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Sexual Misconduct and the Question of Rehabilitation Nachum Binyamin Klafter, MD November 27, 2012

There are, presently, a number of scandals in England, Israel, and America involving rabbis who are alleged to have engaged in forbidden sexual relationships with large numbers of women. I have personally heard first-hand allegations from victims, and highly credible second-hand reports from the victims psychotherapists and close relatives, against three individuals. In two cases, the rabbis advertised themselves as psychotherapists and developed large and lucrative practices as glatt-kosher, frum therapists, who practice according to Torah-based principles rather than the assumptions of modern psychology which originate in the secular world. Neither of those therapists is licensed. In the third case, the accused is a senior rabbinic figure who serves as the manhig of important religious institutions, including serving as a Dayan on a Beit Din. He has been the spiritual guide for numerous congregants and community members. Individuals close to these scandals have asked for my assistance in advising rabbonim about how we can discern which rabbis or therapists who have violated sexual boundaries can be rehabilitated if they receive the proper help and treatment, and which cannot be rehabilitated and therefore should simply be removed from their professions so they will no longer have access to vulnerable individuals. I have prepared the following brief essay on this topic, which I thought would also be of interest to the Nefesh Organization. You are all free to share this with anyone who you think would benefit from it. The following information is relevant both to mental health professionals who provide psychotherapy treatment, and to rabbis who provide spiritual guidance in the form of pastoral counseling. For the purposes of this essay, I intend no important distinctions between the terms therapist, counselor, or psychotherapist. All refer to mental health professionals who are providing talk-therapy for individuals suffering from psychological disorders or emotional distress. Many rabbis who serve as pastoral counselors provide not only spiritual guidance for spiritual problems, but also emotional assistance for psychological difficulties. Therefore, the term counselor may also refer to the role of a rabbi. The term client will be used throughout this essay to refer to either a patient in treatment by a mental health professional, or a congregant or talmid receiving spiritual guidance from a rabbi.

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When a client comes to a therapist for treatment or to a rabbi for spiritual guidance, he or she is called upon to reveal his or her emotional difficulties and spiritual problems. Revealing shameful and painful feelings and experiences makes the client extremely vulnerable to the counselor. The counselor, however, remains in a relatively protected

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position, offering advice or insight but not sharing his or her own difficulties, and therefore is not emotionally vulnerable to the client in the same manner. This situation is therefore extremely asymmetrical in that there is a great power differential between the client and the therapist or rabbinic counselor. In such relationships, it is very easy for the client to develop exaggerated feelings of admiration, dependency, and love for the therapist or rabbi. Alternatively, some clients may feel resentful of being disempowered and vulnerable, and these feelings may cause them to act desperately or aggressively in order to attempt to reestablish a sense of equity in the relationship. In order to avoid being in a submissive, dependent role, a client may try to change the nature of that relationship in order to assume a different role as the counselors friend, colleague, or even lover. It is therefore extremely important for therapists and rabbinic counselors to make certain that they do not exploit the power differential inherent in counseling relationships. The term, boundaries, is used to delineate the conduct between client and counselor which will preserve the integrity of the helping relationship, such that the counselor is primarily serving the client's needs, and not vice-versa. For example, if a therapist is treating an accountant for anxiety and depression, it would be a boundary violation for that therapist to ask the accountant to provide professional accounting services for him or her as a favor. The client may be very happy to do so, for all sorts of emotional reasons. But now, rather than simply paying money in order to receive the counselors professional services from the therapist, the client is now also providing his own professional services for the counselor at no charge. When boundaries are not intact, clients are vulnerable to exploitation. The term, sexual boundaries, refers to the universally accepted rule of ethics in both rabbinic counseling and all professional mental health disciplines (counseling, social work, psychology, and psychiatry) which states that it is always a violation of ethics for a rabbi or therapist to engage in any sexual activity with his client. Sexual activity completely destroys the integrity of the counseling relationship. The counselor is no longer devoted to providing professional counseling services in the clients best interests, but is now acting in order to gratify of his own sexual wishes. This makes it impossible for the client to receive any real spiritual guidance or true emotional assistance. Sexual activity between a therapist and a client, or between a rabbi and congregant, cannot be understood in the same way that we think about typical sexual relations between two consenting adults. The reason we must understand it differently in this context is because of the above-mentioned power differential and vulnerabilities which are inherent in a counseling relationships. We believe that most clients (seeing a therapist for emotional assistance or a rabbi for spiritual guidance) will be in a state of diminished capacity to say "no" when solicited for sexual activity. It is also the universal consensus of therapists, rabbis, and researchers that a sexual relationship with one's spiritual leader or mental health counselor is nearly always destructive, causing long-term detrimental effects for the client. It typically precipitates a mental health crisis, including increased risk for suicide. In cases of boundary violations by clergy, there is also typically

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a spiritual crisis resulting in a sense of profound betrayal ones religious authorities and institutions, often leading to an abandonment of religious life and a rejection of previously held religious beliefs and values. In all disciplines of the mental health profession, any sexual activity with a current or former patient/client is absolutely prohibited and is grounds for professional disciplinary action, typically involving suspension or termination of one's license. In some jurisdictions, this is also subject to criminal prosecution. Similarly, sexual misconduct by Rabbis is obviously forbidden by the halakha just like any other sexual activity outside of marriage, but it is further reprehensible than usual sexual prohibitions because of the destructive impact on the client's spiritual and psychological well being. It is worth noting that there are also some jurisdictions where sexual misconduct by clergy has been criminalized. Rabbis and mental health professionals are, themselves, only human. The vast majority of clergy and mental health professionals conduct themselves admirably and do their best to act at all times in their clients' or congregants best interests. However, a small minority of therapists and rabbis, at one time or another over the course of their careers, have exploited their clients by taking advantage of them sexually or financially. Researchers who study this phenomenon estimate that between 2% and 10% of therapists have engaged in sexual relations with their clients. In other words it is estimated that between 90% and 98% of therapists have never violated sexual boundaries with their clients. Researchers have studied the same phenomena with clergy, including rabbis, and the numbers are the about the same: It is estimated that between 2% and 10% of Rabbis have engaged in sexual contact with their congregants or students. When it has been clearly established that therapists or clergy have engaged in sexual boundary violations with their clients, one of the first questions asked is whether the therapist or rabbi can be helped by treatment and supervision in order to be rehabilitated for the purposes of returning to his professional role in a manner that we do not expect a continued pattern of sexual boundary violations. Researchers who have studied clergy (including rabbonim) and mental health professionals who violate sexual boundaries have developed four categories under which the offenders can be designated. The following summary of these categories has been adapted from the classic text by Glenn Gabbard and Eva Lester, Boundaries and Boundary Violations in Psychoanalysis (Washington, DC: American Psychiatric Publishing, Inc., 2002). Some minor modifications reflect my professional experience evaluating therapists and rabbis who have committed misconduct. 1) Lovesick offenders: These individuals typically have a long history of proper and ethical professional conduct over the course of their careers. However, these individuals have essentially fallen dangerously and pathologically in love with a client, and what was once a professional relationship has become a sexual relationship. By "pathologically in love, I mean that this love the leads to behaviors which are destructive for everyone involved. Typically, this episode of sexual misconduct is highly out of character for lovesick offenders, usually a one time occurrence in the course of their careers. These individuals typically feel extremely remorseful when they realize that the client has been

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emotionally harmed. They typically will willingly pay for treatment of the victimized client by another professional to achieve recovery from this emotional damage of the boundary violation. Lovesick offenders will typically be willing to surrender their licenses or agree to step down from their rabbinical posts while they engage in a form of rehabilitation treatment. They agree to have their psychotherapeutic or pastoral counseling supervised by a more senior colleague. The lovesick offender is typically sincerely interested in helping the individual that he has harmed. In the course of their rehabilitation therapy, we often see that these counselors were going through a divorce, suffered a recent death of a loved one, suffering from physical illness, or experiencing some other form or loss which made them more vulnerable than usual, and extremely needy for the clients admiration and affection. These individuals can generally be properly rehabilitated with therapy and extended supervision. The therapy they require will typically focus on the fact that their own (i.e. the Rabbis' or Therapists') emotional vulnerability caused them to misinterpret the admiration and gratitude typical in a counseling or rabbinic pastoral relationship and experience it as though it were the erotic love of a healthy, mature, relationship between two consenting adults. These individuals are generally not defensive or aggressive, and do not threaten their victims in order to intimidate them from reporting the misconduct. They often require good legal representation because they are very bad at advocating for themselves. They feel truly remorseful about having lost their professional judgment and indulging a relationship which caused harm to the individuals they were responsible to help. 2) "Selfless"Offenders: Like the first category, these individuals typically have a history of proper professional conduct, and the sexual misconduct is highly out of character for them. However, these individuals have difficult saying "no" or setting limits. Counselors in this category often like to think of themselves as "selfless" and "giving", and go out of their way to be generous and helpful even at their own expense. Oddly, the relationship turns sexual not because of aggression on the part of the therapist, but because the client is extremely demanding for emotional gratification and special treatment. The asymmetry of the therapeutic relationship causes the client to feel very vulnerable, but the counselor responds to this vulnerability by indulging the client's requests for extra time, extra contact, hugs, hand holding, special treatment, meetings outside of professional hours or outside of the office, extra affection, etc. The therapy or spiritual counseling gradually loses all semblance of a professional relationship and starts too look like a friendship and then a romantic courtship. One of the striking features about this pattern of boundary violations is that the offending counselor feels unable to say "no" because he is afraid of rejecting or refusing the client. He may actually believe that he is saving the client, despite the fact that this sexual relationship is ultimately destructive. Selfless offenders often do not enjoy these relationships and only wish they could stop them, but feel trapped, stuck, and over their heads. This pattern is probably the most commonly observed among violators who seek the help of a colleague in order to stop the boundary violations. They can be rehabilitated but require a more extensive psychotherapy than the first category because of an underlying personality imbalance which makes them vulnerable to seductive and demanding clients. This is be a long term risk factor for this

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happening again, and long term supervision by experts to help them manage boundaries in their professional work is imperative. Like the previous category, these individuals do not threaten their clients and are typically cooperative with investigators. However, in my experience, these individuals have difficulty seeing that they have actually caused harm to their clients. They have difficulty understanding that their clients were operating in a state of diminished capacity. They often feel that they are the injured parties and are reluctant to see themselves as perpetrators who have harmed others. 3) Psychotic Offenders: This is the simplest category to understand. The counselor or rabbi who is a psychotic offender has become mentally impaired, and simply lacks the judgment to conduct himself ethically. This is completely out of character with the individuals normal state of functioning. It may be due to a brain tumor, dementia, a stroke, a psychotic break due to major mental illness. The title chapter of Irvin Yaloms well known book, Loves Executioner and other Tales of Psychotherapy (Penguin Books), portrays the aftermath for the victim of a sexual boundary violation by a therapist who became psychotic. Psychotic offenders can be rehabilitated if the underlying medical or psychiatric illness can be successfully treated. 4) Predatory Offenders: These individuals, unlike the first 3 categories, show the following characteristics: a long history of exploiting multiple clients sexually over many years; i.e., sexual contact with clients is not out of character for these offenders characteristic methods to groom clients for sexual exploitation purposeful selection of clients who are the least likely to report the misconduct due to their low self-esteem and lack of assertiveness threaten clients with retribution, humiliation, lawsuits, or other forms of harm in order to intimidate them from reporting the misconduct often pretend that they are in love with the client and that these loving feelings are unique and unprecedented, while in reality they are doing this with multiple clients simultaneously have skillfully avoided numerous allegations and complaints of sexual misconduct over time through skillful lying and aggressive political tactics such as threatening their concerned colleagues with lawsuits for libel or slander, or fabricating allegations against them severe arrogance lack of regard for others in general, not limited to the clients they have exploited absolutely no remorse; often feign remorse but their behavior (i.e., continuing to lie, threatening their other victims to intimidate them from making accusations, etc.) reveals that they in truth feel no remorse unlike the above categories who readily submit to supervision and cooperate with investigators, predatory offenders deny wrong doing, continue to lie, and will not cooperate with investigators they make no actual attempts to stop their behavior

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sometimes discovered to be habitual liars in general, and have often committed financial fraud, professional ethical infractions, and/or other criminal acts often extremely charismatic and superficially impressive often extremely self-righteous and indignant to such an extent that they feel justifying in making threats, filing lawsuits for slander and libel, etc., despite it being very clear that the allegations against them are valid They cannot be rehabilitated. Typically there have already been multiple attempts at rehabilitation which have all failed. They need to be removed from counseling or from the rabbinate, and need to pursue a line of work where they will not have an enhanced potential to victimize vulnerable individuals.

It is also worth clarifying two other points about predatory offenders. First of all, it is important to recognize that sexual exploitation does not only take the form of sexual intercourse or other acts of direct sexual contact. Some predatory offenders abuse their patients with other sexual behaviors which, despite being perceived by laypersons as less serious, nevertheless constitute exploitation of clients by the counselor to whom they have put their trust in for guidance, and therefore cause them massive psychological and spiritual harm. For example, I am aware of a predatory violator of sexual boundaries who would not allow the clients he was victimizing to touch his body in any way; he instead had them lie naked and masturbated while gazing at their bodies. Another demanded that his male clients submit to rectal examinations. A third instructed his clients to engage in sexual talk with him by telephone. (These are not the same individuals who were alluded to at the beginning of this essay). Secondly, the predatory sexual offenders I have learned about over the years have also engaged in many other bizarre and exploitive practices, distinct from sexual boundary violations. Here are examples: charging exorbitant fees, far higher than even the most prestigious and well-trained psychotherapists or psychiatrists in any major city, e.g. $500.00/hour; holding sessions for three, four, or even six hours at a time; instructing child clients to play alone with toys in another room during treatment sessions while the counselor attends to paper work; demanding to be flown first-class to other countries in order to attend professional conferences; borrowing money from clients (which would be bad enough) and failing to repay them; pressuring clients to persuade their relatives and friends to also come for treatment to the same counselor; directing their clients to procure illicit drugs for them; advertising phony credentials on their rsums; lying about their training and licensure status; inventing new modalities of treatment which are physically dangerous for patients and have no proven or even plausible method of efficacy; selling nutritional supplements or other organic products at exorbitant prices; harassing patients who have attempted to stop their treatment in order to coerce them to return for more sessions; etc. Therefore, in many cases of predatory sexual boundary violations (actually all the cases I am personally familiar with), additional bizarre, and exploitive practices raise questions about whether such practitioners are providing any real therapy at all. When counselors are licensed, there is at least recourse to report irregularities to licensing boards. When counselors are unlicensed, there is no recourse

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to curtail their treatment other than civil lawsuits or, if relevant, criminal prosecution. This is one of the reasons why licensure is so important. Even though licensure, in itself, does not guarantee competence or high quality of service provided, it at least indicates that a practitioner has been trained in the conventional modalities of therapy at an accredited institution, and provides a venue for unsatisfied or harmed parties to register a formal complaint. Confusion over the issue of TESHUVA with predatory offenders: I recently heard testimony from the victim of a predatory rabbi/therapist who was discovered to be engaging in sexual relations with numerous clients, all of whom were frum, married women with many children. He was mandated by a Beit Din to attend therapy for rehabilitation, to help him stop committing these boundary violations. He was believed by the rabbis who investigated him to be sincere, and to have made a genuine commitment to teshuva, and therefore was allowed by the Beit Din to continue practicing therapy in consideration for his familys dependency on his parnassa. He made a promise to stop seeing women for counseling, and signed an agreement to that effect which was also signed by two witnesses. However during the entire time he was involved in his rehabilitation therapy, which occurred after the signed an agreement to stop treating women, he continued to see women for therapy appointments and to have sexual contact with, including the victim I spoke with. In his banter with her during their sexual encounters, this rabbi/therapist mocked the therapist who was attempting to oversee his rehabilitation, calling him a stupid, incompetent, fool. The rabbonim who were believed he was in a sincere teshuva process had no way of monitoring whether he had in fact stopped seeing women. They made no attempt to monitor this. They made no attempt to interview other clients he had seen, and made no attempt to see how widespread his boundary violations were. In fact that they were entirely unqualified to assess anyones suitability for rehabilitation. They had no real mechanism of enforcement since he is unlicensed as a therapist. They accepted this rabbi/therapists claims of repentance at face value. My experience is that this type of investigation is the rule and not the exception when boundary violations are handled without the involvement of professionals or legal authorities. It is also my experience that when the primary objective is to prevent chilul HaShem rather than to prevent further violation of innocent clients, the victims are threatened with humiliation in order to prevent them from sharing their allegations with others. Therefore, the victims who have come forward are re-victimized. Because teshuva is a basic yesod in Torah Judaism, many rabbonim make a seemingly reasonable assumptions that predatory perpetrators can be rehabilitated because the forbidden sexual behavior is best understood in their view an issue of sin and teshuva. A lengthy exposition on this topic is beyond the scope of this brief essay, but a few points are in order: First, if a predator would sincerely engage in a sincere teshuva process, then he would voluntarily agree to leave that profession so he won't be tempted to harm others. If were doing teshuva, he would not continue lying and threatening his other clients, or continue his zenut with other clients while in the midst of rehabilitation. Some

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rabbonim cite the Rambam's famous description of teshuva me'ulah (ultimate repentance), represented by the ability of the penitent to now control his yetzer, even while in the same room with the same individual with whom he had previously sinned. There are numerous problems with this kind of thinking. Foremost, teshuva meulah is irrelevant to dinei Torah or ethics investigations, because whether someone has attained teshuva meulah can only be known by HaShem, Himself. We, as mortals, cannot attest to someone else's teshuva me'ulah and vouch for their ability to be overcome the same nisayon. Our primary responsibility needs to be to protect the public. The extensive, universal consensus of expert opinion about boundary violations is that predatory professionals cannot be rehabilitated. Our attitude must be the following: Yes, I hope that this offender will succeed in completing the process of teshuva one day, but that is an issue between him and G-d. As far as we are concerned, he cannot serve as a rabbi or therapist ever again. Predatory offenders have long histories of denying and lying to cover their misdeeds. It is difficult for some rabbonim to fathom the extent and depth to which dishonesty has penetrated the character of such a person and become a basic feature of his personality. Some rabbonim naively believe that they can sit down and reason with predatory offenders. They ask them to sign agreements, and force them to make solemn pledges that they'll never do this again. Such agreements are simply meaningless with predatory offenders. All cases of boundary violations need to involve a consultation and evaluation by a paid professional with expertise in professional ethics and misconduct. That professional needs to be from a different community, so that he/she will be free of all social, rabbinic, and communal pressure. The findings need to be shared with lay leaders as well as with rabbonim. Education for rabbonim and lay leaders about why it is unrealistic to rehabilitate predatory offenders would be an essential part of the consultation process. Summary: Predatory offenders show very different behaviors and characteristics than the other counselors who have violated boundaries. An experienced clinician can reliably determine whether a given offender is predatory, and therefore can make a very informed recommendation about whether he should can be rehabilitated. While there is not a guarantee that all offenders from categories 1, 2, or 3 will be successfully rehabilitated, there is indeed an absolute guarantee that offenders in category 4, "predatory offenders", cannot be rehabilitated. *** I hope to soon address the following related topics, which are beyond the scope of this brief essay: A critical review of Torah-based therapies The phenomenon of unlicensed therapists in ultra-Orthodox communities, and why they are dangerous for members of our kehillot Confusion about teshuva vs. rehabilitation for rabbis and therapists who have violated sexual boundaries or committed financial improprieties

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-Nachum Klafter, MD 7502 State Road, Suite 2280 Cincinnati, OH 45255 (513)474-8900 FAX(513)233-6693 doctorklafter@cinci.rr.com