Dear Therapist:

​My daughter has always been an all-around healthy 17-year-old . She does tend to have anxiety but it’s always been kept in check. Lately though she’s become a shell of herself. She’s had trouble eating and sleeping and is not herself. We’ve tried very hard to get to the root cause of her distress. Finally she confided that she’s been having intrusive thoughts of kefira [heresy] type themes. She’s horrified by the thoughts which are the antithesis of her...upbringing. She says the more she tries to ignore them the more they come to haunt her...She feels defective and humiliated that she...struggles with these thoughts. We were told this could be a symptom of OCD. Can the panel please confirm if that is true and elaborate on what we can do to calm our daughter. How can we get these intrusive thoughts to stop?

 

Response:

I cannot tell you whether your daughter’s thoughts constitute kefira, or whether they are indicative of obsessive thoughts. These two questions are intimately connected. The first question is not whether her thoughts would...be considered kefira, but rather what it is about them that your daughter considers to be problematic.

Most of us have, on one level or another, had questions. I don’t know what types of questions and thoughts concern your daughter. These can range from very basic and specific...to intricate and global questions about faith and belief. For example, if your daughter is actually questioning her faith, and at times does not want to be religious, this comes in direct conflict with her entire upbringing, social circle, and self-definition. This can obviously be very anxiety provoking.

It sounds, however, like your daughter may not be actively questioning her faith. It sounds more like she is bothered by the simple fact that kefira-like concepts intrude into her thoughts. This could be compared to thoughts of wanting to break something popping into my head. If I know that I would never follow through, this thought shouldn’t technically bother me. However, if it does bother me, I am more likely to have this thought continuously crop up. At a certain point, the thought may not even be accompanied by my initial emotion (anger), but rather truly be simply an intrusive thought.

In your daughter’s case, she may not be considering following through on her thoughts. In fact, she may not even be contemplating their meaning. It may simply be the general concept that enters her mind, immediately causing her to avoid the thought. When this occurs, it is the automatic response (thought-fear-avoidance) that allows the cycle to continue. If she were to properly focus on the thoughts, perhaps she would recognize that they do not actually constitute a problem, but that they are transient thoughts that do not make her a bad person.

I think that it is imperative that your daughter be seen by a professional. Although there may be a relatively “simple” concept of how to address your daughter’s issues, this does not by any means indicate that it is easy. There are processes that should be followed, and doing this on one’s own will typically yield few (if any) results.

One of the many questions that I would ask is whether your daughter is concerned simply about having the thoughts themselves, or whether her fear relates to her actual interest in frumkeit and her future. I would also want to know whether she has other specific obsessions, or if she has an obsessive personality. I would also ask whether the anxiety that you referenced is typically obsession-related.

There are many such questions that should be asked during a complete evaluation. Therapy is a dynamic process that relies on constant information gathering. Any specific strategy would depend upon many factors, such as information gleaned during the assessment process and on an ongoing basis. If your daughter does, in fact, have obsessive thoughts—and these are limited to those related to kefira—it is possible that just a few sessions could make a big difference. If her issue is more generalized, it is important to deal with the problem as early as possible in order to help prevent this thought-fear-avoidance cycle from becoming further reinforced and ingrained in her general thought process.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200