| This qualitative exploratory study examines the experiences and attitudes of the Orthodox Jewish female patient in psychotherapeutic treatment. The study investigates how Orthodox Jewish psychotherapy clients' religion, culture and identity interact with and color their treatment experiences, and in particular, how the "matchedness" of the practitioner's religious identity---Orthodox, Jewish-but-not-Orthodox, or non-Jewish---further mediates those experiences. The study uses a multiple, embedded case studies design (Yin, 1994) encompassing interview narratives of 3 Orthodox Jewish women who reported on a total of 26 discrete courses of psychotherapeutic treatment. (A course of treatment meant continuous treatment from one therapist. Treatment duration ranged from one session to 11 years.) A two-tiered analysis examined the data by case (primary analysis unit), across treatment courses (secondary analysis unit) within case, and cross-case. Analytic strategies applied included replication logic across cases (by using a standardized semi-structured interview instrument based on Wikler, 1983), and explanation-building and chronological time-series analysis within cases. Results are reported within three categories: Orthodox Jewish Specific themes, Universal Cultural Matching themes, and themes regarding Universal Issues in the Individual Patient's Psychotherapeutic Encounter. Findings identify phenomena which may influence psychotherapy process and outcome in the context of (a) the specifically Orthodox Jewish client (e.g., cultural touchstones, halachic [Jewish legal] and hashkafic [religious ideological] considerations, community ecology, and Orthodox attitudes to treatment); (b) cultural matching in general (e.g., "over-haimishness " [over-familiarity or over-rapport] and "identity-bleeding"); and (c) universal experiences of individual patients in psychotherapeutic treatment (e.g., stigma, getting significant others' "buy-in," developmental stage, "honing-in," "pendulum-pick," and "graduating" a therapist). Attributes identified as characterizing a "good therapist" are also discussed. Implications are reported for three constituencies: practitioners who might work with this population; prospective and current Orthodox Jewish psychotherapy consumers; and the Orthodox community at large, including its leaders and laypersons. Suggestions are made regarding the training of practitioners who may work with the Orthodox specifically, or who may need to be sensitive to cultural matching issues in general. Suggestions are made for supporting increased community psychoeducation. Strategies are offered for helping the Orthodox individual be an intelligent psychotherapy consumer. Recommendations are made for future research. |
