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Stimulating Ethical Awareness: Talmudic Approach

STIMULATING ETHICAL AWARENESS:

A Talmudic Approach

HENRY ABRAMOVITCH, JERUSALEM

The Talmud recounts a bitter dispute (Baba Metzia 59) concerning the ritual purity of a specific construction of clay oven. One Rabbi, Eliezer was so passionately certain of the correctness of his position that he called out, “If the halakha (law) is with me, may this tree fly.” And the tree hovered in the air. But the Rabbis replied, “In these matters, we do not listen to flying trees.” R. Eliezer continued, “If I am right, may this stream flow uphill.” and miraculously it did. Rabbis were once again unimpressed. Finally, in desperation, he turned towards heaven and cried out, “If the halakha is with me, may a heavenly voice speak forth.” and behold, a heavenly voice called out, “The halakha is according to R. Eliezer”. The Rabbis responded: “In such matters, we do not listen to heavenly voices.” As a result, the clay ovens which he had declared kosher, were publicly destroyed. R. Eliezer himself, who refused to yield was excommunicated and died outcast and alone, although universally acknowledged as the most brilliant theoretician in his generation.

This story epitomizes the transition in the nature of ethical discourse from a prophetic to a Rabbinic or legalistic, consensus style authority. The Jungian world, I have suggested (Abramovitch 1995), is undergoing a similar transition. It is moving from a prophetic time: “When there was no Ethics Committee and each analyst did what was right according to their own capital “S” Self”; to a legalistic-consensus time when the majority on an Ethics Committee will determine what is right an just.

There is a danger in the transition from the prophetic to Rabbinic perspective. It is not, as classical school critics claim, the loss of ‘the spirit of the work’, but the problem that once a complaint arrives at the Ethics Committee, an alleged violation of ethics has already occurred.

Many ethical violations e.g. sex with patient, are un-repairable, even when “justice” is done. Ironically, analysands tend to report such boundary violations only at the end of the affair, in revenge. The danger is that punishing wrongdoers is treating the “disease”. Our emphasis would better be on prevention.

Ethical matters take place at the intersection of how we appear to ourselves and to others (persona) and the archetypal values and ideals we all hold so dear (self); it is at once intensely personal but essentially collective. If the prophetic mode is too personal; then the committee approach is overly collective. We require a third way linking these two opposites, along what might be called the Persona-Self axis (Abramovitch 1993).

This third way involves stimulating ethical awareness in each member within the group life of each society.

To illustrate what I mean by “stimulating ethical awareness”, I want to report on what we have tried to do in my own society, Israel Institute of Jungian Psychology (IIJP).

First, we decided that every year we would have at least one annual event dedicated to ethics. Ethical sensitivity is akin to muscles, they both must be used or else they will become flabby and useless in a real crisis.

This year we devoted an entire day to Ethical Dilemmas.

We began with an active imagination to the following question:

“What is the worst thing an analyst can do?”

The answers were revealing; most were not actual ethical violations, but involved some sort of literal, or symbolic, abandonment. Having set the emotional tone, we then followed the Talmudic tradition of Textual Study. As a group we read our own Codes of Ethics and Code of Practice, discussing it line by line (agonizing for the intuitives among us). We had all read the code privately but reading as a society was different. It solidified us as an ethical community. It also led to some important clarifications and changes in the code itself.

We then moved deeper into the Talmudic mode of examining cases.

What makes a discussion Talmudic is a method in which formulations are challenged by specific examples designed to test the conceptual consistency of the formulation. Intellectual inquiry is grounded in examples rather abstractions. (Steinsaltz 1977).

We discussed a wide range of dilemmas (involved in moving from one analyst to another, when and how to communicate unsuitability of a candidate, how candidate obtain permission from their analysand (See Appendix 1).) The dilemma which raised the most feeling was the case of terminal illness in the analyst:

“A colleague comes to you and says that they have just received a diagnosis of cancer with an average survival time of18-24 months. Analyst has a full practice including analysands, candidates in analysis and in supervision.

Analyst is receiving palliative care, and feels well enough to continue working. Analyst feels, in fact, that the illness has made him a better more attuned analyst. But analyst is not sure what to do. What would be your advise? What are the ethical implications? Are the issues different for analysands, candidates, control candidates? Would the kind of cancer make a difference? Would a change in expected survival time to 3 months, 6 months or 4 years? What should analyst say to analysands and when? At what point should he stop practicing?”

Although patients ought to be transferred ahead of time, I know from my own colleagues who died how difficult it was for them to let go of their patients who provided them with so much vitality and meaning in their last days. (Kaplan & Rothman 1986)

What did emerge was the need for Ethics Committee to serve in a consultative role when analysts are uncertain of the correct way to proceed. I myself have recently discussed how during an absence, I gave the keys of my clinic to a patient, an act, had I heard about it from someone else, I would have thought dangerously inappropriate (Abramovitch 2002). In my case, I had the support of my analyst group. Bringing the matter to the committee for an ethics consultation now seemed a wiser course of action.

 

SIMULATION

Finally, we conducted a simulation of an actual ethical complaint. Although we have, as most of you know, many disputes and accusations in Israel, - the old three Jews, seven political parties syndrome - we had little actual experience in handling formal complaints. In many societies, specific individuals who serve on ethics committees do develop ‘ethical expertise’ but because of the confidential nature of the hearings, such expertise is rarely disseminated through the society as a whole. Further, in our experience, actual complaints tend to become highly politicized, and polarized into shadowy power complexes of for him/her or against him/her which militates against the kind of ethical awareness I am advocating. In any case, in our old-new society, there was no institutional memory of handling ethical complaints, except for the remarkable case in the old Association when the Director of Training called each member personally to apologize for sending all applicants for a “hand test” (or palm reading) to determine their suitability for training acting against the explicit directive of the society.

The English believe ‘The Devil is in the details’; but Jews trained in Talmud have always believed that ‘God in the details’.

As a result, in preparation for the simulation, we reviewed the 17 steps set forth in our code, from the first receipt of a complaint through to the end of the appeal process, so that everyone was really aware of details (see APPENDIX 2). Next we simulated with role playing in fishbowl so that each stage was transparent to all (in a way that could never happen in practice) different members taking the roles of complaining analysand, the complained against analyst, members of the ethics committee, witnesses, members of the appeal committee etc. In Israel, at least among Jungians we have not had formal complaints about sexual violations (though like everywhere there are rumors – but ethics committee do not listen to rumors, any more than flying trees). What we have had, are issues about elder, senior analysts developing cognitive impairment. Imagine yourself on ethics committee dealing with the following case.

 

ETHICS COMMITTEE- SIMULATION

Chairperson receives a letter from a disgruntled patient complaining that analyst is incompetent and senile, falling asleep in session, forgetting appointments, making comments that are irrelevant. Demands that analyst be prevented from practicing.
At this point, it was decided that the complaint had merit and the analyst was consulted.

Analyst presented a very different picture of a disturbed unmarried, person who cared for her mother who had Alzheimer’s Disease. She came to therapy late and discovered how angry she was at her mother, for dominating her life, via her illness and previously through her personality. Recently her mother died and there was a strong negative transference from the mother to analyst and a delusional transference that I, too, have Alzheimer’s Disease. Previously, we were working well but since her mother’s demise, she is resistant to any interpretation. Sessions were missed twice due to analyst’s flu, and to analysand’s confusion, a third time. At that point, analysand abruptly cut off all contact, refused to come to any more sessions.
Ethic Committee must evaluate the complaint, invite presentations and decide on a course of action.
Whatever the decision, the other party will appeal the decision and an ad-hoc appeals committee will be formed
The appeals committee will review the material, invite submissions and decide.

This was a very moving experience and forced members to confront issues they would much rather have avoided e.g. should the committee send the analyst for a psychiatric evaluation. Each of us asked ourselves: ‘How would you feel being sent for such an evaluation?’ In our simulation the “analysand” at first refused to waive confidentially so that the accused analyst was unable to speak. The Ethics Committee decided that without such permission, it would be impossible to pursue the complaint adequately, and the analysand relented.

The skeptics among you will say tha there is one obvious problem with such events stimulating ethical awareness, viz. that the people who most need to attend, do not come.

This brings me to another important issue, specifically how to warn a colleague who is danger of going over the ethical edge. In terms of the simulation, an analyst who is just beginning to show some cognitive impairment but before any complaint is lodged.

Many of us forget that the commandment “Love your neighbour as yourself” is not an isolated motto but rather comes as a conclusion to a discussion of the dangers of suppression: “You are not to hate your brother in your heart; rebuke, yes rebuke your fellow, that you do not bear sin because of him! You are not to take-vengeance, you are not to retain-anger against the sons of your kinpeople – but be-loving to your neighbor (as one) like yourself.” (Leviticus 19:17-9; Everett Fox (1995) translation; cf. Genesis 21:22-33; Proverbs 25:9-10; Matthew 18:15-17). Jan Weiner has remarked: “We save our best for our patients and our worst for our colleagues.” (Weiner 2003, personal communication). Thus the harder commandemtn would be:”love your colleagues as yourself!”.

The Talmud delves into the issue of how to warn but the opinions are deeply divided. (Kugel 1987; Zohar 1990; Shmesh 1997). Some say that a rebuke should be given only if it is likely to be effective (“R. Ile’a stated – the words of R. Eleazar son of R. Shimon: ‘As it is worthy to say that which will be obeyed; so it is worthy not to say that which not be obeyed’ ” – (Yebamoth 65b) ); others say not to warn implicates the bystander in multiple guilt (“Whoever is in a position to prevent wrongdoing and does not do so is responsible for the iniquity of all wrongdoers who he might have restrained.” – (Maimonides Mishe Torah, Hilhot De’ot VI:7) and one should ‘continue until the sinner assaults the admonisher and says to him “I refuse to listen” (op. cit.). Others say it is impossible, at least in this generation (“R. Tarfon: ‘…is there be anyone in this generation capable of rebuking; R. Elazar son of Azariah: …is there be anyone in this generation capable of accepting a rebuke; R. Akiva: … is there be anyone in this generation who knows how to go about rebuking.’ ” (Sifre on Leviticus 19:17 (Kedoshim 4). Although one Rabbi (R. Yohahan son of Nuri) claimed that rebuking R. Akiva only increased the love between them (op. cit. Cf. Proverbs 9:8). In some ways, the split in the Israeli society resulted from the inability of members to confront the inappropriate behavior of a selected few. We failed to function as an ethical community and failed to tell our colleague of their fault but bore hatred in our hearts. Rebuking a colleague, especially a powerful senior analyst is frightening, dangerous, even institutionally suicidal. Warning colleagues, however, becomes possible when it is part of a group culture of warnings, a skill honed and practiced in secure settings, protected from power complex and threat of revenge – as happened in the first case brought to trial in Israel of a psychiatrist (non-Jungian) who responded when colleagues did try to caution him by threatening in return: “If you accuse me, then I will publicly accuse you.”

I ask you to consider how you would confront the President of your society, your training analyst or even personal analyst when you feel there are on a dangerous ethical precipice. The doubled ‘rebuke, yes rebuke’ in the Hebrew original has traditionally been understood to mean that the obligation applies doubly: ‘disciple to master’ as much as ‘master to disciple’.

Now imagine that these senior analysts are the ones encouraging and helping you think about how you might do that very thing. Such a discussion/workshop stimulating ethical awareness goes to the heart of what I think we need.

Let me conclude with another famous controversy in the Talmud, concerning the same Rabbi Akiva, the scholar who secretly, against all the authorities, began to write down the Oral Law consolidating the move from the prophetic to the legalistic.

Many scholars were gathered at Lod and they were asked: Which is greater, good deeds or talmud torah (Torah learning)? Rabbi Tarphun answered and said: Good deeds are greater. Rabbi Akiva answered and said: talmud torah. All other scholars answered and said, Study is greater, since study leads to good deeds. (Kiddushin 40b).

Transposing the incident to our times might go like this:

Candidates asked their Training analysts: What is more important, ‘Doing analysis properly or studying how to do it properly?’ The first analyst said the former; but eventually all agreed with a second that studying was paramount, since it leads to doing analysis properly and hence ethically.

In this tradition, I am calling for an activist IAAP Ethics Committee who will assist societies to study how to do analysis ethically, to stimulate ethical awareness in the group life of Societies and in the IAAP as a whole, so as to keep our moral muscles in shape; and thereby reduce, not only, the number of formal complaints received by Ethics Committees, but also, (and this may be even more important) the actual number of ethical violations, most of which, as we know, are never reported.

 

Bibliography:

Abramovitch H. (1993). ‘Disguise as a Transition to Homecoming.’ In The Transcendent Function: Individual & Collective Aspects. Proceedings of the 12th International Congress for Analytical Psychology. (ed. Mary Ann Mattoon).

Einsiedeln, Switzerland: Daimon Verlag. pp. 250-7.

Abramovitch, H. (1995). ‘Ethics: a Jewish perspective’ in Cast the First Stone: The Ethics of Analytical Therapy (eds. L. Ross & M. Roy) Boston: Shambhala. pp. 31-6.

Abramovitch, Henry (2002)

‘Temenos Regained: Reflections on the Absence of the Analyst’

Journal of Analytical Psychology 47: 583-97.

Kaplan, Alex H. and Rothman, David (1986) “The Dying Psychotherapist” American Journal of Psychiatry 143:561-72)

Kugel, James L. (1987). “On Hidden Hatred and Open Reproach: Early Exegesis of Leviticus 19:17.” Harvard Theological Review 80:43-61.

Shemesh, Aharon (1997). “Rebuke, Warnings and the Obligation to Testify in Judean Wilderness Writings and Rabbinic Halakha” Tarbitz 66:149-166. (Hebrew).

Steinsaltz, Adin. (1977). The Essential Talmud. NY: Bantam Books.

Zohar, Z. (1990). “Between Love and Enmity: Three traditional modes of understanding the commandment of tokhha (Rebuke) – and their socio-religious implications “ in Essays in the social scientific study of Judaism and Jewish society / edited by Simcha Fishbane and Jack N. Lightstone, Concordia University, Montreal: 1990. pp.105-124.

APPENDIX 1:

Ethical Dilemmas Discussed at Ethics Day, IIJP

 

1a. DUAL RELATIONSHIP: BARTER

A patient, a professional editor and translator, in analysis reveals that there was a barter arrangement in the previous analysis with another member of the Institute. Instead of payment, the patient provided editorial and translation services. The arrangement appears to have worked satisfactorily and offers a similar arrangement to you. How would you respond? What are the ethical implications?

1b. Similar, except that the arrangement broke down when the analyst was unhappy with the translation-editorial work and then demanded payment. The patient broke off the analysis.

1c. Would it make a difference if the patient were a candidate? A supervisee?

1d. Would it make a difference if you learned about the arrangement, not in analysis, but in conversation at a professional meeting?

1e. If you felt it was appropriate, how would you confront your colleague?

2a. You have information about the unsuitability of an analysand in analysis with you applying for training. What are the ethical implications?

2b. Would it make a difference, if the information were obtained from another patient?

2c. From another colleague?

2d. From behavior you personally observed?

3a. Your supervisee is about to present the final paper, after having obtained permission previously. In the week before the final exam, the patient develops a negative transference and withdraws permission. The candidate asks for an emergency session and asks what she/he should do.

3b. Do candidates always need to request permission from their patients before presenting their final presentation?

3c.What form should this permission take?

3d. Would it make a difference if this is the second time such a permission-withdrawal of permission has occurred?

APPENDIX 2:

Stages in Dealing with Complaints in IIJP:

Chairperson receives a letter of complaint.
Chair decides whether complaint has merit.
Chair may decide to consult informally with the person against whom the complaint is made.
Chair consults with Chair of Ethics Committee to decide if there are sufficient grounds to proceed with investigation of the complaint
If no, letter rejecting complaint is sent to person who lodged complaint, setting out reasons for its deferment
If yes, The member is informed of the complaint in writing;
two additional senior analyst are selected to serve on Ethics Committee.

Ethics Committee meets to decide on how to proceed with complaint e.g. individual or joint meetings
Participants are invited to make presentations to Ethics Committee and to invite additional members to make presentations.
Ethics Committee reviews all presentations
Ethics Committee makes its decision whether a breach of Code of Ethics has been committed and if yes, which of the 9 courses of actions are appropriate
Parties are informed of the decision in writing within 2 weeks of its decision and informed of the right to appeal.
If one or both parties appeal, an ad-hoc committee is appointed.
Appeal Committee reviews all documented material.
Appeal Committee invites presentations from all interested parties.
Appeal committee reviews presentations and all evidence and makes a decision to uphold or amend the initial decision.
The appeal committee informs parties of its decision which is final.

The formal code is as follows:

THE ETHICS COMMITTEE

Composition:

1. The Ethics Committee will consist of a Chairperson and two other senior analysts who will form an ad-hoc committee to deal with specific complaints.

2. The Chairperson will be a member of the Israeli Institute for Jungian Studies, but the other senior analysts will be members of IAAP but not necessarily members of Institute.

3. The current Chairpersons of the Certifying Board or the Training Committee shall not be eligible to serve on the Ethics Committee.

4. Analysts who acted as Personal Analysts, past or present, or Control analysts, past or present, with the member against whom a complaint is filed, shall not be eligible to serve on this Ethics Committee.

Procedure:

5. The Ethics Committee will investigate complaints made concerning breaches of the Code of Ethics of the Institute and recommend appropriate action to the President and Executive Committee.

6. It is the responsibility of every analyst or candidate to report ethical violations.

7. Colleagues are encouraged to point out unethical behavior to the offender in a friendly attempt to change the offender’s behavior.

8. Complaints concerning unethical behavior must be sent in writing to the President of the Institute.

9. The President may use his judgment whether initially to communicate informally with the person, against whom the complaint has been made, in an attempt to change his/her behavior and encourage the person to seek further consultation or analysis.

10.The President will refer the complaint to the Chair of the Ethics Committee and together they will decide whether there are sufficient grounds for the complaint.

11.Should they decide that there are grounds for the complaint, they will inform the member in writing concerning the complaint and request his/her response in writing. At this stage, the Chair of the Ethics Committee and the President will select two additional senior analysts who can serve as members of the Ethics Committee for this case.

12.Failure to cooperate with the Ethics Committee comprises an additional violation and itself may be grounds for expulsion from the Institute.

13.The Ethics Committee may use its discretion whether to invite the complainant and complained against for a joint meeting or for individual meetings.

14.All participants may invite additional members who may throw light on the proceedings to appear before the Ethics committee.

15.If, after a thorough investigation, the Ethics Committee finds that the individual has committed a breach of the Code of Ethics, it may recommend one or more of the following courses of action to the Executive Committee:

a) The member makes apology and/or reparation to complainant.

b) The member is warned or reprimanded.

c) The member is required to undergo supervision by a senior colleague for a period decided by the Ethics Committee.

d) The member is required to have further personal analysis.

e) The member is suspended from membership on Committees.

f) The member is suspended from supervising candidates.

g) The member is suspended from teaching

h) The member is placed on probation, suspended or expelled from the Institute.

The last four courses of action (e-h) require confirmation by members of the Institute, after having been informed by the Ethics Committee of its recommendations. Expulsion requires at least a two-third majority.

16.A written record will be kept of all complaints. All communications and discussions of the Ethical Committee shall be documented and held in strictest confidence. Previous complaints against a specific member, however, may be consulted and taken into consideration when making recommendations concerning the appropriate course of action.

17.The Ethics Committee will inform both the complainer, and the member, against whom the complaint has been made, within two weeks of their decision, in writing.

18.The complainer and the member against whom the complaint has been made, each have the right of appeal against the recommendations of the Ethics Committee.

19.If an appeal is lodged, a new ad-hoc Committee will be

appointed to deal with the appeal. The Appeals Committee will receive all available documents concerning the complaint. It will have the right to invite complainer and the member against whom the complaint has been made to appear, as well as any other relevant individual.

20.The decision of the Appeals Committee will be final.

STIMULATING ETHICAL AWARENESS:

A Talmudic Approach

HENRY ABRAMOVITCH, JERUSALEM

The Talmud recounts a bitter dispute (Baba Metzia 59) concerning the ritual purity of a specific construction of clay oven. One Rabbi, Eliezer was so passionately certain of the correctness of his position that he called out, “If the halakha (law) is with me, may this tree fly.” And the tree hovered in the air. But the Rabbis replied, “In these matters, we do not listen to flying trees.” R. Eliezer continued, “If I am right, may this stream flow uphill.” and miraculously it did. Rabbis were once again unimpressed. Finally, in desperation, he turned towards heaven and cried out, “If the halakha is with me, may a heavenly voice speak forth.” and behold, a heavenly voice called out, “The halakha is according to R. Eliezer”. The Rabbis responded: “In such matters, we do not listen to heavenly voices.” As a result, the clay ovens which he had declared kosher, were publicly destroyed. R. Eliezer himself, who refused to yield was excommunicated and died outcast and alone, although universally acknowledged as the most brilliant theoretician in his generation.

This story epitomizes the transition in the nature of ethical discourse from a prophetic to a Rabbinic or legalistic, consensus style authority. The Jungian world, I have suggested (Abramovitch 1995), is undergoing a similar transition. It is moving from a prophetic time: “When there was no Ethics Committee and each analyst did what was right according to their own capital “S” Self”; to a legalistic-consensus time when the majority on an Ethics Committee will determine what is right an just.

There is a danger in the transition from the prophetic to Rabbinic perspective. It is not, as classical school critics claim, the loss of ‘the spirit of the work’, but the problem that once a complaint arrives at the Ethics Committee, an alleged violation of ethics has already occurred.

Many ethical violations e.g. sex with patient, are un-repairable, even when “justice” is done. Ironically, analysands tend to report such boundary violations only at the end of the affair, in revenge. The danger is that punishing wrongdoers is treating the “disease”. Our emphasis would better be on prevention.

Ethical matters take place at the intersection of how we appear to ourselves and to others (persona) and the archetypal values and ideals we all hold so dear (self); it is at once intensely personal but essentially collective. If the prophetic mode is too personal; then the committee approach is overly collective. We require a third way linking these two opposites, along what might be called the Persona-Self axis (Abramovitch 1993).

This third way involves stimulating ethical awareness in each member within the group life of each society.

To illustrate what I mean by “stimulating ethical awareness”, I want to report on what we have tried to do in my own society, Israel Institute of Jungian Psychology (IIJP).

First, we decided that every year we would have at least one annual event dedicated to ethics. Ethical sensitivity is akin to muscles, they both must be used or else they will become flabby and useless in a real crisis.

This year we devoted an entire day to Ethical Dilemmas.

We began with an active imagination to the following question:

“What is the worst thing an analyst can do?”

The answers were revealing; most were not actual ethical violations, but involved some sort of literal, or symbolic, abandonment. Having set the emotional tone, we then followed the Talmudic tradition of Textual Study. As a group we read our own Codes of Ethics and Code of Practice, discussing it line by line (agonizing for the intuitives among us). We had all read the code privately but reading as a society was different. It solidified us as an ethical community. It also led to some important clarifications and changes in the code itself.

We then moved deeper into the Talmudic mode of examining cases.

What makes a discussion Talmudic is a method in which formulations are challenged by specific examples designed to test the conceptual consistency of the formulation. Intellectual inquiry is grounded in examples rather abstractions. (Steinsaltz 1977).

We discussed a wide range of dilemmas (involved in moving from one analyst to another, when and how to communicate unsuitability of a candidate, how candidate obtain permission from their analysand (See Appendix 1).) The dilemma which raised the most feeling was the case of terminal illness in the analyst:

“A colleague comes to you and says that they have just received a diagnosis of cancer with an average survival time of18-24 months. Analyst has a full practice including analysands, candidates in analysis and in supervision.

Analyst is receiving palliative care, and feels well enough to continue working. Analyst feels, in fact, that the illness has made him a better more attuned analyst. But analyst is not sure what to do. What would be your advise? What are the ethical implications? Are the issues different for analysands, candidates, control candidates? Would the kind of cancer make a difference? Would a change in expected survival time to 3 months, 6 months or 4 years? What should analyst say to analysands and when? At what point should he stop practicing?”

Although patients ought to be transferred ahead of time, I know from my own colleagues who died how difficult it was for them to let go of their patients who provided them with so much vitality and meaning in their last days. (Kaplan & Rothman 1986)

What did emerge was the need for Ethics Committee to serve in a consultative role when analysts are uncertain of the correct way to proceed. I myself have recently discussed how during an absence, I gave the keys of my clinic to a patient, an act, had I heard about it from someone else, I would have thought dangerously inappropriate (Abramovitch 2002). In my case, I had the support of my analyst group. Bringing the matter to the committee for an ethics consultation now seemed a wiser course of action.

SIMULATION

Finally, we conducted a simulation of an actual ethical complaint. Although we have, as most of you know, many disputes and accusations in Israel, - the old three Jews, seven political parties syndrome - we had little actual experience in handling formal complaints. In many societies, specific individuals who serve on ethics committees do develop ‘ethical expertise’ but because of the confidential nature of the hearings, such expertise is rarely disseminated through the society as a whole. Further, in our experience, actual complaints tend to become highly politicized, and polarized into shadowy power complexes of for him/her or against him/her which militates against the kind of ethical awareness I am advocating. In any case, in our old-new society, there was no institutional memory of handling ethical complaints, except for the remarkable case in the old Association when the Director of Training called each member personally to apologize for sending all applicants for a “hand test” (or palm reading) to determine their suitability for training acting against the explicit directive of the society.

The English believe ‘The Devil is in the details’; but Jews trained in Talmud have always believed that ‘God in the details’.

As a result, in preparation for the simulation, we reviewed the 17 steps set forth in our code, from the first receipt of a complaint through to the end of the appeal process, so that everyone was really aware of details (see APPENDIX 2). Next we simulated with role playing in fishbowl so that each stage was transparent to all (in a way that could never happen in practice) different members taking the roles of complaining analysand, the complained against analyst, members of the ethics committee, witnesses, members of the appeal committee etc. In Israel, at least among Jungians we have not had formal complaints about sexual violations (though like everywhere there are rumors – but ethics committee do not listen to rumors, any more than flying trees). What we have had, are issues about elder, senior analysts developing cognitive impairment. Imagine yourself on ethics committee dealing with the following case.

ETHICS COMMITTEE- SIMULATION

Chairperson receives a letter from a disgruntled patient complaining that analyst is incompetent and senile, falling asleep in session, forgetting appointments, making comments that are irrelevant. Demands that analyst be prevented from practicing.
At this point, it was decided that the complaint had merit and the analyst was consulted.

Analyst presented a very different picture of a disturbed unmarried, person who cared for her mother who had Alzheimer’s Disease. She came to therapy late and discovered how angry she was at her mother, for dominating her life, via her illness and previously through her personality. Recently her mother died and there was a strong negative transference from the mother to analyst and a delusional transference that I, too, have Alzheimer’s Disease. Previously, we were working well but since her mother’s demise, she is resistant to any interpretation. Sessions were missed twice due to analyst’s flu, and to analysand’s confusion, a third time. At that point, analysand abruptly cut off all contact, refused to come to any more sessions.
Ethic Committee must evaluate the complaint, invite presentations and decide on a course of action.
Whatever the decision, the other party will appeal the decision and an ad-hoc appeals committee will be formed
The appeals committee will review the material, invite submissions and decide.

This was a very moving experience and forced members to confront issues they would much rather have avoided e.g. should the committee send the analyst for a psychiatric evaluation. Each of us asked ourselves: ‘How would you feel being sent for such an evaluation?’ In our simulation the “analysand” at first refused to waive confidentially so that the accused analyst was unable to speak. The Ethics Committee decided that without such permission, it would be impossible to pursue the complaint adequately, and the analysand relented.

The skeptics among you will say tha there is one obvious problem with such events stimulating ethical awareness, viz. that the people who most need to attend, do not come.

This brings me to another important issue, specifically how to warn a colleague who is danger of going over the ethical edge. In terms of the simulation, an analyst who is just beginning to show some cognitive impairment but before any complaint is lodged.

Many of us forget that the commandment “Love your neighbour as yourself” is not an isolated motto but rather comes as a conclusion to a discussion of the dangers of suppression: “You are not to hate your brother in your heart; rebuke, yes rebuke your fellow, that you do not bear sin because of him! You are not to take-vengeance, you are not to retain-anger against the sons of your kinpeople – but be-loving to your neighbor (as one) like yourself.” (Leviticus 19:17-9; Everett Fox (1995) translation; cf. Genesis 21:22-33; Proverbs 25:9-10; Matthew 18:15-17). Jan Weiner has remarked: “We save our best for our patients and our worst for our colleagues.” (Weiner 2003, personal communication). Thus the harder commandemtn would be:”love your colleagues as yourself!”.

The Talmud delves into the issue of how to warn but the opinions are deeply divided. (Kugel 1987; Zohar 1990; Shmesh 1997). Some say that a rebuke should be given only if it is likely to be effective (“R. Ile’a stated – the words of R. Eleazar son of R. Shimon: ‘As it is worthy to say that which will be obeyed; so it is worthy not to say that which not be obeyed’ ” – (Yebamoth 65b) ); others say not to warn implicates the bystander in multiple guilt (“Whoever is in a position to prevent wrongdoing and does not do so is responsible for the iniquity of all wrongdoers who he might have restrained.” – (Maimonides Mishe Torah, Hilhot De’ot VI:7) and one should ‘continue until the sinner assaults the admonisher and says to him “I refuse to listen” (op. cit.). Others say it is impossible, at least in this generation (“R. Tarfon: ‘…is there be anyone in this generation capable of rebuking; R. Elazar son of Azariah: …is there be anyone in this generation capable of accepting a rebuke; R. Akiva: … is there be anyone in this generation who knows how to go about rebuking.’ ” (Sifre on Leviticus 19:17 (Kedoshim 4). Although one Rabbi (R. Yohahan son of Nuri) claimed that rebuking R. Akiva only increased the love between them (op. cit. Cf. Proverbs 9:8). In some ways, the split in the Israeli society resulted from the inability of members to confront the inappropriate behavior of a selected few. We failed to function as an ethical community and failed to tell our colleague of their fault but bore hatred in our hearts. Rebuking a colleague, especially a powerful senior analyst is frightening, dangerous, even institutionally suicidal. Warning colleagues, however, becomes possible when it is part of a group culture of warnings, a skill honed and practiced in secure settings, protected from power complex and threat of revenge – as happened in the first case brought to trial in Israel of a psychiatrist (non-Jungian) who responded when colleagues did try to caution him by threatening in return: “If you accuse me, then I will publicly accuse you.”

I ask you to consider how you would confront the President of your society, your training analyst or even personal analyst when you feel there are on a dangerous ethical precipice. The doubled ‘rebuke, yes rebuke’ in the Hebrew original has traditionally been understood to mean that the obligation applies doubly: ‘disciple to master’ as much as ‘master to disciple’.

Now imagine that these senior analysts are the ones encouraging and helping you think about how you might do that very thing. Such a discussion/workshop stimulating ethical awareness goes to the heart of what I think we need.

Let me conclude with another famous controversy in the Talmud, concerning the same Rabbi Akiva, the scholar who secretly, against all the authorities, began to write down the Oral Law consolidating the move from the prophetic to the legalistic.

Many scholars were gathered at Lod and they were asked: Which is greater, good deeds or talmud torah (Torah learning)? Rabbi Tarphun answered and said: Good deeds are greater. Rabbi Akiva answered and said: talmud torah. All other scholars answered and said, Study is greater, since study leads to good deeds. (Kiddushin 40b).

Transposing the incident to our times might go like this:

Candidates asked their Training analysts: What is more important, ‘Doing analysis properly or studying how to do it properly?’ The first analyst said the former; but eventually all agreed with a second that studying was paramount, since it leads to doing analysis properly and hence ethically.

In this tradition, I am calling for an activist IAAP Ethics Committee who will assist societies to study how to do analysis ethically, to stimulate ethical awareness in the group life of Societies and in the IAAP as a whole, so as to keep our moral muscles in shape; and thereby reduce, not only, the number of formal complaints received by Ethics Committees, but also, (and this may be even more important) the actual number of ethical violations, most of which, as we know, are never reported.

Bibliography:

Abramovitch H. (1993). ‘Disguise as a Transition to Homecoming.’ In The Transcendent Function: Individual & Collective Aspects. Proceedings of the 12th International Congress for Analytical Psychology. (ed. Mary Ann Mattoon).

Einsiedeln, Switzerland: Daimon Verlag. pp. 250-7.

Abramovitch, H. (1995). ‘Ethics: a Jewish perspective’ in Cast the First Stone: The Ethics of Analytical Therapy (eds. L. Ross & M. Roy) Boston: Shambhala. pp. 31-6.

Abramovitch, Henry (2002)

‘Temenos Regained: Reflections on the Absence of the Analyst’

Journal of Analytical Psychology 47: 583-97.

Kaplan, Alex H. and Rothman, David (1986) “The Dying Psychotherapist” American Journal of Psychiatry 143:561-72)

Kugel, James L. (1987). “On Hidden Hatred and Open Reproach: Early Exegesis of Leviticus 19:17.” Harvard Theological Review 80:43-61.

Shemesh, Aharon (1997). “Rebuke, Warnings and the Obligation to Testify in Judean Wilderness Writings and Rabbinic Halakha” Tarbitz 66:149-166. (Hebrew).

Steinsaltz, Adin. (1977). The Essential Talmud. NY: Bantam Books.

Zohar, Z. (1990). “Between Love and Enmity: Three traditional modes of understanding the commandment of tokhha (Rebuke) – and their socio-religious implications “ in Essays in the social scientific study of Judaism and Jewish society / edited by Simcha Fishbane and Jack N. Lightstone, Concordia University, Montreal: 1990. pp.105-124.

APPENDIX 1:

Ethical Dilemmas Discussed at Ethics Day, IIJP

1a. DUAL RELATIONSHIP: BARTER

A patient, a professional editor and translator, in analysis reveals that there was a barter arrangement in the previous analysis with another member of the Institute. Instead of payment, the patient provided editorial and translation services. The arrangement appears to have worked satisfactorily and offers a similar arrangement to you. How would you respond? What are the ethical implications?

1b. Similar, except that the arrangement broke down when the analyst was unhappy with the translation-editorial work and then demanded payment. The patient broke off the analysis.

1c. Would it make a difference if the patient were a candidate? A supervisee?

1d. Would it make a difference if you learned about the arrangement, not in analysis, but in conversation at a professional meeting?

1e. If you felt it was appropriate, how would you confront your colleague?

2a. You have information about the unsuitability of an analysand in analysis with you applying for training. What are the ethical implications?

2b. Would it make a difference, if the information were obtained from another patient?

2c. From another colleague?

2d. From behavior you personally observed?

3a. Your supervisee is about to present the final paper, after having obtained permission previously. In the week before the final exam, the patient develops a negative transference and withdraws permission. The candidate asks for an emergency session and asks what she/he should do.

3b. Do candidates always need to request permission from their patients before presenting their final presentation?

3c.What form should this permission take?

3d. Would it make a difference if this is the second time such a permission-withdrawal of permission has occurred?

APPENDIX 2:

Stages in Dealing with Complaints in IIJP:

Chairperson receives a letter of complaint.
Chair decides whether complaint has merit.
Chair may decide to consult informally with the person against whom the complaint is made.
Chair consults with Chair of Ethics Committee to decide if there are sufficient grounds to proceed with investigation of the complaint
If no, letter rejecting complaint is sent to person who lodged complaint, setting out reasons for its deferment
If yes, The member is informed of the complaint in writing;
two additional senior analyst are selected to serve on Ethics Committee.

Ethics Committee meets to decide on how to proceed with complaint e.g. individual or joint meetings
Participants are invited to make presentations to Ethics Committee and to invite additional members to make presentations.
Ethics Committee reviews all presentations
Ethics Committee makes its decision whether a breach of Code of Ethics has been committed and if yes, which of the 9 courses of actions are appropriate
Parties are informed of the decision in writing within 2 weeks of its decision and informed of the right to appeal.
If one or both parties appeal, an ad-hoc committee is appointed.
Appeal Committee reviews all documented material.
Appeal Committee invites presentations from all interested parties.
Appeal committee reviews presentations and all evidence and makes a decision to uphold or amend the initial decision.
The appeal committee informs parties of its decision which is final.

The formal code is as follows:

THE ETHICS COMMITTEE

Composition:

1. The Ethics Committee will consist of a Chairperson and two other senior analysts who will form an ad-hoc committee to deal with specific complaints.

2. The Chairperson will be a member of the Israeli Institute for Jungian Studies, but the other senior analysts will be members of IAAP but not necessarily members of Institute.

3. The current Chairpersons of the Certifying Board or the Training Committee shall not be eligible to serve on the Ethics Committee.

4. Analysts who acted as Personal Analysts, past or present, or Control analysts, past or present, with the member against whom a complaint is filed, shall not be eligible to serve on this Ethics Committee.

Procedure:

5. The Ethics Committee will investigate complaints made concerning breaches of the Code of Ethics of the Institute and recommend appropriate action to the President and Executive Committee.

6. It is the responsibility of every analyst or candidate to report ethical violations.

7. Colleagues are encouraged to point out unethical behavior to the offender in a friendly attempt to change the offender’s behavior.

8. Complaints concerning unethical behavior must be sent in writing to the President of the Institute.

9. The President may use his judgment whether initially to communicate informally with the person, against whom the complaint has been made, in an attempt to change his/her behavior and encourage the person to seek further consultation or analysis.

10.The President will refer the complaint to the Chair of the Ethics Committee and together they will decide whether there are sufficient grounds for the complaint.

11.Should they decide that there are grounds for the complaint, they will inform the member in writing concerning the complaint and request his/her response in writing. At this stage, the Chair of the Ethics Committee and the President will select two additional senior analysts who can serve as members of the Ethics Committee for this case.

12.Failure to cooperate with the Ethics Committee comprises an additional violation and itself may be grounds for expulsion from the Institute.

13.The Ethics Committee may use its discretion whether to invite the complainant and complained against for a joint meeting or for individual meetings.

14.All participants may invite additional members who may throw light on the proceedings to appear before the Ethics committee.

15.If, after a thorough investigation, the Ethics Committee finds that the individual has committed a breach of the Code of Ethics, it may recommend one or more of the following courses of action to the Executive Committee:

a) The member makes apology and/or reparation to complainant.

b) The member is warned or reprimanded.

c) The member is required to undergo supervision by a senior colleague for a period decided by the Ethics Committee.

d) The member is required to have further personal analysis.

e) The member is suspended from membership on Committees.

f) The member is suspended from supervising candidates.

g) The member is suspended from teaching

h) The member is placed on probation, suspended or expelled from the Institute.

The last four courses of action (e-h) require confirmation by members of the Institute, after having been informed by the Ethics Committee of its recommendations. Expulsion requires at least a two-third majority.

16.A written record will be kept of all complaints. All communications and discussions of the Ethical Committee shall be documented and held in strictest confidence. Previous complaints against a specific member, however, may be consulted and taken into consideration when making recommendations concerning the appropriate course of action.

17.The Ethics Committee will inform both the complainer, and the member, against whom the complaint has been made, within two weeks of their decision, in writing.

18.The complainer and the member against whom the complaint has been made, each have the right of appeal against the recommendations of the Ethics Committee.

19.If an appeal is lodged, a new ad-hoc Committee will be

appointed to deal with the appeal. The Appeals Committee will receive all available documents concerning the complaint. It will have the right to invite complainer and the member against whom the complaint has been made to appear, as well as any other relevant individual.

20.The decision of the Appeals Committee will be final.