“In order to assess the utility of a treatment for a disorder, you NEED to know what the disorder is!”

Why the Guilt? [Guilty Pleasures / Issue 956]

Honestly, it made me very sad to read all those “Guilty Pleasures” — the comforts Family First contributors won’t give up. Why the guilt? I don’t think this mentality stems from virtuous character. Hashem wants us to enjoy this world and all the big or small pleasures that come with it! And goodness knows, you deserve it!

To all of the wonderful mothers of Klal Yisrael, you’re amazing! You give and give and give to your children all day and night, you work hard for hours on end, you cook and clean and think of your children nonstop, and maybe you also work very hard to help support them — and you’re rethinking buying a scented candle?

Please, keep on buying those pretty little things that make you that much happier. Please, keep on lighting those scented candles that make you that little bit calmer. Please, have some chocolate or cookies that you look forward to and feel special. Please, give yourself that little break with a good book that gives you a little bit of emotional restoration.

You’re important! Taking care of yourself is very important, and needs no justification. Good for you that you discovered something that helps you. Whatever that is for you, please, enjoy it.

Name Withheld

With a Full Heart [Second Guessing / Issue 956]

I’m responding to the story of Atara, who didn’t know what to do about the Rosenfeld children using her swing set uninvited throughout the summer, which culminated in her speaking harshly to Sara Rosenfeld.

One thing both life, and my teacher Mrs. Batya Gallant, taught me is that chesed needs to be done with a full heart. If you do it resentfully, out of a feeling of obligation, because you can’t say no, or because you feel bad for someone but don’t have the energy or resources to fill what they lack, that attitude will seep through, and you’ll end up hurting the person you’re trying to help.

When I think of Chazal’s statement, “Kol hamerachem al ha’achzarim sofo shemitachzer al harachmanim — anyone who is merciful to the cruel will end up being cruel to those who are merciful,” I wonder if they’re hinting to that idea — if you don’t put up limits when they’re necessary, you end up hurting those in need of your kindness.

Raizy Jotkowitz

Not What We Needed to Hear [Connections / Issue 955]

Dear Mrs. Radcliffe,

Just like the reader who wrote you asking about the usefulness of somatic therapy in healing complex trauma — to which you responded (and I’m paraphrasing), “According to the DSM, complex trauma doesn’t exist,” and “How can you ask about a diagnosis that can’t possibly have been given by a professional and is being assumed by you” — I, too, live with the effects of complex childhood trauma.

One of the primary results of living inside the walls of a traumatic hurtful upbringing is not trusting yourself; not the thoughts you think, the feelings you feel, or the air you breathe. You’re owned and consumed by the belief of what was fed to you — something is wrong with me, I’m defective, I’m broken, I’m not like everybody else.

I don’t know what triggered you to respond the way you did. (Yes, I’m using that word by choice.) Perhaps you don’t like new modalities, perhaps you don’t like therapy fads or trends, perhaps you have experience with people “misdiagnosing” or “misnaming” their issues.

But you didn’t hear or see the reader asking the question. You didn’t hear where she was coming from, see the rainbow spectrum of what living with childhood trauma feels like. You didn’t hear or see how much courage it takes to believe that you have childhood trauma (versus “the problem is you”). Had you seen and heard the reality of the questioner, your response would have come from a place of awareness and compassion, not clinical correctness. You would have known that the very, very worst thing one can say is “complex childhood trauma doesn’t even technically exist.”

So because your answer clearly triggered something in ME, and upset me this much, I’ll answer the reader myself:

Dear Reader,

Any and all therapy modalities can be effective or not effective for all things. If you want to explore that, sure, go ahead, give it a try. I wonder about its effectiveness myself. But the main thing you need to bring with you is openness to the fact that there is the possibility of healing, compassion for the hurt that you feel inside, and curiosity as to where this might lead you.

Signed,

Someone Who Does Understand

Sarah Chana Radcliffe responds:

Let me start by saying that I do very much like your last sentence to the letter writer. My ending sentiment — “Rest assured that there is no one right way for you to get better. However, modern therapies all provide valuable opportunities for growth and healing” — is more distant in comparison.

In your letter you ask a valid question: What prompted me to respond this way? You then go on to suggest perhaps I don’t like the new therapies and so on. In fact, I myself am trained and certified in all the new (and old!) therapies, having been studying and practicing now for 50 years. I love and use them all, as appropriate for the individual needs of the client.

I wanted to highlight something new for readers, something they may not already know. I did this by responding literally to the question the letter writer wanted answered. She stated that somatic (body-based) therapy is the “in therapy” right now, and she wanted to clarify whether or not she really needed that approach for her complex trauma or whether this might just be a form of following the crowd as to what’s popular in the therapy world today. She added that although she was now doing talk therapy, she felt certain she needed a bottom-up (body-mind) approach instead. She ended her thoughtful, well-considered question with, “Can you advise?” which I understood to mean, “Can you advise me as to whether a body-mind approach is the best path for treating my complex trauma?”

That is the question addressed in the article. I saw no need to praise her courage in coming forward. I saw no need to acknowledge a deep pain or vulnerability that she didn’t talk about. I saw no need to validate her brokenness, defectiveness, or alienation. I respected her intelligent question, and I set out to answer it.

But here’s the rub: She was asking about the appropriateness of an intervention (bottom-up therapy) for a specific diagnosis (complex trauma) — a diagnosis that isn’t included in the diagnostic manual of mental health conditions (DSM-5). Why does this matter? Can’t we just assume she has some sort of trauma syndrome and answer the question accordingly?

No!

In order to assess the utility of a treatment for a disorder, you NEED to know what the disorder is! I wanted this person and Family First readers to learn that it matters how the process of diagnosis occurs and to appreciate that getting a correct diagnosis isn’t as simple as people might think.

Incorrect diagnosis can lead to incorrect treatment, unnecessary time and expense, and sometimes even harm. Indeed, you yourself have assumed (projected?) that this person is almost a shell of a human being only because she said she has complex trauma! Without meeting her, getting her history, hearing her symptoms, understanding her issues, forming your own diagnosis, or anything else, you have made a host of assumptions that might lead you down a certain treatment pathway.

I wanted people to be aware that the psychological profession itself isn’t always unified around diagnoses or treatment approaches, so that consumers will be cautious and informed when looking into therapeutic treatments for themselves and their loved ones. The diagnosis she claims isn’t so straightforward, and I wanted readers to know this.

Knowing where she got her diagnosis from would have provided some clarity since each possible source has specific implications.

For example, let’s consider these possibilities:

1) She was professionally diagnosed in a country that adheres to the ICD-11 diagnostic system and she has symptoms that meet criteria for “C-PTSD” as outlined in that system. If that is what happened, then I might say, “Yes, mind/body treatments are likely to help you as they are an excellent treatment for childhood trauma syndromes.”

2) She might have been diagnosed by a practitioner who is licensed in a jurisdiction that relies on the DSM-5. In this case, the practitioner might be highly trained and fully qualified to diagnose her symptoms and has chosen to offer a “clinical” diagnosis of “complex trauma” — that is, not an official diagnosis, but one that makes sense to both the professional and the client. Again, in the hands of such a professional, it could make sense to see if the mind-body approach would help.

3) She might have received this particular diagnosis from someone who was not highly trained in diagnosis, in which case she might not have a trauma syndrome, but could actually have another condition altogether — one that might respond better to a completely different treatment approach. This can happen when professionals know a lot about trauma treatment, but have less expertise in other mental health conditions and their treatments.

4) She might have diagnosed herself based on what she learned from books, Internet resources, social media, and/or friends. Again, this would leave us having no clue as to whether she has a trauma syndrome or something else altogether. Therefore, it would be impossible to say whether a bottom-up approach would be most helpful for her.

I stated in the article that, “I’m wondering who gave you your diagnosis.” Now you know why I’m wondering. I need to know what she has before I can advise her on the best thing to do about it. Since I don’t have these answers from the writer, I simply point out the complexity of the diagnostic process and urge her to ensure she has a proper diagnosis. I then suggest she can either rely on the diagnostician’s opinion of what the best intervention would then be, or if she prefers she can try whatever therapeutic approach she wants (i.e., the bottom-up approach if that makes sense to her) and see if she gains relief from her symptoms.

As you note, I didn’t automatically assume that she’s a broken childhood trauma survivor who was looking for anything that day beyond an answer to her question. Indeed, I think making that assumption would have been inappropriate for all the reasons above.

Blood, Sweat, and Tears [Can This Marriage Be Fixed?/ Issue 950]

Frankly, I loved the article from an anonymous couple about the causes of the rising divorce rate among young couples in our community, and if you gave me 100 blank pages it wouldn’t be enough to tell you all the reasons why.

I grew up in a family where my grandfather, Rav Nota Greenblatt z”l, traveled the globe unchaining women and writing gittin for ladies stuck in untenable marriages. I grew up in a home with parents who spent hours every week trying to put back together the souls of post-divorce women.

This article was clear — it wasn’t referring to women bound by abusive marriages or mentally ill spouses. There are extreme situations where the only option is to leave. Our community heavily relies on a classic familial structure, and when there isn’t one, challenges seep in at every corner.

So while divorce may solve some things for some women, it also creates a whole new host of issues that one may not have foreseen: children without fathers to sit with in shul, women with no financial support because their ex-husbands did in fact remarry and start brand-new families, and they were long forgotten.

Based on what I saw in my childhood home, which was filled with buckets of tears from post-divorce pain, I feel this article did a great job showing that sometimes divorce is necessary and sometimes our imperfect marriages need our blood, sweat, and tears, but not a divorce.

May the wholesomeness of peaceful living be bountiful in our kedushadig lives.

Aliza Horowitz

Jerusalem, Israel

(Originally featured in Family First, Issue 958)