How Tennessee's new 'religious freedom' therapy law hurts LGBT patients

In the days before the Orlando tragedy struck, Quinn Gee was already somewhat overworked. In addition to holding down her day job at Allstate, the 28-year-old therapist, who specializes in LGBTQ relationship and trauma issues, counsels her own clients in the evenings and runs long weekend shifts at a mental health facility. Plus, just a few months ago, she and four other black therapists in the Memphis area opened up their own firm a bit east of the city. It’s a relatively small affair, a few rooms with blue upholstered couches and muted watercolors in an office building next to the nail salons and big box stores that line US-72. But they’re doing well, considering how young they are.

In the days after the nightclub shooting, Gee was completely besieged: She offered a day of free therapy to whoever asked, and in the course of a day more than thirty people stopped by or called, which isn’t to mention the emails and Twitter messages she received from places as far away as Norway. People were terrified, they were traumatized, Gee says, they needed help making sense of their fear. It’s difficult to find therapists in Tennessee who are queer, “and even within that, to find a queer person of color that will be competent as a therapist,” she says. “There’s a lot of healing to do.”

Gee is the only therapist in her state listed in the American Counseling Association’s database of queer-friendly counselors, a designation that’s become significantly more pressing since the passage of Tennessee’s so-called “therapy law,” a bizarre and wide-ranging piece of legislation that’s drawn significant criticism from mental health professionals and activists alike. Among the constellation of recent laws that allow businesses to deny service to those whose identities conflict with so-called Christian values, this one is fairly unique, between its application to an entire professional practice and its encroachment on the ethics of health care. Refusing to bake a cake for a same-sex marriage is one thing; declining to treat a gay individual is quite another, and the law may portend new grounds upon which “religious freedom” will be fought.

According to members of the ACA, the law was originally lobbied into existence by the state’s local Family Research Council affiliate, FACT—an organization whose president, former senator David Fowler, has called the removal of same-sex impulses from the American Psychiatric Association’s list of mental disorders “off track.”

Senator Jack Johnson and other Republican lawmakers ostensibly drafted the bill in response to a 2014 provision in the ACA’s code of ethics, a policy that mirrors the directive taught in nearly all accredited therapy programs—namely, that a counselor shouldn’t refuse to treat a client based on their own “personally held values, attitudes, beliefs, or behaviors.”

“We’re in the Bible Belt. A lot of the counseling and therapy offered is Christian-based.”

Originally worded to allow mental health professionals to refer a client elsewhere if their lifestyles conflicted with a counselor’s religious beliefs, the bill rattled around the House and Senate for a few months and, in early April, passed the House 68-22. By the time it landed on Governor Bill Haslam’s desk in the middle of the month, however, its language had been expanded to include a therapist’s “sincerely held principles.” Which could, theoretically, allow an   anti-war therapist to refuse to treat a veteran for PTSD or an atheist to turn away a fervent believer like Haslam.

But, of course, this is Tennessee, where the governor vetoed a bill to make the Bible the official state book in part because it “trivializes the Bible,” a state that shares its borders with those who make it illegal to use a bathroom as a trans person and protect businesses refusing to serve same-sex couples. Proponents of the law say it protects therapists: ”We counselors are not robots—we’re human,” one relationship and addiction specialist claimed during a preliminary hearing earlier this year. And even secular practitioners sometimes describe it as “an impotent law,” pointing to the existing ethical guidelines that prevent licensed therapist from discriminating against clients, or to the fact that referrals based on a counselor’s skill set are relatively common.

But there’s a wide chasm between referring someone to a specialist and making treating people with certain sexual identities a specialty in of itself—particularly in a state like Tennessee, where much of the population lives in rural communities and where faith-based counselors are something of a norm. “It’s unheard of,” says Art Terrazas, the head of governmental affairs for the American Counseling Association, which guides the licensing process for therapists in Tennessee and eighteen other states. “It really was an unprecedented act of a legislature rewriting a code of ethics for a profession.”

“It gives people who were compelled by law to treat people with humanity the right to impose therapy that’s against our code of ethics, or to say, I don’t want to deal with you,” Gee says. “And no therapist asked for this. This didn’t come from us.”

David Fowler’s attempt to dispute a four-decades-old scientific fact notwithstanding, homosexuality hasn’t been classified as a disease of the mind since 1973. Yet the larger issues surrounding mental health treatment for populations in conflict with religious belief remain insidious and wide-reaching. This month, a potentially closeted gay man described as “mentally ill” committed one of the worst hate crimes in U.S. history. Only five states have legal protection against conversion therapy for minors—in one recent much-blogged-about case, a Texan teen’s extended family crowdfunded legal fees to bust her out of a Christian facility purporting to turn her straight. And legal action against organizations who claim to create “ex-gays” only found solid precedent in 2015, with the New Jersey case against the organization formerly known as JONAH, a Jewish non-profit that had been in the conversion game since 1970.

Across the board, Americans who identify as LGBTQ are reported to have vastly higher rates of depression, anxiety, mood, and substance abuse issues than the general population. And Tennessee itself is enmeshed in a mental health crisis—since 2013, the state’s suicide rates have been steadily climbing, regularly surpassing rates in the rest of the nation. Republican lawmakers, in debating the bill, stipulated that therapists would be unable to refuse care to a person in immediate danger of hurting themselves and others, but that kind of violence is just one of myriad issues people face.

There are 1,260 therapists listed on Psychology Today’s database of mental health care professionals, by far the most visible and accessible index of its kind; four hundred, most of them clustered around Nashville and Memphis, identify themselves as being open to treating gay and lesbian people. Some are shocked by the law: One pastoral therapist wrote me a fairly moving testament to Jesus’s love for the disenfranchised and cc’d his state legislator. But more than one of those supposedly gay-friendly therapists mentioned treating (or referring out) “homosexuals” and “pedophiles” in the same breath, too.

To wit, one therapist who practices out of Greenville, a rural town in the northeastern corner of the state, wrote to me that she “believes Christ, or whatever Supreme Power there may be, loves homosexuals the very same as me … I have educated myself also on pedophilia, and believe they are as worthy and valuable and loved by God as I am.”

So even if the Tennessee law does, as some claim, have little effect on therapists who studied and were licensed under guidelines that expressly forbid them from denying care based on religious conviction, the new law reads in some ways as an institutionalization of more subtle conflicts within the profession—a culture incubated not just in Tennessee but in the knee-jerk tendencies of the surrounding states, despite national organizations’ efforts to curb such ideological encroachments.

As Jade, a nurse who works alongside queer-friendly counselors in a small-town treatment center, tells me, her experience of tolerance is far from typical. “We’re in the Bible Belt,” she says. “A lot of the counseling and therapy offered in the area is only ‘Christian-based.’ There are churches on every corner.”

Terrezza from the ACA worries that if the law is not overturned, there may soon be therapists licensed in Tennessee who have been allowed to shirk what he considers one of the cornerstones of the practice. “People keep saying counselors shouldn’t be forced to abandon their beliefs when their client walks through the door,” he says. “But what religion values domestic violence, substance abuse, depression?”

Quinn Gee attended the University of Mississippi for her undergraduate degree, where she says she felt like “a deer in headlights” living around so many white kids for the first time. It’s one of the reasons she places such a high premium on ministering to people who might otherwise feel alienated by therapists who don’t get where they’re coming from. “Just cause mental illness isn’t suicidal or homicidal, that doesn’t mean it’s not important,” Gee says—and for a lot of those “regular everyday things” gender, race, and ethnicity play such a huge role there are things that “not even a white LGBTQ therapist could understand.”

Given the religious bent of her area—even if Memphis is relatively cosmopolitan—she says she sees a lot of the same issues come up among her clients: They deal with shame and spiritual conflict, wonder if they should come out at work, have a hard time dating in communities where it can be difficult to find (or identify, or go out in public with) a prospective bae.

“We’re encroaching on mainstream America. They’re frightened. They’re feeling the heat.” — Pamela Sheffer

On the other side of the Tennessee River, a nearly four-hour drive through the western part of the state, not too far from the county where a gay teenager killed himself in a high-profile tragedy five years ago, a woman named Pamela Sheffer is swamped, too. As the program director for the Oasis center in Nashville, Sheffer values providing resources to LGBTQ kids that are, in her expressive youth-group parlance, “open and affirmative.” Unfortunately, after five years of providing therapy sessions and despite the addition of more counselors, she and her staff are reaching capacity as far as mental health services go. Nearly half the young people enrolled in the program, says Sheffer—many of whom are trans—are dealing with suicidal thoughts. “and this is even though they’re getting mental health assistance,” she says. “They’re still struggling.” Combing through the familiar, self-reported channels (the Psychology Today list, for instance) she and her team are having difficulty finding therapists they feel comfortable referring their clients to throughout Middle Tennessee.

Parents drive their kids to the Oasis center from eleven different counties across Tennessee and Kentucky. In some cases, it’s an hour and a half drive. Gas gets expensive. It’s hard to find the time. But “these are parents who love their kids, even if they may not quite understand,” says Sheffer. “They’re on point enough to know they need more than what their local health department in their local county can give them.”

What’s left unsaid is how many kid’s parents in the surrounding counties are significantly less on point.

Really, the issue isn’t that people will get denied by therapists, Sheffer says. ”It’s the aversion rate,” the risk that young people, already isolated, won’t look for the help they need in the first place. And besides, she’s seen the largest spike in her clients’ needs not in the aftermath of the therapy law but over the last year-and-change, as federal laws have granted civil rights to same-sex couples. “It really put a target on the backs of our young people who are living out,” she says. “We’re encroaching on mainstream America. They’re frightened. They’re feeling the heat. We’re getting more negative attention.”

The negative attention isn’t particular to this law, of course. In Mississippi, doctors can now legally refuse to counsel people who wish to switch genders and refuse fertility treatments to same sex couples; another bill in Tennessee, defeated but expected to come up again, would apply similar freedom of denial rules to social work and psychology interns practicing in the state. They could have overarching ramifications for assumptions often taken for granted in these industries—for instance, that helping a patient is more ethically sound than denying them, or that standardized guidelines provide patients the best sort of care. Or even that individual biases, in the early days of a professional’s training, are something to be trained out of rather than guarded.