Patients, chaperons and healers: enlarging the therapeutic encounter

The common assumption in most therapy is that the process is initiated by a need in the patient and managed or directed by the therapist. If there are other people involved, except for the case of group or family therapy, they are at best marginal to the ongoing process as conducted in the therapy room. This paper, jointly written by a social anthropologist and psychiatrist, presents a model of therapy in an ultra-Orthodox Jewish community in which chaperons accompanying the patient (a common feature in the setting) may fulfil important functions as cultural bridges, sometimes even going so far as serving as active co-therapists. Ethnographic data is offered to demonstrate how chaperons may assist in enabling the healers to overcome feelings of 'cultural distress' and discomfiture on the part of the patients and how they assist the therapists to be 'culturally sensitive' in their use of psychiatric methods in a population which has deep misgivings about such procedures. The paper concludes with an argument for increased openness and flexibility in the practice of psycho-therapy, particularly in cross-cultural encounters, which would allow for greater use of chaperons.