Is psychotherapy possible with unbelievers?: The care of the ultra-orthodox community

Abstract

The ultra-orthodox (haredi) community is a sizable proportion of the population of North Jerusalem. They are proportionately underrepresented among new referrals to the Community Mental Health services, tend to drop out of treatment early, and only present with severe psychopathology. Fear of stigma, contact with the irreligious world, "yihud" with opposite sex therapists, suspicion of irreligious healers of the Jewish "nefesh", and seeing such a need as a sign of weakness of faith all serve to deter the religious patient from seeking help. The therapist's anti-religious sentiments, his feelings of being belittled and used, and lack of attention to these feelings help diminish the therapist's changes of a successful outcome. Differences in communication style, language, concepts and interests affect the prospects of establishing a therapeutic alliance. The views of two Rabbis involved in the field of mental health are presented. Their views portray the structure of the ultra-orthodox society, and its expectations and misgivings concerning psychiatry, psychotherapy and therapists. Ten suggestions are proposed for improving communication between the Community Mental Health services and the ultra-orthodox community.