NALGAP leaders say Tenn. counselor law will seriously harm LGBT patients | Addiction Professional Magazine Skip to content Skip to navigation

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

May 6, 2016
by Gary A. Enos, Editor
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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.”



The most important case concerning this issue was Ward v. Wilbanks which involved a counselor at Eastern Michgan University who was dismissed from the University's counseling program for refusing to accept as her client a person in a same sex relationship. The University believed this was a violation of the ethics code of the counseling profession. The counselor filed a lawsuit and after the initial court's decision in favor of the University and a reversal by the Sixth Circuit Court the University settled rather than appeal to the U.S. Supreme Court.

The American Counseling Association's case for defending its code of conduct is powerfully presented in:

Ethical Implications of a Critical Legal

Case for the Counseling

Profession:Ward v. Wilbanks

David M. Kaplan
This article presents the official position of the American Counseling Association on a seminal legal case for professional counseling: Ward v. Wilbanks.
The focus is on three key questions: Is it permissible to deny counseling services
  to a homosexual client on the basis of a counselor’s values? Can referrals be made at      any time a counselor wishes to do so? When is a client a client?

As a Tennessee Licensed Marital Therapist, and an Ordained Baptist minister, I have been accepting LGBT patients since 1983, prior to licensure legislation in Tennessee. Although I may not completely understand personally the personal choices and world view any patient may hold, I feel it is a professional responsibility of any Licensed therapist to accept patients, clientele, or families regardless of their world view, as long as the therapist-patient relationship is mutually respectful of one another. The only right any person carries is to "care" about any person's pain or health. We have no right as a therapist to impose our standards on another, as in rejecting the services to the LGBT client by a licensed healthcare professional is just that very thing-basically imposing inductively our world view on another, which is unethical. Therefore, I believe it is unethical for the ACA and the legislation of my home state to support the inductive world view of the therapist on a patient, client, or a family. For example, divorce in many faiths and a held belief of some individuals is considered Biblically anathema; thus , ought a Licensed Marital and Family Therapist refuse to treat a divorced person? The Legislator who proposed this legislation represents the locale of my clinical office in Tennessee. While he may represent the thinking of many of his constituents, for the largess of his constituents don't carry a License of the Healing Arts. I consider the legislation to violate the professionally responsible ethics of any practitioner.

Ridiculous and unconcerned about the well-being of the client (at the very least)!

Political correctness aside, if one party in the counseling relationship is uncomfortable (fo Any reason) with the other party then the counseling process will go nowhere, fast! This legislation is not interested in improving or benefitting people, it's nothing more than taking more rights and shoving chaos down our throats.

There is absolutely nothing wrong with making a simple referral to an appropriate counselor to help a client get REAL help while also protecting the rights of a counselor. That would be a win-win arrangement, not this over-reaching, political correctness, order out of chaos nonsense!

Also, i personally have a gay sibling, a gay ex-wife (mother of my daughter), and my organization works with the gay community every day... so, please, save the aggressive responses and angry "homo-phobic" comments. It's called common sense! If we truly care about iur patients then we will refer them to the appropriate health professionals. We don't send addicts to the see the plumber and we won't put a patient with a counselor that doesn't fit. Real professionals do everything they can to insure our patients have the BEST care, not resentful or uncomfortable care!

We can NOT legislate ourselves into a perfect world and they will not improve care for ANYONE by forcing professionals to see everyone.

In America, we respect other's beliefs even if we disagree with them. Remember, that's what made America the greatest country on earth. You have the right to do your thing while others have the right to do their thing. Forcing a counselor to meet with someone they aren't comfortable with is an infringement on the patient's right to best possible care.


I am keen to learn if "case studies" are helpful to counselors who have
LGBTQ clients.

Two questions:
1) Are these generally available elsewhere?
2) How problematic is the disciplinary approach in a case study? If a social worker describes
his/her intervention, will that be useful for a psychologist or counselor?


Bill Cohen, Publisher & Editor-in-Chief
Harrington Park Press