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Jun 22, 2010
OMAHA, Neb. (AP) — Rules changes for Nebraska’s licensed counselors have been held up for more than a year over concerns about conflicts between religious convictions and sexual orientation.
Jim Cunningham, executive director of the Nebraska Catholic Conference, says psychologists, therapists and other licensed counselors should be able to refuse to treat or refer clients because of religious or moral convictions. But, he says, the proposed addition of sexual orientation to anti-discrimination rules makes it unclear whether that’s allowed.
“Our concern had to do with services that we would not be able to provide because they would promote or enhance or validate conduct that is contrary to our religious beliefs,” Cunningham said.
“To make a referral would be cooperation ... so that would be problematic as well.”
So, Nebraska’s top medical officer, Dr. Joann Schaefer, is pushing three state credentialing boards to allow counselors to refer patients elsewhere without concern for the controversial issue — what’s called a whole-patient referral. That would mean a counselor with a moral or religious objection would have to find a referral for the patient, although it wouldn’t have to be the most appropriate one.
“It’s what I feel is the fairest to the patient,” Schaefer said.
But Schaefer’s suggestion — a compromise she says is based on discussions with the boards and others — has drawn the ire of several professional associations. They say whole-patient referrals would violate their code of ethics.
“We believe that a therapist has the right to refuse service based upon religious or moral convictions,” said Terry Werner, director of the Nebraska chapter of the National Association of Social Workers. “However, they absolutely must provide a thorough and comprehensive referral. Anything less than that, in our minds, is in violation of our code of ethics and is not in the best interest of the client.”
Psychologist James Cole, who’s on the board of the Nebraska Psychological Association, said the referrals Schaefer is suggesting would meet the needs of the counselor, but not of the patient, who could be dumped on someone without the expertise to help with a specific problem.
Cole said the referrals wouldn’t be limited to conflicts over sexual orientation, but would also apply to things like gender identity and opposing religious beliefs.
“The whole thing opens a Pandora’s box on abuse,” he said.
Schaefer disagrees. “They can’t dump you as a patient,” she said. “They have to put you in the hands of someone that can help you.”
She offers this example: A patient seeks help for depression, then later reveals he or she is gay and wants counseling for a same-sex relationship. A counselor with a moral or religious conviction against gays or same-sex relationships could refer the patient elsewhere for treatment of depression, without having to provide a referral for the relationship counseling.
The distinction appeases the Nebraska Catholic Conference.
“For us,” Cunningham said, “it’s an issue of trying to balance and accommodate convictions of conscience with regard to services that would be contrary to the credential holder’s religious beliefs or convictions of conscience.”
The disagreement over the referrals was been going on for a couple of years. It stemmed from a review of the ethics rules for licensed counselor by three state credentialing boards — those that govern psychologists and counselors for mental health problems and drug and alcohol abuse. The boards each decided to add or amend their anti-discrimination clauses, and that’s when the Nebraska Catholic Conference filed its objection.
Schaefer said it’s not unusual for regulation changes like this to take years, even a decade.
The process is lengthy. Each time a board proposes changes, a public hearing is required. Tweaks based on that hearing require another hearing, and so on. Once the advisory boards approve the changes, the state Board of Health must approve them and send them on to Schaefer, the attorney general and the governor for approval.
The Board of Psychology has voted at least five times to reject Schaefer’s compromise language. They’ve sent their own changes — which require treatment or an appropriate referral — on to the Board of Health, which will take them up on Monday.
The other two boards haven’t decided yet how to proceed.
Chris Lewis, vice chairwoman of the Board of Alcohol and Drug Counseling, said the regulations need to be updated, but trying to appease all sides is difficult. The board will talk more at its June 24 meeting.
The Board of Mental Health Practice meets in July.
Chairman John Danforth said the state has no anti-discrimination clause whatsoever for counselors under his board’s purview, so “what’s being tossed around is what to put in where there’s nothing now.”
He said the board understands the Nebraska Catholic Conference’s concern, but the conversation is really about the standards of caring for patients.
Anne Buettner, legislative chairwoman for the Nebraska Association of Marriage and Family Therapy, agrees.
“The compromise is to appease the Catholic conference, but ethics is beyond compromise because you have to put the client’s needs first,” she said.
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