Introduction
In this post-Christian, postmodern world, faith-based clinicians, educators, trainers, and students are being threatened with censorship, denial of dissertation proposals, loss of professional license, loss of school accreditation, and more. To address these threats, a diverse group of over 80 Christian stakeholders in the mental health professions gathered for “The Road Forward Religious Liberty Summit” in July 2022. Participants were divided into six groups that focused on these critical interest areas: Legal and Legislative, Education and Research, Ethical Standards and Guidelines, Clinical Service Providers, Advocacy and Public Policy, and Public Relations. Each group conducted a SWOT Analysis (Strengths, Weaknesses, Opportunities, and Threats) and recommended immediate steps and long-term goals for their chosen areas.
The main discussion points were summarized across interest area and SWOT analysis issues and placed in a 6 x 6 matrix consisting of a total of 392 summary bullet points. Points raised in discussion groups were analyzed for emergent themes. These themes were then reviewed to identify composite themes by interest area and by issue. Finally, a grand theme emerged from the composite themes. Interest area composite themes included: (1) Stand and Defend (Legal & Legislative); (2) Equip and Explain (Education & Research); (3) Establish and Protect (Ethical Standards & Guidelines); (4) Master and Heal (Clinical Service Providers); (5) Advance and Secure (Advocacy & Public Policy); and (6) Identify and Invite (Public Relations). Issue composite themes included: (1) Strengths: For Such a Time as This; (2) Weaknesses: A House Divided; (3) Opportunities: Seek First Things First; (4) Threats: Conflicts Without, Fears Within; (5) Immediate Steps: Let Your Yes be Yes; and (6) Long-term Goals: Build on the Rock. The Grand Theme that emerged was Be Bold & Courageous. Work began on a white paper entitled In Good Faith: Addressing Challenges to Religious Liberty in the Mental Health Profession.
In July 2023, there was a second gathering of nearly 70 participants for The Road Forward: Religious Freedom in Mental Health Leadership Summit II. This was a working conference intended to accomplish two main tasks: (1) to collate literature reviews and annotated bibliographies in each of the six areas that addressed the themes that had emerged during the first summit; and (2) to develop a one- to two-page consensus document that elucidated and expanded the themes for each interest area across the six issues. This information helped further contribute to the foundation of the In Good Faith: Addressing Challenges to Religious Liberty in the Mental Health Profession white paper.
The Road Forward Summit III: Operation Engagement and Mobilization met in July 2024 with nearly 60 participants in attendance to focus on (1) updating attendees on religious liberty issues and threats in the faith-based mental health field; and (2) presenting the current version of the In Good Faith white paper for dissemination. Participants in each interest area met with participants in the other interest areas to articulate and defend our position in the mental health profession, to collaborate and strategize action steps, and to establish and mobilize the community of faith-based mental health professionals under one unified front.
Key findings and salient results from the SWOT analysis created by each interest area are summarized and discussed below. Interest area composite themes are identified followed by descriptions, challenges, and action steps intended to address the challenges within each area. The issue composite themes are not included here but will be expanded upon in another issue.
Legal and Legislative; (Stand and Defend)
Faith-based mental health professionals have many strengths working to their advantage in the legal realm. The first and most notable strength is the protection afforded to them under the U.S. Constitution (U.S. Const. amend. I). Freedom of speech is a guaranteed right under the First Amendment, as is the right of individual freedom of conscience and freedom to adhere to such religious organization or form of worship as the individual may choose under the Free Exercise clause (Cantwell v. Connecticut, 1940). At the heart of both guaranteed rights is the principle that each person should decide for themselves the ideas and beliefs deserving of expression, consideration, and adherence (Turner Broad Sys., Inc. v. FCC, 1994). Despite a world of increasing social restriction and political correctness our court system, going all the way up to the Supreme Court, has continually held in favor of freedom (e.g., 303 Creative v. Elenis, 2023; Hurley v. Irish American Gay, 1995; and Brush and Nib Studio v. City of Phoenix, 2019). As a result, Americans experience more protection for speech and religious exercise now than we have in the history of our nation.
Another protection afforded faith-based mental health professionals comes in the form of health care rights of conscience bills. Seven states have passed these bills, which provide that a health care provider or health care institution shall not be required to participate in a health care service that violates their conscience. These bills define conscience broadly, holding that “conscience” means a sincerely held set of moral convictions arising from belief in and relation to God, or to which, though not so derived, arises from a place in the life of its possessor parallel to that filled by God among adherents to religious faiths (Goodrich v. Good Samaritan Reg’l Health Ctr, 2023). These bills also provide immunity for such action against the government and prohibit discrimination for such action by the government, employers, or insurance companies. These bills hold generally in part that: It shall be unlawful for any person, health care provider, health care institution, public or private institution, public official, or any board that certifies competency in medical specialties to discriminate against any health care provider in any manner based on his or her declining to participate in a health care service that violates his or her conscience (Mississippi Health Care Rights of Conscience Act, 2004).
One of the most vexing issues in this area is the line between faith-based mental health professionals’ words being considered “professional conduct” rather than “speech.” Courts have used this distinction to justify upholding regulations which banned mental health providers from engaging in sexual orientation change efforts (SOCE) with patients under 18 years of age. Because of this decision, mental health professionals who seek to enjoin or prevent enforcement of similar regulations are restricted by this ruling until state legislatures pass laws striking down the current regulations, or the U.S. Supreme Court decides rulings of this type are unconstitutional.
Faith-based mental health professionals should continue to act according to their deeply held religious beliefs. Attorneys should collaborate with educational, training, and credentialing programs to inform mental health professionals on their legal rights and protections of their sincerely held religious beliefs that manifest in their professional activities. They should also equip faith-based mental health professionals to defend their pre-established Constitutional rights before such an occasion should arise to do so.
Education and Research; (Equip and Explain)
Given the market demand for mental health services that incorporate clients’ religious and spiritual values, faith-based educational institutions are uniquely positioned to offer clinical training integrated with a faith-congruent and/or faith-based worldview that seeks to equip graduates to competently enter the mental health professions. For example, inclusion of the Christian worldview is vital to the pursuit and proclamation of truth within the mental health profession.
Unfortunately, the effectiveness and importance of faith-based mental health assistance has not been effectively disseminated both to the profession and to potential clients. Contributing factors include the within-group variations on how faith-based mental health professionals practice, the lack of collaboration among faith-based professional organizations, the ambivalent relationship between faith-based mental health care and various institutions of faith, and resistance from the secular professional community. The need exists for increased production of evidence-based research on faith-based approaches to mental health care, and interdisciplinary relationships among faith-based professionals in responding to needs and opportunities.
Real and existential threats, both external and internal, exist that have polarizing and divisive effects. Externally, a secular culture’s projected stereotypes of faith-based mental health care and, internally, a misunderstanding of what faith-informed mental health care involves threaten to marginalize mental health professionals. For example, non-faith-based mental health professionals have entreated accreditation entities to remove approval from faith-based institutions due to their perceived bias within their code of conduct for students. Furthermore, accreditation bodies require faith-based institutions to put forth an inequitably strenuous effort to comport their worldview, mission, and purpose to establish their foundation for accreditation.
Due to the importance of worldview in education, all higher educational institutions, religious or not, need to be explicit about their worldview, mission, and purpose to establish their foundation for accreditation. Those with a religiously informed worldview should initiate the process of creating a recognized accrediting body for faith-based institutions and identify faith-based organizations and individuals willing to support and finance research grants specifically for faith-based mental health care and the protection of faith-based client welfare and pursuit of self-determination. Faith-based institutions need to unite in their efforts toward common goals and mobilize to equip faith leaders, both professional and laity, to respond to the mental health needs that are rapidly increasing.
Ethical Standards and Guidelines; (Establish and Protect)
There is a primary need to provide an ethical foundation, framework, and process that helps to establish and protect faith-based mental health professionals in their work. However, a house divided against itself cannot stand, and a primary weakness appears to be that the faith-based mental health profession is at risk of collapsing. The lack of a consistent, clear, and scripturally informed worldview across training and practice produces fear and confusion among faith-based mental health professionals. As a result, there is a lack of ethical cohesion across the profession and the interpretation and application of ethical standards and guidelines. Moreover, faith-based mental health professionals are not clear and forthright about how their worldview impacts practice. Finally, faith-based mental health professionals have no clear self-regulating and disciplinary functioning body to monitor such issues.
The AACC Code of Ethics (American Association of Christian Counselors, 2023) provides a strong and detailed foundation for Christian mental health professionals regarding the boundaries and application of biblical and ethical guidelines in practice. Commitment to and use of the AACC Code of Ethics by Christians across mental health professionals can help to increase understanding of biblical truth, clarity in professional practice, and serve as a foundation upon which to build consistency in education, training, and professional identity. The AACC Code of Ethics provides professional and doctrinal clarity that can lead to greater unity for Christian mental health professionals and security for the public regarding the positions and practices of such clinicians. Consistent understanding and application of the AACC Code of Ethics can strengthen ethical processing and decision-making in both training and clinical practice. As Christian mental health professionals understand and use the code in practice, biblical principles and worldview will increasingly drive critical thinking and ethical decision-making. Current cultural and legal challenges can spur Christian mental health professionals to strengthen theory, theology, ethics, and advocacy as practitioners. While the AACC code is specific to the Christian religion, it could serve as a model for mental health professionals and organizations of other faiths.
Religion, faith, and spirituality underlie both ethics and ethical decision-making in the lives of clients and mental health professionals. For example, clients may have conflicts between their religious values and their sexual attractions or experience of gender dysphoria. It is important for them to process these issues in a way that addresses their beliefs and values without a mental health professional predetermining a specific outcome. However, those who adopt a gay affirmative only or trans-affirmative only therapy approach have an outsized influence on professional organizations and associations, licensure boards, and ethical codes and often use their positions to silence, disenfranchise, or even eliminate those who do not ascribe to their worldviews or positions.
Faith-based mental health professionals should improve communication and collaboration among professionals across disciplines and faiths regarding the current ethical issues and challenges. Steps should be taken to activate and mobilize those within the faith-based mental health professions to participate in advocacy, regulatory, and equipping efforts.
Clinical Service Providers; (Master and Heal)
There are many strengths in the area of faith-based mental health practice. For example, Christian practice is anchored in the unwavering truth of Jesus Christ as compared to moral relativism. Christian mental health professionals have moral standards they abide by that govern their behavior of right and wrong. Religion and spirituality are also vital components in the research and practice of therapy that make a marked positive difference in the mental health of clients. Another strength is that the applied research in faith-based mental health is diverse. It includes culturally relevant topics that inform ethical practice with multiple populations who seek out faith-affirming treatments. Finally, faith-based mental health practices are evidence-based and are regularly used in practice to treat faith-based clients.
However, there is a lack of unity and consensus in faith-based mental health practices. This is, in part, due to the within group variance of different faiths and their goals for mental health. For example, within the Christian faith, mental health practices may be disconnected from the pre-eminence of Jesus Christ. In addition, there is an overall lack of communication and awareness of current issues that affect faith-based mental health practitioners, which thereby impedes a unified response.
Faith-based mental health professionals need to help educate the public about how mental health care can incorporate faith and have a dramatic impact on an individual’s mental healing and spiritual growth. In addition, faith-based mental health professionals can unify and create coherent bodies to develop consistent worldviews according to their faiths, from which they can view and understand clients and treatments. Such professionals can also serve on state boards and professional associations to influence and present the faith-based perspective.
Tragically an existential threat exists to the faith-based mental health professions because sincerely held religious beliefs and values are viewed as discriminatory and, as a result, unethical. Licensing boards, professional organizations, and training standards are increasingly hostile to faith-based mental health professionals. They are being threatened with expulsions and sanctions that jeopardize their livelihood and service to a public that seeks their services.
There is an urgent need to centralize leading faith-based educators, mental health providers, and faith leaders, as well as distinguish the scripturally informed faith-based worldview and its implications for mental health practice, education, and training. For example, those of the Christian faith must develop a specific definition of Christian counseling that includes the non-negotiables of the Christian faith and how the non-negotiables are relevant to mental, emotional, relational, behavioral, and psychological health. Faith-based mental health professionals must gather research that affirms and validates how each worldview is tied to effective theory and research and then articulate how this is executed in faith-based mental health care. Faith-based mental health professionals need to educate other faith-based clinicians with the knowledge and skills in faith-based treatments and how to be bold in offering them and using them with appropriate clients.
Advocacy and Public Policy; (Advance and Secure)
An important strength for the faith-based mental health profession is that state and federal laws and regulations are currently relatively supportive and protective of religious liberty. In addition, competent individuals and organizations are already actively addressing key issues in this arena. For example, the Christian Employers Alliance has the mission “to unite, equip, and represent Christian-owned businesses to protect religious freedom and provide the opportunity for employees, businesses, and communities to flourish” (Christian Employers Alliance, 2023). Finally, because several mental health professionals have been targeted for their faith, their personal stories have and can continue to motivate people to action.
Unfortunately, there is a sense of vulnerability and powerlessness within the faith-based mental health profession. For example, most faith-based mental health providers fear suspension or revocation of their licenses if they speak out or fight against any law or ordinance that violates their religious beliefs. This impression is rooted in a lack of understanding and education of their basic rights as a citizen of the United States. In addition, there is a strong cultural pressure in the professional mental health community to suppress religious values and conform to a humanistic worldview. As a result, the religious and spiritual voice is being eliminated from the professional forum. Moreover, advocacy and public policy groups tend to be single-issue focused in their mission and operations, which lends itself to a myopic view of the mental health profession as a whole.
A number of opportunities exist to advocate for the faith-based mental health profession. Because many individuals seek integration of their values and beliefs in mental health practice, they should be willing to support and advocate for religious liberty in this arena. Resources exist to promote the engagement of mental health professionals and clients in this religious liberty campaign. Battles to protect religious liberty have been publicized in the media and have garnered attention nationwide. For example, the United States Supreme Court holdings have recently barred government encroachment on freedom of speech and freedom of expression specifically. This has inspired a wave of advocacy amongst both public and private institutions seeking to capitalize on this progress.
A perpetual threat to faith-based mental health professionals is potential defamation and retaliation they would receive if they engaged in advocacy work. This ultimately affects their reputations, careers, and livelihoods. This has created legitimate fear in faith-based practitioners who otherwise might speak out. Moreover, numerous public policies, such as President Biden’s Executive Order on Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, Intersex Individuals (Executive Order No. 14,075, 2022), exist to shut down their voices.
Faith-based mental health professionals need to use current resources to educate and mobilize other faith-based mental health professionals on the issues related to religious liberty in the field. Current advocates need to be identified and coordinated to create a focused public education effort on these issues. For example, Christian mental health professionals can begin to educate Christian college students and churches on engaging in the civics process and how to be a part of change within their professions. Faith-based mental health professionals need to be educated and recruited to be involved in public policy efforts, including legislation and litigation. For example, training faith-based mental health professionals in how to give testimonies at legislative hearings and how to provide competent and impactful media interviews is critical. Faith-based mental health professionals also need to be encouraged to be more involved in research production and dissemination. Obtaining financial resources for advocacy and public policy efforts needs to be developed through donor identification and public awareness. Secular mental health advocates have been actively and relentlessly engaging in this arena while faith-based mental health proponents need to gain more traction. Finally, equally recognized, faith-based licensing and accreditation options for mental health professionals need to be considered.
Public Relations; (Identify and Invite)
Faith-based mental health professionals are becoming equipped to educate and mobilize others to respond effectively to the challenges to religious liberty in the mental health field. There are opportunities to engage groups of faith-based mental health professionals to recognize the threat to their right to practice and mobilize those who have experienced the benefits of faith-based mental health care and want to protect access to those services. Public relations campaigns can focus on the message of why faith-based mental health professionals are needed to address the mental health crisis in the United States, why they are currently facing an existential threat, and how the public will suffer irreparable harm if they are not protected.
Accreditation agencies and licensing boards have adopted standards that violate a faith-based professional’s religious liberty by restricting or censoring speech. The threat to silencing the voice of this now marginalized group is real. The dominant message in the culture is that people of faith are uneducated, discriminatory, and bigoted haters. The longer this narrative continues without a strong, contradictory, and truthful rebuttal, the more these lies will be perpetuated and, ultimately, destroy the profession.
As the public face of this mission, the first step is to formulate a plan that engages the members of the faith-based mental health profession and the community at large—for example, establishing “My Christian Mental Health Professional” as a public relations strategy to engage those who have benefitted from Christian counseling to share their stories publicly. This can create a groundswell of support for the profession as well as place a positive spin on the Christian counseling narrative. Next, faith-based mental health professionals must identify like-minded supporters and organizations who share their goals and invite them to join the initiative. Faith-based mental health professionals need to utilize organizations like the AACC to provide education, knowledge, and tools to fight for religious liberty. Faith-based mental health professionals also need to create relationships in order to engage with policymakers and legislators to advocate for the inclusion of faith-based mental health services in healthcare systems, insurance plans, and public programs.
Conclusion
This special feature has provided a summary of efforts intended to address challenges to religious liberty in the mental health professions. The In Good Faith white paper is one means of enhancing the quality and influence of the mental health profession. At each of the Road Forward Summits, faith-based stakeholders expressed love and identification with the mental health professionals to which most believe are divinely called. It is unfortunate that radical activist factions within the mental health profession who are hostile to conservatively religious educators and practitioners have too much influence over professional training, identity, ethics, and the narrative within the culture. It is therefore imperative that all faith-based mental professionals be bold and courageous in who they are, what they do, who they work for, and ultimately in their commitment to their Creator. Contributors to the Road Forward and In Good Faith efforts remain hopeful for peaceable and equitable outcomes regarding challenges to religious liberty within the mental health profession.
The authors would like to thank the members of The Road Forward Summits for their contributions to the SWAT analysis, immediate step, long-term goals, and portions of the In Good Faith white paper.
References
303 v. Elenis (2023). 143 S. Ct. 2298.
American Association of Christian Counseling (2023). AACC Code of Ethics. https://eusyx65ph6e.exactdn.com/wp-content/uploads/2023/02/AACC-Y-2023-Code-of-Ethics-FINAL-Draft.pdf
Brush and Nib Studio v. City of Phoenix, 247 Ariz. 269 (2019).
Cantwell v. Connecticut, 310 U.S. 296 at 303 (1940).
Christian Employers Alliance. (2023, September 8). About Us. https://christianemployersalliance.org/about-us/
Executive Order No. 14075, 87 FR 37189 (June 15, 2022). https://www.federalregister.gov/documents/2022/06/21/2022-13391/advancing-equality-for-lesbian-gay-bisexual-transgender-queer-and-intersex-individuals
Goodrich v. Good Samaritan Reg’l Health Ctr. 2023 U.S. Dist. LEXIS 70379 (S.D. Ill. Apr. 21, 2023).
Hurley v. Irish American Gay 515 U.S. 557 (1995).
Mississippi Health Care Rights of Conscience Act, 2004 Miss. S.B. 2619.
Turner Broad Sys., Inc. v. FCC, 512 U.S. 622, 641 (1994).
U.S. Const. amend. I.