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.

Problematic tshuva of gender separation in therapy

I recently posted an article interviewing Dr. Bunzel - a psychiatrist in Bnei Brak - and the teshuva he got from Rav Zilberstein regarding psychotherapy. It has been circulating the internet amongst frum therapist and has caused a significant amount of consternation. I have been debating whether to answer what I consider as a very poorly written teshuva and egregious attitude  to gender separation and therapy or to just ignore it as many are. Someone sent me  this morning an erudite and cogent response to the issue by Dr Klafter - a frum psychiatrist who contributed a chapter to my book on abuse - which effectively refutes the premises of the article and teshuva. I just sent a request to Dr. Klafter for permission his reply here on this blog. I assume he will give permission and will post it. Otherwise I will post the halachic concerns that he raises on my own.

[update: Dr. Klafter has agreed to my request - click link to access his article ]

Dr. Klafter's critique

Alan Dershowitz: Friends Seminary & Anti-Semitism

JPost

The Friends Seminary of New York, which invited the notorious anti-Semite Gilad Atzmon to one of its classes, and assigned its students to read his hate-filled writings, has now backed out of an agreement to invite me to the school to talk to the students about the evils of anti-Semitism.

The headmaster of the Friends Seminary, a school which is supposed to be committed to honesty and integrity, has broken his solemn promise to me, and to members of its own community, to allow its students to hear both sides of an issue that really has only one side: namely, the illegitimacy of bringing hate-mongers into high school classrooms.

Report on IPad factories: Are Chinese sweatshops evil?

New York Times

The second enlightening twist, for me, was a note sent to me from a young man, born in China and now attending an American university.

My aunt worked several years in what Americans call “sweat shops.” It was hard work. Long hours, “small” wage, “poor” working conditions. Do you know what my aunt did before she worked in one of these factories? She was a prostitute.

Circumstances of birth are unfortunately random, and she was born in a very rural region. Most jobs were agricultural and family owned, and most of the jobs were held by men. Women and young girls, because of lack of educational and economic opportunities, had to find other “employment.”

The idea of working in a “sweat shop” compared to that old lifestyle is an improvement, in my opinion. I know that my aunt would rather be “exploited” by an evil capitalist boss for a couple of dollars than have her body be exploited by several men for pennies.

 ABC expose

Secular arguments for abolishing Chareidi exemption from military service

Haaretz by Nechemiah Strasler

If we had real leaders, they would stop trying to pull the wool over our eyes and tell us the truth to our faces - that everyone has to serve in the army. With no exceptions. It is no longer possible to continue with the Haredi cowardice and evasion. It is not possible to continue with a situation in which only Haredi mothers are able to sleep well at night. Or, as Supreme Court Justice Elyakim Rubinstein said this week: "From a civilian and moral point of view, I am deeply and profoundly perplexed why all of the public does not have to participate in being exposed to sacrifice. This echoes the words of Moses: 'Will your brothers go to war while you sit here?'"

The answer to Rubinstein (and to Netanyahu, Barak, Livni and Lapid ) is clear. The ultra-Orthodox activists know it well. The Haredi public also understands. They know that Haredi activists deliver the most important goods to them - their lives. They know that military funerals never leave from Bnei Brak, that there are no Haredi wounded in Sheba Medical Center, Tel Hashomer, and no shell-shocked men in Ramat Beit Shemesh. From their point of view, let the secular donkey and the religious fool continue to sacrifice their lives in order to protect those who are better than others, the yeshiva students.

Netanya Principal suspected of rape denies allegations

YNET

The Kfar Saba Magistrate's Court on Thursday extended the remand of the principal of a haredi school for girls in Netanya who is suspected of sexually assaulting students. The suspect denied the allegations.

Meanwhile, the family of a 20-year-old teacher at the school complained that the principal had abused his power to have sexual relations with her, Ynet learned.

The suspect, 47, is a prominent figure in Netanya. He was arrested earlier this week after two former students at the establishment filed complaints against him saying he sexually assaulted them. Police suspect him of indecent acts, sodomy, sexual misconduct, nonconsensual sex and rape. The acts involved both minor and adult victims.[...]

Rabbi Ronnie Greenwald: Children at Risk /Aguda Convention

Stolen Valor Act: Freedom of speech vs Lying about being a hero

NYTimes

Over the course of an hourlong argument on Wednesday, the Supreme Court seemed gradually to accept that it might be able to uphold a federal law that makes it a crime to lie about military honors, notwithstanding the First Amendment’s free speech guarantees. The justices were aided by suggestions from the government about how to limit the scope of a possible ruling in its favor and by significant concessions from a lawyer for the defendant.

The case arose from a lie told in 2007 at a public meeting by Xavier Alvarez, an elected member of the board of directors of a water district in Southern California. 

“I’m a retired Marine of 25 years,” he said. “I retired in the year 2001. Back in 1987, I was awarded the Congressional Medal of Honor. I got wounded many times by the same guy.” 

That was all false, and Mr. Alvarez was prosecuted under a 2005 law, the Stolen Valor Act, which makes it a crime to say falsely that one has “been awarded any decoration or medal authorized by Congress for the armed forces of the United States.” Mr. Alvarez argued that his remarks were protected by the First Amendment.
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In a related issue of a person falsely claiming to be a hero on 9/11

CBS news

Israeli Court Invalidates a Military Exemption

NYTimes

The Israeli Supreme Court has invalidated a law that exempted from military service ultra-Orthodox Jews engaged in religious studies, adding a new urgency to the government’s negotiations with religious parties over a more equitable distribution of the burdens of citizenship. 

The 6-to-3 decision, handed down late Tuesday, declared the so-called Tal Law unconstitutional at a time of growing tension in Israel over the place of the ultra-Orthodox. The law, in effect since 2002, granted exemptions to tens of thousands of religious academy students. It was widely viewed as a failure, and Prime Minister Benjamin Netanyahu had already said it would not be renewed when it expired this summer.  

Still, the ruling will now force the government’s hand to come up with a new way forward, one that will be strongly resisted by religious party coalition members. 

Departing Chief Justice Dorit Beinisch, writing for the court majority, said the law had failed to live up to its aim of increasing the number of ultra-Orthodox in the army. Using data presented by the army, the decision noted that last year fewer than 1,300 ultra-Orthodox youths enlisted out of a pool of 8,500, a rate of 15 percent. Among the rest of the Jewish population, the enlistment rate is 75 percent.

The terrorism of Off the Derech children in Bnei Brak

 In response to RaP's comment:

There are organization dealing with this. In fact when I was in Boro Park this past year - at least once a week an appeal was made for such organizations in the shul of Rav Menashe Klein where I davened every day. They were specifically for chassidic youth.

Workers in these programs in American told me that 70-80 per cent of the members of these programs have been abused.

There are programs here in Israel also. I remember once - several years ago - a rav who runs one of these organizations made an appeal in Rav Sternbuch's shul and noted that the Chazon Ish said that it is not necessarily the nebach but in fact it was the brightest and best adjusted who went off the Derech.

I also once was visiting Rav Shlomo Zalman Auerbach with a friend of mine whose father was a very prominent rosh yeshiva in America - but he had become a Breslavor chasid. When Rav Shlomo Zalman heard the name of his father he literally jumped out of his seat. I later asked my friend why he had reacted that way. He said, of the yeshiva class of Rav Shlomo Zalman at Eitz Chaim - most of his classmates when off the derech.  It upset him to see that I had not followed in my father's path - not that he had a problem with Breslov itsef. 

Finally Rav Menachem Porush's son - who is involved in politics and social action - once mentioned at a conference on the subject the following.

"It is not that we have more drop outs than in previous years. The issue is that in previous years the drop out left the community - 'he went to visit his aunt in California.' However today the drop outs are kept in the yeshivos and beis yaakov's and where they are a corrosive element to the others students."

A friend of mine noted that Meah Sharim has retained basically the same number of apartments for a hundred years - despite the fact that they have always had large families. He said this was primarily due to the children going off the derech in large numbers and leaving the community.

So yes there are families who kick out there children when they go off the derech- but there are also many who try to keep them in - sending them to special yeshivos to try to help them. Har Nof itself has a number of seminaries and yeshivos which deal specifically with this problem.

BTW Rabbi Greenwald - as well as his sons are recognized experts in dealing with this problem in the Chareidi world and their services are definitely being used.

High Court rules 'Tal Law' for yeshiva student deferrals - can't be extended

JPost

n a majority ruling of six justices against three, the High Court determined that the law, whose full title is the 'Deferral of Service for Yeshiva Students for whom Torah is their Profession Law' is not constitutional, and therefore the Knesset cannot extend it in its present form when it expires on August 1st. The law was originally passed as a temporary law requiring renewal every five years.

Principal suspected of sexually assaulting students

YNet

Former student in haredi establishment accuses principal of indecent acts, says others assaulted too. Police suspect senior haredi leaders tried to keep affair under wraps

Placebo works as well as anti-depressants for mild depression

Ben Gurion U Conference on Children: "There is not a day in which there is not a report of sexual abuse in the chareidi community"

 YNET

מנהל השירות הפסיכולוגי־חינוכי במודיעין עילית, ישי שליף, אמר כי למד עם השנים שיש צורך להתמודד עם הבעיה של פגיעה מינית במגזר החרדי. לדבריו, בגיבויו של הרב יוסף שלום אלישיב התקבלה פסיקה לגבי הצורך בדיווח בנושא, בעקבותיה "אין יום שעובר ללא דיווח".

מנהלת מרכז "בלבנו" לטיפול בילדים ונוער שנפגעו מינית, בת שבע שיינין, הוסיפה כי החברה החרדית נבדלת מרצון, מה שמייצר סיכון גדול יותר לילד החרדי. "הילד החרדי לומד מגיל אפס לציית, בלי לשאול למה. ילדים לא ייספרו על דברים רעים מחשש ללשון הרע".

שיינין הוסיפה ואמרה כי קיים הבדל בין ילדים בעלי תשובה לילדים חרדים, בכמות הדיווחים, לטובת בעלי התשובה, להם קל יותר לדווח.

מנהלת מרכז הסיוע לנשים דתיות, דבי גרוס, חשפה כי בשנה שעברה הופעלו כ־2,000 סדנאות לילדים חרדים בגילאי שלוש עד 18 בנושא מניעת פגיעות מיניות.