Bad Therapy or Misunderstood Therapy?

Chaim Neuhoff, PhD (with input from many colleagues)

While reading Ami magazine's interview with Abigail Shrier, author of the recent book, Bad Therapy, I found myself nodding in agreement with many points that were made. However, I was left disappointed that the non-professional opinions of a secular journalist were featured center-stage in a frum magazine on the topic of frum mental health and parenting.  I wish to address both the title “bad therapy” and its insinuation as well as some of the possible misconceptions sprinkled throughout, but I would like to begin with a brief discussion of those parts where I find Shrier to be right on target.

This was an interview on a very important and sensitive subject, one that affects many suffering individuals in our community. Shrier’s book is primarily geared towards those who practice secular psychotherapy in the broader culture. Unfortunately, many have espoused the beliefs that she discusses and rightly opposes. Fortunately, in the frum world, this is far from reality. This really underscores the importance of having so many frum clinicians because all these important issues that one may run into in the secular therapy world are largely non-issues with us as will be delineated below.  

One focus of the article was to push for authoritative parenting (as defined by Diana Baumrind) as opposed to permissive parenting. This is exactly what many of us have spent decades promoting in our professional work. As the research demonstrates and as our Seforim tell us, effective parenting is about a healthy mix of love, warmth, and connection together with structure, discipline, and limit setting. This is the balance of yemin mikareves usmol doche that is so necessary both in parenting and in life. Healthy and happy children emerge from the healthy balance inherent in authoritative parenting. (As an aside, the author appears to conflate permissive with gentle, the former is certainly problematic, but being kind, gentle, loving, and firm are all part of authoritative parenting).

Another point that she as well as others discuss is the harmful effects of technology exposure and providing children with digital autonomy. Research demonstrates a strong correlation between the advent of the smartphone and the proliferation of social media with increased prevalence in depression, anxiety, and other mental health related effects. Our Rabbonim saw this long before this was borne out by research and, thankfully, as a community, we are shielded from some of the negative effects of technology. Our therapists, who regularly see the terrible fallout of this, are at the forefront of alerting parents to these dangers and helping them effectively deal with the tragic results of those who slip.

Other correct points made include the negative effects of coddling children and restricting them from acquiring independence. Again, this is well documented and correct.  In addition, the idea that we (as a society) are focused more on kids' feelings and experiences, and less on expectations and discipline— to their detriment— was also fair.  These themes have been discussed by many prior to Shrier and are a given in the world of most frum therapists. 

Having said that, I’d like to briefly describe the reality of frum therapy as practiced in the frum community by frum therapists. Frum therapists spend their days with the large number of suffering, yet unseen, in our community. There are so many who are crushed by the stresses of day-to-day living including struggles with parnossa, sholom bayis, health problems, shidduchim, and children with Yiddishkeit challenges. We see those who are depressed, anxious, have OCD, ADHD, and are trauma victims We see many who battle so much pain and heroically rise above and work so hard at their therapy so that they can create a successful and healthy life for themselves and generations to come. To best help them, we have a mandate of virapo yirape and therefore study the best practices that the profession has to offer. Competent therapists therefore undergo serious and rigorous education, obtain professional licensure, and constantly seek further training and supervision, thereby enabling them to heal our brothers and sisters in the most effective way possible. In these aspects, our training resembles secular professionals. 

However, unlike secular therapists, we understand that our work needs to be consistent with our hashkafa and communal values. This is the bedrock of culturally sensitive treatment. We understand and try to perfect our ability to be nosei b’ol and to provide a safe and reliable space where those who experience a daaga b’lev ish can be yasichena la’achairim. In fact, hundreds of frum therapists regularly meet with Gedolei harabonim to discuss these very issues. Like Rav Meir in his quest to learn from Acher, we seek to utilize the ochel while discarding the psoles (see chagiga 14). Our Rabbonim help us navigate this tricky path--taking the finest of what medical research has to offer while ensuring that it is consistent with Torah values and is appropriate for our community. During the last few months, we were addressed by Rav Yitzchok Sorotzkin, Rav Sholom Kamenetsky, Rav Uri Deutsch, the Novominsker Rebbe, Rav Zalman Gips, Rav Yaakov Bender, and others. 

 Often misunderstandings of our role can lead to insinuations that the community of frum therapists engage in practices such as facilitating parental alienation/estrangement or are doing therapy in a manner that is harmful. While unquestionably there are bad therapists among us who either don't train well or don't work with communal values, these are a select few and certainly not the typical.  

 People fail to distinguish between a) established research backed by solid evidence-based studies and b) conjecture based on vibes garnered from anecdotal interviews. While the latter may have merit, it needs further study to become established fact.  Shrier, again, often appears to conflate these two. The source for her conclusions is too often based on anecdotal evidence and stories. It may feel warm and fuzzy to wax nostalgic and quote stories about experiences of her grandmother post-holocaust or of parenting approaches two generations ago, but this may or may not be relevant in today's very complex world. As an aside, her claims that her grandmother didn't have trauma because "no one told her she had trauma." is doubtful. One needs to understand other factors in her grandmother's life that caused this very significant event not to become traumatic. In addition, a serious clinician would listen well to the inner workings of her grandmother's psyche before determining if, indeed, she had no trauma. It is important to realize that just because the holocaust generation didn’t know the word trauma, they most certainly suffered the consequences of it. While some may have been more resilient, many were not and suffered grave consequences, which were passed down to the next generation all without being labeled as trauma. 

So, while Shrier is to be commended for taking a brave conservative approach in a liberal world, the discerning reader needs to disentangle what is real and what is agenda-driven. Her views on therapy are yet another example of where she lets her personal views lead the way.  She makes therapy and therapists into the straw man for her arguments while she herself admits that the vast majority of U.S. children are not in therapy. She seems to be basing her arguments on social-emotional learning that is done in schools, but here too her anti-therapy arguments are primarily based on interviews and anecdotal evidence, which are hardly reliable. If indeed this can be shown, it would be incumbent on our community of therapists to take these findings seriously.

The absence of nuance usually results in using a sledgehammer when a scalpel is needed. Of course, there are times that therapy and/or medication is not necessary even for those who are struggling, but to make broad insinuations about this is damaging and can cause harm to many who need this professional support.