Therapy with Rachel Fernbach, LMHC, LCAT, LMT

Rachel Fernbach is a mental health counselor and creative arts therapist based in Brooklyn, NY and licensed to provide remote therapy sessions to clients throughout New York and Massachusetts. Many of Rachel’s clients are artists and creative professionals seeking therapeutic support or looking to further explore their spirituality. Rachel also helps adults across the lifespan navigate anxiety, depression, trauma, or chronic pain/illness. Rachel’s work with clients is informed by her previous experience as a dance/movement therapist and an expressive arts therapist, as well as her knowledge of CBT and her training as a yoga teacher—all of which she uses to support clients of all backgrounds in reaching their therapeutic goals.

We asked Rachel more about her work with clients and her guiding philosophies on therapy.

Rachel’s background and personal life

How did you decide to become a therapist?

When I was in college, I became interested in holistic healing, and wound up taking classes in Reiki and Reflexology. I found that I felt a lot of joy and meaning while caring for others, and this eventually led me to train as a massage therapist. After a few years working in that field as both a therapist and teacher, I found myself longing to be able to go further with my clients. I saw, time after time, that people would come to me with years worth of stress and pain built up in their bodies with the hope that I would somehow make it evaporate in an hour's time. Although a massage might provide some relief in the short term, I was dissatisfied with the limits of what I could offer in the long term.

I decided to become a psychotherapist so that I could provide a different sort of help, with the goal of supporting my clients in digging a little deeper and learning to care for themselves, while developing of a sense of autonomy in wellbeing.

What was your previous work before going into private practice?

My past experience includes working as a dance/movement therapist for elders with dementia, working as a school-based expressive arts therapist for small children on the Autism Spectrum, practicing hands-on massage therapy, and teaching massage therapy topics to adult learners. I appreciate how my early work experiences brought me into relationship with people across the spans of age and ability, giving me the skills to meet so many different needs in the present moment.

Rachel’s specialties and therapy philosophies

What guiding principles inform your work?

My approach is multi-faceted, with a core set of principles guiding my work:

  1. A foundation of empathy and compassion: providing clients with a baseline of respect and unconditional emotional support; creating a space in which they can be honest about what they're feeling, no matter what it is
  2. Taking action: helping clients to identify tools and strategies that they can use during the week in order to move through challenges
  3. Nervous system regulation: using mindfulness, breathing exercises, and somatic movement to teach clients how to calm themselves and settle their reactivity
  4. Celebrating strengths and success: emphasizing what's going well and helping clients increase confidence in their ability to face their difficulties
  5. Trust in the process / everything in time: trusting that the parts of you that need care and support will make themselves known when they feel safe and ready; there is no agenda and no rush

What clientele do you work with most frequently?

I work with adults over the age of 18 and tend to be a great fit for artists/makers/creatives, people who are interested in spirituality/contemplative practices, and people who are interested in their bodies. I also have a special niche for women who have been diagnosed with Endometriosis, as well as for people who want to learn how to live in wellness despite chronic pain and/or chronic illness.

Can you tell us more about your specialty in anxiety?

I see fear and worry as very normal feelings. Everyone has these feelings from time to time. Life can be scary and unpredictable and it makes sense to have feelings in response to the things we can't control. Sometimes, anxiety serves as a coping mechanism, and sometimes it's a habit. Addressing anxiety in the context of therapy is something that may be helpful if your fears and worries are making it difficult for you to participate in your life in the ways that you would like. We'll work together to understand where your feelings are coming from, and what will help you feel more capable of meeting your challenges.

My approach to anxiety is essentially a 3 step process:

1.) Making space to talk and give a voice to the feelings. Sometimes just sharing your anxiety with a supportive witness can help to alleviate distress. You don't have to hold it all by yourself.

2.) Working together to identify what, in the present moment, you can take action on in order to keep moving forward despite your worries or fears.

3.) Guiding you through breathing exercises to help you learn what it feels like to be calm and grounded. This is a skill that you can use every day to regulate your own nervous system and care for yourself.

As time passes, we will continually honor and celebrate your ability to take action and make change, no matter how small or big.

Can you tell us more about your specialties in chronic pain and chronic illness?

Chronic pain and illness are difficult to live with. I often hear from clients who are overwhelmed and struggling to cope with not only their physical pain, but the emotional, mental, and spiritual pain which develop in response to the way pain impacts every area of their lives. People come to me to receive support for their experiences, which are often dismissed, diminished, or poorly understood by the people in their lives, however well-meaning. In our work together, we make space for the hard feelings, and focus on cultivating an attitude of acceptance for what can't be changed. We work together to look for what's good, what's possible, and what small, intentional steps you can take each week to commit to actions that will help to alleviate pressure.

With my background in somatic movement, I'm also interested in helping my clients to develop a new relationship with their bodies—one that is grounded in kindness, self-acceptance, and listening. I encourage clients to develop the skill of identifying what they need in each moment and to build a robust "care kit" that they can reach for with confidence when needed.

Can you tell us about your work with clients recovering from trauma?

I'm interested in the ways that trauma lives in the body and expresses itself through movement patterns, muscle tension, breathing and heart rate rhythms, and nervous system reactivity. My approach to trauma and stress is incredibly gentle and patient; I trust that sensitive material will come to the surface when safety and trust have been reliably established. I'm not in a rush to have my clients tell stories which may re-traumatize them.

Instead, we focus from the beginning of our work on learning how to feel what's happening in the body in the present moment, and to speak about it. We expand awareness of sensations and emotions and actively build skill to tone the nervous system through structured breathing exercises and guided body scans. As time passes and tension is released from the body, it becomes easier to talk about what has happened in the past and how those events may be contributing to symptoms that are occurring now, whether they are physical, emotional, or relational.

This context can help things make more sense, and clients may start to have a clearer understanding when they ask: "Why am I like this?" My hope is that it may become possible for clients to say: "I experienced something very difficult that impacted me... and I'm not the same as I was before, and that is okay. I'm learning how to move forward and take good care of myself. I take small steps every day toward the future I want to live in."

What do you find most rewarding about your work?

Helping people is deeply meaningful to me. I feel privileged to witness my clients as they progress and feel so happy when I hear them express their own sense of growth and confidence when they realize that something has changed for the better.

Therapy sessions with Rachel

What will our first session together be like? What happens in ongoing sessions?

The first step in working together is a free initial consultation, which is a 15-20 minute conversation during which you'll have the chance to share what you want out of therapy, as well as ask me any questions you have. Next, we'll schedule a 45-50 minute intake session, and I'll send you an intake packet with a questionnaire, policies, and consent documents. In that meeting, we'll have more time to get to know each other and talk about your history and needs. The following week, we'll transition to your first therapy session, which I prep for by reviewing what you shared with me in the first session and making a plan for your treatment.

In the first weeks of therapy, our main focus is on getting to know each other while building a sense of teamwork and support. If you're not sure what to talk about, I will help you by asking question or giving you prompts. I'll probably ask about your family, friends, work, and hobbies. I'll be paying attention to the details you share, and noticing the ways that you express yourself. As we converse, I may pause you when I feel that something you've shared is worth a deeper look. If I notice that you're feeling something challenging, I may also ask you to turn inward for a moment and notice the sensations of your body.

From week-to-week, sessions may include talk therapy, mindfulness practice, somatic movement, or art making. I will track what's working best for you and continually offer the tools that I feel will best meet your needs.

How long do clients typically see you for?

I see clients once a week until they feel that they are ready to "do life" on their own. At that point we may transition to seeing each other every other week or as needed. For established clients, my door is always open for a tune-up when desired.

I practice long-term therapy because I believe that healing and growth take time, building meaningful relationships takes time, and developing new habits takes time. Clients who work with me tend to stay on for 6-12 months or longer.

Are there any books you often recommend to clients?

I recommend Nonviolent Communication by Marshall Rosenberg to every client I see, as I feel that anyone can benefit from expanding their emotional vocabulary and learning how to understand and express their needs. It's a great resource for increasing self understanding, as well as a useful tool for navigating conflict in relationships.

Do you assign “homework” between sessions?

Sometimes! It you want homework, I will offer it to you. If you could take it or leave it, I will offer it to you, and you can choose. If you hate homework but I feel strongly that it may be beneficial, I may gently offer it if you appear to be open to trying something new.

A typical homework might look like this: at the end of session I will ask you to reflect on what you've experienced this week, and to create a prompt or encouragement for yourself for the week to come. I'll ask you to write it down in your own words while we're together and to commit to placing it somewhere that you will see it everyday. I'll ask you to make a practice of reading your prompt each day, or in moments when you feel overwhelmed or stuck. Another type of homework could look like practicing a breathing exercise for a couple minutes each night before bed. Or it could look like reading an article that I send you.

I offer homework for a very intentional reason: I have seen consistently that clients who are engaged with their process and who take responsibility for their growth progress steadily. Growth is a process and a practice, and I want to help people learn how to take ownership of their wellbeing. Having a little project to work on in-between sessions is supportive of this purpose.

How do you help ensure I'm making progress in therapy?

I find that the clients who come my way tend to be very ready to move forward and just need the right kind of support. A consistent structure creates reliability and safety, which are foundational to the therapeutic process, so I give every session a clear beginning, middle, and end. As clients grow comfortable with our work together, I track the ways in which they open up and share, and I make space for them to gradually "take the reins" and lead.

As I see progress, I begin to offer small challenges and encouragements that I feel will be well received. If for some reason I'm not seeing progress, I bring it up and ask how the client is feeling about their work. Sometimes, just addressing this moment with some curiosity and kindness is a way to open up the conversation to something that they felt uncertain of how to bring up.

How do I know that it’s time to start seeking therapy?

When life feels like to too much to handle alone, therapy can be a big help. If you're struggling to make decisions, feel overwhelmed by your obligations, or feel stuck and unable to see a way forward, having dedicated support might make things more manageable. If you've noticed that certain things seem to keep happening over and over, and you aren't happy with the outcomes, therapy could be a great way to explore what it's all about.

How can I prepare for our first session?

Showing up and trying are enough. If you have questions for me, it might be helpful to write them down beforehand so that you'll remember what's most important. Aside from that, there's nothing you need to do; I will make a plan for us, and I will help you get acquainted with the process.

How will I know it’s time to end my time in therapy with you or reduce session frequency?

When you're ready, you'll know. Most likely, you'll realize that you don't need my help to get through a challenge, and you'll come to session and tell me what a great job you did and that you feel really proud of yourself. When I start hearing statements like that consistently, I will ask you if you're ready to talk about ending our work or switching to fewer sessions per month. You may feel ready to end completely, or you may notice that there's a part of you that still wants the security of being able to check-in. By that point, I anticipate that you will have the confidence to know what the best choice is for you.

Why should I seek therapy, rather than turning to my partner, friends, or other loved ones?

Therapy is not the same as talking it out or venting with a loved one. Therapy is a growth process that is about you getting your needs met, with the guidance of a professional who has thousands of hours of training and experience in helping others. Your therapist is there to help you understand why you're experiencing your life in the ways that you are and to help you gain skills in navigating challenges in healthy ways.

The one-sided nature of the therapeutic relationship gives you time and space to be self-centered—without needing to attend to anyone but yourself. This is a type of relating that doesn't mesh well in personal relationships; the give and take that lead to healthy connections is a complex dance between individuals who all need something different. Being in therapy gives you a little window each week during which you're released from this kind of relational responsibility, and this freedom is a foundation for being able to turn inward and really work to understand yourself and what you're trying to change.

Your therapist doesn't need you to take care of their feelings; they just need you to show up and be willing to participate. It's much different than what your best friend, partner, parent, sibling, child, or coworker might need from you.

What advice would you share with therapy seekers?

If you try therapy once and it doesn't feel helpful, it might be worth trying again with someone else. It can sometimes take a little bit of effort to find a therapist who is the right fit for you.

Visit Rachel’s profile to read more about her and contact her for an initial consultation!