by R. Shmuel Zuckerman
וַיֹּאמֶר ד’ אֱלֹקִים לֹא טוֹב הֱיוֹת הָאָדָם לְבַדּוֹ אֶעֱשֶׂהּ לּוֹ עֵזֶר כְּנֶגְדּוֹ – בראשית ב
And the Lord G-d said: ‘It is not good that the man should be alone; I will make him a helper opposite him.’ (Genesis II)
ואמר רבי אלעזר מאי דכתיב [בראשית ב] אעשה לו עזר כנגדו זכה עוזרתו לא זכה כנגדו – יבמות סג
Rabbi Elazar taught: What is the meaning of the passage “I will make for him a helper opposite him”? If he merits she will he help, if he doesn’t merit, she will be against him. (Talmud – Yevamos 63)
This classic passage from the Talmud, speaks of the relationship between husband and wife. Two humans, each with their own nature come together, and the results can either be great, with each one complementing the strengths and weaknesses of the other, or it can be a source of conflict.
The passage of the Talmud is clearly teaching about marital harmony. At the same time, the lesson of two humans growing with each other, is transferable and underscores one of the important dynamics of pastoral care. Pastoral care, like many other disciplines of mental health, often has a clinician helping a client to analyze his or her own life. To do so effectively, sometimes, the clinician must challenge the client. This challenge, if done properly, can bring out the best in the client. By challenging, respectfully and with genuine care, the clinician can help the client realize strengths and resources that were present but dormant, and develop new ones. When the clinician is unable or unwilling to challenge or stimulate the client, the clinical relationship is not realized to its fullest potential. More concerning, and at times even damaging both to the relationship and even to the client, is when the clinician does not challenge in a positive way.
Importantly, however, differences in belief or worldview between the clinician and client do not mean that there cannot be a clinical relationship. The purpose of this paper is to explore how these differences, can not only be tolerated in a clinical relationship, but how those very differences can actually enhance the clinical pastoral relationship.
Pastoral care is at the very root of Judaism. The Torah teaches about our greatest leader Moses, that in his formation as a leader that, “Moses went out to his brethren and saw their distress” (Exodus II). Rashi (cf. Midrash Exodus I) tells us that Moses committed his eyes and heart to the pain of his brothers. The same midrash teaches us that it was this demonstrated care, that earned Moses the sacred duty of serving the Jewish People. Likewise, King David, is identified by the midrash as being abundantly compassionate to the sheep, and thus was chosen by G-d to be, literally, the pastor of the Jews. Care, concern, and compassion, the basics of pastoral care, are at the root of Jewish leadership and Judaism.
But, seeing the pain of others is insufficient. Consider that in the case described in the Bible about Moses, the pain was plainly visible.
“…and he [Moses] saw an Egyptian man striking a Hebrew man – one of his [Moses’] brothers.” (Exodus 2)
Many times, however, pain, especially emotional pain may not be readily visible. At times, even the client themselves may not be consciously aware of the pain. Emotional pain may be suppressed. It requires not only the care, but the skill of a clinician to assist the client in discovering the pain. Then, and only then, can there be true compassion, because only then, is the real pain felt by the client, and only then is the clinician aware of the pain. This is a fundamental aspect of clinical pastoral care. (cf. Midrash Rabba Genesis 93:4)
The clinician, in order to help the client access these pains, must, firstly, be aware of the clues and, secondly, skilled and confident to raise the issues. Many times, the client needs not only the safety of the validation of the clinician, but also may need the clinician to facilitate the verbalization and expression of those feelings. The questions that we ask as pastoral caregivers are, at times, hard ones, and ones that, intentionally reverberate within the client. It can become problematic when the clinician, too, is triggered by the questions, or does not even raise them because of the clinician’s own discomfort with the issues. If the underlying issue is too sensitive or delicate for the clinician, then he or she will be unable to raise them even for someone else. In psychological terms, this would be understood as the challenge of countertransference resistance.
And, at the same time, I maintain that there is a resource even within the countertransference. If we deconstruct the countertransference, we understand that it is that the situation is an emotional trigger. Not all emotional triggers are negative. On contrary, passion is the product of an emotional feeling. Passion is one of the most powerful motivations. And so, the nearness too, is an important resource, it can motivate a clinician to use the full depth of his or her intellect and emotion.
Moreover, this nearness and distance is not limited to religious theology or even a broader worldview. But, each and every lived experience we have, both the pleasant and painful generate emotions. Any and every life experience has left us with feelings, some positive and some negative. Feelings, like pain or suffering, can function to upset, frustrate or sadden us. They also can inspire compassion for others who are feeling or have felt those same experiences, not necessarily in context but in content. The challenge is to find the balance of having those feelings, but gearing them to compassion and empathy. The more those feelings are processed, the more the countertransference is processed, the more they can be converted from resistance to assistance. At the same time, since it will always be present, it will likely always be both assistance and to a degree resistance. Therein is the advantage of otherness. That is to say, that difference is sufficient, at times, to limit the resistance; and still nearness is close enough to enhance the assistance.
In this niche, in this perspective of knowledge, understanding, respect, but difference, I found that being not Chassidic, was advantageous in the pastoral care relationship. I am aware enough of the Chassidic theology, the beliefs are close enough to my own that I am keenly aware of the Chassidic theology. Yet, my beliefs are distinct enough to be able to ask the questions without it triggering an intense emotional response in myself.
It is this sacred forum – a balance of nearness and distance, which I use to provide pastoral care. The effect has been productive and meaningful for patients and their families. I use the model of the Talmud, a helper opposite, to help while being different. The following clinical vignette is a glimpse of the balance and how the distance can be advantageous. It illustrates how I used my differences to help, the patient and family, my clients. It is very real, and profoundly human.
~ ~ ~ ~ ~
The family did not think the patient was going to die despite the fact that she had cancer in several of her abdominal organs and was no longer awake. It was that a day that many Chassidic Jews believe to be particularly auspicious for miracles. I recall, the patient’s sister said to me clearly, “G-d could give her a new liver if He wants.” Indeed, I too, believe that He could. As the situation worsened over the next few days, the family began to become anxious. Finally, one afternoon, I came into the room, and the patient was barely responsive. This room had music playing continuously. I asked about the music and whether it was a Chassidic tradition and was told that it wasn’t, just that the patient liked music. I could make out that the lyrics were Hebrew; they spoke about the presence of G-d in human pain and suffering. I asked what the origin of this particular passage was and they didn’t know, so I looked it up. It was from the teachings of one of the Chassidic masters, Rabbi Nachman of Breslov.
I commented to the family that the words were powerful, to which the niece responded that G-d’s hand was always visible. I hesitated, and then asked, “Where do you see G-d in this room?” The niece and sister of the patient began to weep, and hugged each other, I too began to cry. They finished and then said to me, you can’t always see it, but it is always there.
I, too, could not see the hand of G-d in that room until that very moment. But, the hand of G-d was very present and visible in that moment, to bring two Jews of such different practices to connect in such a profoundly human way and to verbalize a bedrock of our shared faith, that G-d is present, even in the most distressing moments.
~ ~ ~ ~ ~
Nearly three hundred years ago when the Chassidic movement was rising, those who did not embrace the movement were termed by the Chassidim as Misnagedim, literally, oppositional. I would by all standards be classified by them in that way. My own beliefs are deeply rooted in the Lithuanian Yeshiva beliefs. I am ordained in this way, and hold those beliefs firmly.
Yet, the term Misnagedim (מתנגדים) is, etymologically, from the same root word as kenegdo (כנגדו) from the passage in Genesis about husband and wife, “opposite him”. The opponent in that passage was not oppositional but challenging and brought out the best in both. In that vein, I am proud to be one of the Misnagedim.
One night, though I rarely worked nights, I found myself in the room of another Chassidic patient. Someone had brought a guitar, and they began to sing. They sang, or rather chanted, for a quite some time; I stood and observed. It was a moving experience to be present, though I did not understand the Yiddish lyrics. I shared the experience with my supervisor who asked me if I felt the presence of G-d in the room. “No”, I said, “I felt the depth of their emotion.”
A Misnageid was feeling the soul of a Chassid, one human was feeling another, and what is Godlier than that.