Culturally competent adaptation of cognitive-behavioural therapy for psychosis: cases of Orthodox Jewish patients with messianic delusions

Abstract

Cognitive behavioural therapy (CBT) is an evidence-based treatment for various psychopathologies. CBT has also been used in psychosis, however relatively few articles deal with the culturally competent adaptation of CBT for psychosis, and none for the Orthodox Jewish population. We analysed cases of messianic delusion among Orthodox Jews, for whom we used a culturally competent adaptation of CBT. Our therapeutic work consisted of sorting out acceptable beliefs from delusions, and to acknowledge those acceptable beliefs. We recognised how patients themselves reframe their views when they become less delusional. We tried to accompany the patients in this reframing process. We advocate an approach in CBT where therapists can use a few culturally appropriate ideas taken from the patient's grossly delusional thinking, and help the patient reframe their frankly delusional thoughts into more culturally or socially accepted ideas.

Keywords:

• cognitive behavioural therapy
• cross-cultural therapy
• Orthodox Jews
• psychosis

Notes

1 The last (deceased) Rabbi of Lubavtich (or Chabad) Chasidism is often called “the Rebbe” by his followers.

2 The discussion of this “antinomian” feature is developed by Littlewood (1983).

3 See Zohar 2, 89a–89b; see also Ginsburg (1989). As well as Hayyim Vital; Ta'amei ha-Mitzvot, Parshat Bereshit, 16b.

4 This is from a sicha (talk) of the Rebbe on 12 April 1991 (or, 28 nissan, 5751), at 770, Eastern Parkway Brooklyn, New York, the Chabad headquarters. An excerpt from the Rebbe's talk:

What more can I do to motivate the entire Jewish people to clamor and cry out, and thus actually bring about the coming of Moshiach?. All that I can possibly do is to give the matter over to you. Now, do everything you can to bring Moshiach, here and now, immediately... I have done everything I can: from now on, you must do whatever you can … .

5 This is from a sicha (talk) of the Rebbe on 12 May 1991 (or, 28 iyar, 5751), at the the Chabad headquarter in New York.

6 See Babylonian Talmud Tractate Yevamot 89b–90b for a discussion about various practices of rabbinic authorities to adapt he law in order to respond to the people's needs.

7 See Mishnah Makkot 1:10. When we talked to Yehuda, it was clear that he was familiar with this passage.

8 Here is the text of the disclaimer proposed by the patient:

I, [name of social workers], agree that I didn't frame [name of patient] willingly and intentionally and that I received no benefit from this hospitalization or evaluation of [patient] and that I agree not to receive benefit from any declaration of [patient] being “mentally ill or insane”. Furthermore, I agree that if there was a claim that existed prior to today in a celestial/heavenly tribunal that it continues to exist and that it is not forgone/forgiven in any way.