Dr. Zev Alexander, Judge Phillip Marcus and Rabbi Dr. Alex Mondrow Moderated by Rabbi David Fine

welcome and thank you uh this is a very important panel I think not because of me but because of the panelist excuse me on a uh very important issue so I'll speak as uh little as possible but I do want to say a few things um so the first thing Mo a little okay is that better okay first of all I'm like I'm I don't do paper I only do phone so that's why I'm holding my phone not because I want to check my whatsapps while I'm speaking um it's bad because when there are other speakers they think I'm not paying attention but I'm actually writing most of what they say down so uh the first thing on my Note is uh to uh explain what barai is because whenever I say it people think oh it's a method of learning tanak and um so Rabbi sh did a very good job of that so I'll just tell you that if you want to learn more it's a Israel rabbis onew word.org um I want to also thank uh everyone who uh made this day possible um it was really my honor when Rabbi sha called me and said that the OU wanted to do something like this and uh I think I was at least one of the first calls that he made uh because of my experience in teaching excuse me Israeli rabbis or training Israeli rabbis in many areas including mental health and whether that uh wisdom that I've attained over the last 13 years doing this could be applied to the Anglo uh community in Israel as well and like you said we've really become uh such good friends that uh two days ago when I we sent out the uh wedding invitations uh for my son's wedding in four weeks I sent him an invitation so uh wait I just lost my uh okay um and zamir and Ira and all the other people who really helped make this day uh possible okay so um this we've heard all day about sort of the Kum right what we should be doing as rabbis Educators Robinson Community leaders uh but there's also a lot of shave alasa and RAB brewitz uh one of the one of the things he said this morning was that sometimes you want to do so much but if you do the wrong thing you could actually create very big problems that you never you you wanted to solve a problem and instead uh you create a creative problem so sometimes despite all the desire to help and do sometimes it's about retreating and knowing when uh not to do something and that's basically going to be the subject of uh this panel uh we also wanted to include uh in a bit of a broader way uh a a discussion about the proper relationship between mental health workers and and rabbis and and Ritson as well as a little bit of a discussion about uh professional ethics uh as as it uh as it applies to this to this uh department so to speak of of mental health so we have um three very distinguished uh panelists and um if I read all their bios you know we'll be here until t dester uh so because of their um numerous uh accomplishments um so um I know all of them and um so I'll just say something nice about all of them uh you have uh you you could Google all of them and and they like I said they're all the top people in their in their field so uh Dr Zev Alexander is uh as one of the top mental health the top psychiatrist in in Jerusalem he's very much uh sought after uh many many many accomplishments has helped many many many people in numerous ways and um something that it did say in his uh in his uh biography is that uh he's able to combine the medical aspect uh with uh talk therapy and if anyone knows anything about psychiatry in Israel right uh you know most of what happens is you go um and you get your medication whatever you're there for 15 minutes 10 minutes and then you leave and uh Dr Alexander is able to really uh combine both uh in a very very u m ful way so uh Dr Alexander we're very happy that you're here with us thank you for taking the time and uh I just have to find our WhatsApp so I could read the question sorry um so I guess I I guess I'll start with um do you believe that a a partnership between between the mental health worker and the rabbi is a good idea I want to um say a few things as background before answering a very specific and very important question uh I think it's very important to Define some terms okay there's a lot of people in arel and in America in England Australia that talk with each other there's coaches there's to there's social workers there's PhD there's Sid there's MD there's psychoanalyst there's different schools of psychoanalysis there's a lot going on in the world of treat when a when a RV sits with somebody I think we have to Define what the person who is going to the RV thinks is happening what the RV is thinking what the reison is thinking what what everyone goes in with the expectation because the treatment relationship is unique and in order and we've learned that it's important to have a certain kind of frame boundaries you know a time and a place a specific amount of time payment involved so when a doctor or let's say a psychologist a physician meets with the patient there's something unique happening and I think that there's a lot of value to saying not every professional who has a license and has training is good it's very important to say there's a lot of Duds in Nephrology and in dentistry and in car mechanics and Psychiatry has a lot of terrible practitioners ERS in every country and so there and there's fantastic chaplain who don't have training in grad school Beyond chapy but are the nicest people and are wonderful so I think when to go back to the specific question it depends each case is going to be different but the goal of treatment I believe my background is in psychoanalysis the goal of treatment is to give a patient the ability to have an authentic individual life experience or make their choices if a RV is too connected to that person to allow that person out of whatever framework that they come from that might be part of their pathology or part of their conflict then the r sitting with a person can exacerbate the symptoms and often times um I should also say as background people who treat you know we we say ham yo so in Psychotherapy it used to be if you were in training you were also in treatment that's not really the case anymore not everybody has been through treatment we expect people to maintain supervision for a while but like the previous speaker I don't know the process for rinic supervision after training but there's a lot that can very simple there is none there's a lot that can go wrong and the the title of the talk was on ethics I reviewed in the past few days the websites for the American U psychoanalytic Association the American Psychological Association the American Psychiatric and I even looked at the social work one it's fascinating to look through the ethics guide books of the secular World they all mention boundary violations and we're all at risk we have to know that we're all at risk and we have to know that treatment doesn't prevent boundary violations and it's not just about things that are you know egregious the concept that they bring up on a lot of these websites is a dual relationship problem I don't want to steal your if you're not know but but I was thinking about it I try really hard never to go to SCH where I know a patient of M doin and that means I have to move shs a lot and um and it's not fair to them and if I know that um that a patient is involved in a thing that through 16 different connections it might be helpful to me to have them comment on a thing like I used the word car mechanic before but let's say I'm new in town I don't know where to bring my car and tpot but this person would I can't ask and I and I think that there's so many hundreds of tiny little things that can affect treatment when you ask people what went what what went wrong with your treatment I don't know if ranim get the level of supervision detail to see so when I speak to a patient who's in a Yeshiva and their treater is one of the ream in the Yeshiva I'm thinking I don't know I don't know how that may be but but it seems like we really need to give a patient space and privacy that the only thing that happens when they talk with the professional is that they're talking with the professional and the RV as the bridge back and forth may be in the introduction maybe in the referral but in an ongoing way I think it styes the person's individuation and growth and agency and all that stuff the the the anecdote I'll share from training is you know what consult theas on Psychiatry is like when the department of surgery calls you because a patient wants to leave AMA they call psychiatra will you come the person you know wants to leave but if we take out the line they're going to die so can you come see them so that we can let them leave or can you convince them to stay so the consult the aison secret that they taught us in residency is the surgical resident is the patient why are they Consulting you the patient is just a patient but the department of surgery can't figure out how to how to do this how to talk to the pat they're fully capable of assessing capacity they're fully capable of spending another 20 minutes and being like what's wrong what did we do wrong but they bring in Psychiatry because the surgeon doesn't want to and so the same thing we have to analyze the family circumstances the religious circumstances the whole the you know what's called the objects in a person's life my my qu you're discussing a lot of the challenges right I I think my question is more um towards let's say a rabbi understands those challenges and and and and is a and wants to avoid them right he passes uh some somebody on refers them to Dr Zev Alexander right so after that happens right the rabbi doesn't intend to continue seeing them in any kind of uh therapy relationship is there a a relationship between the rabbi and you meaning the in order to help the patient is that possible meaning I as a rabbi I see the person atmin and on chabis and KES and at the lecture and at the she and I I spent a lot more time with him than the 50 minutes that he goes to you so wait 50 minutes weekly or 50 minutes every 6 months no 50 minutes weekly so then I'm not sure that's true well because aov has 100 people right is the RV really interacting with a person because they see them at MHO meaning the person's telling me about their dreams they're telling me about their relationships they're telling me about their fears I I would treat a R's input the way I would treat a parents input meaning it's useful I guess but the real thing that we try to help the patient see is this is all you like what do you bring to the room so if I'm a rabbi in wherever in R and I have somebody I I refer them to you after that are you saying from a mental health perspective my job is done well let me think of a scenario where where what you're saying is different if somebody has a severe psychotic illness where their goal is to not be in the hospital but to be maintained in a community so then I would say the more support we can provide for a patient you know like who's bringing them for their weekly blood test for clopine you know if the rabbi can organize a volunteer from the community that's amazing that's a type of Psychiatry where somebody's let's call it low functioning or very high needs if somebody's you know um manic at SCH and the whole Community saw it and like it's very upsetting to the community and to that family so then maybe there's a role for the Community to be part of the healing but let's let's say the bread and butter Psychiatry person's having panic attacks depression you know I think that they want real real privacy and wouldn't want their clinician to talk but sometimes if there's like an absent family or there's big problems then it could play a role I I was thinking of another scenario where what does a RV do that we don't do um actually I want to quote this source of this when I was in training um rabish Lomo cat said to me you know what I noticed about mental health is you don't offer anything you dissect everything I thought it was very smart like our job is to be so we hear what the patient has to say but I don't get up you know and say okay here's the positive things you should do with your life like you know like you should have this as your hobby and you should believe in these things and often times a rabbi doesn't have to follow the protocol of being neutral like you get to give toar Torah you can Inspire the person the the pitfall of a lot of doctors you might have seen over the years is we all want to be rabbis and the rabbis want to you know be mental health professionals and it's we both have that y Sahara that we want to offer the patient like a little I don't think that's good treatment if I do that I notice I'm like H what's going on for me today why am I doing that I can interview you all day there are a lot of many important uh issues I want to ask you one more question question and then we'll move on to the others because we don't have uh unlimited time so we've been hearing all day and those of us who are Educators and Ritson and rabis we we talk about it all the time that our job is maybe to identify the fact that there's a problem and then refer them uh to to to someone uh like you so it's very easy to say that but I want just to get a little bit more sophisticated a little bit more Nuance so somebody comes into my office Rabbi fine I want to make an appointment with you comes into my office and I he either tells me or she tells me explicitly that they're suffering from some kind of mental health uh problem or uh or I detect it or I or I sense that there's some kind of issue going on here they come in to talk about something else but I I really understand that there's something else behind this that may be a mental health uh issue so at what point am I do I say okay go see mental health uh is there anything more that I could do or or is just just right away you know refer them out thank you for bringing up this important opportunity to make a public service announcement we still suffer from stigma preventing people coming for treatment and the more we as ranum psychiatrist social workers normalize going to treatment for ourselves for family it's not a big deal this one goes for this type of physical therapy this one goes for you know eoin therapy this one early and often make referrals early and often and make it not a big deal I am shocked I've been here since 2017 I am still shocked everybody knows the famous syphilis research in American the tus Tuskegee right where they just let the illness go and watched in Israel the level of psychiatric care is so abysmal when I meet a 38-year-old who's had who's had panic attacks daily since they're 16 and never seen a psychiatrist I think this is a first world country how is this happening so just right away just say you should see a psychiatrist the same way if somebody had one diabetes attack and and you know their sugar was 400 or whatever like you would send them immediately so Psychiatry it it there's not enough psychiatrists there's not enough therapists there's certainly not enough for children but refer and make the community aware that it's totally cool like I think that this would be helpful this is called a panic attack or this is called anxiety or or you're having um you know struggles because your parents are going through something at home you know it's fine let's we can find you somebody to deal with and I want to say one last Point there's a psychologist on Twitter named Jonathan shedler if any of you are on Twitter you should follow Jonathan shedler he's a genius and he's s h e d l r I think he's in Colorado but what he says is he says a lot but what he said is people will say oh I tried therapy and it wasn't I'm good I'm never going back after seeing somebody four times he says it's an interesting thing you don't like hear a bad song and say well I'm never listening to music again right you go to a restaurant the pizza wasn't good that's it for Italian food but like people give up very quickly because that's what Freud talked about this is resistance so the the runam can recognize it's okay it's okay that it didn't feel great the first appointment it's okay it's expensive it's okay it's far away to encourage people you know we'll find you somebody else because yeah if you think that there's an issue it's like with appendectomies you should refer more people for surgery and have their appendix be normal then miss even one so it's okay to take out a healthy appendix every once in a while so that you never miss I mean this is the concept of specificity like we want to be sensitive and specific in our screening but go for it refer tell them I have somebody for you or why don't you talk to this person and I think that's a great question because it would help decrease the stigma the fir Community all the stripes are still a little bit more sensitive than other populations and it's getting in the way of people's Health thank you thank you I have more questions about referrals but uh we'll go to the others and then if there's uh any more time we'll we'll go back to that so um Judge Philip Marcus uh I will read a little bit about your bio because uh I'm not sure everyone is as familiar uh so Judge Philip Marcus was born and educated in England he moved to Israel 1978 he was admitted as an advocate at the Israel bar in 1979 and and appointed a judge of the Jerusalem magistrates Court in 1995 he served as a judge of the family court from its opening in 1997 until his retirement in 2012 it goes on for a while because you have so many accomplishments and when we spoke on the phone and when we spoke out there I don't understand when you sleep uh so um one of the areas that you told me when we spoke there's like some kind of echo here right um one of the I don't need a mic do I uh one of the um uh top the the areas that you told me that you uh uh that you are involved in is the issue of professional ethics and Dr Alexandra just mentioned the whole issue of professional ethics so I want to give I want to add on to what sort of continue what he said and then have you uh address it as well so um when you are a member of when you're a psychiatrist you're a member of the American Psychiatry Association and whatever it's called and the Psychological Association and the plumbers Association and the car mechanics and the truth of the matter is is that in the Orthodox ravinet there really is no uh uh ethics uh conduct of Ethics I looked it up uh last night I have it on my phone here I won't read from it but in 2018 not so long ago the rabinal Council of America finally put together a code of ethics for uh its members now um and it's it it IT addresses a lot of things that are specific to the rabit right uh meaning if you are a rabbi uh and uh a psychologist are you allowed to see somebody in your Shore right um and other things of that nature but could you just give us a little bit of from from somebody who deals in this as a professionally could you sort of tell us what what the whole idea the whole notion of professional ethics can add to this idea of rabbis and and rabbitson and and Educators dealing in mental health firstly thanks for the I I think I can thanks for the invitation thanks to Ira thanks to get help is sorry that's that reminds me the most important or not the most important one of the most important things uh is that uh judge Marcus serves on the uh Ethics Committee of get help Israel ghi which our good friends uh IRA and Tanya PCO started not so long ago and and have made an enormous contribution uh to mental health and the Anglo community in Israel Ira had to be in America at this time and he couldn't be here but he has a large part of the credit for making today possible so okay thanks car never goes away um I I've been uh studying and lecturing to counselors and Professionals in many fields on professional ethics because I've seen that there is a lot of misconception about what ethics are and also uh as uh R fine says there are some professions where there is no written code if there is a written code it doesn't include all the things it needs to include um so I'm not going to give a twoh hour lecture or even a one hour lecture about what are the constituent parts of professional ethics I'm going to speak very briefly about some of the things which in my view are likely to come up when a rabbi or a teacher or a Ritson is uh faced with uh someone may know may not know uh and is being asked for help the uh principle thing that has to be understood is that somebody comes to you for advice thinks that you know better than they do what is required that puts you under a colossal uh responsibility uh to stay within the bounds of your professional competence and to know where the border is between that and the other professions you may be involved in what as Donal Donald rsfi said the problem isn't what we don't know the problem is what we don't know that we don't know and that means that uh a rabbi somebody who takes his role seriously has to know enough about the other fields uh which he may be involved in in order not to cross the line the trouble is that there's so much rubbish out there there's so much fake science there's so much um noise that it's very difficult uh sometimes to distinguish what is the real uh idea what psychologists are supposed to do what psychotherapists are supposed to do uh and and uh where the borderline is between mental illness and simply being upset uh particularly the case uh there is an extremely important article about concept creep in which the writer who Hal I think his name is describes the way in which psychological Concepts like trauma and like even words like violence have become extended Way Beyond the original scope in Psychology and in the other sciences and they've been dumbed down a piece about a demonstration uh at exitor university in England last week um there was some there was a a few Jewish students maning a desk about what's going on since October the 7th and one of the pro Palestinian protesters said by sitting there you are violent and I thought violence it's been flattened and it's been Spread Way Beyond so the the the terminology is difficult uh you said that there is a resistance to getting help that's the response that you often get maybe Dum dumbed down uh even from that so the first thing is to understand what you know and also to understand what you don't know that will give you the clue when to refer things out but there are several other things that a rabbi ought to know um and these are ethical legal issues for example confidentiality everybody knows that Rabbi has to keep confidential uh anything that's told to him in confidence and it's will be presumed that he's not going to lab about things but there are limits to confidentiality for example the law provides that in any case where a professional or even a nonprofessional has reasonable grounds to suspect that an offense has been committed against a child or a person who is not able to about themselves there is an obligation to report to a social worker or to a police officer that means that although the word Moser is still part of our vocabulary the law requires and there is a criminal sanction if a rabbi doesn't report something you should have reported 6 months imprisonment that's not nice and therefore uh Rabbi should familiarize himself with the limits of confidentiality the rabbi has responsibilities not only to the individual congregant the rabbi has responsibility to the family of the congregant and particularly where there is marital Strife to the children of the couple and also to the kahila and also to the state so that the the realm of the oneon-one talk uh is is fine maybe for a psycho anist or psychiatrist or psychologist but the rabbi uh because he occupies a position uh in a community has to take the different concentric circles of interest uh very seriously um there's another issue here and that is the halik issue and the Hal does tell us a great deal about human relationships uh and and certainly rabis expected to be familiar with the not only with Mish uh but alsoo um and and that requires um a a certain mindset the last thing I want to say is that we have to be very careful about the language we use and the terminology we use because there are huge differences in the medical terminology psychological terminology the legal terminology and the general terminology how many people here think that schizophrenia is a split personality well I'm very pleased to see that because until about 15 to 20 years ago they thought schizophrenia was a split personality how many people here think that a borderline personality disorder is somebody who lives in Matula well well there are unfortunately uh lawyers and other people who still think that a Broadline personality disorder is somebody who you know doesn't like living on the border but the these words are the General Public may be thinking in these terms and and so we have to be very careful uh as to how we speak about these things uh that's uh on one toe one foot I I have one more question for you um so we said before that you are on the Ethics Committee is that what it's called of the ghi um so first of all why why is there a need for an Ethics Committee and what do you do the uh any Professional Organization um needs to justify its existence and make sure that the members of the organization are behaving in a proper fashion the mental health professionals who are members of get help Israel are all subject to their own professional ethics boards um it may be in the Ministry of Health it may be elsewhere however uh ghi like any organization which puts out the names of professionals has to make sure that those professionals uh live up to the standards that the organization uh wants uh to be adhered to and that means that uh although a client may come with a complaint which may be appropriate for dealing in the professional association to which that professional belongs nevertheless uh that may take a great amount of time and in the meantime gii will wants to stop referring people to that profession uh because by including that profession in the list ghi is making a representation that that person is competent and ethical and decent and and does his job properly so that uh the ethic the Ethics Committee uh doesn't sit regularly when there's complained it's dealt with seriously but it's dealt with pretty quickly so that obviously we will get information from the complainant we'll get information from the professional involved and will uh reach a decision as whether that person should be or should not be removed from the ghi list great thank you I think that there needs to be a lot more cooperation between the legal sector and the rabbi sector so I'm so glad that Ira you know suggested that you uh sit on this panel and you've certainly contributed a great deal so now Dr Alex mandro uh so we talked about uh split personality uh so you're a rabbi you're a a psychologist doctor Dr alandro and um so I'd like you uh to and just to give a little bit more he was the rabbi of at of the synagogue at the Albert Einstein College of Medicine he recently made Aliyah and has a practice here in Jerusalem as well as in tinac that's what it says here um and he does a lot of uh very other important things but I think the focus here is also that he does a lot of training at Reit um uh we're not going to get into this now but a very important part of his work is uh emotional intelligence and uh rabinal student and rabbis which is very very fascinating and maybe we'll have another conference and and talk about that um but why don't you talk about uh the split personality and um and uh what it means to be a rabbi and and a psych right multiple personalities okay thank you thank you I say it's uh hard to be the third in in the line here but um I'll I'll share with you a couple of just a couple of insights and hopefully that will that will you sort of build will build off of that I think it's very interesting that the I I I was a rabbi first I I was a rabbi for about 7 years before I completed my doctoral training and then I I invested myself heavily in my doctoral training and now I'm trying to integrate the two in different in different ways but it really is challenging I think one of the one of the pieces which you really both of the other panelists alluded to is really this has to be an element of self-awareness an understanding of ay what your professional competencies are what your strengths are what your weaknesses are but also understanding perhaps the most powerfully what you know what you don't know and also the role in which you're playing in a particular moment it's uh it's actually very interesting one of the one of the largest differences that that a rabbi I think differs from the way that a psychologist will and very often I think really both of the speakers alluded to is that a rabbi very often is functioning in a prescriptive capacity a rabbi very often gives prescriptions they're saying this is is this kosher is it not Kosher can I go here can I not go here am I allowed to do this am I not allowed to do that you're and very often not always but very often they're being to we're in the frame of mind of both either Hally or in an ethical kind of way prescribing what should be done now not only prescribing of medication but there's there's a way of prescriptively telling people what they should or should not be doing as a psychologist it's very often almost always it's the opposite we're either observers or we're describing we're in a descriptive role we're not in a prescriptive role and the way of functioning is very very different and so it's it's a very interesting thing that over over time for example in my own in my practice when I have uh I have families come in or individuals come in and they know my SM might be hanging on the wall right next to my doctoral degree but I I tell them very clearly I want you to know in this capacity I'm I'm not a I'm not a rabbi it's true I have atic training but I'm a psychologist and and and I will refer them if it's a related question or something along those lines and it goes back in a certain way to what the Alexander alluded to in terms of having a multiple relationship or a dual relationship it's very complex because I'm not their rabbit and I will very clearly tell them I'll say I'm your psychologist I'm not your Rabbi then sometimes it's a flip and and it goes back to the multiple personality pieces is that sometimes if somebody's asking me a sh a student of mine who's asking me a question so I might do the opposite I might have to say look I'm going to answer you based on let's say the but you should speak to your mental health professional about the application in this particular case because I'm not your psychologist I'm not your psychiatrist and it's a very very delicate it's a delicate balance to strike that's probably almost impossible you know as much as I like to say it out loud that I try to but it's a very very difficult and a very delicate uh balance to strike between being a psychologist and a rabbi but I think it first starts by understanding to some degree the role that's different a and then also the the um the self-awareness to understand hey what's being asked of me in that particular moment and and and how am I functioning in that particular situation uh I'll just I'll just add one piece which I think is very important for for the rabbi and the Educators which I think is something that really again was touched upon but I just want to sort of consolidate some of the points that that the previous speakers mentioned which is that I think number one first and foremost there has to be a baseline element of education is that the only way like marus alluded to which is that judge Marcus I'm sorry alluded to is that is that it might or Alexander alluded to anything could be run of A- Mill but the language that we use we have to know what we're talking about there has to be we live in a day and age where it's not okay to not have a baseline understanding in of mental health and the different components of mental health what it means we're not asking you to diagnose we're actually asking you specifically not to diagnose and we train ranim one of the things that we're looking for I'm I'm I'm not saying to use a diagnose but similar to Dr Alexander alluded to I want to know that I have to refer somebody so like if if God forid somebody's having a heart issue I'm not going to pretend that I know what's going on with the heart issue but I'll know that well if it's a suff I better refer them to a Cardiologist that would make a lot of sense and so in a similar way I have to know enough enough to know that on the eyes and the ears on the ground and it could be as Dr Alexander alluded to that a rabbi may not be spending as much time really even with a person even though it might look like it but the one so weak that a person's with a therapist there'll be more they'll be more involved but the one thing theyi will do is they'll have more exposure very often to the person they'll see the person they'll see the person in their natural environment they'll see them in a more higher level of frequency and a rabbi an educator a rabbitson or Aban whatever it is that each each of them has to know enough to know wow this is something that needs to be looked at and if there's a suff exactly like Dr Alexander said there's no harm there's no harm the same way that we in any other medical field we would never say ah you know maybe maybe uh you'll be okay don't ignore that ignore the chest pain really so you see somebody not functioning in a proper way with a baseline education and a person has enough humility to say look you know I don't know what's going on here you refer at one of the things I I said one more point then I'm going I'll pass on mic I just have a question about that yeah I'm one one small one is that I find very helpful when we train rabbis is that they should have someone they can talk to never obviously violating any any elements of confidentiality but how Rabbi in your sh and I want to me the health professional I should strike up a conversation or have a relationship with Dr Alexander so that if I'm concerned I can say hi I'm RAB mandro I just had a quick question if you have a conrant or a student of mine I'm not sure about such and such and such you just guide me for like 10 minutes and over time if you develop a relationship the same way you a psychologist might have a relationship on the reverse with a r CU he has a shil in the other direction so having that relationship is invaluable and that relationship can really help to be able to identify things to be able to understand have a better Nuance understanding and if we grow in that way we both defeat the stigma most importantly we help the people that are coming to us so I just want to I just want to get a little deeper about this because Dr Alexander you seem to suggest that you know there's a very clear demarcation there's once the rabbi hands it off to the mental health worker there's really no more of a relationship you seem to be a little bit more me but um what I really want to say is uh yes I may not be totally focused on that congregant of uh like the psychologist is for the 50 minutes when I see them at M cuz there's hundred other people at M but at M I may see him doing or her doing something that maybe the psychologists didn't see and maybe I should be in a position where if I had a relationship I could tell the psychologist and that could help the psychologist uh in terms of uh of their own treatment right and also similar to that not totally similar but sometimes a rabbi can do something that a psychologist can't so I'll give you one example I've gotten uh calls several times um from psychologists it's only one example but it's an important one right tell this person who's suffering from anorexia that they must eat Anum keer right so if I tell them they're not going to listen but if the rabbi tells them then they'll feel much more comfortable so if there's no relationship between the mental health worker and the rabbi how could how could those those things are helpful how how could how could those things happen Okay so I I'm definitely not going to do justice to to but but I actually I don't disagree with Dr Alexander I was speaking about my own struggle sometimes being a rabbi and a psychologist together but I absolutely fundamentally agree with Dr both on a confidential and ethical level but even not even more but in different plane in terms of care in terms of the nature of the Care once a person becomes a patient of the psychologist and the psychiatrist and it's related to a mental health issue the doctor becomes the the quarterback the doctor is the coach the doctor defines everything obviously within the Contours of confidentiality AB absolutely the the idea that a psychologist or a psychiatrist can go to a rabbi and tell the patient to to eat that's a a blatant violation I think with with a oh okay fine so that's a question that's that's a clinical decision that's a clinical decision that's actually a clinical decision that sometimes we do actually employ sometimes especially when treating things like eating disorders or OCD things like that where we will have the rabbi uh sort of partner with you know with is necessary but it's a Clin but but but fundamentally it's not a halic decision it's fundamentally a clinical decision and so and so in that case I personally think that is again as long as the as long as the physician the me the psychotherapist the psychologist whoever it is is quarterbacking it and and saying look you know in this particular case we really need to utilize the the force the strength of the r of a Dian depending on the context in this especially inish communities in different ways there is a lot of value to incorporating but again it has to be within the the it has to be within the clinical framework that the doctor decides with obviously within the the parameters that are set by by uh by confidentiality completely and and to me I I just think just as far as referrals go goes to your point I I really do believe once once the referral is made it really becomes it's no longer the rabbi's uh choice to be involved at at all the only way that I might suggest that I I have utilized sometimes and in a way it has to be with the permission of the client is simply letting the person know I'm here for you that's it and that that is actually something I just I'll pass it on to to judge Marcus is that is that the one of the primary differences between a doctor a psychologist a psychiatrist and a rabbi it's important to know this is that we have there are very very strict boundaries when it comes to a psychiat psychologist but a rabbi it's not that the ethical boundaries might be different but the reality is different you're on the ground you might be in out of their homes you might be see them in sh you might be at a s you'll see them everywhere you'll see you'll see them everywhere the rabbi is definitely going to DAV in the show where his congregant is daving where the psychiatrist is going to run away from actually don't know where you dve in then you dve in in your living room but but I think that so so in that sense there there really is a there's there's a there's a fundamental difference between the role that that a mental health professional plays and a rabbi plays but as a supportive character again with the agreement of the person involved to say look I'm just checking in with you I'm not I'm not asking you to get involved in your care in your therapy I'm not getting involved in the analysis whatever you're doing I just want you know I'm here for you I I I feel an AAS I sent you to Dr Alexander I feel an AAS that I sent you if you need anything I'm here for you that's that's a supportive role I'm not just I'm not dumping you off and then leaving jumping ship that I think is actually a very crucial role that also minimizes the stigma that a that has a meal because you don't treat him any differently just because I sent you to Dr Alexander I'm so not going to talk to you the opposite I'm Tre you exactly the same if if anything I'm here for you more but only in a positive way not in a way that in any way affects the treatment in itself judge yeah I'm not familiar with the role of the quarterback but I am familiar with the role I realized that was a culturally appropriate I am familiar with the role of the I am familiar with the role of the trip wire and the judge has an important role as being the trip wire he may be the first person who has any kind of understanding that there is behavior which points to a psychiatric problem or a psychological problem or a relationship problem um and particularly B noo um unfortunately there are rabbis who put Shalom Bay above everything and they've adopted a Catholic attitude to divorce lenu and they they haven't read a other the you don't live with a serpent in the same basket um and unfortunately there is a tendency to adopt values which are not uh Jewish values they their values from outside just want to point out one more thing and that is the importance of introspection a person has to know himself in order to be in any kind of position of authority you have to know what your predilections are you have to know what your prejudices are what your biases are because if you don't then you're going to make mistakes that should be an essential part of training for anybody not only in the Mental Health Professions but in any profession because and and and that leads to another thing you must not suppress those predilections you must be aware of them all the time I remember when I was hearing the small claims I had a case involving collision between two vehicles and the plaintiff comes along and then the defendant comes in he's one of the Russian from Mir I didn't know him at all I had no personal cont but I had to hold on to the chair not to get up because when the time enters you get up that means I had to be aware of my immediate tendency to get up but to be aware of the problems that it would cause if I were to appear to be discriminating in favor of of this Tomy prop uh so so you have to know yourself and uh should be part I hope it's part of the training of rabbis that they should be taught that to Chua means identifying the bad points and being aware of them but also identifying the good points and being aware of them as well thank you okay we have a few more minutes so I did say I wanted to get back to referral so this I'm going to start with Dr Alexander and then um go back to Dr mandro to fill in um refer refer refer so um you said before there are a lot of Duds out there um so could you give us like maybe not the Ten Commandments but the three Commandments of referral what should rabbis know when they need to refer somebody I think that we're fortunate certainly in The Firm community that we're connected to each other if you're in Nebraska and you're an endocrinologist and you need to refer to an orthopedist if you just show up you just have to wait and see you have you know takes a long time the learning curve I think we it's one of the things about the cohesion that we have is that we can ask people not in the field hey you know your neighbor like you can ask other people I am a RV I'm looking for somebody who's good at working with OCD the family is interested in Family Therapy with their daughter for eating sort this person has a substance issue who do you know that the I would say if you're asking me to do it like the there SRO so ask ask each other feel comfortable I think it's a wonderful idea to make friends with inter collegial departments it's it it the the previous speaker was mentioning how to do self-care I mean that 4minute conversation I have with a friend who's a RV at the end of the day about a topic sometimes normalizes it for me and then I can go home and just like not need to talk about it again and I think that it's very help ful to have friends that say oh this person's good for this but not for that um so that would be one two I I really think that um you have to be we all have to be humble that we don't know you don't always know what's going on in the treatment room specifically in Psychiatry our patients sometimes have very horrible things to say about us doesn't mean good works not happening and so they might oh he's a jerk or oh this you never know but I think um so the second one would be like you know get a lot of data before really making a decision about whether or not somebody's an outcast um and then the third one would be that when you make a referral there needs to be patience because a person's 25 years old it's going to be more than 25 sessions before maybe you start to see progress if it's talk therapy if it's medicine it can be you know weeks and weeks until you get the right combination so we're we are trying our best but I I think that um I've learned from my colleague somebody who's not very good with one patient can be the best shal for another and so you know we all the English speaking MD psychiatrist sort of here you know I'll be the seventh doctor that somebody saw and then they think I did a good job in the first six are terrible but I have enormous respect for the people that they're badmouthing it happens all the time so I I think you know just Hashem Hashem is making the like you know there's very good treatment and as long as um as long as there's not something very clear ethically going on that's dangerous I think you it's hard to know what went wrong with it certain dud but Al also 85% of the time if somebody writes for an SSRI the person's going to get a bit better meaning it might not be the ultimate best treatment relationship but start with something um um and we make mistakes you know medicine has mistakes I I wanted to if I can add one part the way that the confidentiality works for a professional and please correct me if I'm wrong about an N to thr somebody can call me and leave me a message I don't have to call them back so if for is like listen I know you saw him three weeks ago and you put him on this and you know he's shaking in SCH and I don't know when his next appointment is but like he he he's embarrassed or he didn't want to come to SCH cuz his hands are trembling that's fine I don't need to call you back and I might even call the patient and say the r called or you could say I told him to call you and I told him I'm calling you and does that help do you do youate it's wonderful it's wonderful I everyone has my WhatsApp number like go ahead I mean I'm busy but I listen and it helps and I think that um it's the same way with anything if a teacher or if a girlfriend says hey can you then we take the information and we're happy to use it I I think the idea of making referrals in general is it doesn't have to be a bullseye but you're saying to the person this what you're going through is worth speaking to a professional about and that's the main message so I want to I want to what's going to sound at first to undo what Dr Al but I'm not it's actually just framing it I'm going to piggyback actually Dr Alexander just said when whenever anybody comes to you for a referral whether it's as a as a rub or if it's a psychologist and a can't see them not it's not a good match for Meander said you know part of self-awareness understand not every not every patient is good for you you know that's also part of the self- awareness but but the the first thing I would just say just going stepwise is that it's a it's anas both to give the the the referral and understand that that's a mandate that we have but when I give a referral I feel very strongly it's my responsibility I tell the person I said I take the responsibility of giving you a referral very seriously that I'm going to look care carefully at you I'm going to talk to you I want to get a better understanding because I can't just throw you know throw a dart at a board and say oh this person says he's good for this this this woman's good for that that's that's not okay I think that there is there has to be an element of of research to a degree that a person can because the because there is a lot of responsibility a lot of that we have and we do give a referral largely because of the response that Dr Alexander mentioned very often we're not n we're not going to know always if it's a perfect sh but we have to try our best to make sure that at least to the best that we can that that that it is to to to the degree what when I look for myself if I know people personally if I the first thing that I look for is it really touches on things that we're speaking about here in a different way is I I look first is a person a mench is the person I'm referring to is a mench of person and that and mention it's full of sense is a person's Yer the person's going to keep confidentiality the person cares about you the person's going to be Etc people like what do you mean because unfortunately there are duds who are not just Duds because they are duds like we make mistakes but there people who are unethical unfortunately and I think it's a big responsibility after that you look for training is the person well trained is the person have a good background you know especially in Israel where it's a little bit more laxed but in the states we're all very particular to licensing boards we have we have we have we have we have degrees from accredited universities you want to check a person's training to make sure that there that there there's comp there's certain Baseline level of Competency and then the last piece which I think is really to a degree with Dr Alexander was alluding to is then you don't know it's a little bit like a sh you try your best especially when it comes to therapy you know you hope you hope you hope it's a you try your best yeah I think you'll be a good fit this ruing will be a good fit with shim I'm going to I'm trying my best now the last piece and and is that if I can't do that because I don't know the people we don't know everybody our our our our circle of of of awareness of influence is is limited so then I'll do exactly what Dr aland mention then you start to look for people then you have to you can ask people we ask colleagues you a lot of different networks and we capitalize on that Network to look for people like that but even when I do that I personally qualify I say look this person I think is a good I don't know him personally and then particularly in scenarios like that I make it my business of whatever capacity I'm I'm serving in just to follow up and say by the way hey I I I referred you to so and so uh a month ago just how's how's it going I don't want to know anything else I'm not I'm not prying I don't want to know about the care you feel like it's moving in the right direction and very very often not often always people are very appreciative oh you didn't you didn't just Punt and you know kick kick me away the answer is no like I really care about you so I'm just I'm not prying I don't want to know anything about the clinical care right now I just want to know are you feel like you're growing you feel like you're moving in the right direction do you feel like there's anything I can help you with support and that's it okay it's 402 we said we would end at four um I have a five o' meeting in Modine so I have to go myself I I just want to say uh uh two last things this was the one session that we didn't even talk about the war and I think that that's important because uh this is important in the war but it's also important after the war and I know that when we spoke Rabbi sha and and and and zamir and I um we spoke about this really just being a beginning and uh and we mean that we want to see what else could happen so please let us know you know what you think of today what you thought of today and let's all try and figure out how we can make this more than just a one day conference so that's uh what right um and I just want to end off very personally about something um you know I I've never been at a conference where I cried and I cried twice today once when Rabbi Howard was speaking and once when Rabbi BT was speaking I won't go into uh why at this point cuz because it's late but both of them had to do with we heard every speaker except on this panel because this is a little bit more technical say yeah and I'm basically summarizing you could learn all the theories and you could learn all the research and all the techniques and all that but we heard everyone say basically that the most important thing is just our presence and being with people right and that's really I think uh what we have to offer I just want to end uh B based on what I just said I just want to end with a quick story so two weeks ago I'm in a t-shirt store in mud um my son had his Mas you know when you get your he was in Sim you got his red beret at the end of uh his uh training and we're ordering shirts because that's what you do when you go to a masak you know something funny and the picture and the inity of the all that so I'm standing at the at the counter on one end paying there are three people behind the counter workers somebody walks in and comes up to the cash register and says the following he says my son was killed in the Nova festival and in a week we're having a ceremony at the site of the Nova Festival um with the family and friends we want to make t-shirts can you help us so the guy says yes we can help you silence and then they just go about the the ordering the t-shirts so I was busy paying for mine and like around 60 seconds later I walked over to him and sorry I said you know and I asked him what his son's name was and I took his hand I just squeezed it and when I tried to take my hand away he squeezed it he wouldn't let go and it took 60 seconds but I felt I'm not trying to say this to a k by self credit I have some Rabbi training and I give rabic training so uh what I'm saying is is that it's it sometimes it's just so simple that we miss it right that we don't think to do it because it's just so simple now those workers were not bad people right they didn't not want to be sensitive they're just uncomfortable talking about it they don't know what to do but we know what to do we've done it and I think that sometimes the simplest act 30 seconds 60 seconds taking someone's hand putting your arm around well I know you're not supposed to do that whatever but uh uh um you know uh these kinds of simple acts I think could have the greatest effect and really show that we want to be with somebody which all our speakers really said at the end of the day was the most important thing so thank you very much for coming be in touch thank you to our wonderful [Applause] [Music] panelist