The practice of psychotherapy is not for sissies. An agreement to engage in a therapeutic relationship becomes, in many instances, an invitation for one human being to accompany another into the darkest, most terrifying spaces in the cosmos: the depths of the human psyche. It's a private space, the boundary of which is held and protected by the therapist so that the patient can explore those depths as far as they choose to without harm.
That's why I find myself at odds these days with the Tennessee Legislature and with Governor Haslam, who recently signed HB1840 -- the Counseling Discrimination bill -- into law. With his refusal to veto this bill, Gov. Haslam took us outside the boundaries of reasonable rules of practice into nanny-state meddling and legalized assault against the LGBTQIA+ community.
The state of Tennessee requires that I have a license to practice therapy. To maintain that license I have to play by the rules, which include completing a minimum number of continuing education (CE) hours every year. Not that many years ago, rules for professional counselors, marriage and family therapists and pastoral counselors were amended to require that 3 clock hours of professional ethics be included in the total number of hours required in each 2-year license renewal cycle.
Ironic, isn't it. My practice board (the members of which are generally appointed by the Governor) seems to value ethics competency enough to call them out specifically in the rules. Yet the Governor and legislators in Tennessee can make a law that specifically invalidates the codes of ethics for which professionals are held accountable.
Why do we have professional practice boards? Here's what the state of Tennessee says:
The mission of each board is to safeguard the health, safety and welfare of Tennesseans by requiring those who practice health care professions within this state to be qualified.
In other words, professional rules and standards are meant to protect the citizens using professional services. So why did Gov. Haslam sign a bill that changes the rules to protect therapists, instead, thus demonizing a specific subset of citizens?
Of course, supporters still insist that the bill also protects citizens needing counseling services.
Just days before Gov. Haslam signed HB 1840 into law, NPR's Steve Inskeep talked him on Morning Edition's special broadcast from Knoxville. During the interview, Haslam posed a question that I think is crucial to the whole discussion on HB 1840:
HASLAM: So on the therapist bill - I mean, the American Counseling Association says that you should always counsel from a valueless position. In other words, you don't put your own values into the conversation. You're there to help. I personally wonder, like - I think regardless of whether you're a religious person or not, everybody comes into every conversation with a particular worldview and things that you believe are right or wrong. And so I think the question is can you counsel from a totally non-value-based position?
When I heard him say this, I actually gave Haslam a spontaneous thumbs-up. What a great question! It goes right to the heart of the whole discussion about HB 1840. How can you counsel from a totally non-value-based position?
If you are a mental health professional, you have likely (I hope!) given huge amounts of time to study, contemplate, and consult with experienced practitioners on this very question. You think about the answer from your first day of professional training until you retire from practice...and maybe even beyond that. Really, can a human being do anything from a totally non-value-based position?
My answer is, we can't.
What we can do, though, is to cultivate awareness of our own values and worldviews. We can discover from the patient what they need to make the therapeutic space safe enough for them to do their psychological work. We can learn how to respectfully explore the subjective experience of people we see, rather than make people into objects. We can stay aware of the thoughts and feelings that arise when we're with someone, and explore these in self-analysis and with peers and supervisors to identify biases and unhealed aspects of ourselves that may create barriers to healing for the patient.
A decision about whether or not we can work together is best made collaboratively by me and the person seeking help. The standards of practice in my profession have always included ways to help people find the best care possible, even if it isn't from me. Respectful referral in a way that does not harm the patient is not a big mystery to those of us who do this work. We don't need interference from politicians to get it done.
One of the best ways we, as helpers, can be professionally accountable to the public is to take full responsibility for our own psychological health and development. That includes personal work that can take us into the dark and terrifying spaces of our own psyches.
Therein lies the gift, I think, that mental health practitioners of all kinds can offer to the world. Doing such work with ourselves and others allows us to see that discovery and full integration of human experience, no matter how dark and terrifying, is possible. Such a process, for one thing, liberates us from the inevitability of projecting our own fears onto others, seeing them as real, then needing to enact hateful, discriminatory legislation to protect us from terrors we have only imagined as out there.
See these related articles:
Counseling bill detrimental to clients' health (Letitia Flores, May 2, 2016 / Knoxville News-Sentinel)
Message from ACA CEO Richard Yep Regarding Tennessee HB1840 (American Counseling Association, April 27, 2016)
TN's HB 1840 Negatively Impacts the Mental Health of LGBTQ Youth (Statement from The Trevor Project)
Bill Would Discriminate Against Vulnerable Patients (Dianne Bradley, April 5, 2016 in The Tennessean)