Urgent Call to Action for Concerned Therapists
Help Amend Oregon’s Laws to Allow Therapists to Practice Ethically Once Again
Oregon State Representative Ed Diehl is working on a very important project. If you are a therapist concerned with how our field has been coerced into mistreating matters of gender, he needs your help.
Representative Diehl is proposing much needed amendments to state laws that, as currently worded, make it very difficult for therapists to do anything but “affirm.”
He needs practitioners’ help identifying “specific therapies that are different from current state law.”
We are calling on all clinical practitioners of psychotherapy — PhDs, PsyDs, LMFTs, LPCs — to help Mr. Diehl turn things around in Oregon by drawing upon your professional knowledge base.
We need you to describe specific evidence-based, theoretically grounded, ethically sound, and time-tested models of therapy, and articulate how the manner in which Oregon defines and prohibits conversion therapy in ORS 675.850 conflicts with therapists’ ability to practice.
Under current state law:
(A) “Conversion therapy” means providing professional services for the purpose of attempting to change a person’s sexual orientation or gender identity, including attempting to change behaviors or expressions of self or to reduce sexual or romantic attractions or feelings toward individuals of the same gender.
(B) “Conversion therapy” does not mean:
(i) Counseling that assists a client who is seeking to undergo a gender transition or who is in the process of undergoing a gender transition; or
(ii) Counseling that provides a client with acceptance, support and understanding, or counseling that facilitates a client’s coping, social support and identity exploration or development, including counseling in the form of sexual orientation-neutral or gender identity-neutral interventions provided for the purpose of preventing or addressing unlawful conduct or unsafe sexual practices, as long as the counseling is not provided for the purpose of attempting to change the client’s sexual orientation or gender identity.
Representative Ed Diehl is proposing legislation that instructs licensing boards (and judges) on how to interpret Oregon’s existing licensing statute.
A lawyer has recommended that he list the services that we want licensed therapists and psychiatrists to be free to provide by adding a paragraph to Oregon’s existing licensing law. It might read something like this:
“Nothing in this chapter should be construed to prohibit or limit a licensed practitioner’s speech* or conduct to:
______________;
______________;
______________; and
______________.
Please contact Rep.EdDiehl@oregonlegislature.gov by the end of January at the latest with your comments on how the language of the state law, as currently worded, needs to be amended in order to allow therapists to provide evidence-based, ethical care.
I intend to work on my own comments when time allows, but am swamped right now, and thought a crowd-sourced answer may be more powerful and effective.
Ed also needs therapists who are willing to testify to a committee. Please let him know if you can help with this.
Ed Diehl for Oregon
Rep.EdDiehl@oregonlegislature.gov
(503) 986-1417
Responses to Call-to-Action
The following are my suggestions for your consideration regarding amendments to ORS 675.850.
The American Counseling Association’s 2014 ACA Code of Ethics (https://www.counseling.org/resources/aca-code-of-ethics.pdf) is a central standard of in the field of counseling. 2014 ACA Code of Ethics §A.1.a. Primary Responsibility states “The primary responsibility of counselors is to respect the dignity and promote the welfare of clients” (pg. 4). If any feature of the “gender-affirming care” model conflicts with this primary responsibility, the client’s dignity and welfare must be preserved over ideological dictates. For a counselor to do otherwise would be to hold a model of care or a theory over a client’s welfare. Nosingle counseling model, not Cognitive Behavioral Therapy, not Jungian psychoanalysis, not transpersonal therapy, no therapy or theory can override this primary responsibility of a counselor: “gender-affirming care” is no exception. The law must protect a counselor’s primary responsibility.
2014 ACA Code of Ethics §A.2.d. Inability to Give Consent states, in part, that “Counselors recognize the need to balance the ethical rights of clients to make choices, their capacity to give consent or assent to receive services, and parental or familial legal rights and responsibilities to protect these clients and make decisions on their behalf” (p. 4). If a client is a minor and/or has conditions that limit the client’s capacity to consent, the counselor must balance these factors with family involvement and the need to protect the client. The law must protect a counselor’s ability to make such decisions and involve family or other parties if it is called for, regardless of what “gender affirming care” might admonish a counselor to do.
2014 ACA Code of Ethics §A.4.a. Avoiding Harm states that “Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm” (p. 4). If a counselor believes that his or her actions may harm a client, the counselor is ethically forbiddenfrom engaging in those actions. Setting any legal standard that a counselor is required to act in a way that harms his or her client would directly contradict current ethical guidelines and which could put a counselor in a position where he or she must break the law to keep his or her license, or to give up his or her license to avoid breaking the law. The law must protect a counselor’s ability to not engage in actions that harm the client: “gender-affirming care” cannot coerce a counselor into knowingly harming a client.
2014 ACA Code of Ethics §A.4.b. Personal Values states, in part, that “Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors” (p. 5). If a client is ambivalent about his or her identity in some meaningful sense, affirming any one particular interpretation or polarity would be a way of the counselor imposing his or her own values and therefore violating an ethical requirement of the profession. “Gender affirming care” pressures counselors to “affirm” precisely during times when the client is unsure about some aspect of their identity. A counselor is not a guru: the law must protect clients from counselors who might impose their own views.
A popular textbook for counseling trainees is Capuzzi, D., Stauffer, M. D. (2016). Counseling and Psychotherapy: Theories and Interventions, 6th Edition. John Wiley & Sons.
On page 1 of this textbook: “The helping relationship is the foundation on which the process of counseling and psychotherapy is based. It is not possible to use the concepts and associated interventions of a specific theory unless such applications are made in the context of a relationship that promotes trust, insight, and behavior change.” Later, “The helping relationship is the foundation on which the process of counseling or psychotherapy rests” (p. 20). The book goes on to describe the six core conditions of the helping relationship, one of which is genuineness or congruence: “Genuineness and congruence describe the ability to be authentic in the helping relationship (D. W. Sue & Sue, 2013). The ability to be real as opposed to artificial, to behave as one feels as opposed to playing the role of the helper, and to be congruent in terms of actions and words are further descriptors of this core condition (Kolden, Klein, Wang & Austin, 2011)” (p. 10). One of the ways the textbook describes for a counselor to generate congruence: “… present one's thoughts, feelings, and actions in a consistent, unified, and honest manner” (italics mine) (p. 10).
In other words, the helping relationship is foundational in all counseling, regardless of what paradigm the counselor is using. The helping relationship depends on congruence: the client must trust the counselor and the counselor must be honest with the client to justify that trust. If a client gets the sense that the counselor is lying to him or her, the entire counseling enterprise might be in jeopardy. “Gender-affirming care” admonishes the client to affirm the “gender identity” of the client, whether or not the counselor agrees with the client or even believes that “gender identity” is a meaningful term. The law must protect a counselor’s freedom to be honest with the client. If a law requires a counselor to affirm an idea the counselor does not hold, in other words, to lie to the client, the very foundation of the counseling enterprise, the helping relationship, is at risk.
Arguably, the single most important reference in all of the mental health field is Association, A. P. (2022). Diagnostic and Statistical Manual of Mental Disorders, Text Revision (DSM-5-TR), 5th Edition.
The law must protect the freedom of counselors and other mental health professionals to use DSM-5-TR according to professional standards. “Gender-affirming care” must not infringe on a mental health practitioner’s ability to use whatever diagnoses that professional deems fit, according to current best practices and the technical standards outlined in DSM-5-TR. In particular, two diagnoses that mental health practitioners must maintain the ability to use with clients are: Delusional Disorder (F22) (p. 104) and Factitious Disorder Imposed on Self (F68.10) (p. 367). “Gender-affirming care” seems to assume that a client is definitely seeing the situation clearly (i.e., is not delusional) and is being totally honest with the mental health practitioner about the client’s symptoms. Delusional Disorder (F22) and Factitious Disorder Imposed on Self (F68.10) exist precisely because neither of these conditions can be guaranteed in any particular relationship between a mental health practitioner and a client, and, indeed, may be so pronounced in a given client that a formal diagnosis is called for. The law must protect a mental health practitioner’s ability to use all diagnoses in the DSM-5-TR and more generally to assess whether any given client is delusional or lying about his or her symptoms.
I don’t know how to formally reference legal documents, but here’s the document to which I’ll be referring:
EXPERT REPORT OF DR. JAMES CANTOR
PFLAG, INC., ET AL., Plaintiffs, v. GREG ABBOTT, ET AL., Defendants.
NO. D-1-GN-22-002569.
IN THE DISTRICT COURT OF TRAVIS COUNTY, TEXAS 459th JUDICIAL DISTRICT.
In this expert report, Dr. Cantor states that “The research has repeatedly demonstrated that once one explicitly acknowledges being gay or lesbian, one is only very rarely mistaken. That is entirely unlike gender identity, wherein the great majority of children who declare cross-gender identity cease to do so by puberty, as already shown unanimously by all follow-up studies” (p. 42). The law must protect the ability of all mental health professionals to allow for the possibility that the client is mistaken, particularly if that client is a child. Even if the client is not diagnosed as delusional and even if the client is being honest about his or her symptoms, the client may simply be making an error in judgement or perception. To preclude the possibility of errors in client judgement or perception would not only be absurd on its face, since clients are just fallible human beings, but would also go against Dr. Cantor’s report that, at least for children, their assessment of their “gender identity” is not just possibly false, but likely to be false.
In his report, Dr. Cantor describes the “gate-keeper model” (p. 44), in which a clinician methodically assesses the benefits and risks of different decisions with respect to the various interventions a client diagnosed with gender dysphoria might be considering. The law must protect the gate-keeper model, as described by Dr. Cantor in particular. More generally, the law must protect a mental health practitioner’s ability to weigh the risks and benefits of the various interventions that “affirmation” can entail.
Hi Ed,
I understand you are looking for input from therapists regarding the current “conversion therapy” law and how it is worded.
I am an LPC, and have practiced in Oregon under that license since 2008. I have worked in the mental health field and in agencies in Oregon since 1996. I am attaching a Substack article I wrote that explains my position and challenges here in Oregon to provide proper care. It is an anonymous article, because these laws make my licensure vulnerable to activists. I don’t believe mental health providers can give proper, ethical care to patients if we are afraid to lose our livelihood just for doing what we have always done, and what we believe to be right.
What we need to be able to practice is exploratory therapy, examining causes of depression, anxiety and suicidal ideation that often have causes unrelated to gender dysphoria. We need to be able to gently challenge thought processes that explore gender roles and not just focus on one. Many teens, girls in particular, struggle with puberty and how uncomfortable it is. As therapists we need to be allowed to normalize this struggle and not just agree that they are the opposite sex because there body is uncomfortable. We also need to be able to explore social experiences and interactions due to the possibility of social contagion.
I also believe that affirmative therapy is most damaging to young gay and lesbian individuals. By not allowing them to explore and just reassuring what they currently think is correct, it negatively affects their ability to lead a healthy lifestyle and accept that they may be female with strong male traits or a male with strong feminine traits and be ok with that.
Here is my contribution to possible language that you need:
“Nothing in this chapter should be construed to prohibit or limit a licensed practitioner’s speech* or conduct to: Practice exploratory therapy in relation to gender identity and teach evidence based skills to address gender dysphoria without referral for chemical or medical transition.
I am willing to help in ways I can, but also have to have some anonymity. I am working on developing a program for detransitioners, and I don’t want to get in the cross hairs of activists before I can get that program off the ground. Thank you SO MUCH for your willingness to address this! This would be the first of many steps that need to happen, but it would give us the freedom we need to protect vulnerable youth and adults.
Dear Ed Diehl,
Here are my proposals:
Nothing in this chapter should be construed to prohibit or limit a licensed practitioner’s freedom of speech, or freedom of religious or political belief, to:
A) Provide professional services for the purpose of supporting the return of a person’s sexual orientation or gender identity to an original state, following conversion or coercion into a different one;
(i) Counseling that assists a client who is seeking to undergo a gender de-transition or who is in the process of undergoing a gender de-transition; or
(ii) Counseling that provides a client with acceptance, support and understanding, or counseling that facilitates a client’s coping, social support and identity restoration following identity-based abuse, including counseling in the form of affirming heterosexual orientation, and affirming feminine or masculine identity;
(iii) Interventions provided for the purpose of preventing or addressing unlawful trans gender conversion conduct or unsafe sexual practices;
and
(iv) Counseling that assists a client who is seeking to recover from forced or coerced conversion to a political/religious sexual or gender identity.
Kind regards,
Anonymous UK Doctor
