Anyone familiar with me and/or my work knows that I have a great deal of respect for those involved in the mental health field. I have been a member of the San Gabriel Valley Psychological Association since 2008 and have attended almost all of their monthly lunch meetings since joining that organization. I spend a great deal of time reading psychological research and articles and engaging in discussions with a great many mental health professionals in order to improve the way in which I approach both my work and my life. In addition, I have been very open about the fact that I worked with a psychoanalyst twice a week for approximately two years, commencing in January 2009, in order to work through the dysfunction in my family and how it impacted me. I believe that among other things, this has helped me to become far more psychologically-minded in everything that I do. I firmly believe that I am a much better person and professional because of my appreciation and respect for the mental health field and those involved in it.
That having been said, I would be remiss if I praised the work of all of those involved in the mental health field. As with anything else, the caliber of those involved in the field range from exceptional to poor and everywhere in between. According to a 2004 poll, "mental health treatment has become an important part of American life. 27 percent of adults, or an estimated 59 million people, have received treatment in the past two years. Of these, the large majority report high levels of efficacy and satisfaction, regardless of the type of treatment they have received.... [However,] consumers lack key information for selecting a therapist." This unfortunate reality can and does lead to tragic consequences.
For example, on July 24, 2014, the Williams Institute hosted a webinar titled "Perspectives on LGBT Suicide Prevention." The reason for the webinar was as follows: "New research indicates that few LGB people sought help prior to attempting suicide and when LGB people did seek help it was not effective in preventing suicide attempts. Further, counseling from a religious or spiritual advisor was associated with worse outcomes. Compared with individuals who did not seek help at all, those who sought help from a religious or spiritual advisor were more likely later to attempt suicide."
This is extremely disheartening, especially considering that "addressing spirituality and religion in counseling may have therapeutic value in the extent that incorporation helps counselors to support clients connecting to others, moving outside of themselves, and contributing to the common good. Those who hold religious beliefs also participate in positive social relations as well as social and community service activities…. Counselors who recognize the role of religion in clients' lives are better able to encourage these positive pursuits, contributing to the overall health of clients….
Both the American Counseling Association (ACA) and the American Psychological Association (APA) formally acknowledge religion in their ethical guidelines as an issue counselors need to take into account in their practice…. Richards and Bergin provided five reasons to include spiritual assessments in counseling. First, spiritual assessments help counselors to obtain a better understanding on their clients' worldviews. Second, counselors are aided in their ability to determine in a religious orientation is healthy or unhealthy. Third, spiritual assessments help counselors to evaluate whether a client's religious or spiritual community is a source of help. Fourth, a counselor can better decide which spiritual or religious interventions will be helpful to a client. Lastly, spiritual assessments assist counselors in determining how a client's presenting problems are spiritual issues are related. Religion and spirituality's positive or negative impact on marital and family systems and view of others can be evaluated through spiritual assessments which are also beneficial from a counselor's point of view in that they are useful in diagnosis and treatment planning. In regard to diagnosis, assessments help counselors to differentiate between problems that are entirely religious or spiritual, those that are a mental disorder with religious or spiritual content, and those that are psychoreligious or psychospiritual problems but are not considered a mental disorder."
According to the American Psychological Association, homosexuality is "not an illness, mental disorder, or emotional problem…. Most people experience little or no sense of choice about their sexual orientation."
It is essential that we understand why the outcomes for LGBT people who sought counseling from a religious or spiritual advisor was worse, and in fact lead to an increased likelihood of suicide. I think it is important to analyze why such "help" actually worsened the situation. In order to do so, I would like to share some recent comments made by various mental health professionals in the Marriage Counseling & Therapy Network LinkedIn group.
"The source behind homosexuality is Satan, as well as everything else that's contradictory to God's word."
"Like anything we have the ability to change. I work as a clinical counselor in a Christian setting. Many of my clients who have same sex attraction also hold to a Biblical world view. You may disagree with this world view but it is not appropriate to tell people they have to change their world view to fit a political agenda. That is intolerant. For individuals with a Biblical worldview we should not disrespect their world view and tell them to just live in a way that they believe is sinful. Love that is rooted in a shared relationship with God can transform a person."
"While homosexuals may not have control over their sexual desires in their current state, the Scriptures assume that they can control the behaviors that these desires promote. The Bible is very clear about that. I am not judging other's behaviors, but the Bible does, and I believe it does, or shall I say He does for reasons that have to do with His knowing better what is in our best interests than we do. The RC church still accepts the Bible to be God's Word as I do. I am fully aware that there are millions of religious people who accept homosexual orientation, but I suspect less than 1% of them hold conservative views of their scriptures, for cognitive dissonance does not allow someone to accept all of one's scriptures if it condemns a behavior one wants to accept. While the Bible mentions homosexual behavior (or those who have such behavior), not once does it refer to the idea of a life-long homosexual orientation, but instead always implies that such individuals can give up such behavior, which would not be possible if one were 'born that way.' Christian psychology that incorporates its beliefs into its practice is a well-respected profession that is taught at several accredited colleges and universities throughout the country. Nonetheless, in my practice I always request and obtain new clients' consent and permission to incorporate direct Christian beliefs, practices, or Bible verses into their psychotherapy and counseling, before I actually do so. I repeat: I do not force my beliefs, Christian or regarding homosexuality, onto my clients (or my students). I believe strongly in the ethical principle of self-determination and in individuals coming to their own conclusions, even if I disagree."
"When one refuses to engage the rule and law of a creator God, they are left to the mercies of their own depraved, deviant and lost imaginations about what constitutes normative and moral functionality."
It should be noted that "there is no scientific debate about whether homosexuality is a choice. The professional mental health and scientific organizations uniformly reject the idea. Many of them make even stronger statements about these issues." Therefore, how can such "help" not harm those members of the LGBT community who have the misfortune of working with such "professionals?" Remember, "in regard to diagnosis, assessments help counselors to differentiate between problems that are entirely religious or spiritual, those that are a mental disorder with religious or spiritual content, and those that are psychoreligious or psychospiritual problems but are not considered a mental disorder."
The answer lies within the American Association of Christian Counselors Code of Ethics, which provides in pertinent part as follows:
"Christian counselors acknowledge that the first rule of professional-ministerial ethical conduct is: do no harm to those served….
1-126 Application to Homosexual and Transgendered Behavior
Christian counselors refuse to condone or advocate for the pursuit of or active involvement in homosexual, transgendered, and cross-dressing behavior, and in the adoption gay & lesbian & transgendered lifestyles by clients. We may agree to and support the wish to work out issues of homosexual and transgendered identity and attractions, but will refuse to describe or reduce human identity and nature to sexual reference or orientation, and will encourage sexual celibacy or biblically proscribed sexual behavior while such issues are being addressed.
Christian counselors differ, on biblical, ethical, and legal grounds, with groups who abhor and condemn reparative therapy, willingly offering it to those who come into counseling with a genuine desire to be set free of homosexual attractions and leave homosexual behavior and lifestyles behind. Either goal of heterosexual relations and marriage or lifelong sexual celibacy is legitimate and a function of client choice in reparative therapy.
It is acknowledged that some persons engaged in same-sex change or reparative therapy will be able to change and become free of all homo-erotic behavior and attraction, some will change but will still struggle with homosexual attraction from time to time, and some will not change away from homosexual practices."
Interestingly enough, On January 13, 2014, "the UK Guardian reported that the Association of Christian Counsellors* prohibited reparative therapy for their members. The statement backing up this action sounds very much like the sexual identity therapy framework." The asterisk is to clarify that there is "no relationship with American Association of Christian Counselors." I would want to make that distinction extremely clear as well, since unlike the American Association, that one is actually directing its members to be ethical.
It should go without saying that mental health professionals must not allow their personal beliefs to harm others, and especially not when acting in their professional capacity. One would think that this is such a basic concept, it should not need be spoken. Thing again! In fact, in 1997, "the American Psychological Association's office of the Public Interest added a 'Resolution on Appropriate Therapeutic Responses to Sexual Orientation' to their list of Lesbian, Gay, and Bisexual Concerns Policy Statements, establishing 16 Guidelines for Psychotherapy with Lesbian, Gay and Bisexual clients. In this resolution, the American Psychological Association declared that the organization 'supports the dissemination of accurate information about sexual orientation, and mental health, and appropriate interventions in order to counteract bias that is based in ignorance or unfounded beliefs.'" Moreover, such "therapy" is legally banned in California and New Jersey with regard to minors because it is their parents who subject them to such psychological abuse. Such "treatment" has been found to be ineffective, and often to cause severe emotional harm, including suicidality.
"Despite these monumental changes, there remains a cohort of psychologists who practice reparative (or conversion) therapies that promote heterosexist beliefs, and perpetuate the validity of homosexuality as a mental illness. Currently, there is significant debate regarding the rights of clients who seek out such services in an effort to reconcile their sexual orientation with their religious beliefs. Advocates for the mental health rights of sexual minorities warn other mental health professionals about the potential misuse and harm that can result from reparative therapies…. Conversion therapy was banned by the American Psychiatric Association (2000) and a similar stance was taken by the American Psychological Association (1998) and other professional organizations....
The profound existence of homophobia in conservative religious communities makes the coming out process even more difficult for gay and lesbian individuals who have had a religious upbringing. Religious involvement may be associated with greater internalized homophobia or self-image that includes negative societal attitudes toward homosexuality. This is especially true for conservative Christian denominations….
As a result of these conservative religious stances regarding homosexuality, many gay and lesbian individuals find themselves rejecting their religious faith in order to accept their sexual orientation. Others believe that in order to live according to God's will, one must forsake homosexuality. A struggle exists because gay and lesbian individuals from conservative religious groups are asked to choose between their sexual orientation and their religious beliefs, a difficult choice especially for those raised in a religious atmosphere. Spiritual challenges are at the heart of the gay and lesbian experience, and as such, therapists are often called upon to address spirituality issues with gay and lesbian clients. Homophobic messages that religious institutions perpetuate are likely to result in an increased level of internalized homophobia for the gay or lesbian individual, a delay in the development of a homosexual identity for the gay or lesbian individual, and add conflict to an already difficult path that gay and lesbian individuals must face….
Many researchers see rejecting part of the self, whether it be one's religion or sexual identity, as having negative effects on a gay or lesbian individual's mental health. Dual identity formation and reconciliation is thus an extremely relevant issue with potentially very harmful effects for the gay or lesbian individual…. Research has shown that conflict between one's religious and sexual identity is associated with more distress, shame, internalized homophobia, depression, and suicidal ideation….
Individuals who experience conflicts between their religious beliefs and sexual orientations at times believe that the solution to the dilemma is to allow or deny either identity. Such a solution, however, yields both personal and emotional loss. If one attempts to minimize one's sexual nature, one risks giving up a profound avenue of connection with, and growth through, another human being, while if one attempts to minimize one's religious orientation, one risks losing the community in which one has found nurture, meaning, and a sense of belonging."
Isn't it fascinating that by following the American Association of Christian Counselors Code of Ethics and "do no harm to those served," when Christian Counselors are working with the members of the LGBT community, they are very much harming those they serve. In fact, on November 12, 2014, "for the first time in its history, the United Nations Committee Against Torture (CAT) expressed concern over the dangerous and discredited practice of conversion therapy being used on LGBT youth in the United States... despite the fact that it has been condemned by every major medical organization, and is known to lead to severe depression and even suicide." Other than explaining that the United States is controlled by religious zealots and has no real Separation of Church and State, despite what the Constitution provides, I have no idea how the United States can respond.
Along those same lines, I made the following comment in the discussion in Marriage Counseling & Therapy Network LinkedIn group: "And this is why I will be writing a series of articles on the damage that mental health professionals can cause their clients. This discussion has provided a wealth of material." In response, a Licensed Marriage and Family Therapist said, "Mark B Baer, when you write about how mental health professionals can cause their clients harm, please remember that there are plenty of us out there who would never, ever indicate that homosexuality was somehow a reflection of something wrong in the client. I treat every one of my clients with dignity and respect, no matter what sexual orientation they identify with. If they are in my office they need help with something and it is my job to help them figure out what that is and guide them to a place of peace and comfort in their lives. It is not our place to judge."
In the past, I have written about "Judicial Bias - A variable that is often overlooked in family law litigation." The fact of the matter is that every human being is biased. Our individual backgrounds and life experiences shape our personal values, beliefs, assumptions and biases. How do our personal values, beliefs, assumptions and biases impact our decision-making and the work we do, that is the question.
Fortunately, that particular therapist is not the only mental health professional to be "floored and embarrassed" by the above-referenced comments. Allow me to share the reactions from others.
"I would suggest that the Christian whose urges were against his religious beliefs talk to his minister, not a mental health professional"
"When people use their 'worldview' to exploit others and take money from them when they are vulnerable with the promise of changing one's sexual orientation, which cannot be done, I have a problem with that.... You can hide behind your religious tenets to try to influence someone into your point of view. What you cannot do is to cloak it under the guise of 'psychotherapy'. Leave it where it belongs as quackery exorcisms.... I don't care what your world view is, just don't impose it on me and then bill me and the insurance company as 'psychotherapy'. Satan is the mental health professional that encourages LGBT people to hate themselves."
"It is frightening to know that there are still clinicians who are afraid of same sex love inspire of knowing the harm homophobia and heterosexism have caused. And hiding behind religion is ridiculous."
"I was not aware of the Bible as a scientific text."
"You are entitled to your views. The trouble with them, in my opinion, is that they presume homosexuality to be in essence a pathology. I agree with the AAMFT that states, 'Homosexuality is not a pathology and therefore in and of itself does not warrant treatment.'"
"Maybe the folks you were treating were looking for a reason since they are probably Christian with the same outdated beliefs. Your commentary angers me because you apparently have no clue about being gay and obviously you have no desire to find out. I hope no one else comes to you who is gay because you seem to have a need to tell them that they're doing something wrong. Maybe you need to ask Jesus to forgive you for your arrogance in thinking you know how others should live."
"Homosexuality is not a condition or disorder that requires treatment. It simply, and not so simply, just is.... In the treatment of clients who present with mental health issues, how is it ever helpful to talk in terms of Satan? Our job is to be Non-judgmental, Not to Judge."
"There are as many ineffective or destructive therapists as there are ineffective or destructive attorneys. There are also many who have their own religious views that govern their practice."
"Over the last few years I have encountered some dangerously harmful personalities in the mental health field. I'm personally embarrassed & ashamed to have these individuals taint / misrepresent the immense benefits that can be gained through counseling with an ethical & successful provider."
Gary Direnfeld, MSW, RSW wrote an article about the negative side effects of counseling titled "Iatrogenic Effect: A negative consequence brought forth by the healer."
I want to again reiterate that the very serious issue of what I will refer to as religiously biased mental health professionals is hardly limited to issues pertaining to homosexuality. In fact, the following comment by a Licensed Clinical Social Worker completely set me off: "Truth is a man of character and integrity probably would not be divorced by a good moral non biasing woman and mom and this needs to be a factor in the court system also." If only things were so black and white!
The following quote from Cathy A. Murray is a fitting conclusion to this article: "In post secondary school, nurses learn the difference between religion and spirituality. Spirituality is the focus of our assessments and we ask whether religion is part of one's spiritual practices. In other words, religion is one method of spiritual practice.... Sometimes religion is used as a vehicle to avoid the real issues."