Does Religiosity Predict Attitudes Toward Psychotherapy?

Transcription

1 Journal of Psychology and Judaism, Vol. 24, No. 4, Winter 2000 ( C 2001) Does Religiosity Predict Attitudes Toward Psychotherapy? GABRIELLE KAMINETZKY, MA is a doctoral candidate in clinical psychology at The Derner Institute for Advanced Psychological Studies at Adelphi University. The present study is the result of research that was conducted in partial fulfillment of her master s degree in clinical psychology. Portions of this study were presented at the August 1999 meeting of the American Psychological Association in Boston, MA. GEORGE STRICKER, Ph.D. is Distinguished Research Professor of Psychology in the Derner Institute, Adelphi University. He received a Ph.D. in Clinical Psychology at the University of Rochester in 1960 and an honorary Psy.D from the Illinois School of Professional Psychology, Meadows Campus, in He received the American Psychological Association Award for Distinguished Contribution to Applied Psychology in 1990, the American Psychological Association Award for Distinguished Career Contributions to Education and Training in Psychology in 1995, and the National Council of Schools and Programs of Professional Psychology Award for Distinguished Contribution to Education and Professional Psychology in He has been President of the Division of Clinical Psychology of the American Psychological Association, the Society for Personality Assessment, the New York State Psychological Association and the National Council of Schools of Professional Psychology. Dr. Stricker is the author of about 20 books, about 30 book chapters and more than 100 journal articles. Several studies have demonstrated that Jewish people have positive attitudes toward psychotherapy. This study differentiates among Orthodox, Conservative, and Reform Jewish groups to test whether there are differences in the level of religiosity and practice among these different affiliations to Judaism and whether these 251 C 2001 Human Sciences Press, Inc.

2 252 Kaminetzky and Stricker differences may influence attitudes toward seeking psychological help. Despite significant differences in religiosity and level of practice, results indicate that positive attitudes are present among all affiliations. However, Orthodox Jews are significantly more likely to use their rabbi as a source for psychological counseling and perhaps as a conduit to professional treatment. KEY WORDS: psychotherapy; religion; attitudes; judaism. Several studies have attempted to ascertain what it is that determines one s attitude toward psychotherapy (Brody, 1994; Fischer & Cohen, 1972). In one study, Fischer and Cohen (1972) used the Fischer and Turner Attitude Toward Seeking Professional Psychological Help Scale (1970) to assess the relationship between help seeking attitudes and certain demographic variables. They found that social class had no connection to help seeking attitudes, but that education level and scholastic major were significantly related. Social science majors were more in favor of seeking professional help, and the more education one had, the more open one s outlook was to professional help-seeking. Although religion did not achieve statistical significance, Fischer and Cohen found that Jewish subjects tended to express more favorable attitudes toward psychotherapy than Catholics or Protestants. Jews presented the most positive attitudes at every socio-economic level (Fischer & Cohen, 1972). The purpose of this study is to replicate partially and to expand upon Fischer and Cohen (1972); particularly, the religion variable. Is the favorable attitude that Jewish people have toward seeking psychological help characteristic of all Jews, or rather, is it characteristic of certain subgroups within the religion? Do the differences that are inherent in the levels of practice within Judaism influence the attitude toward seeking psychotherapy? Do attitudes differ as a function of the nature of religious belief? Other authors (Farber & Geller, 1977; Fischer, Winer, & Abramowitz, 1983) also have found that Jews seem more favorably disposed to psychotherapy. In addition, many studies show that Jews are consistently over-represented among helpseeking populations (Fink, Shapiro, & Goldensohn, 1970; Greenley & Mechanic 1976; Scheff, 1966). Fischer and Turner (1972) did not advance any hypotheses as to why this is the case. Other authors (including Fischer, 1983), though, have attempted to understand this phenomenon. Fischer, Winer, and Abramowitz (1983) noted that Jews are proportionately over-represented in terms of positive attitudes toward help-seeking as well as actual help-seeking behavior. The authors speculated that this was perhaps due to the religion s historical emphasis on an appreciation for the arts, the humanities and social sciences...or the softer side of human experience (p. 182). Greenley and Mechanic (1976) found that university students who had applied for services from a psychiatric clinic were more likely to be Jewish or to have no religious affiliation, less likely to be Catholic, and are less likely to engage in

3 Attitudes Toward Psychotherapy 253 religious activity (p. 181). They cite Henry, Sims, and Spray (1968) and attribute the over-representation of Jews to a particular inclination toward introspection in the Jewish culture (p. 178). Lovinger (1984) cites Zuk who mentions that Jews are generally willing to accept psychotherapy because of their strong verbal orientation, greater readiness to accept the reality of feelings, emphasis on the importance of family relationships and positive attitude toward problem solving (p. 181). Gersten (1979) noted an important exception to this general willingness in his discussion of very Orthodox and Hasidic Jews. Very Orthodox Jews are reluctant to seek psychological help, and when in distress, they would rather take medication, as the pharmacological route is associated with medical treatment, which is more acceptable in the community. In addition, within the general Orthodox community, there is a significant stigma associated with seeking professional mental health treatment. Many Orthodox Jews are ashamed of and embarrassed to be in treatment (Wikler, 1986). Within this community, there is also concern that seeking professional help will mean that they will be perceived as insane and ruin potential matrimonial prospects. According to Spero (1986), the mental health professional is regarded with suspicion among some circles in the Orthodox Jewish community because there is fear that the therapist will try to alter or undermine one s religious philosophical views (Spero, 1986). The concerns of the Orthodox community regarding mental health care highlight a problem with the designation Jewish that is used in the literature, because there is, in fact, no single, homogenous Jewish or religious population (Spero, 1986, p. 211). This detail is often disregarded in studies of Jewish personality (Spero, 1986). If this is, in fact, the case, then who are the Jews that the literature has designated as open to psychotherapy? Jewish populations vary in cultural heritage, intensity of religious commitment, and the degree to which Jewish mannerisms, argot, beliefs and attitudes influence and gain expression in everyday behavior (Spero, 1986, p. 211). Jews belong to different social classes with different educations, origins, and religious groupings (Orthodox, Conservative, Reform, etc.) (Sanua, 1982, p. 54). Furthermore, Jews live in different geographical areas ranging from highly concentrated cities to small towns, and thus have different types of stresses impinging upon them and affecting their psychological adjustment (Sanua, 1982). Brody (1994) found that ideological factors were far better predictors of psychotherapy attitude and use than demographic, stress, or depression factors (p. 10). Brody maintained that many of the variables relevant to the use of psychotherapy belong under the heading of traditional ideology. Traditional ideology was used in his study to refer to a set of beliefs common among a group of individuals adhering to conventional, conservative or historically older (i.e., characteristic of pre-industrial Western society or some current day non-western societies)

4 254 Kaminetzky and Stricker attitudes and beliefs (p. 6). Traditionals are thought to reject psychotherapy for several reasons related to their ideology. Brody (1994) found that traditionalism was negatively correlated to attitude toward and use of psychotherapy services. The present study looks at the relation between psychological help-seeking attitudes and religious grouping within Judaism. Within Judaism there are at least three recognized groups (Orthodox, Conservative, and Reform). Orthodox Jews are differentiated from other adherents to Judaism in their abiding concern with the collection of biblical, post-biblical and rabbinic law and lore which have been carefully preserved over the 3,000 years of Jewish civilization and which place on its individual members the responsibility of carrying out these infinitely detailed laws and transmitting them intact to the next generation (Ostrov, 1976, p. 147). In effect, Orthodox jewry is defined by its very effort to preserve a specific system of immutable values, norms, laws, and institutions which represent an essential integrating force in individual, familial and communal identity (Ostrov, 1976, p. 147). In general, Orthodox Jews are differentiated from the other branches of Judaism by their strict adherence to traditional religious practices. It is important to note that, within Orthodox Judaism, there is the unofficial designation of the Modern Orthodox Jew who attempts to integrate modern values such as individualism, liberalism, and universalism (Greenberg, 1983, p. 15) without diminishing the authority of rabbinic tradition. Hasidic Jews, often called Ultra-Orthodox or Very-Orthodox, differ from other Orthodox Jews insofar as they are led by a rebbe, a learned religious leader who is the central figure in communal life, and in their retention of the dress, language, and customs of Eastern Europe (Ostrov, 1976). The Reform movement first came about in the eighteenth century. The movement was started in Germany in an effort to adapt traditional Jewish practices to the opportunities that were opening up for Jews in Western Europe. Many of the laws and customs were discarded in an effort to assimilate into the larger culture. The Conservative movement, which came later, restored some of the extensive deletions made by Reform Judaism and produced the three separate groupings that came to the United States: Orthodox, Reform, and Conservative. These designations now refer to the degree of adherence to the detailed ethical-ritual code prescribed by the Torah and elaborated over the following 2500 years (Lovinger, 1984, p. 82). Basic concepts and practices, such as the value of study, views of G-d, concern for others, and the importance of ethics and the family were not in dispute (Lovinger, 1984, p. 82). A specific aim of this study is to illustrate the differences that are inherent in the Jewish population by assessing the different levels of religious practice as well as the attitudes that are characteristic of the different groups within. It is

5 Attitudes Toward Psychotherapy 255 hypothesized that the more traditional or Orthodox one is in the spectrum of Judaism, the more an unfavorable attitude toward psychotherapy will be espoused. Orthodox Jews, who are generally highly observant of the religion s rituals and observances, are similar to the more traditional-minded individuals highlighted by Brody (1994), and as such should exhibit fairly negative attitudes toward helpseeking from a therapist. Conversely, the more secular minded or modern Jew (i.e., Conservative or Reform), who is more immersed in and affected by the surrounding culture, should have attitudes that are more in keeping with the findings that show that Jews, in general, are well disposed toward help-seeking. METHOD Participants Adult men and women (N = 202) ages 18 and older were solicited from universities, synagogues, day-schools, and temples in the New York metropolitan area. The participants self-classified according to one of 3 religious groupings within Judaism: Orthodox (N = 69), Conservative (N = 73), and Reform (N = 60). Procedure Each participant completed two measures. The first is a shortened form of the Fischer-Turner Attitude Toward Seeking Professional Psychological Help Scale (ATSPPH; Fischer & Turner, 1970). The Fischer-Turner scale was developed in 1970 and consisted of 29 likert-type items such as, The idea of talking about problems with a psychologist strikes me as a poor way to get rid of emotional conflicts and There are times when I have felt completely lost and would have welcomed professional advice for a personal or emotional problem. The items were presented in a 4 point agree-disagree response format. This instrument was used to measure attitudes toward seeking professional psychological help. Attitude scores derived from this scale were shown to have good reliability and low to zero correlation with social desirability (Fischer & Cohen, 1972). The scale was developed and validated with students of varying ages and backgrounds and has been used on a variety of different populations in subsequent studies (Brody, 1994; Fischer & Cohen, 1972; Olkon, Moriwaki, & Williams, 1973). A shortened form of this scale was developed by Fischer and Farina (1995) and consists of 10 items adapted from the 1970 scale. This version was used in this study. The psychometric features of the new scale matched those of the original version. Scores from the new version correlated.87 with full-scale scores derived

6 256 Kaminetzky and Stricker from the original form (Fischer & Farina, 1995). The new scale had the same response format as the original, with a high score indicating a willingness to seek help from mental health professionals when one s personal-emotional state warrants it (Fischer & Farina, 1995, p. 371). The second measure was a 29-item questionnaire compiled by the authors and called Religion and Psychology Measure (RPM). It contained questions about religious observance and beliefs as well as contact with the discipline of psychology. There were 23 items in this questionnaire that referred directly to different religious rituals and beliefs (i.e., Do you celebrate the Jewish high holidays? Do you keep a kosher home? Are you a Sabbath observer?). Respondents were required to mark yes or no, with a high score indicating considerable adherence to religious rituals and suggesting high religiosity. The internal consistency of the 23 items was.90 (Cronbach s alpha). Five of the items solicited information on past psychological help-seeking behavior (i.e., Have you ever consulted a social worker, psychologist or psychiatrist for help in solving an emotional problem?) and were embedded in the questionnaire. The last item on this measure asked the participants to rate, on a scale of 0 7, how religious they consider themselves to be, with 0 denoting not religious at all and 7 denoting very religious. The rationale for the use of this scale was that the format enables persons with diverse religious commitments and understandings to express their sense of self as religious (Schwartz & Huismans, 1995, p. 97). In addition, a short demographic questionnaire was completed by subjects to obtain information on specific items that can potentially interact with a person s attitude toward psychotherapy. These items included age, gender, education, occupation, and religious grouping within Judaism (Orthodox, Conservative, or Reform). RESULTS When the 23 religious items on the RPM were summed and an analysis of variance was computed for the type of Jew variable, significance was achieved, F = , df = 2/201, p <.001. As expected, Orthodox subjects kept more religious practices (mean score, 20.25) than their Conservative and Reform coreligionists. In addition, Conservative subjects indicated that they observe more religious practices (11.73) than Reform subjects (9.53). These results demonstrate that the self-classification of Orthodox, Conservative, and Reform is meaningful in that there are real differences among groups in terms of religious observance. When an ANOVA was computed for type of Jew and the self-rated religion scale as dependent variable, the Orthodox rated themselves as significantly more religious than either Conservative or Reform subjects, F = 46.13, df = 2/201,

7 Attitudes Toward Psychotherapy 257 p <.001. Both Conservative and Reform subjects experience themselves as similarly less religious than the Orthodox, even though Conservative subjects observe significantly more religious practices than their Reform counterparts. The mean attitude scores of subjects categorized by type of Jew, sex, education, and age were computed. A simple one-way analysis of variance was calculated for the type of Jew variable. Contrary to expectation, type of Jew had no connection to attitudes toward psychotherapy, F = 1.94, ns. The Orthodox group attained the lowest scores on the attitude scale. However, the mean scores of the Orthodox group (18.30) was not significantly lower than either the Conservative (20.26) or Reform (19.28) group. In addition, type of Jew did not interact significantly with any of the demographic variables. A one way ANOVA was also computed for age of subjects and this was significant, F = 8.16, df 3/201, p <.001. Subjects between the ages of and espoused the most favorable attitudes (21.71 and 21.31, respectively) and were significantly higher than the other age groups. Subjects between the ages of were next (18.27), and the group followed (17.53). Education level was correlated with attitudes toward psychotherapy for subjects and this proved significant, r =.41, p < 001. As the level of education increased, so too did the attitude score. Subjects with graduate professional training and a college degree espoused the most favorable attitudes (21.23 and respectively). A t-test was computed for sex of subjects and this also was significant, t = 3.12, df = 1/200, p <.005, with female subjects more favorably disposed to seeking help for an emotional problem (20.46 for females and for males). When Chi-Square tests were computed with specific items on the RPM questionnaire the results were as follows: Significantly more Orthodox subjects consulted a rabbi with an emotional problem, Chi-square 9.57, df 2, p <.01; believed in a rabbi s authority to make decisions about psychological questions, Chi-square 30.26, df 2, p <.001; and felt it was important to distance oneself from the surrounding culture to preserve religious integrity, Chi-square 32.16, df 2, p <.001. There was no significant difference among the three groups in their response to the question; Have you ever consulted a social worker, psychologist or psychiatrist for help in solving an emotional problem? DISCUSSION One of the objectives of this study was to illustrate that there are real differences among Jews. Although there were no differences among the different groups of Jews in terms of attitudes toward psychotherapy, there were significant differences among the three groups in terms of religiosity and level of religious practice. The Orthodox, as expected, observe significantly more of the religious

8 258 Kaminetzky and Stricker practices than Conservative or Reform. The Conservative observe more than the Reform. Even though Conservative Jews observe more practices than Reform, their feeling of religiosity is not higher. Both the Conservative and Reform groups view themselves as significantly less religious than the Orthodox. It is methodically unsound to use Jews as a unidimensional variable. The self-classification of subjects by religious affiliation, i.e., Orthodox, Conservative, and Reform (and perhaps unaffiliated) seems to be a valid and effective distinction, as it accounts for the differences inherent in the population. The study has demonstrated a common denominator among the three very different and sometimes antagonistic groups. Orthodox, Conservative, and Reform Jews all have positive attitudes toward seeking psychological help. From the results, it is apparent that, among Jews, the amount of observance of religious practices and the degree of religiosity does not relate to the attitude toward seeking help for an emotional problem. In addition, it seems that the Jewish religion does not fit into the rubric of traditional ideology as described by Brody (1994), and Jewish people are not, in essence, traditionals, even though they adhere to historically older attitudes and beliefs (Brody, 1994, p. 6). The nature of their beliefs allows room for, and may even foster a curiosity about, the process of psychotherapy. Although it is true that, unlike the Conservative and Reform groups, the Orthodox indicated that they believe that it is necessary to separate themselves from the surrounding culture to preserve their religious integrity, this does not seem to prevent them from being educated (there were no significant differences in terms of the level of education among the three groups, with approximately the same amount of college graduates and graduate professionals) as well as sophisticated about the options available to them in terms of their mental health. The Orthodox seek help for psychological problems much like the Conservative and Reform. There was no significant difference between the total scores of the ATSPPH scale among the three groups. In addition, much like the Conservative and Reform groups, their attitudes translated into actual behaviors as they indicated that they sought help in the past from mental health practitioners. However, it is interesting to note that there were significant differences among the three groups with specific variables that may influence the path taken to care for their mental health. Although Orthodox participants were equally as likely to have seen a mental health professional, approximately half of them indicated that they feel that a rabbi is capable of solving psychological problems. In addition, 34 of the 69 respondents (compared with 18/73 Conservative and 20/60 Reform) had actually sought help for an emotional problem from a rabbi. Perhaps it is the rabbi who then refers his congregant to a mental health practitioner. The rabbi s approval may render the idea of treatment acceptable. The Conservative and Reform groups do not seem to view the rabbi s role in the

9 Attitudes Toward Psychotherapy 259 same manner. Perhaps they view their rabbi more exclusively as spiritual guide or religious leader rather than pastoral counselor. Many questions remain unanswered, the most obvious concerning why it is that Jews have these positive attitudes toward seeking psychological help. Why is it that Jewish people have been found to be over-represented in the help seeking arena? Another question concerns the very Orthodox or Hasidic Jew. It appears that the Orthodox Jews answering the questionnaires were probably among the modern Orthodox, and, as such, are immersed in the secular world despite the added strictures that the religion imposes on them. Today s modern Orthodox Jew is educated and sophisticated and, as such, would appreciate and understand the benefits psychotherapy could offer just like his Reform or Conservative counterpart. The question remains, however, do the same positive attitudes prevail among Hasidic Jews who value separation from the general culture? REFERENCES Brody, S. (1994). Traditional idealogy, stress and psychotherapy use. The Journal of Psychology, 128, Farber, B.A., & Geller, J.D. (1977). Student attitudes toward psychotherapy. Journal of the American College Health Association, 25, Fink, R., Shapiro S., & Goldensohn, S.S. (1970). Family physician referrals for psychiatric consultation and patient initiative in seeking care. Social Science and Medicine, 4, Fischer, E.H., & Cohen, S.L. (1972). Demographic correlates of attitudes toward seeking professional psychological help. Journal of Consulting and Clinical Psychology, 39, Fischer, E.H., & Farina, A. (1995). Attitudes toward seeking professional psychological help: A shortened form and considerations for research. Journal of College Student Development, 36, Fischer, E.H., & Turner, J.L. (1970). Orientations to seeking professional help: Development and research utility of an attitude scale. Journal of Consulting and Clinical Psychology, 35, Fischer, E.H., Winer, D., & Abramowitz, S.I. (1983). Seeking professional help for psychological problems. In A. Nadler, J.D. Fisher, & B.M. DePaulo (Eds.), Applied perspectives on help seeking and receiving (pp ). New York: Academic Press, Inc. Gersten, L. (1979). The mental health needs of the pious. Sh ma: A Journal of Jewish Responsibility, 9, Greenberg, B. (1983). How to run a traditional Jewish household. New York: Simon and Schuster. Greenley, J.R., & Mechanic, D. (1976). Patterns of seeking care for psychological problems. In D. Mechanic (Ed.), The growth of bureaucratic medicine (pp ). New York: John Wiley and Sons. Henry, W.E., Sims, J.H., & Spray, S.L. (1973). Public and private lives of psychotherapists. San Francisco, CA: Jossey-Bass Inc. Lovinger, R.J. (1984). Working with religious issues in therapy. New York: Jason Aronson. Olkon, G.H., Moriwaki, S., & Williams, K.J. (1973). Race and social class as factors in the orientation toward psychotherapy. Journal of Counseling Psychology, 20, Ostrov, S. (1976). A family therapist s approach to working with an Orthodox Jewish clientele. Journal of Jewish Communal Service, 53, Sanua, V.D. (1982). The state of mental health among Jews. In R.P. Bulka and M.H. Spero (Eds.). A psychology-judaism reader (pp ). Springfield, Illinois: Charles C. Thomas.

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