Psychotherapy and Teshuvah

A traditional perspective.

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In classical psychotherapy, the diminution or cessation of suffering is the goal. Insight, behavioral change, and medication may be employed separately or in combination. Theoretically, insight should lead to pain relief. Resultant behavioral changes are useful insofar as they maintain a better functioning system and prophylax against future suffering.

Cause or Effect?

Teshuvah posits that appropriate behavior will pave the way for higher level understanding and transformation of feeling states. Cognitive-behavior therapy, which works to correct habitual negative self-perceptions and other cognitive distortions agrees with this point of view. Classical psychodynamic psychotherapy, however, posits the reverse--properly harnessed insight will motivate correct behavior.

It is important to emphasize that there are many forms of psychotherapy, and that we have presented these processes in a simplistic form for the purposes of discussion. Our intention is not to provide a precise analysis of the processes involved in either psychotherapy or teshuvah, but rather to provoke some discussion about how these two processes may work in tandem, or at variance, with one another.

This articulation is particularly important in light of the fact that there are numerous rabbis who are involved in pastoral counseling, as well as many religiously observant clinicians who often feel caught in a dilemma of how to honor the patient's goals, even if those goals clash with the therapist's moral code.

Practical Application

A clear understanding of the principles and practices of teshuvah and psychotherapy is valuable to rabbis providing pastoral counseling as well as to psychotherapists treating frum [religiously observant] clients because it will facilitate more honest and ethical negotiations with persons seeking help.

Indeed, it is particularly important for clergy and religious educators to understand and disclose the nature and limits of the work they can offer a person seeking to reduce their pain in a therapeutic process with them.

At the core of this discussion is the idea that, for a religious Jew, the process of psychotherapy might fill a different need than that of teshuvah, but that there may be a real need for an individual to engage in both processes at different times in their lives. Therefore, there is a need for a greater collaboration between religious leaders and mental health professionals to ensure a deeper understanding of these processes and the ways in which they work to reduce human suffering.

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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.