Indiana’s Religious Freedom Restoration Act, signed into law by Governor Mike Pence last week, has raised a great deal of controversy. In the psychotherapy community, the law could have an immediate impact in the form of professional events and conferences moving out of the state. In the longer term, the bill is likely to impact training and practice by making it harder for universities and licensing boards to discipline discriminatory behavior.
AAMFT
The rising tide of student debt
How much should it cost to become a psychologist, family therapist, social worker, or counselor? Student debt is piling up for thousands of current students in the mental health professions, many of whom will struggle to pay it off after graduation.
Whose conscience matters?
When can a therapist decide their own morals and values outweigh those of their clients?
The AAMFT has kindly made my article on conscience clause laws in mental health the cover story for the September issue of Family Therapy Magazine. You can read the article here if you’re an AAMFT member.
Of course I’m biased here, but I think you’ll find it worth the read. While I’ve written about the topic a few times here on the blog (most recently, I wrote about conscience clause laws being considered in Washington, Texas, Arizona, and Michigan), my focus here has been much narrower than it is in the magazine. In the FTM piece I take a broad look at the issue, from the origins of conscience clauses to the best arguments for and against them. While these laws are often spurred by a desire to protect religious practitioners, you don’t need to be religious to be impacted by them, and you might be surprised at what the laws would appear to allow:Is this a price worth paying to protect therapists’ moral views? My skepticism is raised when considering that the religious practitioners and legislators backing these bills often seem to have a desire to legitimize discrimination against gay and lesbian clients. So, you know, that’s not okay. But the issue isn’t black and white, as I hope the magazine article illustrates. In addition to the main article, a sidebar I had written about conscience clause laws being considered or adopted in various states around the country was transformed into a really cool national map infographic. I wish I could take credit for that — it’s great visual layout — but that’s all magazine staff. Check it out. # # # I have another article in the works proposing a way therapists could consider the appropriateness of a conscience-based referral, within the fuzzy boundaries of existing law and the existing AAMFT Code of Ethics. So stay tuned for that (for several months, in all likelihood, but I’ll keep you updated). Your comments are welcome. You can post them in the comments below, or email me at ben[at]bencaldwell[dot]com.Most conscience clause laws are so broadly written that they could allow […] therapists to refuse to treat sexually active unmarried couples, or therapists morally opposed to immigration to refuse treatment to clients based on nationality, even in a mental health emergency.
California may become first state to limit “reparative therapy”
Senate Bill 1172 would stop licensed therapists from providing reparative therapy to minors. It awaits Governor Brown’s signature or veto.
Updated 9/30/12 – Governor Brown signed the bill into law. It takes effect January 1, 2013.
Senate Bill 1172, a proposed California law that would prevent licensed therapists from offering so-called “reparative therapy” to minors, has passed the state Assembly and Senate and is currently on Governor Jerry Brown’s desk. The Governor has until the end of this month — less than a week away — to sign or veto the bill.
If he signs it, California would be the first state in the US to take such action. Other states are eyeing the California bill closely, with some planning to propose similar bills. Gay rights organizations are also paying close attention to the bill, and have been pushing the Governor to sign it.
“Reparative therapy,” also sometimes known as “conversion therapy” and referred to in the bill as “sexual orientation change efforts,” is a form of therapy that aims to help people distressed by same-sex attraction change those attractions and ultimately become more heterosexual. The therapy was pioneered by Dr. Joseph Nicolosi, who suggests in his original book on the topic that same-sex attractions are unhealthy.
All the major professional associations in mental health have issued statements discouraging their members from using reparative therapy, though none has gone so far as to declare the practice inherently unethical. (See statements from the AAMFT, ACA, APA, CAMFT, and NASW; there’s a nice history of associations’ stances on the topic here.) These statements typically cite the lack of research support for any therapy succeeding in altering sexual orientation, and the serious risk of harm that comes to gay and lesbian clients when a therapist tells them that their sexuality is wrong or unhealthy.
However, the therapy remains practiced by a number of mental health professionals, who offer anecdotal reports of clients who say they were helped by the approach.
While professional associations are usually loath to accept government intrusion into clinical practice, it is noteworthy that all of the major professional associations in mental health in California are now either neutral on the bill or actively supporting it. All were initially opposed, but as the language of the bill has been amended, all have dropped their opposition. Here is where the major mental health professional associations currently stand:
AAMFT-CA: Support
The American Association for Marriage and Family Therapy, California Division was (with NASW-CA) one of the first associations to move from opposition to support. (Full disclosure: I’m the current Legislative and Advocacy Committee Chair for AAMFT-CA, and I’ve worked a great deal on this bill.)
NASW-CA: Support
The National Association of Social Workers, California Division was (with AAMFT-CA) one of the first associations to move from opposition to support.
CPA (Psychologists): Support
The The California Psychological Association had initially joined three other organizations (Psychiatrists, CAMFT, and CALPCC) in jointly oposing the bill. While all four organizations have since dropped their opposition, CPA appears to be the only one of the four to move to a position of support.
CALPCC: Neutral
The California Association of Licensed Professional Clinical Counselors has dropped its opposition, though the bill is not currently mentioned anywhere on the group’s web site.
CAMFT: Neutral
The California Association of Marriage and Family Therapists has dropped its opposition to the bill. The CAMFT web site includes a relatively soft caution to its members about the use of reparative therapy (referred to here as “sexual orientation change efforts”) but otherwise does not address the bill.
CPA (Psychiatrists): Neutral
The California Psychiatric Association has officially withdrawn its opposition to the bill, citing a 1998 statement of the American Psychiatric Association which reads in part, “The American Psychiatric Association opposes any psychiatric treatment, such as ‘reparative’ or ‘conversion’ therapy, which is based upon the assumption that homosexuality per se is a mental disorder.”
Whatever your stance on the bill, both sides are suggesting you contact Governor Brown’s office directly to let him know. The Governor’s office can be reached by phone at 916-445-2841, by email here, or on Twitter at @JerryBrownGov.
# # #
Your comments are welcome. You may post them in the comments section below, via email to ben [at] bencaldwell [dot] com, or to my Twitter feed.
Proposed Ethics Code revision would remove MFTs’ social responsibility
The proposal would eliminate three sections of the AAMFT Code of Ethics that currently call for service and responsibility to larger systems. Members have until January 31 to weigh in.
The AAMFT Board of Directors is proposing an incremental change to the marriage and family therapy profession’s Code of Ethics, the guiding document that defines professional standards in the field. At least one of the proposed changes would drastically redefine what it means to be an MFT.
Some quick background: The AAMFT Code of Ethics was last updated way back in 2001, and much has changed in the profession since then. In particular, the emergence of new technologies for both marketing and service delivery has raised concerns about how to best manage confidentiality and informed consent. The AAMFT Board has known the Code was in need of updating, but did not want to engage in a full-scale overhaul of the Code at this time; that would be about a two-year undertaking. So, they instead are looking at smaller-scale changes. (Full disclosure: I chaired a Task Force, at the Board’s request, looking at possible changes to the Code over the summer. The Task Force was just one of several sources of input for the Board as they developed the current proposal.)
One element of the proposed revised Code is shocking to me. It would change what it means to be a marriage and family therapist. The Board is proposing removing each of the following sections from the AAMFT Code of Ethics:
6.6 Marriage and family therapists participate in activities that contribute to a better community and society, including devoting a portion of their professional activity to services for which there is little or no financial return.
6.7 Marriage and family therapists are concerned with developing laws and regulations pertaining to marriage and family therapy that serve the public interest, and with altering such laws and regulations that are not in the public interest.
6.8 Marriage and family therapists encourage public participation in the design and delivery of professional services and in the regulation of practitioners.
Together, these are the sections that place MFTs in a position of larger social responsibility and make us accountable to the communities we serve. The removal of these sections would have far-reaching implications: If MFTs no longer need to have a place at the table when laws are being developed or altered that are not in the public interest, do we simply allow others to set for us the legal standards that govern our profession? Do we now need to stay out of the same-sex marriage debate? Is it OK for us to be ignorant of major legal issues in our field, from the fight for Medicare reimbursement to the Texas lawsuit over MFTs’ ability to diagnose?
Perhaps on an even more fundamental level, we can look at the proposed removal of 6.6. Is contributing to a better community and society no longer a value of this profession? If so, I would be a lot less enthusiastic about being a part of it.
And that’s the rub. A Code of Ethics is more than just a list of behaviors that can get you in trouble in a profession; it also serves as a vital statement of what it means to be an MFT. It reflects our values and desires as a professional group. One of those values, historically, has been responsibility to the communities we serve. If nothing else, devoting some of our professional activity to services with minimal return is a clear way of demonstrating through our behavior that we truly understand systems and our role, as professionals, in those larger communities.
The Board did not provide its rationale for this proposed change (or any others). But the reasons are likely not important. These subprinciples are key to my identity as a marriage and family therapist. They set AAMFT, as an association, and MFTs as professionals apart from other professional groups. Serving the community through pro bono work and involvement in policy discussions is part and parcel to being an MFT. Isn’t it?
Members can review the full proposal of changes to the AAMFT Code of Ethics through the AAMFT web site (you will need to log in). Members can submit comments through January 31 via email; the address to send feedback can be found here. Whether you agree with me on this issue or not, if you are a member, please do weigh in on the full proposal. The more feedback AAMFT gets from members on the proposed changes (most of which are really quite good!), the better.
# # #
If you’re wondering, the CAMFT Code of Ethics encourages (but does not require) pro bono work. It also has language nearly identical to AAMFT’s 6.7 above, about influencing laws.