Alex Blaze

No reasonable compromise on mental health

Filed By Alex Blaze | June 21, 2010 5:00 PM | comments

Filed in: Living
Tags: mental health, nebraska, psychology, referral

These people sound like they'd make the greatest counselors ever:

Jim Cunningham, executive director of the Nebraska Catholic Conference, says psychologists, therapists and other licensed counselors should be able to refuse to treat or refer clients because of religious or moral convictions. But, he says, the proposed addition of sexual orientation to anti-discrimination rules makes it unclear whether that's allowed.

"Our concern had to do with services that we would not be able to provide because they would promote or enhance or validate conduct that is contrary to our religious beliefs," Cunningham said.

"To make a referral would be cooperation ... so that would be problematic as well."

In fact, driving along the highway and not crashing into any car with one of those rainbow stickers on it is cooperation with the homosexual lifestyle, so that would be problematic as well.

Now, on one level, while this is a terrible precedent to be setting to carve out cases when it's OK to discriminate (here: if you blame Jesus for your prejudice, it's fine), on some level it's probably best for a mental health professional who can't even stand to write a referral for a gay person to be allowed to not treat them. Sure, I think that they shouldn't be allowed to practice, but considering the amount of damage the mental health profession has caused gay people over the last few centuries, maybe there should be a red flag when it comes to the people who'll use that position of power and expertise to hurt another person.

But what makes this article interesting isn't that it's just another religious exemption to anti-discrimination policy being carved out that will effectively make the anti-discrimination policy moot (who'll be around to prevent abuse of this policy? most homophobes would ascribe their narrow-mindedness to religion, but what evidence could they provide to show that it really is religion's fault?), but the fact that the rightwing here is so thoroughly unsatisfied with any reasonable compromise.

Because what they're debating isn't whether counselors should have to treat people they don't like - they've already said no to that - but whether they should even have to refer them to anyone else afterwards. Does a restaurant that doesn't want the homosexuals to touch anything lest they need to sanitize the establishment afterwards even have to say: "There's a nice place for you people down the street, just keep that homo stuff off my property"? That's the debate.

So someone proposed a compromised: "whole-patient referral," which means that a referring counselor gets to ignore someone's sexuality while referring them to someone else. In other words, it means the opposite of what its name implies.

[Nebraska's top medical officer, Dr. Joann] Schaefer disagrees. "They can't dump you as a patient," she said. "They have to put you in the hands of someone that can help you."

She offers this example: A patient seeks help for depression, then later reveals he or she is gay and wants counseling for a same-sex relationship. A counselor with a moral or religious conviction against gays or same-sex relationships could refer the patient elsewhere for treatment of depression, without having to provide a referral for the relationship counseling.

The distinction appeases the Nebraska Catholic Conference.

Now normally that's a detail I won't comment on and I'll just wait for the people who work in this field to pick it up in the comments, and since I'm not a mental health professional I'm sure some people could say, "Yeah, that's a great distinction. Someone who's in a same-sex relationship they feel the need to discuss with their counselor and just recently came out can totally keep those issues separate from chronic depression, go Joann Schaefer," but somehow I doubt it. Which is probably why:

The Board of Psychology has voted at least five times to reject Schaefer's compromise language. They've sent their own changes _ which require treatment or an appropriate referral _ on to the Board of Health, which will take them up on Monday.

The other two boards haven't decided yet how to proceed.

So there's hope still that the board will come up with a more reasonable compromise.

But as these sorts of exemptions to anti-discrimination rules keep on being made throughout the country, it's important to remember that the goal isn't to allow Christian professionals to deny services with LGBT people, but to prevent them from having any sort of interaction with us at all. It's not about maintaining the integrity of their work, but to completely indulge their immaturity and allow them to run shrieking "Gays! Ewwwww! Gross!"

And, no matter what, there is no compromise with these folks. In every field, their goal, no matter what they say, is to eliminate us. I'm sure Nebraska counselors weren't having this conversation when the required reaction to a patient coming out was referring them to reparative therapy.

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Professional therapists make referrals whenever they are unable or even unwilling to provide services for a client. Therapists who refuse even to provide referrals would not be non-cooperating. They would be unprofessional and unworthy of whatever certification they hold.

If they fail to make a referral, an appropriate referral, they ought to surrender their licenses.
You do NOT inflict human misery in a healthcare profession simply because you object to someone's beliefs. The Nazis used that rationale to let Soviet prisoners die in the millions, and they stood trial and were executed for it.

It is called a crime against humanity, certainly not the first one by the Roman Catholic Church, nor, sadly will it be the last.

"Jesus says 'let 'em die?"
I don't recall that from the Gospels

twinkie1cat | June 21, 2010 6:09 PM

The relationship with a mental health professional is so intimate and life changing that there should be an exemption of homophobic counselors who do not work in public clinics to avoid serving homosexuals. It is too dangerous to the client to have to engage with a bigot at a fragile time of his or her life. With any other service I would say the homophobic professional needs to find another job---pharmacists, nurses, teachers. But since the job of these people is to change people's thinking, a negative personal agenda is unacceptable.

Given that, clinics that tolerate homophobes need to have a sign on the front door stating that they do not treat homosexuals so incidents can be avoided and other health professionals should be informed of the agenda of these groups. And while doing that, they also must not accept Medicaid, Medicare, or any other government funded insurance, only private pay clients.

The article however, gives me problems. THESE ARE NOT CHRISTIAN COUNSELORS. Jesus Christ never discriminated! Christianity does not discriminate against gays! Christians do not discriminate against gays. They are CATHOLIC COUNSELORS, part of the same group that shut down their foster care system in Washington DC to avoid placing children with gay couples. Catholicism and Christianity are NOT the same thing although some Catholics do become Christians and some Christians are Catholic.

Jesus did not do it. The Pope did! The Pope is not Jesus and has no more direct line to God than any Christian does. He was lifted up by men, not by God and because of his leadership position, will be judged more harshly by God. The Bible says that.

I don't think there's going to be a solution that is 100% effective here.

This isn't just about gays and lesbians, it's a problem with so called "value neutral therapy." Those of us in the mental health field are taught to practice without a preconceived set of values or judgments about any behavior. In theory this is a great idea. It allows the clients to explore and create a system of values that works for them in their own situation, while we the therapists are simply a catalysts for growth rather than the vehicle behind it. And most of us really do try to stay value neutral. But in practice, it is impossible. No matter who you are, or what you believe, you have a set of values that you operate from and it will end up limiting your effectiveness for a client if they use a radically different set of values than you.

That's not to say i can't comfort someone whose grieving if i don't agree with their politics, but i would find it very difficult to have an effective therapeutic relationship with someone who was strongly anti-semetic and didn't believe that was something they needed to change about themselves.

That might be my problem as a therapist, and maybe that means I need to grow professionally so that someday I could effectively help them. But I know that I am not strong enough to feel unconditional positive regard toward that person as I am now. I would refer them to someone else.

We need to think what's best for the patient. And going to a person uncomfortable with homosexuality for gay couples counseling is probably not the best choice. I might vehemently disagree with a therapist's bigotry, but i wouldn't want to put a patient in a position where their therapist has personal hang-ups with their lire choices.

We need to make sure that mental health professionals are the best fit for their clients. Who's the one in therapy anyways? The counselors can deal with their own hang-ups on their own time. Let them do a referral so long as the client is getting the best care possible. All the rest is secondary.

I cannot speak to the therapeutic issues, but I can speak to the legal issues. They are asking for a religious excuse to commit what is called Abandonment, a violaion of most licensure laws and medical ethics.

Further, it is a systematised and organised abandonment plan. At that point it becomes conspiracy and a crime.

And this conspiracy has at its heart the intent to deny medical and/or therapeutic treatment to a specific population with a reasonable expectation of a negative outcome being inflicted upon that population.

At that point it becomes a crime against humanity

I am a gay psychiatrist.

A therapist who stops see a patient/client without an appropriate referral is guilty of abandonment and has committed a serious ethical violation.

All of us who practice in the mental health field will eventually see patients we can't work with for a variety of reasons, and we should NOT see them if we feel that way. We lose all objectivity under those circumstances.

However, if you have begun to see someone, and decide you cannot continue for any reason, it is ethically appropriate to terminate treatment. In Iowa, we must continue to see the patients for 30 days for emergencies only and give them a list of three alternative providers.

Violations of this are referred to our licensing boards. In the event a client/patient is damaged as a result of abandonment, he/she can sue for those damages.

As a former Nebraskan and having received my medical degree there, I am certain that Mr. Cunningham's comments are not representative of all of the Roman Catholic therapists in the state.

Perhaps someday someone will catch him on camera at the Miami airport...

The first time I went to a therapist as an adult was in 1992 or 93 in Bloomington, Indiana. I was assigned to a therapist at the center and went in for the first session. During the session, the counselor told me I was going to hell for being gay and that she wouldn't be willing to work with me on "anything relating to that issue." She was, of course, showing her Christian love by being willing to work with me on anything she deemed appropriate.


I never went back.

It is sad that this is still an issue. I'm actually in grad school for counseling and I know classmates that say they will not work with LGBT clients. But am I allowed to refuse a bigot or a fundamentalist Mormon? No. It is under the guise of religious freedom that they are allowed to do this. Many therapist work with people with issues that they don't agree with (Foresic psychologists work with criminal/murder suspects).

But this issue in ingrained with the argument of a pharmastist deney birth control or a school only giving astinence only sex education.

I'm glad to say that this article has envoked me to bring the conversation to the student. I have the support of 4 faculty members and will be running it in July. Thanks Alex and Bilerico!