The question of why I don’t have a private practice feels ever present. I have answers…some good, some not as good. Truthfully, as my LIU students who have been subjected to my professional hashkafic mussar shmuezim can attest, I struggle with the larger picture, not only of mental health in the frum community, but the even larger picture of tzarus in the frum community.
It is self-evident that there is no shortage of profound tzarus in our communities. Simply perusing the emails from the NEFESH listserve that touch of the intensity of pain and dysfunction is itself disturbing, and much appreciation and admiration is due for the courageous therapists that tackle these severe problems.
Still, as I survey the field, I see more and more schools opening to train frum mental health professionals, more clinics opening to serve the frum community, more individuals going into private practice (often disturbingly soon after graduation), and seemingly endless demand for services. Of course, one could argue that this is all for the good. If more people need help, then we need more people to help them and more institutions to support this help. On a number of occasions, I’ve heard frum mental health professionals lament that even more people should be seeking our services than are presently.
I wonder, however, about the larger picture. Is mental health treatment the answer to every problem, and is mental health treatment the answer to what plagues our communities? That appears to be the conventional wisdom. In fact, I often hear frum mental health professionals speak approvingly of how Rabbanim are “becoming more aware of mental health,” as if they are finally coming to their senses about what are the real problems and who is best suited to solve them. This doesn’t sit well with me. Of course, I’m not suggesting that the issue of mental health and mental health treatment isn’t a vital piece of the puzzle, but I am troubled by the notion that it is the whole enchilada, especially to the exclusion of attending to spiritual dysfunction.
Any good clinician appreciates that individuals are complex beings, and that problems should be assessed in a comprehensive, multi-faceted manner. We are psychological, biological, spiritual, and social beings, and our problems are multi-faceted. Of course, a good many excellent therapists make admirable efforts to engage clients in multiple realms, working with other professionals to address the bigger picture. Still, we live in a world of fragmentation, which itself may contribute to the dysfunction in our communities. In the past, we may speculate that individuals were “held” more closely by communities, and those that helped felt a responsibility for the whole person. Now, we live in a world of radical individualism where we are on our own, and those that help are defined by distinct professional specialization and boundaries. I wonder if, by providing more and more individual and specialized mental health treatment in response to the tzurus in our communities, we are, in some sense, feeding the very trends that promote individualism to the detriment of community, specialization, disconnect, lack of attention to the spiritual, and dysfunction.
I believe it is time for a different approach. Rather than expanding the “industry” of mental health treatment, with individual practitioners seeing individuals and charging significant fees, I believe we need to counter the trends that promote disconnect and lack of community control and seek instead to re-assert community engagement and multi-faceted approaches. I believe that mental health professionals, Rabbanim, m’chanchim, doctors, mashbias, etc. need to do more than have occasional contact, but need to work closely together to treat the individual as a multi-faceted person existing in a community context. I believe that every individual deserves a comprehensive assessment that includes the psychological, physical, educational/vocational, social, and spiritual realms, and, equally importantly, sets out a plan of recommendations for interventions in all of the stated realms. “Treatment” would be coordinated closely with professionals in each of these realms, and provided, with varying degrees of intensity, by said professionals.
I appreciate that, for some readers, the idea of a “spiritual plan” may sound odd. Other than learning a sefer or going to a shiur, what could be in such a “plan? Sadly, many of us have been raised with the notion that spiritually is a static, not dynamic realm that exists in a narrow corner of our lives. “I believe,” so what more work is there to do on emunah? I believe that the spiritual can and should be a highly dynamic realm, with much specific work that can be done to address real spiritual problems and improve spiritual health. A frum Yid who says about him or herself, “I am garbage,” is certainly a candidate for cognitive and supportive therapy, but there is also something deeply flawed about this individual’s relationship to G-d and Torah that also requires intervention. Rather than finding ourselves in frequent dilemmas of therapists wondering if they are crossing boundaries into Rabbanus, and Rabbis wondering they are crossing boundaries into mental health, why not construct a jointly developed and executed plan for both said professionals to intervene with their expertise?
I envision committees of concerned, frum professionals who would offer comprehensive assessments, and develop treatment plans that address various realms. No, it’s not an especially well developed plan at this point. Perhaps organizations like Achiezer or Relief could be the focal points of these committees. Perhaps there is room for DISRIP (Outcome based payments) funding to fund such an effort. Perhaps, if the community embraced the idea, new funding sources would emerge that would support this work. Perhaps a professional care coordinator could be the connective glue that holds together the multi-faceted treatment plan. It certainly has the potential to reduce potential incomes of therapists, as some of the treatment, and presumably payment, would go to other professionals. Still, I do believe that while therapists certainly want to make a parnassa, they also care deeply about doing what’s best for clients.
So I offer this as a starting point. A challenge and shout out to those who are intrigued or interested to begin to advocate for change. Any takers?