''Nothing makes religious people as nervous as sex, or at least unregulated sex’
Berne {1973}''

Love, intimacy, sensuality, relating communication and sexuality are some of the positive words used when describing the process of psychosexual therapy. Words less often used are shame, guilt, disappointment, secrecy, anger and rage. Psychosexual and relationship therapy offered from a Humanistic Integrative orientation approaches the work from a perspective which, whilst acknowledging the value of the more traditional cognitive behavioural, psychodynamic or medical viewpoints also emphasises the empowerment and equality of the individual or couple. The need to identify and work with the family of origin constructs which have informed the couple or individual, in addition to the effects of gender, ethnicity and cultural belief system of the therapist upon the therapeutic relationship are all part of this complex therapeutic alliance. Sexuality and the increased awareness of woman has impacted on many communities; however those from minority groups who may have clear and strict rulings regarding their sexual practices and behaviour have largely been ignored within current literature and within approved psychosexual training environments. To understand the complex nature of any difficulties presented by Jewish women, the genesis of the belief system and the historical context must be understood. In 1970 Masters and Johnson introduced ‘sensate focus’ which, it could be argued has become the backbone of sex therapy in the UK. What this system fails to address, with any level of depth, is the past and present emotional, spiritual, social and cultural reality of the clients. Furthermore, it does not address the cultural mores of many minority groups. However Masters and Johnson also stated that ‘there is no such thing as an uninvolved partner in any marriage in which there is some form of sexual inadequacy’ and whilst we may consider the language outdated, the tenet is something which could be considered to be as accurate today as it was then. This chapter focuses on sexuality and Jewish women and how to perform psychosexual therapy from a humanistic perspective with this client group. In considering the difficulties inherent in any such task, we need to address aspects of Jewish law, which has both a written and oral tradition. Thus far then, we are congruent with humanistic therapy. However the oral and written traditions within Jewish law do not always appear to be in harmony and therefore contradictions may be found. The Talmud is the central text; within it are found the Gemara and Mishna. Gemara is the Talmudic commentary on the Mishna, which is the second century rabbinic legal code and forms the basis of the Talmud and its oral code. Halakah - ‘the way’ is Jewish law, these have specific rulings, and are both oral and written traditions. The Torah contains the whole body of religious teaching and laws and specifically the five books of Moses. Rabbinical discourse over the interpretation of these laws, teachings and rules has been part of Jewish life and tradition since the creation of these documents. Broadly speaking Jews are divided into two ethnic groups; Sephardic Jews are generally accepted as those who originate from Spain, Portugal, Iran, Iraq, North Africa and India. Ashkenazie Jews are those who originate from Germany, and are of Eastern European descent. A lesser used term is that of Mizrahim that specifically denotes those who originate from Asia and North Africa. Other definitions include Masorti, Liberal, Reform and Orthodox; within the orthodox tradition there are several sub divisions. Thus, there are many complexities within these labels and divisions and it is not within the scope of this chapter to develop these in any depth.
In my work as a psychosexual and relationship therapist I am often presented with, and confronted by, the beliefs with which Jewish women were brought up and current styles, techniques, methods and philosophy within Humanistic therapy which are often at variance with these beliefs. Individuals and couples’ work using integrative methods is a creative and challenging way of working where there are some profound disclosures, and where the meaning for the client forms the foundation of the therapeutic contract. This combination can, at times, feel like an awesome journey to embark upon.
Within the work of a psychosexual and relationship therapist it is openly acknowledged that sexuality and sexual/sensual functioning and the capacity to be intimate plays an important role in all our lives. Looking holistically at the issues we are not only confronted by what is commonly regarded as the biological drive, our libidinal energy, but also by that of sexual attraction which may have nothing or very little to do with availability or compatibility. Sex may be experienced as power with or over. Thus, work within this domain contains endless components and curiosities for the practitioner and client alike.
Looking historically at psychotherapy, which is often labelled ‘the Jewish science,’ Brewer {1982:2} suggests that Jews outweigh non-Jews in the profession. Her suggestion that:

‘within the past ten years women have turned to women therapists with their
problems. Within the Jewish community, there is now a greater number of female
sex therapists, in a field which has traditionally been dominated by males’.

I would add, however that Jewish women cannot be seen a single collective; they come self labelled, from different back grounds and cultures and with different belief systems.
‘Onah’ describes the conjugal rights of a woman who is married, including the marital obligations of the husband. Briefly, the husband is instructed to ensure that his wife has sufficient sexual and sensual enjoyment and activity within the marriage. Whilst instruction or prescription may be a part of the more conventional approach to sexual therapy, it is, in essence contra-indicated when working with an egalitarian and integrative approach to therapy. Clearly, it is difficult to work freely and holistically within a community, which in some parts, is controlled by a strict adherence to Jewish law. Additionally, within Jewish law, a man is obliged to produce at least two children, preferably one of each sex; should his wife prove to suffer with infertility difficulties and the husband cannot fulfil this requirement a divorce is legitimised. A woman who is unable to become pregnant may bring forth a multitude of sexual and social difficulties, which can attack the very foundations of her gender role.
For Jewish women the fact that sexuality is a social and historical construction is particularly obvious, there existing a religious and historical tenet in Talmudic law. One of the difficulties in succinctly defining sexuality is the lack of precise and uniform vocabulary. It is also true that many social symbols are based on sexuality. Thus many people when describing sexuality talk in symbolic language, vague terms or with a clinical and political distance which does not reflect the totality of the human experience of sexuality.
Despite over two decades in practice I am still reminded by many clients of their difficulties when invited to talk through their sexual and intimate issues. This often coupled with either lack of information or misinformation and can lead to a position where folklore or opinions become fact; and it is then a source of great distress to the individual or couple. This difficulty appears to have no respect for age or orientation.
There is a wealth of information on Jewish law and its application to life, equally there is a wealth of information on offering sex therapy from a traditional and often medicalised and pathologised belief system. Sadly, there is very little written about the application of sexual and relationship therapy from a Humanistic integrative bias. Perhaps it is true to say that one of the first integrative sex therapists was Wilhelm Reich followed by the neo-Reichians and more recently the Gestaltists. A fundamental issue is that psychosexual therapists spend a great deal of time learning by doing; each session is potentially an experiential learning arena and informs the practice of the therapist. I suggest that it is vital that we do not become theory bound and therefore encourage our own tendencies to work with an integrative and at times contradictory system. Thereby we use that which is valuable to the client. This would mean that issues of purity will be lost; our exploration of other methodologies can enhance our work and we would be congruent to life by abandoning a linear system working with an openly dialogic environment which respects the level of energy of the client. As therapists, we work with what is alive for us and meaningful for the client.
This style would in itself create some difficulties when working with more orthodox women within the Jewish community who adhere to the traditional teachings on sexuality. These would include only having sexual intercourse in the ‘missionary position’, with the lights off at predetermined times within the middle portion of the woman’s menstrual cycle whilst at the same time putting the responsibility on the husband to ensure his wife’s sexual pleasure and gratification.
From an integrated perspective, this is clearly untenable, and unless the psychosexual therapist comes from the same or similar traditions, therapy, which is full of richness, exploration, innovation and experimentation, is largely unworkable. The constraint placed on any sexual therapists would be so great as to encourage a prescriptive and advice giving environment.

Authors such as Jong, Miller, Roth and Potok achieved popularity in part, through their description of Jewish life as a conglomeration of mythology and caricature, no less effective for encompassing the kernel of truth apparent in all stereotyping. It could be argued that this demonstrates a form of internalised anti-Semitism, perhaps disguised as another Jewish stereotype - self-deprecation.

Portrayal of Jewish women in these part autobiographical novels range from Jong’s rapacious sexual being to the archetypal matriarch. Jeffrey Weeks in his essay ‘Questions of Identity’ {Caplan 1987:31} says:
‘ Sexual identity and sexual desire are not fixed and unchanging. We create boundaries and identities for ourselves to contain what might otherwise threaten to engulf or dissolve into formlessness’.

As therapists, this is a notion we can and do work with. However, this is juxtaposed by a traditional Jewish perception, which might be that rigid boundaries are both necessary and essential to preserve their intrinsic Jewishness. Plaskow states {1990:179}:

‘The heart of Jewish ambivalence toward sexuality is roughly this: The sexual
impulse is given by God and thus is a normal and healthy part of Jewish life.
Sexual relations are appropriate only within the framework of heterosexual
marriage, but within marriage, they are good, indeed, commanded. Yet sexuality -
even within marriage - also requires careful, sometimes rigorous control, in order
that it not transgress the boundaries of marriage or the laws of niddah {a mensturating woman} within it’.

The idea that civilisation requires sublimation of the sexual drive runs through the work of many writers. For Jewish woman it may well be that adherence to traditional mores and values are a means of ensuring the continuing identity of the Jewish people. Judaism has always acknowledged that women are sexual beings and the ‘Madonna/whore’ dichotomy prevalent in Christian belief has therefore not existed for Jewish women. Furthermore, Judaism has never welcomed celibacy as having any religious or spiritual worth.
The growth of Western psychotherapy and its relationship with Eastern traditions over the last 100 years has taken a particular interest in sexuality. Freud’s name is inextricably linked with the concept of sex, despite much of this being associated with repression, fixation and anxiety. One may be forgiven for thinking that Freud’s beliefs and theoretical understanding of sexuality was largely governed by his relationship to his mother, a Jewish woman. If we look at the notion of penis envy and the concept that the clitoris is inferior, we must also address the serious ramifications that this belief supports. Within the world of established Freudian psychotherapy and no doubt within some areas of Judaism, the notion that the vaginal orgasm is ‘mature’ whereas the clitoral one is ‘immature’ can have great influence. Orthodox Jewish women who may only experience penetrative sex in the missionary position, with an absence of foreplay, are unlikely to experience a clitoral orgasm. Denied that which is commonly regarded as the more intense orgasmic experience they then may be asked if they comfort themselves that they experience the more ‘mature’ sexual pleasure as described by Freud, a Jewish man, thus making congruent the traditional orthodox teachings surrounding sexual practice.

Humanistic therapy also has many Jewish exponents. Wilhelm Reich, Fritz Perls, Jack Rosenberg and Abraham Maslow have in common what could be described as a more life affirming view of female sexuality; their belief being that women have a powerful and energetic sexual drive which they have a right to develop, pursue and enjoy. They do not see sexual activity as a purely procreative or physical activity. It may also be true that many men have been raised to believe that unless they are in control sexually then the experience is a negative or humiliating one and the sexually liberated woman poses an inevitable threat. One way of dealing with this possible or supposed threat it to demonise women. Judaism, is no exception to this. Lileth, the folkloric figure who predates Eve as Adam’s companion, is described as a longhaired temptress insisting on the woman superior position in sexual activity; she also kills babies. The man who is tempted by this figure risks all, including, as the sins of the father are visited on the children, the continuation of the race.

Clearly there is much therapeutic work to be done when working with this original template. During the formative years of psychosexual therapy, the emphasis was placed on behavioural techniques not on psychotherapeutic longer term involvement. During the last twenty years this original form of sex therapy has moved into areas that are more diverse; these rely on the motivation, inter-action and communication skills of both therapist and client. Any sexual therapist does, however, need to be appropriately conversant with the physiology, anatomy and organic causes of sexual difficulties.
In an earlier research study, which I undertook in 1995, I asked Jewish women about their experiences in psychotherapy and psychosexual therapy. All these women had to a lesser or greater degree, at some time within their therapeutic process explored the relevance of sexuality, its impact on their lives and to what degree being Jewish had affected them. All the women spoke about the way in which therapy had given them a language to understand and express their sexuality in ways that had previously been denied. At its simplest level, the therapeutic alliance had given these women accurate and factual information regarding anatomy and physiology, bodily functioning and a safe environment in which to explore their issues. The women who I interviewed had diverse experiences of Psychosexual therapy both medium and long term. They had experienced behavioural, psychodynamic and humanistic therapists; no school of therapy had been used more than any other. I therefore had to surmise that it was the therapy in itself and not the school or method which had allowed for a more openly dialogic environment where a commonality of language was created, that each woman’s choice was validated and thereby enhanced the fluidity of their sexual, sensual and intimate language. Additionally it allowed some of these Jewish women to confront issues about monogamy, orientation confusion and divorce. An important factor for these women was that they were able to undertake a depth exploration of the meaning of their Jewishness and its relationship to their sexuality.
The paradox of healthy sexuality is that its very liberation and openness creates potential vulnerability. Simply, in order to experience the excitation of vulnerability a woman needs to feel safe enough in her environment to have access to her full emotional and expressive world. Some of the comments which I received from these women included ‘ being Jewish is me, therefore it must effect my sexuality’, ‘being Jewish is a fundamental part of my identity, it informs me physically and emotionally’, ‘ being Jewish informs my sexuality, I idealise family values’, ‘ I feel bad and guilty for not wanting or taking pleasure in sex at the ‘right’ times’, ‘how do I as a Jewish woman teach my sons and daughters about sex and how do I teach them to have views which are open and consistent with Judaism?’.
The essence of these women’s Jewishness ran through these statements and cannot, I believe, be dissassociated from them being sexual women. Judaism and its teachings and relevance to woman are full of contradictions. Whilst women are seen as sexual beings with rights and needs, they are seen as people who will be sexually available at prescribed times, heterosexuality is assumed. Links between sexuality, fertility and femininity are also issues, which are present and create challenges within the therapeutic environment.
Working with a Jewish woman, either in a couple or as an individual raises additional questions, not least the one of ethnotherapy. Weinstein Klein says:

‘Ethnotherapy seeks to move people from conflicts in their identity to a more
secure and positive grounding in their group, as well as more positive
self-esteem. Personal problems are then seen through an ethnic lens in their
defining social context’.

One must question: can we truly fit the client with the therapist? We need to address not only the gender of the therapist but also the religious and political background of both client and therapist. None of us are free of folklore, myth and anecdotal tales; I suggest that working humanistically we need to identify and work towards resolution of these lest we contaminate the process.

Jewish therapists working with Jewish clients may have an exacting task within their internal and external supervision process; this is indeed fertile ground for transferential issues. Clearly early sexual information and education play an important part in determining later sexual attitudes and practices. Within formal Jewish education, there appears to be little or no formal sex education, furthermore there is very little data on Jewish women. With this in mind, the Chief Rabbi commissioned a survey in 1993. Within this study the questionnaire was entitled ‘Survey of Attitudes’ although many of the questions asked were factual and included issues such as income, education, kosher food and family issues. Sexuality was omitted from this major piece of work.
During my own research study I spent some time asking the women what effect, if any, Jewish law had on their sexuality. When considering the effect of Feminism on their sexuality these women recognised the gulf between traditional Jewish law and twentieth century feminist politics. They fell into two distinct camps, half choosing effectively to opt out of tradition whilst holding on to what they perceived as part of their essential Jewishness and birthright and the remainder choosing to find a way through the dilemmas. All the women I had spoken to brought these issues to therapy. Hershal writing in Jewish Women in Therapy (1990:39} states:
‘For Jewish women who do not see themselves reflected in the images and roles
set forth by classical Judaism, the task is to develop an identity that will combine the
values of feminism with those of Judaism. Feminist therapists can be crucial in making
women aware that the negative stereotypes regarding femaleness they have internalised
are derived from classical male authored Jewish texts’.

Thus, personal challenges may confront family norms leading to the potential for an inter-familial re-evaluation of what it means to preserve Judaism. Part of the therapeutic process may be to consider whether the relationship between the conscious denial of certain aspects of Jewish law and the acceptance of the general assumption, which affirms the rights of women, is congruent with integrative therapy.

Sexuality with all its fluidity and variation must also be seen in the context of self-esteem, body image, environmental, personal and social security. Therefore, how safe Jewish women feel in Britain today is a question, which is worthy of asking. Second generation women often dealing with, and confronted by, the holocaust may have specific psychosexual issues to examine. Did Jewish women change after this relatively recent trauma? Perhaps given that Jews had never, in modern times, had a ‘home land’ until the creation of Israel, the issues contained within assimilation, particularly for the non orthodox, are issues that have to be dealt with in some form or other. This may have been through denial or keeping themselves in what could be regarded as modern time ‘shtetle’ {small Jewish towns or villages} enclaves.

There is little doubt that the children and grand children of holocaust survivors and refugees have passed on to them a set of values and beliefs which have caused much confusion, anxiety and pain. There is a commonly understood notion that the one and a half million children who died in the concentration camps need to be replaced, and families rebuilt. A Jewish psychotherapist documented in Baker’s work {1993:158} states:

‘You know, I’ve got no family; my mother came to this country as a child
and all her family perished; my father’s parents died, too, when he was little
and he was separated from his only sister. The most important thing for me to
do was to become a mother, a Jewish mother’.

I have little doubt that marriage and producing children is seen as a fundamental part of being Jewish and, thus, that the continuation and preservation of Jewish people within society is guaranteed. Another important aspect of the holocaust experience in which six million people died was the brutalisation of the racial psyche. Thus Jewish women must not only ensure the continuation of the line but also ensure that they are never again so vulnerable. This coupled with the guilt of the survivor who when so many died, and whose grief at whole chapters of families disappearing could been seen as leading to a calcification of any experiences, sexual, racial or inter-personal, which could then lead to further vulnerability. The holocaust continues to have a profound impact on attitudes to children and family values. The significance of relationships and having a Jewish partner who understands these values and cultural norms appears to be of similar concern. The continuation of the Jewish line is carried through the mother, even if the father is a non Jew. Jews do not seek converts; however, the orthodox community does not accept those who do convert to Judaism.

Judaism and its teachings and relevance to women is full of contradictions. Whilst women are seen as sexual beings with rights and needs, they are also seen as people who will fulfil their husbands needs both sexually and as mother and home maker. The woman is the reason that the husband remains faithful. Single men are often viewed with suspicion, they are obliged to marry and produce children. Exclusive relationships are deemed essential; in reality we know that this is not always the practice. One of the many contradictions is that in written Jewish law a woman may remain unmarried and childless, however, in oral law this is not the case. Rabbinical interpretation carries a great deal of weight. Woman may be ordained as rabbis within the Liberal and Reform but not in the Orthodox movement.

When working in the domain of Jewish women and sexuality it is important to attempt to define sexuality. There would also be some distinction to examine between that which is generally understood to be healthy or unhealthy sexuality coupled with the notion that in order to have sex you need to have love. This would clearly be important when working with any client from any culture.
The duality of function focussed on women’s genitalia is also an important issue; sexual pleasure and reproduction may not always go in parallel. Whilst some people will take this for granted others may not only see these two functions as inextricably linked and inseparable but find the notion of pure sexual pleasure, with no attention or desire placed upon reproduction, as one which is almost unthinkable.
As therapists working within this complex field, we need to have some understanding and cognisance of the multi-faceted issues involved when working with Jewish women and their sexuality. To address specifically the objectives and aims of the psychosexual and relationship domain within any client group we must address our fundamental task and mandate which is offered by the client. As therapists, we need to be of service to our clients, the majority of whom present with poor communication skills, difficulties in resolving conflict, anger management, sexual confusions and difficulties, inhibition and psychogenic dysfunction. Many clients will attend seeking pharmacological answers and treatments; for some there may be a place within their therapeutic process where these treatments are appropriate, for others, there is no such ‘quick fix’.

Jewish psychosexual and relationship therapists working with Jewish clients need to confront and explore their own internalised messages and their degree of comfort with their own form of Jewishness. From the outside Jews may be seen as a homogenous group, from within there are many divisions and sub sections. On a simple level, it may not be possible to offer or perform integrative sexual and relationship therapy with some of the more orthodox branches of Jews and indeed they may not seek intervention from a therapist. In the event that they do, the Jewish therapist is faced with some dilemmas. According to Jewish law there are some relationships which are not sanctioned, these would include an incestuous relationship, a mixed or trans-religious relationship, adulterous relationships, a relationship with anyone who is the product of a defined forbidden relationship, and same sex relationships. Transgender or gender dysphoric work or the use of surrogates is also forbidden. Thus, a large population may be excluded from therapeutic work. For the therapist this may raise ethical issues should any of these excluded or forbidden relationships come to light within the process of therapy. In essence, the therapist is faced with only three choices: they may terminate therapy, they may be critical of the client and move into a ‘critical parent’ figure or they may do nothing. Jews, within the law, must not support or collude with any transgressions. Issues about menstruating women and the prohibition of sexual intimacy during this period of the month abound. If, as Jewish law prescribes sexual activity must take place in an environment of holiness, the spontaneous, free and more experimental forms of intimacy and sexuality are by this very guiding rule excluded.
Clearly not all Jewish clients present with the more orthodox or conventional forms of Judaism, however it is my experience that many clients carry with them these beliefs and mores into their therapy, it may be from these emotional places within that an environment of criticism and frustration or perhaps regret and confusion form the basis for the therapy.

As integrative therapists we need to be aware of our own introjects when working with this client group. Furthermore, a solution focussed form of sexual therapy will not I believe work with the more religious Jewish women and we are therefore invited to construct a form of therapeutic alliance which will honour both our own beliefs and ethics and support the client in her desire to change and heal. It is incumbent upon us to be sufficiently well informed about any cultural group and Jewish women are certainly no exception to this.

by Judi Keshet Orr