Ethics Quiz: Therapist Biases And Ethics Confusion

(Boy, does this freak disgust me...)

(Boy, does this freak disgust me or what...)

The Tennessee Senate’s Senate Health and Welfare Committee members have overwhelmingly approved a proposed bill that seeks to protect  therapists from 2014 changes in the American Counseling Association’s Code of Ethics. The Code decrees that “counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs and behaviors.” The bill, however, will allow practitioners to refuse to accept a patient without legal or professional penalties as long as they refer the individual  to another qualified professional.

The Tennessee Association for Marriage and Family Therapists opposes the legislation, saying “This bill is in direct opposition to the ethical code of the American Association of Marriage and Family Therapy and potentially harmful to clients,” the group said in a statement. “Our mandate to do no harm to the consumer, we believe, would be violated.” A therapist who testified before the committee opined that “they can keep their belief system and still offer good counseling but not based on their religious beliefs.” Others have objected to a legislative body dictating professional ethics.

Your Ethics Alarms Ethics Quiz today is…

Is the proposed bill reasonable and ethical, or just a way to allow bigoted counselors to discriminate?

For me this one’s easy, and I am shocked that the issue even came up.

The new American Counseling Association’s Code of Ethics rule is the unethical provision here, and a horrible example of a professional organization compromising good practice to kowtow to political correctness and irrelevant political agendas.

I have a close friend, a recovering alcoholic, who saw a therapist to address several emotional and psychological issues. After months of frustrating and ultimately useless sessions, the psychologist finally revealed that he had a long-standing problem with alcoholics and the issue of alcoholism, and couldn’t effective deal with them. Usually, he said, he refused to take alcoholics as patients. Of course, alcoholism is linked to many other conditions, like clinical depression. How dare this quack take on a patient he knew he was biased against and unable to treat compassionately— alcoholism was a major factor in his family—and then only reveal the bias after a few thousand dollars or so in fees?

Yet this situation is what the American Counseling Association is mandating, I suppose to curry favor with the LGBT furies, and avoid their wrath. It cannot possibly be in the best interest of any patient to be treated by a counselor or therapist who harbors a bias against him or his sexual preferences. A very least, the Ethics Code should require a counselor holding such biases, religion-based or not, to be transparent, let the potential patient know about them, and explain how these feelings could impede treatment. A counselor or therapist with a personal objection to a client’s sexual orientation has a personal conflict of interest. It is amazing to me that any professional organization would require that a counselor ignore the likely effects of conflict to the detriment of the patient, just so the association can grandstand its progressive support for the LGBT cause, when its result may  be detrimental to  LGBT patients.

For contrast, see the legal ethics rules, one of which (Rule 1.7) says…

…a lawyer shall not represent a client if …there is a significant risk that the representation…will be materially limited by ….a personal interest of the lawyer.

The only way this rule can be ethically overcome is if the client consents with full knowledge of the lawyer’s adverse interests, and if the lawyer sincerely and reasonably believes that his personal interest or biases will not adversely effect the quality of the lawyer’s representation client. This is how the situation should be handled in any relationship of dependence and trust.

That witness who said that “they can keep their belief system and still offer good counseling but not based on their religious beliefs” is full of malarkey. How does he know what “they” can or can’t do effectively? Only the therapist holding the beliefs and bias can know. That “do no harm” argument from the Association reinforces my biases against counselors and therapists. It isn’t harmful to patients to force therapists to treat people whose conduct and sexual preferences they find reprehensible, or who they think are engaged in willful sin? What is the matter with these people? The whole profession needs an ethics counselor.

The Code of Ethics in question is dead wrong, and embarrassingly unethical. Thus Tennessee’s proposed bill is necessary, and LGBT advocates should be supporting it.

_________________________

Pointer: Fred

Ethics Alarms attempts to give proper attribution and credit to all sources of facts, analysis and other assistance that go into its blog posts, and seek written permission when appropriate. If you are aware of one I missed, or believe your own work or property was used in any way without proper attribution, credit or permission, please contact me, Jack Marshall, at jamproethics@verizon.net.

 

25 thoughts on “Ethics Quiz: Therapist Biases And Ethics Confusion

  1. I agree completely with you assessment. The ACA’s ethics rule is not aimed at making sure that patients are ethically treated, but rather is an attempt to force those with strongly held beliefs that are inconsistent with LGBT principles out of the profession.

    • I must agree with you; abandoning Hanlon’s Razor this really seems to be a maneuver to use an ethics code to mau-mau some therapists out of the practice. I would add that it’s nice to see my state’s legislature on the right side of an ethical argument.

  2. Damn! Gotta get home in front of a real computer and comment on this one. I agree. My comment concerns the very intimate nature of psychological counseling, and of course a personal anecdote. Hopefully I’ll get home in time to add something new.

  3. Bullseye. The LGBT Furies are not merely concerned with equal rights, they want everyone who disagrees with them forced into the closet or disgraced.

  4. In addition to being unethical, I feel like this rule is defending against a liberal boogeyman that’s actually less scary than the potential reality.

    I mean, my understanding of conservative views on the subject is that no one is denying that people believe they are gay or trans, and that most religious or conservative counselors are likely to view those things as… psychological issues that require treatment. In that case, they’re hardly likely to turn down treatment for someone because they’re gay or trans, but rather to “help” them in ways that might prove ultimately harmful. Unless the code also has rules against treatment outside of widely established psychological standards, but I find it hard to imagine a way to make or enforce that rule, given the individualized nature of therapy.

    As Jack pointed out, turning them away or disclosing their biases and offering the patient the choice to leave or stay would be the best and most ethical treatment they could offer. But I still find it hard to believe that there are large numbers of counseling services who refuse to treat people because, in their opinion, they’re crazy.

  5. Having retired a number of years ago as a psychologist and licensed professional counselor, I find this effort both offensive and extremely dangerous, both for the counselor and the client, patient, what ever you want to call the recipient. ANY psychologist who actually knows what he/she is doing will tell you that it is virtually impossible to avoid having personal belief systems effect therapeutic efforts. One of the first steps in the process is to form some sort of rapport with the recipient. If that cannot be done, then there is no therapeutic process, because there is no trust nor is there a base for the process. And I do not mean the sort of rapport exhibited by Alexander Hamilton and Aaron Burr.

  6. Yeah, it’s not even a hard call.

    Ostensibly, the LGBT furies might have an argument if they argued universality: It may be ethical for an individual psychiatrist, having recognized his biases to refuse and refer, as opposed to giving service that is sub-par or outright damaging to the patient. However, it approaches unethical if EVERY psychiatrist did so, the argument being that biased help might be better than no help.

    That said, just like with the potential wedding cakes… Someone is out there. Someone is out there that will bake you the damn cake, and someone is out there that can help you deal with your issues.

    And so, as always, I’m of the opinion that these characters should be encouraged to flag their biases, loud and proud… An 8×11 sign on the door with an encircled rainbow and a big black slash through the middle: No gays allowed. I want the bigots to wear their intolerance on their sleeves because I don’t want to give the asshats my money. I don’t want spit in my cake or lies in my head? Let them have their bitter intolerance, I have my pride.

    • Hearts and minds can’t be compelled, they can only be won. Some can’t or won’t be won. Some will only go so far. That said, if you accept a patient/client, you have to do your best for him, whatever his issues and using whatever means you agree are appropriate. Maybe someone with gender dysphoria comes to you wanting to be normal as best they can, and maybe they just want to transition. If you take the case, with a goal clearly in mind, you must move toward it. If you can’t do that, then you should say so at the outset, and the client should look for someone who will help.

  7. I guess this means that counselors can refuse to provide therapy to “the homeless” who haven’t bathed in months! Think of the counter transference issues issues if they couldn’t.

    • Therapists, like lawyers, give advice and guidance. If they cannot give good advice and guidance, in their own judgment, to smelly people, then they should be able to refuse. This is in the patient’s interest, not the therapists’

  8. This is another example of the liberal solution exacerbating the problem it’s meant to fix. As dragin_dragon and joed68 note, the single most important element in a therapeutic relationship is the relationship, i.e., the rapport, fit, and alliance among the therapist and client. As usual, Jack, your analysis is on the mark.

  9. Maybe I am a bit obtuse, but I had to read the American Counseling Association’s Code of Ethics provision at least 30 times before I understood it. It says that a counselor should ‘refrain’ from referring a client/patient based on personal beliefs of the counselor. What? That is really odd. From a legal standpoint, I refer cases all the time if I don’t believe I can handle them or I don’t have a firm belief in the client’s case. As a therapist or counselor, the American Counseling Association wants counselors to treat patients even if the patient’s situation violates the counselor’s personal beliefs? How is that appropriate? How is that in the best interests of the patient? Tennessee got it right, in my never-to-be-humble opinion.

    jvb

    • I know you’re going to hate slogging through this, but here’s the Texas Counselor’s Code of Ethics.

      http://www.dshs.state.tx.us/counselor/lpc_ethics.shtm

      Couple of interesting things:
      Texas Counselors are required to terminate counseling if it is obvious no gains are being made (and if you cannot stand the person or his belief system, none will be) and must, when terminating, facilitate transfer to another counselor.

  10. The bill, however, will allow practitioners to refuse to accept a patient without legal or professional penalties as long as they refer the individual to another qualified professional.

    From the WPATH Standards of Care v7

    “Ethical Guidelines Related to Mental Health Care

    Mental health professionals need to be certified or licensed to practice in a given country according to that country’s professional regulations (Fraser, 2009b; Pope & Vasquez, 2011). Professionals must adhere to the ethical
    codes of their professional licensing or certifying organizations in all of their work with transsexual, transgender, and gender-nonconforming
    clients.

    Treatment aimed at trying to change a person’s gender identity and lived gender expression to become more congruent with sex assigned at birth has been attempted in the past (Gelder & Marks, 1969; Greenson, 1964), yet without success, particularly in the long-term (Cohen-Kettenis & Kuiper, 1984; Pauly, 1965).

    Such treatment is no longer considered ethical.

    If mental health professionals are uncomfortable with, or inexperienced in, working with transsexual, transgender, and gendernonconforming
    individuals and their families, they should refer clients to a competent provider or, at minimum, consult with an expert peer. If no local practitioners are available, consultation may be done via telehealth methods, assuming
    local requirements for distance consultation are met.”

    The Code of Ethics in question is dead wrong, and embarrassingly unethical. Thus Tennessee’s proposed bill is necessary, and LGBT advocates should be supporting it.

    Concur with caveats. So do the medical experts on the issue.

    I feel that any “counselor” who refuses to either treat a patient, and also refuses to refer them to someone who is competent to treat them, should have the book thrown at them.

    In addition, anyone training to become a counselor who is unable or unwilling to treat Jews, Catholics, Blacks, Alcoholics, GLBTI, etc patients is professionally incompetent to practice. Existing practitioners should perhaps be grandfathered in. despite their incompetence. Perhaps a limited license to practice is appropriate in such circumstances. No legal penalties, but professional restrictions, as they are not capable of fully doing their job.

    • I have a close friend, a recovering alcoholic, who saw a therapist to address several emotional and psychological issues. After months of frustrating and ultimately useless sessions, the psychologist finally revealed that he had a long-standing problem with alcoholics and the issue of alcoholism, and couldn’t effective deal with them.

      The problem is that the psychologist was incompetent to practice.

      Having said that, the principles behind the ADA (Americans with Disablities Act) should apply, as the psych may well have had useful talents in his professional field, and even a “calling”. Some form of limited licence to practice would be appropriate, in order to stay within the ethical guidelines of his chosen profession, but also not be put in a situation where his incompetence is an issue.

      While the welfare of the patient must be paramount, it should not be the only consideration.

      Bigotry should, I think, be considered a disability, as should Racism, with appropriate restrictions on license to practice, just as there are restrictions of drivers licenses regarding manual vs automatic, or size of vehicle.

    • zoebrain said, “…anyone training to become a counselor who is unable or unwilling to treat Jews, Catholics, Blacks, Alcoholics, GLBTI, etc patients is professionally incompetent to practice. Existing practitioners should perhaps be grandfathered in. despite their incompetence. Perhaps a limited license to practice is appropriate in such circumstances. No legal penalties, but professional restrictions, as they are not capable of fully doing their job.”

      It’s “incompetence” for a professional counselor to have personal morals, opinions, or beliefs that might contradict with treatment of a patient? Okay, now I get it; we should be replacing all of these kinds of professional counselors with computer software.

      With all due respect Zoe, I think you have completely missed the point that the specific provision within the code of ethics that Jack pointed out is unethical. Not referring a potential patient to another professional counselor is unethical when the professional counselor knows that there is a reasonable likelihood that their own human traits (traits that we all have) regarding morals, opinions, beliefs, etc might negatively affect the outcome in this particular case.

      I would completely agree that any professional counselor should consider personally reevaluate their reasons for being in their chosen profession if they feel they shouldn’t be counseling a specific kind of patient, but to force a professional counselor to treat a patient knowing full well that their own personal traits might negatively affect the outcome of the treatment is unethical at best and completely immoral at its worst.

      • Well said. The goal of any counseling and/or therapy is to help the client function better is his/her social milieu. If a counselor is not going to be able to do that, then he/she must be able to refer.

  11. Jack said, “A very least, the Ethics Code should require a counselor holding such biases, religion-based or not, to be transparent, let the potential patient know about them, and explain how these feelings could impede treatment.”

    That one sentence sums it up nicely!

    What blows my mind is the fact that a law is required to give these professionals legal recourse for refusing to follow an unethical provision in a code of ethics. I’m having a really hard time wrapping my head around this conundrum.

    It seems to me that being excessively PC will destroy the very core of everything that makes us who we are.

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