Sunday, February 26, 2012

Dr. Klafter's critique of Rav Zilberstein's psak against therapy with opposite sex client

The noted frum psychiatrist - Dr. Nachum Klafter - submitted the following essay for posting on this blog regarding the recent psak of Rav Zilberstein [discussed here and here]. He requested that the reader be aware of two things: 1) This is a current draft of an essay that is be prepared for written publication, therefore any corrections or disagreements are welcome. 2) The essay is directed toward psychotherapists, and therefore may tend to over-explain some of the halakhic ideas as many of the readers are not rabbonim, and may under-explain some of the psychological content because the readers are trained psychotherapists. Dr. Klafter can be reached at doctorklafter@cinci.rr.com
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7 comments :

  1. I am unclear why this issue is coming up now. Therapy in the Orthodox community has existed for decades.

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  2. Shmuel Silberman said...

    I am unclear why this issue is coming up now. Therapy in the Orthodox community has existed for decades.
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    I don't know

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  3. Recipients and PublicityFebruary 27, 2012 at 9:56 AM

    It may help the readership to know that there is a medical and professional hierarchy among mental health professionals based on their college and university training and their state certifications and licenses.

    All of the following are legitimately called and known as therapists, they must be licensed by the state or government to practice, but they are not all equal professionally and not in the medical powers they wield:

    *Psychiatrists are medical doctors who have attended medical schools and completed their internships and residencies (training in hospitals), and have then gone on to do fellowships and specialize in the field of psychiatry that permits them to write prescriptions for psychotropic or any medications AS WELL AS do psychotherapy. They are not necessarily always the "best" therapists, while some may be the best "shrinks" in the world, but they are at the top of the medical psychiatric field.

    *Psychologists and academic PhDs and NOT medical doctors. They have studied at accredited colleges and universities and have gone from obtaining a Bachelors degree, then a Masters degree, and then a Doctorate for which they must write an in depth THESIS in a specialized subject approved by their academic advisers at the university that will give them their PhD eventually upon graduation and completion of all required course work. They can provide psychotherapy if they are licensed by the state or government but they CANNOT write prescriptions for medications.

    *Social Workers and Counselors usually require a Masters degree. Sometimes they may have only a Bachelors. They need to be licensed and may provide psychotherapy if they have been trained to do so in clinical mental health settings supervised by senior Social Workers or Psychologists. They cannot write prescriptions for patients who need medications.

    Usually, the above three groups of mental health professionals work together as a TEAM, especially in a clinic or hospital, as they create "treatment plans" to help "cure" the patients who come seeking help from them or are just brought in following mental health crisis. For example: There may be twenty Social Workers, three psychologists and only one psychiatrist on staff in one clinic or hospital. There are usually more Social Workers on staff and they are almost always FEMALES. Then there are usually PhD psychologists who are often specialists in specific areas, and may be either male OR female. Then, especially when patients require medications (to calm anxieties, for sleep disorders, deep depressions, and control psychotic or other serious mental conditions etc) there MUST be a psychiatrist involved and of course that means he or she MUST be a fully qualified medical doctor who has trained in this field, and like ALL doctors, whether the doctor is male or female, they have trained and are qualified to treat and care for either male or female patients and can and do evaluate ALL patients, write prescriptions, and do what it takes to regain the health and functionality of the patients they are treating.

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  4. Recipients and PublicityFebruary 27, 2012 at 11:21 AM

    Dr. Michael Bunzel is well aware of the NEFESH organization. He was quoted as speaking at its Israeli branch Nefesh-Israel in 2005. He is nor resorting to strong-arm tactics to force his views upon his colleagues and it is not hard to see that they are going to resist his arbitrary moves, even as he runs to get Rabbonim to back him up, one of the oldest "tricks in the book" that will help neither patients nor therapists. Dr. Bunzel would have been a lot smarter had he FIRST sought consensus from his colleagues but he will get nowhere by trying to "bludgeon" them with a blunt club of flagrant frumkeit.

    He was once quoted in an article that describes the setting up of the NEFESH branch in Israel known as Nefesh-Israel, see this quote from The Lancet (Volume 366. Issue 9496. Pages 1516-1517.) 29 October 2005:

    "Mental health and religion in Israel's ultra-Orthodox Jews

    Nefesh-Israel was founded in 2001 by Judith Guedalia, director of the neuropsychology unit at Jerusalem's Shaare Zedek Medical Centre, and Leah Abramowitz, a senior social worker. Nefesh was originally set up in New York around 10 years for mental-health professionals who treat observant Jews to swap experiences and knowledge at conferences and training courses.

    Guedalia, who trained in the USA, was moved to set up Nefesh-Israel after hearing about some of the problems faced by ultra-Orthodox Jews. She heard of one case in which a man whose request for a male psychiatrist was turned down three times. “Can you imagine a woman being turned away if she asked for a female gynaecologist? I felt that the ultra-Orthodox as a group were under respected and their values were viewed as odd by many mental-health professionals”, she says....

    In Israel, as elsewhere, many psychiatrists come from a secular or at least non-religious background that can stand at odds with those who are strictly observant. Guedalia seeks to bridge these gaps....There is a strong taboo surrounding mental illness, mainly because of its adverse effect on prospective couples whose family histories are scrutinised before an arranged marriage. But gradually, more ultra-Orthodox are beginning to seek the help of professionals who are learning about their way of life.

    Such all-encompassing religious belief can prove a minefield for mental-health professionals when dealing with ultra-Orthodox individuals. Nefesh-Israel also tries to help professionals who hold their own religious convictions to reconcile them with modern therapies. Guedalia says there are parallels with the treatment of Catholics, Muslims, and other religious minorities in the west.

    The last Nefesh-Israel conference included papers on topics including: menstrual psychiatric disorders; the cognitive-behavioural aspects of the views of several classic Jewish commentators and the rabbinic attitude towards the use of manipulation for therapeutic purposes; coping with the aftermath of a terrorist attack; divorce; and child abuse. Meanwhile, segregated seating is provided for the conference participants, who range from ultra-Orthodox to secular....

    Michael Bunzel, a haredi psychiatrist, spoke of genetic disorders in terms of how they can affect marriage prospects and when a rabbi should be consulted. Some disorders, such as Tay-Sachs disease that affects the nervous system, occur most frequently among descendants of Ashkenazi Jews.

    He also noted that some haredi women hide a psychiatric problem before marriage and take their medication in secret only to have to stop when they get pregnant, causing their husband to learn of their illness...."

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  5. Recipients and PublicityFebruary 27, 2012 at 11:48 AM

    What it boils down to is that we have here a case of a highly pro-active individual, Dr. micahel Bunzel, age 46, motivated by burning religious zeal who is deploying his professional training as a psychiatrist in the service of a Charedi politically correct agenda (a twisted form of "psychiatry at the service of the totalitarian state" rather than finding more moderate and helpful solutions), when what is called for is a more neutral dispassionate role expected from a medical practitioner who is not supposed to inject himself into controversial religious disputes, but needs to focus of healing his patients first and foremost.

    It is not surprising in the least that Dr. Michael Bunzel has also signed the controversial "Declaration On The Torah Approach To Homosexuality: The Torah Declaration is a public statement signed by 212 Rabbis, Community Leaders, and Mental Health Professionals" that "Same-Sex Attractions Can Be Modified And Healed...."; "The Process Of Healing: The only viable course of action that is consistent with the Torah is therapy and teshuvah. The therapy consists of reinforcing the natural gender-identity of the individual by helping him or her understand and repair the emotional wounds that led to its disorientation and weakening, thus enabling the resumption and completion of the individual’s emotional development...."; "The Mitzvah Of Love And Compassion...."

    This has caused some current ongoing controversy in mental health circles for a number of reasons relating not so much to the validity of the religious principles, but about the role of therapy and the underlying assumptions in all this. In short it's a dynamite zone, that Dr. Bunzel was more than happy to jump in to and lend his signature thus affirming his activist role and personality in general.

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  6. Recipients and PublicityFebruary 27, 2012 at 12:18 PM

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  7. I agree that Dr. Bunzel should have sought some input from his professional colleagues. The rabbis who signed onto Rabbi Zilberstein's "psak" should have heard other viewpoints.

    For me, the most important part of Rav Moshe Feinstein's teshuva is the explicit acknowledgement that men possess different sexual natures. Various studies, that I've observed in passing over the years, have borne out this truth. Some men think about sex near constantly, others, almost never. Sexual activity among men is also highly variable. Some married men, very frequently; others, lose their interest entirely.

    For this reason, I believe Rabbi Zilberstein's psak, as a blanket prohibition against opposite gender therapy, contradicts Rav Moshe's teshuva about a man taking public transportation. There is no accounting for an individual's personal sexual proclivities in Rabbi Zilberstein's psak, unlike Rav Moshe's. I don't question the right of Rabbi Zilberstein and his co-signers to issue their psak, and disagree with other poskim, but I believe we should see it for what it is, as being inconsistent with Rav Moshe's teshuva.

    Additionally, some men may feel more comfortable with a woman therapist. Some men, the macho variety, may feel awkward about disclosing their personal weaknesses to another man. I don't see where Rabbi Zilberstein's psak take this factor into account.

    That being said, I do agree with that part of Rabbi Zilberstein's message that deep and extended psychological therapy is different from other short-term psychological treatment, and a medical doctor, in the presence of a female nurse, doing an exam on a female patient that lasts all of several minutes. Ein apitropus l'arayos. The power of sexuality is so great that it can never be sufficiently guarded against. Most of us have had our eyes opened on too many occasions proving the truth of this Chazal wisdom.

    I also agree with Dr. Klafter that rabbis like Rabbi Gedalia Dov Schwartz have gotten it right. Every therapist-patient encounter needs to be evaluated on an individual basis. Dr. Klafter's observation about Rabbi Dovid Cohen never suggesting a blanket ban on opposite gender therapist-patient treatment is also right on the mark, given Rabbi Cohen's very deep experience with Nefesh and Ohel.

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