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Journal of Sex & Marital Therapy

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Modifying Sensate Focus for Use with Haredi (Ultra-Orthodox) Jewish Couples
David S. Ribner a a School of Social Work, Bar-Ilan University, Ramat Gan, Israel. Online Publication Date: 01 March 2003

To cite this Article Ribner, David S.(2003)'Modifying Sensate Focus for Use with Haredi (Ultra-Orthodox) Jewish Couples',Journal of

Sex & Marital Therapy,29:2,165 171

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Journal of Sex & Marital Therapy, 29(2):165171, 2003 Copyright 2003 Brunner-Routledge 0092-623X/03 $12.00 + .00 DOI: 10.1080/00926230390155050

Modifying Sensate Focus for Use with Haredi (Ultra-Orthodox) Jewish Couples
DAVID S. RIBNER
School of Social Work, Bar-Ilan University, Ramat Gan, Israel

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Marital and sex therapists have long recognized the role that religion may play in the etiology of sexual dysfunction. Considerably less attention has been paid to religious standards for sexual conduct as a couples voluntarily accepted behavioral context. A therapist working in accord with such belief systems may require creative modifications of treatment protocols to maximize potential for change while minimizing sources of resistance. This article examines inherent challenges that occur when using aspects of sensate focus with Haredi Jewish couples as a result of adherence to traditional rules defining and influencing intimate behavior and suggests treatment alternatives for clients of this population. Marital and sex therapists have long recognized the role that religious beliefs may play in the etiology of sexual dysfunction (Bullis & Harrigan, 1992; Masters & Johnson, 1970; Simpson & Ramberg, 1993). The perceptual conflict of whether sex is good or bad and the behavioral challenge of shifting from absolute celibacy to sexual union have been recorded in the professional literature (Jehu, 1979; Parrinder, 1987). Considerably less attention has been paid to religious standards for sexual conduct as a couples voluntarily accepted behavioral context, which substantially defines the therapeutic framework (Burt & Rudolph, 2000; Simpson & Ramberg, 1992). Working in accord with such belief systems may necessitate creative modifications of treatment protocols in order to maximize potential for change while minimizing immutable sources of resistance. This article examines the use of aspects of sensate focus with Haredi Jewish couples and the inherent clinical challenges resulting from their adherence to traditional rules defining and influencing intimate behavior.

Address correspondence to David S. Ribner, School of Social Work, Bar-Ilan University, Ramat Gan, Israel 52900. E-mail: matzeel@hotmail.com

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THE HAREDIM
The word haredi (plural: haredim) means God fearing and refers to those within the Jewish community whose lives are governed by scrupulous observance of Jewish law in order to come closer to God (the term UltraOrthodox is often used to refer to this population). Any deviation from Divinely ordained Biblical requirements generally is unacceptable; the emphasis is placed on stricter rather than more lenient legal interpretations, resulting in higher levels of spirituality. The focus is not on asceticism, but rather a belief in Gods active involvement with humanity, which leads to the need to sanctify all aspects of daily life. The following are common to all Haredim:
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Modes of dress that are modest and tend to be uniform, particularly for males; Relatively specific gender role expectations, including social and occupational interactions; Central values of marriage and large families; Strict prohibition of male-female physical contact before marriage and explicit rules governing contact after marriage; Gender-segregated educational institutions starting from pre-school; Daily prayer and study of religious texts, which are more communal for men than for women; Living in Haredi neighborhoods and, wherever possible, making use of exclusively Haredi communal institutions. Professional help for personal, family, or communal problems that must conform to religious guidelines, with only life or death situations permitting any deviance.

SEXUALITY IN TRADITIONAL JEWISH MARRIAGE

Sexuality in traditional Jewish marriage has been well documented (Friedman, 1997; Linzer, 1970; Ostrov, 1978) and will be discussed here only briefly. Judaism understands marriage as fulfilling two equally important functions: procreation and human completion. This latter point means that single adults are viewed as essentially unfinished, with wholeness coming only through the partnership afforded by marriage. The Biblical phrase It is not good for man to live alone (Genesis, II, 18) is understood not as sage advice but as part of the blueprint for creation (Soloveitchik, 2000). Sexual expression is exclusive to the marital relationship and is essential to the physical and spiritual well-being of both partners, as manifest in the mutual obligation to provide sexual pleasure. Withholding of physical intimacy is grounds for divorce, and forced sexual contact is expressly forbid-

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den. Jewish law has relatively little to say about actual sexual activity between marital partners, although time plays an important role, as will be noted below. As the general public has become more attuned to definitions of sexual dysfunctions and options for treatment, so, at its own pace, has the Haredi community. However, a dearth of adequately trained therapists has proven an impediment to those desiring access to trustworthy professionals. Traditionally, this gap has been filled by various communal functionaries, such as rabbis, their wives, and more recently, paraprofessional premarital advisors for both men and women. A condition of sex therapy with Haredim is that the couple may consult a rabbinic authority at any or all stages of treatment. Although the rabbis primary operating principle will be the couples sexual compatibility and satisfaction, he may require modification of specific treatment suggestions to conform to religious dicta.

THE USE OF SENSATE FOCUS

According to Kaplans (1974) definition, sensate focus is a two-step interventive model that emphasizes tactile, verbal, and visual interaction and that is designed to achieve an enhanced level of physical pleasure without any expectation of performance or the need to reach orgasm. The exercises, carried out with both partners naked and in a relaxed state, emphasize sensory selfawareness by each participant and the transmission of knowledge of these feelings to the partner. Sensate focus with Haredi couples has the potential to be a particularly effective therapeutic tool. The lack of premarital sexual experience for almost all of this population, combined with cultural imperatives such as modesty in all realms of human behavior, fits well with this technique, which can be adapted easily to cultural expectations and client comfort level. However, four factors, which pervasively influence Haredi sexual norms, should be taken into account at the outset of the treatment process.

Modesty
The biblical phrase and you shall walk in modesty with your God (Micah, VI, 8) is understood by the Haredim as a principle applicable to almost every aspect of daily life. Although modesty in dress is the most recognizable manifestation of this standard, it has relevance as well to a couples intimate life. It should be noted here that this tenet does not mandate sexual intercourse through a hole in a sheet, an example of erroneous common knowledge frequently ascribed to this religious population. Sensate focus encourages an opennessphysically and emotionally that can be perceived as antagonistic to the value of modesty. Using sensate

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focus while maintaining Haredi values can be more readily accomplished under the following conditions: For the overwhelming majority of Haredim, there will have been no premarital physical contact with the opposite sex or any opportunity to see someone from the opposite sex not completely clothed. Although total nudity is the encouraged norm of marital sexuality, the experience of being unclothed or being with someone in the same state may be an ongoing source of discomfort. This should be a focus of empathic understanding, and the therapist should legitimize the awkwardness of the couples physical and emotional self-revelation. The therapist must take into consideration the tolerance levels of both spouses and the time each will need to gain comfort and mastery of new expectations regarding the removal of clothing and the treatment protocols for mutual touching. In line with this, the therapist should consider a more graduated version of sensate focus that is specific to each couple and designed to maintain a sense of modesty and to avoid sensory overload. This can be accomplished by beginning with both partners wearing familiar night clothing and pleasuring each other using only back massage. Progressive stages can move from nongenital front massage to unclothed-to-the-waist back massage to fully naked back massage, and so forth. The therapist must make a clinical differentiation between a normative ambivalent response to previously forbidden and now permitted activity and the problematic use of modesty as a tool for maintaining distance or achieving control. Therapists must expect fear of new sexual experience and its implications for various levels of intimacy and openness among those for whom nudity with another, as an example, may have no personal paradigm. However, when the invocation of modesty serves a dynamic rather than sacred function, it is no longer a therapeutic context but the focus of therapy itself. Such lines may be finely drawn, necessitating consultation and possibly more direct involvement with a rabbinic authority to clarify religious boundaries.

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Time
Traditional Jewish law prohibits any physical contact between spouses during the days of menstruation and for a week after. It encourages the couple to engage in nonsuggestive conversation and physical distancing, including not passing items from hand to hand or not drinking from the same cup. Observance of these Laws of Family Purity is considered an inviolate and integral aspect of identity as an Orthodox Jew. This 2 weeks on/2 weeks off pattern of contact characterizes marital life until menopause, with two notable time frame exceptionspregnancy and nursing (until postpartum menstruation resumes)when uninterrupted contact is permitted. As a consequence of these observances, the sequential nature of sen-

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sate focus will almost inevitably be interrupted, at times with breaks lasting even longer than 2 weeks (e.g., during some instances of prolonged vaginal bleeding). For a therapist respecting the given structure, we raise the following observations: These regular breaks can serve as natural time boundaries separating one phase of treatment from the next and as a time for practicing without anxiety about coping with a looming next task, as well as for providing an upper limit before a definite off time. There is little risk of a therapist forcing a phase into a too long or short of a time frame because the 2 weeks when touch is permitted presents a treatment option not an immutable standard. The intervening days when physical contact is forbidden offers an opportunity to enhance the nonphysical aspects of marital intimacy. A couple experiencing the contrast between the two facets of a spousal relationship can integrate both; they can strive to achieve these simultaneous two aspects when touch is renewed and emphasize the genuineness of intimacy when physical contact is temporarily suspended. When physical contact recommences, several days of the previous phase of sensate focus should be repeated before going on to the next step. This allows for an easier transition from a positive known experience to a possibly untried anxiety-provoking new one.

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Communication
Normative development and socialization within the Haredi community discourages the acquisition of language that specifically describes sexual organs, particularly of the opposite sex, and sexual behaviors. In recent years, this has somewhat been ameliorated through the use of premarital advisors to prepare brides and grooms for their sexual lives together. Even this educational advancement, however, does not seek to achieve a comfort level with sexual terms and norms, only a familiarity. Thus, the very language of sex therapy can raise a couples anxiety level when the initial goal is to lower it. I recommend the following: Both spouses should agree upon a comfortable language of intimacy before beginning any actual contact exercise or at least before reaching a phase that involves erogenous areas. Jewish religious literature contains many metaphoric phrases to connote sexual organs and activities (e.g., the organ to mean penis and that place to mean vagina). Clients should be encouraged to use properly specific words with which they are most at ease. This will doubtless be a learning process for many therapists, as well. The therapist should be sensitive to different guidelines related to norms of modest behavior for sexual communication between the two genders.

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Haredi women are socialized to be less verbally explicit regarding their intimate desires and to make primary use of nonverbal cues, whereas men have more leeway in this regard. Unless this code of behavior is expressly viewed as problematic by either spouse, the therapist should see this situation as a creative challenge in which all participants strive to achieve a clear, reciprocal, and culturally comfortable method for conveying and hearing sexual messages.

Ejaculation
As noted earlier, Jewish tradition sees procreation as one of the two primary functions of sexual union. Consequently, nonvaginal ejaculation, which prevents the possibility of pregnancy, falls outside the category of acceptable sexual activity. Although sensate focus is not designed to result in orgasm, arousal may occur sufficient to reach ejaculatory inevitability. Should this occur, the mans resultant feelings of guilt, shame, and anger may be directed at the therapy and therapist and may lead to the couple ending treatment immediately. As noted earlier, it is essential that the couple be encouraged to confer with their rabbi before initiating treatment, with the option of rabbi-therapist consultation at any stage. This will be particularly important when dealing with problems such as retarded ejaculation, where the treatment of choice may require temporary ejaculation outside the vagina. We suggest a three-step approach to forestall a negative outcome: Haredi couples initially should be given permission to engage in full sexual intercourse at any point during sensate focus exercises when the husbands arousal may approach his control threshold. I direct couples to take no chances, which generally produces a lowered state of anxiety. With the above in mind, it is useful to attempt to define these exercises, at least in the initial nongenital phases, as relaxing and pleasurable rather than as intense and sexual. Helping couples create such an atmosphere can lower sexual expectations and avoid, or at least delay, an advanced stage of arousal. In several cases, I have instructed couples in the use of the squeeze technique to reduce arousal and allow for the exercise to continue without the need for intercourse. Such an intervention is predicated on the husbands capacity to recognize his arousal pattern sufficiently to indicate when the squeeze should be done, and on his wifes willingness to do so.

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CONCLUSION
In the Haredi world, sexual satisfaction in marriage is deeply rooted in the fundamentals of Divine creation and accepted notions of how the universe

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should operate. Consistent with this principle is the acknowledged responsibility of the couple to fix a faulty situation when needed, as an example of striving for perfection. It is this context that allows professionals to be called upon when couples themselves reach a stage of frustrated helplessness. However, a non-Haredi therapist working with Haredi clients confronts a dual challenge: earning the trust of this somewhat insular community and adapting intervention techniques that pose no threat to its values. Clearly, if essential values are respected, mutual trust becomes a realistic objective. The model that I suggest here is consistent with the norms and beliefs of my Haredi clients (and their rabbinic authorities) and may be adaptable as well to other traditional populations whose sexual values represent uncharted territory for clinicians. In such situations, tolerance, respect, and creativity will enable the clinician to assist without compromising the integrity of any participants in the therapeutic process.

REFERENCES
Bullis, R. K., & Harrigan, M. P. (1992). Religious denominational policies on sexuality. Families in Society: The Journal of Contemporary Human Services, 73, 304 312. Burt, V. K., & Rudolph, M. (2000). Treating an orthodox Jewish woman with obsessive-compulsive disorder: Maintaining reproductive and psychologic stability in the context of normative religious rituals. American Journal of Psychiatry, 157, 620624. Friedman, A. P. (1997). Marital intimacy: A traditional Jewish approach. Northvale, NJ: Jason Aronson. Jehu, D. (1979). Sexual dysfunction. New York: Wiley. Kaplan, H. S. (1974). The new sex therapy. New York: Brunner/Mazel. Linzer, N. (1970). The Jewish family: A compendium. New York: Commission on Synagogue Relations, Federation of Jewish Philanthropies. Masters, W. & Johnson, V. (1970). Human sexual inadequacy. Boston: Little, Brown. Ostrov, S. (1978). Sex therapy with orthodox Jewish couples. Journal of Sex & Marital Therapy, 4, 266278. Parrinder, G. (1987). A theological approach. In J. H. Geer & W. T. ODonohue (Eds.), Theories of human sexuality (pp. 2148). New York: Plenum Press. Simpson, W. S., & Ramberg, J. A. (1992). The influence of religion on sexuality: Implications for sex therapy. Bulletin of the Menninger Clinic, 56, 511523. Soloveitchik, J. B. (2000). Family redeemed. New York: Toras HoRav Foundation.

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