1. Values, Competence, and Ethics at the Intersection of Care Law and Ethics in Counseling Conference University of Holy Cross New Orleans, Louisiana April 3 – 7, 2016

2. What Am I Going to Cover How our ethics address the issues of Personal and Professional Values Competence in the Face of Values Conflicts with Clients Impact on Client Care Perry C. Francis, Ed.D. 2

3. Who Am I? Counselor Educator since 1998 Chaired the ERTF that brought forward the 2014 ACA Code of Ethics One of the defendants in the Ward v Wilbanks case Co-editor of the JCD special section that reviewed the ramifications of the Ward v Wilbanks case Prior to all this, I was Lutheran parish pastor and campus minister (ELCA) On occasion, I still preside over services Perry C. Francis, Ed.D. 3

4. Big Forest – Several Trees – Many Branches Perry C. Francis, Ed.D. 4

5. Let’s Begin with a True Story Perry C. Francis, Ed.D. 5

6. Common Elements in Their Stories There faith is an intrinsic part of their identity and values They do not want to do harm Perry C. Francis, Ed.D. 6

7. Definition Discriminatory Referrals Occurs when a mental health professional refers a client when s/he believes that s/he cannot work with the client’s presenting concern (in this case due to a values/religious/ lifestyle conflict) before the professional has consulted with the client or sought consultation, supervision, further education, or other means to increase his or her capacity to provide services. When the professional has not sought these services, s/he may be referring inappropriately and committing an act of discrimination and micro-aggression. Shiles, 2009 Perry C. Francis, Ed.D. 7

8. How Many? Marriage & Family Therapists (n = 741) 61.7% believed it was ethical to refer based solely on a client’s sexual orientation 88.4% have not done so Perry C. Francis, Ed.D. 8

9. How Many? Social Workers ( n = 235: students, BSW, MSW, Ph.D) 95% reported welcoming to LGBT clients and 94% reported following the NASW Code of Ethics 47% would vote for politicians who supported discriminatory policies 35% would deny people the right to use the bathroom for their gender with which they identify 31% would fine transgender individuals for using the “wrong” bathroom 13% would permit bullying of LGBT youth 44% believe sexual orientation is a choice Perry C. Francis, Ed.D. 9

10. How Many? Counselor Educators (n = 71, qualitative survey) 13 CE indicated that how they taught was not consistent with the ACA position The ACA position does not impact how I will instruct my students. The ACA does not dictate to me, as a professor, how I will teach on this issue, or any other issues. Perry C. Francis, Ed.D. 10

11. How Many? Counselor Educators (n = 71, qualitative survey) I hope that wiser counselor educators will help the profession learn that religious freedom and respect and counseling services for homosexuals can coexist. Perry C. Francis, Ed.D. 11

12. Does This Really Happen? Perry C. Francis, Ed.D. 12 Ford & Hendrick (2003) When presented with a values conflict with a client: 40% referred the client to another professional 25% discussed the issue with the client 21% indicated “other” or that the experience “did not apply” 18% consulted with a colleague 4% engaged in self-examination, sought additional information, viewed the issue from the client perspective 1% helped the client explored the issue

13. We Have a Problem We ask that counselors are: Genuine Real Transparent Perry C. Francis, Ed.D. 13

14. The Values of the Profession Enhancing human development throughout the life span; Honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and Uniqueness of people within their social and cultural contexts; Promoting social justice; Safeguarding the integrity of the counselor–client relationship; and Practicing in a competent and ethical manner. Perry C. Francis, Ed.D. 14

15. NOTE The ACA 2014 Code of Ethics does not ask or require you TO CHANGE YOUR VALUES You are asked to put on the values of the profession as you enter into the client’s world Perry C. Francis, Ed.D. 15

16. Consequences of These Conflicts Arizona Law (Ward v Wilbanks) Cannot expel a student for refusing to counsel someone for sincerely held beliefs Tennessee Pending Legislation (ACA Code of Ethics) Allow for referrals for sincerely held beliefs Mississippi Pending Legislation (ACA Code of Ethics) Allow for referrals for sincerely held beliefs Perry C. Francis, Ed.D. 16

17. What Are We Missing? Competence verses Values Perry C. Francis, Ed.D. 17

18. Addressing Personal Values Perry C. Francis, Ed.D. 18 Research has demonstrated: Therapist values influence the effectiveness of therapy Client & therapist values are often different Therapists tend to have more liberal sexual values Client values are often influenced (changed) by therapist values Client values often move toward the therapist values

19. Addressing Personal Values Psychotherapists are called upon to [bracket off] their values to the best of their ability If a therapist suspects his/her values are impacting the session or client, he/she should consult with another professional or seek supervision Perry C. Francis, Ed.D. 19

20. Gaining Competence Competence is not an either/or concept Continuum of competence Competence is always growing and changing with the people and issues we work with. Growing Competence Requirements Staying current with literature & knowledge Acquiring appropriate skills (CEUs, supervision, consultation, etc.) Understanding when referral is necessary due to inability to gain competence required Perry C. Francis, Ed.D. 20

21. What Are We Missing A conflict of values is not only a competence issue…it is a diversity/multicultural issue Difficulty or disagreement does not imply a lack of competence No therapist is competent with all populations Perry C. Francis, Ed.D. 21

22. Gaining Competence Competence is not an either/or concept Continuum of competence Competence is always growing and changing with the people and issues we work with. Perry C. Francis, Ed.D. 22

23. Questions to Ask Before Making a Referral Perry C. Francis, Ed.D. 23 Based on my training & experience, do I feel competent to work with this client? Can I be respectful of my client’s beliefs related to their presenting concern? How might my reaction to this client differ from my reaction to a client with a similar presenting concern, but with different demographic variables?

24. Questions to Ask Before Making a Referral Perry C. Francis, Ed.D. 24 Can I expand my competence regarding this issue through reading, supervision, or other professional activities? Am I willing to work at expanding my competence, and if not, why? Is this an area that the counseling profession regards as essential for competent practice?

25. Questions to Ask Before Making a Referral Perry C. Francis, Ed.D. 25 Would referring this client cause more harm than good for this client and for other clients with similar characteristics who are considering counseling? Have I exhausted all other options before considering this referral? Shiles, M., 2009. Discriminatory referrals: Uncovering a potential ethical dilemma facing practitioners. Ethics & Behavior 19(2), 142-155.

26. One Last Thought Perry C. Francis, Ed.D. 26 This is about the ability to manage one’s values (whatever they might be) when working with a client with a different set of values

27. Thank You Perry C. Francis, Ed.D. 27 Compassion is the basis of all morality. Schopenhauer, (1788 - 1860) German philosopher Ethics are so annoying. I avoid them on principle. Darby Conley, Get Fuzzy Comic, 08-15-07 US cartoonist