Dear Therapist:
I would like to thank you for this insightful column that so many gain from weekly. As a mesivta rebbe I occasionally need to send a bochur to therapy when I feel that his struggles may be mental health related and baruch Hashem I have generally had good experiences. There is a question that comes up that I would like to hear your opinion on. When are a bochur’s struggles or lack of motivation in learning something that the rabbeim should be working on or when are they symptomatic of something that is a mental health issue. I am not talking about a bochur who clearly is experiencing serious depression or anxiety but rather a capable bochur who is struggling to keep to a schedule or stay involved. When is this something that we need to deal with as rabbeim whose job it is to motivate the bochur and when might it require the work of a mental health professional?
Response:
It’s good to know that yeshiva faculty is caring and engaged enough to become involved in our children’s emotional needs. Simply knowing that their rebbe is concerned for them can be a tremendous help for many of our children. Assisting them in obtaining help that they need is indeed holy work, and can be lifesaving.
Each individual is just that—individual. We would like to believe that there is a formula for everything, and that we can make determinations based on scientific findings. In real life, however, this is a recipe for failure. Human beings cannot—and should not—be viewed from a generalist perspective. The study of the human mind should be viewed as a very general guide. Much more important is the study of the particular person.
Whenever we address others about concerns that we have, we need to be mindful of their personalities, our relationship with them, and their likely responses. You mentioned that in the case of serious depression or anxiety the decision to approach the person is easier, ostensibly since they clearly need help. In many instances the approach itself is easier as well, since the person is in pain and is desperately seeking a solution.
Your question is about those whose issues are not as evident. They have a problem that has a seemingly small impact on their lives. In many cases this may be true. When this is the case, the question is whether discussing the problem is more likely to be helpful or harmful. In many instances, the person is aware of the problem, and being approached in the proper manner can be helpful. In other instances, the person may be (consciously or unconsciously) avoiding the issue. This might be due to various concerns and emotions. When considering whether, how, when, and through whom to approach someone, we should try and get a sense of these factors.
In some cases what appears to us as a relatively minor issue can be much more significant to the person experiencing the issue. For one boy who struggles to keep to a schedule or to stay involved, this may be simply a matter of disinterest or immaturity. For another boy, this could be indicative of deeper issues. Another boy could have trouble focusing, but is emotionally fine. For yet another, trouble focusing is embarrassing and makes him feel like a failure or a loser—thus leading to feelings of anxiety and depression.
You are a rebbe who presumably has a close relationship with various boys, and who has the opportunity to study them in their “natural habitat.” Additionally, you are hopefully not overly emotionally enmeshed, and are thus in a singular position to make more dispassionate determinations.
When most of us see someone struggling, we naturally want to help. One thing that we should question is whether we are trying to address their needs or ours? Is our concern legitimately about the other person, or are we projecting our feelings onto them? For example, if we had trouble focusing in high school—and this strongly affected our self-esteem—are we making unfounded assumptions about others who have trouble focusing?
If your objective determination is that someone could benefit from therapy, there are a few things to bear in mind. The approach should be specific to the individual. For some, being straightforward about your concerns is the best way to go. For others, it is important to first be certain that they understand that you care about them and are not judging them. (Even if it is clear to you that this is not about judgment, it can easily be perceived as such.) For some, having a five-minute discussion will be sufficient; for others the issues will need to be broached slowly over time.
To what extent to involve boys’ parents in the discussion is a separate matter. With regard to the actual approach, however, the decision may be for the parents to initiate the discussion. Or it may be determined that a more positive result can be obtained when the rebbe is the first to address the issue. Sometimes, a team approach is indicated.
There is no broad answer to your question. However, there are some general guidelines that can help to attain a positive response. It is important to take each boy’s emotional needs into consideration. Be sure to show him that you are not in any way judging him. Help him to understand that his issues are normal, and that he is okay. Help to normalize therapy, so that he feels that there is nothing “wrong with him.” And make sure he knows that you care about him, and only want him to be happy and to succeed.
-Yehuda Lieberman, LCSW
psychotherapist in private practice
Woodmere, NY
adjunct professor at Touro College
Graduate School of Social Work
author of Self-Esteem: A Primer
www.ylcsw.com / 516-218-4200
Disclaimer
The contents of this blog, including text, graphics, images, and other material are for informational purposes only. Nothing contained in this blog is, or should be considered or used as, a substitute for professional medical or mental health advice, diagnosis, or treatment. Never disregard medical advice from your doctor or other qualified health care provider or delay seeking it because of something you have read on the Internet, including on this blog. We urge you to seek the advice of your physician or other qualified health professional with any questions you may have regarding a medical or mental health condition. In case of emergency, please call your doctor or 911 immediately. The information contained on or provided through this blog is provided on an "as is" basis, without any warranty, express or implied. Any access to this blog is voluntary and at your own risk.