Spiritually Oriented Treatment with Jewish Clients: Meditative Prayer and Religious Texts

Home , Jewish assimilation, Off the derech

Spiritually Oriented Treatment With Jewish Clients: Meditative Prayer and Religious Texts

Avidan Milevsky Michael Eisenberg The Hebrew University of Jerusalem Loyola University of Maryland

The current paper examines the limited literature on spiritually oriented treatment with Jewish clients and suggests two novel techniques of integration. The paper reviews the differences that exist between various denominations of Jews and the unique issues that may surface in therapy with Jewish clients based on these denominational variations. The paper suggests some specific applications including integrating meditative prayer and sacred texts in psychotherapy with Jews. Additionally, the paper provides a case study for each of the two application suggestions and concludes with a summary and

broadly. future direction. publishers. Keywords: spiritually oriented treatment, Jewish clients, meditative prayer, sacred texts, psychotherapy allied disseminated its be of

to A growing body of literature has highlighted the benefits of attention in this and many other areas of study (Wikler, 1989; one

not integrating spiritual and religious issues in psychotherapy (Bergin Wieselberg, 1992). As Arredondo and D’Andrea noted (1999), or is & Jensen, 1990; Breitbart, 2002; Pargament, 2007). Beyond the “Jews have been largely attributed an invisible status in the fields

and work documenting a link between spirituality and positive psycho- of counseling and psychology in general and within the multicul- logical outcomes (Gartner, Larson, & Allen, 1991; Milevsky & tural counseling movement in particular” (p. 14). However, con- user

Association Leh, 2008; Milevsky & Levitt, 2004; Renz, Mao, & Cerny, 2005), sidering the cultural distinctiveness of American Jews (Schlosser, several clinical studies have suggested that the psychotherapeutic 2006) and the fact that Jews, particularly Orthodox Jews, under- process is enhanced when issues of spirituality and religion are utilize psychological services offered by the majority culture individual addressed in therapy (Post & Wade, 2009; Smith, Bartz, & Rich- (Feinberg & Feinberg, 1985; Margolese, 1998), it is important to the ards, 2007). However, the limited work in this area examines these focus on issues of spirituality and religion in the treatment of Psychological of processes primarily with Christian samples, rarely assessing issues Jewish clients. use of spiritual and religious integration in other religious groups This review will examine the differences that exist between (Norcross, 2002; Worthington & Sandage, 2001). various denominations of Jews and the unique issues that may American

personal One such group is American Jews. Although there is consensus surface in therapy with Jewish clients based on these denomina- the about the importance of assessing multicultural issues in many tional variations. Additionally, we will suggest some specific the by areas of psychological study, American Jews have received little applications for integrating prayer and sacred texts in psychother- for apy with Jews and provide a case study for each suggestion. The paper will end with a summary and future direction. solely copyrighted This article was published Online First April 30, 2012. is AVIDAN MILEVSKY received his PhD from Florida International University. Differences Existing Between Various intended He is currently a visiting professor at the Department of Psychology at The is Denominations of Jews Hebrew University of Jerusalem and an associate professor of psychology document at Kutztown University of Pennsylvania. He also practices psychotherapy

article Clinicians working with Jewish populations are encouraged to at Wellspring Counseling in Towson, Maryland. His research interests This first understand the substantial differences that exist between

This include spirituality and well-being, family dynamics, parenting, and sibling relationships. members of various denominations of Jews (Bilu & Witztum, MICHAEL EISENBERG is a graduate student in the clinical psychology pro- 1993; Langman, 1995, 1999; Meyerstein, 2006). The three primary gram at the Department of Psychology, Loyola University of Maryland. He denominations of Jews are Orthodox, Conservative, and Reform. received his Bachelors of Arts degree with Honors from Johns Hopkins Orthodox Jews “accept that God gave the Torah, the Hebrew University. His areas of research include cultural differences in guilt and Bible, to the People of Israel at Mount Sinai, along with a divinely issues of spirituality in mental health. ordained interpretation of its commands” (Schnall, 2006, p. 277). PORTIONS OF THIS PAPER were presented at the meeting of the American They believe that every word of the Bible is of divine origin, and Psychological Association, Washington DC, August 2011. We thank Dr. that all rabbinic commandments were transmitted by God at Don Walker and Ken Ziegler for their assistance with the conceptualization Sinai. This transmission is recorded in the Talmud. Orthodox Jews of the paper and Rabbi Yimiya Milevsky and Jonathan Milevsky for the research assistance. apply the teachings of the Torah and the Talmud to all aspects of CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to Avidan life, including daily routines, personal interactions, family life, and Milevsky, Associate Professor, Department of Psychology, Kutztown business matters. University of Pennsylvania, Kutztown, PA 19530. E-mail: Milevsky@ On the other hand, Conservative and Reform Jews practice a kutztown.edu more open Judaism and emphasize the need to view Jewish law in

336 SPIRITUALLY ORIENTED 337

the context of modernism (Schlosser, 2006). Conservative Jews affect the prospects of the family member trying to marry. Family believe in God, whereas the Reform movement views God in a reputation is important partly because the matchmaker may not more ambiguous and spiritual manner (Meyer, 1995). As such, know the individual very well and is therefore forced to rely on Conservative Jews are more likely to ascribe divine authority to more general family information when determining marriage suit- the Bible than Reform Jews. However, both denominations view ability (Lehman & Siebzehner, 2009). It is common for both the Talmud as discussions with historical value but with little partners in a possible match to research their potential mates, legislative authority (Raphael, 1984). Thus, Talmud based rabbinic which may involve speaking with teachers and friends. The pro- religious rituals are mandatory laws to Orthodox Jews, but more spective dating partners may feel pressure from being investigated. akin to voluntary enrichment for Reform and Conservative Jews Studies have found that these various pressures associated with (De Lange, 2000). finding the right mate are associated with increased conflict within orthodox families (Milevsky, Niman, Raab, & Gross, 2010). Unique Issues With Jewish Clients Moreover, religiously committed Jews may view mental health professionals with distrust, especially if the therapist is a non-Jew Clients from these various Jewish denominations may present (Greenberg & Witztum, 1991; Strean, 1994). The long history of with unique issues partly as a function of their level of assimilation oppression Jews experienced, and the fact that their lives are so

broadly. into the majority culture. Considering that Reform and Conserva- strongly defined by their faith are both factors that could contribute tive Jews are more open to all facets of modernity, the issues faced to this phenomenon. It is recommended that therapists inform their publishers. by families from these denominations may not differ in a consid- observant Jewish clients that they are aware of the basics of erable manner from issues faced by an average majority-culture Judaism and have some understanding of its culture and lifestyle. allied disseminated

its family. However, even in these more liberal denominations, there It is strongly encouraged that therapists obtain informed consent be of may be some intergeneration conflict associated with the younger from their clients to consult with the family’s rabbi to ensure that to

one generation seeking to assimilate at levels that the older generation the clients are comfortable that the intervention is religiously not or may find unnerving. This dynamic can be seen in the common sanctioned (Rabinowitz, 2000; Schnall, 2006). Along the same is phenomenon of grandparents insisting that their grandchildren lines, therapists should familiarize themselves with the laws of and marry within the faith, a position not necessarily adopted by the modesty practiced by Orthodox Jews, considering their relevance

user younger generation. Assimilation has been a major concern during to the setting of therapy (Margolese, 1998). For example, seclusion Association previous generations and the recent rampant assimilation is seen as with an opposite-gender therapist may be problematic for some a major issue by the older cohort of Jews, threatening the survival clients and hence provisions may be necessary, such as leaving the

individual of Judaism (Karesh & Hurvitz, 2006). This generational chasm is office door open or making it clear that others can access the room

the further amplified due to growing evidence suggesting that the freely, to avoid reluctance (Buchbinder, 1994). Furthermore, phys- Psychological of phenomenon of assimilation is viewed in a more nuanced manner ical contact with members of the opposite gender is avoided

use by the younger generation than previous ones. This phenomenon, (Margolese, 1998); hence, shaking a client’s hand should be done described in detail by Waxman (1983), still exists today where a only when the gesture is initiated by the client.

American growing number of American Jews have lost affiliation with the Finally, religiously committed parents might believe that their personal the communal structure of Judaism, but still retain a strong ethnic child’s spirituality naturally prevents them from having a diagnos- the by identity. This shift suggests a more subtle assimilation process than able condition that needs treatment. For example, an Orthodox

for the dichotomous process perceived by the older generation. The Jewish teenager was referred by their pediatrician to treatment due older generation may view assimilated Jews with contempt, con- to concerns about symptoms of anxiety. During the initial stages of solely sidering its traditional association with subservience to gentile treatment with the first author of this report, the adolescent’s copyrighted

is culture, its historic rejection of links to the common history and mother said that her son did not need psychotherapy because he destiny of the Jewish people, and a perceived betrayal of ancestry was a “big masmid” (i.e., someone who is very studious regarding intended

is who suffered to sustain Judaism (Vago, 1982). Jewish learning and texts). As a result, this parent found it difficult In Orthodox families the struggle with modernity entails addi- to believe that her son needed psychotherapy. document

article tional layers, which may contribute to family discord (Bilu & This Witztum, 1993). For example, a problem receiving recent attention

This Integrating Prayer in Psychotherapy within the Orthodox community is the departure from orthodox practice of many adolescents and young adults (Margolese, 2005). Differences between the denominations of Jews also exist in Referred to as going “off the derech,” or off the way, Orthodox terms of approaches to prayer. Traditionally, prayer in the Jewish families may perceive this departure as a function of a clinical faith is practiced communally. A quorum of at least 10 Jewish issue and may seek the advice of a mental health professional to males age 13 or higher, called a minyan, is required in order to deal with this issue. It is generally becoming easier for youngsters engage in the ideal form of prayer. Furthermore, the prayers from sheltered backgrounds such as Hasidic or Ultraorthodox chanted are meticulously scripted and are organized in a prayer communities to go “off the derech,” since they can get informa- book called a siddur. However, prayer can also be recited privately tion, contacts, and helpful resources from the Internet to help them if an individual cannot attend the communal prayer in the syna- reestablish themselves in their new living situation. gogue. The prayers recited individually are identical to the scripted Orthodox families may also encounter turmoil during the pro- and organized prayer recited communally excluding several minor cess known as “shiduchim,” which is when young adults within the sections that can only be recited with a minyan. With changes to family begin dating for marriage (Wieselberg, 1992). This process the tradition emblematic of more assimilated Jewish denomina- adds pressure on all family members, since their reputation may tions, such as Conservative and Reform, prayer has evolved in 338 MILEVSKY AND EISENBERG

these groups to include more female representation in communal ering the family turmoil created by the adopted child. Maya was prayer and the incorporation of nonscripted individualistic prayer. very disturbed by the fact that her parents were giving her sister Considering the traditional focus on communal and scripted back to her biological mother, and experienced a profound sense of prayer, Orthodox Jews may view private, in-session prayer as loss. Maya was also fearful that her sister’s biological mother was inappropriate. As such, instead of actually engaging in prayer not a good influence on her and that something bad may happen to during sessions, therapists may want to discuss in treatment the her sister after she moved in with her biological mother. client’s experiences and thoughts when they pray communally The therapist suggested that the family organize a departure (Miller & Lovinger, 2000). Religious Jewish clients should be ceremony which will include the recital of the traditional traveler’s open to discussing the thoughts they may have during their prayer. The prayer is a prayer for a safe journey recited at onset of prayers, considering the importance placed on focusing and con- every intercity journey. The therapist encouraged the family to centrating during prayer in traditional laws of prayer. The require- focus the prayer on the journey their daughter was about to embark ment that individuals praying be engaged in proper thoughts and on with her biological family producing the following amalgam- focus on the words and meaning of the prayers uttered is called ated prayer: “May it be Your will, God and the God of our kavanah. In addition to the traditional reasons for the importance ancestors, that You lead her toward peace, guide her footsteps of having kavanah, such as the magnitude of the conversation toward peace, and make her reach her desired destination for life,

broadly. between man and God, engaging clients in a discussion about gladness, and peace. May You rescue her from the hand of every having proper kavanah during prayer can serve a therapeutic foe, ambush along the way, and from all manner of punishments publishers. benefit as well. Having clients focus on the words uttered during that assemble to come to earth. May You send blessing in her prayer may create a relaxed state during prayer similar to the handiwork, and grant her grace, kindness, and mercy in Your eyes allied disseminated

its relaxation experienced during meditation (Kaplan, 1985). In this and in the eyes of all who see her. May You hear the sound of our be of state, clients may engage in spiritual, cathartic thought. In many humble request because You are God who hears prayers and to

one meditative traditions, relaxation entails focusing on an object of supplications. Blessed are You, Adonai, Who hears prayer.” not or meditation. This object can be a sensation, such as a smell or The ceremony and prayer were conducted in-session with the is feeling, or it can be a specific word. Encouraging clients to have family and therapist. Maya recited the traveler’s prayer. The ex- and kavanah during prayers can help create a meditative state which perience was profoundly moving for the family and Maya reported

user has been used in prior work as a technique to reduce anxiety and in a follow-up session that the experience was a turning point in Association other disturbances (Kristeller, 2010). It may also lead to increased her acceptance of her sister moving away from home. This case religiosity and feelings of closeness to God, which can increase provides an example of the multifaceted ways in which prayer can

individual well-being. be used with Jewish clients within the psychotherapeutic process.

the For nontraditional Jews, some form of prayer during the actual Psychological of psychotherapy session may be beneficial. The type of prayer Integrating Sacred Texts in Psychotherapy

use should be discussed with the client to create a product that is both meaningful and sensitive to the prayer tradition of the client. The The two primary Jewish sacred texts are the Bible and the

American Reform and Conservative movements altered and edited the orig- Talmud. The Bible, known as the Tanach, consists of 24 books personal the inal Orthodox text, the prearranged set of prayers, but still use it as divided among three sections. The Torah (or “Teaching”) is the the by the basis for their own services. Many changes were made to the first section and contains five books (“the Pentateuch”) focusing

for Hebrew text to make it more gender neutral, accepting of other on the early history of the founding of the Jewish people and on ethnicities, and free of references to animal sacrifice. More fun- basic commandments for living. A core foundational text, it is solely damentally, an English translation accompanies the Hebrew text generally afforded the greatest respect and importance within the copyrighted

is that does not translate at all literally, but rather captures the spirit Jewish tradition. The Nevi’im (“Prophets”) is the second section, of the prayer in modern, poetic language. There is an attempt to concerned mainly with the Jewish prophet era following the entry intended

is transform prayers into things of beauty and relevance. As such, into the Land of Israel by the Jewish people. The Nevi’im also some clients may have felt alienated or distant from prayer in the describes the Hebrew monarchy, the division of the monarchy into document

article past as a result of a disconnection with tradition. Hence, prayer in two kingdoms, and detailed prophecies that warn of the impending This therapy with these clients needs to be approached cautiously as the destruction of the temple in Jerusalem. The final section, the This experience may reignite the alienation or may result in a religious Ketuvim (“Writings” or “Scriptures”), is a collection of prophe- reawakening (Miller & Lovinger, 2000). sies, reflections about living, and stories of Jewish leaders during the Babylonian exile (McDonald, 2007). Case Study: Prayer as an Intervention With The Talmud is a vast collection of rabbinic discussions occur- a Jewish Client ring during the latter era of the Second Temple and the years following its destruction (100 BCE – 475 CE) pertaining to the The case involved Maya, a 16-year-old Jewish female whose practical interpretation of the Bible. It covers the application of family was seeing Dr. Milevsky to deal with difficulties the family Biblical law in daily Jewish life including the laws of prayer, was experiencing with Maya’s younger sister. The 14-year-old keeping the Sabbath, holidays, interpersonal matters, marital is- sister was adopted as an infant and had recently experienced sues, and dietary restrictions (Steinsaltz, 2006). In addition to the pervasive behavioral disturbances. During this time the sister’s Talmud being the primary resource for understanding Jewish law, biological mother resurfaced and offered to take back her child. it also contains numerous discussions about living in general Although reluctant to give up their child, the adopted parents including insights into the meaning of life, emotions, dreams, agreed to transfer custody back to the biological mother, consid- internal conflicts, well-being, and character growth. SPIRITUALLY ORIENTED 339

The need to understand the substantial differences that exist Based on the recommendations of groundbreaking work by between members of various denominations of Jews is further Rosmarin, Pargament, and Mahoney, (2009), as part of the cogni- highlighted when determining the appropriate use of sacred texts tive restructuring, the therapist integrated discussions about trust in with Jews, considering the diverging approaches toward these texts God, and how Sarah’s beliefs about God’s daily interventions, taken by the various denominations of Jews. Considering that referred to as Hash’gacha Pratis (personal supervision), was an- Orthodox Jews apply the teachings of the Bible and the Talmud to tithetical to experiencing anxiety. The therapist encouraged Sarah all aspects of life, including daily routines, personal interactions, to read the classic Jewish text dealing with trust in God, Duties of family life, and business matters, the use of both passages from the the Heart (Ibn Pekuda, 1996), specifically the chapter titled “The Bible and the Talmud would be appropriate and accepted to an Gates of Trust.” The chapter highlights the various aspects of Orthodox Jewish client. On the other hand, Conservative and belief in God, including the idea that God has knowledge of, and Reform Jews practice a more egalitarian Judaism and emphasize power over, the workings of all aspects of the world and that God the need to view Jewish law in the context of modernism. Con- in his mercy is compassionate to all. These ideas helped counter servative Jews are more likely to ascribe divine authority to the the client’s anxious feelings by challenging her low tolerance for Bible than Reform Jews. However, as mentioned, both denomina- uncertainty with the realization that although she may be uncertain tions view the Talmud as discussions with historical value but with about her health and safety God has knowledge of her situation, is

broadly. little legislative authority. As such, the use of the Bible in thera- in control of it, and has her welfare in his best interest. After peutic intervention may be more appropriate with Conservative several weeks of spiritually oriented cognitive–behavioral therapy publishers. and Reform Jews than the use of the Talmud. using sacred texts, Sarah experienced a minimization of her fears and anxieties. allied The Tanach contains several themes and scriptures that can be disseminated its used in the context of psychotherapy. Several vivid accounts of be of family conflict exist, especially in the Torah, which can inform the

to Summary and Future Directions one process of using scriptures with Jewish clients. For example, the not or Spirituality and its use in psychotherapy and psychological care

is book of Genesis contains multiple descriptions of conflict between parents and children, such as the conflict between Abraham and his in general is a nascent area of research and investigation. There is and son Ishmael (Genesis 21, 11), Isaac and his son Esau (Genesis 27, little question that spirituality could be an important tool, consid- user 35), and Jacob and his son Joseph (Genesis 37, 10). Furthermore, ering its many empirically supported benefits. American Jews are Association several dynamics that exist between siblings in modern families one group that already enjoy a strong emphasis on spirituality can be found in the biblical narratives of the influence Ishmael had within their culture, and would therefore seem to be ideal candi-

individual over his younger brother Isaac (Genesis 21, 9), the conflict be- dates for spiritual integration in psychotherapy. However, Jews

the tween Esau and his brother Jacob (Genesis 27, 41), and the rivalry have not received sufficient attention regarding multicultural is- Psychological of between Joseph and his brothers (Genesis 37, 4). sues in therapy. Studies are indicating that attending to spiritual

use The integration of these Biblical scriptures in therapy can be issues in psychotherapy with Jewish clients may enhance treatment beneficial for both the process and content of psychotherapy. outcomes. Prayer, with its potential to be a meaningful meditative American Considering the importance of family within the Jewish faith, experience, is one powerful technique that may be implemented in personal the Jewish clients are often apprehensive about discussing family psychotherapy with Jewish clients. Additionally, Jewish sacred the by conflict issues with others, especially with someone perceived as texts include classic psychological themes such as family dynam- for ics and sibling rivalry which can help strengthen or enrich the an outsider (Schnall, 2006). Hence, highlighting these biblical psychotherapeutic process. accounts and allowing for an open discussion of the prevalence of solely While spirituality provides benefits in numerous areas of phys-

copyrighted family conflict even in what would be considered by a Jewish ical and mental health, the mechanism by which spirituality causes is client as holy biblical families can assist in normalizing the con- these benefits is still unknown. This could be a key area of future

intended flict and may make it more likely that clients would be honest

is research. Furthermore, few studies have been conducted to mea- about the conflict that exists in their families. sure satisfaction with psychotherapy among various denomina- document

article tions of Jews specifically when religious and spiritual issues are This Case Study: Sacred Texts With a Jewish Family addressed. Lastly, little work is available dealing with specific This religious and spiritual techniques, such as integration of prayer and A 17-year-old Jewish Ultra-Orthodox female was seeking psy- sacred texts, which may be beneficial to the psychotherapeutic chotherapy at the recommendation of one of her teachers from an process with Jewish clients. all-girls religious high school. Her teacher referred Sarah for psychotherapy after Sarah confided in her about her pervasive References fears and anxieties related to her own health and safety. Sarah presented with pervasive fears about getting sick and acute anxi- Arredondo, P., & D’Andrea, M. (1999, November). How do Jews fit into eties pertaining to personal injury and safety concerns. During her the multicultural counseling movement? Counseling Today, pp. 14, 36. initial intake, she reported that every time she felt a minor head- Bergin, A. E., & Jensen, J. P. (1990). Religiosity of psychotherapists: A national survey. Psychotherapy: Theory, Research, Practice, Training, ache or pain she feared that she had cancer. In addition, Sarah 27, 3–7. doi:10.1037/0033-3204.27.1.3 indicated that she was anxious about being alone at night for fear Bilu, Y., & Wiztum, E. (1993). Working with Jewish Ultra Orthodox of experiencing a home invasion. The first author engaged Sarah in patients: Guidelines for a culturally sensitive therapy. Culture, Medicine cognitive–behavioral therapy and helped her challenge some of and Psychiatry, 17, 197–233. doi:10.1007/BF01379326 the irrational aspects of her fears. Breitbart, W. (2002). Spirituality and meaning in supportive care: 340 MILEVSKY AND EISENBERG

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