“The most recent anti-LGBTQIA law allowing Tennessee therapists to refer out clients whose social identities might violate that therapist’s “sincerely held principles” presents an ethical quagmire for anyone in the mental health field. It teeters on the high thin wire between referring out because a practitioner recognizes they aren’t competent to serve this client (e.g. if a client comes to me who seeks long term psychoanalysis and my training is in brief cognitive behavioral therapy) and referring out because this client’s race/religion/gender identity/sexual orientation makes a practitioner uncomfortable and thus more likely to be ineffective as a provider. This dilemma is especially interesting to those of us who serve what might be considered a “vulnerable” population, as we are more likely to be therapists in a community health setting that provides care for those often in greater need of resources, care and… acceptance.
Over the course of the mental health field’s professionalization, a variety of ethical frameworks have been crafted to act as a guide in ‘morally’ ambiguous times. A Huffington article said that the American Counseling Association’s ethical code would be violated, but failed to mention that the violation would extend to other organizations as well. In fact, multiple organizations’ ethical codes will be violated if practitioners refer out based on this new law. Here are a few of what those codes require…
• The American Association for Marriage and Family Therapy require therapists to “provide professional assistance to persons without discrimination on the basis of race, age, ethnicity, socioeconomic status, disability, gender, health status, religion, national origin, sexual orientation, gender identity or relationship status.”
• The National Association of Social Worker’s ethical code requiring social workers “should not practice, condone, facilitate, or collaborate with any form of discrimination on the basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, or mental or physical disability.”
• The American Psychological Association’s ethical code that states psychologists “are aware of and respect cultural, individual and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language and socioeconomic status and consider these factors when working with members of such groups.”
But seriously now folks, what if a therapist personally believes that someone who was born gay can turn straight? Aversion therapy is a no-no for a reason. The APA explicitly states that “The longstanding consensus of the behavioral and social sciences and the health and mental health professions is that homosexuality per se is a normal and positive variation of human sexual orientation.” So, it’s understandable that LGBTQIA groups (like the Tennessee Equality Project) are starting a petition to ask the governor to veto the bill. As a social worker, I’m of two minds about this whole debacle.
I support everything LGBTQIA and, yes, we shouldn’t discriminate against anyone, no matter their social identity. This seems fairly obvious. But this is admittedly sticky territory. The stickiness comes up because mental health practitioners have a duty to act with non-maleficence, or to “do no harm,” and chances are that if you’re a therapist in Tennessee and your personal beliefs deviate from what any of the above ethical codes demand, you’re going to do some harm. This principle becomes increasingly important when serving marginalized populations who are often at greater risk.
The truth is that, as an industry, it’s irresponsible to let people practice who are not committed to respecting individual and cultural diversity. It’s irresponsible of a therapist to think that they can serve any vulnerable population if their “sincerely held principles” interfere with their ability to respect the autonomy and dignity of another human being. Especially when it interferes with their ability to accept clients “where they are at.”
So I say fine. Let the law stand but amend it to say that “if a therapist refers a client out as a result of ‘sincerely held principles,’ that same therapist be excluded from participating in any national professional association. The practitioner be required to forfeit their license until they’ve participated in a numerous cultural competency and diversity trainings, a bounty of ethics trainings (on top of their yearly required ethics trainings), and exposure therapy to whatever their ‘sincerely held principles’ say is ‘morally’ wrong.”
Use this wildly discriminatory law to filter out those in the helping profession who cannot commit to the ethical standards that drive the industry.”
My original intention for this piece was to publish on Huffington, but it’s been sitting in their “wait to be reviewed” line for upwards of three weeks, making the content decreasingly relevant by the moment. Buried beneath the flurry of Donald Trump related “news,” I have no doubt many important articles sit unpublished.
So I’m publishing it here. It’s important to me, and I think it should be important to the world.