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.