Free speech v. patient care

While reading the article "Free speech v. patient care" in the July/August Monitor, I found myself unexpectedly sympathetic to the student who refused to address, with her practicum patient, issues that she knew violated her deeply held religious convictions. I say unexpectedly because I am personally 100 percent in favor of LGBT rights and support the training of students in diversity awareness.

One of the ethical guidelines that is important, but is not acknowledged in the article, is the importance of the therapist knowing his or her own limitations, and not agreeing to work in an area that is beyond her area of competence or effectiveness. It seems to me that there is a difference between learning about diversity and how to work with people different from oneself, and working with a troubled person struggling to get clarity in an area that the therapist/student has strong biases and discomfort. I think it was appropriate that the student refused to work with a gay person around issues with which she knew she held strong prejudicial beliefs. Her training would not likely dislodge her strong religious beliefs. It is good, it seems to me, to protect the vulnerable patient from her input in these areas. Perhaps the settlement reflects that position, though the article didn't emphasize it.

Carole Light, PhD
Scaly Mountain, N.C.

In response to the article "Free speech v. patient care," I agree that students should be taught how to handle cases in which the client's goals conflict with the therapist's strongly held values, religious or otherwise. However, if the conflict cannot be resolved, the student has an ethical obligation not to treat. This is not an "unwillingness to attain required competencies" to treat all kinds of clients, but is rather a moral imperative on the part of the student. Diversity training should not attempt to create value-neutral therapists.

The illustrations in the article are all examples in which the student holds conservative religious beliefs, e.g. that homosexuality is wrong. However, what if the reverse is the case and the client is conservative? Consider the couple who insist on couples counseling to establish a patriarchal family, or the man who wants to feel less anxious about cheating on his wife, or the wife whose unalterable goal is to be more accepting of her husband's emotional abuse, or the man who wants only to decrease his homosexual urges, or the client whose sole goal is to feel less guilty about manipulating his employees? If these goals conflict with the therapist's values, why should the student-therapist not have the right to refuse to treat?

Gerald Zuriff, PhD
Cambridge, Mass.

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