"Preserving religious freedom in the mental health profession"

[Scott Lloyd]

25 minutes ago, thesometimesaint said:

As a mental health professional it is against our Code of Ethics to refuse treatment, or force my religious beliefs, on my clients.

So your ethics, then, would forbid you from being selective about whom you would take on as a client? What about Elder Wickman's concern that LDS Family Services folks might be forbidden to require a bishop's referral before providing treatment?

 

Edited June 19, 2017 by Scott Lloyd

[Gray]

1 hour ago, Scott Lloyd said:

How nice it is to live in a locale where the above fear is unrealistic due to the broad availability and selection of health care and the extremely high likelihood of finding providers whose ethical values are consistent with one's own.

By the way, what part of the Third World do you live in?

As I said, I used the example to illustrate the principle of the importance of Healthcare providers giving evidence-based treatments.

[clarkgoble]

9 minutes ago, thesometimesaint said:

As a mental health professional it is against our Code of Ethics to refuse treatment, or force my religious beliefs, on my clients.

I don't think "force" is really what's at question. Rather "offer." Again, I think the problem some have is that while this is stated as the ideal, it's almost always enacted in a double standard way in which liberal consensus is the de facto view.

[clarkgoble]

3 minutes ago, Gray said:

As I said, I used the example to illustrate the principle of the importance of Healthcare providers giving evidence-based treatments.

That is ideal. Although given the lack of strong evidence for treatment in the details by therapy that might make things problematic. There's simply not a ton of evidence for most things. And what evidence there is often is ambiguous - often not replicated and with insufficient variables tested and small sample sizes. I mean even in medicine proper they're still struggling to become evidence based. Therapy is whole levels of magnitude beyond that.

[BlueDreams]

9 hours ago, Scott Lloyd said:

I wish to highlight my report of this important address given last week by Elder Lance B. Wickman, the Church's general legal counsel and an emeritus General Authority Seventy. He spoke to a seminar involving workers in LDS Family Services gathered in Salt Lake City from several nations.

While there has been much said by Church leaders about current threats to religious freedom lately, this is the first discourse I've heard specifically pertaining to such threats in the field of mental health.

Two days earlier, Elder Holland spoke to the same group and commended them for their empathy in serving the needs of the "poor in spirit" and "lifting up the hands that hang down and strengthening the feeble knees." If that is true, it would be tragic indeed to curtail the effectiveness of those in the mental health profession by too much genuflecting to political correctness and special interest groups.

Here are some noteworthy excerpts from my report:

Interesting. I'm not sure how I feel about it, as a mental health professional, myself. It's a fine line. And in the mental health profession we definitely ride that line, I think. 

Currently in the mental health field there's a number of conflicting concepts in ethical treatment that can tie to this: The rule that you cannot simply deny service based off of religion, race, sexual orientation, etc. Mixed in with the general rule to do no harm. Mixed in with the ethos that if one does discontinue services that we give options for other forms of therapy or therapists to seek out. Because we're dealing with the mind, relationships, and personhood as opposed to the more physiological aspects of humanity, the balance can be far more sticky to get just right. 

Here's an example from my own boat. As a LDS sex therapist with an MFT degree, I can and will and have seen LGBT clientele. And will in the future.  But my clientele and current specialty focuses on religious heterosexual couples 9.9 times out of 10. It is what it is. I came to realize in my sexuality course, reading specific articles about sexual concerns for LGBT people that I would likely be a crappy therapist to go to for sexual concerns for LGB(and probably T, I just haven't had one yet)....because my knowledge in terms of sex therapy in this area is really really scant. So I would not feel comfortable helping a Same-sex couple with their sexual problems....not based on my own religious beliefs, but because I would feel really unqualified and would not be the best therapist to properly help them. Any other issue in this same area and I would be fine: helping with relational problems,  figuring out how or even if they want to express their sexuality in whatever way, weighing their varying identities to find a balance they feel at peace with...sure. No problem. But that one specific issue, not so much. So I would likely refer out. The next problem with that is, is there a therapist period that can be helpful and qualified in the region for them? Probably. But in some areas where there are very few options in mental health professionals, leaving them without help from you can be leaving them with subpar help or no help period. Which is worse. That changes the ball game, and I would need to take them with clear understanding as to my limitations as a therapist. 

I watched in smaller groups while at BYU, therapists wrestle with doing therapy for LGB couples (again, MFT....which means most of us are dealing with relationships/systems...ergo couples). I can understand some of their reticence. Luckily I assume many LGBT people also self-select therapists to meet up with their concerns. At first when I started self-selection by clientele would really really bother me. I would get a few who would assume my own behaviors and responses to situations based on one specific fact: I was LDS. They would asked just how LDS I was, some would have to convince their partner that I would be okay as a therapist, and others would want to make sure that religion would stay out of therapy.  Some of the most adamant have been people who are leaving/left the church. But at the same time I'm sure there are LDS who do similarly. Preferring therapists that "get them" or that seem more likely to promote similar standards. I think having the flexibility to pick and choose therapists on these bases makes sense. As is catering to specific demographics as a specialty (minorities, religious peoples, LGBT, etc) BUT on the therapists end there has to be at least some flexibility to meet with groups we may struggle with or not fully comprehend their issues. There's simply not a perfect therapist out there for every person and demographic niche.

The other issue is that to some extent I need to suspend my own personal preferences and beliefs. Not entirely, but enough that I'm not pushing my beliefs and attitudes onto my clients unnecessarily. Let's take abortion for a minute. When that comes up as an issue they're really really thinking about, I don't find it right for me to say: hey, you, don't do that! life is sacred!...though I do believe life is sacred, I would personally never get an abortion beyond really important medical reasons, etc. I don't label myself as pro-choice or pro-life, but I'm not a fan of elective abortions that are really about stupid choices more so than medical necessity, tight and difficult circumstances, or rape. But I can't just bring that up. I can explore their choice with them and I would think it would be also ethically unsound to let them go through it, without exploring, if they hold their own strong religious beliefs about abortion that may lead to later shame or grief for what they chose down the road. I will usually state that I have a bias, but that's just me and not this person currently thinking about it. 

I think both camps can be limiting in their scope of practice based on their beliefs and practices. I saw that once with an interview with LDSFS that I will not go in detail with here because I don't think it's necessary. And that therapists on the more secular end of things can end up isolating more religious clientele without meaning to. Both, I think they are two sides of the same coin: assuming they know the right way to do things and what should be, when they may not and may be inadvertently limiting their scope of treatment for specific demographics by assuming a blanket answer for all peoples. 

In the secular world, I remember the first time I went to this conference in AAMFT that had a presentation on spirituality in therapy. It was terrible. They were trying to incorporate spiritual concepts in an amorphous way that wasn't tied to any religion but could somehow apply to all. It felt like they just ended up taking the teeth out of religion as healing agents in people's lives. And were weary of talking about spirituality in their own constructed terms. In that sense I think the therapy world is still grappling with how to deal with people in people's terms, not just the secular formatting. And I do think that formatting can be limiting because it ignores large influences in people's life...or just acts really awkwardly with them. Whether one thinks things shouldn't entail religion, such as mental health, doesn't change the fact that many many people particularly in the US definitely do not separate the two. Done right, religion can be a powerful ally in the therapy world. Which I think LDSFS is one example of trying to broker it. I do think that shutting said things down would be a stupid move. I don't know how likely that is to actually happen currently, though.  

 

I do hope that we can maintain more flexibility in the Mental health field. Because it's needed. This isn't the same thing as the medical field, though there are definite efforts to make it as such. I think treating humans as a line of symptoms and clinical fixes is at some point bound to flop and make mental health fields less effective. But it is the push that I see happening at times in the Mental health field, insurance agencies, etc. I do agree that there needs to be protections to allow for more plurality in practices and ideologies. The more therapist feel like the humans they treat and are the greater the capacity for healing. 

 

With luv,

BD

[thesometimesaint]

22 minutes ago, Scott Lloyd said:

So your ethics, then, would forbid you from being selective about whom you would take on as a client? What about Elder Wickman's concern that LDS Family Services folks might be forbidden to require a bishop's referral before providing treatment?

 

LDS Social Services does not refuse to take on clients based on religion.

[Danzo]

29 minutes ago, Gray said:

I'm afraid I don't understand what you're trying to say here.

In order to sound more credible, you would need to show that you have a religious view, that some might view as quackery. 

Try not to  use a ridiculous straw man that believes something you don't believe.  Try grappling with issues that people on this board (A Mormon Discussion Board, not a JW Board) would take seriously.

There are many, but blood transfusions are not one of them.

[clarkgoble]

A legitimate worry many members have is that more secular therapists won't even be able to understand their concerns due to ignorance of their religious beliefs. The amount of ignorance of religion by many well educated people is staggering. That's a big change from decades ago.

Edited June 19, 2017 by clarkgoble

[thesometimesaint]

DB:

Thank You.

[pogi]

3 hours ago, Gray said:

As long as the treatments offered are based on valid clinical research, I'm fine with whatever is offered. Faith-based treatments should be squarely outside of any licensed clinical or hospital setting, when it comes to health practitioners acting in that role.

What about the licensed practice of holistic medicine?

Edited June 19, 2017 by pogi

[USU78]

4 minutes ago, pogi said:

What about the licensed practice of holistic medicine?

There are a lot of chronic issues that Western medicine is ill-equipped to handle

[Scott Lloyd]

54 minutes ago, thesometimesaint said:

LDS Social Services does not refuse to take on clients based on religion.

As I understand it, they require a bishop's referral. Perhaps I'm wrong.

[Scott Lloyd]

1 hour ago, Gray said:

As I said, I used the example to illustrate the principle of the importance of Healthcare providers giving evidence-based treatments.

I don't see Elder Wickman as quarreling with that in his speech.

As I have thrice quoted him now:

Quote

“Government has a valid interest in reasonable regulations that protect patients from harm, but harm does not mean any therapy that contradicts secular ideologies about gender and sexuality,” Elder Wickman said.

Secular ideological or political arguments about gender and sexuality have little-to-nothing to do with "evidence-based treatments."

[Gray]

6 hours ago, Scott Lloyd said:

 

How about you deal with the real issues and examples in the speech I reported on instead of dreaming up extreme hypotheticals of your own?

Do you approve of the eminently qualified physician being fired from his position because someone posted a YouTube video of him giving a sermon in his role as a Seventh Day Adventist lay preacher championing traditional morality?

 

Based on the information provided, I would disapprove.

 

6 hours ago, Scott Lloyd said:

Do you approve of Catholics being forced to provide abortions or contraception services in contravention of their own religious convictions?

 

Yes, 100%

 

6 hours ago, Scott Lloyd said:

Do you approve of Catholic foster care and adoption agencies being forced to place children in situations that conflict with Catholic religious convictions?

 

Only if they take Federal funding.

 

 

6 hours ago, Scott Lloyd said:

Do you approve of forbidding mental health care providers from being selective in whom they will serve as clients (which could mean that LDS Family Services could no longer require a bishop's referral before providing services)?

 

Only if they take federal funding.

 

6 hours ago, Scott Lloyd said:

Do you approve of barring people of faith from entering mental health care professions?

Absolutely not.

 

[Gray]

6 hours ago, Scott Lloyd said:

 

From my news story:

 

It sounds like he might be obliquely referring to conversion therapy. If so, that's quackery and harmful, and should be banned under any circumstances.

But my response would really depend on what he has in mind, which is not made explicit in the piece you're quoting.

Edited June 20, 2017 by Gray

[Gray]

6 hours ago, Calm said:

The subject originally is mental health.  I have had friends in psychology programs be told they will not be accepted because they are religious and religion should have no part in therapy.  The view of these advisers is secular practitioners can effectively deal with those clients with religious beliefs, but religious practitioners will not be able to distance themselves enough and instead allow their personal views to interfere.

If someone wants to discuss their perspectives of the world from a faith based approach, why should they not be able to find a qualified therapist who is also religious and hopefully close in belief so communication and understanding comes easily?

Hmm, a question worth considering.

[bluebell]

4 hours ago, USU78 said:

There are a lot of chronic issues that Western medicine is ill-equipped to handle

It's true.  At this point, western medicine (and maybe other kinds to, i have no idea) is all about managing symptoms.  It cures very very very little of what befalls us.

[Gray]

6 hours ago, clarkgoble said:

If I understand the worries there are two.

First people who, to use your analogy, behave objectively untied to their religion in their practice but express personal positions they don't push on people in their practice. That appears to be the concern of the Seventh Day Adventist who was fired for preaching fairly mainstream sexual norms in church.

Second people who would be forthright about the approach they take to social work, are upfront about it, but are forced out because the perception is there's only a one size fits all legitimate approach to social work - a kind of secularism. To give an example it's hard to imagine a therapist getting in trouble for telling someone they should relax about premarital sex. But that's as much as position as the idea it's wrong. I think that particularly religions would like to offer therapists who accept the tenants of the religion and work accordingly. Whereas more or less there's a view that only the mainstream secular view and its changing values are legitimate.

I think the ideal case is that the therapist uses evidence instead of ideology when discussing what might cause harm, but still respect the world view of the patient and offer help that falls within the framework of the person's religious beliefs. Any therapist SHOULD be able to do that.

Taking an example again from non-behavioral medicine, a doctor would be remiss in telling her patients that green tea is somehow harmful - there is no evidence to support it. However, she could work with her LDS patients who didn't want to take some kind of supplement that had green tea in it, and find alternatives for them.

[Gray]

6 hours ago, clarkgoble said:

That is ideal. Although given the lack of strong evidence for treatment in the details by therapy that might make things problematic. There's simply not a ton of evidence for most things. And what evidence there is often is ambiguous - often not replicated and with insufficient variables tested and small sample sizes. I mean even in medicine proper they're still struggling to become evidence based. Therapy is whole levels of magnitude beyond that.

I can't argue with that, although I'd say some evidence trumps no evidence.

[Gray]

5 hours ago, Danzo said:

In order to sound more credible, you would need to show that you have a religious view, that some might view as quackery. 

 

I'm not sure why I would need to do that. It sounds like a game of ideological chicken? My religious views are entirely in harmony with scientific consensus, so I'm afraid I can't offer any support for quackery.

I do hold religious views that are often scorned by those of a more traditional religious bent, but those views don't intersect with medicine or science.

 

5 hours ago, Danzo said:

Try not to  use a ridiculous straw man that believes something you don't believe.  Try grappling with issues that people on this board (A Mormon Discussion Board, not a JW Board) would take seriously.

There are many, but blood transfusions are not one of them.

I didn't offer up any strawman arguments. I offered a story to illustrate a principle - that is, that health professionals should be ready to provide essential services without regard to their own feelings.

If you want an LDS example, there could be many, depending on the LDS person. Medical marijuana and certain kinds of fertility treatments could be issues.

 

 

[Gray]

5 hours ago, pogi said:

What about the licensed practice of holistic medicine?

It should, in my view, be banned.

[USU78]

21 minutes ago, bluebell said:

It's true.  At this point, western medicine (and maybe other kinds to, i have no idea) is all about managing symptoms.  It cures very very very little of what befalls us.

Example: if one contracts Lyme, but isn't diagnosed and treated quickly, it turns chronic. The CDC, however, doesn't recognize the research on what chronic Lyme does, and won't even recognize it as a disease requiring insurers to cover it.

There's pending litigation to compel the CDC to do the right thing.

[MormonVideoGame]

12 hours ago, Calm said:

But there are people who would prefer doctors who will not use blood transfusions because it aligns with their own faith and they do not want to be forced into receiving treatment they don't want if by chance they become unable to direct their own treatment.

As long as a certain standard of skill is obtained and doctors are open with their patients up front, why not allow the client/patient to have a choice?

They do, in the US the law even allows parents to refuse blood transfusion for their children during life or death situations, I guess religious freedom is more important. 

7 hours ago, BlueDreams said:

Interesting. I'm not sure how I feel about it, as a mental health professional, myself.

You have an MD? a PhD in Psychology? AASECT certified? 

1 hour ago, Gray said:

I think the ideal case is that the therapist uses evidence instead of ideology when discussing what might cause harm, but still respect the world view of the patient and offer help that falls within the framework of the person's religious beliefs. Any therapist SHOULD be able to do that.

Respect the worldview of the patient as long as his/her worldview isn't the problem. 
Patients need to be careful too with the therapists because "therapist" Title is not protected like MD, PhD are. 

[clarkgoble]

2 hours ago, Gray said:

I can't argue with that, although I'd say some evidence trumps no evidence.

Depends on the nature of the evidence. Really weak evidence is ambiguous enough that I think you just have to say you don't know. i.e. treat it as non-evidence. Typically initial studies are wrong, but tell you where to direct further research.

[clarkgoble]

2 hours ago, USU78 said:

Example: if one contracts Lyme, but isn't diagnosed and treated quickly, it turns chronic. The CDC, however, doesn't recognize the research on what chronic Lyme does, and won't even recognize it as a disease requiring insurers to cover it.

There's pending litigation to compel the CDC to do the right thing.

Part of the problem is the way they consider diseases. Lyme disease is the disease from a particular bacteria. The problem is that a tick bite might give many different bacteria. The way disease investigation is set up is to reduce things as much as possible. Our approach to medicine really, really doesn't deal well with complex diseases with multiple causes. There's a lot more to study, but I suspect part of what is going on is chronic lyme disease being due to multiple causes with a lot of diversity in the cases ranging from parasites, bacteria and possibly even viruses.