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These notes are an attempt to summarize the remarks of Rav Reuven Feinstein during a question-and answer session with mental health professionals. This meeting took place ב ניסן תשע"ז in Staten Island. Please consider any mistakes to be mine.

Before answering the specific שאלות, I’d like to make an introductory comment. There is a fundamental distinction between the work of a secular mental health professional and that of one who works within a halachic framework. Life presents conflicts, which can create anxiety, stress, and suffering. Often these conflicts involve one’s halachic obligations, which when unresolved inevitably leads to negative consequences. How then do we resolve these conflicts? A secular psychologist is naturally inclined to take a permissive stance when religion is involved, thereby removing conflict. We too seek to remove conflict, but not necessarily via being matir. Sometimes the Torah takes a firm stance and prohibits things, and that itself resolves the conflict. We also don’t deny the need for Teshuva if this is necessary to resolve internal conflict and may need to help people find other methods and skills to accept a situation (rather than habitually permitting everything).

1) Suffering: We often work with people who have suffered terribly in their lives. Many struggle with the question of why Hashem would let them suffer. This is particularly challenging when they suffered as children. We work with those that suffered incest, physical and emotional abuse, and emotional neglect as children. Can the Rosh Yeshiva give any Torah Hashkofa or suggestion on how to provide hope/meaning to those struggling with this question? They can't fathom why a caring G-d would allow a vulnerable child to be hurt.

Is there any message that can be given to children who suffered incest?

There is a perennial question. How can we reconcile the concept of a loving and good G-d with the existence of suffering? Some religions divide the good and bad parts into two entities: G-d and Satan. We believe that all comes from Hashem--אני אמית ואחיה. If we know that even suffering comes directly from Hashem, how then can we accept it?

It is important to note that Hashem is not interested in people suffering. Yes, suffering does happen, but there is always a message and some reason for it. We may or may not understand the specific reason, but we do believe that there is a reason for it and utilize the suffering as an opportunity to turn closer to Hashem. 

First, there is a concept of כל מאן דעביד רחמנא לטב עביד. Events which, on the surface, seem bad, do have a function and a reason. There is an even deeper concept of גם זו לטובה. This means that negative events are, in fact, good, even if we are unable to see it at the moment. For example, someone who lost his mediocre job and lost his parnassa was forced to open his own business and thereby became wealthy. In the grand scheme, this lost job was for the persons benefit, even if at the time it appeared to be unnecessary suffering. These concepts illustrate our belief that Hashem is intimately involved in our day to day lives and seeks our benefit. 

 We also should realize that everyone suffers; everyone has their own נסיון and their own pekel. For example, some may have a nisayon of same sex attraction and some may have a nisayon of coveting their friend’s wife. These are struggles given to us by Hashem who also provided us with the ability to surmount them. Each situation needs practical strategies to survive and overcome them, but underlying it all is an understanding that this is my unique nisayon. 

Regarding children's suffering, children are punished due to parents (this is derived from Dasan and Aviram). When they become מחויב in מצות, they are responsible for themselves. For example, children suffering from cancer has nothing to do with anything that they did. It is somehow related to the parents (which we lack full clarity of the specific cause). When children suffer abuse, the message that we should give them is that Hashem loves you and Hashem is with you. Furthermore, whatever happened, there are no actual blemishes on the body other than psychological, which can be healed. Iy”h you will grow up and move past these things.  

2) Validating feelings:  Very often our patients have negative feelings such as anger, this can sometimes be focused towards Hashem (Why did he let me suffer so much?). Successful therapy entails sincere validation of feelings.

In general, is one allowed al pi Torah to have negative feeling /emotions? Is this approach in therapy consistent with Torah Hashkafa?

What is an appropriate therapeutic stance for someone who is angry at Hashem?

One who is angry at Hashem is obviously connected to Hashem and believes in Hashem to be angry at him. The problem is that being angry at Hashem makes little theoretical sense. When we suffer, we may or may not understand the reason, but there is a reason for everything. Hashem is good to us although we may not understand the good. We do, however, have a choice as to how we react to adversity. We can accept it and become closer or we can become angry and bitter. A true מאמין in Hashem understands that there is a reason for all and accepts. 

That being said, many are not holding there yet and we need to validate their feelings. We can understand that people are angry (even if not justified) and validate that. We listen, we tolerate, we understand, but we don't agree. If they are ready to hear it, we can share the השקפה that this is a נסיון and not a punishment. 

3) Confidentiality. Confidentiality is the bedrock of the therapeutic relationship. The expectation of complete privacy is what allows for the patient to fully engage in the process. In addition, therapists who violate confidentiality can face legal action and lose their license.

How should a therapist handle confidentiality when it seems to conflict with the religious obligation of “lo saamod al dam raiacha”?   The following are 4 examples that were presented:

- A young adult male who works as a mashgiach in a restaurant discloses in therapy that he is a michalel Shabbos bifarhesya (in this specific case he was responsible for checking lettuce).

- A married woman tells her therapist that she has had an extramarital affair.

- A married woman tells her therapist that she does not go to the mikvah and her husband does not know.

- A patient with a serious mental health diagnosis (or a man who shares that he is not attracted to women) is about to get engaged and the other side is unaware.

Can the R”Y provide guidance to address this issue.

These situations along with most others are not a conflict and there is no need to break confidentiality.

We should impress upon the משגיח who is not checking lettuce appropriately that he should find another job since he obviously doesn’t care about bugs and will not be ethical. That being said, it is not clear if checking is a חיוב, even though we are נוהג איסור. The כרתי ופלתי says that bugs are בטל in 1/960, an amount that one can rely is sufficient for ביטול of possible bugs in lettuce. Therefore, while we do check, we don’t need to report someone who does not. If the Kashrus organization was truly מקפיד on this, they would do better due diligence in their hiring process.  

Regarding the woman who claimed that she had an extramarital affair, she is not believed. The halacha is like the משנה אחרונה that she is not נאמן-we don’t trust her. Therefore, it is not the therapists business to disclose anything. Similarly, a woman who claims that she is not going to the מקוה is also not believed and the therapist has no obligation to report. This is because it is the husband’s obligation to ensure that she went and remove the חזקת טומאה via inquiring (directly or in a roundabout way such as “was it crowded”). If the husband didn’t do this, it is his mistake. If the husband did inquire and then she tells a therapist that she didn’t go, she is not believed as this requires two witnesses to establish (since the assumption is that she is has a חזקת טהרה from the husband’s inquiry).

As far as שידוכים are concerned, there is generally no need for a therapist to break confidentiality. In fact, people understand this and will not ask a therapist for information. I understand this question as should a therapist volunteer information and the answer is no.

In these situations, we rarely know if our providing information is helping or hindering the situation. We don’t know if these facts will affect the marriage or if this is something that the parties can manage with. Even in situations of mental illness (e.g., bipolar, schizophrenia) it may end up seriously affecting a marriage or it may not come to a state of serious interference such as if the person is appropriately medicated or if the spouse assists. Similarly, with a man who feels limited attraction to females, we need to ascertain if they are attracted enough to accomplish the חיוב of פריה ורביה. If a man feels he can perform for his wife or vice versa if a woman feels that she can perform for her husband, one need not share negative information about them.

Volunteering information based on our own conjecture constitutes לשון הרע. While we may think that we improve things by sharing negative information, we often accomplish exactly the opposite. Even in response to general questions, there is no need to provide specific negative information and doing so is a violation of לשון הרע. Often, people ask information just for reassurance regarding something that they are planning to follow through with (e.g., my daughter is about to get engaged, what do you think of him) and negative information causes harm. Furthermore, people often know they have an issue with a child and they know of someone else who also might have an issue. If we speak out a potential problem, this just connotes that everyone is aware of this problem and unnecessarily complicates the situation. Similarly, רביים often share their evaluations of students with the next year’s Rebbi. This is Lashon Hora. For example, when one רבי says that this child is oppositional the label travels with the child. If, on the other hand, the new רבי approaches the situation with a clean slate and without any preconceived notions, he may realize that this child when stimulated appropriately does phenomenal. We do much damage with our subjective reports.

The היתר of saying Lashon haro לתועלת is only if there is a definite purpose—not a ספק. For example, if we are asked a very specific pointed question where we become aware that there is a definite תועלת in knowing this information. This is not applicable to a fishing expedition where one asks a general question such as “do you know anything that may compromise marital satisfaction” This is not necessarily a תועלת and is considered lashon hora. Related to this exception is if we are aware that there is a definite harm that may ensue to someone such a client threatened to kill someone and we think that they will carry it out, we may report to the potential victim.   

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4) Kibud Av Vaeim:

Sometimes there may be a conflict between the Chiyuv of Kibud Av Vaeim and other emotional factors. How would the Rosh Yeshiva suggest that one handles the situations below?

  - A patient experienced an extremely difficult or abusive relationship with a parent and now finds that maintaining a relationship is very painful and has a serious negative impact on their emotional well-being. This can sometimes be experienced as a perpetuation of the abuse, what are the kibbud av vaeim obligations for such a person    

  - A child is confused by the discrepancy between one of his parent’s behaviors and the community standards. Examples follow:

A community has a strict internet ban but his mother does not obey the rule of the community leaders and chooses to have devices with internet access. She accesses the internet in the presence of her children. The children are aware of the ban and often tell mother that they don't want to look at websites on her devices. How should the therapist and father approach this situation?

A child becomes aware that his father watches pornography. What is the best way to address this issue with the child? Are we to be concerned for the potential diminishing of respect in the eyes of the child?

Regarding the חיובי כיבוד אב ואם of a child who is experiencing an abusive relationship with parents, we need to evaluate the situation. Is the child like דמא בן נתינה or like רב אסי? Dama Ben Nasina was the non-jew who refused to wake his father even at a large financial loss. The Medrash relates that his mother physically attacked him in a public setting and he kept quiet. He refused to embarrass his mother because he understood that he owed his life to his parents and was willing to absorb the humiliation. Most people, however, are similar to רב אסי.  The גמרא in קידושין relates that he asked Rav Yochanan for permission to leave Eretz Yisroel because he couldn’t fulfill the Mitzvah of כיבוד אב ואם with his parents and thought that it would be a greater fulfillment of the Mitzvah if he didn’t keep contact. Thus, we can tell people that it is best to separate from their parents if this will prevent a worse outcome. Where a therapist does this, he or she should attempt to convey the debt that one owes one parents who brought them into this world and gave them life. In these situations, a therapist also needs to make a careful assessment of the situation vis-à-vis the client’s ability to be מקיים Kibud Av Va’aeim and needs to determine client is both able to and needs to be on their own.  

Regarding the mother who does not abide by community standards, my assumption in this situation is that the children are offered to watch the videos. The גמרא discusses that if one sees a parent engaged in an עבירה, one needs to ask in a respectful and questioning way “didn’t you teach us not to do this?” The child should be encouraged to be strong and should be told that he/she is able to withstand the temptation.

A therapist seeing a child who witnessed his father watching pornography should clarify what is bothering the child. The therapist may want to question the child to ascertain if he is sure and promote the possibility of mistake (Maybe he had to look up something? Maybe it was by mistake?). If the father does it regularly, he should help the child see that the father has a problem and put it into context. Every person struggles with their Yetzer Hora. This is the father’s unique yetzer hora, which hopefully he will conquer soon.

5) Inyonei Kidusha:

1. a) Can the Rosh Yeshiva address the topic of providing an education regarding sexuality and masturbation for pre-teens/teens? Is there a difference regarding boys and girls?
2. b) Is there ever a circumstance that a therapist can suggest to a patient to watch pornography or masturbate when working on issues of sexuality?

In general, it is best not to provide preemptive education as this provokes unnecessary curiosity and, with certain students, educates them on topics that they don’t need to or are not ready to hear about. Parents should discuss with their children general body safety issues and both parents and Rabbeim should suggest that there is nothing shameful about sensitive topics and they can approach any time to discuss. Generally, most children know about these topics by themselves. They pick up information through learning גמרא and through other sources. If they have questions, they will ask. If they are not asking, it is most likely because they already know.

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There is a difference between boys and girls. For men there is an איסור of הוצאת זרע. For women, there is no technical הוצאת זרע and therefore no איסור. It is not natural and just aמעשה מיאוס and not recommended, but not prohibited.

Regarding suggesting pornography, I have never had the שאלה, but have heard that פוסקים have given people a היתר when it will facilitate them being with their wives. If one seeks to view pornography or masturbate as a means to prevent a more serious avaira, it is doubtful that this will help avoid other איסורים and therefore should not be recommended. In fact, it will likely lead to these איסורים.

6)  Children at risk/off the derech;

Unfortunately there are times that a child/teen’s emotional struggles (broadly defined) trigger a situation where they end up off the derech.

The question is:

 if a parent is dealing with a child who r"l is showing symptoms of mental illness (PTSD, depression, anxiety, etc.), but the child is also lacking in shmiras hamitzvos, or even all together not frum, should the parents try to control, criticize, set limits, give consequences and confront the child about ruchniyus related issues or should they realize that it is most likely only due to his inner emotional pain and become fully supporting and accepting of the child in order to allow him or her to feel completely unchallenged and completely comfortable in their home, so that 

(1) The child won’t have additional issues to deal with which may delay his dealing with his underlying issues as conflicts with the parents have been stopped.

(2) The child feels that he has their full support which will give him the strength to sooner deal with the underlying issues and succeed in his recovery.

What if younger siblings are in the same home and witness this acceptance?

This is a common שאלה. I have dealt with parents who have used a total acceptance approach, sometimes successful and sometimes not. And I have worked with parents who have used a tough love approach (even sending the child from the home), sometimes successful and sometimes not. I don’t know if there is a rule either way. In general, I would say that parents should have minimal expectations. For example, a child who is struggling with Yiddishkeit and living at home can be told that he is expected to come to a Shabbos meal dressed appropriately while the parents ignore that he does not attend Shul. I would definitely not recommend to put other children in סכנה because of this child.

In general, these situations can stem from many sources and often may be the result of parents who have used a very tough and punitive approach. It also may happen due to abuse or other terrible situations beyond the child’s control. In any case, an understanding and collaborative relationship with normal expectations is the appropriate way to approach it. A therapist who has a keen understanding of a specific case has a right to recommend a specific approach, even a permissive one. This is a הוראת שעה.  

I wish you much הצלחה in your work. You are doing the right thing and are saving people.