Other Sexual Health

Talking to Youth about Sex and STDs

Brady Swenson

Talking to Youth about Sex and STDs Mary Beth Szydlowski • Donna Harwood • Barb Flis and Becky Griesse

Talking to Youth about Sex and STDs

Mary Beth SzydlowskiDonna HarwoodBarb Flis and Becky Griesse

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.

Commentary Sexuality

Auntie Conversations: Black Women Talk Sex, Self-Care, and Illness

Charmaine Lang

These auntie conversations were just as much about me as they were about my aunts and mama. I really want to know what to expect, what to anticipate, and perhaps, even, what not to do as I age and grow in relationships so that I, too, can have a fulfilling and healthy partnership.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

“You’re just being nosy,” one of my aunts said, after I asked her if she enjoyed having sex with her husband. I assured her this was all part of a research project on the intimate lives of Black women. She relented a bit, but still gave me the side-eye.

I’ve been engaged in archival research for the last year. While the personal letters of Black women writer-activists and the newspapers of the Third World Women’s Alliance are remarkable and informative, they provide little insight into the intimate lives and sexual desires of Black women. After all, sex improves our mood and alleviates stress: That immediate gratification of pleasure and release is a way to practice self-care.

So on a recent trip home to Los Angeles, I asked my aunties to share their stories with me at a little gathering they threw in my honor.

And they did.

I asked them: “What’s your sex life like?” “Do you want to have sex?” “Are you and your husband intimate?” “You know … does he kiss you and hold your hand?” And I learned that contrary to tropes that present us as either asexual mammies or hypersexual jezebels, the Black women in my life are vulnerable and wanting love and loving partners, at all stages of life.

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Between 1952 and 1969, my maternal grandmother had six daughters and one son. All of them grew up in South Central Los Angeles, witnessing white flight, the Watts riot of 1965, and the crack epidemic. At the same time, the women have kept the family intact. They are the ones who always plan big dinners for the holidays and organize food drives for their churches. And they arranged care of their mother toward the end of her life. I’ve always wondered how they were able to prioritize family and their own desires for intimacy.

So I asked.

My 57-year-old aunt who is a retired customer service representative living in Pomona, California, told me: “My lifetime of sex consisted of first starting off with getting to know the person, communicating, establishing companionship. Once that was done, the sex and intimacy followed. When you’re younger, you have no frets. You experiment all the time.”

I wanted to know more.

“You’re not just trying to get in our business? You’re actually going to write something, right?” was my mother’s response.

When asked about the state of her sex life, my 59-year-old aunt, a social worker, said: “I am a married woman without a physical sex life with my husband. His illness has a lot to do with this, along with the aging process.”

My Pomona aunt went into more detail about how as we get older our ability and desire changes.

“You try to keep pace with pleasing your partner, and he tries to please you. But it is hard when you are a full-time worker, wife, and mother, and you commute to work. You’re tired. Hear me: You’re tired; they are not. You grow older, gain weight, and get sicker. You start to take medicine, and all that affects your ability and desire to perform.”

“For me, in a nutshell, [sexual activity] feels like work: I don’t feel excited. When it happens, it happens,” she said.

I learned the combination of energy spent on wage work, domestic labor, and mothering is draining, dissipating the mood for sex or intimacy. A husband who does not have the same domestic responsibilities has more energy for sex. The unbalanced load equates to differences in desire.

I wondered: Did my aunts talk to their partners about this?

Illnesses, such as diabetes and cancer, can cause anxiety, depression, and fatigue, which interrupt lovemaking. Talking to a partner can help to create a new normal in the relationship.

However, as my social worker aunt made clear, “It takes two to talk openly and honestly, which I find very difficult most of the time.”

“To be vulnerable is hard because I do not want to get hurt emotionally, so I protect my heart from harm,” she explained. “[My husband and I] can be harsh and curt to each other at times, which leads to me shutting down and not expressing my true feelings. My husband can be prideful and unwilling to admit there are issues within the relationship.”

Aunt April, a 47-year-old Los Angeles teacher, had some things to share too. “My love life is complicated. After suffering an overwhelming and devastating loss in 2011 of my husband and mate of nearly 20 years, I’m very hesitant to fully try again.”

She hasn’t dated since 1991. After much counseling, grieving, and encouragement from her 12-year-old daughter, she decided to give it a try.

“I have been seeing someone, but I have a lot of fear that if I relinquish my heart to him, he will die. So, I think about sabotaging the relationship so that I don’t have to get to know him and start worrying about his well-being and wondering if he feels the same way I do. In my mind, it’s easier to be casual and not give too much of my heart,” she said.

Intimacy, then, is also about being vulnerable in communicating how one feels—and open to all possibilities, even hurt.

As a 34-year-old queer Black woman figuring out my dating life, my aunt’s words about communication struck me. At times I can be guarded, too, fearful of letting someone get close. I started to ask myself: “What’s my sex life like?” and “What role does intimacy play in my life as I juggle a job and doctoral studies?”

These auntie conversations were just as much about me as they were about my aunts and mama. I really want to know what to expect, what to anticipate, and perhaps, even, what not to do as I age and grow in relationships so that I, too, can have a fulfilling and healthy partnership.

“I enjoy sex more now then I did before,” my mama, Jackie, said. Now 55, she remarried in 2013. She lives in Gilbert, Arizona, and works in the accounting and human resource field. “My husband loves me unconditionally; with him, I’m more comfortable. It’s more relaxing.”

My mama expressed her ability to enjoy herself with her husband because of the work she put into loving herself and prioritizing her needs.

I always talk to my mama about my dating life: heartbreaks and goals. She always says, “Learn to love yourself first.” It really isn’t what I want to hear, but it’s the truth. Self-love is important and central to the success of any relationship, especially the one with ourselves. My social worker aunt often takes trips to the spa and movies, and my aunt April is an avid concertgoer. They have found ways to have intimacy in their lives that is not informed by their relationship status.

The journey to self-love can be arduous at times as we discover parts of ourselves that we don’t like and want to transform. But with much compassion and patience, we can learn to be generous with the deepest parts of ourselves and each other. And isn’t that a necessary part of intimacy and sex?

The stories shared by my womenfolk reveal a side of Black women not often seen in pop culture. That is, Black women older than 45 learning how to date after the loss of a partner, and finding love and being intimate after 50. Neither mammies nor jezebels, these Black women, much like the Black women activists of the 1960s and 1970s I study, desire full lives, tenderness, and love. My aunts’ stories reassure me that Black women activists from decades past and present have intimate relationships, even if not explicit in the body of literature about them.

The stories of everyday Black women are essential in disrupting dehumanizing stereotypes so that we can begin to see representations of Black women that truly reflect our experiences and dynamic being.