From time to time I meet with a couple suffering from anxiety related sexual dysfunctions who also have halakhic questions connected to the problem.  Some of the halakhic questions are complex and hard to answer and others are simply a matter of not having been educated properly by their chosson or kallah instructors.  When I ask if they have consulted with a rabbi about their halakhic questions, some will say they are too embarrassed, or fear the reaction, or the answer. This puts me in a position of conflict.  On the one hand, especially when I know “the answer”, I want to relieve them of the stress and help them by telling them, “it’s permitted”. I put quotations around the words “the answer”, knowing of course, that when it comes to halakha there is no one answer. Certainly in halakhic matters that are rooted deeply in custom, values, and are highly personal, such as sexual matters there often is no one single answer. Yet the conflict remains for me because they are suffering.

A therapist, and even more so, a therapist who is a rabbi, needs to be careful about boundaries.  When a therapist becomes a moral religious authority to the extent that he offers halakhic guidance, this can have unintended negative consequences.  For psychotherapy to thrive, an environment of moral neutrality and acceptance needs to be maintained as much as humanly possible. If the therapist is inducted into a status of halakhic decisor, it may make the couple hesitant to discuss other matters.  In essence, for this couple, the therapist will morph into the persona of that same rabbi mentioned above whom they are afraid to ask questions of.  

Professional boundaries are not just arbitrary rules.  They function much as guard rails on the road; the point is not merely to avoid banging into them.  Rather, the point is to see them from far away to help you orient yourself and stay on the right path.  If you are bumping into the boundary, you are already a reckless driver even before you drive off the cliff.  It is painful though, especially because the sexual question the couple is grappling with requires psychological and halakhic expertise and sensitivity, and in fact I authored a responsa on this very issue that was reviewed and approved by a world renown posek.  I can be a rabbi as much as I want, except right here and right now when I am needed. Ouch.

What is the deeper issue?  Ironically, the couple is suffering from various forms of sexual dysfunction caused by anxiety.  Perhaps part of this anxiety comes from feeling ashamed of their normal sexual needs. Their fear of discussing this with a “real” rabbi is part of the problem. Possibly, they also had experiences where they were shamed and blamed by parents, teachers or rabbinic authority for their normal sexual needs, either directly or by implication.  Regardless, my answering them is a “cheat code” and not really dealing with the problem. The couple must find a way to understand how their shame contributes to their anxiety, and how their fear stops them from getting the proper religious support that they need from a rabbi to thrive in their marriage.

When it comes to sexual dysfunctions caused by anxiety for a couple, there are other situations as well where therapists can be induced to provide answers that do not reach the root of the problem.  Sex therapy techniques are based on behavioral and educational processes. The educational part addresses cognitive distortions and unrealistic expectations that cause anxiety and dysfunction. The behavioral techniques address maladaptive learned responses encoded within the body, and seek to gradually change associations and behaviors that are originally  caused by anxiety, but become ingrained. I find them to be helpful in providing quick relief and tangible changes. However, in this situation as well, it may not be only a matter of answering the question or changing the behavior. Understanding the psychodynamic context and helping the couple mindfully develop past it, is vitally important. The anxiety comes from shame, and is a deeply rooted defense against conflicts about body, self and pleasure.  Without understanding the deeper issues and working on them, the treatment may fail.  

Consider the following metaphor: You are a contractor who is presenting your project for final inspection and approval by the building department.  For some unknown reason, the fire alarm randomly goes off at rare intervals and then just as quickly goes back to normal. You check all the systems and have not found any cause.  So, you decide to secretly cut the wires before the inspection in order to pass. That was a stop-gap measure, and perhaps the problem is some anomaly that does not affect long-term safety.  But, what if you missed something? What if there is a vent or shaft that somehow is picking up on real smoke from a shorted wire? Here too, I consider sex therapy techniques important and useful to bring immediate relief.  However, when they are done with little regard for possible deeper psychological concerns, they can fail or even do damage. In this way, it is the same as the therapist being induced into answering the halakhic question without respecting how the entire system plays into the anxiety, and how the answer is merely a band-aid.