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Counseling Psychology Model Training Values Statement Addressing
Diversity: History, Current Use, and Future Directions
Article in Training and Education in Professional Psychology · November 2012
DOI: 10.1037/a0030810
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Training and Education in Professional Psychology
2012, Vol. 6, No. 4, 196 –203
© 2012 American Psychological Association
1931-3918/12/$12.00 DOI: 10.1037/a0030810
Counseling Psychology Model Training Values Statement Addressing
Diversity: History, Current Use, and Future Directions
Kathleen J. Bieschke
Laurie B. Mintz
The Pennsylvania State University
University of Florida
In 2006, the “Counseling Psychology Model Training Values Statement Addressing Diversity” was endorsed
by the Council of Counseling Psychology Training Programs, the Association of Counseling Center Training
Agencies, and the Society for Counseling Psychology (CCPTP, ACCTA, and SCP, 2009). The Values
Statement articulates expectations for trainees, trainers, and the training environment intended to foster the
development of trainees’ competences to provide services to individuals who represent a challenge to trainees’
worldviews. As the courts and state legislatures move in the direction of dictating training for psychologists,
we make the case that a training statement akin to the originally published Values Statement has tremendous
utility in today’s climate. To illustrate its utility, examples of how it has been used in counseling psychology
academic training programs are provided. We argue that professional psychology is in danger of losing its
professional autonomy in regard to setting standards for the profession and the academic freedom to determine
the appropriate training for our students. We recommend (a) clarifying ethical mandates regarding working
with demographically diverse clients; (b) defining the professional competencies that emanate from these
ethical mandates; and (c) adopting a uniform training statement that is applicable to all of professional
psychology.
Keywords: competence, diversity, values, ethics, training
& Bieschke, 2009; Mintz et al., 2009; Winterowd, Adams, Miville,
& Mintz, 2009).
The purpose of this paper is to introduce the “Counseling
Psychology Model Training Values Statement Addressing Diversity” (2009; hereafter, the “Values Statement”) to trainers and
educators in professional psychology, including an overview of its
development and a brief synopsis of its content. We then describe
the current legal and legislative landscape. We make the case that
a training statement similar to the Values Statement has tremendous utility in today’s climate, due to its potential to guide professional psychology in dealing with the thorny, yet inevitable,
values-related issues that arise in training. Accordingly, this paper
comprises an unabashed call for professional psychology programs
to consider the creation and adoption of a similar, albeit more
broadly applicable, document.
How does the profession of psychology deal with trainees who
are reluctant or even refuse to work with clients who are different
from themselves? What is the proper course of action when a
trainee’s reluctance or refusal is connected to his or her own social
identity or religious values? These questions were posed by Mintz
and colleagues (2009), and for the field of counseling psychology
the answer came in the form of “an aspirational statement articulating training values” (Mintz & Bieschke, 2009, p. 635). This
statement, endorsed by three organizations central to the field of
counseling psychology, appeared for the first time in print in 2009,
along with a series of articles describing the context for its development and specific recommendations for its implementation in
academic training programs and university counseling-center
internship-training sites (Illfelder-Kaye, Lese-Fowler, Bursley,
Reyes, & Bieschke, 2009; Loewy, Juntunen, & Duan, 2009; Mintz
History and Development of the Values Statement
DR. KATHLEEN J. BIESCHKE received her PhD in counseling psychology
from Michigan State University. She is a professor and director of clinical
training in the counseling psychology PhD program at The Pennsylvania
State University. Dr. Bieschke’s research interests focus on educating and
training psychologists to provide competent services to sexual and gender
minorities.
LAURIE B. MINTZ earned her PhD in Psychology from The Ohio State
University. She is a professor at the University of Florida, having previously been a faculty member at the University of Missouri. Her scholarship
focuses on training issues, the efficacy of bibliotherapy, and the treatment
of women’s low sexual desire.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to
Kathleen J. Bieschke, Department of Educational Psychology, Counseling,
and Special Education, 306 CEDAR Building, The Pennsylvania State
University, University Park, PA 16802. E-mail: kbieschke@psu.edu
The Values Statement arose from an effort among training
directors in counseling psychology to effectively deal with real-life
values conflicts in training settings. Specifically, the spark for the
Values Statement was ignited in November 2004 by a query on the
Council of Counseling Psychology Training Programs (CCPTP)
listserv from a training director of an American Psychological
Association (APA)–accredited counseling psychology doctoral
program:
We are having some problems in our program where some of our
students would strongly prefer not to work with gay/lesbian/bisexual
clients due to strong religious beliefs . . . . I would like to know how
you are handling these types of situations in your programs, particularly when students’ personal values do not match the values of the
196
VALUES STATEMENT
counseling psychology profession (i.e., . . . to serve culturally diverse
clients including gay/lesbian/bisexual clients).
This post was followed by a vibrant discussion on the listserv
including more than 40 posts, some quite lengthy. This discussion
was then continued in person, in February, 2005, when more than
40 counseling psychology training directors gathered at the annual
CCPTP meeting; central to this impassioned discussion was the
question of how to deal with students who refuse to work with gay,
lesbian, or bisexual clients on religious grounds. At the same time,
it became clear that the issue was broader than this one scenario.
Other training challenges discussed included, but were not limited
to, dealing with trainees who exhibit sexist and/or racist attitudes.
Throughout this discussion, “the tension between respecting trainees’ values and the ethical imperative to not reinforce discriminatory practices (within and outside of therapy) weighed heavy in the
discussion” (Mintz et al., 2009, p. 647). At the end of the discussion, it was concluded that there was a vital need for guidance in
dealing with value clashes in training. The counseling psychology
training directors in attendance strongly endorsed the notion that a
model training Values Statement regarding diversity would be an
immensely useful first step.
Despite this clarity regarding the need for a Values Statement,
its actual development was far from straightforward. As detailed in
Mintz and Bieschke (2009), the writing team consisted of the vice
president for education and training of the Society of Counseling
Psychology (SCP), members of CCPTP, and members from the
Association of Counseling Center Training Agencies (ACCTA).
The team started with a diversity Values Statement currently in use
at an APA-accredited academic training program. The writing
team then painstakingly and substantively revised this existing
document, with the goal of writing a statement that addressed
diversity across academic training programs and internship settings. Numerous drafts were generated, with feedback on each
draft sought from a variety of groups (e.g., executive board members of SCP’s Student Affiliate Group; the executive board members of CCPTP, ACCTA, and SCP; and trainees at the writing
team’s training sites). In the summer of 2006, more than two years
after the initial post on the CCPTP listserv, endorsement was
sought and obtained from CCPTP, ACCTA, and SCP.
Readers are strongly encouraged to read the final Values Statement (CCPTP, 2009) in its entirety. This dense, three-page document begins by placing respect for diversity in the context of the
APA’s ethical principles and code of conduct (APA, 2002), the
Guidelines and Principles of Programs in Professional Psychology (APA, 2005), and the social-justice focus of counseling psychology. Following this is a clearly stated belief that training
communities are enriched by members’ openness to learning about
and acceptance of diverse others, achieved in an atmosphere of
respect, trust, and safety. The Values Statement goes on to acknowledge that no one is completely free of bias and prejudice,
while at the same time laying out the expectation that both trainees
and trainers in counseling psychology be committed to the values
of respect for diversity, equity, and inclusion. The Values Statement also articulates the expectation, consistent with an APA
ethical principle cited therein, that trainers and trainees be willing
to examine their personal values and to learn to work effectively
with “cultural, individual, and role differences” (APA, 2002, Ethics code, Principle E, p. 1063). Following this is an entire para-
197
graph dedicated to the attitudes expected of trainers. This paragraph requires trainers to examine their own biases, model
personal introspection, and be committed to lifelong learning;
paramount is the expectation that trainers treat trainees in a way
that is respectful and inclusive of trainees’ identities. Subsequently, the Values Statement articulates a clear expectation that
trainees examine and attempt to resolve any attitudes, beliefs,
opinions, feelings, or personal history that might impair their
abilities to provide effective services to individuals different from
themselves. The second-to-last paragraph articulates the expectation of an atmosphere of education for all, and one in which bias
and prejudice will be openly challenged. The Values Statement
concludes with a summary statement articulating a commitment to
a supportive process that facilitates the development of the knowledge and skills necessary to working effectively with “all individuals, inclusive of demographics, beliefs, attitudes, and values”
(CCPTP et al., 2009, p. 643). As summarized by Mintz and
Bieschke (2009), the Values Statement was conceptualized as “a
model stance that training programs can adopt with respect to
diversity training values” (p. 635).
Utility of a Training Statement in Today’s Climate
Since 2004, when a training director on the CCPTP listserv
described how religious trainees in her program were refusing to
work with same-sex attracted clients, a parallel and increasingly
acrimonious conversation has taken place in legal and legislative
arenas. We provide a brief overview of these issues and then turn
our attention to detailing how a document similar to the Values
Statement might prevent such future legal and legislative battles,
as well as how a document such as this could be used in training
to resolve such issues. We bolster our argument for utility of such
a statement for prevention and resolution of training-related values
issues by illustrating how counseling psychology programs are
currently using the existing Values Statement.
Current Legal and Legislative Landscape
Two recent court cases have drawn attention to student valuesrelated issues that can arise in the course of training. On July 27,
2010, a federal judge upheld the right of a training program at
Eastern Michigan University to dismiss a student in school counseling, Julea Ward, who requested during her practicum training to
refer a gay client to another counselor, based on Ward’s religious
beliefs. The judge rejected a lawsuit that charged that the dismissal
was an infringement on the religious freedom and free-speech
rights of Ward; the judge concluded that the university was enforcing a legitimate curricular requirement, based in the American
Counseling Association’s (ACA) Code of Ethics, that counseling
students learn to work with a diversity of clients (Jaschik, 2010).
On January 27, 2012, however, the United States Court of Appeals
(6th District) ruled that “Ward’s free-speech claim deserves to go
to a jury” (Ward v. Polite et al., 2012). In this ruling, the Court of
Appeals juxtaposed this case with that of another case of a dismissed student, Jennifer Keeton from Augusta State University.
Keeton was dismissed from her counselor education program
when she made clear her intent to provide conversion therapy to a
client, and then refused to accept a remediation plan from her
training program. In the Keeton case, the 11th Circuit ruled for the
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BIESCHKE AND MINTZ
university. In juxtaposing the Keeton and the Ward cases, in their
decision on the latter, the United States Court of Appeals (6th
District) wrote:
At one level, the two decisions look like polar opposites, as a student
loses one case and wins the other . . . But there is less tension, or for
that matter even disagreement, between the two cases than initially
meets the eye. Keeton insisted on a constitutional right to engage in
conversion therapy—that is, if a “client discloses that he is gay, it was
her intention to tell the client that his behavior is morally wrong and
then try to change the client’s behavior.” . . . That approach, all agree,
violates the ACA code of ethics by imposing a counselor’s values on
a client, a form of conduct the university is free to prohibit as part of
its curriculum. Instead of insisting on changing her clients, Ward
asked only that the university not change her—that it permit her to
refer some clients in some settings, an approach the code of ethics
appears to permit and that no written school policy prohibits (Ward v.
Polite et al., 2012; p. 20).
The ruling generated a variety of concerned responses. According to Douglas C. Haldeman, former chairman of the American
Psychological Association’s Committee on Lesbian, Gay, and Bisexual Concerns, the court’s emphasis on referral was misplaced
(Oppenheimer, 2010). Both Haldeman and American Civil Liberties Union attorney Daniel Mach believe the issue is one of
discriminatory patterns of treatment, noting that counselors cannot
refuse to treat groups of people (e.g., Jews, Blacks, Muslims,
sexual minorities) based on the counselor’s beliefs and values.
Steve Sanders, a lawyer who specializes in both sexuality and
academic freedom, sees the core issue as one of competence,
explaining that the case was “about the ability of an aspiring
counseling professional to deal competently—that is, according to
standards established by her chosen profession—with a particular
category of clients” (cf. Jaschik, 2011).
Despite professional opinions that the issue is one of attaining
competence in accordance with ethical standards and preventing
students’ from engaging in discrimination, recent legislative actions mandate an opposing approach. In 2011, Arizona enacted a
law (HB 2565) that specifies that training programs:
Shall not discipline or discriminate against a student in a counseling,
social work or psychology program because the student refuses to
counsel a client about goals that conflict with the student’s sincerely
held religious belief if the student consults with the supervising
instructor or professor to determine the proper course of action to
avoid harm to the client.
Further, as of this writing, Michigan has proposed a bill (SB
518), known as the “conscience clause” or the “Julea Ward conscience bill,” that would allow students enrolled in any higher
education institution (public or private) in Michigan to refuse to
counsel clients based on a moral conviction. In addition, training
programs would not be permitted to discipline students for making
such a decision. Another state, Nebraska, has proposed similar
“conscience clause” legislation (LB 461; Health Care Freedom of
Conscience Act) that targets students indirectly. Specifically, this
bill gives health-care providers the right to decline to treat or
provide a referral to a patient for a health-care procedure “which
offends his or her conscience.”
All of this legislative activity raises serious concerns for those in
the profession. While the provision of referrals due to psycholo-
gists’ values has been given scant attention in the literature, one
recent article frames this practice as “discriminatory referral”
(Shiles, 2009, p. 142). Relative to training, such legislative activity
threatens both academic freedom and the maintenance of accreditation standards. As Judith Kovach, Executive Director of the
Michigan Psychological Association/Foundation states in relation
to the proposed Michigan bill, “. . . students would enjoy enormous latitude to refuse to complete their academic assignments
based solely on their personal beliefs” (personal communication,
January 10, 2012).
Utility of a Training Statement
Whether pending legislation will be enacted and the Ward court
case will settle is yet to be determined. What is becoming increasingly clear is that the courts and the legislature are beginning to
dictate the training of professional psychologists. Indeed, we contend that failure to act swiftly and collectively as a field is tantamount to yielding ownership of the training of new professionals
within the field of psychology. We believe that a statement akin to
the Values Statement has the potential to inform how the profession might move forward.
One especially useful aspect of the previously published Values
Statement (CCPTP, ACCTA, and SCP, 2009) is that it offers an
alternative to the dichotomous thinking that currently characterizes
the legal and legislative discussions. Specifically, whereas in these
arenas the argument has been framed as an either/or question (e.g.,
religious trainees change their values and provide competent care
to gay clients or keep their values and refer gay clients), the Values
Statement offers a path in which trainees can simultaneously
maintain their values and offer competent care to diverse others.
The Values Statement does this by outlining the competencies
expected of trainees in regard to working with clients whose
worldviews differ markedly from their own.
Explicating Competencies
The discussion of clinical competencies begins and ends with
one question: What is best for clients? Although this question may
appear simplistic, its answer is far more complex. The expectation
that psychologists are able to demonstrate the capacity to work
effectively with any client with whom they have contact, regardless of the challenges posed to a therapist’s worldview is consistent
with Principle E of the APA’s Code of Ethics (i.e., that psychologists learn to work effectively with “cultural, individual, and role
differences;” APA, 2002, p. 1063). Though the courts focus on
religious trainees who report discomfort working with a client who
expresses attraction for the same sex, there are limitless other
possible scenarios, the consideration of which informs the discussion of religious trainees. The following real-world clinical cases
are such examples: (a) A lesbian-identified therapist working with
an evangelical Christian; (b) an agnostic therapist working with a
client of the Mormon faith; (c) a Jewish therapist who finds herself
providing treatment to a client who is proud of the Nazi war
criminals in his family; and (d) a liberal therapist working with a
member of the Tea Party. Each of these true cases presented
challenges to the therapist’s worldview, and in each case, the
treating therapist maintained the therapeutic relationship and
stance, and the client received effective treatment.
VALUES STATEMENT
As such examples demonstrate, it is inevitable that a psychologist will encounter clients whose worldviews not only differ from,
but may offend, his or her own worldview. It is for this very reason
that the Values Statement explicated competencies necessary to
ensure that trainees are able to serve diverse clients. The focus of
the Values Statement was not “issue-based” competence; it is not
feasible that trainees demonstrate competence to treat each and
every presenting concern (Bieschke & Mintz, 2009). Rather, because trainees must demonstrate the skills and ability to work
effectively with “cultural, individual, and role differences” (APA,
2002, p. 1063), then the required competency is to serve clients
regardless of one’s own worldview. The path to acquiring such
competency, outlined by the Values Statement, lies not in changing one’s own worldview or refusing to serve clients, but in having
the ability to competently treat clients regardless of one’s worldview. The Values Statement maintains that trainees have the right
to maintain their personal belief systems while simultaneously
engaging in professional behaviors that might be inconsistent with
those beliefs: “Stated simply, both trainers and trainees are expected to demonstrate a willingness to examine their personal
values and to acquire and utilize professional relevant knowledge
and skills regardless of their beliefs, attitudes, and values” (p. 643).
The Values Statement is not the first to clarify such an expectation. Pipes, Holstein, and Aguirre (2005) delineate how APA’s
Code of Ethics protects the right of psychologists to behave and
think as they like in their private lives, while at the same time
requiring them to “constrain their behavior within a variety of
ways within their professional role” (p. 330). Along these same
lines, the Ethical Acculturation Model (EAM; Bieschke & Dendy,
2010; Handelsman, Gottlieb, & Knapp, 2005) urges trainees to
thoughtfully integrate their values with those of the profession.
Importantly, the hallmark of the EAM, as well as the argument
made by Pipes et al., is the acknowledgment that one’s personal
values and professional values and skills can coexist even when
they are in conflict. In short, the Values Statement, like these other
writings in the field (Bieschke & Dendy, 2010; Handelsman et al.,
2005; Pipes et al., 2005) suggest that trainees learn to provide
competent care to clients, irrespective of their personal beliefs
about these clients’ group memberships or demographic characteristics.
Current Use of the Values Statement in
Training Programs
Developing trainees’ ability to work with clients who challenge
or threaten a deeply held personal belief system or worldview is an
arduous process. This process is especially difficult for trainees
whose beliefs (e.g., same-sex relationships are sinful) differ from
requirements and standards adopted by the profession (e.g., APA’s
Code of ethics; APA, Guidelines for psychological practice with
lesbian, gay, and bisexual clients). Further complicating the attainment of this competency is the relative lack of power trainees have
within the training environment. As outlined previously, one of the
goals of the Values Statement was to provide guidance to counseling psychology programs in creating a training environment in
which trainees could develop this oft-difficult competency. Indeed,
just how academic programs and internship training sites might
implement this model stance was the focus of several articles in the
same journal issue in which the Values Statement first appeared
199
(Illfelder-Kaye et al., 2009; Loewy et al., 2009; Winterowd et al.,
2009). For example, Loewy et al. (2009) discussed the Values
Statement vis-à-vis admissions to graduate programs, arguing for
the importance of screening for the ability of applicants to learn to
adhere to the Values Statement and outlining a model admissions
process that utilizes the Values Statement. To illustrate, this model
process includes the suggestion that students be informed of the
expectations outlined in the Values Statement early in the admissions process, with the goal of ensuring the best fit between the
applicant and the program. Winterowd et al. (2009) provides
concrete suggestions for academic training programs in counseling
psychology to incorporate the Values Statement into all aspects of
training, including curriculum, practicum, research training, and
evaluation. Certainly, these articles were founded on the hope that
the Values Statement would be adapted by counseling psychology
programs and oft-used by trainers and trainees in the field (Mintz
& Bieschke, 2009).
Given that several years have elapsed since the publication of
these articles and in light of the current legislative and legal
climate, we wondered whether and how counseling psychology
programs had actually implemented the Values Statement into
their programs. We therefore posted a request on the CCPTP
listserv in March 2012 asking programs to provide us with a few
sentences about how the Values Statement was utilized in their
training programs. Approximately 1/3 (n ⫽ 26) of 72 CCPTP
member programs responded to our request. These responses, in
combination with a review of program websites, illustrate three
themes that we believe have the potential to further assist the
profession in assisting trainees in navigating situations in which
their worldviews and professional standards regarding diversity
collide: (a) thoughtful adoption; (b) informed consent; and (c)
meaningful integration. Prior to detailing these themes, it is important to note that nearly all of the programs reported using the
Values Statement in more than one way. Thus, the examples
presented below were often actions taken in concert with the other
actions described, rather than isolated actions or examples.
Thoughtful adoption. Many programs have carefully considered adoption of the Values Statement. Some programs described
having program faculty members vote on adopting the statement.
Others reported modifying the statement. In fact, 68% of programs
that posted a version of the Values Statement to their program’s
website had modified the statement, and the extent of these modifications varied considerably. For example, some programs took
particular care to modify the statement to fit their own particular
institutional contexts by extending it to other, related programs in
the department (e.g., master’s programs). Interestingly, whereas
some programs modified the Values Statement to fit their institutional contexts, others used the Values Statement to modify their
programs. One program director discussed how adoption of the
Values Statement influenced the development of that program’s
goals, objectives, and competencies. Yet another stated that they
used the Values Statement as a foundation for defining diversity
and the responsibilities that counseling psychologists have, related
to social justice.
Informed consent. Programs appear to be using the Values
Statement to inform prospective students and the public about the
competencies expected to be developed in the course of training
that are related to diverse others. Indeed, our review of program
websites of accredited counseling psychology programs revealed
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BIESCHKE AND MINTZ
that 47% posted a version of the Values Statement. Communicating such information is consistent with Domain G (i.e., Public
Disclosure) of the APA’s Commission on Accreditation (CoA)
Guidelines and Principles (G&P, CoA, 2012). Additionally, some
training directors noted that the Values Statement was one way in
which they attempted to be consistent with Standard 7.04 (Student
Disclosure of Personal Information) of APA’s Ethics Code (APA,
2002), which requires training programs to provide information in
its admission and program materials about the extent to which
self-disclosure about personal information is required as part of
course- or program-related activities. Consistent with the notion
that informed consent should go beyond a legalistic description of
information (Faden & Beauchamp, 1986), several training directors described more detailed attention to the Values Statement
during the admissions process. Examples of how applicants become acquainted with the Values Statement during the admissions
process included providing it in materials given to applicants,
verbally discussing it with applicants as a group, and touching on
it during individual interviews. A few programs ask students to
sign a copy of the statement prior to being admitted to the doctoral
(or master’s) program.
Meaningful integration. Many programs indicated that they
included the Values Statement in their handbooks. Programs also
gave examples of how the Values Statement was integrated
throughout the program as part of orientation, the curriculum, and
student evaluation. Relative to orientation, programs described
how the Values Statement was reviewed with incoming students.
For some, it was at this time that students were asked to sign the
Values Statement. One program described how the EAM (Bieschke & Dendy, 2010; Handelsman et al., 2005) was used in
conjunction with the Values Statement at orientation. In this program, students were introduced to the Values Statement and the
EAM simultaneously, and asked to discuss how it might be applied
to working with clients who challenge their worldviews. Students
were asked to reflect on how the EAM and the Values Statement
inform the paths they might take to attain competence with such
clients. In regard to curriculum, some training directors described
infusing the Values Statement throughout the curriculum, while
others incorporated the statement into a single course (e.g., professional issues, ethics, multicultural, philosophy, and theories). It
was evident that including the statement in courses not only
highlighted the centrality of the Values Statement for the program,
but also provided trainees with some context about how the Values
Statement emerged from the field. Finally, a few programs used
the Values Statement as part of their standard student evaluation
processes. One program described how students were asked to rate
themselves in accordance with the virtues associated with the
Values Statement (see Winterowd et al., 2009 for more details).
Another program reported that the Values Statement was useful
when working with a student who evidenced difficulty engaging in
self-reflection within the supervisory context.
What is clear from the responses to our brief, informal survey is
that counseling psychology programs are utilizing the Values
Statement. They are adopting it to their specific contexts, using it
to provide informed consent to potential trainees, and incorporating it into the curriculum in multiple ways, as well as using it as
an evaluative tool. Although there is no way to accurately determine how many problems (e.g., court cases, student remediation
plans, student dismissals) have been prevented by the Values
Statement, we surmise that at least some have been prevented due
to the self-selection that comes with informed consent. Likewise,
while one training director specifically noted that the Values
Statement was useful in dealing with a trainee evidencing problems, we also assume that the Values Statement may have been
used by others in this way. The Values Statement has clearly been
useful in guiding counseling psychology programs in the current
climate, and we therefore recommend that a more wide-ranging
statement be created and adopted by professional psychology
programs more broadly. This and other recommendations follow.
Recommendations
It seems that the Values Statement has served its intended
purpose for the field of counseling psychology to guide programs
in (a) informing students that working with diverse others is a
requirement that cannot be abdicated based on challenges to one’s
worldview or belief systems; and (b) creating the requisite atmosphere needed to foster the attainment of this required competency.
However, the issue that first spurred the development of the Values
Statement (i.e., religious trainees refusing to work with gay or
lesbian clients) is not unique to the field of counseling psychology,
as evidenced by ongoing court cases (e.g., the Julea Ward case
discussed above) and recent legislative actions. Of grave concern,
state legislatures have begun to move in the direction of dictating
training for psychologists that contradicts the professional standards and ethics on which the Values Statement rests. As we noted
earlier, failure to act swiftly and decisively as a profession cedes
control of our profession to the legislature and the courts. The time
to act is now, and recommendations to do so are below. These
recommendations pertain to (a) clarifying ethical mandates regarding working with a range of demographically diverse clients; (b)
defining the professional competencies that emanate from these
ethical mandates; and (c) adopting a uniform training statement
regarding the attainment of these competencies.
Clarifying ethical mandates. The Values Statement both
quoted and rested upon an ethical principle cited therein, and that
is, that psychologists “are aware of and respect cultural, individual,
and role differences, including those based on . . . sexual orientation” and that “psychologists try to eliminate the effect on their
work of biases based on those factors” (APA, 2002, p. 1063).
Along these same lines, Standard 3.01 of the APA ethics code
requires that “in their work-related activities, psychologists do not
engage in unfair discrimination based on age, gender, gender
identity, race, ethnicity, culture, national origin, religion, sexual
orientation, disability, socioeconomic status, or any basis proscribed by law” (APA, 2002, p. 1064). Similarly, although the
ACA ethics code has an entire section titled “Nondiscrimination”
which states that “Counselors do not condone or engage in discrimination based on age, culture, disability, ethnicity, race, religion/ spirituality, gender, gender identity, sexual orientation . . .”
(p. 10), the United States Court of Appeals (6th district) wrote that
“Ward asked only that the university . . . permit her to refer some
clients in some settings, an approach the code of ethics appears to
permit . . .” If, however, refusing to treat an entire group of people
is equivalent to discrimination as several professionals (e.g., Haldeman and Mach; Oppenheimer, 2010), argue, then such referrals
are something that the ethical codes do not permit. Using this same
VALUES STATEMENT
logic, terminating an ongoing client relationship based on group
membership would also not be permitted.
It is interesting to note, however, both termination and referral
are mentioned in the APA ethical code. Under Standard 10.10
(Terminating Therapy), it is stated that: “Psychologists terminate
therapy when it becomes reasonably clear that the client/patient no
longer needs the service, is not likely to benefit, or is being harmed
by continued service.” Thus, the APA ethics codes make it clear
that termination is permissible under certain circumstances. However, as outlined by Behnke (2009) it is important to distinguish
between termination and abandonment. Behnke states that “Abandonment is inappropriate termination.” We contend that terminating a client based on counselor values is inappropriate termination,
and existing case law (Bruff v. North Mississippi Health Services,
Inc., 2001) supports this interpretation. According to Hermann and
Herlihy (2006) when describing a case in which a counselor
refused to see a client with whom she already had established a
relationship, “The court . . . commented on the potential effect of
Bruff ’s actions on clients. The court considered testimony indicating that refusing to counsel a client . . . could have a negative
impact on the client” (p. 415). Hermann and Herlihy (2006) further
explicate the issue of abandonment, stating that:
Any harm done in the Bruff case may have been compounded by the
number of counseling sessions prior to Jane Doe revealing her lesbian
sexual identity and Bruff’s subsequent refusal to counsel Jane Doe . . . .
After several counseling sessions, Jane Doe may have invested a great
deal of trust in her counselor, enough trust to disclose her sexual identity
without fear of judgment (pp. 417– 418).
Such writings demonstrate that terminating an ongoing counseling relationship based on counselor values comprises abandonment. Trainees therefore must learn to work with a diversity of
clients, including those whose values or worldviews conflict with
their own, lest they put future clients in a subsequent position of
being abandoned. It seems, however, that trainees who request the
right to refer clients based on their values are not focused on such
future scenarios; the focus, such as in the Ward case, is generally
on referral before a counseling relationship has been established.
As noted earlier, the APA ethics code also mentions referral and
in fact, even addresses diversity in this clause. Specifically, under
Standard 2 (Competence), it is stated that:
Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with
age, gender, gender identity, race, ethnicity, culture, national origin,
religion, sexual orientation, disability, language or socioeconomic
status is essential for effective implementation of their services or
research, psychologists have or obtain the training, experience, consultation or supervision necessary to ensure the competence of their
services, or they make appropriate referrals, except as provided in
Standard 2.02, Providing Services in Emergencies (APA, 2002, pp.
1063–1064).
It seems that this paragraph mandates psychologists to seek
training in working with diverse others when professional knowledge exists and if they do not have such knowledge, to refer.
However, in an article specifically addressing the ethical issues
surrounding referrals based on therapist beliefs systems, Shiles
(2009) states that, “As it is currently worded, the either/or language of Standard 2.01 may . . . [provide] . . . a potential loophole
201
to allow discriminatory practices in the field of psychology” (p.
147). Shiles explains that the current either/or language may allow
psychologists to take the less time- and work-intensive route and
that is, to “refer a client than to engage in the training, consultation,
and personal exploration that is required in such circumstances” (p.
147).
In considering such potentially expedient client referrals based
on a psychologist’s worldview, two core ethical issues are at stake:
competence and nondiscrimination. As many writers have noted,
members of our profession are ethically mandated to attain the
skills, knowledge, and competence to work with diverse categories
of clients (e.g., APA, 2003; Jaschik, 2011; Pack-Brown & Williams, 2003; Shiles, 2009). Yet, the profession’s ethical code does
not state explicitly that refusal to attain such competence is an
ethical violation, and further, seemingly allows referrals based on
group membership. The code also does not address whether referral based on other demographic characteristics (e.g., political party
as in the Tea Party example given above) is acceptable. The code’s
lack of clarity on this point has serious implications for the practice
of psychology, as well as for the education and training of future
psychologists.
In light of today’s political climate, and in the interest of
preserving the autonomy of our profession, it may be time to make
it abundantly clear that (a) psychologists must attain competence
to work with clients who are demographically different, or in other
words, attain “demographic competency”; and that (b) psychologists’ worldviews and belief systems do not allow them to opt out
of attaining such competency. Both the American Counseling
Association (ACA) Code of Ethics and Canadian Counseling and
Psychotherapy Association Code of Ethics can provide direction
with respect to the opting out of obtaining demographic competence. The Canadian code lays out an ethical decision-making
process that includes asking a question about universality: “Would
I make the same decision for everyone? If every counselor made
this decision, would it be a good thing?” The ACA code has a
section titled “Avoiding Harm and Imposing Values” which states
that “Counselors are aware of their own values, attitudes, beliefs,
and behaviors and avoid imposing values that are inconsistent with
counseling goals. Counselors respect the diversity of clients, trainees, and research participants” (pp. 4 –5). Although these codes are
clearer and less inconsistent than our own, even greater clarity may
be needed. It may be wise for APA’s ethics code to state explicitly
that psychologists strive to obtain knowledge necessary to provide
competent treatment to clients who represent the full range of
demographic groups represented in our culture. We contend that
the time has also come for APA to specify that psychologists
cannot refuse to obtain the skills and knowledge needed to treat
individuals based solely on demographic characteristics. In short,
our first recommendation pertains to an examination of our ethics
code, with the hopes of making it more explicit in terms of the
obligation of members our profession to attain competence to work
with clients who represent demographic diversity.
Defining professional competencies. A critical professional
competency is the attainment of competence to serve demographically diverse groups, or what we previously termed “demographic
competence.” However, a second, related type of competence must
also be defined: Competence to work effectively with those who
challenge one’s belief system. Harris and Wasilewski (2004) term
the “the ability to hold our core values even while we entertain and
202
BIESCHKE AND MINTZ
create new ideas” as “dynamic inclusivity” (p. 2). Dynamic inclusivity reflects a valuing of all worldviews, including those diametrically opposed to one’s own. Valuing oneself and the other
simultaneously is a crucial aspect of the process of dynamic
inclusivity. Although Harris and Wasilewski were not writing
about psychological skills, their description of dynamic inclusivity
precisely captures the competency that the Values Statement initially attempted to define. In other words, in the process of obtaining and maintaining demographic competency, psychologists
and psychology trainees must also demonstrate what we hereby
term “dynamic worldview inclusivity” and that is, the flexibility
and ability to work proficiently, and with honor, respect, and care,
with clients whose worldviews differ dramatically from their own.
It is important to understand the relationship between demographic competency and dynamic worldview inclusivity. Demographic competency applies whether a trainee is working with a
demographically similar or dissimilar client; this competency pertains solely to the client demographics. To illustrate, both a religious psychologist and a gay or lesbian psychologist must possess
demographic competency in terms of both religion and sexual
orientation. However, the extent to which obtaining demographic
competency is difficult will vary upon the extent to which a trainee
and his or her client’s worldviews differ. If they are quite disparate, this is when the second competency pertaining to effectively
working with and honoring those whose worldviews differ—
dynamic worldview inclusivity— comes into play. Though much
writing in the field has focused on multicultural competencies or
diversity-related competency, we believe that more clarity and
broader-reaching implications arise by delineating two related
competencies: demographic competency (i.e., the ability and
knowledge to work with diverse client demographics) and dynamic worldview inclusivity (i.e., the capacity to work with and
value those whose worldviews differs from one’s own). Framing
the competencies in this way has important implications for training, the focus of our third and final recommendation.
Adopting a uniform training statement. Our final recommendation pertains to a training statement related to the two
competencies outlined above (i.e., demographic and dynamic
worldview inclusivity).
To more fully understand why a training statement is needed,
further examination of the issue of client referral based on demographics is in order. First, as noted earlier, there is currently
ambiguity in the APA ethics code about client referral; on the one
hand, the code dictates the attainment of knowledge to treat demographically diverse clients and on the other, allows referral if
such knowledge and skills are not obtained, except in emergency
situations in which referral is not permitted. Although, as per our
above recommendation, we advocate greater clarity in this code,
we adamantly assert that this code does not give trainees the ability
to opt out of obtaining any specific form of demographic competency, and in fact to do so, would be in violation of our ethics code.
The code reads, “Psychologists have or obtain the training, experience, consultation or supervision necessary to ensure the competence of their services, or they make appropriate referrals . . . .”
(p. 1064). To allow a trainee to opt out of obtaining demographic
competence would require the code to be read as follows: (a)
“Psychologists have or obtain the training, experience, consultation or supervision necessary to ensure the competence of their
services, or they decide not to get this competence based on their
own values and instead refer entire demographic groups of clients;” or (b) “If they deem it consistent with their values, psychologist have or obtain the training. . .” Certainly, most if not all
psychologists, would view these interpretations as absurd. Entering a psychology training program, and indeed the profession, is
voluntary (Pipes et al., 2005) and our responsibility to the public is
to ensure that future psychologists have the competence needed to
effectively serve clients, irrespective of client demographics. Indeed, as articulated earlier, attaining such competence during training also serves to prevent subsequent client abandonment. If the
competency of dynamic worldview inclusivity is obtained in training, upon graduation and professional practice, that therapist
would not be at risk of abandoning clients based on discovering
something about that client’s worldview that clashes with his or
her own.
We therefore affirm the necessity of a training statement. Trainers need guidance on how to facilitate a trainee’s ability to obtain
both demographic competence and the competence of dynamic
worldview inclusivity. Trainees have the right to be informed of
what competencies they are expected to develop prior to deciding
to enter the profession. The current Values Statement, which
already articulates a commitment to a supportive process that
facilitates the development of the knowledge and skills necessary
to working effectively with “all individuals inclusive of demographics, beliefs, attitudes, and values” (CCPTP, ACCTA, and
SCP, 2009, p. 643) is an excellent starting place.
However, several improvements are needed. For starters, the
word “values” in the title of the document implies that there is a
moral issue at stake, and that there are choices to be made. This
weakness can be traced back to the initial post on the CCPTP
listserv. The initial poster asked, “. . . How you are handling these
types of situations in your programs, particularly when students’
personal values do not match the values of the counseling psychology profession (i.e., . . . to serve culturally diverse clients
including gay/lesbian/bisexual clients).” A better question, we
believe, is, “How should programs handle situations in which
students want to operate in the professional arena in accordance
with their personal values when these values are in conflict with
the mandates and standards of professional ethics and behavior?”
We believe that the next-generation statement should include
several substantive improvements, including, but not limited to, (a)
making it applicable to all professional psychology trainers, not
just counseling psychology trainers; (b) being explicit that trainees
do not need to give up their personal and/or religious values; and
(c) being explicit that trainees are expected to attain both demographic competency and demonstrate the competency of dynamic
worldview inclusivity. Our recommendation is that a committee,
including broad representation from the field (e.g., clinical, counseling, school), begin the difficult task of crafting a model statement for professional psychology.
Conclusion
We are at a high-stakes crossroads for the training of professional psychologists. The Preamble of The Canadian Counseling
and Psychotherapy Association Code of Ethics states that the code
“. . . is part of a social contract, based on attitudes of mutual
respect and trust by which society supports the autonomy of the
profession in return for the commitment of its members to act
VALUES STATEMENT
ethically in the provision of professional services.” We are dangerously close to losing both our professional autonomy in setting
the standards for our profession and the academic freedom to
determine the appropriate training for our students. Swift action is
needed, in the form of decisive ethical codes, an articulation of
competencies emanating from these codes, and uniform and clear
training standards. While the Values Statement comprises the first
attempt of one subgroup within professional psychology to define
training standards, crafting a statement that reflects professional
psychology as a whole and attention to the current social climate
is necessary.
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Received May 16, 2012
Revision received October 3, 2012
Accepted October 9, 2012 䡲