A college psychology professor's observations about public policy, mental health, sexual identity, and religious issues
Recently, TN’s legislature passed and Governor Haslam signed into law a measure which allows counselors to refer clients if the client’s goals conflict with a counselor’s “deeply held principles.”
Now, the American Counseling Association has decided to move the 2017 conference out of Tennessee.
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Previously, I posted a link to a Tennessee bill which gives permission to counselors to refer clients over conflicts with a counselor’s “sincerely held beliefs.”
Last week, Tennessee Governor Bill Haslam signed the bill into law. His reasoning was summarized in a statement after he signed the bill:
The following is the Gov. Haslam’s statement on Senate Bill 1556 (http://www.capitol.tn.gov/Bills/109/Amend/HA1006.pdf):
“Although Senate Bill 1556 has received attention for its perceived focus, my job is to look at the actual substance of the legislation. After considerable thought and discussion with counselors both for and against the bill, I have decided to sign Senate Bill 1556. There are two key provisions of this legislation that addressed concerns I had about clients not receiving care. First, the bill clearly states that it ‘shall not apply to a counselor or therapist when an individual seeking or undergoing counseling is in imminent danger of harming themselves or others.’ Secondly, the bill requires that any counselor or therapist who feels they cannot serve a client due to the counselor’s sincerely held principles must coordinate a referral of the client to another counselor or therapist who will provide the counseling or therapy,” Haslam said.
“The substance of this bill doesn’t address a group, issue or belief system. Rather, it allows counselors – just as we allow other professionals like doctors and lawyers – to refer a client to another counselor when the goals or behaviors would violate a sincerely held principle. I believe it is reasonable to allow these professionals to determine if and when an individual would be better served by another counselor better suited to meet his or her needs.”
The bill was signed by the speakers on April 13 and transmitted to the governor for action on April 15.
The bill language is available at http://www.capitol.tn.gov/Bills/109/Amend/HA1006.pdf.
While I appreciate the amendments requiring care in cases of homicidal or suicidal risk, I don’t support this bill. This bill allows discriminatory actions toward anyone, including religious people, based on a vague condition of a counselor’s conflict involving “sincerely held principles.” While I believe some conflicts could be so great that a referral would be the best course of action in the immediate situation, this bill points counselors in another direction. For mental health care to be fully integrated with health care, a value of treating all people is required. I don’t want a health care system where providers are allowed to delay care based on personal disagreements with patients. I do think providers should be allowed to decline performing certain treatments (e.g., abortion, hypnosis, EMDR, etc.) but I don’t think a referral based on personal disagreement should be the norm in health care.
A controversial bill which would allow counselors to refer clients based on the counselor’s “sincerely held principles” was passed by the Tennessee Senate earlier this week. Already passed by the House, the bill now awaits action from Governor Bill Haslam. He has not declared his position on the final version of the bill.
Originally, the bill referred to a counselor’s “sincerely held religious beliefs” as being a reason why referral would be allowed. Earlier this week, the Senate voted to amend the bill to change that language to allow referrals due to a counselor’s “sincerely held principles.”
The most current version of the bill states:
No counselor or therapist providing counseling or therapy services shall be required to counsel or serve a client as to goals, outcomes, or behaviors that conflict with the sincerely held principles of the counselor or therapist; provided, that the counselor or therapist coordinates a referral of the client to another counselor or therapist who will provide the counseling or therapy.
The bill does not allow such referrals if the client is suicidal or homicidal. In such cases, counselors provide services.
While I opposed the earlier language as well, the amended standard of “sincerely held principles” would greatly expand the reasons counselors could discriminate against clients. Counselors who don’t like a client’s politics could fall back on their “sincerely held” political views to refer. One can imagine many scenarios where the views of a counselor and a client conflict.
The practical implications are frightening. Minority clients in rural areas may not be able to find a compatible counselor. Clients may lose trust in the profession and decline to seek help when needed. The legislation does not provide any restrictions on when such referrals may be conducted. What if a counselor learns of a conflict after 20 sessions into counseling? According to this bill, the counselor would be able to refer the client, possibly undoing weeks of progress.
According to the Chattanooga Times Free-Press, this bill has a direct tie to the case of Julia Ward at Eastern Michigan University. Representative Jack Johnson told the Times Free-Press that the American Counseling Association is to blame because they changed their ethics code to forbid referrals based on religious beliefs in response to the 6th Circuit case where Ward was kicked out of Eastern Michigan because she referred a gay client and refused to comply with the educational requirements to get experience counseling gay clients.
I was the expert witness on behalf of Ward in that case and I oppose this bill. Generally, I think counselors must refer clients when they believe they might be harmful to clients, even if the harm includes the effects of counselor bias. However, the problem in such a case is with the counselor and not the client. The focus of an ethical counselor must always be the benefit of the client, not the comfort or rights of the counselor. This bill is so broad that the counselor can refer simply because of a disagreement over ideology, an unacceptable deviation from the nature of the counselor’s role. It seems unavoidable that referred clients will experience stigma and lose trust in the profession.