WORKING WITH JEWISH ULTRA-ORTHODOX PATIENTS - GUIDELINES FOR A CULTURALLY SENSITIVE THERAPY

The epistemological gap between the medical reality of mental health p ractitioners and the sacred reality of their Jewish ultra-orthodox pat ients poses a major challenge for therapy. Based on our work with psyc hiatric patients from the ultra-orthodox community of northern Jerusal em, we propose a set of guidelines to cope with this challenge. Basica lly, we seek to incorporate religiously congruent elements, composed o f metaphoric images, narratives and actions, into the wide range of ou r ''secular'' treatment modalities in order to respond to the patient' s suffering, often expressed through distinctively religious idioms of distress. This endeavor calls for ''a temporary suspension of disbeli ef'' on both sides. The guidelines presented include three sets of fac tors which appear pertinent to working with ultra-orthodox patients. T he first set is contextual in nature, dealing with the image of the cl inic and its physical setting; the second discusses the necessary role requisites of the therapists; and the third one, accorded a central i mportance, deals on various levels with the therapeutic interventions administered in terms of form and content. Several case vignettes are presented to illustrate three classes of religiously informed interven tions: healing rituals, dream interpretation, and the use of culturall y congruent metaphors and stories. In the concluding part we discuss e thical and instrumental issues that the proposed therapeutic guideline s may raise.