Get Real! The Great No-Orgasm-from-Intercourse Conundrum

Heather Corinna

On Get Real!, Heather responds to the dozens of teens who ask about young women and orgasms.

Editor’s Note: We’re delighted to bring Get Real!, Heather Corinna’s
popular sexuality advice column, to you on Rewire, now every week!

Way too many people ask:

18, female and my boyfriend and I had no previous sexual relationships.
I’ve been engaging in intercourse about a month now, and I was
wondering why I haven’t orgasmed yet. I’ve been able to orgasm through
masturbation but not with my boyfriend doing the work. What do you
think is wrong? Is it normal? Or are we just too inexperienced? If so
how do I tell my boyfriend about it?

Heather replies:

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get a LOT of questions like this, every single day, and have for as
long as we’ve been online. Here are just a few more recent ones:

I have been with my boyfriend for the last three years,
and just last May we had sex for the first time. I was a virgin, he was
not. We have had sex on a few occasions, but I cannot reach orgasm
through oral or vaginal sex. This can be very frustrating. I able to
reach an orgasm through masturbating, but nothing else. Could it be
that I am far to used to masturbating that I cannot reach an orgasm in
any other way? We love each other very much, but this one thing is
proving to be… well challenging. If I masturbate and do not touch my
clit, I get nothing. Many help sites suggest to find a way of reaching
orgasm through masturbation first, but if I cannot do so… is getting
one through sex impossible?

I am 18 yrs old and currently in a relationship that has
lasted around 3 years. I love him and he loves me, but we have the
classic problem of not being able to make me orgasm. I am sexually
attracted to him and am not ashamed of my body and I have orgasmed
before but only on my own. Until recently, the only way I could get
myself to orgasm was by using a vibrator or allowing allowing water to
run over my vagina in the bath. However, I am really trying to get to a
point where I can orgasm with him without any sort of stimulation from
a vibrato,r etc. We thought that if i got to know myself better through
masturbation that would help. I can now bring myself to orgasm through
my own stimulation, but only when I read about or see something sexual.
We are both really trying and I would love any sort of outside help.
Thank you for all of your help!

I’m an 18 year old girl who use to have sexual feelings
by just watching porn or just thinking but since I started having sex I
never felt horny or neither do I ever enjoyed sex, I just feel a little
pain and nothing else. I want to enjoy sex. What can I do to enhance my
sexual feelings to the maximum? I don’t care if I feel horny every day.

We say this often around here — to the point that I’m certain no
one reading around is missing it — but I’m going to start by saying it
again here.

The majority of women — according to most studies, at least 70% —
do not and will not reach orgasm through vaginal intercourse or
vagina-only stimulation (like "fingering" that’s only about vaginal
insertion) only.

Again: most women do not reach orgasm through intercourse alone. Given
that’s a majority, we can safely say that it is most normal NOT to
reach orgasm through intercourse alone, or only do so infrequently.

That’s really not very surprising. The vagina, all by itself, is not
all that rich with sensory nerve endings. The sensory nerve endings it
has are not only within the first couple inches of the vagina (the
reason why penis length really is a non-issue for women who sleep with
men), but they tend to be more responsive to very targeted stimulation
rather than the more general stimulus vaginal intercourse usually
provides. For sure, plenty of women still enjoy vaginal intercourse.
From a physical perspective, that feeling of fullness can be nice, and
can also provide some stimulation of the internal clitoris.
Some sexual positions for intercourse — like women being on top, for
instance — can also provide more direct clitoral stimulation. From an
emotional perspective, intercourse has a lot of good publicity as
something that is important and brings people closer (and even just
thinking it so can make it so sometimes), risking pregnancy tends to up
the emotional ante, and just being face-to-face with any sort of sex
can create a feeling of closeness. Plus, since unlike women, a majority
of men do reach orgasm through intercourse, pleasing one’s partner has
its own excitement and intimacy.

But overall, if and when women want to reach orgasm when intercourse
is involved, they’re going to have to be doing something else WITH
intercourse to get there — such as manual clitoral stimulation from a
partner, using a vibrator, masturbating — or having intercourse be
part of other sex they are having before or afterwards. A lot of the
time we get asked about this, the person asking does already know at
least one thing — and usually more than one — which does work for
them when it comes to what feels great and gets them to orgasm. When
that’s the case, there’s no problem: that is the thing that you’d then
add to intercourse (or do instead, whichever), either yourself, by
showing a partner how to do what you do that works for you by yourself,
or by having them do whatever it is they do that feels delicious.

If that’s still confusing, think about it this way: women have, on
our bodies, the only organ on EITHER the male or female body that
serves no other purpose but to provide sexual pleasure: our clitorises.
Our vaginas are really about reproduction more than anything else when
it all comes down to it. With men, for the most part, their bits are
more all-in-one: the penis is both a reproductive organ and a primary
organ of sexual pleasure. They have something else, too, that isn’t the
penis or within the penis, the prostate gland. While the male prostate
does serve a purpose other than sexual pleasure, it’s a bit more like
our clitorises, save that most men will be able to reach orgasm without
direct prostate stimulus: it’s just that that stimulus often provides
longer, stronger orgasms.

All of that really only has to be a bummer if you and yours make it
one. The facts of how our bodies do and don’t respond to orgasm isn’t a
problem: our bodies aren’t the problem. Thinking that they are is
effectively a body image problem, just like thinking your thighs or
breasts aren’t the right size, or you’re not the right weight. Your
body is how it is and accepting it as-is is not only good for your
mental health, it’s good for your sex life.

It’s unrealistic ideals and expectations which are the big problem
here. In a lot of ways, when we’re talking about sexuality, especially
female sexuality, the world gets it backwards in how it presents what
real-deal sex and isn’t. The activities which are usually most likely
to be completely satisfying for women are called foreplay, and the one
that isn’t sex. Some of that backwards-thinking has to do with
long-time ignorance, some of it with patriarchy, some of it with
heterosexism, some of it with how some folks really, really, only want
sex to be about reproduction. But all of it is pretty bunk, no matter
what perspective it’s coming from. What "real sex" is is the sex anyone
is having which is stimulating, exciting and satisfying, and for women,
that tends to be either things other than intercourse or intercourse
which is combined with other things. Making it a goal to reach
intercourse through orgasm alone not only isn’t a realistic goal, it’s
probably going to keep you from having sex you really enjoy. Sex
between people should be about finding what unique things and dynamics
work for those two people, not about meeting anyone else’s ideals, or
unrealistic daydreams about how sex should be… were our bodies not
exactly as they are in real life. Again, for most women, making it a
goal to reach orgasm during intercourse is a bit like making it a goal
to find that elusive pot of gold held by a cute little leprechaun at
the end of the rainbow.

That isn’t to say that any other activity guarantees anyone will
reach orgasm, either. Not everyone will orgasm from oral sex or manual
sex, or won’t every single time. What works for you will tend to be
pretty individual, may vary from partner to partner, and from year to
year, and that’s all okay. Getting hung up on what’s "supposed" to work
is a good way to prevent yourself and your partner from finding out
what does.

I also often get the impression that people forget it usually will
take women longer to reach intercourse than men, and that when people
do talk about "foreplay," they don’t mean doing something for a few
minutes so that a woman is in the mood enough to say okay to
intercourse. While most men can reach orgasm through intercourse for
just a few minutes, plenty of women are going to need 20 minutes —
sometimes more — of a kind of sex that really revs her engine, and
that often will include more than just touching her genitals or
breasts. Heck, even men benefit lot when sex is about the whole body
and more than one activity.

Another common response I get is that women can get sooooo close to
orgasm, but then pull back because things feel too intense. Orgasm IS
intense. Not always crazy-intense, but it’s intense, and that’s a lot
of why everyone wants to have one so bad. If you’re feeling really
close, but like one more touch will make you lose your mind, that’s
when you keep things going, not when you stop: getting over that hump
tends to be what gets you to the orgasm. Too, though, if you’re feeling
suddenly HYPERsensitive, and just can’t take any touch at all, it’s
likely you HAD an orgasm already. Sometimes, people have unrealistic
expectations about what orgasm even feels like.

Let’s also remember that what does and does not "work" for us
sexually isn’t just about the physical, nor just about if we are loved
by and feel love for our partners. It’s not even just about if we find
partners attractive. If we have real chemistry matters, and sexual
chemistry is a crazy, sometimes random thing. We can have it with
people we don’t like very much, and not have it with people we do. We
can love someone to death, be in love with them, find them attractive,
but just not feel fireworks when we get sexual, and that doesn’t tend
to be something anyone can make happen. It’s usually either there or
it’s not. As well, things like what the dynamic is when we’re having
sex — like if a partner is very emotionally distant when we want
closeness, very gentle when we want something more aggressive (or
vice-versa), one of us is very passive and the other active, if a
partner likes to talk about sex during in a way they find sexy, but you
find either hilarious or grotesque — matters. Some kinds of sexual
dynamics that work for one person may not for the other — for
instance, for people who prefer BDSM dynamics, "vanilla" dynamics often
won’t cut the mustard. Someone who wants very tender, slow sex but
whose partner is only interested in battering-ram quickies isn’t likely
to be satisfied. If someone is mostly attracted to women and only
sleeping with men, it’s no shocker sex isn’t that exciting for them; if
a person identifies their gender in one way, but their partner treats
them in ways that gender-wise don’t fit that identity, it can feel like
you’re not really present, for obvious reasons.

Something else you’ll want to bear in mind is that sex is one of
those things that tends to take time and practice to get really
awesome. Sure, every now and then the stars and everything else will
just happen to be in some kind of perfect alignment that we wind up
having drop-dead-amazing sex without having spent time with a partner
or ourselves, or without doing what we usually need to do to reach
orgasm and/or feel satisfied. But those times are the exception, not
the rule. Usually, it’s just going to take time — and when I say time,
I mean years in a lot of cases, and in some respect, a lifetime of
learning for all of us — for a person to learn to really get
themselves there alone. It’s going to take time for any two people to
experiment and explore one another, learn to communicate well about sex
and respond accordingly, get over hangups and be comfortable enough
together to seriously let it all hang out sexually and have sex be
total gangbusters.

In general, younger people — particularly women — also don’t have
orgasms of the same quality or with the same frequency as their older
counterparts. Much of that just boils down to time again: the time it
takes to get to know your body, the time it takes to get to know a
partner’s body. Other issues are probably at play there, too, like just
really feeling comfortable having sex at all, accepting one’s body as
it is, doing what feels good, not what you think you should be doing,
as well as hormonal issues. If you’re not there yet, it should be okay,
because what you are doing should feel good and be pleasurable, even if
and when it doesn’t result in orgasm. If it doesn’t feel great —
physically and emotionally — even without orgasm, that’d be a problem
even if you did come.

But there’s another big difference between older women and younger ones a lot of the time, and that’s plain old assertiveness.

For instance, check out the findings of this study at The Guttmacher Institute: Almost
20% of women believed that they never have the right to make their own
decisions about contraception, regardless of their partner’s wishes; to
tell their partner that they do not want to have intercourse without
birth control, that they want to make love differently or that their
partner is being too rough; and to stop foreplay at any time, including
at the point of intercourse. Many sexually active young women perceive
that they do not have the right to communicate about or control aspects
of their sexual behavior.

They used a pretty small sample for that study: based on what I’ve
observed in talking to young women about sex for the last ten years,
I’d say that way more than 20% of young women have a tough time being

If you want to have satisfying sex and orgasm, you usually have
got to be able to speak the heck up about what you want and need, about
what feels good and what doesn’t, without reservation.
If we’re
close enough to and comfortable enough with someone to be having sex
with them, it really, truly should be no big whoop to say things like,
"Hey, try that a little to the left," or "Can you move a bit more
slowly," or "Let’s switch to this position," or "It feels even better
when you rub my clitoris while we do this," or "Don’t stop doing
exactly that, I think I’m going to come." Personally, I’m of the mind
that if saying those kinds of things isn’t easy-peasy, then it’s best
to slow down with sex and develop that comfort and communication FIRST.
That’s something you can do as you move to sex gradually, too, and one
good way to know if you and yours are really at a point where sex is
going to be likely to be beneficial for y’all.

I know that plenty of young women who come here were reared with the idea that they shouldn’t have
to do that, or that being sexually assertive is somehow unfeminine or
unacceptable, but I’d encourage you to leave that rubbish at the door,
particularly if you’re invested in sex that is satisfying for you. Why
is saying what you want when you want something to avoid, or wish you
didn’t have to do? Channel your inner broad, says I. Speak up, gals.

Know what else? Women aren’t always alone in having these concerns.
I hear plenty of young women worried about boyfriends being responsive
to them if they DO speak up, do voice what they want, do really want to
experiment and explore to find what works, but often enough, we get
letters from boyfriends who are just as concerned as you that you don’t

Take a look at a couple examples:

My girlfriend has never had an orgasm, and I’ve never
really had a problem pleasing ex-girlfriends. It seems like I can get
her almost there, but then she makes me stop because it hurts. I tried
gentle oral sex, but it just seems like right before she is about to
orgasm her clitoris get so sensitive that it has a painful burning
sensation, and i have to stop before she gets there. It will take about
2min before I can touch her without it hurting. After that it just
repeats, and I can never seem to get her to orgasm before her clitoris
becomes over sensitive. I was just wondering what is going on, or what
I can do to help her. I don’t know if it’s psychological or just
physical, but I definately want to fix it for her. Any advice at all
would be much appreciated.

I’ve recently begun dating a young woman in her early
twenties who has been sexually active for several years, since she was
16. She confessed a few days ago that she has never had an orgasm. As
her most recent partner I am almost intimidated by the fact that she
openly knows that she will not orgasm during sex. I foreplay
incessantly to try and maximize her chances of an orgasm, but with no
effect; she says it’s not me, she’s always been like that. My question
may sound ignorant, but it goes like this: Is there anything that I can
do as a partner to maximize, and really maximize, the chances of giving
her an orgasm, or is there a limit to what a partner can do?

See? You can talk to these guys and tell them what feels good. They want to know. Seriously.

And if you don’t know yet, your partners should be open to you
simply saying you want to try a lot of different things to find out.
Since that exploration and experimentation is one of the best parts of
sex, that should be exciting for anyone, not a drag.

And guys, if you’re reading and want to know how to help? Pass some
of this stuff on to your female partners. Let them know you want them
to tell you what to try, and let them know that you’re more than open
to experimenting. Ask a lot of questions and be responsive to the
answers. Reassure them that your goal is pleasure, and that if it feels
good for them and is also something you want to do, you’re down with
it, even if it doesn’t result in orgasm, now or period. Let them know
that your esteem is not so miniscule that you have a problem with her
using her own fingers or a vibrator as part of the sex you have; your
sense of self so underdeveloped that her suggesting one thing feels
better than another isn’t going to upset you. Remember that sexual
activities outside of intercourse really aren’t "foreplay," they’re
other kinds of sex, and more often than not, the kind that are most
satisfying to most women.

For everyone: please remember that sex is really supposed to be fun.
That’s one sexual ideal that isn’t unrealistic. Certainly, it is also
about intimacy, about closeness, often about love, about personal
growth, but just having a good time has a place in all of that, and
just having a good time is going to get you a lot closer to orgasm than
stressing out about it.

And with that, I leave the lot of you with a few links to help — hopefully — put this puppy to bed:

Commentary Economic Justice

The Gender Wage Gap Is Not Women’s Fault, and Here’s the Report That Proves It

Kathleen Geier

The fact is, in every occupation and at every level, women earn less than men doing exactly the same work.

A new report confirms what millions of women already know: that women’s choices are not to blame for the gender wage gap. Instead, researchers at the Economic Policy Institute (EPI), the progressive think tank that issued the report, say that women’s unequal pay is driven by “discrimination, social norms, and other factors beyond women’s control.”

This finding—that the gender pay gap is caused by structural factors rather than women’s occupational choices—is surprisingly controversial. Indeed, in my years as a journalist covering women’s economic issues, the subject that has been most frustrating for me to write about has been the gender gap. (Full disclosure: I’ve worked as a consultant for EPI, though not on this particular report.) No other economic topic I’ve covered has been more widely misunderstood, or has been so outrageously distorted by misrepresentations, half-truths, and lies.

That’s because, for decades, conservatives have energetically promoted the myth that the gender pay gap does not exist. They’ve done such a bang-up job of it that denying the reality of the gap, like denying the reality of global warming, has become an article of faith on the right. Conservative think tanks like the Independent Women’s Forum and the American Enterprise Institute and right-wing writers at outlets like the Wall Street Journal, Breitbart, and the Daily Caller have denounced the gender pay gap as “a lie,” “not the real story,” “a fairy tale,” “a statistical delusion,” and “the myth that won’t die.” Sadly, it is not only right-wing propagandists who are gender wage gap denialists. Far more moderate types like Slate’s Hanna Rosin and the Atlantic’s Derek Thompson have also claimed that the gender wage gap statistic is misleading and exaggerates disparities in earnings.

According to the most recent figures available from the Census Bureau, for every dollar a man makes, a woman makes only 79 cents, a statistic that has barely budged in a decade. And that’s just the gap for women overall; for most women of color, it’s considerably larger. Black women earn only 61 percent of what non-Hispanic white men make, and Latinas earn only 55 percent as much. In a recent survey, U.S. women identified the pay gap as their biggest workplace concern. Yet gender wage gap denialists of a variety of political stripes contend that gender gap statistic—which measures the difference in median annual earnings between men and women who work full-time, year-round—is inaccurate because it does not compare the pay of men and women doing the same work. They argue that when researchers control for traits like experience, type of work, education, and the like, the gender gap evaporates like breath on a window. In short, the denialists frame the gender pay gap as the product not of sexist discrimination, but of women’s freely made choices.

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The EPI study’s co-author, economist Elise Gould, said in an interview with Rewire that she and her colleagues realized the need for the new report when an earlier paper generated controversy on social media. That study had uncovered an “unadjusted”—meaning that it did not control for differences in workplace and personal characteristics—$4 an hour gender wage gap among recent college graduates. Gould said she found this pay disparity “astounding”: “You’re looking at two groups of people, men and women, with virtually the same amount of experience, and yet their wages are so different.” But critics on Twitter, she said, claimed that the wage gap simply reflected the fact that women were choosing lower-paid jobs. “So we wanted to take out this one idea of occupational choice and look at that,” Gould said.

Gould and her co-author Jessica Schieder highlight two important findings in their EPI report. One is that, even within occupations, and even after controlling for observable factors such as education and work experience, the gender wage gap remains stubbornly persistent. As Gould told me, “If you take a man and a woman sitting side by side in a cubicle, doing the same exact job with the same amount of experience and the same amount of education, on average, the man is still going to be paid more than the woman.”

The EPI report cites the work of Harvard economist Claudia Goldin, who looked at the relative weight in the overall wage gap of gender-based pay differences within occupations versus those between occupations. She found that while gender pay disparities between different occupations explain 32 percent of the gap, pay differences within the same occupation account for far more—68 percent, or more than twice as much. In other words, even if we saw equal numbers of men and women in every profession, two-thirds of the gender wage gap would still remain.

And yes, female-dominated professions pay less, but the reasons why are difficult to untangle. It’s a chicken-and-egg phenomenon, the EPI report explains, raising the question: Are women disproportionately nudged into low-status, low-wage occupations, or do these occupations pay low wages simply because it is women who are doing the work?

Historically, “women’s work” has always paid poorly. As scholars such as Paula England have shown, occupations that involve care work, for example, are associated with a wage penalty, even after controlling for other factors. But it’s not only care work that is systematically devalued. So, too, is work in other fields where women workers are a majority—even professions that were not initially dominated by women. The EPI study notes that when more women became park rangers, for example, overall pay in that occupation declined. Conversely, as computer programming became increasingly male-dominated, wages in that sector began to soar.

The second major point that Gould and Schieder emphasize is that a woman’s occupational choice does not occur in a vacuum. It is powerfully shaped by forces like discrimination and social norms. “By the time a woman earns her first dollar, her occupational choice is the culmination of years of education, guidance by mentors, parental expectations, hiring practices, and widespread norms and expectations about work/family balance,” Gould told Rewire. One study cited by Gould and Schieder found that in states where traditional attitudes about gender are more prevalent, girls tend to score higher in reading and lower in math, relative to boys. It’s one of many findings demonstrating that cultural attitudes wield a potent influence on women’s achievement. (Unfortunately, the EPI study does not address racism, xenophobia, or other types of bias that, like sexism, shape individuals’ work choices.)

Parental expectations also play a key role in shaping women’s occupational choices. Research reflected in the EPI study shows that parents are more likely to expect their sons to enter male-dominated science, technology, engineering, and math (often called STEM) fields, as opposed to their daughters. This expectation holds even when their daughters score just as well in math.

Another factor is the culture in male-dominated industries, which can be a huge turn-off to women, especially women of color. In one study of women working in science and technology, Latinas and Black women reported that they were often mistaken for janitors—something that none of the white women in the study had experienced. Another found that 52 percent of highly qualified women working in science and technology ended up leaving those fields, driven out by “hostile work environments and extreme job pressures.”

Among those pressures are excessively long hours, which make it difficult to balance careers with unpaid care work, for which women are disproportionately responsible. Goldin’s research, Gould said, shows that “in jobs that have more temporal flexibility instead of inflexibility and long hours, you do see a smaller gender wage gap.” Women pharmacists, for example, enjoy relatively high pay and a narrow wage gap, which Goldin has linked to flexible work schedules and a professional culture that enables work/life balance. By contrast, the gender pay gap is widest in highest-paying fields such as finance, which disproportionately reward those able to work brutally long hours and be on call 24/7.

Fortunately, remedies for the gender wage gap are at hand. Gould said that strong enforcement of anti-discrimination laws, greater wage transparency (which can be achieved through unions and collective bargaining), and more flexible workplace policies would all help to alleviate gender-based pay inequities. Additional solutions include raising the minimum wage, which would significantly boost the pay of the millions of women disproportionately concentrated in the low-wage sector, and enacting paid family leave, a policy that would be a boon for women struggling to combine work and family. All of these issues are looming increasingly large in our national politics.

But in order to advance these policies, it’s vital to debunk the right’s shameless, decades-long disinformation campaign about the gender gap. The fact is, in every occupation and at every level, women earn less than men doing exactly the same work. The right alleges that the official gender pay gap figure exaggerates the role of discrimination. But even statistics that adjust for occupation and other factors can, in the words of the EPI study, “radically understate the potential for gender discrimination to suppress women’s earnings.”

Contrary to conservatives’ claims, women did not choose to be paid consistently less than men for work that is every bit as valuable to society. But with the right set of policies, we can reverse the tide and bring about some measure of economic justice to the hard-working women of the United States.

Analysis Law and Policy

Do Counselors-in-Training Have the Right to Discriminate Against LGBTQ People?

Greg Lipper

Doctors can't treat their patients with leeches; counselors can't impose their beliefs on patients or harm them using discredited methods. Whatever their views, medical professionals have to treat their clients competently.

Whether they’re bakers, florists, or government clerks, those claiming the right to discriminate against LGBTQ people have repeatedly sought to transform professional services into constitutionally protected religious speech. They have grabbed headlines for refusing, for example, to grant marriage licenses to same-sex couples or to make cakes for same-sex couples’ weddings-all in the name of “religious freedom.”

A bit more quietly, however, a handful of counseling students at public universities have challenged their schools’ nondiscrimination and treatment requirements governing clinical placements. In some cases, they have sought a constitutional right to withhold treatment from LGBTQ clients; in others, they have argued for the right to directly impose their religious and anti-gay views on their clients.

There has been some state legislative maneuvering on this front: Tennessee, for instance, recently enacted a thinly veiled anti-LGBTQ measure that would allow counselors to deny service on account of their “sincerely held principles.” But when it comes to the federal Constitution, providing medical treatment—whether bypass surgery, root canal, or mental-health counseling—isn’t advocacy (religious or otherwise) protected by the First Amendment. Counselors are medical professionals; they are hired to help their clients, no matter their race, religion, or sexual orientation, and no matter the counselors’ beliefs. The government, moreover, may lawfully prevent counselors from harming their clients, and universities in particular have an interest, recognized by the U.S. Supreme Court, in preventing discrimination in school activities and in training their students to work with diverse populations.

The plaintiffs in these cases have nonetheless argued that their schools are unfairly and unconstitutionally targeting them for their religious beliefs. But these students are not being targeted, any more than are business owners who must comply with civil rights laws. Instead, their universities, informed by the rules of the American Counseling Association (ACA)—the leading organization of American professional counselors—merely ask that all students learn to treat diverse populations and to do so in accordance with the standard of care. These plaintiffs, as a result, have yet to win a constitutional right to discriminate against or impose anti-LGBTQ views on actual or prospective clients. But cases persist, and the possibility of conflicting court decisions looms.

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Keeton v. Anderson-Wiley

The first major challenge to university counseling requirements came from Jennifer Keeton, who hoped to receive a master’s degree in school counseling from Augusta State University. As detailed in the 2011 11th Circuit Court of Appeals decision considering her case, Keeton entered her professional training believing that (1) “sexual behavior is the result of personal choice for which individuals are accountable, not inevitable deterministic forces”; (2) “gender is fixed and binary (i.e., male or female), not a social construct or personal choice subject to individual change”; and “homosexuality is a ‘lifestyle,’ not a ‘state of being.'”

It wasn’t those views alone, however, that sunk her educational plans. The problem, rather, was that Keeton wanted to impose her views on her patients. Keeton had told both her classmates and professors about her clinical approach at a university-run clinic, and it wasn’t pretty:

  • She would try to change the sexual orientation of gay clients;
  • If she were counseling a sophomore student in crisis questioning his sexual orientation, she would respond by telling the student that it was not OK to be gay.
  • If a client disclosed that he was gay, she would tell him that his behavior was wrong and try to change it; if she were unsuccessful, she would refer the client to someone who practices “conversion therapy.”

Unsurprisingly, Keeton also told school officials that it would be difficult for her to work with LGBTQ clients.

Keeton’s approach to counseling not only would have flouted the university’s curricular guidelines, but also would have violated the ACA’s Code of Ethics.

Her conduct would have harmed her patients as well. As a school counselor, Keeton would inevitably have to counsel LGBTQ clients: 57 percent of LGBTQ students have sought help from a school professional and 42 percent have sought help from a school counselor. Suicide is the leading cause of death for LGBTQ adolescents; that’s twice or three times the suicide rate afflicting their heterosexual counterparts. And Keeton’s preferred approach to counseling LGBTQ students would harm them: LGBTQ students rejected by trusted authority figures are even more likely to attempt suicide, and anti-gay “conversion therapy” at best doesn’t work and at worst harms patients too.

Seeking to protect the university’s clinical patients and train her to be a licensed mental health professional, university officials asked Keeton to complete a remediation plan before she counseled students in her required clinical practicum. She refused; the university expelled her. In response, the Christian legal group Alliance Defending Freedom sued on her behalf, claiming that the university violated her First Amendment rights to freedom of speech and the free exercise of religion.

The courts disagreed. The trial court ruled against Keeton, and a panel of the U.S. Court of Appeals for the 11th Circuit unanimously upheld the trial court’s ruling. The 11th Circuit explained that Keeton was expelled not because of her religious beliefs, but rather because of her “own statements that she intended to impose her personal religious beliefs on clients and refer clients to conversion therapy, and her own admissions that it would be difficult for her to work with the GLBTQ population and separate her own views from those of the client.” It was Keeton, not the university, who could not separate her personal beliefs from the professional counseling that she provided: “[F]ar from compelling Keeton to profess a belief or change her own beliefs about the morality of homosexuality, [the university] instructs her not to express her personal beliefs regarding the client’s moral values.”

Keeton, in other words, crossed the line between beliefs and conduct. She may believe whatever she likes, but she may not ignore academic and professional requirements designed to protect her clients—especially when serving clients at a university-run clinic.

As the court explained, the First Amendment would not prohibit a medical school from requiring students to perform blood transfusions in their clinical placements, nor would it prohibit a law school from requiring extra ethics training for a student who “expressed an intent to indiscriminately disclose her client’s secrets or violate another of the state bar’s rules.” Doctors can’t treat their patients with leeches; counselors can’t impose their beliefs on patients or harm them using discredited methods. Whatever their views, medical professionals have to treat their clients competently.

Ward v. Polite

The Alliance Defending Freedom’s follow-up case, Ward v. Polite, sought to give counseling students the right to withhold service from LGBTQ patients and also to practice anti-gay “conversion therapy” on those patients. The case’s facts were a bit murkier, and this led the appeals court to send it to trial; as a result, the student ultimately extracted only a modest settlement from the university. But as in Keeton’s case, the court rejected in a 2012 decision the attempt to give counseling students the right to impose their religious views on their clients.

Julea Ward studied counseling at Eastern Michigan University; like Keeton, she was training to be a school counselor. When she reviewed the file for her third client in the required clinical practicum, she realized that he was seeking counseling about a romantic relationship with someone of the same sex. As the Court of Appeals recounted, Ward did not want to counsel the client about this topic, and asked her faculty supervisor “(1) whether she should meet with the client and refer him [to a different counselor] only if it became necessary—only if the counseling session required Ward to affirm the client’s same-sex relationship—or (2) whether the school should reassign the client from the outset.” Although her supervisor reassigned the client, it was the first time in 20 years that one of her students had made such a request. So Ward’s supervisor scheduled a meeting with her.

Then things went off the rails. Ward, explained the court, “reiterated her religious objection to affirming same-sex relationships.” She told university officials that while she had “no problem counseling gay and lesbian clients,” she would counsel them only if “the university did not require her to affirm their sexual orientation.” She also refused to counsel “heterosexual clients about extra-marital sex and adultery in a values-affirming way.” As for the professional rules governing counselors, Ward said, “who’s the [American Counseling Association] to tell me what to do. I answer to a higher power and I’m not selling out God.”

All this led the university to expel Ward, and she sued. She claimed that the university violated her free speech and free exercise rights, and that she had a constitutional right to withhold affirming therapy relating to any same-sex relationships or different-sex relationships outside of marriage. Like Keeton, Ward also argued that the First Amendment prohibited the university from requiring “gay-affirmative therapy” while prohibiting “reparative therapy.” After factual discovery, the trial court dismissed her case.

On appeal before the U.S. Court of Appeals for the Sixth Circuit, Ward eked out a narrow and temporary win: The court held that the case should go to a jury. Because the university did not have a written policy prohibiting referrals, and based on a few troubling faculty statements during Ward’s review, the court ruled that a reasonable jury could potentially find that the university invoked a no-referrals policy “as a pretext for punishing Ward’s religious views and speech.” At the same time, the court recognized that a jury could view the facts less favorably to Ward and rule for the university.

And although the decision appeared to sympathize with Ward’s desire to withhold service from certain types of clients, the court flatly rejected Ward’s sweeping arguments that she had the right to stray from the school curriculum, refuse to counsel LGBTQ clients, or practice anti-gay “conversion therapy.” For one, it said, “Curriculum choices are a form of school speech, giving schools considerable flexibility in designing courses and policies and in enforcing them so long as they amount to reasonable means of furthering legitimate educational ends.” Thus, the problem was “not the adoption of this anti-discrimination policy, the existence of the practicum class or even the values-affirming message the school wants students to understand and practice.” On the contrary, the court emphasized “the [legal] latitude educational institutions—at any level—must have to further legitimate curricular objectives.”

Indeed, the university had good reason to require counseling students—especially those studying to be school counselors—to treat diverse populations. A school counselor who refuses to counsel anyone with regard to nonmarital, nonheterosexual relationships will struggle to find clients: Nearly four in five Americans have had sex by age 21; more than half have done so by the time they turn 18, while only 6 percent of women and 2 percent of men are married by that age.

In any event, withholding service from entire classes of people violates professional ethical rules even for nonschool counselors. Although the ACA permits client referrals in certain circumstances, the agency’s brief in Ward’s case emphasized that counselors may not refuse to treat entire groups. Ward, in sum, “violated the ACA Code of Ethics by refusing to counsel clients who may wish to discuss homosexual relationships, as well as others who fail to comport with her religious teachings, e.g., persons who engage in ‘fornication.'”

But Ward’s approach would have been unethical even if, in theory, she were permitted to withhold service from each and every client seeking counseling related to nonmarital sex (or even marital sex by same-sex couples). Because in many cases, the need for referral would arise well into the counseling relationship. And as the trial court explained, “a client may seek counseling for depression, or issues with their parents, and end up discussing a homosexual relationship.” No matter what the reason, mid-counseling referrals harm clients, and such referrals are even more harmful if they happen because the counselor disapproves of the client.

Fortunately, Ward did not win the sweeping right to harm her clients or otherwise upend professional counseling standards. Rather, the court explained that “the even-handed enforcement of a neutral policy”—such as the ACA’s ethical rules—”is likely to steer clear of the First Amendment’s free-speech and free-exercise protections.” (Full disclosure: I worked on an amicus brief in support of the university when at Americans United.)

Ward’s lawyers pretended that she won the case, but she ended up settling it for relatively little. She received only $75,000; and although the expulsion was removed from her record, she was not reinstated. Without a graduate counseling degree, she cannot become a licensed counselor.

Cash v. Hofherr

The latest anti-gay counseling salvo comes from Andrew Cash, whose April 2016 lawsuit against Missouri State University attempts to rely on yet murkier facts and could wind up, on appeal, in front of the more conservative U.S. Court of Appeals for the Eighth Circuit. In addition to his range of constitutional claims (freedom of speech, free exercise of religion, equal protection of law), he has added a claim under the Missouri Religious Freedom Restoration Act.

The complaint describes Cash as “a Christian with sincerely-held beliefs”—as opposed to insincere ones, apparently—”on issues of morality.” Cash started his graduate counseling program at Missouri State University in September 2007. The program requires a clinical internship, which includes 240 hours of in-person client contact. Cash decided to do his clinical internship at Springfield Marriage and Family Institute, which appeared on the counseling department’s list of approved sites. Far from holding anti-Christian bias, Cash’s instructor agreed that his proposed class presentation on “Christian counseling and its unique approach and value to the Counseling profession” was an “excellent” idea.

But the presentation itself revealed that Cash intended to discriminate against LGBTQ patients. In response to a question during the presentation, the head of the Marriage and Family Institute stated that “he would counsel gay persons as individuals, but not as couples, because of his religious beliefs,” and that he would “refer the couple for counseling to other counselors he knew who did not share his religious views.” Because discrimination on the basis of sexual orientation violates ACA guidelines, the university determined that Cash should not continue counseling at the Marriage and Family Institute and that it would be removed from the approved list of placements. Cash suggested, however, that he should be able to withhold treatment from same-sex couples.

All this took place in 2011. The complaint (both the original and amended versions) evades precisely what happened between 2012 and 2014, when Cash was finally expelled. You get the sense that Cash’s lawyers at the Thomas More Society are trying to yadda-yadda-yadda the most important facts of the case.

In any event, the complaint does acknowledge that when Cash applied for a new internship, he both ignored the university’s instructions that the previous hours were not supposed to count toward his requirement, and appeared to be “still very much defend[ing] his previous internship stating that there was nothing wrong with it”—thus suggesting that he would continue to refuse to counsel same-sex couples. He continued to defend his position in later meetings with school officials; by November 2014, the university removed him from the program.

Yet in challenging this expulsion, Cash’s complaint says that he was merely “expressing his Christian worldview regarding a hypothetical situation concerning whether he would provide counseling services to a gay/homosexual couple.”

That’s more than just a worldview, though. It also reflects his intent to discriminate against a class of people—in a manner that violates his program’s requirements and the ACA guidelines. Whether hypothetically or otherwise, Cash stated and reiterated that he would withhold treatment from same-sex couples. A law student who stated, as part of his clinic, that he would refuse to represent Christian clients would be announcing his intent to violate the rules of professional responsibility, and the law school could and would remove him from the school’s legal clinic. And they could and would do so even if a Christian client had yet to walk in the door.

But maybe this was just a big misunderstanding, and Cash would, in practice, be willing and able to counsel same-sex couples? Not so, said Cash’s lawyer from the Thomas More Society, speaking about the case to Christian news outlet WORLD: “I think Christians have to go on the offensive, or it’s going to be a situation like Sodom and Gomorrah in the Bible, where you aren’t safe to have a guest in your home, with the demands of the gay mob.” Yikes.

Although Cash seems to want a maximalist decision allowing counselors and counseling students to withhold service from LGBTQ couples, it remains to be seen how the case will turn out. The complaint appears to elide two years’ worth of key facts in order to present Cash’s claims as sympathetically as possible; even if the trial court were to rule in favor of the university after more factual development, Cash would have the opportunity to appeal to the U.S. Court of Appeals for the Eighth Circuit, one of the country’s most conservative federal appeals courts.

More generally, we’re still early in the legal battles over attempts to use religious freedom rights as grounds to discriminate; only a few courts across the country have weighed in. So no matter how extreme Cash or his lawyers may seem, it’s too early to count them out.

* * *

The cases brought by Keeton, Ward, and Cash not only attempt to undermine anti-discrimination policies. They also seek to change the nature of the counselor-client relationship. Current norms provide that a counselor is a professional who provides a service to a client. But the plaintiffs in these cases seem to think that counseling a patient is no different than lecturing a passerby in the town square, in that counseling a patient necessarily involves expressing the counselor’s personal and religious beliefs. Courts have thus far rejected these attempts to redefine the counselor-patient relationship, just as they have turned away attempts to challenge bans on “reparative therapy.”

The principles underlying the courts’ decisions protect more than just LGBTQ clients. As the 11th Circuit explained in Keeton, the university trains students to “be competent to work with all populations, and that all students not impose their personal religious values on their clients, whether, for instance, they believe that persons ought to be Christians rather than Muslims, Jews or atheists, or that homosexuality is moral or immoral.” Licensed professionals are supposed to help their clients, not treat them as prospective converts.