Tuesday, November 07, 2006

Lashon Hara in a group setting - what is the halacha?

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I was sent the following questions that were posted on a list serv for religious psychotherapists regarding Lashon Hara in a therapeutic setting.

I think this is a perfect example of why survivors of sex crimes have to be extremely careful when they are looking for a therapist in the observant world.

Can you imagine what it would be like to be disclosing your abuse history and your therapist stops you midstream and tells you what you are saying is Lashon Hara?

Perhaps some can make a case about speaking out in a group therapy setting, yet when one stops to think about the reasons why a survivor of a sex crime would be in a therapeutic group, the concept of Lashon Hara seem ridiculous.

Would say that it is Lashon Hara to speak with a rabbi (i.e., in the spiritual counselor's hat) about people to seek help and support. Should that also be forbidden? For many speaking to a therapist is very similar speaking with a rabbi.

It would be the same sort of stupidity to ask if it is okay to show the body to a doctor (i.e. forgoing modesty rules). Would a woman give birth in full clothing because it is not allowed to show Erva (i.e., privates) to a doctor?

You do what you need to do in the right setting to heal. Just like a physical ailment, pain has boundaries that flex for doctor's appointments and modesty, psychological issues calls for flexing of the usual 'what you can and cannot talk about with others' rules.

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Subj: Lashon Hara in a group setting - what is the halacha?
QUERY:
What is the range of halacha in expressing feelings in a group setting in terms of lashon hara and motzei shemra? Could any terms at the beginning be expressed by the therapist....what would those terms be, and what would be the ramifications of doing that?

*********

The Lashon Hara question is such an interesting one! I love this listserv - all these issues I never learned about in grad school! I will add to the question: Is there an issue of Lashon Hara in any therapy session - not just group? Especially in small community settings, where there is a greater likelihood of the therapist knowing the parties mentioned?

As far as setting limits about what can and cannot be talked about in therapy - yowza! I shudder thinking about the therapeutic implications of that one!

________, Psy.D.

18 Comments:

Anonymous Anonymous said...

I'm very interested in hearing what the response was to this question!

November 07, 2006 12:15 PM  
Anonymous Anonymous said...

I have spoken about this now with numerous posekim and rabbonim, and what follows is my understanding of why communications to the therapist during psychotherapy are not forbidden loshon hora:

There are many different types of therapies. I practice psychoanalytic therapy, psychoanalysis, supportive therapies, and use medications. I have practiced group psychotherapy in the past, during my training mostly. I am not facilitating any groups at present.

All of the therapy I practice operates according to free association--that is, the patient attempts to speak whatever comes to his or her mind. The patient and the therapist together notice what thoughts are expressed, how one thought leads to another, and what toughts are blocked. Since all human beings have sexual, aggressive, narcissistic, and angry feelings and thoughts, it is inevitable that an individual will, probably sooner than later, find him or herself thinking things that make him or her embarrassed or ashamed, and that he or she cannot say out loud. Often, he or she cannot even really think these thoughts in an open, unedited manner. The fact that my patient has angry or nasty thoughts about his mother, for example, does not lead me (or any other qualified therapist) to the conclusion that his mother is really an angry or nasty person. I see these communications as evidence of what is happening inside my patient in the present moment. These angry or other feelings often stem in large part from the patient's neurotic and narcissistic problems, and expressing these feelings and thoughts during therapy is the only way to learn about them. The patient knows very little about all of this, and cannot do it without the guidance of a psychotherapist or psychoanalyst.

Professional boundaries, and halakhic boundaries (yichud, negiya, etc.), a therapeutic stance, and confidentiality are in place to insure that there are no "real world" consequences of anything that my patients feel, think, or say when they are on my couch. It is a setting where loshon hora will not be accepted. I see what they say about other people as having mainly to do with what is going on inside of them, and not the actual characteristics of other people. It like a safe steel room where bombs can be defused and no one will get hurt. In addiiton, all these communications are "le-to'eles", namely, they are stated for the constructive purpose of being healed from mental disturbances which are interfering with their ability to live their lives on the terms they wish, including their ability to form a relationship with the Ribbono Shel Olam, to learn his Torah, and to fulfill His Ratzon.

To subject the free association process to another layer of editing becuase of loshon hora concerns (or kibud av ve-em concerns, or hirhurei aveira concerns) would absolutely destroy the psychoanalytic process, and would effectively prevent me from helping any of my patients in any significant way. Loshon hora becomes a very powerful form of resistence with frum patients, and needs to be dealt with delicately, like all other resistances.

Example: a patient says, "I'm having a thought about my mother, something she once said to me, but I can't tell you what it was because that it loshon hora." There are different ways to deal with this. The best technique would be to help the patient understand his/her emotional discomfort with telling this story about his/her mother. Is it embarrassing becuase of what he/she had done to provoke his/he mother? Is what she said humiliating? Does it simply feel disloyal to have angry hurt feelings about one's mother? This is all "grist for the mill" so the saying goes. But none of this is loshon horah. The most wonderful parents in the world can have very, very neurotic children. It is not easy to grow up with tzadikim or chachamim as parents. If someone is impaired in his ability to form relationships, consummate a marriage, hold a job, make friends, keep friends, etc., etc., becuase of unconcious neurotic conflicts, psychoanalysis or psychoanalytic therapy may be the treatment of choice, and it rests upon the free association process.

This is my understanding of how it works in individual psychoanalytic therapy.

November 07, 2006 1:15 PM  
Anonymous Anonymous said...

I didn't make myself clear enough...and your response was so considerately thought out, however you seem to be talking about the therapist's response, and in a one to one setting. That wasn't my question at all. The question was in relationship to an emotional support group, and not a one to one setting, where the people in the group might easily know the people being talked about in a deragatory manner, and whether that presents a problem and if so, how it should be dealt with.
Thank you.

November 07, 2006 2:11 PM  
Anonymous jeanette friedman said...

the point is that it has to do with pikuach nefesh. many sexually abused people become suicidal. About ten years ago, one young chassidic boy gang-raped by school mates committed suicide. They were never even put in detention, let alone jail. This summer an 18 year old cousin of mine committed suicide after he couldn't take anymore verbal abuse.
What takes precedence? Allowing abusers to win even during a therapy session? This shrink needs to be tossed out on whatever s/he sits on.

November 07, 2006 3:28 PM  
Anonymous Anonymous said...

..The fact that my patient has angry or nasty thoughts about his mother, for example, does not lead me (or any other qualified therapist) to the conclusion that his mother is really an angry or nasty person. I see these communications as evidence of what is happening inside my patient in the present moment.... and expressing these feelings and thoughts during therapy is the only way to learn about them....

this is a stance that I also take regarding communications about certain people. The problem is though, how do you deal with loshon horo issues in a group, in my case a parenting group, where mothers from a small chassidische community know pretty much of each others world.

One of the rules we stated at the unset of the sessions was: that each other will be discreet about who is participating, and about what another mother does or says, this steared a discussion among the mothers some donot care what will be said others found that rule very necesarry. Another rule is, we guard our boundary's: everyone goes as far as she wants.
Some issues that mothers bring up concern problematic relations or situations with family and other people, even without saying names one can know sometimes which person is mentioned , and though I look at it through therapeutic glasses, ( those issues hurt and can block healthy behavior f.e)
and till now none of the mothers complained about loshon horo issues or made a remark,
I donot know what it means for the other mothers to speak about it or hear about it in group... and if they would feel bad because they could look at it as speaking loshon horo? and how should i best deal with it (that it helps them grow, not block them, especially since they are really courageous to join the group)

any helping thoughts?

November 07, 2006 4:47 PM  
Anonymous Anonymous said...

It has been pointed out for me that the original question about loshon hora was about support groups and how to handle the issue. A related question would be for how to handle loshon hora in group psychotherapy.

Group psychotherapy: In a therapy group consisting of frum yidden, the
rules of confidentiality as far as group membership should be no different than any other group. The boundaries of membership in a psychotherapy group need to be clearly specified, and these boundaries include a commitment to
never disclose the group members identities or the substance of their
communications to anyone on the outside. (There are many other boundaries as well which need to be observed to prevent sabatoge to the group process, beyond the scope of this). As far as loshon hora spoking during group therapy, I do not think that the group therapist can DECLARE what the rules are for loshon hora, and whether a given case is "le-to'eles" or whether it could be said differently, or else this will no longer be group thearpy. It will become a loshon hora workshop. A loshon hora workshop may be a wonderful thing to participate in, but it is not effective treatment for psychological disturbances. Someone will speak loshon horah, and another
group member will object to this, and then another member will say that this is "le-to'eles" and should be allowed. What will ensue is a group process.

The group, which functions as an organic entity, will need to come up with its own unique solution or compromise to this and all other dilemmas. One member will hurt another's feelings. The member with hurt feelings may become needlessly argumentative when his/her ego is bruised. The other members will notice this and confront them about what they are doing. This is the stuff of group psychotherapy. Handing down directives from above
will sabotage the group process, in my opinion, and will short circuit that entire process. The members are responsible for their own loshon hora. They are free to consult with their rabbonim. They are free to share the guidance they received from their rabbonim with the other group members. They are free to disagree with one another. The group therapist cannot become the posek for the group. The group therapist needs to remain neutral and help the group see the interpersonal dynamics which are playing themselves out. The group therapist needs to accept the fact that group members will violate halakha, and needs to allow the other members to do
what they wish to. The group therapist also needs to respect the fact that
the halakhos of loshon hora in a therapeautic setting are very complex and
each members rov may give a different pesak. A therapist who cannot remain
neutral about this and other frumkeit issues may have great difficulty
practicing effective group psychotherapy.

Support Groups: I really think that support groups are very different form
group psychotherapy, and that there need not be the same degree of
neutrality about loshon hora. For example, in a support group for
divorcees, the group facilitator (different role than group psychotherapist)
needs to monitor whether anyone's behavior (including but not limited to
loshon hora) is interfering with the goals and objectives of the support
group. If the group is becoming uncomfortable with a member repeatedly
speaking loshoh hora and the effectiveness of the group is compromised, then
the group facilitator should process this with the problematic member
privately. We all have our own styles for dealing with things like this
that work for are own personalities. However, I would express this
caveat--what should be addressed is how this behavior is interfering with
the effectiveness of the group, and not the fact that it violates so many
lavin min ha-Torah and me-de-rabbonan. The group facilitator is responsible
for the effective functioning of the group, and not for the shemiras
ha-mitzvos of all the group members. It is true that kol yisrael areivim
zeh la-zeh, but tochacha should not be given in a manner and setting that will prevent a person from receiving needed treatment or assistance.

These are my thoughts on this. This is strictly da'as ba'alei battim.

November 07, 2006 9:33 PM  
Anonymous Anonymous said...

Jews are required to follow the laws of shmiras haloshon in ALL settings. That having been said, there are halachas for when loshon hara is permitted. We should ALL be learning those halachas. I don't understand why it is strange that a psychotherapist would enter into a discussion about what the boundaries of halacha are in a therapeutic setting, and how to handle it if the boundaries are being violated. There is no reason why the halacha should stop a survivor of sexual violence from speaking out in either a group or individual session, provided there is a therapeutic purpose to that speech and provided it follows the halachas of shmiras haloshon, which take such situations into account. The Torah applies to survivors, therapists and all of us. Shailohs need to be asked, professional discussion needs to be continued, and survivors need to get help---all within the context of Torah, not in spite of it and not outside of it.

Therapists can still work well with survivors of abuse. It seems to me that the author of this post simply has an axe to grind.

Zalman Lachman LCSW
Monsey, NY

November 09, 2006 10:50 AM  
Anonymous Anonymous said...

Many of us have an axe to grind. My abuser told me that even if I told people about what happened, no one would find out because "no one speaks lashon hara". I take particular pleasure in proving him wrong.

I challenge you, Zalman Lachman LCSW - had you gone through the events I have gone through, you would not be speaking that way, from your high pedestal.

This is a survivors forum. There is a lot of anger here and frustration for how this is being swept under the rug in the orthodox community. Our abusers power over us was by keeping us quiet - by speaking out, we take our power out.

The way I see it, halacha is set by the rabbis according to what is most convenient for them. Silencing people from talking about abusers under the guise of not speaking lashon hara is yet another example of that.

November 09, 2006 7:59 PM  
Anonymous Nachum Klafter, MD said...

I am an orthodox Jewish psychiatrist, psychotherapist, and psychoanalyst. I am an Associate Professor of Clinical Psychiatry at the University of Cincinnati, where I coordinate the psychotherapy training in our Psychiatry Residency Training program.

I admire the assistance you are attempting to provide to abuse survivors on this website.

I would like to clarify something. Orthodox Jewish psychotherapists practice psychotherapy according to the same principles and standards that their non-observant and non-Jewish colleagues do.

There is absolutely no prohibition of loshon hora during psychotherapy treatment for patients. A devoutly religious person who scrupulously avoids loshon hora at all times can speak anyting on his or her mind freely during psychotherapy treatment because the laws of loshon hora do not apply. It would be impossible to receive proper treatment if a patient can't talk about his thoughts and feelings about other people, or how they have treated him. With survivors of sexual abuse, it would be all the more more preposterous to imagine psychotherapy treatment where the restrictions of loshon hora would apply. I say this because there may be observant patients who are reading your website and who may be mislead by some comments you have posted, and will be afraid to talk openly to their psychotherapists.

I do not believe that all Orthodox Jews necessarily need to be treated by an Orthodox therapist. In some cases, treatment can be easier to negotiate with a therapist completely outside the Orthodox community, or therapist who is not Jewish. However, some patients feel much more comfortable being treated by an Orthodox psychotherapist. The most important thing is that someone is a qualified therapist. Sexual abuse is complex and survivors should only go to a psychotherapist who is well qualified. The best way to know who is good is endorsements from former patients.

Be-hatztlacha. We must all work toward reduction and elimination of sexual and other forms of abuse in the Jewish Community.

Nachum Klafter, MD
University of Cincinnati
doctorklafter@cinci.rr.com

November 10, 2006 1:24 AM  
Anonymous Anonymous said...

I have to share with you the shock I felt as I read the postings on this blog.

Please warn all survivors in Monsey to stay away from Zalman Lachman.

Zalman, if you read this I think you need to go back to school and learn about survivors of sexual abuse, incest, rape, etc. It definately seems like you are part of the problem. Do you really want to silent a victim for sharing their experiences of being raped?

Shame on you. I would expect better.

What school did you go to? We should all contact your graduate program to make sure they are teaching some of the basics.

November 10, 2006 5:57 PM  
Anonymous Anonymous said...

I too have a problem with the tone of the issues being raised here. I am an incest survivor. I am not sick. I would never go to a therapist that referred to me as a patient. I was a victim of a crime. You can refer to me as a client. I find the term patient used to describe an individual who enters counseling relationship to be condescending.

November 10, 2006 6:01 PM  
Anonymous Anonymous said...

I agree with the posting above. This is not a "patient" blog. This is a blog for those who are survivors of sex crimes. If this was a blog for individuals with a physiological problem I would understand calling it a "patient blog." We are not sick, we have been victimized. There's a huge difference.

These "therapists" have got to get a life and get off their high horses. They are no better then a survivor. We are all human.

I'm very fortunate that I found a therapist who looks at therapy as being a partnership. She always tells me that we are taking a trip together. That I'm the tour guide and she's just visitor. She explains that when you have someone coming to your home town for the first time and you take them out to see the sites, that the visitor often sees things more clearly because they haven't seen what ever it is before. I'm not sure if I'm explaining this right, but she definitely does not put herself above me.

Get rid of that hierarchal bs already.

November 10, 2006 6:09 PM  
Anonymous Jennifer A. Maltz said...

As a member of ______, the organization which hosts the site of the original posting regarding Lashon Harah, I would like to comment on the questionable appropriateness of reposting a quote from our listserv onto your own.

Just as many of the survivors who have commented on this thread have pointed out that we, as therapists, do not know how you feel as survivors - you, as non-therapists, do not know how we feel as Orthodox therapists, trying to do the right thing for our clients as well as for ourselves.

The listserv you intercepted was an internal one; ______ is an organization of, by and for mental health professionals. Its primary purpose is to provide a forum for internationally based therapists to disucss various professional issues, especially as they interface with our being Orthodox Jews. Being as we are an international group, we rely on this listserv to connect and communicate with one another.

Individual therapists are not only allowed, but encouraged, to bring up whatever issues, thoughts and ideas they might have encountered over the course of their professional lives. Those topics are then open to discussion by other therapists.

Just as clients would understandably hesitate to reveal their thoughts and feelings to a therapist they thought might stop them at any moment due to Lashon Harah (or any other reason), so too, by pirating our listserv, and critiquing it, you have made us hesitate to reveal our thoughts and feelings on a myriad of sensitive, professional topics.

And this is to your detriment, as our clients. Because it is through the discussions on the Nefesh listserv that therapists who might have once believed that Lashon Harah is an issue in therapy, can learn that it is not. And can, perhaps become a more informed therapist. If our listserv is being monitored and critiqued by those outside of our organization, we all lose.

Jennifer A. Maltz, Psy.D.

November 11, 2006 6:46 PM  
Anonymous When Good Choices Help and Bad Choices Hurt said...

Choosing Inpatient Treatment: When Good Choices Help and Bad Choices Hurt
Reprinted by Permission, © (1995) Nancy Shaufele, MS
http://theawarenesscenter.org/choosinghospitals.html


When Susan began having flashbacks of her traumatic childhood, she tried to handle them alone but soon became overwhelmed. In desperation she looked for psychiatric hospitals in the phone book and chose one with a big ad.

After verifying her insurance, hospital personnel whisked Susan away to a locked unit with psychotics, drug addicts, and worst of all, perpetrators. During the next few days she repeatedly begged for help with the flashbacks that continually plagued her. fortunately, Susan left the hospital before her insurance benefits were depleted; however she was afraid to seek other treatment.
How can you prevent yourself from having a situation like Susan's? This article contains some guidelines that can help you select inpatient care. Although it's important to seek the help of qualified professionals and referral services, the decision rests on you. Therefore, you need to become an informed consumer.

Understanding Your Needs.
There are two times when a survivor is most likely to consider inpatient treatment. The first is during a crisis period, when she/he is having trouble functioning in his/her life; safety and stabilization are the critical objectives of this type of stay.

The second occurs when a survivor has been in therapy awhile and feels blocked in his/her progress. He/She may choose to enter inpatient treatment to work intensely o specific issues for a limited time. This is most helpful when the survivor already has a good support system and a trusted therapist.

If you're questioning your need for hospitalization, it's important to know why you are thinking about inpatient care. Be as specific as possible. Ask for objective opinions from people you trust: your partner, therapist, and friends. You will need this information when you talk to an intake counselor.
Interviewing an inpatient facility is the same as interviewing a therapist. You are requesting specific services from qualified professionals. If you want your house painted, you interview painting contractors, ask about references, and sign a written contract. You must be at least as careful when you make mental health decisions, that can affect the rest of your life.

The Interview Process
Gather your referrals and begin the interview process. No matter how much you trust the person who gave you the referral, you need to conduct your own interview with each facility. After you complete every interview, take notes about it, including your feelings and impressions. Continue this process with each facility.

The process may seem daunting-- and can be. If inpatient care is a possibility in your recovery, you can empower yourself by making preliminary decisions now -- before you are unable to make them with the care and thoughtfulness they require.

In a crisis, you may not be able to make these decisions for yourself so it's important to have a trustworthy advocate. Select that person before you need them and educate them about selecting inpatient treatment.

There are two major considerations for inpatient care. The first is the program's credibility. You need to understand the quality and type of care you'll receive, as well as the training and experience level of the care provider.

The second consideration is financial. You need to know exactly what the program will charge you and how much of that charge your insurance will cover. Two ways to upset the stability you achieved in the hospital is to be discharged suddenly and/or receive a enormous bill that you cannot pay.

Here are something's to look for when interviewing an inpatient facility:

Treatment:
1. How many individuals and group sessions will you have? Who will lead them?
2. What specific programs will you be in?
3. What will your overall treatment plan be?
4. How much input will you have into your treatment plan?
5. How many survivors have they treated?
6. What programs do they offer specifically for survivors?
7. What credentials and training do the staff have in abuse issues?
8. What is the setting?
9. Is the facility locked or unlocked?
10. How long have they been operational?

Money:
1. What is the cost per day?
2. What specifically does that cost include?
3. What costs are not covered by your insurance?

Discharge:
1. How do they handle discharge planning?
2. How much input will you have into your discharge plan?
3. How can they help with your transition to home?
4. Do they offer aftercare resources?

Remember that inpatient care is a tool, not a cure. Many survivors receive treatment, only to feel disappointed when they return home and realize that their healing is not complete.
If you are gathering information now in preparation for possible future hospitalization, you don't need to reveal information to the hospital. Do not give them insurance information or let them pre-certify you for admission. If you are pre-certified at too many inpatient treatment facilities, you may trigger a red flag at your insurance company. At this point, all you have to say is, "I'm shopping, thanks".

Verifying Your Selection
Once you have narrowed your selection, and before you make a final decision, consult with a professional or counseling referral service. They may have updated information about the facility that you need to know.

The decision to seek inpatient treatment has the potential to be a life-saving, growth-enhancing process or another source of victimization. By making a thoughtful, well-informed decision, you can empower yourself and be a strong advocate of you own recovery.

November 12, 2006 10:26 PM  
Anonymous Anonymous said...

When a patient in therapy talks in a way that might be considered Lashon Hara outside the therapy office, I use it as a therapeutic point of entry. The exploration becomes about what inside the patient stimulated those feelings and a discovery of what the patient can learn about himself/herself. It is a process that then leads to the examination of those feelings, what they represent , what the other person touches inside of them. Ultimately ,successful therapy leads to a more self directed awareness that what they say about others is a reflection of themselves. As they own their own feelings, they have less of a need to project them onto others and as they come to accept more in themesleves and develop better ways of accepting and managing their own feelings, they become more accepting and less judgemental of others. Lashon Hara then does not present as an issue.

Denying a patient the access to exploration of the meaning of their words by telling them their words are wrong is both harmful to the patient and ultimately does less to stop the issue of Lashon Hara as it is not addressed at its source. Trying to control others through rules that are externally imposed is not effective and in therapy can be harmful.

November 14, 2006 6:39 AM  
Anonymous Anonymous said...

anonymous said...
"I would really like to settle this issue once and for all (if that is possible among Jews): [I guess it is not..] A PATIENT IN PSYCHOTHERAPY TREATMENT CAN SAY WHATEVER IS ON HIS OR HER MIND AND WILL NEVER BE VIOLATING LOSHON HORA."

I don't know how anyone can make such an absolute statement. The importance and effectiveness of psychotherapy notwithstanding, doing an aveira is still not permissible. Sometime a cigar is just that. Not every loshen hura has to be important in therapy.
YET, I strongly believe that it is not the therapists business to call the pt./client on his/her wrongdoing.

November 14, 2006 6:41 AM  
Anonymous Anonymous said...

Anonymous said:
"I don't know how anyone can make such an absolute statement. The importance and effectiveness of psychotherapy notwithstanding, doing an aveira is still not permissible. Sometime a cigar is just that. Not every loshen hura has to be important in therapy.

YET, I strongly believe that it is not the therapists business to call the pt./client on his/her wrongdoing."

I would like to publicly agree with the above sentiments--both that a) it is not our task to give tochacha to our pts. and b) there is no halachic free-for-all with regard to lashon haro (although it is quite often waived based on the "toeles" exemption).

November 14, 2006 6:43 AM  
Anonymous A Survivor said...

I read what Jennifer Maltz said and I have to say that on some levels I understand where she is coming from, but on the other hand I am outraged at the comments being made. The type of discussion that is going on makes me really understand why my past therapist didn't work for me. I always felt like I was being shamed and blamed for my thoughts and feelings. I needed to share my experiences in an environment that was non-biased. At the urging of a friend in a self-help group I went to another therapist who wasn't observant. Actually my current therapist isn't even Jewish.

I never feel shamed or blamed. I am never worried if what I say is loshon hara. I can just be. I also am not being psychoanalized.

My therapist is my partner in healing. Not someone who makes me feel that they think they are better then I am.

November 14, 2006 6:50 AM  

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