HTH...

So, Huffington Post is up in arms (along with a multitude of their commenters) regarding a law in Tennessee that will allow "therapists and counselors to reject patients they feel would violate “sincerely held principles.”

Lots of things to work through here:

- I hate to disagree with the ACA (well, not really), but requiring therapists or counselors to see people with whom their values clash can be fraught with disaster.  In training therapists I always make it clear that they have to have their own values in check when working with clients and if they cannot, then they should refer out.

Let's be clear here - this is not like refusing to bake wedding cakes for people, which means throwing some batter together and adding happy slogans.  Therapy requires a relationship, it takes a lot on the part of both participants and if values-based differences will either stifle client progress or even have iatrogenic effects, then a good therapist can and should always decline to work with a client and refer them out.  The first ethical tenet in therapy, as in medicine, is do no harm. So to say that a counselor cannot refuse treatment based on “personally held values, attitudes, beliefs and behaviors” is absurd.

In truth this depends on why the person is seeking treatment. Suppose a gay man seeks treatment with a provider for depression.  If the man's sexuality is not a focus of treatment, then the values are not an issue.  suppose that the individual is depressed because his partner has HIV?  Do we really want to force a practitioner who is not accepting of homosexuality to see this person?  Do we not think it will impact treatment?  If it does impact it negatively and there should be litigation, can this practitioner claim that the ACA would not allow him to refer this client out?

- Concerns about "clients of color" were also expressed - but this is not the same issue as one of "values".  Refusing to see a client from a different racial or ethnic group is not the same.  If that client holds values that are not consistent with those of the therapist and that discrepancy will impact therapy in a negative way, then a referral should be required.

Therapists are ethically and legally bound to practice only within the scope of their expertise and competence. Hence, a gay man seeking services for relationship difficulties may find that someone with differing values will also not be competent in working with gay relationships.

I have to wonder - in a world and time where so many need "trigger warnings" and "safe places" why then would someone insist on being able to see a therapist who does not share their beliefs, who may consider their sexuality as perverse? Why would they want to force a therapist to see someone when she knows she would not be helpful to them.

As a psychologist, I may be more than willing to work with any client who comes in my door - as long as they are seeking help I am qualified to give.  But that is a personal decision.  No, none of us should be free to discriminate on the basis of race or ethnicity.  However, not all professional therapists  - even those who may be very good at it - may be capable of putting personal values, beliefs or feelings aside.  That is not a case of "I will not see you because you are black."  It is a case of "I am not the best person to see you because I disagree with your goals or your lifestyle."

It may not be what I would have to do, but I respect a therapist who is self-aware enough to know when they should not see a client.

In truth, this idea that therapists should have to see anyone is an unfortunate consequence of the social justice movement.  It takes only the needs of the "oppressed" into account, without considering the rights or needs of others. Suppose a man comes to therapy with his issues being his wife will not be sufficiently subservient to him.  Suppose the only therapist in his area is a feminist who sees this as a repulsive idea.  Is it then her role to enlighten him, regardless of the reason he is seeking services, to reeducate or indoctrinate him?  Should she see him because she knows what society and social justice would say is best for him or should she refer him elsewhere because his  goals is not consistent with her values?  In today's climate, it is likely she would see him so she could make him fit her ideal.