Chicken Soup Group: Peer Group Supervision for Therapists Treating Orthodox Jews

This paper will discuss my personal experience as an Orthodox psychiatrist engaged in the treatment of Orthodox clientele and how our peer group supervision has facilitated the resolution of clinical problems in the treatment of this special subgroup of patients. As other group members address possible areas of overlap and potential conflict between dynamic psychology and Judaism, I, as an MD who prescribes medication, will focus on particular issues that this raises for the Orthodox Jewish community. I will demonstrate how the peer group forum has enabled me to deal with some difficult clinical problems.     

Genetic Counseling for the Orthodox Jewish Couple Undergoing Preimplantation Genetic Diagnosis

Orthodox Jewish patients who seek genetic counseling are often placed in a difficult position of having to choose between their desire to follow Jewish religious instruction (halacha) and following the advice of the genetic counselor. In this article we will present the work of the Puah Institute based in Jerusalem that is dedicated to assisting and guiding such couples to navigate through the medical system and medical recommendations and create a harmony between modern genetic counseling and the Orthodox Jewish tradition. In light of the expanding use of preimplantation genetic diagnosis (PGD) for a variety of medical and non-medical conditions, this dilemma is even more poignant. There is an ethical debate regarding PGD and the correct parameters for its use. Here we present the Orthodox Jewish view of the use and abuse of PGD. We present three case studies that sought the assistance and guidance of the Puah Institute. Each of these cases raises ethical dilemmas for the genetic counselor and for the rabbinic counselor. We discuss; the status of the embryo, the status of a carrier of a genetic abnormality and whether PGD is an obligation or good practice. In addition we deal with whether PGD and the search for the desired traits can be defined as eugenics or not.     

Challenges of Pre- and Post-Test Counseling for Orthodox Jewish Individuals in the Premarital Phase

The Jewish community has traditionally taken ownership of its health, and has taken great strides to raise awareness about genetic issues that affect the community, such as Tay-Sachs disease and Hereditary Breast and Ovarian Cancer syndrome. Thanks in part to these heightened awareness efforts, many Orthodox Jewish individuals are now using genetics services as they begin to plan their families. Due to unique cultural and religious beliefs and perceptions, the Orthodox Jewish patients who seek genetic counseling face many barriers to a successful counseling session, and often seek the guidance of programs such as the Program for Jewish Genetic Health (PJGH). In this article, we present clinical vignettes from the PJGH’s clinical affiliate, the Reproductive Genetics practice at the Montefiore Medical Center. These cases highlight unique features of contemporary premarital counseling and screening within the Orthodox Jewish Community, including concerns surrounding stigma, disclosure, “marriageability,” the use of reproductive technologies, and the desire to include a third party in decision making. Our vignettes demonstrate the importance of culturally-sensitive counseling. We provide strategies and points to consider when addressing the challenges of pre- and post-test counseling as it relates to genetic testing in this population.     

Assessing and treating sexual dysfunctions in Orthodox Jewish couples: a summary of 41 consecutive cases

ABSTRACT

Orthodox Jews are a distinct subgroup with specific beliefs and values towards sexuality, reproduction, modesty, and openness to mental health treatment. This paper reviews the treatment of 41 Orthodox Jewish couples who presented for sex therapy. Most couples were referred by a rabbinical leader. The most common presenting problem was an unconsummated relationship; present in 27 couples. In 34 couples the initial presenting complaint was a male sexual problem yet in 20 of 41 couples both partners described having some sexual problem. Almost 50 per cent of both men and women were also diagnosed with a comorbid psychiatric disorder, which was almost always previously undiagnosed. The most common presenting problems were vaginismus, male inhibited arousal, and/or inhibited male orgasm. Two case examples illustrate some adaptations to assessment and treatment that can be helpful in treating sexual problems in Orthodox Jewish couples.     

Denominational Variations Across American Jewish Communities

This article explores the Jewish identity of different Jewish denominational identification groups using the Decade 2000 Data Set with its 19,800 interviews of Jewish households in 22 American Jewish communities. We relate the Jewish identity of individuals in each denominational group (Orthodox, Conservative, Reform/Reconstructionist) to the denominational composition of the community. Communities are clustered via k‐means cluster analysis based on their denominational profiles. We examine the extent to which individual Jewish identification varies by the denominational composition of the community in which an individual resides, finding that considerable variation exists in Jewish identity measures depending on the type of denominational profile that exists in the individual's community. That is, Orthodox Jews, for example, behave differently in a community with a significant Orthodox population than in a community with few Orthodox, but many Reform Jews. Implications for Jewish communities, as well as for the broader interreligious community, are considered.     

Orthodox Peer Supervision and Orthodox Group Therapy: Two Groups—One Religion

Group Psychotherapy with Orthodox Jewish patients creates specialized benefits for members such as homogeneous cultural and religious goals plus feelings of camaraderie and familiarity. However, heightened sensitivity to social stigma in Jewish circles and the fear of being judged cause greater difficulty for such patients. This paper reviews the experience of the group members and the experiences of the author in leading such groups. Similarities and differences between Orthodox Jewish therapy groups and an Orthodox Jewish Peer Supervision Group are explored.     

A Case of Child and Family Therapy: Is Anger Permissible in This Home?

This article illustrates the impact of a peer supervision group on the treatment of an Orthodox Jewish child and her family system. Examples of treatment difficulties encountered when Orthodox therapists treat Orthodox patients are also presented. It highlights the use of a peer supervision group as a means to manage some of these treatment difficulties.     

Issues in the psychopharmacologic assessment and treatment of the orthodox Jewish patient

As with members of other cultural and religious groups, patients within the Orthodox Jewish community present with their own distinct clinical psychiatric issues related to their unique beliefs and practices. This article reviews the existing literature and anecdotal experience on the psychopharmacologic assessment and treatment of Orthodox Jewish patients. Specific aspects examined include this group's perceived intense stigma in receiving treatment, the priority this community places on cognitive functioning, and how the influence of Jewish laws on marriage and sexual practices impacts one's treatment decisions. The relevance of Jewish dietary laws, the Sabbath, and the community's interest in alternative treatments are also discussed. The limited ethno-psychopharmacology research related to Orthodox Jewish psychiatric patients is reviewed. We conclude that understanding issues such as these is critical if one is going to work within this cultural system in order to successfully address their mental health issues. However, the dearth of controlled research in this community needs to be addressed to provide more effective treatment.     

Nathan Birnbaum and Tuvia Horowitz: Friendship and the Origins of an Orthodox Ideologue

Nathan Birnbaum, early Zionist, Yiddishist and later general secretary of the Orthodox Agudat Yisrael, is a perplexing figure to modern Jewish historiography. While the trajectory of his early career as a Zionist and his leadership in the first Conference for the Yiddish Language have been well charted, his later years have been largely overlooked. In the years leading up to and during the First World War, Birnbaum turned his back on the secular political groups which had defined his public persona, and became a ba'al teshuva, a penitent returnee to Orthodox Judaism. Essential to his turn to Orthodoxy, and to his very quick arrival and success in the Orthodox political world, was his relationship with a young rabbi from Eastern Hungary, Tuvia Horowitz. Horowitz, the nephew of the Viznitser Rebbe, sought out Birnbaum upon receiving rumors of his teshuva while a refugee in Vienna, and the relationship between the two men quickly grew to a warm collegiality. Detailed in the extensive correspondence which spanned the rest of Birnbaum's life, their friendship sheds light on Birnbaum's intellectual transformation, as well as the central role played by Horowitz in Birnbaum's emergence as an Orthodox leader.     

The Earnings of American Jewish Men: Human Capital,Denomination, and Religiosity

This article analyzes the determinants of the earnings of American Jewish men using the 2000/2001 National Jewish Population Survey. Nonresponse to the question on earnings is analyzed. Earnings are related to conventional human capital variables, as well as Jewish-specific variables. Except for the size of place and region variables, the standard human capital variables have similar effects for Jewish men and the general male population. Jewish day schooling as a youth enhances earnings. Earnings vary by denomination, with Jewish men who identify their denomination as Conservative earning the most, with secular and Orthodox Jews earning less. The effect on earnings of religiosity (measured by synagogue attendance) is not monotonic. Earnings are highest for those who attend about once a week, are lower for those who attend daily, and are lowest for those who never attend.     

Family size and psychological functioning in the Orthodox Jewish community

Caring for children is a known psychosocial stressor; however, its effects on psychological functioning may have substantial cross-cultural variance. We explored relationships between family size and a variety of psychological outcomes among Orthodox Jews in four separate studies: (1) an international treatment-seeking sample (n?=?82), (2) a community sample from Canada (n?=?226), (3) an out-patient clinical sample from greater New York (n?=?82), and (4) a large dyadic sample of Israeli couples (n?=?789). Surprisingly, results suggested that family size was not associated with greater stress, anxiety, depression, global functioning, family functioning, family communication, family satisfaction, or even parenting stress. It is possible that the high religious value placed on family life as well as structural adaptions in families buffer against potential stressors associated with child rearing, and further research on these potential effects is warranted.     

Counseling Jewish Women: A Phenomenological Study

The field of counseling has paid little attention to religion in general and Jewish women's realities in particular. This article presents the findings of a qualitative phenomenological study examining 12 Ashkenazi, non‐Orthodox, Jewish American women's self‐reported understanding of their Jewish identity, revealing the themes of Jewishness and being Jewish in a broader societal context, as well as 7 related subthemes. Recommendations are offered for counselors, educators, and researchers who work with Jewish women.     

The Seminal Contribution of Rabbi Moshe Feinstein to the Development of Modern Jewish Medical Ethics

The purpose of this essay is to show how, on a wide variety of issues, Rabbi Moshe Feinstein broke new ground with the established Orthodox rabbinic consensus and blazed a new trail in Jewish medical ethics. Rabbi Feinstein took power away from the rabbis and let patients decide their treatment, he opened the door for a Jewish approach to palliative care, he supported the use of new technologies to aid in reproduction, he endorsed altruistic living organ donation and recognized brain death (thus laying the groundwork for Orthodox Jewish acceptance of heart transplantation), he downplayed the value of social worth in triage decisions, and was a fierce defender of the rights of the fetus. I develop broader theological principles from Rabbi Feinstein's ethical positions and compare them to those of his Jewish and Christian contemporaries.     

Effectiveness of Cognitive Behavioral Therapy for Anxiety and Depression Among Orthodox Jews

Several clinical papers have provided clinical recommendations for how to provide cognitive behavioral therapy (CBT) for obsessive-compulsive symptoms among Orthodox Jewish individuals. However, no published studies have described culturally adapted CBT for anxiety or depression in this population or quantified the effectiveness of such approaches. We evaluated the effectiveness of CBT for symptoms of generalized anxiety and depression in a sample of Orthodox Jews (n = 65) and a comparison sample (n = 42) presenting to the Center for Anxiety, a private outpatient clinic with three offices in the New York area (www.centerforanxiety.org). A chart review revealed that all patients received CBT-based interventions with appropriate religious-cultural adaptations of treatment, which we present in two case studies. We observed statistically and clinically significant treatment gains from pretreatment to midtreatment (anxiety: t = 8.56, p < .001; depression: t = 8.01, p < .001), and again from midtreatment through termination (anxiety: t = 3.68, p < .001; depression: t = 3.62, p < .001). No significant differences in anxiety or depression were observed between Orthodox Jewish patients and controls at any time point or for treatment effects (anxiety: Wilks’ Lambda = .950, F = 2.65, p = .076, η_p² = .050; depression: Wilks’ Lambda = .99, F = 2.00,p = .49, η_p² = .014). This paper offers clinical insight into delivery of CBT to Orthodox Jewish patients, as well as preliminary support for the effectiveness of CBT in treating symptoms of generalized anxiety and depression within this population.     

Gender Differences in American Jewish Identity: Testing the Power Control Theory Explanation

This paper addresses discrepancies in previous research about whether there are gender differences in Jewish identity. Four factors of Jewish identity are examined: multifaceted Jewish engagement, social Jewish identity, communal religious identity, and cultural Jewish identity. Using the 2011 New York Jewish Community Survey, gender differences in Jewish identity in seven denominational groups of American Jews are examined. The power control theory (PCT) is tested as an explanation for the gender differences, and found to be lacking. Measures of power imbalance in current family situations are used, in addition to measures related to socialization; the rationale for this variation is discussed. According to PCT, the Orthodox would exhibit greater gender differences in Jewish identity, but the opposite is true: significant gender differences are found for non-Orthodox denominations more than are found for the Orthodox. Being raised Orthodox does not contribute to the gender differences. Measures of power imbalance within families do not contribute to the explanation of variance in any of the Jewish identity factors. Possible generalization of the findings is discussed, as well as directions for further research.     

Ethnography and Jewish Ethics

This essay offers a Jewish approach to ethnography in religious ethics. Following the work of other ethnographers working in religious ethics, I explore how an ethnographic account of reproductive ethics among Haredi (ultra‐Orthodox) Jewish women in Jerusalem enhances and improves Jewish ethical discourse. I argue that ethnography should become an integral part of Jewish ethics for three reasons. First, with a contextual approach to guidance and application of law and norms, an ethnographic approach to Jewish ethics parallels the way ethical decisions are made on a daily basis in Jewish communities. Second, ethnography bolsters the voices of those involved in ethical discourse. Third, ethnography facilitates the bridge between local ethical questions and global ethical discourse.     

Mission and Reconciliation in the Orthodox Church

This article examines the Orthodox view on reconciliation as reflected in the famous patriarchal and synodical encyclicals early in the last century and in more recent official documents: the Messages of the Primates of the Orthodox Churches, the approved documents of the Holy and Great Council of the Orthodox Church, and Ecumenical Patriarch Bartholomew’s official statements. These are looked at in reference to (i) the mission statement of the Commission on World Mission and Evangelism, Together towards Life, and (ii) the papal encyclicals Unitatis redintegratio and Ut unum sint. The article further examines the need for a common Christian witness and the reactions within the Orthodox world from a tiny but vocal anti-ecumenical minority. It underlines the importance of a Universal Declaration of Human Responsibilities along with the existing Universal Declaration of Human Rights to address the ecological problem and inequities of the current world economic system, based on the interrelatedness of economy and ecology and the consolidation of the interfaith dialogue for a wider reconciliation. The article also underlines the highest priority of the theological dialogues at all levels and by all bodies of the Orthodox ecclesial reality as a necessary step to promote reconciliation. Finally, the article assesses (i) the dialogue aiming to achieve the visible unity of the church; (ii) dialogues generally focusing on Christian unity, or even unity with other faithful; (iii) dialogues aiming as much as possible at common Christian witness; and (iv) dialogues focusing on the church’s responsibility toward society and the integrity of creation.     

Theosis and Baptist–Orthodox Discussions

Baptist–Orthodox discussions could take the shape of a continuous and constructive dialogue if their historical understandings of the Bible are investigated based on their specific perspectives on doctrine. Concretely, the idea of theosis, present in Greek Patristics and later used by the Eastern Orthodox Church as deification, can be investigated by Baptists in at least three distinct ways: as Christification, as participation, or as perichoresis. All these are prevalent in the works of contemporary Baptist theologians such as Dongsun Cho (United States), Paul Fiddes (United Kingdom), and Emil Barto? (Romania). Based on the foundation provided by theosis and its range of interpretations, the Baptist–Orthodox dialogue can be further strengthened by a series of common concerns such as apologetics, evangelism, politics, economics, social work, and education.     

Acculturation orientations towards Israeli Arabs and Jewish immigrants in Israel

The State of Israel can be characterized as having two integration policies: an assimilationist one towards “valued” Jewish immigrants and a somewhat ethnist one towards its “devalued” national minority, namely Israeli Arabs. Using the Host Community Acculturation Scale (HCAS), this study explored Jewish undergraduate (N = 153) acculturation orientations towards “valued” Jewish immigrants of Russian and Ethiopian background and towards “devalued” Israeli Arabs. Results showed that Jewish undergraduates mainly endorsed the integrationism and individualism acculturation orientations towards Jewish immigrants. However, they were more segregationist and exclusionist towards Israeli Arabs than towards Jewish immigrants of Russian and Ethiopian background. Assimilation was weakly endorsed towards both Jewish immigrants and Israeli Arabs. Based on an extensive questionnaire, multiple regression analyses showed that each acculturation orientation had a distinct psychological profile. The integrationism and individualism orientations were endorsed by undergraduates who were tolerant towards ethnic diversity, felt secure personally, culturally, and militarily, and did not endorse the social dominance orientation (SDO). In addition to not feeling threatened by the presence of Israeli Arabs, integrationists and individualists were identified as secular Israelis and Labour Party sympathizers rather than as religious Jews. In contrast, the assimilationism, segregationism, and exclusionism orientations were endorsed by undergraduates who felt insecure personally, religiously, culturally, and militarily, who tended to be less tolerant towards ethnic diversity, and who were more prone to endorse the SDO. In addition to feeling threatened by Israeli Arabs, they avoided close relations with Russian and Ethiopian immigrants. Segregationists and exclusionists were identified mainly as Jewish nationals. Orthodox Jews, and as Likud Party sympathizers. Exclusionists were distinctive in also feeling threatened by the presence Jewish immigrants of Russian and Ethiopian background. While taking into consideration the context of intergroup relations in Israel, results are discussed using the Interactive Acculturation Model (Bourhis, Moïse, Perreault, & Senecal, 1997).     

The relationship between religiosity/spirituality and well-being in gay and heterosexual Orthodox Jews

Numerous studies have demonstrated positive relationships between religiosity/spirituality and emotional well-being. Little research exists, though, on these relationships in Orthodox Jewish and gay populations. Therefore, data from two studies focusing on heterosexual Orthodox Jews (Study 1, 52 females, 18 males) and gay Orthodox Jews (Study 2, 191 males) are presented. The studies assessed religiosity, spirituality, and well-being using validated self-report measures. In Study 1, religiosity and spirituality were generally positively correlated with well-being. In Study 2, spirituality was positively correlated with well-being, while religiosity entered into a complex pattern of relationships. For gay Orthodox Jews, religiosity may not have the same associations with well-being that it does for heterosexual Orthodox Jews, although spirituality may provide an alternative pathway for emotional benefits.