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Sunday, August 18, 2013

Torah Psychotherapy: Learned from Torah or doesn't violate Torah?

Posted on 11:30 AM by Unknown
 Update:8/18/13 I'd like to summarize what I understand Ploni is suggesting regarding developing a Torah therapy. 1) It is desirable to have psychotherapy based upon the insights of those who contributed to our Mesorah instead of either a purely secular therapy or one that the therapist hopefully selects elements that are compatible with  Torah and avoids those elements which are against the Torah. 2) There is also at the present no clear guidelines for the goals of therapy. Ploni is suggesting that we identify Torah appropriate goals and avoid inappropriate goals. 3) Before a true  Torah therapy is developed it is important that there be some official psak as to what secular therapy is appropriate for use with frum Jews.  4) Therapy needs on going rabbinic supervision as well a prescreening by rabbis.
My simple response to this is a practical one. I don't think it is feasible because it is essential creating mashgichim for therapy. In Ploni's future I can see that we have Bedatz therapy and therapists and OU therapy and therapists. Who are these mashgichim going to be? By and large rabbonim who don't understand therapy - but think they do. So why should they supervise it? In addition it would seem that each client would need not only to find a therapist but also a rabbinic supervisor to assure that therapy is going on in line with rabbinic approval. I find this rather intrusive and counterproductive as well as cumbersome. An alternative would be that only rabbis would be allowed to be therapists. This also is not a good idea because many talented therapists are not capable of learning properly while many Torah giants would simply relate to a client as they do a shtender. We see how child abuse has been handled with rabbinic supervision and I don't have reason to think therapy would be handled any better. I find the idea of total rabbinic supervision rather depressing. Furthermore while I think theoretically it is possible to build a Torah therapy, I am not convinced that a Torah therapy would actually work better than a selective use of secular therapy or developing new neutral techniques which don't claim roots in halacha or hashkofa.
 =============================
There have been a number of heated discussion about the issue of Torah psychotherapy. Part of the problem is clearly defining what is meant. Equally important is whether the "Torah therapy" is actually derived from Torah sources in the Hirschian sense - or whether they are simply translation of secular language and metaphors into Torah terms? In other words, does the Torah define what a good marriage or child rearing is - or are secular standards used and Torah is simply used as a tool. Does Torah prescribe ways to reduce anxiety or become more sociable or outgoing  - or is it derived from Dale Carnegie or Freud?
Update: See additional discussion about frum self-help books

Update: This is more than an academic question. A friend was informed by an activist in a major Torah community that 50% of community charity monies are now going to provide psychotherapy. Most of it was spent on frum therapists who had received at most a years training in a frum therapy program. The askan was not only upset about the amount of money being spent but he said he had no idea of whether the therapists were competent and had no way of determining whether the money was being well spent.

Update 8/14/13 If in fact the therapy is truly Torah therapy - then it would seem that there could be no excuse to use secular therapy. However problems clearly exist when Torah principles of what constitutes proper education or the ideal marriage clearly are inconsistent - not only with modern secular values but also that of the vast majority of Orthodox Jews. 
================================================
Conclusion - Update 8/16/13 It is apparent from the comments to this post is that there is no such thing as Torah Psychology or Torah Therapy that was given at Sinai. There are psychological insights which are found in our Tradition which can be used in therapy - but they don't constitue a program of therapy. A psychology or therapy based primarily or exclusive on Torah sources might be desirable - but it doesn't exist at present and it clearly is not part of our Tradition from Sinai.
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There are a number of possibilities. 
1) Mental health achieved by prescribing Torah activities.  A person with low self esteem might be told to make a siyum to build his self esteem. A person who is shy, might be encouraged to do chesed to be less self-conscious. A man who has anxiety and depression by being in an adulterous relationship with another man's wife is told to stop sinning and do teshuva. A person might be told to pray at the graves of great tzadikim.

2) Therapy done by a rabbi or rebbetzin.  Some believe that any therapeutic technique that is done by a religious authority is Torah therapy. This may or may not include using religious language and examples. Thus there is absolutely no difference in the technique - only the person doing the therapy. An example is Rav Yitzchok Zilberstein's declaration that while psychologists have techniques for evaluating whether a person is a pedophile or child molester - only a talmid chachom actually knows.

3) Traditional secular psychotherapy techniques that don't violate halacha OR HASHKAFA [Ploni's correction]. A secular therapist once told me that the cure for the depression for his  yeshiva bachur client - was to get a girl from and engage in sexual relations. Obviously this was not acceptable. Another example is that some therapy is predicated about speaking lashon harah about parents and friends. A Torah therapy would seek a cure without using such techniques if at all possible.

4) Techniques developed from classic Jewish sources such as mussar or chassidic writings- without reference to secular sources. These typically involve using a conceptual framework of spirituality that if found in seforim such as Mesilas Yeshorim- often kabbalistic ideas are utilized.. No reference is made to secular psychology at all. However a secular therapist will typically recognize these techniques as variations of secular therapy.
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Thus ultimately the question is whether there is an inherent Torah approach to curing mental health problems. To answer this question it should be sufficient to observe whether great Torah scholars are also great therapists? I personally think the answer is no. Rav Moshe Feinstein is quoted in the introduction to the 8th volume of the Igros Moshe that being a gadol in Torah doesn't make one a successful politician or provide other wisdoms. Gedolim typically tell people with psychological problems to go the therapists. It is really no different than a medical problem. While there clearly are rabbis who have an innate talent for therapy - it doesn't seem that this is the result of studying Torah. There are in fact wise people from all sorts of backgrounds who are able to give therapeutic advice and direction.
A corollary of this answer that there is no inherent Torah therapy is the reality that advice from rabbis is not beyond question. One rosh yeshiva told me about a friend of his who was having marriage problems. He said it was obvious that the couple should never have gotten married. However since he was a student of Rav Moshe Feinstein he went and asked for advice. Rav Moshe told him emphatically that he should remain married. The man suffered for 5 more years and finally couldn't take it any more and got divorced. The rosh yeshiva - who was close with Rav Moshe - said his friend wasted 5 years of his life.  I have heard this regarding other gedolim such as Rav Steinman. Rabbis - even amongst the greatest - are known to have bad marriages or messed up children. This is readily stated in the Talmud.

Update 8/15/13 From Rav Wolbe's article on Psychiatry and Religion it is clear that there is no independent Jewish psychology or psychotherapy given at Sinai - but psychology which has been adapted or filtered to be appropriate for a religious Jews. this is from page 77.


היחס של היהדות הדתית אל הטיפול הפסיכיאטרי.

ידוע הוא יחס התורה של חכמת הרפואה בכללה: הרשות ניתנה לרופא לרפא - "ורפוא ירפא" כתיב  - וחיוב מוטל על האדם:

"ונשמרתם מאד לנפשותינם"  ~. ויש מרבותינו הסוברים כי פקודתו של רופא יש לה דין של "מצוה מדאורייתא" בכל החומרות שלה. והי' צריך להיות מובן מאליו, כי לפסיכיאטרי' מגיע אותן מעמד כמו לשאר ענפי הרפואה. הרי דבר פשוט הוא: כל הפרעה רצינית, אם נוירוטית אם פסיכוטית, צריכה לבוא בהקדם האפשרי לאבחנה פסיכאטרית ולטיפול מתאים. למרבה הצער, האמת הפשוטה הזאת אינה נחלת הציבור הרחב, וזאת משתי סיבות: נפוצים משפטים קדומים בכל הקשור למחלות-נפש, וגם שוררת אי-ידיעה ככל השייך לתחום זה.

ישנם משפטים קדומים רבים בענין, הראשון - המחריד ביותר: יש החושבים, כי חולה-נפש מהווה כתם על המשפחה כולה. בעיני ראיתי, איך משפחה טובה מאד התכחשה לבן יקר שיצופרני; בתחילה התכחשה לאבחנה. אחר-כן. עם התקדמות המחלה, התעלמה מהחולה עצמו, שעזב את הבית והתגלגל במסדרון של איזה מוסד בחוסר כל ובלי שום טיפול. כמוכן, כל מי שיש לו השפעה על משפחות החולים, חייב ללחוץ על המשפחה שיביאו את החולה לטיפול פסיכיאטרי, ובהקדם! - משפט קדום שני מכוון נגד האישפוז: על מי שהי' מאושפז פעם, מוטבעת גושפנקא של "אינו מן הישוב", וזה מערים קשיים על עתידו אפילו אם הבריא לגמרי. עוד זאת חוששים קרובי החולה, שהאישפוז עצמו יגרום הרעה במצב החולה. גם בזה יש צורך בהסברה לציבור הרחב, כי הרופאים מודעים לאפשרות זאת, והם עושים כל אשר ביכולתם למנוע אישפוז מיותר. רצוי שהציבוו ידע, כי היום עומדות לרשות הפסיכיאטרים תרופות חדישות שחוללו מהפכה בטיפול במחלות פסיכוטיות. [...]

בעיות אלו משותפות לציבור הדתי ולפסיכיאטרים. יש צורך דחוף בארגון קורסים לרבנים בפועל ולמחננים, במטרה להפיץ ידע בסיסי על הסימפטונים של נוירוזה ןפסיכוזה ודרכי הטיפול שלהן בקווים כלליים, כדי שידעו להפנות חולים בהקדם אל הרופא. ידיעה בסיסית היתה מסלקת הרבה משפטים קדומים!
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