinician who understands his or her cultural background.”
So how do clients move forward? Some find a new profession they connect with. For both Jewish and veteran clients, many spend time mourning and processing their loss. Within the military there are overt traumas like watching people be killed, PTSD, and acute trauma. They need time to sit in that space. As Tamara Evans explained, veterans are used to being tough guys, not sharing or being vulnerable, so it takes a while for them to open up. Because they shove their emotions aside for so long they often self medicate with drugs or alcohol until they realize they have to face their feelings. Evans says that therapy lays the groundwork for healing, which is when clients can address their trauma properly. “Until they get that insight and willingness, trauma work is really difficult,” she says. “Only when a person is able to manage their moods can they start trauma work, not before.”
Mood management is obviously a big part of the process. The center offers cognitive behavioral interventions, helping clients address harmful thought patterns such as negative core beliefs, identify past events that distort their perceptions, recognize their power in how they experience the world, and develop insight into their behavior patterns.
What Devora Shabtai finds most meaningful in her work is post-traumatic growth—when clients process painful memories and experiences full of negativity and toxicity and transform them to create meaning. This is when the painful past becomes inspiring. They learn the importance of love, relationships, and passion. This process is how they get to the other side, to heal and find peace. Many of the center’s alumni even choose to stay in the field to help others as a therapist or sponsor.
Rabbi Mendy Heber, director of Chabad at the City of Delray Beach, works with Shabtai on the center’s Jewish programming. He explains that he’s seen the center come full circle when they engage with alumni who have graduated from the Jewish track. “We had an alum who came to lead a group for some of the other clients and talk about his experience,” he says. “They had a Q&A session, which was a lot more relatable for clients.”
Is anyone beyond help? “There’s no one we’re not able to help,” Shabtai says emphatically. Not everyone is ready to be sober though. “It sounds cliche but it’s a journey and a process, which takes time,” Shabtai says. “Many people relapse along the way—sometimes we are someone’s fifth treatment attempt. Family members need to understand that addiction is a disease and learn how to address mental health issues.” Even if a person is not stabilized, they know that people are in their corner. “When they’re ready they will seek treatment. We tell them our center is ‘one call away,’” she declares. “They create trust and relationships with us, so they know they can turn to the support and resources when they need it.”
One thing that Shabtai would like to see at the treatment center is more recovery-based community programming. “We need more opportunities for and resources in the community,” she says unequivocally. That involves helping people get jobs, more spaces to come together in fellowship, more sober living that is Jewish. There are only a couple of sober living situations for Jews around the country, Shabtai adds. “It’s really invaluable for people to have this Jewish camaraderie.” She wants to see more of her alumni get invited to Shabbat meals and participate in shul events. She wants them to feel like they can rejoin regular communities. Such programs do exist, but only to a small extent. There is one sober living place in Monsey, New York, and several Chabads host Al-Anon meetings or similar programming. But it is not common for synagogues to cater to these types of situations.
Shabtai feels strongly that certain steps need to be taken: Rabbis should create space in their synagogues, individual community members should go out of their way to invite people who are struggling, and more sober living should be opened. If and when that happens, Shabtai is certain the infrastructure will go a long way to help treatment be successful for Jews suffering from mental health and addiction issues in the long term. In the meantime, Transformations Treatment Center is at the forefront of fighting this battle, one soul at a time.
Originally published in the Purim 2022 issue of The Jewish American Warrior.