Putting the Critical Voice Aside—Religion, Politics, and Therapy As Described by Secular Therapists Working with Ultra-Orthodox Clients: A Qualitative Study from Israel

Abstract

Israel’s Ultra-Orthodox Jews (Haredi) are a culturally distinct and tightly-knit community. Since their lifestyle, which rests on the strict interpretation of religious sources, sets them as a cultural minority within the dominant secular culture of modern Israeli society, addressing mental health within this group requires tailored approaches that consider the community’s values and lifestyle, as well as the distinct social and political dynamics between secular therapists and Haredi clients. However, while Haredi’s unique position often becomes a source of tension in Israeli politics and society, it also affects therapeutic encounters between ultra-orthodox clients and secular therapists, as this unique dynamic between religious and secular cultures can lead to ambivalent attitudes toward each other. This study was designed to examine the unique experiences of secular therapists in providing mental health treatment to the ultra-orthodox sector in Israel in the current social-political situation. Twenty-one qualitative semi-structured interviews conducted with secular psychologists and art therapists regarding their experiences with working with ultra-religious clients identified three main themes: (1) a feeling of an outsider, (2) colliding viewpoints, and (3) sameness. While interpretative phenomenological approach was used, the interviews were analysed using thematic analysis based on Colaizzi’s approach. These themes highlight the ambivalent experience and illuminate this captivating intersection of therapy, religion, and society. Public workplaces should consider enabling intercultural therapies, acknowledging their benefits and challenges.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10943-025-02298-3.

Introduction

One of the signs of (late) modernity is the deconstruction of identity as a stable and objectively given category. Consequently, individuals must continuously choose and confirm the validity of decisions once made (Beck & Beck, 1999; Bauman, 2007; Berger, 1980; Giddens, 1997) and are doomed to (re-)construct their identity continually (Bauman, 2007; Giddens, 1997). However, culture and religion play a significant function in protecting an individual’s social world from the need to constantly define, confirm and legitimize (Berger, 1980, 1990), as exemplified by the Haredi community in modern Israel (Coleman-Brueckheimer et al., 2009). This function of religion becomes particularly visible in moments of crisis and breakdown that are currently taking place in Israeli society, dealing with many threats and systemic changes resulting in anomie, where religion helps to defend sameness, identity and tradition.

Moreover, religion affects the Haredim’s social interactions with their social systems—including healthcare workers. Though ethical standards require therapists to respect their Haredi clients’ cultural and religious background, they are remarkably ignorant about this community, and their impressions are often influenced by biased media coverage and the current social-political context (Finkelman, 2014; Zicherman, 2014). This is important since the Ultra-Orthodox in Israel are becoming more open to receiving therapy also among secular therapists (Doron, 2020; Freund & Band-Winterstein, 2017; Ginsberg & Sinacore, 2013; Keidar et al., 2021, 2022). Therefore, there is a need to understand better the mutual perspective of Haredi community members and secular healthcare professionals.

The Haredi Society

Israel’s ultra-orthodox (UO) or Haredi Jews constitute a culturally distinct and tightly-knit community. They follow strict guidelines for religious observance, adhere to conservative dress codes, and often reside in distinct communities with their educational institutions. This allows them to concentrate on religious principles and separate themselves from secular influences (Coleman-Brueckheimer et al., 2009). Since they regard non-religious sources as false and harmful, threatening Judaism and their world, the Haredi society enforces strict censorship that limits the freedom of opinion and information. In a Haredi household, there are officially no “impure” books or newspapers that might violate their strict rules of modesty, avoidance of mixed-gender interactions, and patriarchal familial hierarchy (Doron, 2020). Modern technologies and communication methods are carefully monitored to prevent secular influences that could undermine the community’s information policies (Dödtmann, 2023). Haredim often minimise contact with the outside world, including non-Haredi Jews; their children do not attend secular schools, they delay entry into the labour market and abstain from military service.

At the same time, the UO are not a homogenous community but consists of different groups and subgroups distinguished by external characteristics, adherence to tradition, ideology, modernity, receptiveness to external economic factors and openness to the broader society, including therapy (Popovsky, 2010). The UO community encompasses three main streams: (1) Hasidim, a group centered on a Hasidic “court” presided over by a rebbe who moulds the character of his congregation; (2) Lithuanian, distinguished from Hasidim by relatively greater openness to modern life; and (3) Sephardim, Jews originated in North Africa and the Middle East and who have mostly embraced Lithuanian culture (Brown, 2017; Zalcberg Block & Zalcberg, 2023; Zalcberg-Block & Zalcberg, 2024). Despite internal tensions and some differences, they all share some common characteristics, which include the strict interpretation of Jewish law; men’s dedication to studying the Torah, with a focus on the value of community gatherings for study and prayer; deference to religious leaders (rabbis); stringent dress codes for women; opposition to or apprehensions about the pre-messianic State of Israel; separation from the mainstream population by gathering in enclaves within specific cities and areas because they believe that their survival is in jeopardy from the outside world (Haimovich & Leiser, 2017; Zalcberg Block & Zalcberg, 2023; Zalcberg-Block & Zalcberg, 2024).

The Haredim and the Seculars

In Israel, there is no balance of power between the majority and minority groups. Haredi Judaism is the fastest-growing Jewish religious stream in the twenty-first century. The Haredi community in Israel is estimated at around 1,335,000, constituting 13.3% of Israel’s total population (Cahaner & Malach, 2023). It enjoys a special status as a culturally protected minority (Stopler, 2016), one that does not look up to the dominant culture and has no wish to assimilate with it. On the contrary, they take great measures to keep a safe distance from what is perceived as a colliding culture. Although recently, there have been some changes in the Haredim’s attitudes toward the seculars, they still hold a good deal of suspicion, lack of trust, and even hostility towards the secular general public, which, in turn, often has great contempt for the UO community (Doron et al., 2024) which can lead to mutual negative attitudes (Zicherman, 2014). This is not surprising, as secular individuals may financially support the UO population but are often perceived by them as promiscuous, uneducated, and enslaved to materialistic values like money and external appearance. As a result, they are seen as a danger to the observant way of life and the source of all that is flawed and ill in the Jewish people (Caplan, 2006, 2007). Despite being a minority group, their influence extends across various aspects of daily life, including positions of power within the government (e.g., Cohen, 2006; Cincotta & Kaufmann, 2009), with the Haredim having the deciding votes in every election since 1977 (Lintl, 2021).

Far-reaching changes have recently been taking place within Haredi society in general and in the attitudes towards the surroundings in particular, demonstrating a willingness to embrace both the ideas and practices of the general Israeli culture. These changes are expressed in all areas, including adherence to health policies, public health services, and therapy (Band-Winterstein & Freund, 2015; Simhi et al., 2020). However, despite the changes, encounters between Haredi Jews and non-Haredi culture have potential conflicts and tensions (Finkelman, 2014). The disagreements and harsh sentiments between seculars and the UO community in Israel have a long history that spans many years, and due to the significant growth in numbers of the UO sector in Israel, the problem of the diverted groups has become an important topic of discussion in the public discourse. This issue has been the cause of several heated debates and discussions among various sections of Israeli society, including the government, religious leaders, and the general public (Finkelman, 2014).

Haredim and Intercultural Psychotherapy

Addressing mental health within the UO community requires tailored approaches (Greenberg & Witztum, 2013), with values such as modesty, conformity, and a strong attachment to tradition that heavily influence treatment interventions (Caplan, 2006; Caplan & Stadler, 2012). Moreover, the UO value humility and collective identity over personal growth, contradicting psychotherapy’s focus on individual enhancement (Haimovich & Leiser, 2017). Culturally sensitive care is crucial for achieving treatment goals, with the Haredi community expecting professionals to be acquainted with their culture (Neriya-Ben Shahar et al., 2024). Secular therapists (STs) face challenges while working with UO clients including building trust and encountering biased views expressed by the UO community (Band-Winterstein & Freund, 2015; Berman & Woolley, 2024; Hoffman & Rossman, 2012), stigmatisation of mental health issues (Haimovich & Leiser, 2017) and the question of involving Rabbinical authority advice on health issues that is sometimes influenced by considerations other than the client’s health condition (Zalcberg Block & Zalcberg, 2023). As the UO value collectivism and family over the individual, these considerations may include the reputation of the client’s family or jeopardising prospective marriage arrangements (Freund & Band-Winterstein, 2017).

Far from being a completely segregated society, the UO community can be portrayed as constantly moving across the boundaries, as even the most extreme UO must use secular services (Haimovich & Leiser, 2017) such as psychotherapy. This compulsion creates intercultural interactions that can strain therapeutic relationships, especially when therapists lack an understanding of the Haredi principles, values, and lifestyle, such as conformity, having large families with an average of six children (Cahaner & Malach, 2023), advising a Rabbi about many daily issues, and keeping traditional gender roles (Doron, 2020; Neriya-Ben Shahar et al., 2024). Building trust is a gradual process with the therapist perceived as culturally estranged and is crucially dependent on the therapist’s professionalism and demeanour (Berman & Woolley, 2024; Keidar et al., 2022).

Intercultural interactions require obtaining cultural competence and involve a complex and multifaceted challenge. The ultimate goal is to ensure clients receive effective therapy and achieve their treatment objectives. However, while having the client’s interests in mind, research and literature on intercultural therapy have highlighted unintentional power structures of dominant vs. minority groups. This dominance is based on a perceived balance of power and hegemony of Western culture, often seen as “supreme” and fiercely defended (Halstead, 1995).

As such, effectively navigating intercultural encounters in Israel requires a thoughtful and nuanced approach that considers the abovementioned distinct social and political dynamics (Doron et al., 2024). However, while previous studies have focused on the premises and goals of intercultural therapy with UO clients or described psychological encounters from the Haredim’s perspective, much less attention tends to be paid to the secular therapists’ experiences (Doron et al., 2024). Therefore, this paper examines the unique experiences of STs in providing mental health treatment to the UO sector in Israel by posing the following research questions: 1) What are the experiences of STs when working with UO clients? 2) What are the challenges and barriers in therapy with UO clients? 3) How do the therapist’s concepts regarding the UO sector affect their encounter with the Haredi clients? 4) How does the current sociocultural situation in Israel affect the therapists’ encounters with UO clients?

While these issues are especially pertinent in the current complex social climate of Israel, they are equally relevant to other diverse societies, which emphasize the critical role that intercultural (medical) care plays in contemporary healthcare, requiring doctors, nurses, and other therapists to embody cultural competence as an essential part of their daily practice (Beach et al., 2006; Berman et al., 2024; Tucker et al., 2011). Thus, while it is argued that all healthcare professionals should consider patients’ cultural backgrounds, including values and norms, religious beliefs, traditional customs and lifestyles, as essential to quality care, this study emphasizes the importance of cultural background for therapeutic encounters between patients and therapists. It also highlights how the meanings attached by therapists influence their perception of intercultural therapy and how the social reality of therapy is formed and constructed (Giddens, 2013).

In addition, since a therapeutic encounter involves a social interaction between a patient and a specific social and cultural setting, such as a medical facility, the therapist’s actions are influenced by the meanings and interpretations they place on their clients, their circumstances, and their responses rather than being solely determined by external factors (Meddin, 1982; Roe et al., 2010). Therefore, we contend that, despite the almost complete lack of research around STs’ perspectives on working with the OU, it is crucial to examine the demands, difficulties, and advantages arising from the therapeutic interaction as well as the underlying meanings associated with the behaviors and activities of their UO clients. Particularly because social behaviors are manifestations of the social-political context, culture, and “hidden” forces that reflect these meanings. Consequently, it includes thoughts on these events from the perspective of healthcare workers; this approach thus offers the option of examining the interaction between the STs and the Haredim.

Methods

Study Design

While most studies on intercultural therapy with UO Jews are focused on the client’s perspective (Haimovich & Leiser, 2017; Hess & Pitariu, 2011), much less is known about STs’ perceptions of and experiences with therapy with UO clients. Therefore, this study was designed to explore secular therapists’ (psychologists, psychotherapists, and art therapists) encounters with Ultra-Orthodox Jews in Israel. Since there are only a few studies on the STs’ perspective on working with Haredi clients (Freund & Band-Winterstein, 2017; Hoffman & Ben-Shalom, 2014; Keidar et al., 2021), a qualitative approach was adopted to provide a nuanced perspective on the subject (Creswell & Porth, 2017). It presents data from semi-structured interviews with twenty-one STs who performed therapy with UO clients. At the same time, while this study is part of a larger project exploring therapeutic encounters between STs and the Haredim, it specifically focuses on STs’ perception of the interplay of religion, politics, and therapy. An interpretative phenomenological approach was used because we were interested in understanding the STs’ experiences related to providing therapy to UO clients, how they attached meaning to these experiences, and how these meanings influenced the perception of intercultural therapy with UO clients (Crowther et al., 2017; Peat et al., 2019). This approach helped to gain in-depth knowledge of STs’ perspectives and experiences and the meanings they ascribed to them, which may help better understand challenges in intercultural therapy with the Haredi community.

Participants and Setting

STs (psychologists, psychotherapists, and art therapists) were invited to participate via an invitation letter posted on Facebook and WhatsApp. The inclusion criteria were: being an ST with at least three years of experience in therapeutic practice, being directly involved in therapy with at least two UO clients, having therapeutic experience with both Haredi and secular clients, being willing to participate in the study, and providing written informed consent.

Fifteen STs initially responded to the invitation and volunteered to participate. However, to ensure the validity of findings and achieve thematic saturation (Boddy, 2016), the recruitment process was continued using a non-probability snowball sampling method (Noy, 2008) and the interviewees were asked to provide referrals to other potential participants. In total, twenty-three STs expressed an interest in study participation, but two did not meet the inclusion criteria, so interviews were conducted with 21 STs.

Research Tool

The interview guide was developed using the qualitative pretest interview (QPI) approach (Buschle et al., 2022). Firstly, a preliminary list of interview questions was designed after a thorough analysis of the literature on the therapy involving UO clients (Coleman-Brueckheimer et al., 2009; Hess & Pitariu, 2011; Hoffman & Ben-Shalom, 2014; Band-Winterstein & Freund, 2015; Freund & Band-Winterstein, 2017; Hess, 2018; Haimovich & Leiser, 2017; Doron, 2020; Keidar et. al., 2021). The structure of the interview guide focused on STs’ experiences of their therapeutic encounters with Haredi clients and consisted of eight questions designed to determine the meanings STs gave to their experiences with UO clients in Israel and how these experiences influenced their reflection on self, client, and therapy: What were their experiences when working with UO clients? How does a therapeutic encounter with a UO client differ from the one with a secular client? What are the challenges and barriers to therapy with a UO client? How do the therapist’s personal concepts regarding the UO sector affect their encounter with the Haredi clients? How does the current sociocultural situation in Israel affect the therapists’ encounters with UO clients? Thus, the interview guide facilitated the identification of specific issues related to STs’ experiences with the UO clients (Supplementary material). Two external experts in art therapy and medical sociology reviewed the interview guide, leading to the refinement of two research questions. The interview guide was then approved by the Poznan University of Medical Sciences (PUMS) Bioethics Committee.

Data Collection

Invitation to participate in the study was posted on online platforms and eligible STs were recruited via Facebook pages and specialised WhatsApp groups for psychologists, psychotherapists, and art therapists. The therapists who volunteered and agreed to participate were interviewed between March and July 2023. All interviews were conducted and recorded by the first author (ED) as Zoom conversations, lasting between 38 and 81 min (average length 51 min). None of the participants asked for the authorisation of the transcribed interview.

Data Analysis

The interviews were digitally audio-taped and transcribed verbatim by the first author (ED). Any emotions, silences, intonations, or emphases in the audio recordings were also transcribed for analytical purposes. The same researcher coded, summarised and concluded the interviews. To ensure the quality of the interviews, every participant was asked whether they were understood correctly, and at the end of each interview, they were also given a chance to explain their stance and/or add additional comments regarding issues not discussed in the interview guide. While all respondents confirmed the meanings of their experiences, four therapists added additional comments that were included in the analysis. To ensure the validity of the findings, another researcher specializing in qualitative research (JD) reviewed the conclusions and helped resolve any discrepancies stemming from the transcripts’ summaries. Finally, the findings were discussed in this study’s research group (Lincoln & Guba, 1985).

Next, the interviews were analysed using thematic analysis (Guest et al., 2012) based on Colaizzi’s approach (Colaizzi, 1978). First, all transcripts were read several times to familiarize with the study material. Next, significant statements, phrases, and keywords related to STs’ experiences with the therapy involving UO clients were identified and assigned preliminary codes, which, together with relevant quotations, were consolidated in meaning statements and grouped into thematic clusters. These clusters were then integrated into major themes that were defined and presented as explicit and clear statements.

Ethical Considerations

This study was conducted according to the principles of the Declaration of Helsinki laid down in the 1964 Declaration of Helsinki (revised in 2000) (Sawicka-Gutaj et al., 2022). Ethical approval was granted by the Poznan University of Medical Sciences (PUMS) Bioethics Committee (KB – 139/23, granted 1st February 2023). Before the interview, all participants were informed by the first author (ED) about the study’s purpose and methods, its voluntary and confidential character, and the possibility of withdrawing at any time and/or not revealing information on their personal circumstances without any implications. Because some questions relate to sensitive issues that might cause distress, all respondents were also instructed that they may take the time to decide whether to continue the interview, should they experience any emotional stress while recalling past events. Finally, participants were informed that all information collected would be used only for scientific purposes. Informed and voluntary written consent was obtained from all therapists who participated in the study.

Results

Participants

A total of 21 STs were interviewed, including nine psychologists and twelve art therapists. They were all Israeli Jews with a mean age of 46 (range: 38–73 years) and 13.5 years (3–30) years of professional experience, including 7.5 years of experience (range 2–20) with UO clients (Table 1). Of those, seventeen were female, and four were male. Clinical social workers were also approached, but none responded. Most participants worked in both private and public practices and specialised in providing care to either children (n = 8), adults (n = 4), or both (n = 9). On average, they provided care to 32 UO clients (range 3–150) and worked with the UO population out of their own choice.

Table 1.

Study Participants

Code	Gender	Age	Profession	Years of professional experience	Years of experience with UO clients	Place of work	Type of clients	Estimated number of UO clients
ST1	male	52	art therapist	13	5	public and private	children and adults	15
ST2	female	73	art therapist	13	8	private	adults	12
ST3	female	40	art therapist	12	11	public and private	children & adults	30
ST4	female	40	art therapist	10	3	public and private	adults	9
ST5	female	59	art therapist	20	11	public	children	150
ST6	female	45	art therapist	14	14	private	children and adults	7
ST7	female	60	psychologist	30	20	public and private	children and adults	60
ST8	female	37	art therapist	10	6	public	children and adults	40
ST9	female	43	psychologist	15	7	public	children and adults	15
ST10	female	43	psychologist	15	10	public and private	children and adults	3
ST11	female	40	art therapist	10	8	public	children	30
ST12	male	47	art therapist	14	2	public	children and adults	40
ST13	female	39	psychologist	4	2	public	children	15
ST14	female	38	art therapist	9	2	public	children	2
ST15	female	54	art therapist	13	5	private	adults	3
ST16	female	30	psychologist	3	1	public	children	15
ST17	male	39	psychologist	4	3	public	children	4
ST18	female	41	psychologist	13	6	public	children and adults	50
ST19	female	55	psychologist	22	10	public and private	adults	40
ST20	female	52	art therapist	22	13	public	children	100
ST21	male	49	psychologist	22	15	public	children	50

Themes

The thematic analysis identified three major themes with six associated sub-themes: 1. a feeling of an outsider, 2. colliding viewpoints, and 3. sameness (see Fig. 1).

Fig. 1.

Themes and sub-themes emerging from qualitative analysis

Theme 1

A Feeling of an outsider

Making Me Feel Like an Outsider

In considering the way STs were perceived by UO clients and/or their parents and the comments they faced during the therapeutic encounter, many respondents expressed a feeling of being treated like an outsider. While some therapists felt not being accepted by their clients, they all stressed that there was constant questioning, mainly at the beginning of the relationship, about whether or not STs could understand the Haredi perspective and fully grasp the nuances of the UO culture and community. Respondents also emphasised that UO clients often doubted whether they, as seculars, would supply appropriate therapy considering the context and needs of the UO clients:

The feeling that they don’t accept me as one of them is very present… I’m always the one who doesn’t understand. It’s a very significant experience. (ST 1)

Sometimes, it even becomes an issue between us. How much do I understand, and how much can I understand? (ST4)

Very quickly, sentences like “You wouldn’t understand” or “In our world…” They have these assumptions that our values are different, and I wouldn’t understand their dilemmas or conflicts. That I won’t respect their wishes. (ST 4)

While stressing that many UO clients perceived therapeutic encounters from the ‘us’ vs ‘them’ perspective, many STs felt examined by their clients or parents as to how much they could be trusted. Respondents often mentioned how the Haredim expressed feelings of anxiety, distrust, or even fear and how their clients tested them before they could be trusted so that a client could or could not say something to the therapist. Some also stressed a sense of suspicion from the clients and a clear feeling that they were not ‘one of them’. Many times, it took the therapists longer to develop rapport and earn the client’s respect.

Some parents had a hard time with me being a secular, and if I can still be trusted… It made me feel somehow a foreigner, different and unusual. (ST 5)

There was a great deal of fear and suspicion of me and the secular world I represent. (ST 12)

There was a lot of anxiety and concealment at first; I needed to pass all sorts of tests to make sure they could talk to me about such matters. (ST 14)

Advantages of Being an Outsider

Following this feeling of being an “outsider”, many participants suggested that not being “one of them” had advantages. Some STs pointed out that their client made a conscious choice to be treated by a secular and not a Haredi therapist. The main advantage STs mentioned was that their clients felt free to express feelings and thoughts that were too risky to express to a therapist who is a part of their community or may have ties to it. Issues of doubt and questioning their faith, any irregular thoughts, or what the client perceived as dangerous or unacceptable feelings could more easily be shared with someone who is an outsider. Thus, STs mentioned the paradox that being an ‘outsider’ helped gain their clients' trust:

I think that many Haredim would choose to go to secular therapists because they’re secular. Because there is much more freedom to ask questions of faith. Doubts. I think it is highly recommended to go to a secular therapist. It enables them to be angry at their society. At their social structure. (ST 2)

There were also parents who liked that I don’t live in their city and I’m not a part of the gossip… so if I’m not part of the culture, they can tell me things that they don’t dare tell anyone else. (ST 5)

Respondents also stressed that most of their clients, even if they appeared distrusting, felt that an ST would be less judgmental and less likely to get alarmed by the things they hear and that there was no chance of the whole community hearing about it the next day:

Here is a person that wouldn’t judge me… there is no risk of, god forbid, she would spread the word of my wild ideas against my sector. (ST 2)

That’s why they came to me because here they could reveal all. There was something there that, if found out, would have been disastrous as far as the community goes. (ST 8)

Theme 2

Colliding Viewpoints

Being a Professional Requires Leaving One’s Personal Opinions Out of the Room

When asked about the challenges of working with UO clients, most of the STs talked about how their viewpoints and opinions made it hard for them to work with Haredim. They were often faced with moral dilemmas, colliding of values, and conflicts within the therapy that included professional and personal collisions between their clients’ religion and political stance and those of their own:

I had a critical voice thinking what is this nonsense that you can’t open bottles on Shabbat?! It’s ridiculous... but I said ok and put it aside because this is how they see fit. (ST 11)

My personal opinion has no place here, personally I really don’t care if she says her blessing or not, but I will not say that to her because I should comply with the cultural codes. (ST 5)

I asked a 10-year-old client if she likes to ride a bicycle, and she said that girls are not allowed to ride; it is not modest, and I was shocked! But I had to put that shock aside and be with her in her world. (ST 11)

The respondents felt that the only way they could successfully help their clients was to leave their viewpoints and personal opinions outside the therapy room. At the same time, while they all stressed that being a professional requires leaving one’s feelings and thoughts out when treating their clients, they also suggested that performing with the UO was more noticeable and challenging since many clients’ values were pointed against the secular sector. STs felt that they could talk about anything until it came to politics. There, they felt their criticism present and had to consciously make an effort not to bring it into the therapy:

I will not talk to him about unfair budgets to the Yeshivot [Haredi scholar institutions]…it does not enter the room unless he brings it up, and then, of course, I will try to be neutral. (ST 1)

I don’t sit in front of a person thinking: wow, this person doesn’t pay taxes or serve in the military. It doesn’t enter, as far as I’m concerned. (ST 7)

It’s just hard sometimes when the relationship is close and intimate with clients…so sometimes it’s harder to keep it outside the room… really big things are happening that have to do with the tension between Haredi and seculars, and it doesn’t enter the discourse. The criticism that I have towards the UO sometimes it is hard to leave outside. (ST 13)

I remember the morning after the elections, I had two UO clients, and you want to sit with your back straight, but you also want to kill them because you hate them now. Because they beat you. (ST 15)

Intense Feelings Caused by the Viewpoints and Opinions of the Haredi Clients

STs mentioned the difficulties they experience when facing their UO clients’ viewpoints and opinions. Therapists expressed acute standpoints following things said by their clients. Frequently, they reported experiencing frustration, shock, recoil, anger, or even furiousness and hate. Some felt that all their stigmas and prejudice re-surfaced on account of what they heard, and they were having a tough time staying in control in front of their client. At the same time, respondents suggested that Haredim’s attitudes toward seculars were the most sensitive area of collisions. Thus, many STs enrolled in this study complained that UO often frame seculars as enemies or as persons without moral or familial values:

In one of the sessions, a guy told me that he wouldn’t let his kids meet with secular kids. And I left that meeting shocked…one of the things that came into my head was: primitive leeches. Yes, I went back to my primary perceptions. I got defensive. (ST 1)

One client told me that I wouldn’t understand because seculars don’t really want kids. I had a really hard time with that stigma. I was in the midst of my fertility treatments. (ST 4)

Kids would play the good against the bad, and the bad were the seculars. And you had to sit there as a secular and cooperate with the seculars representing all the evil and the vices (…) Some things would just make me furious every time around, like when they tell me they could have never sent their sons to the military, and how could I… (ST 5)

A client told me they went for Shabbat out of town, and there were traffic jams, and they were very close to missing the Shabbat time… and she couldn’t understand “Why didn’t the seculars stop their cars and just let us pass?!” I was shocked! (ST 15)

In contrast, some respondents stressed the Haredim’s attitudes toward state regulations. For example, STs mentioned issues such as tricking the state into getting allowances, not commemorating Memorial Day, or unfair division of the state budget to Yeshivot (i.e., a traditional Jewish educational institution of Talmudic learning) as issues that evoked the most severe emotions and reactions:

She said, “Why do I have to work?! I have four kids! Why does social security make me work?!” And she’s crying hard. And you look at her, and you’re like… it was hard. (ST 8)

Some things are hard for me… a lot of exploitation of the system... like to screw the system, to take advantage, to receive funds all the time. (ST 15)

Some aspects of this sector I can’t bear, and I get furious and angry, and I want to kill someone, not once and not twice. (ST 18)

In the interpersonal, you are like me in any way… and we’ll be the best to one another; at the national level, I’m against you. (ST 8)

Although describing many negative experiences, none of the participants felt they did not want to continue working with UO.

Theme 3

Sameness

The Feeling That We Are Basically All Alike

Almost all respondents mentioned that we are all alike despite the different lifestyles and external appearances. They said that they found the reasons for referring to therapy in the Haredi sector were the same as any other client and stressed that UO suffers from the same problems as all other clients, seeking help for issues such as family relationships, marital problems, anxieties, and all the life burdens of secular people’s lives. Some participants were surprised by how, underneath the different clothes, all parties involved are basically the same. At the same time, they stressed that every individual, regardless of attire, possesses inherent dignity and that the human spirit is universal. Some also mentioned the ambivalence of their feelings, great alienations and differentiation on the one hand, and a sense of unity on the other:

Under the “gatkes” [long johns], we are all human beings. In interpersonal encounters, I don’t feel many differences. I see mainly people. I don’t see black coats. (ST 1)

I don’t feel a difference; we are all so alike… what do we eventually want? To be loved and appreciated that’s all we want in this world. (ST 2)

Most STs emphasised a fundamental commonality among individuals, going beyond different ways of living and outward expressions. They mentioned that the reasons for prompting individuals from the Haredi sector to seek therapy were essentially the same as those motivating any other persons. UO sought assistance with issues of familial relationships, marital problems, anxieties, and the challenges inherent in the lives of secular individuals. Some respondents expressed their surprise at the realisation that, despite the distinct differences in culture and appearance, underlying commonalities persist that underscore the universality of the human experience. Notably, a recurring sentiment among participants reflected a dichotomy of emotions, alienation, and differentiation contrasted with a sense of unity:

I feel that when I meet people, I meet human beings, and it doesn’t really matter to me what they wear or what they believe in… (ST 4)

Eventually, when there is distress… it is pretty universal. It helped me work with them. (ST 9)

There is something touching about it… at the end, a person is a person. If you put the souls in the middle, it is above all. It is very powerful. (ST 11)

Some STs who specialised in child therapy indicated that children from the Haredi community exhibited no discernible divergence from their counterparts in other social groups. The remaining participants, working with both paediatric and adult populations, refrained from singling out their experiences with children in their responses. Their collective professional observation suggests that the thematic content, attitudes, and interests expressed by children remain uniform across societal sectors, irrespective of demographic distinctions:

With kids, you don’t have to peel off layers of stigma. Kids are kids. It really doesn’t matter. (ST 3)

In the therapeutic encounter with children, there is hardly any difference… a connection is a connection; it’s between people. (ST 5)

My first experience was that there was less of a gap than I had expected. In the end, you arrive at the preschool, and it’s a lot more similar to what I know. (ST 16)

The Value of Intercultural Therapy

A notable unity was found among all STs when asked how they felt about intercultural therapy. All respondents concurred that intercultural therapy constitutes a beneficial process for both the client and the therapist. They also emphasised that it presents an avenue for mutual comprehension between the involved parties, particularly in the context of the prevailing political climate in Israel. The participants noted the imperative of striving to understand the “other side”, highlighting intercultural therapy as a means to foster such understanding through individualised connections:

I am very much in favour of intercultural therapy; I think it is one of the things that, if made possible in all arenas, could have saved us and solved a lot of conflicts. (ST 13)

It was a very exciting experience in the sense that it made it clear to me that the human encounter, in the end, crosses sectors and cultures. (ST 11)

I think that the fact that they can project on me, the fact that they can meet a very different voice from what they usually hear, is very important in therapy and in general as a person. (ST 12)

I see the value in such encounters, and I am happy when clients even check the possibility of coming to therapy with a secular therapist. A mission sounds like a big word for it, but it is important to me to be there and allow these opportunities. (ST 4)

Moreover, they underscored the personal and professional enrichment of engaging in intercultural therapy, noting its capacity to transcend preconceived notions about the Haredi sector:

I think that in this [intercultural therapy] context, something is fascinating about this sector, something different. It enables an encounter with yourself, with your inner alienation, with the likeness and different, other, and separated. (ST 18)

I think it created something different in me as a therapist. More humility and understanding that there are other ways to mental health and well-being. Also, as a community and society that is composed of many different communities. I am in favour of it. (ST 9)

I am very, very, very much in favour of intercultural therapy. I think it enriches both sides and the process. A good therapist is someone willing to challenge his perceptions and recommendations according to the client. (ST 17)

Although all the participants stressed the importance and upsides of intercultural therapy, four mentioned that they would most probably not see a Haredi therapist if it was the other way around. This implies that whereas in the Israeli political arena, where the Haredim hold great power, in the psychological-medical field, it’s more of a power relationship where one side thinks they can help the other but not vice versa.

Discussion

Existing studies provide a nuanced exploration of the intersection between divergent cultural paradigms and value orientations, examining the interplay between the traditionalist-collectivist ethos prevalent among UO clients and the Western cultural foundations intrinsic to psychotherapeutic theory and practice within which STs operate. This intricate dynamic has been discussed by scholars, usually from the client’s perspectives and/or an identification of therapeutic themes (e.g., Band-Winterstein & Freund, 2015; Freund & Band-Winterstein, 2017; Haimovich & Leiser, 2017). The current study adds a political-cultural focus to learning about the experiences of STs working with UO clients.

Intercultural therapy places a substantial responsibility on the therapist to critically assess their assumptions, misconceptions, and blind spots. This entails delving into various topics, including privilege, power dynamics, observation techniques, attunement, and alliance-building. Such exploration encompasses diverse dimensions such as nonverbal cues, linguistic challenges, decision-making frameworks, countertransference dynamics, explanatory frameworks, and stereotypical perceptions (Guzder & Rousseau, 2013). These elements collectively contribute to the cultivation of cultural competency, a requisite skill set expected of intercultural therapists, extensively documented and discussed in scholarly discourse over the years (e.g., Greenberg & Witztum, 2013; Sue et. al., 2009).

The study findings demonstrate the unique intercultural therapeutic situation in Israel as reflected in the therapists’ experiences. STs enrolled in this study described several extreme situations that possibly place therapists in conflicting stances and challenging situations caused by their clients’ beliefs regarding seculars. From an early age, they are taught to reject the “other”, sometimes to a point where they feel morally superior to the seculars (Brown, 2017; Elimelech, 2012; Sagi, 2006).

In a way, the interviews conducted with these therapists were utilised to reconcile their conflicting self-perceptions. In a tumultuous political climate where everyone is pressured to choose a side, the pursuit of self-integration for professionals working with Haredim becomes even more crucial, yet equally challenging. Many of the cultural barriers the interviewees mentioned as problematic in their work with Haredim mirror the prevalent public discourse. They see themselves as loyal Israeli citizens defending their country, in contrast to their Haredi clients who usually do not serve in the army but still enjoy the benefits provided by hard-working Israelis, even in difficult financial times (Doron et al., 2024). The reasons mentioned above have caused secular individuals to develop negative attitudes toward the UO community (Zicherman, 2014). However, it is important to note that research shows that most seculars in Israel know surprisingly little about the Haredim, and their opinions are often influenced by subjective media coverage that focuses on disagreements (Finkelman, 2014; Zicherman, 2014). This was also supported by the interviewees stating that they had not received any supervision regarding work with UO before beginning their work.

Regarding the three main themes that emerged, the outsider theme is familiar in recent studies. The advantages of being an outsider to the UO community and being less likely to expose delicate information or make connections to familiar figures, thus damaging the good name of the entire client’s family, have been discussed (Freund & Band-Winterstein, 2017; Doron, 2020; Keidar et el., 2021). However, the extreme feelings this outsider position raised have not been discussed. A position that was intentional by the Haredi clients, aiming to put the therapist in an unfamiliar, doubtful, and insecure position. The participants described instances where the client or the client’s parents intended to ensure that the therapist knew how they felt and how doubtful they were of their ability to understand situations. Keidar et al., (2021, 2022) mentioned the suspicion therapists felt from parents in the first stages of the process. These current interviewees went further, talking about candid, direct remarks, as well as a casting of doubt and questioning that was pointed at them.

The second theme, colliding viewpoints, raised what seems to be the most extreme feelings from the interviewees. This theme reflects the feelings currently heard in the secular streets in Israel. For some years now, the Haredim have been perceived as “leeches sucking off seculars”. Leeches are only one metaphor; other imagery makes the same point. A few years ago, small round stickers depicting a secular Israeli with a Haredi on his back started turning up at bus stops and lampposts (Efron, 2003: 57–58). It is this atmosphere that colours the therapeutic dyad of seculars and UO, and that gave rise to such extreme thoughts and emotions, including shock, frustration and anger, as exemplified by experiences such as “you also want to kill them because you hate them now”. In particular, many therapists felt sad, shocked, mad, and stigmatised when the Haredim described themselves as “entitled” and the better “other” (Efron, 2003: 264) during the therapeutic encounter. Keidar et al. (2021), who interviewed secular art therapists, mentioned that when dealing with situations of conflicts of values with nationalist ideology, the therapists felt distressed to the point where they failed to conduct culturally competent therapy. Again, the experiences expressed in the current research were more extreme, presenting antagonism and animosity toward Haredim, reflecting a side in the common discourse (Efron, 2003: 57–58).

In addition, some said that their UO client’s un-involvement in what was happening around them was incomprehensible and frustrating, and this once again reflected the common opinion of Haredim living in enclaves (Zicherman, 2017). These conflicts of values and the professional attempts to provide culturally sensitive therapy made the interviewees feel that the only way they could function was to leave their opinions out. Efron (2003: 264) suggests that hating Haredim is a growth industry because Haredi-hating is a defining element of Israeli ethos and is perhaps on the way to becoming the defining element of Israeli identity. He suggests that the UO provides the most helpful foil for Israelis trying to understand themselves.

The third theme may seem like a contradiction to the previous one and a conflicting aspect of the interviewees’ identity. However, these contradictions are not intrinsic to their diverse identity—professional components. Instead, they stem from the political landscape they navigate, a context of violent cultural conflict that pushes their understanding of self to its limits and allows these two themes to coexist. This theme of sameness and alikeness was among the most prevalent experiences. No matter how extreme expressions were reported, they all mentioned that the human experience is one. It is unlikely that the interviewees prioritised appearing “politically correct” and tolerant towards various value systems of the UO rather than appearing as “one-sided”. Instead, it is the context of exploring and acknowledging significant differences that ultimately enables the client and the therapist to discover human sameness, their “common human dignity and frailty”. Both sides must create a sense of safety mediated by sameness (Sperry, 2013).

This point is relevant to all intercultural therapeutic interactions, not just seculars and UO and, certainly, not just in Israel. Our research shows the complexity of such encounters and their potentials for any two cultures. When working with different cultures, moreover “opposing” cultures, one often starts from the position of difference and slowly works towards finding sameness (Connell et al., 2016). This process is possible when the attention is shifted from common knowledge-gathering towards the actual interaction that forms individual “knowledge” (Pilhofer, 2011), where a person is not viewed as a representative of a cultural group but as a unique human being. The therapist’s responsive presence contributes to the mutual process of trying to find a way to deal with the complexity of cultural differences, resulting in a sense of shared humanity (Rober & De Haene, 2014). The findings place this encounter as a clear example of how underlying universal principles, initially obscured by specific details and difficult to discern, are later thoughtfully examined as potential connections. This approach allows therapists of all majorities from around the globe to look beyond the apparent particularities and cultural differences, creating space to explore possible bridges between themselves and others (Rober & De Haene, 2014). Feeling solidarity urges people to sacrifice much for each other's interests and well-being (Yerushalmi, 2024).

When considering symbolic interactionism that focuses on the interactions between individuals at the micro level of society, the case of the STs with UO clients can be a precise example. It posits that the capacity to think and assign meaning is shaped through social interactions. A key idea that sets it apart from other social-scientific perspectives is the belief that social life is always “in process”, never static or in a state of equilibrium. The integration within individuals or society is thought to arise from constantly evolving relationships rather than from any inherent homeostatic tendencies (Meddin, 1982; Roe et al., 2010). The research demonstrated these changing relationships, which were made possible thanks to the one-on-one therapeutic interactions. The notion is that despite extreme values and attitudes from both sides, active involvement in interactions and thinking processes influences social reality.

Study Limitations

This study has some limitations. First, only twenty-one secular therapists were interviewed. Thus, the results represent solely the opinions of those STs who agreed to participate in the study and cannot be generalised to the entire population of STs in Israel. However, despite the small sample, thematic saturation was achieved. Secondly, most respondents were female, which limits the transferability of the results to male therapists, although this imbalance is representative of the female predominance within the therapeutic professions in Israel. Thirdly, although the UO community comprises several groups and subgroups that differ in their commitment to tradition and modernity and their openness to therapy and the larger society, none of the participants mentioned any differences between the groups or experiences influenced by the different streams in the interviews. While it could reflect the ignorance of the non-religious interviewees, it can point to the fact that maybe the Haredim, who look for therapy, belong all to the more open stream. Finally, since the interviews were conducted in Hebrew, the analysis was performed by one author alone, so there was a risk of subjectivity that might have influenced the choice of themes and the data interpretation. However, while most previous studies focused on the premises and goals of intercultural therapy with UO clients or presented Haredim’s perspective on psychological encounters, to the best of our knowledge, this is one of the very few studies that describe lived experiences of STs working with UO clients in Israel. Consequently, it fills the gap in the literature regarding the challenges and needs faced by STs working with UO clients. Moreover, while STs’ perspectives are often overlooked, this study enabled them to share their experiences, which can have therapeutic value.

Future Directions

Further research should delve into the secular-Ultra Orthodox relationship in other medical fields and explore this experience over time, examining how many STs chose to continue their work with the Haredi sector. At the same time, future research should be conducted on a broader sample of therapists as it would make the results more generalizable. Future research should also delve further into the perspective of male therapists. Finally, research examining the impact of a secular environment where psychotherapy with UO clients occurs would also add to our understanding of this topic. On the other hand, research should also focus on interviewing UO clients about their experience with secular therapists, including their motivations for initiating therapy and choosing secular therapists and their perception of barriers and facilitators in psychotherapy with secular therapists.

Conclusions

This paper delves into the unique therapeutic encounter of STs working with the Haredi client in a culturally complicated arena in Israel. Their experiences reflect the many facets of the public discourse regarding the challenges of the secular-Haredi debates. The dyadic relationship gave rise to many professional and personal conflicts and opportunities for understanding and unity. While recent studies suggest that religious clients may benefit equally from treatment delivered by religious and non-religious therapists, the therapist’s religion did not affect the treatment rate, length, or outcome (e.g., Rosmarin & Pirutinsky, 2020). This paper contributes to these results by emphasising how STs can benefit equally from a Haredi client and that such encounter holds advantages in addition to collisions, as stated by one respondent:

I can say that my perceptions changed a lot. If, in the past, I thought of them in a certain way, a negative one, I am not embarrassed to say that today, I look at them in a totally more human and accepting way. Looking at the person with less judgment was very strong at the beginning, and today, it is understanding and respectful. (ST 1)

This is an important message in this complex present time to public workplaces, such as mental health clinics, children development centres, family therapy centres, etc., and to policymakers who should consider enabling such intercultural therapies, acknowledging that they hold many benefits along with the challenges (Berman et al., 2024). Directors and managers of mental health facilities should consider these issues under designated supervision by professionals familiar with both intercultural therapy and minority communities to ensure the therapist’s positioning in the dyad and for the well-being of both parties. This needs to be addressed before the initial meeting between an ST and a religious/minority group patient to prepare the therapist for what they might encounter, to gain information about this sector, their characteristics, and potential conflicts, and to ensure a safe setting and mutual trust. As demonstrated, such encounters can shape individuals’ self-identities, regardless of how local their specific contexts of action may be. These individuals contribute to and actively promote global social influences through the consequences and implications of their actions (Giddens, 1997). Contrary to this view, the political situation has made it very difficult to put these conclusions into action, as the current policy of clinical professional management is to match the therapist to the community and/or affiliation of the client, considering that it would benefit the client. When it comes to the Haredi sector, this is beyond a recommendation, as they frequently expect modifications to be tailored to their needs, and the current climate in Israel is to comply. This, in turn, may contribute to stronger polarization with no opportunities for building bridges between the seculars and the Haredim.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

UO

Ultra-orthodox

STs

Secular therapists

Author Contributions

ED and JD conceptualized the study. ED, ST and JD designed the interview guide. ED collected, analyzed and interpreted the data and conducted a literature search. ED and JD composed the original draft of the manuscript. All authors critically revised and edited the various drafts of the manuscript and approved the final version before submission. JD supervised the study.

Funding

This research received no funding.

Declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Ethics and research governance approval were obtained from the PUMS Bioethics Committee (KB – 139/23).

Informed Consent

Informed consent was obtained from all individual participants included in the study.