Helping the “At-Risk Child”


kids_at_risk1By Dr. Norman N. Blumenthal & Rabbi Shimon Russell, LCSW

Rabbi Yisroel Salanter commented that it is often easier to learn the entire Talmud than to change one midda or personal attribute. All too often, families come to us with heart-wrenching circumstances after having exhausted every other channel of help and advice. They turn to the therapist with a mixture of hope and skepticism sometimes aggravated by a fundamental misunderstanding of how psychotherapy works and what they can expect from it.

The purpose of this article is to address What can therapy offer in such situations? When should therapy be utilized? Who is the client? How do you best get an uncooperative child to attend sessions in a productive way? What are realistic expectations you can hope for from the therapy? Is it important that the therapist be frum? Where do you find a frum experienced therapist? Will going to therapy stigmatize you and affect shidduchim for your other children? How often and for how long should you expect to be having sessions? When does therapy end? Last, but surely not least, we try to address some of the hashkafa questions that invariably emerge when engaged in a treatment or practice so closely linked to one’s thoughts and beliefs.

When Should Therapy be Utilized?

It is unfortunately all too common that people tend to wait until they are facing an emergency before they seek help. The hard reality is that helping redirect a defiant, rebellious teenager into a better direction is a hundred times harder than addressing his difficulties while he is still in single digits. If you notice any distinct change in mood, or markedly defiant behavior in your child, a consultation with a therapist may be indicated. You may be reassured by the therapist that a normal process of development is occurring. Not every troublesome child is a child with a problem. Not every child with a problem needs psychotherapy. On the other hand, you may be fortunate that the therapist can help you to recognize a serious problem that has potential to bring harm to a child’s development, when it is still in its infancy, and as a result you will have the opportunity to nip it in the bud. Remember Chazal admonish us that “ayn adam ro’eh nigay atzmo.” No one can be totally objective about his or her own situation. We all can benefit from an outside objective view of our situation.

Who Is the Client?

Try to avoid seeing “the client” as only the child. When a child is going through a crisis or rebelling, the entire family is often embroiled and also seen as “the client.” That does not mean that all family members need to be in therapy. Generally it will suffice if the parents and the struggling child attend. Never, however, overlook the fact that other children in the family may be very conflicted as they watch the crisis develop. It is wise to ask them if they would like to talk with someone outside the family to vent their own frustrations. Don’t push it on them, just offer it. It is surprising how often they will say yes. The important thing is to resist “sending the sick kid to get help”! Make sure that you communicate to him that you feel in as much need of help as anyone, and that you are more than willing to seek help yourself in order to make your home a happier one for him.

How do you get an uncooperative child to attend sessions in a productive way?

A famous psychiatrist once succinctly summed up the paradox of people’s motivation to change: “Patients come to therapy for two reasons. One is to change and the other is to stay the same.” Everyone both resists and desires change. It is normal and to be expected that most teenagers will balk at spending an hour of their precious time talking to a middle-aged “shrink.” Fighting or locking horns with the teen over this matter is a waste of time. Try to avoid making him think that you see him as sick or crazy. Instead the teen should be encouraged just to try one visit allowing for the dispelling of any misconceptions about therapy. Oftentimes, one visit is enough to win the youngster over. He can also be told that the situation is a family problem probably requiring the parents’ participation as well.

A similar approach is to let the teen know that you are going to seek help to improve your relationship with him, and that he is invited and welcome to join now or whenever he feels ready. Assurances of confidentiality and how “normal” it is to resist attending therapy should be conveyed as well. Should you have your own doubts about psychotherapy, the therapist, or the costs involved, avoid expressing them to the child. This may only lead to exacerbating his preexisting reluctance to go to therapy.

What are realistic expectations you can hope for from the therapy?

Only Hashem can perform miracles. Therapy, as an instrument developed and practiced by humans, has both strengths and limitations. When a patient asks us to change him, we often respond, “I can’t change you – I can only help you be better at whom you are.”

Essentially, we don’t change people’s inherent nature. Rather we help remove the impediments to their being more fulfilled and functional human beings, and observant Torah Jews. Many alumni of successful therapy feel that dormant and suppressed aspects of their unique and worthwhile personality have been freed up, allowing them to live happier and healthier lives.

With the rebellious and angry teen, much of the work requires helping the family reclaim the love and commitment to one another that may have been sidetracked by a long-standing sense of hurt and betrayal. For the teen himself, therapy is an opportunity to reexamine and explore where he fits in both his family and in his community. He can hopefully then learn more appropriate forms of expression of himself as a valued member of his family and community, other than the dysfunctional ones in which he may well feel inextricably trapped.

Why is it important that the therapist be frum?

For the clinician, the bedrock of successful psychotherapy is his ability to empathize. The understanding fostered by true empathy allows the therapist an instinctive sense to determine which of the numerous therapeutic techniques that are available to him, are optimally applied to this client system. Furthermore, from a strictly professional point of view it is hard to imagine the therapist being able to truly empathize with the client, unless he can profoundly relate to, and appreciate the sincere religious affiliation and yearning and struggles of the client.

Additionally there are unique halachic issues that invariably emerge in the course of psychotherapy. A practitioner who has access to poskim insures the halachic propriety of the therapy. Even hashkafa issues are part and parcel of the therapist’s immersing himself in someone else’s life. This is particularly true when working with a rebellious teenager, who may well be straddling the line between the frum and the secular world. Stories abound of secular and non-Jewish therapists incorrectly interpreting the teenager’s struggles as being a natural life transition, and actually encouraging the teenager’s behavior and the parents and community to learn to accept it! Rachmona Litzlan. Obviously this can be avoided by using a therapist with a background of Torah learning and observance. Such a therapist is in the best position to integrate an authentic Jewish outlook into the practice of psychotherapy. The experienced Torah observant therapist will naturally reject the above false understanding of the teenager’s struggles.

A final point. By the time they have come to the therapist’s office, many teens are quite bitter and cynically “turned off” by the traditional Torah or yeshiva perspective. The clinician’s use of frum terminology or perspective can instantly lead to a tuning out or rejection of what the therapist has to say or even the entire therapy process. Like so many of those who work in kiruv, the therapist may have to reach the teen by drawing upon more secular or conventional ideas and concepts to bring him close enough to Yiddishkeit again and ultimately draw more freely upon our sacred sources and outlook. For example, very often the behavior of rebellious teenagers can be discussed from the point of view of personal morality, while the same teenagers will remain unapproachable from the point of view of religion. Only a frum therapist can have a true feel for that distinction, and consequently determine how best to approach the child.

(See psak of Rabbi Moshe Feinstein, l”xz in Igros Moshe, Yoreh De’ah 2: 57, where he writes that one should not seek help from a psychotherapist that is either an atheist or an agnostic, unless there is no frum therapist available and the therapist guarantees in advance not to discuss any issues that relate to Torah or mitzvos.)

Where do you find a frum experienced therapist?

Many of us can recall a time when Orthodox psychotherapists were few and far between. Today there are a growing number of frum and Torah educated clinicians particularly in the large cities. Recent conferences for an international organization of Orthodox mental health professionals hosted close to five hundred participants.

Rabbanim, mechanchim and pediatricians often refer to psychotherapists, and are probably in an optimal position to recommend a therapist for a family struggling with a rebellious teen. There are many communal organizations that have developed lists of such practitioners, such as “The Yitti Leibel Help Line” (Tel 718 435-7669), and “Echo” (Tel: 914 425-9759). The relationship with the therapist is critical to the success of the therapy. Consequently the match between the child and/or family and the therapist should be considered. It is entirely possible that one practitioner ideally suited for one client would be less than perfect for another, given their respective and mutual personalities and styles of relating.

Will going to therapy stigmatize you and affect shidduchim for your other children?

Both government laws and professional ethics mandate full confidentiality for those attending psychotherapy. More importantly, our Torah forbids the disclosure of personal information under almost all circumstances regardless of whether the information is acquired professionally or otherwise. It is, therefore, a safe presumption that your or your child’s attendance in psychotherapy will not be public information.

While we should naturally be discreet about personal and family matters and should concern ourselves with our reputation, one could easily suggest that as a community we have gone overboard in this matter. At least as important as our “marketability” in the shidduch scene, should be the well-being of our children and family.

Taking this a step further, while knowledge that a family is struggling with children or family relationships could be perceived as a blemish, allowing an incipient problem to fester and grow can only further embarrass and humiliate all involved. The potential shame of being seen leaving a therapist’s office is far outweighed by the almost inevitable hardship, pain and shame of an untreated personal or family problem.

Those of us immersed in this unfortunately escalating problem of rebellious teens, know fully well the extent to which this nisayon is present and how many families have been affected. It is often shocking and bewildering how homes replete with genuine Torah observance and true family harmony, struggle with a child or children who are teetering on the brink of kefira and secular pursuits. Those who, through Divine providence, are spared this heart-wrenching experience need to be more tolerant and understanding of these families without exacerbating their pain by scrutinizing them for faults and shortcomings.

How often and for how long should you expect to be having sessions, and when does therapy end?

Having been previously dominated by theories and practices that prescribe lengthy and consuming treatments, there is a perception that psychotherapy requires years “on the couch” or tedious and endless endeavor. The truth is that there are today more active and focused treatments geared towards more rapid and identifiable change.

It is hard to pinpoint an exact schedule for psychotherapy since much depends on the severity of the problems. If there is steady progress, the rate or extent of change at that moment matters little since personal growth develops a momentum of its own that can extend even beyond the scheduled sessions of psychotherapy. The anticipated length of therapy is a legitimate question that one should not hesitate to ask of the psychotherapist once he has had a chance to size things up.

Similarly, the termination of therapy is usually a collaborative process that occurs naturally between the client and the therapist. Ideally, both should be in agreement as to when the therapeutic relationship is no longer needed. It is tempting for the client to end therapy when the presenting problem or crisis they brought in appears to have diminished. Often this is just a temporary state or a reflection of early but incomplete resolution, brought on by bringing things into the open. In truth, the real underlying issues may not yet have been touched. This can take time and patience on both the clients’ and the therapists’ parts to achieve.

Hasn’t the practice of therapy been developed by secular theoreticians who either deny or are oblivious to basic tennets of Torah Judaism such as bechira chafshis, absolute versus relative values, kevishas hayeitzer, kibbud av v’eim, and the like?

Yes and no! The original formulations that inspired the development of the entire field are attributed to Sigmund Freud, an atheist who believed like Darwin that man evolved from apes, and was not a uniquely Divine creation. He believed that the underlying cause of man’s neuroses was that organized religion and society had artificially imposed restrictions upon man’s innate primal instincts and desires. These impositions, he believed, have prevented man from acting upon these primal impulses and presumably finding emotional relief and pleasure by indulging these powerful forces that lay within him. Since its foundation, however, from his students and on, questions have been raised as to the validity of his postulations. Many present day practitioners have moved far from Freudian theory and instead lean heavily on other approaches such as systemic psychotherapy, and cognitive behavioral therapy.

Systemic psychotherapy, derived from systems theory, seeks to understand people’s psychological problems and difficulties more in terms of conflicts in their significant relationships than in presumed underlying frustration of their innate animal instincts. In doing so, they have moved away from discussion about man’s origin and instinctual animal desires, and moved instead towards seeking a better understanding of how an individual’s family culture and system, life experience, particular nature, desires and hopes, goals and aspirations, and so on, impact upon his ability to find happiness in his life. Cognitive behavioral therapy focuses on altering specific behaviors or thoughts that engender depression, anxiety and the like. These theories do not concern themselves with any particular belief system or religion in general, and can be applied without tampering with one’s Torah observance.

Can a treatment so linked to one’s beliefs and outlooks, but developed for humankind at large, apply to a Jew with his unique heritage and status?

It is quite conceivable that even a secular professional may employ the right intervention with positive results, even if his theoretical background is, from our point of view, dead wrong. In the hands of even a highly skilled secular psychotherapist, however, the results of treatment while quite possibly of value, will likely be limited, and possibly be spiritually damaging. Today we are fortunate to have the availability of many skilled frum mental health professionals who have worked hard to filter out the parts of their training that stood in contradiction to our values as Torah observant Jews. Many of these professionals have spent years in yeshiva and kollel. Most, if not all, have a close relationship with a Rav, whose guidance they seek to help them utilize, where appropriate, the skills they have learnt, without being influenced by the mistaken secular theories behind them.

Furthermore, properly applied psychotherapy can actually enhance one’s spiritual life and practice. Someone beset by distress, morbid preoccupation, tension or panic, distracting habits or thoughts and the like, cannot adequately attend to his learning, davening or shemiras ha’mitzvos. Similarly, common life stressers such as marital or family discord, illness or undue interpersonal and financial problems can hardly foster the equanimity and focus needed for a lifestyle governed by Torah. Once freed of these impediments and obstacles, the client can attain new heights of shemiras ha’mitzvos and limud haTorah. Therapists who continue to draw on their yeshiva background cannot help but to see the spiritual advancement of their clients as the ultimate barometer of successful treatment and intervention.

Aren’t all the answers to human suffering and hardship in our Torah, and wouldn’t it suffice to consult a talmid chacham rather than a therapist?

There can be no doubt that all truths and formulae for human fulfillment are embedded in the Torah and in the writings of our Chazal. Consulting regularly with a talmid chacham is essential not only for the prospective therapy client, but for the clinician as well. It is, however, unrealistic to expect a Rav to have the time or technical know-how for the type of day-in-day-out methodology that is the hallmark of successful psychotherapy. In the field of chinuch, the optimal methods of teaching are best known to those who have exhaustively studied our Torah. Nevertheless, no one would suggest that schools should be staffed only with talmidei chachamim as teachers. The Rabbanim guide teachers and are available as resources, while the actual daily implementation of educational techniques is done by trained pedagogues.

Likewise, the frum therapist uses the techniques and methodology acquired through his professional training, all the while trying to maintain his study of Torah and regularly discussing issues and concerns with designated Rabbanim. These Rabbanim are then able, when they feel it is appropriate, to refer to therapists with whom they are familiar and who they feel confident are able to deliver therapy consistent with Torah values.

In Summary

By now the entire Torah observant community is well aware of the tragic incidents of our teenagers at risk. A major source of help and support for both these children and their families is available through the practice of psychotherapy. It is time for the community at large to recognize that many of the prevailing beliefs about both psychotherapy and its practitioners are both outdated and obsolete. The current reality reflects a brand of psychotherapy and practitioners that are aligned with Chazal and their teachings. We must promote the utilization of these valuable resources as a critical element in the battle to reach and redirect these precious neshamos. In concert with mechanchim, Rabbanim and caring baalebattim, the frum psychotherapist is often a key player in this milchemes mitzva, the sacred struggle.

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  1. The best source of referrals for these and all mental health issues is Relief 718-431-9501. They have the haskama of the lakewood mashgiach, harav mattisyahu solomon shlita

  2. Given the occupations of the writers (both practicing therapists) one must take this article with a grain of salt.As Chazel caution, Be wary of advice coming from someone who stands to make a personal benefit out of it.Although I also agree Therapy is sometimes needed the article is deficient as it (1)gives no guidance in as to how to make the most out of therapy and ensure the therapist is (a)competent for YOUR needs(b)isn’t just dragging it out to fill their wallet (soched yaavor einey chacomim…)(2)It is so overly effusive about therapy that it barely comes short of claiming that therapy itself is a cure to the whole at risk crisis.One of the authors of this article itself told me that a few years after writing this article he himself regretted the omissions of those points

  3. “For the clinician, the bedrock of successful psychotherapy is his ability to empathize. The understanding fostered by true empathy allows the therapist an instinctive sense to determine which of the numerous therapeutic techniques that are available to him, are optimally applied to this client system. Furthermore, from a strictly professional point of view it is hard to imagine the therapist being able to truly empathize with the client, unless he can profoundly relate to, and appreciate the sincere religious affiliation and yearning and struggles of the client”.

    This is BIDIYUK, EXACTLY why the community should fund, support and help encourage those who roll up their sleeves to help the teens as mentors. Those who ACTUALLY WENT THROUGH what the teen is going through and has grown from the experience can help the at-risk teen FAR MORE than a fancy degree. Therapists may be nice in theory but without the “hands on” experience they can’t truly “profoundly relate” to the teen. These mentors are the greatest assets everyone overlooks in the rush to fancy therapists.