States advance “conscience clause” bills in mental health

A new Arizona law, and a similar bill proposed in Michigan, would allow students in psychology, counseling and social work to discriminate based on their religious or moral beliefs.

In Michigan, as I reported last week, the Julea Ward Freedom of Conscience Act has passed out of its House committee and is making its way through the state legislative process. Its core is almost identical to a portion of a larger religious-freedom-in-education bill that was signed into law last year in Arizona. That state’s HB2565 includes this mandate:

A university or community college shall not discipline or discriminate against a student in a counseling, social work or psychology program because the student refuses to counsel a client about goals that conflict with the student’s sincerely held religious belief if the student consults with the supervising instructor or professor to determine the proper course of action to avoid harm to the client.

The main difference in the Michigan law is that it requires that the client be referred to a practitioner who will provide the services the client is requesting. The Arizona law simply demands consultation with a supervisor.

The American Psychological Association has voiced its objections to conscience clauses generally. The California Division of AAMFT has expressed similar concerns. In the debate around the Michigan bill, testimony from Judith Kovach of the Michigan Psychological Association addressed that group’s concerns about where laws like this can lead. The National Association of Social Workers and its Michigan chapter likewise oppose the Michigan bill.

I’ll be honest — as an educator, these laws scare me. They place the values of the therapist above the need of the client to receive competent services. (Can you imagine a medical student announcing that she would only treat heart attacks if the patients were white? These bills allow exactly that in mental health, just substitute “bipolar disorder” for “heart attacks.”) The laws are so broadly worded that they would allow any student to discriminate against any type of clients the student does not want to treat. In Arizona, the student would need to be able to reasonably ascribe their prejudice to their religion, but the Michigan bill doesn’t even require a religious basis — by allowing a student’s moral belief to rule the day, the bill would give students free rein to discriminate for any reason the student sees fit. Anywhere they are enacted, conscience clause laws will make it harder for universities to teach their students to work with diverse groups, as students could refuse to treat homosexuals, Latinos, the elderly, or any other group they devalue with absolute protection from university discipline.

For clarity’s sake, I know a number of strongly religious therapists who are excellent practitioners and do not discriminate based on their religious beliefs. It is certainly not my intent to paint all religious students or therapists with the same brush; the overwhelming majority are fully competent and able to integrate their beliefs with the standards of their professions, often engaging in great personal struggle to do so. My concern is with the extremists, the ones whose beliefs are most in need of challenging in order to work effectively with diverse populations.

It is not an overstatement to say that if I were running a graduate program in psychology in Arizona, I would close my doors. I do not know how a program can teach its students about the mental health impacts of prejudice and discrimination and simultaneously allow students to engage in that very same harmful behavior simply because the student holds a particular moral or religious belief that devalues people based on their gender, age, ethnicity, or sexuality.

I am not the only one suggesting that graduate programs in Arizona will have to close their doors… or at least risk losing their accreditation. In fact, program accreditation has proven to be a handy cudgel for fear-mongering on both sides of these bills. Proponents of conscience clause legislation say that without it, religiously-affiliated schools will not be able to adhere to their religious principles and maintain program accreditation. At the same time, opponents of the bills argue that no school in a state with conscience clause legislation would be able to maintain accreditation, as schools would not be able to enforce the ethical requirements of the mental health professions with students. To date, I do not know of a single instance of a graduate program losing its accreditation in the mental health professions over its religious affiliation, but it would not surprise me to hear that some schools may have avoided the accreditation process altogether out of concern for whether their beliefs and practices would be accepted.

Specific to the field of marriage and family therapy, there is some small comfort for graduate MFT programs in that our field is not specifically named in the Arizona law or Michigan bill. A program that is named simply MFT and is not in a larger psychology or counseling program/school is arguably not covered by this legislation. And the accreditation bogeyman may not work in MFT. The Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE), which accredits MFT programs around the country, cleverly sidesteps the issue: It includes a clear statement allowing schools the freedom to operate within their religious principles (page 3), but it does not provide any exception to the Code of Ethics for individual students.

Some in psychology are questioning whether these laws are really about conscience at all. Glenda Russell, a psychologist and coauthor of Conversations about Psychology and Sexual Orientation, argues in APA’s Division 44 newsletter (page 19) that the laws are ultimately about preserving the oppression of gays and lesbians:

That framing [of this legislation as a “conscience clause”] … privileges the actions of people who are trying to usurp years of social science research, interfere with the ethics positions and practices of the profession, undermine the right of the profession and educational institutions to set standards for training, render guidelines for practice with LGB clients irrelevant, return psychological practice to a non-scientific position, and undermine diversity efforts within and outside APA. To speak of such efforts in terms of “conscience” offers these efforts the positive connotations typically associated with acts of conscience—a moral superiority and social value that I frankly think are missing from the efforts to enact the legislation with which we are all concerned. … [I]n the broader scheme of things, these efforts represent one part of the larger systematic attack on the psychological, social, political, and cultural progress made to secure an accurate view of and positive practices toward LGB people within the discipline and in society more generally. … At this level, we are not talking about anything having to do with someone’s conscience. We are talking about a blatant campaign to reassert stigma.

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