In Michigan, as I reported last week, the Julea Ward Freedom of Conscience Act has passed out of its House committee and is making its way through the state legislative process. Its core is almost identical to a portion of a larger religious-freedom-in-education bill that was signed into law last year in Arizona. That state's HB2565 includes this mandate:
A university or community college shall not discipline or discriminate against a student in a counseling, social work or psychology program because the student refuses to counsel a client about goals that conflict with the student's sincerely held religious belief if the student consults with the supervising instructor or professor to determine the proper course of action to avoid harm to the client.
The main difference in the Michigan law is that it requires that the client be referred to a practitioner who will provide the services the client is requesting. The Arizona law simply demands consultation with a supervisor.
The American Psychological Association has voiced its objections to conscience clauses generally. The California Division of AAMFT has expressed similar concerns. In the debate around the Michigan bill, testimony from Judith Kovach of the Michigan Psychological Association addressed that group's concerns about where laws like this can lead. The National Association of Social Workers and its Michigan chapter likewise oppose the Michigan bill.
I'll be honest -- as an educator, these laws scare me. They place the values of the therapist above the need of the client to receive competent services. (Can you imagine a medical student announcing that she would only treat heart attacks if the patients were white? These bills allow exactly that in mental health, just substitute "bipolar disorder" for "heart attacks.") The laws are so broadly worded that they would allow any student to discriminate against any type of clients the student does not want to treat. In Arizona, the student would need to be able to reasonably ascribe their prejudice to their religion, but the Michigan bill doesn't even require a religious basis -- by allowing a student's moral belief to rule the day, the bill would give students free rein to discriminate for any reason the student sees fit. Anywhere they are enacted, conscience clause laws will make it harder for universities to teach their students to work with diverse groups, as students could refuse to treat homosexuals, Latinos, the elderly, or any other group they devalue with absolute protection from university discipline.
For clarity's sake, I know a number of strongly religious therapists who are excellent practitioners and do not discriminate based on their religious beliefs. It is certainly not my intent to paint all religious students or therapists with the same brush; the overwhelming majority are fully competent and able to integrate their beliefs with the standards of their professions, often engaging in great personal struggle to do so. My concern is with the extremists, the ones whose beliefs are most in need of challenging in order to work effectively with diverse populations.
It is not an overstatement to say that if I were running a graduate program in psychology in Arizona, I would close my doors. I do not know how a program can teach its students about the mental health impacts of prejudice and discrimination and simultaneously allow students to engage in that very same harmful behavior simply because the student holds a particular moral or religious belief that devalues people based on their gender, age, ethnicity, or sexuality.
I am not the only one suggesting that graduate programs in Arizona will have to close their doors... or at least risk losing their accreditation. In fact, program accreditation has proven to be a handy cudgel for fear-mongering on both sides of these bills. Proponents of conscience clause legislation say that without it, religiously-affiliated schools will not be able to adhere to their religious principles and maintain program accreditation. At the same time, opponents of the bills argue that no school in a state with conscience clause legislation would be able to maintain accreditation, as schools would not be able to enforce the ethical requirements of the mental health professions with students. To date, I do not know of a single instance of a graduate program losing its accreditation in the mental health professions over its religious affiliation, but it would not surprise me to hear that some schools may have avoided the accreditation process altogether out of concern for whether their beliefs and practices would be accepted.
Specific to the field of marriage and family therapy, there is some small comfort for graduate MFT programs in that our field is not specifically named in the Arizona law or Michigan bill. A program that is named simply MFT and is not in a larger psychology or counseling program/school is arguably not covered by this legislation. And the accreditation bogeyman may not work in MFT. The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE), which accredits MFT programs around the country, cleverly sidesteps the issue: It includes a clear statement allowing schools the freedom to operate within their religious principles (page 3), but it does not provide any exception to the Code of Ethics for individual students.
Some in psychology are questioning whether these laws are really about conscience at all. Glenda Russell, a psychologist and coauthor of Conversations about Psychology and Sexual Orientation, argues in APA's Division 44 newsletter (page 19) that the laws are ultimately about preserving the oppression of gays and lesbians:
That framing [of this legislation as a “conscience clause”] ... privileges the actions of people who are trying to usurp years of social science research, interfere with the ethics positions and practices of the profession, undermine the right of the profession and educational institutions to set standards for training, render guidelines for practice with LGB clients irrelevant, return psychological practice to a non-scientific position, and undermine diversity efforts within and outside APA. To speak of such efforts in terms of “conscience” offers these efforts the positive connotations typically associated with acts of conscience—a moral superiority and social value that I frankly think are missing from the efforts to enact the legislation with which we are all concerned. ... [I]n the broader scheme of things, these efforts represent one part of the larger systematic attack on the psychological, social, political, and cultural progress made to secure an accurate view of and positive practices toward LGB people within the discipline and in society more generally. ... At this level, we are not talking about anything having to do with someone’s conscience. We are talking about a blatant campaign to reassert stigma.
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12 comments:
The introduction of these laws saddens me as a learner and practicing intern in this field.In my opinion,it is the client that we "don't" want to see that teaches us to be more self-aware and effective therapists. My hope for educators and supervisors is that there will be room for conversation about this created within the curriculum when a student begins their graduate work. Educators play such important roles in the development of a therapist and these laws as limiting as they are, should not be allowed to take away what an educator can provide:dialogue that will help students truly think about using this law as an option, and not a free-pass.Introducing critical thinking and constructive inquiry about such laws before students begin practicum may be a way to preserve the message that universities aim to impart to students about prejudice and discrimination.These laws call for increased conversation in grad schools....which could be a good thing.
It is not an overstatement to say that if I were running a graduate program in psychology in Arizona, I would close my doors. I do not know how a program can teach its students about the mental health impacts of prejudice and discrimination and simultaneously allow students to engage in that very same harmful behavior simply because the student holds a particular moral or religious belief that devalues people based on their gender, age, ethnicity, or sexuality.
Ben, I really appreciate your strong stance here. State legislatures dictating the actions of professional training programs, in ways that the training programs believe is actively harmful, violates the principles of good governance and professional practice simultaneously.
I think the problem is caused in part by being a field in incredible transition, with a strong but shrinking cohort of members who cling to their own negative beliefs about same-sex sexual behavior and orientation, while the rest of the field moves on. I feel there should be responsibility on potential students to look seriously at any field they consider and ask themselves "am I willing to do the things needed in order to take on this career?" If you don't want to go into burning buildings and risk life and limb, don't become a firefighter. If you don't want to carry a gun, don't become a police officer or soldier. And if you don't want to practice affirmatively with sexual and gender minority people, don't enter mental health. Except that the field is still, as a whole, very slow to take a clear stance (with the exception of the APA, for the most part) and tell prejudiced members "follow the science or find another professional home."
(This also gets into the whole wide-ranging argument about "what is psychology/therapy/mental health and what evidence should there be for you to practice in some particular way" which comes up for me when I get the endless stream of CEU flyers in my mailbox, offering me professional education credits for "studying my life mantra" and "finding my seat of personal power" and other such feel-good junk science which has nothing to do with helping clients create change, but that's another whole Pandora's Box.)
I have my own issues with COAMFTE's exemption for religious schools, quite frankly, because to re-work your quote, I do not know how a program can engage in prejudice and discrimination and simultaneously train students to understand and counteract the mental health impacts of prejudice and discrimination, simply because the school holds a particular moral or religious belief. And in the case of programs located in schools with "conduct codes" that discriminate against LGBT people, that's exactly what's going on.
What's most frustrating to me as an educator is that I've been using these cases to try to raise awareness in my current program about our clear need for a programmatic policy and plan of action in this area, backed by the university, but these legislative efforts to hamstring our ability to set standards for our students means that nothing will get done any time soon.
Thanks to you both for your great feedback here. Sheila, your comment could be a strong blog post on its own!
Thanks for the encouragement Ben! I finally finished an expansion of the comment and posted it here. I welcome further conversation!
Sadly, my proposal for a panel on this topic (backed by the GLBTQ Caucus) didn't get accepted to AAMFT this year. I was going to lobby for you to be one of my panelists!
Suppose that in Society X pederasty was not illegal, but moderately shunned by the “moral majority”, yet not considered psychologically abnormal by X’s equivalent to the APA. Suppose further that you have a prospective client whom you know practices his pederasty with most of his 12 to 13 year-old students (let’s call him “Socrates”). If you yourself wouldn’t refuse your services to Socrates (perhaps in the name of diversity?), would you have any objections to an otherwise competent therapist who would on the basis of her moral/religious convictions? Assuming we can somehow rig the law in such a way to avoid the vagueness that you take issue with in your post, would you have any objections to a bill that would protect a therapist from the professional backlash she would otherwise incur if she did refuse her services to Socrates?
@J.L.: This argument fails on several levels. 1) Your hypothetical suggests that homosexuality, at least for some, is morally equivalent to pederasty (and let's just call a spade a spade here, you're saying pedophilia). In order to answer the question, you are asking me to adopt that moral equivalency. In my eyes, in the eyes of the law, and in the eyes of all major mental health professional groups, homosexuality and pederasty/pedophilia are absolutely not equal. So your question requires me to assume an entirely different reality and value system. I can't accept that premise. Linking homosexuality and pedophilia is also something that those who engage in fearmongering about homosexuality have been trying to do for decades, with little success. 2) Clients are and should be protected from discrimination on the basis of sexual orientation, as well as a host of other factors. That ensures that therapists holding licenses from the state are well-equipped to treat the public -- that is, all of the public, not just those with demographics the therapist likes. That's a worthy aim, and ensures equal access to needed care. Protecting a therapist's right to discriminate in service provision seems a far less worthy goal, as it would result in state-licensed treatment providers being able to shut out clients on the basis of age, sex, nationality, religion, and so on. That would result in unequal access to care based on those factors. As such, it is much harder for me to see a moral good there. Therapists who wish to only serve clients with similar religious beliefs are already well-able to get trained and provide services -- in religious settings, which are license-exempt. 3) If we're playing in hypothetical-land, how would you feel about legislation that made it OK for an EMT or physician to refuse services to non-vegans, out of the genuinely held belief that eating meat is wrong and they cannot support such a lifestyle? Would you want those refusals to be legally protected, even if it meant that people in some rural areas would need to become vegan -- or at least fake it -- in order to get any kind of health care? I wouldn't.
Hello Prof. Caldwell! Thank you for your thoughtful reply.
“1) Your hypothetical suggests that homosexuality, at least for some, is morally equivalent to pederasty (and let's just call a spade a spade here, you're saying pedophilia). In order to answer the question, you are asking me to adopt that moral equivalency.”
My argument was this:
P1: If some lifestyle A is (a) Not deemed psychologically abnormal by the APA (or some equivalent), yet (b) Moderately shunned by the moral majority, yet (c) not illegal, it is morally permissible for the law to protect a therapist from the professional backlash she might incur if she refuses her services to person with lifestyle A.
P2: Homosexuality meets conditions (a) and (b) and (c).
C: Therefore, it is morally permissible for the law to protect a therapist from the professional backlash she might… etc.
You take issue with P1 on the basis that for one to accept the truth of P1, one must also accept
P1’: Homosexuality and Pederasty are morally equivalent.
But you reject P1’, and therefore reject P1. But what’s the connection between P1 and P1’? Why exactly must one accept P1’ if she also accepts P1? As far as I can see, P1’s being true has nothing to do with the moral status of either homosexuality or pederasty.
As for your second point: my response depends heavily on our getting clear on the issue I have with your first point, so if you don’t mind I’d like to wait until then.
As for your third point: I have a response, but I’d like to keep our discussion as unwieldy as possible, so I'll get to it in turn.
@J.L.: Using your terminology here, without P1', P1 loses any and all relevance to the issue at hand. You might as well be saying, "I know the sky isn't made of polka dots, but what if it was? What then?" It becomes a pointless discussion. To understand your argument as being relevant to the issue at hand, I have to accept P1'. I, as well as the law, and the codes of ethics of all mental health professions, reject P1'.
Prof. Caldwell,
The issue at hand (so it seems to me at any rate—correct me if I’m wrong) is whether a republican democracy such as ours is *ever* justified in protecting therapists from professional censure for acting in accordance with the moral convictions of the vast majority of its constituents.
Even though I’m the first one to acknowledge that moral truth can never be determined by public consensus any more than what’s truly not psychologically abnormal is such *because* some group of experts (e.g., the APA) have declared it such, it generally seems right that a republican democracy ought to protect the freedom of professionals to act in accordance with the moral convictions of the majority even when those moral conviction contradict the opinions (and the professional policies that follow from them) of the putative experts.
P1 above is a principle that seems to capture this intuition. If what I said above is more or less the issue at hand, P1 is (a) meaningful on its own, (b) true or false independently of the moral status of either homosexuality and pederasty, and (c) entirely relevant to the issue at hand.
@J.L.: I disagree that we are talking about the notion of "ever." I think we are talking about this specific instance. Is it ever OK to protect a professional from backlash for failing to serve particular groups? Yes, and I would argue that's already codified -- not every group is a protected class in our non-discrimination clauses. But just because something is ever acceptable certainly does not mean it is always acceptable. That's a logical fallacy. To take the "ever" question and make it relevant to the current issue still requires adopting your P1'. That's still a non-starter.
In any event, we are not talking about therapists' ability to operate within the moral convictions of the majority (or even of the therapists' constituents), we are talking about therapists' ability to operate within their own moral convictions, regardless of whether such convictions are well within, or well outside of, the cultural mainstream.
And to put it simply, those who voluntarily choose to enter a mental health profession are voluntarily giving up that freedom. That was recently reinforced in the ruling in Jennifer Keeton's failed case against Augusta State. ACA, APA, and AAMFT (albeit indirectly, in their case) all prohibit the therapist from imposing their own beliefs in the therapeutic context, and from discriminating against clients on the basis of sex, religion, sexual orientation, and so forth. Prospective therapists who do not wish to make that compromise don't have to -- they can either train and serve in license-exempt religious settings, or they can choose another profession.
Allowing therapists to use their religious or moral beliefs to justify discrimination against protected classes leaves the door wide open for them to post signs on their doors that say "gays and lesbians not welcome here." Perhaps you're OK with that. But that same rationale would also allow them to hang signs that say "Mormons not welcome here" or "Blacks not welcome here." (Being Mormon in many places today, and being Black before the civil rights movement -- and sadly, in some quarters, still today -- would certainly meet conditions (a) (b) and (c) of your P1.)
All of those signs would be repugnant. They all are unacceptable for a professional with a license to serve the public. The result would be dramatically unequal access to competent mental health care, especially in rural areas and among specific language groups. The compelling interest for universities, for the state (via licensure), and for the mental health professions should be in training professionals to provide equal access to competent care, not the protection of an individual practitioner's ability to discriminate against already-oppressed groups.
Hi Ben
Thanks for the work you are engaged in on this site. Great job! I just have a question. Is it really a good idea to mandate religious counselors or interns to work with GLBT people? I am afraid of the effects of compromised or value leading treatments on GLBT folks who are looking for treatment that supports their desire to acclimate to their orientation. I understand the concern about discrimination and it is unfortunately an issue. On the other hand, I refer to other clinicians all the time, especially when I know of someone who has an area of specialization or have a good reputation for treating specific types of issues. Could this be applied here so we don't end up causing psychological harm to people who need help. My students are taught the principles of scope of practice and to know when to refer. I believe this to be ethical treatment. I just cant help but think that there would be a low quality of treatment offered from a counselor who feels they are doing something wrong. I wouldn't refer GLBT clients to them. I think we need to address these issues in places beside the therapy office or graduate school. I don't want hurt people we are trying to help.
Anyway, just my ten cents worth. Great job on the blog... Keep it up...
Ken
Psychologist, Ca
@Ken - Thanks for your comment. I agree that this is a complex issue; while I have concern about the legislation described here, the fundamental question of referral-versus-potentially-poor-treatment is by no means an easy one. You may be interested in this earlier post on the topic: Can a religious therapist refuse to treat gay and lesbian clients?
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