Psychotherapy and Teshuvah

A traditional perspective.

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Varying Methods

In contrast, in psychiatric treatment, the unfolding articulation of what needs to be changed or better understood is often the transformative component of the treatment. Indeed, psychiatric treatment begins with a clinical interview, a highly specialized dialogue between therapist and patient. The therapist sits with the patient and invites him to reveal his misery: "Please, tell me what brings you here."

Most therapists will agree on the diagnosis, or the proximal cause of the suffering. The therapist's specific orientation, the theory of human behavior to which she subscribes, however, will determine the clinical formulation, along with suggestions of treatment options.

Mental health treatments span the gamut from "talking cures" that delve into the distant past and explore the present situation, to those more strictly focused on cognitive/behavioral goals. Individual, family, or group therapy may be advised. Mood altering medication might also be prescribed.

Teshuvah and psychotherapy recognize that people suffer from feelings and behaviors which they are capable of changing. We begin our discussion by reviewing the frames of reference that underly the prescribed restorative and transformative processes of teshuvah and psychotherapy.

Finding the Right Path

Observant Judaism posits a clear frame of reference as to what the proper path in life is. Torah is the blueprint. Failure to adhere to this derekh [path] results in dislocation and pain. The mitzvot constitute the template for proper behavior, and teshuvah offers an authoritative way back from wrongdoing. Conflicts occur when individual desire goes outside the system.

Psychiatry is less unified in its frame of reference for achieving its goal. There are many models of the mind and a smorgasbord of methodologies to chose from. Hence, clinicians' diagnoses and treatment depend on their orientation.

There is no universally agreed upon organizing theory, and therefore, it is far more difficult to know which behaviors are "right" or "wrong." Rather, these constructs are derived on the basis of whether they cause or relieve pain, or increase pleasure. This lack of absolutes can be experienced as liberating and/or threatening. Regardless, this point probably constitutes the most salient difference between the process of psychotherapy and teshuvah.

Transference and Insight

Another point of divergence is teshuvah's notion of transference. Since the process of teshuvah operates fundamentally between man and God, the absence of a human collaborator can make emotional restitution a difficult, lonely task. In contrast, psychotherapeutic work deliberately cultivates the relationship between therapist and patient so that it may serve as the primary template for change.

The goals of insight oriented psychotherapy vs. teshuvah may also differ. In teshuvah the goal is not to end one's pain, but to alter one's behavior. Pain relief may occur as a secondary benefit.

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Dr. Michelle Friedman

Michelle Friedman, M.D. is Assistant Professor of Clinical Psychiatry at the Mount Sinai School of Medicine and Director of Pastoral Counseling at Yeshivat Chovevei Torah.