Saturday, February 25, 2012

Dr. Bunzel's explanation of Rav Zilberstein's teshuva

Before presenting Dr. Klafter's criticism of this pask, I think it is only fair to present a translation of the original article that I had posted to my blog recently. It not only presents Rav Zilberstein's justification for his psak that therapists should only treat clients of the same gender - but Dr. Bunzel's justification for asking the question and why he thinks the clear heter given for hundreds of years by gedolim - is now to be rejected. The translation is mine. It can't be emphasized too much that this psak is radical and represents a major shift in the separation of the sexes. It is not being presented as one that applies to Bnei Brak or Williamsburg - but a universal psak that every religious Jew is obligated to follow - despite ruling to the contrary by gedolim or one's own personal rav.
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What are the parameters for psychotherapy according to Halacha?
Written by Benjamin J. Rabinowitz | 13:11 | 24 of Shevat 5792

This psak Halacha written by Rabbi Yitzchak Zilberstein, Shlita, and signed  by the great sages of Israel and very important rabbis and judges, shlita, states for the first time, clear and binding boundaries with regard to psychological treatments, and states that is "a duty on the therapeutic manager to look after the separation" between therapist and patient of the opposite sex. Furthermore "If that is not possible it is necessary to consult with the rav of the hospital as to what to do in each particular case."

These things came as answers to questions raised by Dr. Michael Bunzel Director of Psychiatry at the Medical Center "Maayanei Hayeshua" and director of community clinic "Sheba".
Before we bring before the reader the long conversation we had with Dr. Bunzel, we present the question as presented to Rabbi Yitzchok Zilberstein shlita:
 "In the treatment of mental health clinic, there are treatments that require a deep connection with the patient - longer than standard treatments. For example the treatment of anxiety or mild depression does not require entering into marriage issues or sensitive private material, however personal problems and crises of life at times require a deep connection between therapist and patient. In the clinic we need to determine whether it is better to have the therapist and patient be the same gender or are patients to be referred entirely based on professional criteria? The questions that constant occure are: 1. Does the age of the therapist and/or patient make a difference? 2. Is there a difference if the patient prefers someone of the opposite sex? 3. Do I as a manager, I have a duty to maintain this complete separation of sexes despite opposition of therapists who are not members of the yeshiva community? "
Concerning these questions Rabbi Yitzchok Zilberstein shlita answered at length spelling out the basics from Torah and the Sages, and concluded with the summary as quoted above.
This letter was cosigned by the following gedolim, Rabbi Aharon Leib Steinman Shlita, Rabbi Shmuel Halevi Wosner Shlita, Rabbi Nissim Karelitz Shlita, Rabbi Chaim Knievsky , Rabbi Shmuel Auerbach shlita, Rabbi Gershon Edelstein Shlita, Rabbi Shmuel Kamenetsky, shlita, Rav Moshe Hillel Hirsch Shlita, Rabbi Shimon Adani Shlita, Rabbi Israel Levi Belsky Shlita, Rabbi Mordechai Gross Shlita, Rabbi Menachem Mendel Shafran, shlita, and Rabbi Yehuda Silman, shlita.

As mentioned, we had a long and fascinating conversation with Dr. Bunzel. In his introductory remarks, he emphasized that although these guidelines are primarily aimed at managers of psychiatric departments, medical doctors and psychologists, but the gedolim have instructed that these  teachings be brought to  the entire charedi public's attention, in order that they know and act according to these guidelines.

Dr. Bunzel stated, "Because not everyone understands why specifically the issue of psychotherapy caused the gedolim and important rabbis to come to a decisive and unambiguous conclusion, therefore it is very important to not only state the guidelines themselves, but what lies behind them."

At the beginning of the conversation we asked to hear from Dr. Bunzel, what led him to now raise the important question. "Some psychologists assert - and bring references from all kinds of rabbis they found - that there is no problem, and they rely on the halachic principle known that “a worker is involved in doing his job.”

This psak takes the new position that there is something unique about psychotherapy and asserts that it is not comparable to other professions. Because of this unique aspect it requires greater caution and restriction than other professions.

Dr. Bonzel emphasized this point throughout the interview. The essence of deep psychological treatment (as opposed to mild cases of anxiety and mild depression), is the need to create a relationship between patient and analyst, and this eventually leads to dependence. 

"One of the most important rabbis said: The main reason that the Chazon Ish was opposed to national service would not that a girl shouldn’t leave the house for somewhere else, but her dependence on those who were are in charge of her. All creation of such dependency puts her into danger. This is exactly what happens in therapy, too. The creation of total dependence of the patient for the therapist and this is exactly the great danger in it. All of psychological treatment is built on and requires a deep and long-term relationship with the patient. The therapist gradually builds this relationship, and the success of treatment is primarily a result of the depth of the relationship between therapist - psychologist, and the patient.” 

The psak of the gedolim explicitly states that the director of the clinic has a duty to take to make sure that a woman does not get referred to a male therapist or a man to a woman therapist. You can not automatically refer a client to those who most available or by a professional classification - because there is the problem of building a relationship, and the spirit of the chachomim is not pleased with this happening. This mixing of the genders is only possible when there is no alternative, but even then there is a requirement to first consult with rav as to what to do in each particular case. "

[I deleted details about Dr. Bunzel’s person life and his description of the change in the nature of therapy]

"When I began to work in this profession, I turned with many questions to Rav Yitzchok Silberstein shlita, who has worked in the area of medicine and halacha for decades. But early on he told me that from the time of the incident of the Get of Cleves (250 years ago) this area of psychiatry and halacha has not been developed. There is almost nothing written in the area of halacha dealing with this topic during this time - even though it has important implication for the halacha concerning cheresh, shoteh and koton.  In fact even today we have no clear undertanding of the definition of a shoteh. 

"Therefore this psak which has now been signed by gedolim, can be legitimately viewed as an event of historic nature as being the first definitive psak since the Get of Cleves in which all the gedolim joined together and offered their views concerning psychitatric treatment. This psak gives support and encouragement to those in the chareidi community who suffer a problem. They can now obtain relief  and response from this field which was not possible in the past. However it is necessary that this treatment be done according to the guidelines of halacha so that chas v’shalom there should not be a creation of a severe stumbling block.

"In this field of psychology and psychiatry, there are very serious detailed ethical regulations concerning the relationship between therapist and patient. We - the Chareidi community - are also allowed to have regulations of psak halacha concerning this therapy. This is exactly what this psak halacha [concerning the separation of the sexes in therapy] has begun. In passing I just want to note that there are also rabbis who are not considered part of the Chareidi community who give halachic rulings to people who are not part of the Chareidi community to conduct themselves exactly as expressed in this psak halacha. That is because they are understand well this severe problems that can result it these guidelines are not followed."
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This ruling of Rabbi Yitzchok Zilberstein has been agreed to by the following gedolim: Rabbi Ovadia Yosef, Rabbi Shimon Adani, Rabbi Shmuel Kaminetsky, Rabbi Yisroel Belsky, Rabbi Shmuel Auerbach, Rabbi Mordechai Gross, Rabbi Moshe Hillel Hirsch, Rabbi Dov Landau, Rabbi Menachem Mendel Shafran, Rabbi Yehuda Silman, Rabbi Pollack.

9 comments :

  1. Recipients and PublicityFebruary 26, 2012 at 1:33 PM

    Ahh, that old anti-psychology bugaboo among the frum. They mock Freud and the whole mental health field. As usual, they want to turn the clock back to the Dark Ages when such things did not exist. It is weird that RDE, a PhD, even gets to promote the rabbis primitive attitudes.

    Sure, everyone must watch out for tznius and yichud issues 24/7, EVEN that rabbis themselves, with so many rabbis being outed as pedophiles and cover-up artists for perverts in their communities. "Charity begins at home" if you want to have credibility.

    Basically, these type of rabbis care neither about patients nor mental health professionals, they are on the usual "Jihad" to protect the "purity of the faith" against anything to do with modernity. They see their "korans" being burned, and then create a riot, albeit somewhat more polite, but sometimes egging their street mobs on with bans and decrees that help no one and nothing.

    They are in some ways very naive and opinionated. This is like those sick Charedi patients who are taken into a hospital and all of sudden get picky when a female doctor comes to treat them or demand that only a woman treat their wives when none are available. Pikuach nefesh does not work that way! Half of of all doctors are women today, and most nursing and medical staff is female and they treat all patients as they see fit. Likewise in situations of therapy it is not always easy to "choose" the gender of a therapist, unless you are rich enough to afford ongoing private therapy, as a hospital or clinic will make that decision, and not patients, even if they are rabbis. Is it even legal in America or Israel to discriminate against a mental health practitioner based on gender?

    An example of the impracticality of the rabbis here is in dealing with sholom bayis problems between a husband and wife who have to go to *a*, meaning *any* therapist, therapist together at some point, and that therapist will be either male or female. When there is couples therapy the husband and wife or choson and kallah etc MUST come together to the therapist and at some point the therapist may NEED to see them individually for the treatment to work.

    So many times psychotherapy willy nilly involves a man (the husband) and woman (the wife) and many times even siblings of both sexes, and when they come for help from a mental health professional, such as when there is some serious emotional or abuse or mental breakdown, or psychosis that NO rabbi on Earth, unless he has trained in modern psychology can help, there will be opposite gender therapists involved in these cases and they may want to see some of those individually as part of the treatment plan. This kind of stuff cannot be "legislated" nor can it be "decreed" from on high how it should be conducted.

    The entire medical filed is being tested by this kind of rabbinic haughtiness and going beyond their zone of competence.

    ReplyDelete
  2. Recipients and Publicity said...

    Ahh, that old anti-psychology bugaboo among the frum. They mock Freud and the whole mental health field. As usual, they want to turn the clock back to the Dark Ages when such things did not exist. It is weird that RDE, a PhD, even gets to promote the rabbis primitive attitudes.
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    RaP I don't think you are paying attention here. I am posting Rav Zilberstein's psak given to Dr. Bunzel to criticize it - not to promote it.

    It is is not the question of whether it is primitive - it is wrong and goes against the accepted view of gedolim up till now. It is part of the problemtaic trend of separating the sexes in the name of tzniyus and avoiding bad thoughts - to the degree that men and women are prohibited from having any interaction.

    In addition Rav Zilbersteins "teshuva" is not a teshuva in the traditional sense of the word. He just shows that the rabbis were concerned about the consequences of men and woman interacting and therefore he says they should go to same gender therapists. He does not address the previous discussion of the issue found in Igros Moshe, or Tzitz Eliezer but simply pulls the rabbit out of a hat. The conclusion has nothing to do with the sources he brings.

    Furthermore Dr Bunzel seems intent are developing a Shulchan Aruch for psychotherapy for Jews all over the world - based on Rav Zilberstein's edicts. Rav Zilberstein is not a world class posek. If Dr. Bunzel wants to use him that is his business but he has been agressively marketing this and for some reason there are other rabbis's who have signed on to the letter - no explanation is given nor is it known what they were told the letter was all about. It really is just about a directer of a psychiatric unit in Bnei Brak wanting to know about gender separation of therapist. It is also not clear that Rav Zilberstein and Dr. Bunzel have the same agenda.

    I will soon post Dr. Klafter's critique and things should be clearer.

    So please give this the attention and care for details that you typically show.

    ReplyDelete
  3. Thanx to RaP for clearly articulating what many of us are thinking.
    And thanx to our host, RDE, for putting so much work and time into it all. While he may have a bias or two, his heart is certainly in the right place.

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  4. Daas Torah said:

    "This ruling of Rabbi Yitzchok Zilberstein has been agreed to by the following gedolim: Rabbi Ovadia Yosef, Rabbi Shimon Adani, Rabbi Shmuel Kaminetsky, Rabbi Yisroel Belsky, Rabbi Shmuel Auerbach, Rabbi Mordechai Gross, Rabbi Moshe Hillel Hirsch, Rabbi Dov Landau, Rabbi Menachem Mendel Shafran, Rabbi Yehuda Silman, Rabbi Pollack".

    "Rav Zilberstein is not a world class posek. If Dr. Bunzel wants to use him that is his business, but he has been aggressively marketing this and for some reason there are other rabbis who have signed on to the letter - no explanation is given nor is it known what they were told the letter was all about".

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    Dr. Bunzel is an LA boy, and speaks English quite well. Perhaps a private discussion with him would prove to be enlightening.

    There seems to be an impressive list of poskim here. You're not impressed with Rav Zilberstein. In your words, "Rav Zilberstein is not a world class posek". How about some of the others who signed? Are they also not "world class poskim"? Rabbi Ovadia Yosef is also not good enough for you? Rabbi Yisroel Belsky?

    As you can easily read Hebrew, you obviously are aware that there are many signatories whose names were deleted from the final list. Most prominent, are 2 other poskim: Rav Wosner and Rav Nissim Karelitz. Are their opinions worthless in your eyes?

    What about all the "eynei ha'edah" of today's generation who signed (and whose names were also omitted from the final list)? Rav Shteinman, Rav Chaim Kanyevsky, Rav Shmuel Auerbach, Rav Gershon Eidelstein? Are their opinions also worthless in your eyes?

    We have here the leading Israeli Torah scholars of today's generation, and also some American ones (Rabbis Yisroel Belsky & Shmuel Kaminetzky), all concurring on the issue.

    You write that this letter "has caused a significant amount of consternation". I understand with your "consternation", since you are a person having a Ph.D.in psychology, and being a provider of "eclectic solution oriented therapy". I also sympathize with any modifications you may need to make in order to implement the directive of the poskim & gedolim.

    However if you're truly looking for "Daas Torah", then why don't you check with these rabbis themselves, before you go bash what they signed on?

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  5. Dr. Bunzel is an LA boy, and speaks English quite well. Perhaps a private discussion with him would prove to be enlightening.

    There seems to be an impressive list of poskim here. You're not impressed with Rav Zilberstein. In your words, "Rav Zilberstein is not a world class posek". How about some of the others who signed? Are they also not "world class poskim"? Rabbi Ovadia Yosef is also not good enough for you? Rabbi Yisroel Belsky?
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    good poiint. Problem is the teshuva written by Rav Zilberstein addressed the question of a Bnei Brak psychiatrist regarding gender separation in his clinic. I have no problem if a psychiatric ward or even hospital is run on the basis of completed gender segregation as they are planning in Bnei Brak. However it is not clear what the additional rabbis signed for or who asked them to sign and why.

    Please read the just posted article by Dr. Klafter. It is not an issue of Ph.D.'s versus gedolim. It is an issue of an approach which has been accepted by gedolim for decades which some are now trying to change. When you want to change the precedent you need to explain why and what the paramters are.

    Dr. Bunzel has expressed his concerns clearly in the posted article.

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  6. The formulation of a question has impact on the response. Dr. Bunzel's description of the relationship between client and therapist neglects to mention that successful therapy depends on the ability of the client to be open. In many cases this can best occur when seeing a psychologist of the opposite sex. Asking a rov to evaluate when this is appropriate can endanger the patient. Mental illness is as serious as physical illness and only an expert is qualified to evaluate treatment.

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  7. What is the halachic decision regarding a Non-frum or Non-Jewish therapist?

    ReplyDelete
  8. Caren May said...

    What is the halachic decision regarding a Non-frum or Non-Jewish therapist?
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    Rav Moshe Feinstein addressed this issue - it is mentioned in Dr. Klafter's article I just posted.

    Basically as long as no apikorsus is involved or presented it is ok- but if a frum therapist is available and is as competent one should use him/her.

    ReplyDelete
  9. Who is Rabbi Zilberstein? Name sounds familiar, but I'm not sure.

    Great point, Rabbi E, about the fact that a pronouncement with signatures (or supposed signatures) is not a teshuva. The dumbing down of Judaism has many people convinced that all a "gadol" has to do is say jump and the response is "how high," whether he explains why we are jumping or not. Halacha developed through explanation, legal precedent, citations, sources, etc. Through shailas and teshuvas. Not "executive order."

    ReplyDelete

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