ACU Student Weighs in on Treating GLBT Clients

6 Commentsby   |  09.27.10  |  Uncategorized

In two recent highly publicized cases, one at Augusta State University in Georgia and the other at Eastern Michigan University, judges ruled in favor of both universities after they dismissed graduate students in their counseling programs who refused to treat homosexual clients. In a recent newsletter, AAMFT summarized the cases and encouraged members to engage in dialogue around this issue. One of our current 2nd year students, Scott Rampy, offered his perspective on this ethical dilemma on AAMFT’s Community Forum. Here’s what he had to say:

To the readers of this forum, I would like to contribute to this conversation as one from a potentially uncommon vantage point. I am a Christian, have an undergraduate degree in youth ministry, am planning a career with dual focus in congregational ministry and MFT, and am a master’s level MFT student at a Christian university. I would like to respond both in terms of my ever-evolving personal theory of practice regarding this issue as well as in terms of the broader realm of practice in our field.

As students training for a profession in which empathy for the other is the highest ideal, this highly charged debate offers an excellent opportunity for us to demonstrate the fruit of our training and our merit as future professionals. It is undeniable that the issue of sexual orientation is a polarizing one in our society. Well intentioned and highly intelligent people come to diverse conclusions on this issue. National and state governments and courts are engaged in a seemingly never-ending struggle to resolve the issue for themselves – and come to differing conclusions. Even within individuals, as Ms. Walker noted herself, the issue raises conflicting questions. Therefore, rather than joining with the polarized rabble, let us have empathy for the diversity of opinions honestly achieved.

My personal theory of practice with LGBTQ clients is no different than for heterosexual clients – the goal is for peace to be present in their lives. My personal belief is that all humans have an obligation towards sexual morality; that is, sexuality expressed within monogamous heterosexual relationships. However, when it comes to practice with clients of an alternative perspective, my goal remains to find how I can allow myself to be used by them to achieve whatever level of peace (shalom) they are seeking in their lives.

In regard to the broader issues broached by these court decisions, I am surprised by the intolerance for the personal beliefs of both clients and therapists alike. My understanding of the LGBTQ community is that a major tenet is honoring diversity of personal belief. This leads me to surprise at the intolerance for the personal beliefs of these two student therapists. It is unfortunately true that Christians are often guilty of this same kind of intolerance for diversity of belief. However, nothing is gained when either group lowers its own practice to the failings of its detractors. If tolerance of the other is a goal, one must be the first to model it towards the other.

Second, in regard to the decisions of the judges in these students’ cases, one’s personal beliefs are not abstract ideals limited to the realm of theoretical thought. What one believes has direct bearing on how one lives. To offer an overly simple example, if one believes the temperature will be below zero and one values warmth, one does not wear flip-flops and shorts. Belief determines action. If not, it is entirely reasonable to question whether it is a belief honestly held. Contrary to the opinions of the judges in their rulings, I submit that to separate belief from action is in fact to deny one their belief. Though it may not have been stated by their university that the students had to give up their personal beliefs, forcing action contrary to beliefs is to force the relinquishment of belief. Specifically, if the students believed they would be living immorally if encouraging the union of homosexual clients, how do they hold onto this belief and practice counter to it as suggested? A good contribution to this discussion would be for someone to operationalize what this proposed separation of belief and action looks like while upholding one’s personal beliefs.

Third, on a similar tone, is it possible to practice therapy devoid of one’s own worldview? How does one leave at the door all the ways they have been shaped by culture, experience, family of origin, education, race, gender, ethnicity, sexual orientation, religion, etc? What is left to bring into the room? These all contribute to the way we relate with our clients, from the way we think, to the questions we ask, to the emotions we feel when we are with them. Doubtless many of us appreciate the contributions of seminal influences in our field – Minuchin, Haley, and Beck to name three. Yet for each of their models of therapy (Structural, Strategic, and CBT respectively), it is the therapist who makes a determination of functional and dysfunctional family structures, hands down paradoxical interventions to facilitate change from dysfunctional to functional behavior, or challenges cognitive distortions, automatic thoughts, beliefs, attitudes, expectations, and assumptions. In systems such as these, it is impossible for the therapist to fulfill their role devoid of their own worldview.

In regard to our own code of ethics, we can also appreciate the ambiguity present and the possible differences in decisions, such as were enacted by the students under discussion. Specifically, compare 1.1 with 1.10, 1.11, and 3.4 (provided below).

1.1  Marriage and family therapists provide professional assistance to persons without discrimination on the basis of race, age, ethnicity, socioeconomic status, disability, gender, health status, religion, national origin, or sexual orientation.

1.10 Marriage and family therapists assist persons in obtaining other therapeutic services if the                        therapist is unable or unwilling, for appropriate reasons, to provide professional help.

1.11 Marriage and family therapists do not abandon or neglect clients in treatment without making reasonable arrangements for the continuation of such treatment.

3.4 Marriage and family therapists do not provide services that create a conflict of interest that may impair work performance or clinical judgment.

Article 1.1 specifically mentions sexual orientation as a category for non-discrimination. However, in 1.10, if personal values are not appropriate grounds for inability or unwillingness, it needs to be made clear what do in fact qualify as appropriate reasons. In 3.4, the students experienced a conflict of interest with their professional role and their personal beliefs. 3.4 mandates that they not provide services that impair their own performance or clinical judgment, while 1.10 and 1.11 mandate that they do provide their clients with alternative opportunities for care. While it is very likely that some readers may still disagree with the conclusions reached by the students, surely it is understandable how they could have made their decision believing that they were operating within the AAMFT Code of Ethics.

We have before us an opportunity for empathy in the face of a situation which commonly results in polarization, a true test of our mettle as persons and professionals who value deep understanding of the decisions of others. Empathy in a situation such as this will allow those on both sides of the issue to acknowledge the complexities of the issue and promote conversation that builds toward agreement rather than separates towards opposition. It is with such a positive tone, which I appreciate and respect, that Ms. Walker opened this discussion. Is there room for the same valuing of the differing opinions among our colleagues to allow for the differing decisions of practice as exhibited by the two students under consideration?


  1. Jason Martin
    8:52 pm, 09.27.10

    That was such a measured and genuinely appropriate response about the nature of the discussion. I especially appreciate how he framed the discussion for what it is. This is not a case about whether or not homosexuality is right or wrong. And that is not the topic appropriate to this context. Rather, this case and this discussion are about a therapist’s right and ability to determine his or her own scope of practice. It is also about a University’s right and ability to determine that scope of practice for its students. (You could substitute another issue for sexual orientation and have the same debate.) These are the questions that should be debated, and I think the author did a very good job of keeping the discussion limited to those topics at hand. Many other conversations have not been as focused and measured. Nice job!

    About my response specifically, my first instinct was to think the Universities wrong for dismissing these students and the courts wrong for allowing them to do so. However, it occurs to me that a Univeristy has a responsibility to train it’s students in a way that is in line with its values as an institution. (ACU certainly strives to do that.) If the values of these Universities were not honored by the students choosing to study there, perhaps the Universities have the right to dismiss them. I haven’t fully played around with that idea in my head yet, so I haven’t truly put it through its paces. But it is an alternative I hadn’t initially thought about.

  2. David Todd Harmon
    9:32 pm, 09.27.10


    This is definitely a conversation that Christian therapists need to be having and I appreciate your willingness to speak to it. Below are my thoughts in regards to your response.

    On your first point, you take a subtle jab at the LGBTQ community by accusing them of being intolerant; however, your post makes no mention of anyone of a homosexual orientation, only to the faculty and judges who played a part in kicking two students out of their programs. I’m not sure we can blame that on the LGBTQ community.

    In your second and third points you discuss therapists’ personal beliefs and worldviews. And to be honest, this sounds like it has to do more with self of the therapist issues rather than the impact on treatment. You do not seem to be questioning the effectiveness or consequences of the therapy that would be provided to a homosexual client, but the potential consequences the therapist would face by ‘encouraging the union of homosexual clients.’

    Which speaks to your point about the code of ethics. If you look at the intent of the code, it is for client protection, especially chapter 1. In each of the sub articles you posted, client protection is the point. And this discrepancy may not mean much in a graduate school or urban setting where therapists are easy to come by. But for someone living somewhere like my hometown, a therapist’s decision not to see homosexual clients may be the difference between them receiving treatment and them not. And what better place to deal with this than in graduate school, where one is forming their theoretical and personal grounding as a therapist while surrounded by significant supervision and camaraderie?

    3.3 Marriage and family therapists seek appropriate professional assistance for their personal problems or conflicts that may impair work performance or clinical judgment.

    Thanks again Scott. I hope this post challenges you as your post has challenged me.

    David Todd Harmon
    Class of ‘07

  3. Jonathan Davis (ACU MFT '97)
    10:24 pm, 09.27.10

    It does warm my heart to see this discussion, because so often Christian institutions take a stance of intentional ambiguity. That say-nothing stance basically allows broader culture (religious and secular) to shape the actions of the institution, rather than promoting an open discussion leading to useful conflict.

    My comments are really questions to evoke the meaning of Scott’s comments. He says “My personal belief is that all humans have an obligation towards …sexuality expressed within monogamous heterosexual relationships.” So, how does Scott express his belief in his therapy with a homosexual couple? What action is attached to his belief?

    This is not a question we can ignore. As Scott says, “Belief determines action. If not, it is entirely reasonable to question whether it is a belief honestly held.” One of his main points seems to be that a therapist’s belief cannot be separated from the practice of therapy (though that separation apparently is precisely what both university counseling faculties apparently asked the dismissed students to do).

    So, then, if we cannot separate our actions from our beliefs, what can we actually do?

    Is it best to say “You know, I think your behavior is morally wrong, and your core sexual identity is, too?” and provide informed consent so that the gay clients and Scott are no further exposed to this dilemma?

    Is it best to not say anything, and hope that the belief can be hidden without being harmful (not too empowering for either therapist or client, and potentially harmful)?

    Or, something else?

    Personally, I don’t believe this tension will be resolved other than by legal cases, just as other issues that become civil rights also required legislation to become mainstream.

    Let’s see if I’m wrong. Perhaps the ACU MFT faculty will “come out” with a clear statement about how to work with a gay couple ethically. That would be extremely interesting to me, and to AAMFT, I suspect. But, I suspect it is impossible politically to make such a statement without alienating either Christians or AAMFT. Any takers?

  4. Michelle Finley
    5:54 pm, 09.28.10

    Hi! I’ve read the post as well as the comments posted thus far, and I have to say I agree with David Todd Harmon’s and Jonathan Davis’ perspectives.

    Like David Todd, my understanding of the code of ethics was that it is intended to protect clients. I was disheartened by the lack of consideration for “self-of-the-therapist” issues that are intricately linked to where a therapist finds him or herself on the issue of treating LGBTQ clients. This issue is not just about LGBTQ clients. It’s just as much about therapists.

    Reflecting on my own experiences as a lesbian and as a therapist who has seen many LGBTQ clients, I can attest that a salient presenting problem is dealing with the repercussions of rejection from family and friends during any stage of coming out and forming one’s identity. This same process is perpetuated at the therapy level under the guise that some MFTs are adhering to their personal/religious integrity. As MFTs we should be aware of the isomorphic nature of how we respond to many LGBTQ clients who already face negative effects for being open with their sexual orientation (e.g., cut off from family, denied jobs, denied marriage rights and adoption rights in many states, etc.). An important question might be: How can we, as therapists, be of greater help to LGBTQ clients in light of common struggles of rejection, censorship, and pressures to repair their orientation (i.e., conversion therapy)? Somehow I do not think continually referring these clients out will be a sustainable answer to this question.

    We need more awareness and understanding of LGBTQ persons, common problems, and best practice.

    There are so many issues out there that could potentially prevent any of us from moving forward in our capacity to have empathy and skills to help people heal. My view is that therapists ought to continually look to themselves, first, to determine how they can grow to be better people and better therapists for anyone–not just people who have issues that make us feel more comfortable or that seem a little more “normal” to our own experiences.

  5. Melissa White
    9:21 am, 10.04.10

    What a well-worded discussion! As I read everyone’s comments, I find myself thinking several different things… How would one’s belief that homosexuality is wrong impact therapy? Does the therapist have a burden to be honest with the client about that viewpoint? Is there a way that a therapist with this viewpoint can still be helpful to the gay client?

    I agree with Jason; these questions could be asked about many different situations, not just homosexuality. It would seem to me that a therapist can continue to be helpful in spite of his/her viewpoints on such matters. After all, the things that bring most people into therapy are things that we all can relate to in some way. If we are focusing on peace, as Scott said, or on coping with emotions, or on making relationships healthier, is not the gay person much the same as anyone else? I realize that there are unique issues, but I believe they are exceeded by the core issues of wanting love and respect, fear of rejection, etc., which are issues that I would hope all therapists would want to help treat.

    As for whether or not therapists must treat clients that live in contradiction with the therapists’ values, that’s hard to say. Would we refer clients out if we knew they were having premarital sex? If they were trying to navigate a divorce? Should we be allowed to do so? If we did, how many clients would we have left? :)

    For me, the end result is that therapists are charged with helping people live life in a way that works better for them, not for everyone else. We each have to assess our own abilities to do this, with the knowledge that our assessments may have emotional consequences for our clients.

    • Jim Walker, MFT
      2:05 pm, 12.22.10

      I’m an MFT therapist who’s been licensed for about 9 years practicing in the SF Bay Area. I’m also a member of California Therapists for Marriage (and Family) Equality, CTME, and Gaylesta I’m also an out gay therapist. I explain this on my web site.

      For the last two years I’ve struggled with heterosexism in policies and practices among certain MFT organizations and MFTs. As a member of CTME I battled with CAMFT, the largest organization of MFTs in the U.S. We asked their leadership to follow in the footsteps of other professional psychological organizations such as the American Psychological Association, the National Assoc. of Social Workers or AAMFT and support same-sex marriages and their families through making a public statement of support for marriage and family equality. Heterosexism in CAMFT had to be confronted again and again before CAMFT adopted a policy of support for marriage and family equality similar to their sister organizations (yet years after the other organizations).

      Which leads me to wonder if there is more homophobia among certain MFT leaders across this country, or less interest in inclusion and social justice, or what? What motivates an organization like the American Psychological Association to be proactive and to have a department of LGBT affairs as part of its organizational structure, and what motivates an leaders in an organization like CAMFT to resist for so long to support mental health policy making that supports the well-being and ethical treatment of LGBTQQ people? How many people need to suffer from the failures and harms of SOCE (Sexual Orientation Change Efforts) or suffer from unethical gender variance treatment mistakes before transphobia and homophobia are seen for what they are?

      Many other forms of discrimination still continue in this country too, but how often are they supported by organized religion, a large organization such as CAMFT or organizations of psychologists such as NARTH?

      There is work being done reduce the discrimination. Oranizations like Soulforce, The Center for Lesbian and Gay Studies and other organizations are doing good work with conservative faith communities and institutions. I recommend a book on LGBT pastoral care published by CLGS called “Ministry Among God’s Queer Folk.” However, more needs to be done for more culturally competent training of marriage and family therapists in this nation. There needs to be more LGBTQ affirmative psychotherapy trainings such as provided by GLAP in New York City and LAGPA, the Lesbian and Gay Psychotherapy Association of Southern California

      As a therapist, I check with my patients as we work to make sure that what we’re doing is helping them, and I ask them how they know that what they feel is helpful really feels helpful. I follow the ethics of my profession and I’m guided by the principle of nonviolence in therapy. I help the people I work with find wholeness from within, and not make themselves conform to some limiting beliefs coming from without. It gets complicated at times so it’s important for us to discuss these issues.

      Thank you for letting me participate in this discussion with you about such important topics. I’m very grateful, and I look forward to hearing more.

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