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Clinicians on the Couch: 10 Questions with Psychologist Susan Orenstein


Every month we interview a different therapist for a peek into how they work and how they live. They share everything from the most challenging part about conducting therapy to how they cope with stress.

They also reveal whether they’d pick the same career path and what they wish their clients knew — and a whole lot more! These interviews are always illuminating and filled with insights because they give us a glimpse inside a place we rarely see: the therapy room.

This month we’re happy to feature Susan Orenstein, Ph.D, a licensed psychologist and relationship expert. Orenstein is the founder of Orenstein Solutions, a group counseling practice located in Cary, N.C.

For the past 16 years, Orenstein has dedicated herself to helping individuals and couples improve their emotional health and foster loving relationships. She specializes in helping couples in distress rebuild trust and reignite intimacy. You can learn more about Orenstein here.

1. What’s surprised you the most about being a therapist?

Every client is so different. What works for one client may not work for another client. A concept or strategy that resonates with one client could fall flat with another. So I realized early on that I constantly need to know my clients; learn about their personalities, learning styles and needs; and continue adding to my toolbox.

2. What’s the latest and greatest book you’ve read related to mental health, psychology or psychotherapy?

Clinicians on the Couch

Wired for Love by Stan Tatkin. I’ve been training in Tatkin’s PACT model and have found it very helpful.

3. What’s the biggest myth about therapy?

One of the biggest myths about therapy is that it is a passive process on the part of the therapist and the client; that it’s primarily about venting in the present and uncovering past family dysfunction from the past. Yes, actually, some of this occurs but in the bigger context of empowering clients to be more active in their lives, know what they want, and reach their goals.

In my sessions, the work is very active and intentional. I’m working with clients to discover who they are, what they want and what’s getting in they way. Then we actively work on creative problem solving — sometimes by playing out a scenario in a role-play, brainstorming, identifying underlying emotions, or doing a mindfulness exercise.

4. What seems to be the biggest obstacle for clients in therapy?

In couples counseling, a big obstacle is when couples come in after suffering for years. Often they’re sleeping in separate beds and seething with resentment or desperately lonely. Often one or both partners feel despondent or resentful, with warmth and loving feelings deep beneath the surface and have given up hope. They think that if they don’t have “that loving feeling,” it’s over. I wish they knew that when needs are addressed in couples counseling, often the loving, tender emotions can be rekindled.

On the flip side, some couples come to me feeling embarrassed because there “isn’t really anything wrong,” yet they feel as if they’re growing apart. I’m so thrilled when couples come to counseling early on, when they feel that first twinge of distancing so that we can make some adjustments and keep the relationship on course.

In summary, these aforementioned obstacles can be overcome if more couples knew that “it’s never too early and it’s never too late” to seek a consultation with a couples therapist.

5. What’s the most challenging part about being a therapist?

Showing clients gaps in how they see themselves that are often initially painful, but ultimately beneficial in helping them with self-awareness and empowerment.

6. What do you love about being a therapist?

Seeing and hearing my clients’ transformation as they become more self-aware, self-confident and connected in their lives. Providing support, encouragement and hope to those struggling and in pain; being able to point out progress, highlighting gains and celebrating each success.

7. What’s the best advice you can offer to readers on leading a meaningful life?

Be real. Take an honest account of your life: what you value, what you want, and what sacrifices you’re willing to make. Find support partners along the way to keep you honest and to let you know that you’re not alone. And let truth and compassion guide your journey. Be kind to others, forgive easily, and take care of yourself.

8. If you had your schooling and career choice to do all over again, would you choose the same professional path? If not, what would you do differently and why?

Yes, I would choose this profession, because it’s always interesting and challenging, and I am able to help empower people to live more loving, purposeful lives.

If I were in graduate school today, I would pursue more formal training in organizational psychology, forensic psychology and also conflict resolution classes. I’ve pursued some of this training post graduation and find it very interesting and valuable.

9. If there’s one thing you wished your clients knew about treatment or mental illness, what would it be?

Developing a healthy lifestyle, incorporating self-compassion, self-care and strong interpersonal skills can help moderate many forms of mental illness. We can change our mindset and literally change our brains. Pills are not the only answer and sometimes they’re the wrong answer.

I wish more clients understood how counseling could be helpful in treating depression, anxiety and relationship issues, not only for short-term relief, but for long-term emotional well-being.

10. What personally do you do to cope with stress in your life?

I enjoy time with my family (my husband of 26 years, two teen boys and dog, Stella). I go to the gym several times a week. I get fresh air. I take in the beauty of music and nature, and I find inspiration and gratitude in the struggle and courage of others.

Clinicians on the Couch: 10 Questions with Psychologist Susan Orenstein

Margarita Tartakovsky, M.S.

Margarita Tartakovsky, M.S. is an Associate Editor and regular contributor at Psych Central. Her Master's degree is in clinical psychology from Texas A&M University. In addition to writing about mental disorders, she blogs regularly about body and self-image issues on her Psych Central blog, Weightless.

APA Reference
Tartakovsky, M. (2018). Clinicians on the Couch: 10 Questions with Psychologist Susan Orenstein. Psych Central. Retrieved on August 8, 2020, from
Scientifically Reviewed
Last updated: 8 Oct 2018 (Originally: 17 May 2016)
Last reviewed: By a member of our scientific advisory board on 8 Oct 2018
Published on Psych All rights reserved.