An Open Letter from a Therapist:
I am really struggling with where to begin. As a general rule, I don’t post things on my professional page that are opinionated in nature. I believe my personal opinions about politics, religion/spirituality, or even food should not really be relevant to my professional clinical practice. Today however I feel the urge to share my opinion about something that I feel is an issue regarding basic human rights and the access to clinical care. Today is a day when I cannot and will not be silent. This morning I read an incredibly disturbing article about a recent bill passed by legislators in Tennessee, House Bill 1840 (info linked in comments section below), that would allow counselors and therapists to deny services to individuals in the LGBTQ community based on “sincerely held principles”. To put it lightly I was completely horrified and alarmed, as this legislation would be in direct violation of both the NASW and the ACA’s Code of Ethics. As the National Association of Social Worker’s Code of Ethics states:
“The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.”
It further states:
“Social workers promote social justice and social change with and on behalf of clients. “Clients” is used inclusively to refer to individuals, families, groups, organizations, and communities. Social workers are sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice.”
In addition, the American Counseling Association’s Code of Ethics states the following:
“The mission of the American Counseling Association is to enhance the quality of life in society by promoting the development of professional counselors, advancingthe counseling profession, and using the profession and practice of counseling to promote respect for human dignity and diversity.”
Now to add some clarification here, on both the social work and counseling track, these Codes are NATIONAL standards. While each state has their own licensing board and requirements for licensing in terms of hours required before independent clinical practice, etc, the codes of ethics for both (which we as clinicians and social workers are all supposed to abide by and uphold) are not different state by state. This legislation is in direct contradiction with these ethical standards, and in actuality if a therapist were to do this in practice, they could and should be sanctioned by the Board.
On a more personal level, I really love what I do. This work is sacred to me, and finding out about this legislation felt like someone came into my sacred place and defiled it. Anyone who is a good therapist is aware of the unique and powerful things that can happen in a therapeutic setting. I have borne witness to some people’s darkest moments, sat with them in compassion during extreme emotional pain, and I have seen people grow, change, experience tremendous joy, overcome trauma, radiate resilience, and be reborn. It is the most rewarding and valuable work I have ever done, and I can never say enough how every person I encountered has changed me and inspired me. My gratitude that I am able to do this work is endless, even on the toughest days.
That being said, this work is not for the faint of heart. Not everyone should be a therapist, regardless of how pure your intentions may be. Being a therapist means being able to put yourself aside to be there and be present for the person sitting across from you. For that person who may be vulnerable, hurting, afraid, ashamed, at risk of relapse, or at risk of giving up and dying. That person may have been wounded and rejected a thousand times over before they work up the courage to seek help. How tragic to get to that point, to finally take that very difficult and brave step, to then be rejected again by the PROFESSIONALS that are supposed to be there to support them. Therapy is supposed to be the one place in our society where you can find an objective person, free of judgement, to support and empower you and meet you where you are. It is supposed to be the one confidential place (safety and child welfare concerns not withstanding) where a person can seek solace and support without fear of judgement or consequence. This legislation is a complete violation of that sacred space, pure and simple. I may not always agree with a client’s idea or beliefs, but that doesn’t matter because it’s not my job to do so. What is my job is to ensure that I manage those feelings appropriately through good supervision and consultation so my own “stuff” doesn’t taint the work.
So if you are a therapist in Tennessee, or anywhere for that matter, and you saw this bill and even one iota of you thinks it’s a good idea, then please, from the bottom of my heart, realize this work is not for you. Please find another way to offer your services or help your community. Because if you agree with this legislation then you are not a true social worker. You are in fact dangerous and harmful in your role to the community at large, and if you have any sense of responsibility and empathy, you will know yourself enough and respect the profession enough to quietly bow out.
And if you are someone who has experienced this from a therapist, or has had any other negative therapeutic experience, I implore you to not give up your search to seek help. There are so many good ones out there, and each and
every one of us is so deserving of safe and empathic clinical care. If you have had a bad experience, then that person didn’t deserve your story and is it their loss. As Brene Brown said “Our stories are not meant for everyone. Hearing them is a privilege, and we should always ask ourselves this before we share: “Who has earned the right to hear my story?” Remember that it is you doing the hard thing in opening up and taking risk, and if a clinician is going to judge you, please know the problem is with them, not you.
My hope is that by writing this letter, at least one person who is living in a place where it doesn’t feel safe to be you, might see this and feel comforted. And might know that you are not alone, those of us in this field for the right reasons have not and will not abandon you. If one person gets that message, then that will be enough.
Thank you
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Beautifully put….thank you….
As a LCSW I totally agree with everything written here. So many people are in the field with their own opinion of what a therapist is
or does. Vulnerable covers an array of people. How can people think they get to chose the type of vulnerability to assist? It’s really crazy to me. This is just a great example of an overreach of power.
Yes. A thousand times yes. Thank you.
beautiful well written. carry on!!!!
Beautifully written without judgment towards those who should not be therapists. As an Associate Professor of Social Work, I can’t agree more with you. Thanks for your voice.
Hang on a sec… In the overheated rhetoric on this issue, I think some important points are getting bulldozed over. This bill is not designed to facilitate the denial of counseling services to LGBTQ individuals on account of their orientation. In fact, it states that a referral to another therapist *must* be made; thus, the individual seeking services will get them, but perhaps not from the therapist contacted at the outset. Furthermore, the bill is narrowly circumscribed to apply only in cases when the “goals, outcomes, or behaviors” of the client conflict with the therapist’s sincerely held religious beliefs. In other words, an LGBTQ orientation by itself is not enough to trigger the provision; that would occur only when, in the course of therapy, the therapist is being asked to affirm statements of value that she or he does not actually believe, or to condone certain behaviors that she or he thinks are actively harmful to the individual. This sounds like a win-win to me. The individual seeking services will get matched with a more suitable therapist, and the first therapist will be protected from being punished for following his or her conscience. Why would LGBTQ people seek counseling from a therapist who holds different views on this matter in the first place? They are either not aware of the differing views, in which case I imagine they would be grateful for help in finding a more suitable therapist, or they *are* aware of the differing views and are not seeking treatment in good faith but are trolling the therapist, specifically hoping to elicit a so-called “denial” and thus bring about repercussions for the therapist and possibly removal from the profession. This latter practice is not live-and-let-live, it is seek-and-destroy those who hold different views. This is not tolerance. HB1840 seeks to protect therapists whose views on issues of sexuality and marriage are now in the minority. It thus promotes diversity in the profession and tolerance for those with unpopular opinions.
Thank you for taking the time to read my essay and consider my perspective. I greatly appreciate it. My hope in writing this piece was to not only provide support for vulnerable people in need but to also generate a productive discussion with people that may not agree with me. I must say that I respectfully disagree with your points and would encourage you to refer again to the Code of Ethics of both the American Counseling Association (ACA) and the National Association of Social Workers (NASW). I agree with you that things get missed in the heated rhetoric of this topic, the most glaring being this law violates both Codes which are national standards. These are Codes that each prospective social worker/counselor are made well aware of prior to entering the field, as they are part of the foundational education provided to prospective students. Any person that is in agreement with the language of this bill should never have entered into the field to begin with, as that way of thinking is the exact opposite of the foundational principles of this field. I’m not saying people have to agree with LGBTQ people or anything that goes against their “morality” (although personally I find that mindset discriminatory and nonsensical), all I’m saying is if you want to enter into a profession you should be prepared to abide by the Codes set forth by its governing bodies. If a person cannot do that, THEY are at fault. In my opinion that’s the equivalent of entering into the job under false pretenses and advertising yourself as someone who believes in things that you don’t. As more a specific example, I would not expect an Evangelical Christian church to perform gay marriages in their place of worship (although I think it’s their loss). I respect their right to practice their religion as they so choose. However, if an Evangelical Christian person chooses to work at a county court house, which is a government job where church and state should be separated (as indicated by the principles this country was founded on), I do expect that person to perform their professional duties as they are outlined, because they chose to apply for and accept that job. I don’t mean to be repetitive but it bears repeating that this law violates our ethics completely. That is, in my opinion, the most important and undeniable point. I hope that makes my perspective more clear, and thank you again for taking the time to read the piece and express your thoughts.
Because of a client has Medicaid And/or lives in an area where there is a shortage of mental health professionals, they may not have a choice.
Waiting lists for low income clients, at least in the states I’ve practiced (Indiana, Chicago, and Boston), there can be up to a 6 month wait list to be seen *at all* by a provider. If you are LGBT identified, and you get assigned to someone who won’t see you because of a deeply held belief, it could be another 6 months before another therapist who takes Medicaid is available. So there’s that.
Sorry for the typos and dangling modifier. I’m typing on my iPad.
OK….but….do you really want a therapist who, on a deep personal level, has issues with your lifestyle? Wouldn’t you rather that therapist have a legal way to turn away the case and get someone who is better suited to your needs? Yes, we should all be better people and see everyone with equal objectivity. But in the absence of that absolutely unreachable goal, wouldn’t you rather have someone whose experience is better suited to the situation? Let’s say I’m kinky and polyamorous. Do you think I should choose as a therapist a very devout Catholic priest? What if that happened inadvertently? Shouldn’t the therapist be able to recognize his or her own shortcomings and make a referral as needed? Medical doctors do that all the time, as do most other professions. Humanity cannot be dictated by a professional association.
Well what I would really want is for a therapist who has such difficulty dealing with other people’s lifestyle choices to not be a therapist. Accepting others lifestyle choices is not a therapists role because it’s not about us, it’s about the client. Of course there are interpersonal challenges but that is why good supervision is so important, to help us work through and process our own countertransference, because again, the work is about the client’s needs, not the therapist. And I definitely don’t want a law that allows therapists to legally discriminate against people for their sexual orientation or anything other reason. You mentioned doctors referring out all the time. It’s one thing for let’s say a general practitioner to refer to a cardiologist for a person that has a heart problem. They don’t do that because that person’s heart problem is contradictory to their “sincerely held beliefs”. It’s because the person needs a specialist. The motive is not the same and thus there cannot be a comparison. The true comparison would be a Christian doctor turning away an LGBTQ person, or a Jewish Doctor turning away a Christian person, or a Christian Doctor turning away a Muslim person, the list could go on. That would be the true equivalent and none of those are ok, but with laws like this it seems that could be the direction we are headed and that is incredibly frightening.
See my reply to the above comment.
Perhaps a solution would be for therapists who hold these strong religious beliefs to change their profession to clergy or a related religious role. They would not be able to receive payment from insurance, but they would be supported by their church. They would also not be held to the standards of the ACA and the NASW, but instead would be subject to their churches standards.
Wonderful! I could not have said it better! This is my heart and passion and my personal faith and values should in no way impede this.
DGeffkeLCSW,
I re-read your initial blog post and was struck by what is clearly your very compassionate nature. I really admire that. I hope I can make the case that your compassion should also extend to your fellow social workers and counselors who hold different beliefs than you. (In case you get the wrong impression: I am not a member of any of these professions; I am just an interested observer.)
You make much of the new law being, in your view, in violation of the code of ethics of the ACA and NASW. You say that instruction in the code is part of every counsellor’s education and that they simply shouldn’t enter the profession in the first place if they cannot adhere to it. Assuming for the sake of argument that your reasoning holds up, it would only apply to those entering social work since 2008 (when the NASW revised its code to include sexual orientation and gender identity into its existing non-discrimination standards). In other counseling professions, it would only apply to those entering since 2014, when the ACA similarly revised its code. Part of the revision was aimed at preventing counselors from making referrals based on conscientious objections to the goals or outcomes that a client was hoping to achieve.
http://ct.counseling.org/2014/05/a-living-document-of-ethical-guidance/
My understanding is that the new Tennessee law was at least partly a response to the ACA’s 2014 code revision, and it aims to re-open the loophole (i.e., religious accommodation) to allow counselors to refer a client in such cases.
I feel the need to reiterate the point, too easily lost among the high emotions on the issue, that the TN law is not a license to discriminate against LGBTQ individuals simply on account of their sexual orientation or gender identity. Rather, it is narrowly construed to apply in cases when the desired “goals, outcomes, or behaviors” of the client run contrary to what the counselor, on account of sincerely held religious beliefs, judges to be best for the mental and emotional health of the client. For example, if a transgender man asks a counselor for help in transitioning to a woman, and the counselor adheres to the traditional Judeo-Christian view that people are either male or female and therefore believes that the best outcome for the client would be to remain a man, then the counselor could refer the client to somebody else without fear of being sued or criminally prosecuted or of suffering consequences from governmental entities. Here is the text of HB1840 for reference: http://www.capitol.tn.gov/Bills/109/Bill/HB1840.pdf
A significant flaw in your argument is the notion that counselors and socials workers can and must always put aside personal beliefs in a professional context. In some cases, maybe even a majority of cases, this should be done. A Democrat should accept a Republican client and vice versa. A Christian with traditional views on sexuality should counsel a gay man who is depressed. But it is not possible in all cases to separate personal belief from professional judgment. Sometimes personal belief *informs* professional judgment and would lead the counselor to advise the client contrary to the client’s stated goals. Without laws like HB1840, counselors could be coerced into dispensing advice that they believe is actively harmful to the client, and *that* would be the real violation of the code of ethics, would it not?
As you said, you would prefer that people who do not adhere to orthodox LGBTQ doctrine do not enter the profession in the first place. This strikes me as a rather blunt solution to a situation that requires a more sharply defined strategy. Would you be willing to tell Dr. Paul McHugh, University Distinguished Service Professor of Psychiatry at Johns Hopkins Medical School and former Psychiatrist in Chief of Johns Hopkins Hospital, that there is no room in the profession for him because he believes that transgenderism should be discouraged and treated rather than affirmed and facilitated? — http://www.thepublicdiscourse.com/2015/06/15145/
Sexual orientation and gender identity is just one set of issues, and it is impossible to predict all the possible ways in which the counselor’s beliefs could run contrary to the client’s goals. What about an atheist counselor being asked to help a client strengthen her spirituality? Should we post signs on the doors of all counseling practices saying “Atheists need not apply”? You see that we are entering the realm of the absurd. By far the more workable solution is to have religious accommodation laws that would allow each case to be adjudicated fairly according to common sense.
I’ve said my piece and I’ll rest my case here. This is your blog after all.
Peace.
I am posting a comment I received via email. The email indicated I had to approve the comment but when I tried to it said “Access Denied”. I’m new to this website so I am not sure how to fix it, but will include the comment here and then my response in an additional comment below.
Author: jveltman (IP: 72.4.31.55, 72.4.31.55)
E-mail: joshua.veltman@gmail.com
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Comment:
DGeffkeLCSW,
I re-read your initial blog post and was struck by what is clearly your very compassionate nature. I really admire that. I hope I can make the case that your compassion should also extend to your fellow social workers and counselors who hold different beliefs than you. (In case you get the wrong impression: I am not a member of any of these professions; I am just an interested observer.)
You make much of the new law being, in your view, in violation of the code of ethics of the ACA and NASW. You say that instruction in the code is part of every counsellor’s education and that they simply shouldn’t enter the profession in the first place if they cannot adhere to it. Assuming for the sake of argument that your reasoning holds up, it would only apply to those entering social work since 2008 (when the NASW revised its code to include sexual orientation and gender identity into its existing non-discrimination standards). In other counseling professions, it would only apply to those entering since 2014, when the ACA similarly revised its code. Part of the revision was aimed at preventing counselors from making referrals based on conscientious objections to the goals or outcomes that a client was hoping to achieve.
http://ct.counseling.org/2014/05/a-living-document-of-ethical-guidance/
My understanding is that the new Tennessee law was at least partly a response to the ACA’s 2014 code revision, and it aims to re-open the loophole (i.e., religious accommodation) to allow counselors to refer a client in such cases.
I feel the need to reiterate the point, too easily lost among the high emotions on the issue, that the TN law is not a license to discriminate against LGBTQ individuals simply on account of their sexual orientation or gender identity. Rather, it is narrowly construed to apply in cases when the desired “goals, outcomes, or behaviors” of the client run contrary to what the counselor, on account of sincerely held religious beliefs, judges to be best for the mental and emotional health of the client. For example, if a transgender man asks a counselor for help in transitioning to a woman, and the counselor adheres to the traditional Judeo-Christian view that people are either male or female and therefore believes that the best outcome for the client would be to remain a man, then the counselor could refer the client to somebody else without fear of being sued or criminally prosecuted or of suffering consequences from governmental entities. Here is the text of HB1840 for reference: http://www.capitol.tn.gov/Bills/109/Bill/HB1840.pdf
A significant flaw in your argument is the notion that counselors and socials workers can and must always put aside personal beliefs in a professional context. In some cases, maybe even a majority of cases, this should be done. A Democrat should accept a Republican client and vice versa. A Christian with traditional views on sexuality should counsel a gay man who is depressed. But it is not possible in all cases to separate personal belief from professional judgment. Sometimes personal belief *informs* professional judgment and would lead the counselor to advise the client contrary to the client’s stated goals. Without laws like HB1840, counselors could be coerced into dispensing advice that they believe is actively harmful to the client, and *that* would be the real violation of the code of ethics, would it not?
As you said, you would prefer that people who do not adhere to orthodox LGBTQ doctrine do not enter the profession in the first place. This strikes me as a rather blunt solution to a situation that requires a more sharply defined strategy. Would you be willing to tell Dr. Paul McHugh, University Distinguished Service Professor of Psychiatry at Johns Hopkins Medical School and former Psychiatrist in Chief of Johns Hopkins Hospital, that there is no room in the profession for him because he believes that transgenderism should be discouraged and treated rather than affirmed and facilitated? — http://www.thepublicdiscourse.com/2015/06/15145/
Sexual orientation and gender identity is just one set of issues, and it is impossible to predict all the possible ways in which the counselor’s beliefs could run contrary to the client’s goals. What about an atheist counselor being asked to help a client strengthen her spirituality? Should we post signs on the doors of all counseling practices saying “Atheists need not apply”? You see that we are entering the realm of the absurd. By far the more workable solution is to have religious accommodation laws that would allow each case to be adjudicated fairly according to common sense.
I’ve said my piece and I’ll rest my case here. This is your blog after all.
Peace.
I want to again thank everyone who has commented on this post, particularly those that have respectfully disagreed with me. In response to the above comment I have only a few points to address.
In regards to the Code of Ethic’s of both professions changing in recent years, I see the point your making about the revisions to include LGBTQ people were recently added to the language. However I received my degree prior to 2008 and it was still part of my education at that time that the basic core value of non-discrimination was a foundational part of this field. If I read your article correctly, they changed the language because in spite of the core principles of inclusion and acceptance of all, people were still discriminating against clients (LGBTQ clients in particular) under the guise of “religion”, so more specific language had to be used to prevent that.
I appreciate your discourse with me as an interested observer, and appreciate your admiration of my passion on this subject. I would like to make clear that in no way am I not compassionate towards clinicians that hold different beliefs than I do. I completely respect other therapists’ right to their own beliefs about anything, whether it be LGBTQ people or anything else. What I don’t respect though is a person using that as a reason to turn someone else away when they need help. I have worked with many clients who I disagree with on a moral basis for one thing or another. However I have had to put my own personal feelings aside (and process them effectively in supervision) because the clinical work is about the client, not me. As it said in the article you posted “The revised code makes it clear that we have completely made the transition as a profession from focusing on the needs of the counselor to the needs of the client — that our clients are more important than we are,” says David Kaplan, ACA’s chief professional officer and staff liaison to the ACA Ethics Revision Task Force.
A significant flaw in your argument lies in the fact that you are not in the profession, and therefore not truly familiar with appropriate ways of clinical conduct. It is not up to a therapist to determine the best outcome for a client (unless their life is in immediate danger). The role of a therapist is to be a support person, or someone that can help you achieve your own goals. It is not the role of the therapist to decide what is best for the client (I am referring to your example about the transgender individual). In the case of that example, that therapist would be acting inappropriately because it is not up to the therapist to decide what gender another person should be. In addition, a therapist can’t “help” a person transition. A therapist can be there to help a person process their thoughts and feelings about transitioning, but they can’t actually facilitate that process. I am familiar with the text of HB 1840, and while I understand the language does not specifically state LGBTQ people, I am fairly confident in the idea that it was developed mainly for that population, however they cannot state that explicitly because of legal ramifications on a federal level (ie what is happening in North Carolina after their bathroom bill). In addition, the language is vague and dangerous, because it can be used to discriminate against not only LGBTQ people, but really anyone that a therapist “doesn’t agree with”. There are people in rural areas of Tennessee that have limited access to therapists. This puts those people at great risk of harm because if they are turned away by the one therapist in their area, what are they supposed to do?
I have to disagree with you on the idea that personal belief cannot always be separated from professional judgement. I believe personal belief can always be managed appropriately with good supervision and clinical consultation. Of course there are going to be differences of opinion between client and therapist, but the purpose of the supervision is to manage those things effectively so they don’t negatively impact the relationship. I also don’t believe a therapist can be “coerced” into giving advice that they believe is harmful to a client. For one, therapists are not intended to give advice. Additionally, what a therapist believes is harmful may be different from what is harmful to the point that a clinician must take some type of action like referring out. As an example, I believe it’s harmful for my clients to smoke cigarettes. The argument could be made that they are endangering their own lives due to the health risks associated with smoking. However, my client has a right to self determination. Smoking cigarettes is not against the law. Does that mean I should be legally allowed to turn a client away because they are a smoker? I absolutely don’t think so, because again, my client has a right to self determination (another ethical standard for social workers), and they have the right to make decisions about how they live their own life.
Lastly, I would like to make very clear that I absolutely never said I would like “people who do not adhere to orthodox LGBTQ doctrine do not enter the profession in the first place”. Those are 100% your words, not mine and I would respectfully ask that you not claim I said things that I did not say. I just simply did not say that in any of my responses. I don’t know what the “orthodox LGBTQ doctrine” is or what you mean by that. What I said, and will say again, is I would like people who cannot adhere to the Code of Ethic’s for either license, to not enter into the profession in the first place. And I would tell Dr. Paul McHugh that if his own personal religious beliefs prevented him from effectively treating his patients then I don’t believe he should be a doctor either. I also agree with we are entering into the realm of the absurd, in that these “religious accommodation laws” are being developed. What’s interesting to me is the same people that want these types of laws generally don’t want laws that accommodate people who are different from them or who’s sexual orientation or gender identity does not fit into their box of what is “moral and right” (gay marriage, gender inclusive bathrooms, abortion, women’s access to birth control, etc). So they are all about creating these laws that protect themselves, but they denounce the laws that protect others. The hypocrisy of that never ceases to amaze me.
Thank you again for your responses, I wish you the best.
I am one who will have to disagree with this post. I hear you state that one is “dangerous and harmful” if they disagree with this bill/your viewpoint. Really?! What may sound like compassion to some sounds very judgmental as well.