Multicultural Counseling

and the Orthodox Jew

Eliezer Schnall

The cultural diversity literature largely ignores the effects of religion, and especially Judaism, on counseling and
psychotherapy. The author reviews the meager and mostly anecdotal accounts relating to Orthodox Jews in the
literature of several related disciplines, including counseling, social work, psychology, and psychiatry. The objec-
tive is to identify the barriers, institutional and personal, that must be overcome before the Orthodox Jew can
receive adequate mental health care and to suggest recommendations for clinical practice.

Research suggests that minority groups tend to underutilize
mental health services provided by the majority culture, and
even those who do enter psychotherapy often terminate pre-
maturely (Margolese, 1998). Orthodox Jews are no excep-
tion. When surveyed, 90% of Orthodox mental health pro-
fessionals reported that the mental health needs of their com-
munity are poorly met (Feinberg & Feinberg, 1985).
Wikler (1989) pointed out that the cultural diversity litera-
ture has usually ignored the effects of religion, and certainly
Judaism, on psychotherapy (see also Wieselberg, 1992). Even
the field of counseling, although styling itself as especially
sensitive to issues of diversity (American Counseling Asso-
ciation [ACA] Mission Statement, 2005, Bylaws, Article 1,
Sec. 2) has disappointingly chosen to mostly ignore the needs
of Jews. According to Arredondo and D’Andrea (1999), “Jews
have been largely attributed an invisible status in the fields of
counseling and psychology in general and within the
multicultural counseling movement in particular” (p. 14).
A thorough review by Langman (1999) found that
“multiculturalism has typically not included Jews” and
“books, journals, classes, and conferences [in counseling
and psychology] make little mention of Jews, Jewish issues,
or anti-Semitism” (p. 2). In a review, published in ACA’s
flagship publication, the Journal of Counseling & Devel-
opment, Weinrach (2002) observed that the counseling di-
versity literature fails even to recognize “the notion of Jews
as a culturally distinct group” (p. 300). He further presented
substantial and compelling evidence to support his asser-
tion that “the treatment of Jews and Jewish issues within the
counseling profession suggests a disturbing pattern of anti-
Semitism” (p. 303).
This tradition of neglect especially compromises the effi-
cacy of those mental health professionals who treat Orthodox
Jews but who lack the research studies that would guide them.
Indeed, “there are no scientifically rigorous studies that ex-
amine psychotherapy with Orthodox Jews” (Margolese, 1998,
p. 38). Ironically, Bilu and Witztum (1993) suggested that
transcultural therapy involving this group is more complex
than with any other diverse group. Moreover, there is evi-
dence that Orthodox Jews, and particularly the newly reli-
gious, suffer increased rates of severe psychiatric disorders
(Bilu & Witztum, 1993) and are increasing as a proportion of
Jews entering psychotherapy (Wikler, 1986). Their numbers
in therapy are almost certain to continue rising, because their
community is presently awakening to the reality of their
mental health needs (Lightman & Shor, 2002; Shaviv, 2002;
B. Twerski, 2002) and experiencing a “dramatic” (Sorotzkin,
1998, p. 94) increase in readiness to accept help from the
mental health profession in meeting those needs.
As with any minority group, there are circumstances when
it may be beneficial or time-saving for the Orthodox Jew
simply to engage a counselor or therapist who shares similar
religious beliefs and cultural values (Simmons, 2001), yet
there are few available (Bilu & Witztum, 1993). Further-
more, even when they are available, they may represent a
poor choice for the patient. For example, even a slight varia-
tion in religious commitments may trigger suspicion on the
part of one or the other. In addition, countertransference
arising from the Orthodox professional’s own unresolved
religious conflicts may complicate matters (Rabinowitz,
2000). Moreover, university-educated Orthodox Jews are
sometimes outright hostile to their more traditional
coreligionists—or may be suspected by the client of being
such a “traitor” (Bilu & Witztum, 1993; Greenberg, 1991).
Given the frequent complexity of using an Orthodox Jew-
ish counselor or therapist, and their relative scarcity, the
option of a non-Orthodox or non-Jewish one must be con-
sidered. Indeed, many mental health professionals suggest

Eliezer Schnall, Psychology Department, Yeshiva University. This article is dedicated to the author’s parents, David and Tova
Schnall, for their love and support. He is also grateful to Sharon Brennan and William Di Scipio for their encouragement on this
project. Finally, the author acknowledges the late Stephen Weinrach, whose work was an inspiration for this article. Correspon-
dence concerning this article should be addressed to Eliezer Schnall (e-mail: eschnall@aol.com).

© 2006 by the American Counseling Association. All rights reserved.

276 Journal of Counseling & Development ■ Summer 2006 ■ Volume 84

Multicultural Counseling and the Orthodox Jew
that with proper training, this is feasible (Buchbinder, 1994;
Sublette & Trappler, 2000). Although there are Orthodox
Jewish leaders who have resisted the idea, the late Rabbi
Moshe Feinstein (as cited in Greenberg & Witztum, 1994a),
widely regarded as a leading contemporary Jewish rabbini-
cal authority, ruled that when necessary, and if appropriate
guidelines are in place, Jews may seek help from a psycho-
therapist who would be viewed, from a religious perspec-
tive, as “a heretic or atheist” (p. 143). In fact, Wikler (1989)
found that only 45% of Orthodox Jewish clients actually pre-
ferred an Orthodox therapist, whereas the majority requested
other therapists or voiced no preference at all. Unfortunately,
therapists culturally competent to work with Orthodox Jews
are rare (Buchbinder, 1994).
Weinrach (2002) called for the counseling field to de-
velop a literature on the topic of Jewish needs as a step
toward rectification of the disregard it has shown thus far.
The present article aims to contribute to that goal by draw-
ing together the meager and mostly anecdotal accounts
about Orthodox Jews in the literature of several related dis-
ciplines, including counseling, social work, psychology, and
psychiatry. The objective is to identify for counselors and
psychotherapists the barriers, institutional and personal,
that must be overcome before the Orthodox Jew can access
appropriate mental health care and to suggest recommenda-
tions for clinical practice.
Description of the Population
The term Orthodoxy was first applied in 1807 when Napo-
leon emancipated the Jews from the ghettos. It referred to
Jews “who accepted the fullness of Jewish law and tradition”
(Kahn, as cited in Strean, 1994, p. 8). More specifically, Or-
thodox Jews accept that G-d gave the Torah, the Hebrew Bible,
to the People of Israel at Mount Sinai, along with a divinely
ordained interpretation of its commands. They apply these
Biblical precepts to all matters, including family life, busi-
ness dealings, and the many rituals of prayer and service. (For
a historical context of this population, see Rabinowitz, 2000.)
Although population estimates are, for many reasons,
difficult to make, it has been suggested that there are be-
tween 5.2 and 6.7 million Jews in the United States, if the
strict Orthodox definition of Jewishness is used (Cohen,
2002). Although the Orthodox constitute only a small minority
of the Jewish population, they tend to live in concentrated
areas, and Wikler (2001) estimated that there might be ap-
proximately 250,000 Orthodox Jews in the New York metro-
politan area alone. There are also relatively large Orthodox
populations in other major North American cities such as
Baltimore, Chicago, Los Angeles, Miami, and Toronto.
It must be emphasized that Orthodox Jewry is a diverse
group, with many subgroups, and that members of the sub-
groups differ to a greater or lesser degree in their language,
diet, worldview, dress, and even religious practice. While these
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differences may, at times, be imperceptible to outsiders, mem-
bers of the subgroups take them very seriously (Wikler, 2001).
The most traditional Orthodox Jews are sometimes called
“Ultra-Orthodox,” as opposed to “modern Orthodox.” Al-
though such labeling may seem convenient to research-
ers, many within that community find it offensive and
insulting (Lightman & Shor, 2002; Weill, 1995.) Furthermore,
in categorizing, one implies that the Ultra and modern Ortho-
dox are distinct and form homogenous groups. Actually, Or-
thodox Jewry forms a spectrum and cannot easily be divided
into neatly defined segments. Even if such terminology were
accurate, it might actually serve to confuse clinicians because
within a single family it is not uncommon to find modern
Orthodox parents whose children hold Ultra-Orthodox views,
often because these parents selected Ultra-Orthodox in-
stitutions for their children’s education.
To avoid misleading and offensive labels, I simply refer
to Orthodox Jews, although original sources may have at-
tempted to be more specific. As a guideline, however, when
counseling Orthodox Jews who are more culturally and reli-
giously identified, the issues raised in this article are likely
more relevant than when counseling those who are more
“modern.” In any event, as with all cultural diversity litera-
ture, the reader is cautioned against making assumptions
about every individual Orthodox Jewish client. The intent
is to highlight the issues a therapist or counselor may en-
counter with this population.
Institutional Barriers
Certain characteristics of the Western mental health care
system as it is presently organized are incompatible with the
needs of the Orthodox Jewish community. As a result, it
becomes less likely that members of this group will seek or
receive adequate care. These institutional barriers are the
focus of the present section.
To the Orthodox Jew, seeking psychological help may
seem to reveal personal weakness. He or she may view it as
admitting that “Orthodox Judaism does not have all the an-
swers” (Strean, 1994, p. 39). Furthermore, members of this
group may be under the impression that Jews are “high
achievers,” and “shouldn’t” (Zedek, 1998, p. 260) require
the assistance of mental health practitioners.
The fact that therapists and counselors are university edu-
cated indirectly contributes to another problem. Many Ortho-
dox Jews view mental health workers as representatives of the
unchaste and decadent secular world from which they try to
isolate themselves and their families (Bilu & Witztum, 1993).
They assume that these professionals will challenge their val-
ues and possibly even attempt to “deconvert” (Heilman &
Witztum, 1997, p. 523) them from religious belief.
Orthodox Jews may also fear that counselors and therapists
will not respect values that are important to their community
(Sublette & Trappler, 2000). For example, there may be con-
277

cern that the secular professional will disregard the domes-
tic tranquility of the family unit (shalom bayis) or will be
quick to report problems to the governmental authorities
that their community prefers to deal with internally
(Lightman & Shor, 2002). Tens of centuries of persecution
and pogroms, culminating with the Nazi Holocaust, have
led many Jews to be suspicious of outsiders, wondering
whether they may be anti-Semitic or have ulterior motives
(Sublette & Trappler, 2000; Zedek, 1998), and those with
the strongest commitments to Judaism may be the most likely
to exhibit this suspicion. Finally, Orthodox Jews may fear
that therapy will require interaction with members of the
opposite sex in ways discouraged or prohibited in their cul-
ture and tradition.
The many rabbinic responsa (as cited in Greenberg &
Witztum, 1994a) that discourage dealing with secular men-
tal health professionals only serve to underscore this mis-
trust on the part of Orthodox Jewish clients. Moreover, clas-
sical Jewish texts are often critical of the medical profession
generally (Margolese, 1998). Greenberg (1991) observed that
the modern Hebrew term for psychiatry is briyut nefesh and
that the latter word literally translates as soul, a word with
religious and Kabbalistic mystical overtones, which may
confuse Hebrew-speaking Orthodox Jews. They will likely
wonder how a non-Jewish or irreligious counselor or thera-
pist, using secular knowledge, can understand a metaphysi-
cal entity like the Jewish soul.
It should also be noted that many Orthodox Jews turn
first to a rabbi if they have social or emotional difficulties.
Results of a survey conducted by Wikler (1986) found very
few instances where Orthodox Jews in therapy had been sent
by their rabbis. Presumably, rabbis were discouraged from
referring to psychotherapists because of the same factors
that discourage Orthodox Jews generally from seeking help
from psychotherapists.
Many Orthodox Jews also claim that their community
attaches a stigma to those receiving psychological help
(Feinberg & Feinberg, 1985). They fear that anyone who
learns of their situation will consider them “crazy” or “in-
sane” (Wikler, 1986, p. 117). This stigma is compounded by
the importance Orthodox Jews place on family background
when considering a partner for marriage, which is often
wholly or partially arranged after careful investigation
(Rockman, 1994a). As such, Orthodox Jews often fear that
by seeking therapy they are ruining their siblings’ or
children’s chances of finding a suitable match or, needless
to say, their own (shidduch anxiety; Greenberg, 1991;
Margolese, 1998; Sublette & Trappler, 2000; Wikler, 1986).
Furthermore, the close-knit nature of their communities
makes it difficult to keep such things a secret.
Although some of the previously discussed issues may
be unique, many Orthodox Jews must overcome another bar-
rier to mental health care commonly encountered by other
minority groups. Often because they have chosen religious
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Schnall
study and service as their primary goal in life, a significant
portion of Orthodox Jews are f inancially pressed
(Buchbinder, 1994; Feinberg & Feinberg, 1985). Without
adequate funds, attaining high-quality care is difficult.
Barriers to Multicultural Competency
Perhaps the most daunting challenge facing a counselor or
therapist who works with Orthodox Jews is that there are so
many different subgroups, each with different customs,
worldviews, and religious practices (Greenberg, 1991; Paradis,
Friedman, Hatch, & Ackerman, 1996; Wikler, 2001). For that
reason, it is also difficult to provide a comprehensive list of
issues relevant to the clinician who wishes to become cultur-
ally competent with this clientele. As such, this section is
meant as a guide to the practitioner, who is cautioned about
making assumptions regarding specific clients.
To be sure, many of the issues applicable to other ex-
amples of cross-cultural counseling or therapy are relevant
to Orthodox Jews as well. Thus, the clinician and client may
have different ideas about the appropriate amount of inter-
personal space. They may also be accustomed to using dif-
ferent body movements or facial expressions, or they may
use language differently (Greenberg, 1991). To further com-
plicate matters, some Orthodox Jews speak Yiddish or He-
brew as their first or primary language.
As mentioned earlier, the Orthodox Jewish community
often attaches a stigma to individuals receiving mental
health services, making it difficult for them to find suitable
marriage partners. In this vein, Wikler (1986) cautioned so-
cial workers to expect an unusually strong interest in confi-
dentiality on the part of the client. They should appreciate
the great resistance and risk that the Orthodox client over-
came in seeking therapy and not mistake his or her behavior
for paranoia. In the case of older Orthodox singles who often
suffer shame at being unmarried, Wikler’s (1986) warning is
even more pertinent. Furthermore, encouraging clients to
speak about their disorder with friends or even relatives, or
to join support groups, may adversely affect their standing
in their community (Paradis et al., 1996).
Counseling the Orthodox Jewish client in matters relat-
ing to family planning is also complex. For example, en-
couraging a client to delay or cease childbearing due to the
stress that a large family can cause will often be resisted
because of the Biblical injunction to “Be fruitful and multi-
ply” (Genesis 1:28), coupled with a desire to replace relatives
murdered in the Holocaust. In this case, “value-sensitive
therapy” (Heilman & Witztum, 1997, p. 522) presumably in-
cludes helping the client deal with the stress of a large family
rather than discouraging his or her raising one (Paradis et al.,
1996; Sublette & Trappler, 2000).
Commonly, therapy involves asking a client to discuss
significant others in his or her life. Yet Orthodox Jews may
be reluctant to convey any uncomplimentary information.
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Multicultural Counseling and the Orthodox Jew
In the case of discussing parents, for example, they will fear
breaking the Biblical injunction to “Honor thy father and thy
mother” (Exodus 20:12). Even speaking about acquaintances or
coworkers may be difficult for a client, given the general prohi-
bition (e.g., Leviticus 19:16) against slander and gossip (Paradis
et al., 1996; Rabinowitz, 2000; Sublette & Trappler, 2000).
When working with this population, even the most
innocuous-sounding suggestions must be carefully consid-
ered. For instance, encouraging a young boy to become in-
volved with sports to siphon off aggressiveness may not be
accepted by parents and teachers, because they may be con-
cerned about the time it will take from his studies (Goshen-
Gottstein, 1987). Examples in a milieu setting include
encouraging a patient to watch television or join mixed-
gender groups, both of which may lead to resistance based
on religious beliefs that will likely be misunderstood by
clinic staff (Margolese, 1998; Silverstein, 1995).
Assessing intelligence or dementia in Orthodox Jews
by asking certain common questions may also be problem-
atic. Because of their relative social isolation, some are
unfamiliar with events in the secular world, and this isola-
tion and its consequences can serve to emphasize therapist–
client differences, perhaps resulting in the client’s suspicion
or derision of the therapist. Greenberg (1991) recommended
asking instead about Jewish religious festivals or the
weekly Torah reading. Unfortunately, a culturally compe-
tent assessment instrument has not yet been devised for
this population.
To further complicate matters, Western-educated profes-
sionals may profess different explanatory models of illness
than do their clients. For example, some clients may view
difficulties, even psychological or emotional ones, as G-d’s
reproof for nonadherence to religious laws. Others may un-
derstand difficulties as divine tests to evaluate whether they
use the opportunity to repent (Margolese, 1998).
Similarly, symptoms may be colored with religious
themes, such as hallucinations containing mystical elements
(Bilu & Witztum, 1993; Greenberg & Brom, 2001; Witztum,
Greenberg, & Buchbinder, 1990). Furthermore, Orthodox Jews
may experience obsessions or compulsions that relate to
observance of Jewish laws of purity, prayer, or dietary re-
quirements (Bilu & Witztum, 1993; Burt & Rudolph, 2000;
Greenberg & Witztum, 1994b; Hoffnung, Aizenberg,
Hermesh, & Munitz, 1989). It can thus be daunting for some-
one not multiculturally competent to differentiate norma-
tive religious practice from aberrant behavior.
As alluded to earlier, the rabbi plays an important role in
the lives of Orthodox Jews. He is well respected, and many
will turn to him for direction even regarding matters seem-
ingly unrelated to religion (Goshen-Gottstein, 1984); of
course, for the Orthodox Jew, religion permeates all areas of
life. This rabbinical involvement has many ramifications for
therapy. For example, a client who seeks psychological coun-
seling on the advice of his rabbi may view the encounter as
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fulfillment of the religious obligation to heed rabbinic di-
rectives. The clinician may thus be surprised that the appar-
ently motivated client displays little desire to engage in the
work of the counseling or therapy itself (Rabinowitz, 2000).
In addition, Orthodox Jewish clients who have never en-
gaged in any form of psychotherapy may bring with them
some very unhelpful preconceptions. They likely have had
experience discussing a variety of issues with their rabbis,
who often supply a “teshuva,” or “response,” to a posed
“she’ela,” or “question.” This type of interchange differs
markedly from the self-exploration often encouraged in
therapy, which may disappoint a client who has different
expectations (Greenberg, 1991).
Western-trained mental health professionals may have
particular difficulty counseling Orthodox Jewish women,
whose role in the family is easily misunderstood. Although
they may have “jobs,” these women are often uninterested
in, or discouraged from, “careers,” and their primary roles
are seen as wife, mother, and homemaker (Goshen-Gottstein,
1984). However, contrary to what that situation may mean to
the counselor or therapist, at least ideally, the Orthodox Jew-
ish woman is seen as complementary, not subordinate, to her
husband (Margolese, 1998). As the Talmud (Tractate
Sanhedrin) states, “A husband must love his wife as himself
and honor her more than himself ” (folio 28).
Outsiders may also misunderstand other aspects of Or-
thodox Jewish spousal relations. To some within this com-
munity, the terms love, romance, and sex life may have little
relevance, because they view marriage primarily as a means
to raise a family. That does not mean that husbands and
wives do not share intimacy and affection, but it does mean
that their definition of marriage may differ substantially
from the definition common in Western society (Goshen-
Gottstein, 1987). Like almost every area of Orthodox Jewish
life, sexual relations are guided by strict laws, which, if unfa-
miliar to the therapist, will substantially complicate marital
therapy. (See especially Lamm, 1966. Ostrov, 1978, may also
be helpful. Rockman, 1994b, provided a thorough summary
of the topic, although inaccurate on at least one point.)
The issue of countertransference is also important when
working with this population. Like all minorities, Orthodox
Jews are often seen as being inferior by the majority culture.
Even Orthodox Jews, and certainly the non-Orthodox, may
feel antagonism toward the most traditional Orthodox Jews
who have chosen to study full-time in place of a “normal”
occupation. This is particularly poignant in Israel, where
many secular Jews feel that those Israelis who do not serve
in the army or work for a living are leeches on the rest of
society (Greenberg, 1991).
Some Jewish mental health workers may also suffer em-
barrassment at the perception that they are identified with
the “backward” Orthodox clients by their non-Jewish col-
leagues. In addition, counselors and therapists of all types
may make the mistake of trying to “replace” religion with
279

psychotherapy, while actually each serves different personal
needs (Rabinowitz, 2000). Others, especially non-Jews, may
instead be overly deferential toward religious customs, not
realizing that a given behavior is actually pathological or
defensive even by religious standards (Ostrov, 1976; Sublette
& Trappler, 2000).
Recommendations for Clinical Practice
Perhaps the most important recommendation for mental health
care workers wishing to serve Orthodox Jews is to liaise with
rabbis and other leaders of their community (Sublette &
Trappler, 2000). This contact will garner credibility and le-
gitimacy (Greenberg, 1991) and help to develop working re-
lationships with the local rabbis. Indeed, referral from a rabbi
may be the only way many Orthodox Jews will seek psycho-
logical help (Bilu & Witztum, 1993). Furthermore, Orthodox
rabbis are usually very concerned about the mental health of
their congregants (Margolese, 1998) and can be a resource
throughout treatment (Zedek, 1998).
For example, consultation with an Orthodox rabbi will
prevent the clinician from suggesting activities that con-
flict with his or her client’s religious views (Buchbinder,
1994; Ostrov, 1976). Conversely, there may be times when a
client does not realize the great flexibility and leniency of
Jewish law, particularly where medical necessity is concerned.
For example, Paradis et al. (1996) described the case of a
patient who refused to take medication on Jewish fast days.
When contacted, his rabbi explained that the medication
was permissible to consume under the circumstances.
Similarly, Hoffman (2001) described instances where there
is rabbinic dispensation to set aside the requirement of
“Honor thy father and thy mother” in favor of the mental
health needs of the given client. It is thus critical to question
the client’s rabbi whenever Jewish law seems to conflict with
therapeutic needs. (For another possible example, see Spero,
1980, chap. 10.) In addition, a rabbi’s guidance is likely
necessary in determining whether a client’s behavior is within
normative religious bounds or is symptomatic of obsessive-
compulsive disorder (Paradis et al., 1996).
Bilu and Witztum (1993) mentioned the importance of
learning the customs and mannerisms of Orthodox patients
in order to know how to put them at ease. As mentioned
earlier, these vary widely and depend on the subgroup in
question. Paradis et al. (1996) provided a helpful glossary of
Jewish holidays and other relevant terms, which can serve as
background prior to more comprehensive study.
Rabinowitz (2000) explained how traditional Jewish
thought can be incorporated into psychological treatment.
For example, unlike the doctrine of “original sin” as under-
stood by certain Christian groups, Jews believe that people
are born with the opportunity to remain in a state of virtue
and purity. Even if one strays from the proper path, there is
always the chance to repent (Zedek, 1998), referred to as
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Schnall
“Teshuva.” This concept, familiar to all Orthodox Jews, may
be useful in that it discourages despair, because there is al-
ways the ability to change.
In addition, accentuating the cardinal principle that G-d
must be served with joy (Deuteronomy 28:47, Psalms 100:2)
may help motivate a depressed patient to comply with treat-
ment. Many classical Jewish works, such as those of Rabbi
Nachman of Breslov who is famous for having emphasized
joyousness, have been translated and/or summarized in En-
glish (e.g., Kramer, 1989) and may be helpful as part of
therapy. In addition to classical Jewish writings, sessions or
homework might also incorporate readings from certain con-
temporary Orthodox Jewish authors who use traditional Jew-
ish thought in encouraging psychological and emotional
well-being (e.g., Pliskin, 1983; A. Twerski, 1987).
When working with this population, it may also be advis-
able to frame explanations and ideas in religious terms. For
example, reminding the client that a healthy mind is neces-
sary to serve G-d makes therapy more compelling. Calling
irrational and inappropriate ideas the “Yetzer Harah” (“evil
inclination”) will make the concepts more familiar. “Opti-
mism” can be explained as “Bitachon” (i.e., “trust in G-d
that all will be for the best”; Buchbinder, 1994).
Some clinicians have actually incorporated Jewish ritual
into therapy. For example, Abramowitz (1993), a social worker,
described how prayer is used as therapy for frail older Jews.
Bilu and Witztum (1993), both psychiatrists, described several
very creative adaptations of Jewish ritual that have been suc-
cessfully added to the treatment of even the most severely
psychotic Orthodox Jewish patients.
Although there may be resistance on the part of Ortho-
dox Jews toward psychotherapy, especially psychoanalysis
(Rabinowitz, 2000), there is far less resistance toward bio-
medical science. Thus, a biological model of mental illness
is often more readily accepted (Greenberg & Witztum, 1994a;
Margolese, 1998; Trappler, Greenberg, & Friedman, 1995.
See, however, Bilu & Witztum, 1993). Similarly,
psychopharmacotherapy may be preferred to psychotherapy
(Greenberg, 1991). When this seems to be the case, referral
to a psychiatrist may be the best option.
There are also many seemingly trivial details that may
help Orthodox Jewish patients feel more comfortable in
therapy sessions. For example, Bilu and Witztum (1993)
described the location and decoration of their clinic, both
intended to make the environment seem less alien to their
Orthodox clientele. Probably even more critical is that all
visible clinic staff members abide by a modest dress code.
This is especially important for female staff, who should
avoid apparel such as short skirts and sleeveless or low-cut
shirts. Sometimes a same-sex clinician may be necessary to
further limit anxiety and facilitate a therapeutic alliance
(Silverstein, 1995; Sublette & Trappler, 2000). Sexual bound-
aries should be carefully observed, perhaps even more strictly
than required by professional guidelines (Buchbinder, 1994).
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Multicultural Counseling and the Orthodox Jew
Even shaking hands with an opposite-sex Orthodox client
may be very problematic.
Although it is usually suggested that mental health cen-
ters be located within minority communities, many Ortho-
dox Jews may actually benefit from referral to a remote
clinic, given their extreme interest in confidentiality
(Sublette & Trappler, 2000). It is also judicious not to sched-
ule Orthodox Jews for consecutive sessions, because they
may be very uncomfortable meeting a member of their com-
munity in such a location (Margolese, 1998; Paradis et al.,
1996). Bilu and Witztum (1993) also suggested a general
flexibility with appointment times as a way to increase com-
pliance when dealing with members of this group, who may
feel ambivalent about attendance.
As previously mentioned, a significant portion of the
Orthodox population is financially pressed, often because
they have chosen to eschew more lucrative careers in favor
of a life revolving around religious study, teaching, or the
clergy. For this reason, Feinberg and Feinberg (1985) sug-
gested using a sliding scale when determining the clinician’s
fee. Buchbinder (1994) suggested using a short-term treat-
ment approach in order not to put further financial strain on
these clients.
Although a general sensitivity for cultural diversity is help-
ful in working with Orthodox Jews (Buchbinder, 1994), spe-
cialized training has been useful in sensitizing professionals
to issues specific to this population (Sublette & Trappler, 2000.
See also “Long Island College Hospital,” 2002). Unfortu-
nately, there are very few programs that provide such special-
ized training, even in areas with substantial Orthodox Jewish
populations. As an alternate, Bilu and Witztum (1993) recom-
mended using a team approach, with at least one member of
the team having expertise in the patient’s culture. In addition,
they suggested having the client invite a chaperon who would
act as the “cultural bridge,” a strategy that has been successful
with other minority group members.
Therapists and counselors who wish to work with this, or
any, minority population are also advised to develop an appre-
ciation for the group’s way of life. For example, although an
Orthodox Jewish lifestyle may place certain stresses on an indi-
vidual, it also contains many supportive elements (Bilu &
Witztum, 1993). Furthermore, religious commitment in general
has been shown to have a positive association with mental
health. Goshen-Gottstein (1987) pointed out that in Geula, a
strictly Orthodox community in Jerusalem, Israel, “there are no
violent crimes such as murder, rape, assault or burglary” (p.
160). There is also evidence that Jewish texts taught in Ortho-
dox schools more effectively encourage the development of
advanced cognitive skills than does modern secular education
(Dembo, Levin, & Siegler, 1997). Therapists and counselors
should also consider that religious difficulties may be effects
of, and not causes of, emotional difficulties (Margolese, 1998).
As with all cross-cultural counseling and psychotherapy,
it is most critical for professionals interacting with Ortho-
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dox Jews to treat clients and their community with respect
and sensitivity (Rabinowitz, 2000). When Greenberg (1991)
asked one Orthodox rabbi what type of therapist was neces-
sary for an Orthodox client, he was told, “What matters most
is that he understands the religious way of life and respects
each person with their outlook” (p. 27). In that way, diverse
groups may be more the same than they are different.
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