The counseling bill approved by the Tennessee General Assembly this week continues to draw fire as various groups appeal to Republican Gov. Bill Haslam to veto it for its potential to discriminate against lesbian, gay, bisexual and transgender patients. (This target group is not mentioned in the law’s language but was the focus of debate about it in the Legislature.)
The bill lets counselors refer patients to another therapist with no repercussions if treating the patient would conflict with the counselors’ “sincerely held principles.”
Today, faculty members in the University of Tennessee’s applied psychology programs (which includes clinical and counseling) sent an open letter to Haslam denouncing the measure, saying it “legislates discrimination against some of our state’s most vulnerable citizens and sets a potentially devastating health care precedent in our communities.”
The law’s supporters say it protects counselors from being forced to compromise their religious beliefs and ensures that LGBT clients receive wholehearted treatment.
The UT professors dispute this and say its scope is potentially much broader, allowing the denial of services to any client on the basis of the counselor’s personal convictions. “For example, the bill’s language suggests that counselors could deny services based on their principled objections to alcohol use, interracial marriage, or the use of contraception. Even more consequentially, a counselor of any faith could deny services to a client of a different faith solely because of their differences in religious belief.”
The letter noted that the law could have unintended financial consequences for the state’s universities and health system: The Council for Accreditation of Counseling & Related Educational Programs (CACREP) could decide to suspend the accreditation of all currently accredited counseling programs across the state, putting further strain on an already over-extended mental health care system. The professors argue that the law will also discourage mental health professionals from working or training in Tennessee because it “will stand as an official state symbol of intolerance and bigotry.”
The professors were speaking on their own behalf, and not for the University of Tennessee administration.
The American Counseling Association and all the state’s professional counseling groups opposed the bill, which would be the first of its kind in the nation. Haslam has said he will study the final language of the bill before deciding whether to sign it.
For more on why so many states are now facing anti-LGBT legislation, see this week’s news feature.
Correction: In a previous version of this story, we said all faculty members of UT’s applied psychology programs signed the letter, which is incorrect; all signers of the letter are faculty members, but they are not the entire faculty of those programs.
Here is the full text of the letter:
Dear Governor Haslam:
We write as a group of psychologists and constituents who are united in our concern about the negative implications of HB1840 on mental health care services in the State of Tennessee. Despite some politicians’ arguments to the contrary, HB1840 legislates discrimination against some of our state’s most vulnerable citizens and sets a potentially devastating health care precedent in our communities. If this bill reaches your desk in any form, we implore you to veto it.
The essential effect of HB1840 is to allow counselors in Tennessee to discriminate against clients without retribution. Though the bill’s authors have couched it in the language of religious freedom, it has a singular, transparent intent: to enable counselors to deny services to clients – that is to say, to discriminate against people seeking mental health services. Though debate over the bill has surrounded lesbian, gay, bisexual, and transgender (LGBT) clients, the bill is broad in its scope and could allow the denial of services to any client on the basis of the counselor’s personal convictions. For example, the bill’s language suggests that counselors could deny services based on their principled objections to alcohol use, interracial marriage, or the use of contraception. Even more consequentially, a counselor of any faith could deny services to a client of a different faith solely because of their differences in religious belief.
People seek counseling for many issues, such as depression, anxiety, substance abuse, and trouble in relationships. Psychological research consistently indicates that a client’s initial interaction with a counselor is critical: if a client feels stigmatized or rejected by a counselor, they are not only less likely to return to that counselor but less likely to seek any mental health services in the future. Counselors are consequently trained to engage respectfully and collaboratively with their clients, regardless of their reasons for seeking therapy. Counselors must also maintain the highest ethical standards and practices to ensure their clients’ safety, some of whom may be dealing with intense internalized shame and demoralization about an aspect of their identity or behavior. Individuals seeking therapy are often in a most vulnerable state. Rather than refuse to treat a client when they present issues that run contrary to their own values or convictions, counselors are professionally obligated to acknowledge, manage, and control their own contrasting opinions and beliefs in order to help the person suffering before them. Counseling should not be about the counselor, but about the person seeking counsel.
Ultimately, the consequences of HB1840 may extend far beyond individual cases of discrimination. If you sign this bill, the Council for Accreditation of Counseling & Related Educational Programs (CACREP) may find cause to suspend the accreditation of all currently accredited counseling programs across the state, putting further strain on our already over-extended mental health care system. Furthermore, regardless of the intent of the bill’s authors, HB1840 will stand as an official state symbol of intolerance and bigotry, discouraging today’s and tomorrow’s mental health professionals from working and training in our state.
The American Counseling Association’s 2014 update to its Code of Ethics is designed to prevent exactly the kinds of dangerous, discriminatory practices that HB1840 advances. Counselors and related mental health care providers are obligated professionally and ethically to provide theoretically- and scientifically-informed services to those seeking help. The profession is already guided by rules, regulations, and procedures that facilitate referrals of clients whose needs may be outside the scope of a counselor’s expertise. These referrals do not represent discrimination based on a client’s sexual orientation, gender identity, or other individual differences. For example, a school counselor working with a client with disordered eating is already able to refer that client to an eating disorder specialist. Similarly, a vocational counselor is already able to refer and collaborate with a psychiatrist if their client is dealing with issues of work performance that would benefit from medication.
We see no reason why the State of Tennessee needs to legislate counselors’ activities with Tennesseans who may be seeking therapy because they are struggling with issues that are deeply stigmatized in our culture, including (but not limited to) sexual orientation and gender identity issues. The relevant professional organizations already provide informed and ethically sound oversight. Instead, we believe the more productive role for the state is to empower our citizens to seek mental health care when needed, and to focus on developing and supporting non-discriminatory health care services.
Leticia Y. Flores
Patrick R. Grzanka
Erin E. Hardin
Jioni A. Lewis
Joseph R. Miles
Gina P. Owens
Gregory L. Stuart
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