Counseling, by its very nature, is value-laden, and the process and results are greatly influenced by both the therapist’s and the client’s worldview. One critical question that must be asked is what to do when there appears to be a conflict of values related to the therapeutic process.
How should a treatment provider respond if a client seeks therapy because his or her behavior is incongruent with their deeply held spiritual or religious values, and those values appear to take precedent above all others? Which set of values is more valid? Should the client have the autonomy to make that decision? The ethical answer to the last question is an unequivocal “Yes!”
The Supreme Court's rare 8-1 decision on March 31 in Chiles v. Salazar regarding Colorado’s ban on conversion therapy for minors (adults are not subject to the restriction) brings this very issue to the forefront and demands that we be prepared to face this dilemma in Christian counseling. The case reached the Court after Kaley Chiles, a licensed Christian therapist, challenged the state law, arguing it placed undue restrictions on the widespread practice of “talk therapy” with her clients.
The majority opinion, authored by Justice Gorsuch, concluded that the ban, in essence, silenced diverse viewpoints and hindered access to supportive counseling, and therefore likely violated the First Amendment free speech rights for mental health practitioners. The actual efficacy or harm of conversion therapy was not addressed. Currently, 23 states and the District of Columbia have enacted similar regulatory legislation, and the ruling will almost certainly have a wider impact (triggering additional lawsuits) while setting a higher legal bar on how free speech is viewed when it also relates to professional conduct.
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Sometimes referred to as “reparative therapy,” conversion therapy pertains to a set of broad practices with a focus on changing a person’s sexual orientation or gender identity, typically from gay, lesbian, or transgender, to heterosexual or cisgender (matching one’s sex as assigned at birth). A similar approach that also addresses same sex attraction is referred to as Sexual Orientation Change Efforts (SOCE). Some of the early procedures included coercive and aversion techniques, and in fact, prompted original efforts to legislate these methods out of concern that minor clients may be harmed and need to be protected by the state. However, not all methodologies are overtly or potentially harmful, especially traditional talk therapy.
With this vitally important decision, free speech involving Judeo-Christian values won the day. Basically, the Supreme Court ruling affirmed the rights of licensed mental health practitioners to engage in voluntary, client-directed conversations about sexual orientation and gender identity, and most importantly, to protect the constitutional freedom of individuals to pursue personal and therapeutic goals that align with their religious faith and beliefs.
A time-honored and foundational principle in the treatment of mental health disorders is a client’s right to self-determination—the freedom to participate in the choice and direction of treatment and in a manner that is based on one’s personal value system. This principle is reinforced by the ethics codes of such prominent organizations as the American Psychological Association (APA), the American Counseling Association (ACA), and the American Association of Marriage and Family Therapy (AAMFT), to name a few. One of the ACA’s divisions, the Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC), developed specific spiritual competencies that should be incorporated into treatment protocols, strongly advocating for the inclusion, integration, and alignment of a client’s religious beliefs and practices.
The professional research literature and hundreds of peer-reviewed articles demonstrate positive support for the benefits of faith, spirituality, and religious values as they pertain to treatment outcomes. When a client receives care within the confines of his/her basic worldview and foundational value system—of which religious affiliation is a significant marker for most—therapeutic results are more positive.
In reality, the Colorado law also represented potential harm to minor clients because it did not allow a treating practitioner to focus on competing value systems, placing clients in an untenable double bind and leaving them with no means to process any inner conflict. If a client’s faith values are incongruent with his/her sexual orientation and/or behavior, then the client and not the state should have the right to ultimately determine which set of values is to be incorporated.
The law also created a gap for minors who have been sexually abused and, as a result, were not only experiencing the trauma of the abuse, but also wrestling with gender confusion and same sex attraction even though they had previously never identified themselves as gay or transgender. Abuse creates an increased risk for depression, substance abuse, and suicidal ideation—and minors were not permitted to talk with a trained clinician about their gender identity issues, unless it was gay affirming.
California, the first state to ban conversion therapy in 2012, has also created its own contrary rationale. For example, SB 543, signed into law in 2010, permits minors ages 12-17 to obtain counseling without parental consent. Likewise, under California law, minors are permitted to consent to treatment for sexually transmitted diseases and to seek contraceptive and abortion-related services. These are complex matters with a number of emotional, psychological, and religiously oriented dynamics in play. It seems a real stretch to argue that minor clients are able to understand the complexity of serious mental health concerns (e.g., substance abuse, child abuse, depression, anxiety and eating disorders, post-traumatic stress, etc.), as well as consent issues around treatment, but are deemed unable to understand/consent to treatment based on what their religious values and beliefs are regarding unwanted same sex attraction or sexual identity. The argument lacks integrity and sound reasoning, and seems to be based more on current cultural or political positions and policies.
Christian counselors and caregivers are uniquely positioned to demonstrate the affirmation of life, the upholding of human dignity, the competent service of professionals, and the cultivation of love and respect toward others. Herein lies not only a wonderful opportunity but also a spiritual responsibility to authentically represent Christ as His ambassadors. With the reality of an increasingly diverse society—one that includes multiple and at times, seemingly incongruent value systems—counselors must recognize how to integrate and balance both their biblical principles and the need to be culturally relevant while still adhering to the basic tenets of ethical practice.
The task—and the challenge—for the Christian counseling field as a whole is to continue to advocate for the faith-based rights of clients to receive care in a manner that respects their values. Spirituality, while intensely personal, offers the “believer” an anchor for the soul. It has a hopeful contagion effect that can motivate a client and enhance the change process in ways that are transformational because it incorporates the whole person. Faith always makes room for the impossible.
“Judge not, that ye be not judged” (Matthew 7:1) is a command against hypocritical, self-righteous condemnation rather than a prohibition against all discernment. It urges humility and self-reflection before criticizing the flaws of others. Truth... yes, but tempered by grace.
Dr. Eric Scalise is President and Chief Strategy Officer at Hope for the Heart, a worldwide biblical counseling, life coaching, and caregiving ministry founded by June Hunt in 1986 to provide biblical hope and practical help. Passionate about helping people understand and apply God's Word to their lives, the ministry provides biblical resources on more than 100 real-life issues. Hope for the Heart is making God’s truth accessible to millions seeking guidance. Learn more at HopefortheHeart.org and listen to our HopeTalks podcast.
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