NALGAP leaders say Tenn. counselor law will seriously harm LGBT patients

Leaders in NALGAP (The Association of Lesbian, Gay, Bisexual, Transgender Addiction Professionals and Their Allies) are expressing serious concern that a controversial therapy law in Tennessee will place counselors at odds with their own professional ethics codes and will further stigmatize help-seeking LGBT individuals.

Tennessee Gov. Bill Haslam late last month signed into law a measure that allows licensed counselors and therapists to deny care to a client whose goals or behaviors conflict with the counselor's “sincerely held beliefs.” The American Counseling Association, which in 2014 enacted a change to its code of ethics that ultimately spurred supporters of the Tennessee bill to take action, loudly opposed the bill during debate. Some opponents have characterized the law as discriminatory to the LGBT population, in a similar fashion to how they have argued against high-profile religious-freedom measures proposed or adopted in other states.

Haslam said in signing the bill that he consulted with numerous counselors on both sides of the issue before making his decision. He added that he considers the law's protections sufficient because the law requires counselors who see their beliefs as in conflict with a potential client's to refer that person to another counselor (the law also will not apply in situations where a client poses an imminent risk to self or others). But leaders in NALGAP say the law is unnecessary because existing professional ethics codes already require counselors to consider any personal biases that might affect their provision of services and to act accordingly.

“With these standards already in place there is no need for a law to mandate what ethical codes already explain—unless there is a wider political agenda, which seems to be the case in Tennessee,” says Craig Sloane, a NALGAP board member and the owner of New Leaf Counseling in New York City.

Sloane says laws such as Tennessee's “reinforce societal and institutionalized homophobia, transphobia and heterosexism.”

He adds, “When LGBT people experience this type of messaging from the media, treatment and religious institutions and from the government itself, they internalize the idea that they are defective as human beings. This internalization generates shame and trauma. It reinforces discriminatory belief systems and creates higher rates of vulnerability for risk of mental health and substance use disorders.”

Access concerns

Several individuals and groups that opposed the Tennessee legislation expressed concern that the law, which took effect immediately upon its signing, will exacerbate problems with access to care in rural areas of the state. Such concerns are echoed by NALGAP president Philip McCabe, a health educator at the Rutgers School of Public Health in New Jersey. McCabe cites several examples cited in Healthy People 2020 initiative goals that refer to oppression and discrimination that affect the health of LGBT individuals, including a lack of appropriate social programs and a shortage of providers who understand LGBT cultural and health issues.

McCabe says of Tennessee's move, “The law is adding more abuse and oppression to an already marginalized community. What is there to stop an LGBT person experiencing severe depression or having suicidal thoughts from acute withdrawal from having a door slammed in their face when seeking help, being told 'we don't treat your kind here.'”

McCabe points to ethics codes such as that of NAADAC, The Association for Addiction Professionals, which specifically includes sexual orientation and gender identity or expression among the areas in which addiction professionals do not discriminate. “The inclusion of sexual orientation, gender identity and expression is very significant, since as a profession we are aware of the impact that oppression can have on the mental health and well-being of individuals needing services, especially sexual minorities,” he says.

He and Sloane believe the Tennessee law, in giving counselors license to withhold treatment, will confuse counselors with respect to the existing codes under which they practice. The governor said, however, that the law merely extends to counselors and therapists the same rights that professionals such as physicians and lawyers have to refer an individual to someone else when that individual's goals conflict with a professional's sincerely held principle.

State legislators adopted the “sincerly held principle” language as an amendment to the legislation's original wording of “sincerely held religious belief.”

The Tennessean newspaper quoted State Rep. Dan Howell, sponsor of the House version of the legislation, as referring to the measure as “a good balanced bill [that] protects the client to ensure that they get assistance and protects the First Amendment right of faith-based counselors.”