The case is stirring a firestorm of discussion among psychotherapists and counselors around the country. Although there are a number of issues, two questions seem to be taking central stage. First, is it ethical for a therapist or a counselor to refer a client to another qualified professional if they feel that they cannot work with that client on moral grounds?  And second, can an institution insist that a therapist or counselor practice in a manner which goes against his or her religious beliefs?

The NY Times quotes Daniel Mach, a lawyer with the American Civil Liberties Union, which filed a brief in support of the college, who said, "Nobody should be forced to change her religious beliefs or be punished for her faith." However, according to the article, "referring a client to another counselor is not a neutral act. He pointed out that high school counselors may be the only compassionate adults available to gay, bisexual or transgender youths, and that turning away such a youth in crisis 'could be devastating'."

Jeremy Tedesco of the Alliance Defense Fund, a Christian legal advocacy organization, defended the counselor's position, according to the Times, saying that she "was not singling out gay men and lesbians, and that she would also refuse to affirm heterosexuals who sought counseling about their adultery" and noting that counselors are allowed to choose not to work with other ethical issues, when someone who is terminally ill is considering ending their life.

One assumes that the counselor felt that she could affirm other parts of this client's life, but not his deeply personal and meaningful desire for a same sex partner. Although I deeply disagree with her position on homosexuality, it seems to me that referral to another therapist was far better than the choice of another counselor cited in the court case, who "said she planned to tell gay clients that homosexuality was wrong." 

But Oppenheimer asks another crucial question: "What," he wants to know, "is the role of the counselor or therapist. Is it to "affirm" the client's beliefs, or to offer support and guidance, even to clients whose practices one may find distasteful or morally wrong?"

I think Oppenheimer is on the right track here. Although most professional therapists are taught to be nonjudgmental, to offer support rather than moral opinions, it would be unrealistic to suggest that we are unbiased. And is that our job? To affirm any choices a client makes?

Years ago, when I was in analytic training, I was struggling to work with an alcoholic, drug addicted client. When I presented my difficulty to my supervisor, she said, "You're pretty critical of this client, aren't you?" I was taken aback, but had to acknowledge that she was right. "Your job is to help her understand what she is doing and why she is doing it," my supervisor said. "Not to sit in judgment of her." Deeply embarrassed, I asked what I could do about these feelings. "Analyze them," my supervisor told me. "Understand why you're so critical. And look into your own flaws and failings. What is there in you that might help you understand this client's experience?"

Those words have become a crucial part of my professional ethic. This is not to say that I am never judgmental, but I try to understand what I might be failing to see as a result of my bias, and then, if I cannot get through my feelings, express my concerns about my difficulty and to give a client a choice about whether or not to work with me. The first time I did this, I was amazed when the person sitting across from me thanked me and said that if I would still work with him, he thought it would be a really useful therapy. I did, and he was right, although in some ways I think I may have changed more than he did in the years that we worked together.

In the case described by Mr. Oppenheimer, the counselor does not appear to have a sense that her belief system might have some psychological meaning. For her, it seems to be simply a fact. This of course, is the problem with much prejudice. It is closed off, accepted as reality, unavailable to examination or the effects of exposing it to the air of human experience.

Therapy is a two-person process. There are times when a client's difficulties lie outside of a therapist's expertise, and it makes sense to refer them to someone who knows more about the specific issues involved. But anyone who undertakes the position of counselor or therapist must be very aware that there are always two sides to the process of therapy. When one side is sealed off, both sides will be affected. The therapist who refers may lose an opportunity to make a meaningful contact not only with another person, but also with an important part of her or his own internal life.

Therapists are, of course, human beings, with our own religious and moral convictions. The old idea that a therapist could be neutral, what Freud called a "blank screen" reflecting back only a client's issues and not her own personality, has been shown to be an impossibility (see the Hoffman reference, below). Everyone has a personality, and, as psychoanalyst Stephen Mitchell puts it, even if a therapist says nothing, a client will pick up clues about his or her beliefs in the silence. My own analyst and mentor, Martin Wagner, used to say that most of us struggle with issues within the context of relationships; and a therapist and client are in a relationship which gives them a chance to try to work on some of those issues. So a therapist's values are crucial to the therapeutic process.

But what happens when they are in conflict with a client's? I have worked with many people whose religious beliefs were different from my own, and I think they would say that I was helpful to them despite - perhaps in some cases because - of these differences. I have also found myself enriched by the process of exploring their beliefs with them, and of being forced as a result to reconsider some of my own thoughts about these issues.

Still, I have at times found myself faced with clients whose behavior was not acceptable to me. In some cases, such as child abuse or neglect, or when a person is a danger to her or himself or to someone else, I am legally required to take certain actions. But in the rare instances when I cannot tolerate a client's behavior, I have found that it is best to be open about that, to frame it as my problem, and to refer them to someone who I believe can work with these issues better than I can.

So while I am deeply and morally opposed to the counselor in question's attitude towards homosexuality, I actually think she may have done the right thing by asking to have the client referred to another therapist. I also understand the school's moral (and perhaps legal) position. Unfortunately, it means that this counselor will most likely go into training with people who will reinforce her closed off views. I wonder if this is part of why she is fighting to stay at the school that has rejected her. Could she, perhaps unconsciously, be looking for someone to suggest she look at her own psyche to understand her criticism of homosexuality? Could she be hoping that someone suggest she look inside herself to find ways to listen to and accept her clients even when she disagrees with their views on life? And can the school help her to do any of this?

References:

Hope And Dread In Pychoanalysis  by Stephen Mitchell, Ph.D. Basic Books, Inc.

The Patient as Interpreter of the Analyst's Experience, by Irwin Z. Hoffman, Ph.D., in (1983) Contemporary Psychoanalysis, 19:389-422

nytimes.com/when-counseling-and-conviction-collide-beliefs