The Tennessee state legislature recently passed a bill that would allow professional counselors and therapists to violate their professional code of ethics and turn away LGBTQ clients, based on "sincerely held principles." Proponents of the legislation cite first amendment rights, specifically religious freedom. However, constitutional rights are different from ethical codes.
As a therapist, I don't believe that counselors who refuse treatment to clients based on sexual orientation and gender identity should be arrested and charged with a crime. I believe these counselors should be disqualified from holding a license as a mental health professional.
In 2014, the American Counseling Association established in their code of ethics that mental health professionals cannot refuse treatment to individuals based on "personally held attitudes, beliefs and behaviors."
People seek therapy to voice thoughts, feelings and experiences that have made them feel isolated. They may have tried to open up to others, and felt misunderstood or invalidated. A core goal of treatment is to decrease feelings of emotional isolation so our clients can participate in friendships and relationships with more openness and security. The experience of social and emotional connection is key to reducing anxiety, depression and the effects of trauma.
What matters most, in terms of providing a mental health benefit to a client, is not the therapist's perceptions or beliefs about their client's experience. Instead, it is the therapist's appreciation of their client's perceptions and beliefs that matter. When I work with someone, I am frequently checking in, with both myself and my client, to determine how my understanding might differ from theirs. While a perfect overlapping of perspectives is impossible, my hope is to break down barriers between my perspective and their own.
Therapists are human. We all have implicit biases and blind spots based on our own life histories that can sometimes interfere with our efforts to address a client's emotional isolation. Fortunately, perfect attunement isn't necessary, or even desirable. An open discussion around understandable misunderstandings activates a client's resilience, assertiveness and self-confidence -- which is also key to reducing anxiety, depression and the effects of trauma.
Not accepting a client's gender identity or sexual orientation, however, does not qualify as an understandable misunderstanding. Clients often come to therapy carrying thoughts and feelings that leave them feeling highly vulnerable. Legitimate concerns, based on past experience, lead them to worry that that act of opening up will make them feel worse. At Mazzoni Center we regularly meet with clients who have attempted therapy in the past, but had difficulty locating an LGBTQ affirming and accepting provider.
The therapy office provides a space in our culture where people can open up about things they're struggling with -- no matter how painful, difficult, or shameful they may be -- and not face moral judgement or negative consequences. The concept of "non-consequentialty" is central to providing effective treatment (provided that a client isn't threatening to harm themselves or someone else). The client experiences relief after confronting their fear of opening up and realizing that negative consequences will not ensue.
This is what we mean when we talk about therapy providing a "safe" space for disclosure. Imagine the impact on a client in a vulnerable state who finds that they are rejected by a healthcare professional on the basis of their sexual orientation or gender identity.
Imagine a client questioning their sexual orientation or gender identity six months into treatment, after they've already developed a therapeutic relationship. And what if the client comes from a family or community that stigmatizes sexual difference or gender variance?
The American Counseling Association understands the serious harm that would result -- primarily to the client, but also importantly to the profession itself.
An outcome that stigmatizes clients seeking help is too damaging to be tolerated within the field of mental health treatment. That's why all of us who take the profession of mental health counseling seriously must stand against this kind of legislation. We must insist that those who wish to practice as a counselor or therapist are truly invested in a code of ethics that puts the people we treat first.
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