I started my Clinical Counseling Master's Program. I have a question for any Catholic Counselors out there

This can be answered by any Catholic/Christian in the field, but I’m really curious.

I had my first “Multiculturalism in Counseling” class last week. I’m not sure what to really take from it. However it did really get me thinking about a lot of the instructors examples regarding LGBTQ+ and transgenderism.

How does a Catholic approach these issues?

My best guess is that sexuality usually won’t be such a major issue, but the area I live in has really started to “flourish” in terms of folks who identify with the LGBTQ crowd along with a lot of transgender ideologies. I feel like when I do become a LMFT, I’ll run into a number of issues where someone believes that transitioning is what they believe will make them happiest. As a clinical counselor, is it my job to let them do that? Is it my job to adhere to their pronoun choices? I feel like that is me, as a devout Catholic, setting aside my inherent values to do a job. Is this though process wrong?

I’m really excited about being a counselor, but I feel I may run into a lot of issues like this. What would be your suggestions?

Thanks so much! God Bless, all.

Excellent question. Not a psychologist here (or in the US, I’m in Australia), but I practised as a clinical gerontologist for several years.

Firstly, some general thoughts.

In respect to areas where there are moral clashes, it’s helpful to keep in mind: (1) your professional licensing board’s regulations; (2) where you work and the organisational policies that govern your practice; (3) the relevant legislation in your jurisdiction (I assume in the US it’s primarily state and federal).

Depending on what action you take, you may fall afoul of either (1), (2) and/or (3), which could expose you to legal action (e.g. negligence) either by the client and/or your employeer in addition to whatever sanctions your licensing board may have.

If you feel uncomfortable with the case, you may refer the client to someone else and/or ask your manager to reassign the case if possible.

Secondly, in respect to LGBTQ policies. In general, I find that this crops up far less than is assumed: they have health professionals (whether counsellors, doctors, social workers, etc.) that specialise in their community and so their first recourse is often to them rather than to a general practitioner in the community.

Aside from that, there are no easy answers that results in both you and the client being mutually satisfied. I don’t see myself as setting my particular religious, moral or ethical values aside when I worked with a client, given that my values suffuse and enrich my practice, and I hope that this is for the benefit of my clients.

However, I did take care to prioritise the patient’s values and goals in respect to their health. It’s a “client-centered practice”, as it were. It’s not so much about what I think is best (or worst) and making a judgement on their decision, but about presenting the clinical information as accurately and intelligibly as possible to the client to ensure that they’re able to weigh up the evidence, their own life circumstsances and so arrive at an informed decision. Sometimes this involves a patient making a decision with which I would vehemently disagree, but nonetheless I respected.

A common example I came across in my work was regarding the discharge destination of elderly patients who had unsuccessfully undergone physiotherapy/occupational therapy after an accident. It was clear, sometimes, that it simply wasn’t safe for them to go home due to their limited mobility and the lack of care arrangements. The only viable place for them to go was into a nursing home. Many of the patients disagreed, many of their children disagreed, and much of the time the patient said “I’d rather die at home tomorrow by falling over than live out the rest of my days in a death factory”.

I disagreed vociferously, but after negotiation and discussion it was something that I accepted: their life, their health, their decision.

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I forgot to add this to my previous post.

I’m not sure if you’ve previously worked in counseling or in another clinical setting. But many frontline health professionals often undertake regular “external supervision” with someone outside of the organisation, usually a more senior professional. The purpose of the “external supervision” is to essentially “lay all bare”, in terms of the difficulties, ethical dilemmas and whatnot with a view to improving their clinical practice.

This is different from whatever internal supervision that takes place inside your organisation with your manager (or whomever else). Sometimes workplace cultures just suck, and internal supervision has little-to-no benefit as your manager just lacks insight or empathy with your values. This is often where external supervision is highly valuable.

In respect to external supervision, I think it’d be helpful enquiring with your professional licensing board to see if they might have local contact information for a Catholic clinical psychologist.

Get a Catholic clinical supervisor who has the licensure you’re pursuing and listen to what he/she has to say. And keep in mind that the laws around this sort of thing vary from state to state.

You have some good advice already, but I’ll add a couple of additional thoughts.

First, your code of ethics will require you either to work with people where they are or disclose that you are unable to do so. Second, agencies often set their own policies; for example, if you end up employed by Catholic Charities, you would not be allowed to refer out for an abortion or gender reassignment. Finally, I recommend that you consult with professionals in the field. https://www.catholicpsychotherapy.org/

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Not to overlook Catholic Dr. Gregory Popcak and others at the Pastoral Solutions Institute.

I can’t imagine licensing orgs for Counselors to permit screening out people who live lives that you find troubling. If you cannot counsel every person with compassion even if they are not perfect, find a different career.

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Personally, I’m wondering if there’s the possibility that your employer will allow you to refer out clients that ask for things that go against your conscience.

I’m hoping to get into the mental health field myself in some capacity; so I find this thread interesting.

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To be fair to the OP, I don’t think this is what they’re suggesting to do. They’re more seeking advice on how to remain true to their values but nonetheless work productively with clients.

But I do agree with you that one needs an abundance of compassion in any sort of frontline role involving mental health.

It really does vary from employer to employer and role to role. Some organisations will only allow it when the case is beyond one’s expertise or when there is a serious ethical issue (ie you know the client personally). Difference of values or discomfort is rarely allowed as it establishes a bad precedent: everyone will want the agreeable cases and the buck will be repeatedly passed for the most challenging clients, who often are the ones most in need of assistance.

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To be fair to the OP, I don’t think this is what they’re suggesting to do. They’re more seeking advice on how to remain true to their values but nonetheless work productively with clients.
But I do agree with you that one needs an abundance of compassion in any sort of frontline role involving mental health.

Yes. Perhaps I could have been more thorough in that regard. I’m highly empathetic and highly compassionate to all plights, be it sexuality, anxiety, depression, etc. I just want to ensure I can retain my inherent virtues.

Everyone has shared some great things here. My Diocese had a list of Catholic counselors and I reached out to one. Perhaps they’ll be able to give me the extra help I’m looking for.

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Love them. Respect them.

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You’re getting a lot of advice from folks who are not clinicians, so I will repeat what I said above: Get a Catholic clinical supervisor who has the licensure you’re pursuing and listen to what he/she has to say. And keep in mind that the laws around this sort of thing vary from state to state.

No mental health professional expects to work with perfect clients (nor is perfect themselves). However, the issues being raised here are more complex than a layperson with no training might imagine.

Here’s JUST one twist: there are therapists who are LGBTQ+ who might not be able to work with heterosexual clients because of their own feelings towards straight folks. Again, this gets very complicated, and the OP should be commended for their desire to do right by their clients no matter who they are, while remaining a faithful Catholic.

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This.

It’s one thing to treat anxiety or depression in an individual, regardless of the person’s orientation.

But what if the person in an irregular relationship wants advice on how to strengthen that relationship?
And to be fair, this holds for heterosexuals, too. (“My live-in paramour isn’t paying their share of the rent and generally slacks off. What should I do?”)
Should we be helping them with this type of problem?
Or if they come to you about sexual intimacy issues and they’re not married.

I can see where this would be a potential land mine.

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I’m not doing a graduate degree in psychology yet, but I was always told that counselors must be neutral ad possible. So you won’t encourage or discourage them from the procedure, you would have to guide them into exploring their all choices and let them choose for themselves (same with abortion). As for pronouns, that’s tricky. I don’t think you would have to use pronouns when you’re talking directly but i imagine case notes would be a problem. This was what my professor told me, who is Catholic and has worked as a counselor before. I don’t know if he’s a practicing Catholic though. But he always emphasised on being absolutely neutral.

I’m interested in what Catholic professionals do in these situations, if they’re working in secular institutions.

I’m Catholic and worked in a clinical setting (gerontologist), most of which were in secular, government-operated hospitals (but in Australia).

In terms of addressing the patient face-to-face, I defer to their preferred pronouns, names, etc. Some interpret this as “oh, by using their pronouns you’re condoning their decision”. I don’t see it that way: to me, it’s an issue of professional courtesy, and a way of establishing a clinician-patient relationship on a sound and functional footing.

The same holds true of case notes. Moreover, case notes require that one objectively and consistently reports what the patient communicates. This is because often the information will be consulted by other health professionals for their clinical decisions, and one’s case notes can be forensically examined by a court due to legal action.

That being said, I’ve generally avoided pronouns in case notes, if only because there tends to be some ambiguity to whom you’re referring. This is particularly the case if one is reporting a complex family situation involving multiple individuals. I’ve always deferred to my whatever standardised clinical shorthand is used by my employer: generally “Pt” for “the patient”, and/or specifying the name of the person about whom one is writing.

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And would greatly narrow one’s job prospects. Heck, in my opinion, don’t buy an expensive degree if you are not going to be able to work in that field.

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You may need to market yourself as a Catholic counselor. There are so many issues that will come up for which you will not be able to advise outside of Catholic teaching, assuming you will be trying to stay true to your faith.

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This is true. I’m a gay man, and at least when it comes to my primary care doctor, I’ve sought out another gay man to be my doctor. Not only because I want a doctor I feel comfortable talking to about possibly sensitive issues and with whom I can establish a good raport, but there are health care issues that are specific to gay men, and most straight doctors probably wouldn’t have educated themselves on those.

And for the same reasons stated above, I’ve also preferred to have another gay man as my therapist/psychologist/counselor if I can. I wouldn’t want to have a therapist who is thinking as I’m talking to him that I’m a big sinner. I wouldn’t be able to open up to a therapist if I had any inkling that he/she disapproved of me because of my sexuality.

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I don’t know of many gay men who have negative feelings towards people for being straight. After all, most of us have straight parents and we wouldn’t be around if there weren’t any straight people. It’s usually some straight folks who have a problem with gay folks.

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