Overview

The intent of this paper is to shed light on the internal workings of the counseling and human services and expose systemic and industry-encouraged practices and ideologies that are misaligned with the profession’s goal of promoting mental health and well-being. Policy solutions are needed to create space for Americans who participate in the system—whether as practitioners or patients—who uphold the existence of an objective reality, who, consistent with their professional obligations, seek good evidence to support their practice, and whose sincerely held beliefs might be contrary to the professional zeitgeist.

Introduction to Censorship and Self-Censorship in Counseling and Human Services Professions

It is increasingly apparent that important standards and practices associated with the counseling and human services professions are neither scientifically grounded nor guided by well-constructed theories. Recent events—including controversies associated with the provision of so-called “gender affirming care”—have also brought needed attention to the profession’s unwillingness to permit civil discussion of contentious issues. These practices were the focus of a 2025 Department of Health and Human Services’ (HHS) report on the gender affirming care model (Department of Health and Human Services, 2025b).

The HHS report offers one of the most robust national literature reviews of gender affirming care to date. Remarkably, alongside its findings, HHS offered those with opposing views an opportunity to rebut the report’s conclusions (Department of Health and Human Services, 2025a). Yet none (e.g., professional societies) marshaled a substantive refutation of either the report’s conclusion or supportive findings of prior international reviews (e.g., Cass, 2024; Council for Choices Healthcare Finland, 2020). The HHS report ultimately concluded that the research on gender-affirming care should be deemed low quality and rated as a treatment protocol that lacks empirical support (Department of Health and Human Services, 2025b).

These conclusions were decried as false and ideologically driven by major professional counseling and human service groups (e.g., American Psychological Association, 2025), some state leaders and politicians (e.g., The Associated Press, 2025), and others (e.g., The Trevor Project, 2025). These types of arguments are logical fallacies that only distract from the fact that major psychological and bodily harms have been perpetuated on vulnerable people in the name of “mental health,” without any sound logic or scientific backing. Rather than answering the HHS report’s evidence, professional bodies sought to place the question beyond debate; dissenting evidence was not refuted but denounced. Unfortunately, this example of misguided action within the profession is not an outlier.

Rulings on Censorship & a Culture of Silencing Dissent

Recent cases before the Supreme Court highlight questionable ideologically driven practices that have been indirectly (e.g., Mirabelli v. Bonta, 2026) or directly advocated for and practiced by the counseling profession (Chiles v. Salazar, et al., 2026). The ruling in the Chiles case pertained to Colorado’s ban on certain viewpoints in talk therapy (i.e., routine or basic therapy). This case rose to the Supreme Court after Colorado lawmakers— lawmakers in more than 20 states and municipalities—barred counseling and human service professionals from speaking with clients in ways that did not affirm the client’s asserted gender identity, even when the client did not want that identity affirmed (Movement Advancement Project, 2026). The Supreme Court ultimately held, 8-1, that the Colorado law, as applied to talk therapy, regulated speech based on viewpoint and is subject to strict scrutiny under the First Amendment, reversing the lower court and remanding the case (Chiles v. Salazar, 2026).

As expected, following the decision, the American Psychological Association (APA) immediately expressed disappointment with the Supreme Court’s ruling (American Psychological Association, 2026). Around the same time, California introduced SB 934, Sexual Orientation or Gender Identity Change Efforts, to make it easier to sue licensed clinicians over claims of psychological injury from non-affirming practice (CalMatters Digital Democracy, n.d.). Similarly, Colorado introduced HB26-1332, Civil Actions for Conversion Therapy Survivors (Colorado General Assembly, 2026).

These recent legal cases and policy changes speak to some of the current political and ideological contexts surrounding clinical practice. What remains less seen is the culture of viewpoint discrimination that is an artifact not of the client-counselor relationship, but of prevailing social views within the profession. Regarding topics like abortion, gender, and diversity, the profession operates more like an advocacy arm that compels adherence to progressive beliefs rather than practicing as a neutral body dedicated to scientific discovery and evidence, as is appropriate for any health industry (Duarte et al., 2015).

Further, most of the profession’s leadership (e.g., American Psychological Association, 2026) has emphasized the importance of current and prospective professionals (e.g., psychologists, psychiatrists, social workers, mental health counselors) advocating for progressive positions on these topics. Indeed, progressive issue commitments are codified in professional codes of conduct, in undergraduate and graduate coursework, and even in some continuing education courses required for maintaining licensure (see Table 6). In this way, demands for ideological conformity and activism can be seen throughout the entire fabric of the profession, including research, education, accreditation for higher learning, licensing, and practice.

Notably, the profession’s stance not only requires adherence to certain ideological tenets, but it also vilifies opposing perspectives (e.g., on gender identity) as oppressive, harmful, and unsupportive of basic “human rights” (American Counseling Association, 2024, p. 1). The resulting culture leaves little room for discussion, signaling that minority opinions are unwelcome and that opposing beliefs are archaic, even inhuman.

Meanwhile, many Diversity, Equity, and Inclusion (DEI) initiatives have become central professional focal points, irrespective of the target population (e.g., AOSW, 2026; ACORN, 2026). Though perhaps unintended, initiatives designed to serve one population can become tools of discrimination against others. Still, these frameworks rarely specify substantive remedies, anticipated outcomes, or measurable benchmarks by which systemic change could be assessed (Brice, 2019). Instead, the DEI approach focuses on a vague intervention strategy for two groups: the oppressed and the oppressor. This dyad is a significant theme throughout the profession, but the rhetoric on such topics sidelines many who would like to enter the field. Simultaneously, this approach suppresses counselors, researchers, and academics from freely and fully participating and contributing to the discipline.

The Culture Elicits Self-Censorship

Although the Supreme Court’s ruling in Chiles v. Salazar opened the prison door for counselors and professionals to speak in opposition to the dominant ideological positions, many are likely to remain silent due to ongoing pressure from leadership and colleagues. A likely contributing factor is that, with few exceptions, the profession has been largely insulated from legal challenges to ideologically driven practices associated with serious harm to patients (e.g., recent exceptions include Texas Children’s Hospital and the Fox Varian cases) (The Free Press, 2026; U.S. Department of Justice, 2026a). Conversely, clinicians and conservative-aligned institutions have faced lawsuits and personal and professional threats (e.g., to their licenses) for refusing to parrot opposing ideological narratives (i.e., suggesting a biological reality exists or that terminating pregnancy may not promote mental health) (U.S. Department of Justice, 2026b).

Perhaps, in part, due to this imbalance, the profession remains doggedly committed to unfettered abortion rights, affirmation-only responses to gender identity confusion, and to conceptualizations of systemic oppression connected to race, economics, sexuality, and biology (see Table 6) (e.g., American Psychological Association, 2022a; American Psychiatric Association, 2023; 2026). For some, these issues are not merely clinical factors associated with mental distress but rather cherished causes deserving of religious-like devotion.

In this environment, clinicians and human service providers who hold minority viewpoints face true systemic discrimination as the professional structure and culture promotes both overt and covert censorship. This can be seen by threats of retribution or licensure revocation from progressive lawmakers, which leads to intense pressure to self-censor. Absent some dramatic change to professional incentives, this pressure is unlikely to abate.

Although this report addresses major systemic problems in the field, its intention is not to discredit but rather to spur reform of these professions. Many theories, research, and interventions derived from modern psychology have been used to promote health and recovery, and have led to advancements in our understanding of human development (e.g., Bowlby 1969; 1973; 1980; 1988) and attachment and trauma (e.g., Ainsworth & Bell, 1970; Ainsworth et al., 1978; Steele et al., 2019; Swerbenski & Russotti, 2025). The many skilled therapists capable of discerning scientific evidence are also deserving of recognition.

However, it cannot be ignored that psychology and human services have also been used to house destructive ideologies, programs, and harmful interventions (e.g., gender, secret social transition, minority stress, and DEI programs). The intermingling of these ideologies with legitimate public concerns (e.g., school mental health crisis, shootings) is all the more tragic, given that it tends to feed the distorted perception that such ideologies are rooted in compassion rather than in radical ideological commitments. Unfortunately, disentangling the rhetoric of compassion from these radical premises and commitments is necessary to safeguard the well-being of patients and their families.

Section I: Influence Over Vulnerable Americans and Culture

Influence by the Numbers

Over the last three decades, there has been a steady rise in the receipt of mental health treatment. National surveys found an increase in adults receiving mental health treatment from 1999 to 2018 at rates of 7% to 11%, respectively (Wang et al., 2023). Studies have continued to show an increase in the use of mental health services, jumping to 19% and 23% in 2019 to 2022, respectively (Terlizzi & Schiller, 2022). In 2024, roughly 60 million adults and more than 11% of youth in America sought professional services for such things as family or personal crises, grief associated with a traumatic event, substance abuse, or chronic and ongoing mental and relational stresses (see Table 1; Substance Abuse and Mental Health Services Administration, 2025).

Recent polls evaluated the American population’s willingness to discuss mental health issues and seek therapy. In one survey, about half of respondents reported a willingness to talk to a close friend, mental health professional, or close family member about their distress (Pasquini & Kikuchi, 2024). Respondents reported a similar willingness to share personal details with counselors (who are initially strangers) as with the people they ranked as the “most intimate” in their lives. In this poll, religious or spiritual leaders and neighbors had a slightly lower likelihood of being seen as a confidant (Pasquini & Kikuchi, 2024).

Similarly, another poll found that 84% of Americans reported feeling comfortable talking with their healthcare provider or therapist about their mental health (American Psychological Association, 2025). In fact, over half of U.S. citizens believe that psychological counseling is an effective treatment for mental health challenges (Gallup, 2023). Forty-one percent of adults reported hesitating to ask for psychological help; nonetheless, a significant number of Americans today seek counseling from a mental health provider (American Psychological Association, 2024c). Similarly, roughly 23% of American families and individuals sought counseling from a mental health professional over the course of a year (Gallup, 2022).

Table 1

Mental Health Prevalence and Service Utilization Among U.S. Adults

Category	Finding
PREVALENCE OF MENTAL ILLNESS
Any mental illness, adults	23.4% — More than 1 in 5 U.S. adults (61.5 million) experienced a mental illness in 2024.
Serious mental illness, adults	5.6% — Approximately 1 in 20 adults (14.6 million) experienced serious mental illness in 2024.
Untreated mental illness	~50% — Of adults with a mental illness in 2024, nearly half received no treatment.
MENTAL HEALTH TREATMENT UTILIZATION
Any mental health treatment	23.0% of adults received mental health treatment in 2023, up from 19% in 2019.
Prescription medication	19% of adults used prescription medication for mental health in 2022, up from 16% in 2019.
Outpatient counseling	13% of adults received outpatient mental health counseling in 2022, up from 10% in 2019.
PERCEIVED MENTAL HEALTH
Self-rated "excellent" mental health	29% — For the first time on record, fewer than 3 in 10 U.S. adults rate their mental health as "excellent," down 14 points since 2019.
WORKFORCE CAPACITY AND ACCESS
Psychologists not accepting new patients	6 in 10 psychologists do not accept new patients; the mean wait time for behavioral health services is 48 days nationally.

Note. All federal utilization figures derive from the Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey on Drug Use and Health (NSDUH), an annually administered, probability-based, nationally representative survey. KFF figures represent secondary analyses of NSDUH public-use data. Prevalence estimates from NAMI reflect SAMHSA/NIMH primary data. Gallup figures are from a probability-based telephone survey (ReconMR, Nov. 2025). HRSA workforce figures draw on APA (2022) and the National Council for Mental Wellbeing (2025) surveys of licensed providers.

The Importance of Properly Wielding Influence and the Power Dynamic

What goes on behind the doors of a therapy session remains private. The therapist’s office is a place where the counselor invites the client to share their deepest fears and pains. Speaking at a deep level involves vulnerability on the part of the client, who may be sharing thoughts and experiences that have never been uttered before or only disclosed to a few. When a client believes their emotion-laden disclosure has been understood and valued, the therapeutic relationship is more likely to strengthen. In practice, the patients’ perception of the therapist as an ally and a trusted expert shifts power from the patient to the therapist.

This understanding of the patient-provider power dynamic is not new; indeed, it has been articulated in many clinical approaches, including early psychoanalytic and Freudian theories (e.g., Freud, 1912; Boyd, 1996). According to Boyd (1996), the therapeutic relationship is characterized by an inherent power imbalance insofar as entering into therapy entails surrendering influence to a professional seen as possessing the expertise needed to address a client’s psychological distress. This power can be wielded for the client’s benefit; however, it also carries the potential for abuse. Subordination to the therapist’s authority arguably entails a degree of subordination to the therapist’s ideological framework as well.

As an active participant in the therapeutic process, the counseling professional’s worldview, ethical standards, and clinical modality must be understood as integral to the therapeutic relationship (e.g., Fuertes et al., 2015). It is expected that the clinician’s theoretical orientation will inform their assessment, intervention, and termination of the therapeutic relationship; however, the impact of clinicians’ ideological framework and how it can lead to an improper assessment and intervention is less understood. Although a recent publication that showed webinars and documents from the World Professional Association for Transgender Health (WPATH) demonstrated how ideology can override clinical judgment and effective practice (e.g., Hughes, 2024). A practice approach that elevates ideology above scientific evidence and without consideration of comorbid factors is particularly concerning, given that therapists are often regarded as instruments of the treatment process. In fact, studies have shown the therapeutic relationship may be the most salient factor when it comes to positive outcomes (Flückiger et al., 2018).

Propensity Towards Authority Bias

To further elaborate on the power dynamic present in a therapy session, one should question what happens when those who are called “experts” give advice, direction, or create standards and requirements that are harming people or violating their consciences.

This very question underscored research from social psychologists following the atrocities of World War II. Stanley Milgram’s (1963) highly discussed and disputed experiments investigated questions like, “how did average people come under the sway of an insidious regime that incited them to participate in horrific acts against innocent people?” Milgram’s study revealed that human beings can, in fact, violate their conscience under the directives of an authority figure. In turn, there is a propensity to justify unethical and harmful actions based on following orders or by saying, “I was just doing what I was told to do."

This means that authority dynamics play a significant role in decision-making. Milgram’s experiments demonstrate that authority bias (a type of cognitive bias) emerges when individuals place excessive trust in the expertise of authority figures (e.g., Burke et al., 2019). In the counseling and human service professions today, we can see the authority bias play out in two primary ways (e.g., Gültekin, 2024).

1. Practitioners who employ or encourage harmful interventions (e.g., gender transition procedures; COVID mandates) because such practices have been touted as a success by the profession’s leaders (e.g., academics, professional organizations).
2. The clients who follow the instructions of the therapist without pause because the clinician is supposed to be the expert.

Section II: Ideological Differences & the Effects on Professional Practice

Predominant Ideological Views of Clinical and Human Service Workers

One window into the ideological orientation of these professionals is where they voluntarily direct their political giving. Contribution records collected by the Federal Election Commission (FEC) are a widely used proxy for the ideological leanings of the people who comprise these professions.

One analysis of FEC data from 2016 found that 90% of mental health professionals who made campaign contributions to one of the two major parties contributed to left-of-center candidates (Verdant Labs, 2026). Breaking the data down further, 83% of child psychiatrists, 85% of school counselors and school psychologists, 86% of mental health counselors, 87% of psychiatrists, 91% of psychologists, 95% of psychoanalysts and psychotherapists, 98% of mental health therapists, and 100% of research psychologists who gave to a political candidate gave in the same political direction. Additionally, so did 90% of academics (Verdant Labs, 2026).

A more comprehensive analysis of the FEC data, but still with limitations, examined political contributions over time. Although this data could not capture non-registered voters, independents, and third parties, a strong, consistent pattern emerged of counseling and human service professionals directing contributions to left-of-center candidates (U.S. Election Assistance Commission, 2016; 2018; 2020; 2022; 2024; see Table 2). This trend in giving is even stronger when looking at psychologists alone and based on their type of employment (see Table 3).

Table 2

Share of Contributions Directed to Two-Party Candidates, by Profession and Across Election Cycle

Note. Data from the Federal Election Commission (2025). Contributions by individuals, 2015–2016 through 2023–2024 election cycles [Bulk data files]. U.S. Federal Election Commission. Retrieved June 2, 2026, from https://www.fec.gov/data/browse-data/?tab=bulk-data.

Table 3

Share of Contributions Directed to Left-of-Center and Right-of-Center Candidates, by Employment Type (Psychologists Only)

Employment type	Democratic share (%)	Republican share (%)
Nonprofit	98.4%	1.6%
Hospital / health system	98.3%	1.7%
University / academic	97.2%	2.8%
Private practice	95.2%	4.8%
Government	92.6%	7.4%

Note. Data from the Federal Election Commission. (2025). Contributions by individuals, 2015–2016 through 2023–2024 election cycles [Bulk data files]. U.S. Federal Election Commission. Retrieved June 2, 2026, from https://www.fec.gov/data/browse-data/?tab=bulk-data. Clinicians, academics, and scientific experts in the profession are undeniably aligned with left-of-center viewpoints. Notably, these numbers include only those who were motivated enough or likely had the means to give to a political candidate. These data do not capture those who share the same ideological commitments but chose not to give. Arguably, that number might be even higher given the ideological alignment of the field with left-of-center viewpoints.

Ideology and Practice

These aforementioned viewpoints are often voiced in clinical practice. A recent study surveyed practitioners to examine whether politics was a source of discussion in a counseling session. This study asked therapists if they discussed politics and personal political beliefs with their clients. The researchers found that 87% of clinicians discussed politics with their clients, and 63% disclosed their personal political views with their clients (Solomonov & Barber, 2019).

Similarly, a counselor’s worldview and religious beliefs have also been found to be a factor that influences the therapeutic relationship and the types of interventions applied in practice (Cummings et al., 2014; Hersh & Goldenberg, 2016). A systematic review of 29 studies found that therapists with a spiritual perspective tended to incorporate their belief system into their practice (Cummings et al., 2014). Therapists who integrated their spirituality into the work were more inclined to have socially conservative views.

Relatedly, one 2016 study asked health professionals to rate the gravity of several clinical issues based on vignettes that were either apolitical (i.e., tobacco use) or expressly political (i.e., abortion) (Hersh & Goldenberg, 2016). The study found no statistically significant difference between liberal and conservative healthcare professionals with respect to the treatments offered. Differences did appear, however, regarding highly politically charged health topics. Conservatives expressed more concern for their patients around the issue of abortion, marijuana use, and sex “work” compared to their liberal counterparts.

There’s No Such Thing as Value-Free Research and Practice

At some level, it should be recognized that ideological, theoretical, religious, and spiritual beliefs of clinicians almost invariably enter their practice. The field has grappled with this issue from its inception, and there has been debate about the role of theory, ideology, and one’s beliefs, particularly around spiritual phenomena in practice. Early psychoanalytic thinkers like Freud and Ferenczi, at minimum, showed curiosity about occult phenomena before refocusing their work on unconscious motivations as an organizing theory (Gershon, 2019). Others, like Carl Jung, expressed support for incorporating occult phenomena into psychoanalysis (Jung, 1936/1954).

Although Jung’s approach may not be advisable, the field should begin to forthrightly acknowledge the impact that a professional’s personal beliefs, in addition to clinical theory, will have on their work. The role of leadership, then, should not be to demand theoretical uniformity, much like Freud did with his theory of the unconscious (Gershon, 2019). Rather, leadership is needed to safeguard opportunities for diverse perspectives to be present within the profession while ensuring practice remains safe and effective. Disclosing and acknowledging the therapist’s clinical approach and beliefs about practice will also help consumers of these services be aware of the help they are enlisting. For example, not all clients want an approach to counseling that blends mysticism or a faith-based perspective.

Spirituality and Religion Should be Valued in Professional Practice

Nevertheless, religious beliefs and spirituality do not need to be sidelined from the counseling space. In fact, research has repeatedly shown the benefits of having a spiritual awareness or religiousness (Lucchetti et al., 2021). The literature also indicates that religiousness and spirituality might serve as protective factors against several mental health conditions, including depression (Mosqueiro, 2021; Braam & Koenig, 2019), suicide (Lawrence et al., 2016; O'Reilly & Rosato, 2015; VanderWeele et al., 2016), substance abuse disorders (Kelly et al., 2020), and posttraumatic stress symptoms (Prieto-Ursúa & Jódar, 2020). In particular, attending religious services has been found to be protective against mood and other psychiatric disorders (Kasen et al., 2012). In one study, those who attended religious services at least once per week were five times less likely to be at risk for suicide compared to those who did not attend religious meetings (VanderWeele et al., 2016).

Given the ongoing mental health crisis, therapists may want to consider whether patients would, in appropriate cases, benefit from the incorporation of spiritual and religious themes in therapy. When these perspectives are quieted, resources that could benefit a person in crisis are not accessed. There is also the risk of stifling innovation, too, which ultimately leaves the person seeking help with fewer treatment options. For example, when it comes to the treatment of gender dysphoria, it is clear that only one perspective has allowed room to test intervention models. There are numerous treatment options for issues such as depression. These options have been the subject of multiple studies and meta-analytic reviews (e.g., Clegg et al., 2026). When a diagnosis is affiliated with ideological beliefs, like gender dysphoria, there are few treatment options. In this case, there is only one treatment option in a systematic review (e.g., Haupt et al., 2020). The lack of treatment options for gender dysphoria is most likely due to the professional risk of researching a topic that might invalidate the dominant discourse on gender-affirming care.

Section III: Theories Driving Practice, Research, and Education

Marxist-Based Theories

The discourse related to ideologically charged topics (i.e., gender) in psychology and human services is often undergirded by theories that hearken to Marxist thought. These theories include minority stress, queer theory, and critical theories on gender, race, and other topics, which are taught and used to guide aspects of practice and research (see Table 4). When these theories are applied to mental health problems, individual distress is viewed as an object of an oppressor-oppressed dyad or a malevolent structure versus a victim class problem (Teo, 1998; Prilleltensky & Gonick, 1996). The organizing theme of these theories is an emphasis on the harm caused by systemic inequalities rather than individual experiences and health factors as contributors to mental distress.

In counseling and human services, these theories are frequently applied to the LGBTQ+ population and issues regarding access to gender affirming care (e.g., Burger & Pachankis, 2024), certain minority groups (e.g., Stamps, 2024), and illegal immigrants (e.g., Valentín-Cortés et al., 2020). Proponents of these theories argue that the law and other societal systems were historically built to benefit a specific racial and social hierarchy. Therefore, simply being "neutral" isn't enough. Rather, one must actively critique and dismantle the underlying structures to achieve actual equity (Mabrouk et al., 2026).

Another commonly used theory in the profession is queer theory. This theory applies the “deconstructive” tools found in critical theory to the concepts of gender and sexuality (Butler, 1990). Queer theorists purport that “normal” sexualities and gender are social constructs used to maintain power. Instead of just seeking “equality,” queer theory seeks to destabilize these categories altogether (Sedgwick, 1990). It argues that labels like “gay” or “straight” are insidious tools of social control that limit human potential (Foucault, 1978).

Similarly, the minority stress framework embodies the idea that systemic discrimination is creating stress on the individual. This notion has been used to explain elevated rates of psychological distress among LGB populations relative to heterosexuals (Frost & Meyer, 2023). The framework has been extended to racial minorities and transgender identified groups, and it has been used to inform several clinical protocols (Pachankis, 2014). It has also shaped recommendations made by the American Psychological Association task force (American Psychological Association, 2021b).

The application of these theories in clinical or human service professions conflicts with the original tenets of the field. The goal of psychological treatment or support, in short, is to pursue individual and familial change and stability by reducing negative outcomes associated with a psychiatric disorder and to bolster one’s psychological capacity (Waqas et al., 2024). When these goals are replaced with an aim to critique and dismantle external systems, clinical work is undermined, and research findings become questionable.

Critics, including J. Michael Bailey, warn that theories like the minority stress framework may foster an “externalization bias,” which leads clinicians to overemphasize systemic causes of distress while underweighting individual psychological factors (Bailey, 2020). In other words, external factors should be considered, but not to the detriment of internal processes. Additionally, cross-cultural investigations of minority stress suggest the model does not operate uniformly across populations, raising questions about its generalizability (Rosser et al., 2008).

Table 4

Critical Theories Used in Counseling and Human Services Research, Education, and Practice

Theory	Key Figures	Core Premise	Counseling Application
Critical Theory	Frankfurt School (Horkheimer, Adorno, Marcuse)	Intellectual work should critique and transform society; power structures are the primary focus, not neutral description.	Shifts the locus of distress from the individual to societal oppression; clinician neutrality is viewed as suspect.
Critical Race Theory (CRT)	Derrick Bell, Kimberlé Crenshaw	Racism is systemic and embedded in laws and institutions; colorblindness is rejected; active structural dismantling is required.	Client distress may be interpreted primarily through systemic oppression; practitioners may adopt an advocacy-centered role.
Queer Theory	Judith Butler, Eve Sedgwick, Michel Foucault	Gender and sexuality are social constructs that maintain power; heteronormativity is challenged; fixed identity categories are destabilized.	Deconstructs “normal” vs. “abnormal” in gender and sexuality; frames traditional norms as oppressive rather than neutral.
Minority Stress Framework	David Frost, Ilan Meyer	Elevated psychological distress in minority groups stems from distal stressors (discrimination, violence) and proximal stressors (internalized stigma, concealment).	Widely used in LGBTQ+ and racial minority mental health; informs APA task force recommendations and clinical protocols.

Clinical Practice or Ideological Advocacy?

Ultimately, the application of these theories exemplifies an entirely different kind of research and practice approach in which the external system and/or factor(s) are the problem. The “oppression,” then, is the focus for change (dependent variable), and education about the problem and activism become the intervention (independent variable). From this framework, external factors are targeted to the neglect of an intervention tailored to the individual or the family for the purpose of change and/or the management of one’s life, work, and relationships (Bandura, 1987; Rogers, 1951; Bowen 1978). Further, a large longitudinal study evidenced that ongoing exposure to ideologically controversial events is proving detrimental to adolescents. This becomes particularly poignant based on ideological positions in which those aligned with progressive views are experiencing more mental health struggles (Gimbrone et al., 2022).

Activist Therapy or Social Justice Counseling?

A clinician who subscribes to the aforementioned theories is likely to follow an approach to “treatment” that underscores activism and macro-level problems rather than personal healing and capacity development (Satel & Sommers, 2005). In fact, the advocacy approach has already been openly embraced by some professionals.

Social justice counseling or activist therapy is an approach to treatment that reframes the counselor’s role from a traditionally neutral facilitator of client self-determination to an active advocate who believes systemic inequities undermine good mental health (Jordan, 2020). An activist therapist is someone who intentionally introduces their own ideological viewpoints into their practice. This type of counseling is rooted in principles that have been advanced by organizations such as the Association for Multicultural Counseling and Development, which emphasizes power, privilege, and oppression as relevant dynamics to the therapeutic process (American Counseling Association, 2024).The key elements to this approach include integrating discussions of structural barriers into treatment, empowering clients to navigate and challenge those conditions, and, in some cases, engaging in advocacy beyond the therapy room (Crumb, Haskins, & Brown, 2019). The concept of liberation (supporting clients in reducing both internalized and external constraints) is often central to this framework (Martín-Baró, 1994).

There are some who are concerned about this form of therapy because of values convergence. This convergence can occur when a client’s beliefs gradually shift to align with the therapist’s views (Bonow & Follette, 2009).The therapist’s role is to shape conversations through framing, reinforcement, and interpretation. Therefore, a clinician’s influence may occur subtly over time rather than explicitly. As a result, perceived therapeutic “progress” may, in some cases, reflect alignment with the therapist’s worldview rather than independent psychological improvement. This raises concerns about undue influence of the therapist and the erosion of client autonomy (Bonow & Follette, 2009).

Section IV: Discrimination in Education and Research

Aside from theoretical positions, discrimination also shows up in the training and research practices for the profession. Johnathan Haidt, a social psychologist, was one of the first to raise concerns about bias in the psychology profession. Following a speech Haidt delivered at a professional conference, The New York Times published an article highlighting his concerns (Tierney, 2011). Haidt was quoted as arguing that the field is a “tribal-moral community” united by “sacred values” “that hinder research and damage their credibility–and blind them to the hostile climate they’ve created for non-liberals” (Haidt, as cited in Tierney, 2011). Haidt was also quoted as saying, “the fight for civil rights and against racism [in psychology] became the sacred cause unifying the left throughout American society, and within the academy” (Tierney, 2011).

Years later, Nicholas Kristof (2016) wrote a commentary echoing these concerns, noting that liberals are famous for prizing “tolerance,” but they express intolerance when it comes to the viewpoints of conservatives or religious people. Kristof noted the bias against Christians and conservatives in academia is further indicated by the low and decreasing representation of these groups in universities and the lack of viewpoint diversity in academic discourse (Kristof, 2016). Another New York Times article, by Mark Lilla, similarly noted that contemporary liberal views increasingly marginalize religious, white, and rural communities (Lilla, 2016). When Haidt (2011) advocated for greater ideological diversity in academic discourse, responses from colleagues included dismissive remarks such as, “you don’t diversify with idiots” (Nature, 2016).

At the time the NYT article commented on Haidt’s speech, empirical data showed the majority of psychology professors were liberal, with liberals outnumbering conservatives by roughly 12 to 1 (Gross & Simmons, 2007). This ideological skew in academia has been consistent for over three-quarters of a century (e.g., Langbert & Stevens, 2020; Klein & Stern, 2005; Klein & Stern, 2009; Honeycutt & Freberg, 2017; Rothman et al., 2005; Buss & von Hippel, 2018). Today, those numbers aren’t much better, but the sentiments about conservatives in the academy may prove even more egregious given the statistics below.

In 2019, the James G. Martin Center for Academic Renewal reported that 39% of college departments do not have a single conservative faculty member (Connor, 2019). This report found that liberal faculty outnumber conservative faculty at the top 50 Liberal Arts colleges in the country is 10.4:1. Science Technology Engineering & Mathematics departments are more likely than the psychology and the humanities to include conservative faculty members (at a 5.5:1 ratio; Connor, 2019).

The current profile of most academics in America is clearly liberal. It seems that profile is not likely to change anytime soon, at least according to research conducted before the midterm elections in 2022. The Center for the Study of Partisanship and Ideology found that roughly 40% of American academics would discriminate against, and would not hire, an openly conservative job candidate (Kaufmann, 2021). This was found to be true in an earlier study in which psychologists reported they would discriminate against conservative colleagues in essentially all activities related to the profession including reviewing their studies and hiring (Inbar & Lammers, 2012). That same study found that conservative academics reported concealing their beliefs out of fear of professional retaliation; and notably, only 6% of the study's sample identified as conservative (Inbar & Lammers, 2012).

Evidence of ideological influence extends beyond hiring practices and into scholarship itself. In a related health discipline, a review looked at the explicit use of critical theories in health pedagogy and scholarship and found that roughly 31% of 154 scholarly publications used critical theories in their discipline (Fassett et al., 2025). This figure does not include those who have been influenced by such theories but are not openly incorporating these views into their work.

Taking it a step further, some scholars explicitly name activism as an underlying motivation for their research and professional practice. In the field of counseling psychology, for example, Goodman et al. (2004) called for training psychologists as “social justice agents,” and for the work to be guided by principles of feminist and multicultural advocacy rather than neutral scientific inquiry. In social work, Tricia B. Bent-Goodley (2015) published a formal call in the profession's flagship journal to embrace and enact activism as a defining feature of the profession. In this way, the social worker is viewed as an agent of change.

Taken together, the available evidence indicates that those responsible for conducting research and training future psychological and human service professionals exhibit documented tendencies to silence and exclude dissenting viewpoints (Inbar & Lammers, 2012; Kaufmann, 2021). Some professionals are also actively incorporating or are influenced by divisive theoretical frameworks (Fassett et al., 2025), strongly identify with liberal viewpoints (Gross & Simmons, 2007; Buss & von Hippel, 2018), and in some cases explicitly position activism (rather than scientific neutrality) as the animating purpose of their scholarship and practice (Goodman et al., 2004; Bent-Goodley, 2015). These dynamics form the backdrop for a broader examination of the role of ideological bias in research.

The Purpose of Research and Use of the Scientific Method

In Western, post-Enlightenment culture, research findings are used to give ideas credibility. Research is the backbone of our health institutions, and it is used to justify many of the policies and laws we make in American society. Research is also used to prop up the inner workings of the profession, and it lends support to the profession’s ability to oppose or affirm ideologies and theories. As the use of science has become integrated into Americans’ daily lives, it’s important to establish what science is, what it can do, and what its limitations are.

First, the scientific method originated around the time of the English Enlightenment period as one approach to observing and learning about the world. Philosopher and statesman Sir Francis Bacon (1620/1994) recognized that human beings possess flawed capabilities to accurately perceive information, and so helped develop the scientific method to account for this innate tendency towards certain biases.

The basic principles of scientific inquiry hold that findings should be replicable, tentative, testable, and open to refutation (National Academies Press (US), 1992). Research should be conducted systematically, with conclusions held provisionally rather than treated as final (National Academies Press (US), 1992). At its core, the scientific method aims for objectivity by limiting personal investment in the outcome. These principles recognize that observation can be shaped by personal experience, ideology, and politics. Although the scientific method cannot eliminate all errors or threats to reliability and validity, it is designed to reduce bias wherever possible. Strong study design, transparency, and appropriate sampling increase confidence that findings can be generalized to similar contexts.

Philosophical and Methodological Approaches to Science

Currently, there are approaches to understanding and observing a phenomenon in counseling and human services where objectivity is not the primary goal of research. These studies, often qualitative in design, have their place and can be particularly useful at the outset of a research agenda where little is known about a particular phenomenon (Morrow & Castañeda, 2012; Busetto et al., 2020). For example, very little is known about the long-term experiences of people who have gone through a detransition process (Expósito-Campos et al., 2024). In this case, it would be appropriate to interview those who fit those criteria and look for patterns or anomalies in the interviews. Qualitative data can help with a study where the researcher wants to use another methodology where generalizations might be allowed. What is important here is not the research methods, per se, but rather the philosophy of science subscribed to by some of these researchers.

One philosophical approach to research that is commonly used is constructivist theory (Whitman, 1993). This approach holds that objectivity is not attainable and that knowledge is situated and contextual (Crotty, 1998; Lincoln & Guba, 1985). Thus, there is no objective or absolute truth. It follows that the aim of research isn’t to find an objective truth or to generalize the study findings to a larger population. The use of qualitative methods and constructivism as a philosophical approach can be useful, but it becomes problematic when this type of research, or researcher, is given too much weight or used to heavily inform practice or policy.

Aside from the theoretical approaches, psychological studies are fraught with difficulties in replicability and there are challenges to understand abstract phenomena by way of self-report, even when experiments have been well-designed (e.g., Pietschnig et al., 2019). In other fields, such as medicine, observation is generally easier and more robust (e.g., change in heart rate, amount of fluid in the body), although still not without error. The psychological professions are often limited by the fuzzy lines between objectivity and subjectivity (Salzberger, 2013; Uher, 2025). These lines are further blurred when professionals adopt activist therapies and research protocols (Redding & Satel, 2023), philosophies that characterize oppressor and oppressed dyads (Freire, 1968), and theories that negate the existence of an objective reality (Crotty, 1998).

Action Research in Human Services

Some researchers go a step further and employ methodological approaches to research that intentionally blur the lines between researcher and participant. This type of approach is often referred to as the critical paradigm, action, or participatory action research (DeCarlo et al., 2021). This is a methodological approach viewed as a tool for community empowerment and needed change (Vaughn & Jacquez, 2020; Heron & Reason, 1997). Here, the researcher may work alongside a group that has been deemed a vulnerable or minority population (e.g., ethnic or “gender” minority) to identify problems and co-create solutions for social and political change (Vaughn & Jacquez, 2020). Research, then, is used primarily as a tool for activism rather than as a means for expanding and generalizing knowledge (Baum et al., 2006). Opponents of this approach argue that this approach runs the risk of turning empirical research into advocacy framed as science (Tetlock, 1994).

When a research design is oriented toward demonstrating a desired change rather than neutrally testing hypotheses or asking research questions, the researcher may also be tempted to suppress null or contradictory findings. While not all academic research in the counseling and human services subscribes to a constructivist philosophy or an action approach to research, the ideological and activist motivations often appear in the peer-reviewed literatures by way of what is published and what is censored or suppressed from publication (Clark et al., 2024; Borjas & Breznau, 2026). Likewise, researchers may censor their own pursuits or study findings for fear of opposing professional discourse (e.g., Clark et al., 2024).

Censorship with Research Findings Contrary to Progressive Ideologies

A subtle form of activism in research was recently observed within a taxpayer-funded study (Paul, 2024). These funds were used to research the effects of transgender procedures on youth mental health (Olson-Kennedy et al., 2025). In this study, a sample of roughly 100 minors were given puberty blockers, but the drugs did not yield a better mental health outcome as hypothesized. Despite receiving taxpayer dollars for this study, Dr. Olson-Kennedy admitted she withheld the research findings for ideological reasons. She wanted to ensure the research was not used by those who opposed transgender procedures on minors (Ghorayshi, 2024).

Researchers are supposed to uphold scientific rigor through the peer-reviewed publication process. The Olson-Kennedy study is just one example where ideology and science converge. Instead, many researchers have fallen under the sway of a dominant ideological orthodoxy (Sullins, 2025; Clark et al., 2024). This push for ideological conformity threatens the core of the scientific method itself. Sullins (2025) noted, “the very thing that makes the scientific method so valuable for advancing discovery is that scholars who wish to ‘correct’ the scientific record must do so, not by censoring their intellectual opponents, but by presenting such overwhelmingly strong arguments and evidence that person’s reasoning from any point of view, not just their own narrow perspective, are widely convinced that their view is the correct one” (Sullins, 2025, p. 13).

Remarkably, ideological alignment has replaced methodological merit as the basic criterion in many social science journals (Sullins, 2025; Duarte et al., 2015). Research that reinforces prevailing progressive narratives, such as those on sexuality, gender, and abortion, are frequently expedited with relaxed scrutiny, while rigorous findings that challenge those narratives encounter disproportionate barriers, including heightened demands for revision, accusations that the evidence could cause “harm,” and outright retraction (Clark et al., 2024; Sullins, 2025; Bauwens, 2026b).

In addition to Sullins’ own research retractions, several other researchers have been put on notice that their research is not welcome (Clark et al., 2024). Below (see Table 5) are a few examples of studies that were accepted for publication but later retracted or the subject of retraction. Notably, there are likely many other studies that were never considered for publication because the topics were not ideologically aligned with the profession (Clark et al., 2024).

The examples below serve as another indication of a broader systemic problem. When publications rely heavily on ideological conformity, the findings become skewed and science is no longer a truth-seeking enterprise, but rather an instrument of advocacy (Duarte et al., 2015). Consequently, erosion in public trust follows (Clark et al., 2024).

Table 5

Peer-Reviewed Study Concerns and Retractions

Researcher & Study	Stated Basis for Action	Action Taken
Sullins (2016) Same-sex parenting & depression Depression Research & Treatment	Researcher’s Catholic priesthood cited as a “conflict of interest”; findings framed as supporting “hate speech” — no methodological misconduct identified.	An LGBT activist complaint was filed after the study was cited in an Australian same-sex marriage debate. Publisher issued an Expression of Concern solely due to the researcher’s religious identity, not because of any flaw in the research.
Sullins (2022) SOCE & suicide risk Archives of Sexual Behavior	Critics conceded findings may be accurate but argued publication was “egregiously problematic” because results could influence LGBT legislative debates.	Corrected analysis showed SOCE reduced suicidal ideation — contradicting prior pro-LGBT studies. Retraction was demanded, but publication still stands. Formal commentary from Strizzi & Di Nucci (2023), who argued publication was "egregiously problematic" on ethical/rights grounds, independent of methodology.
Bailey (2023) Rapid-onset gender dysphoria & social contagion Archives of Sexual Behavior (Springer Nature)	Journal editor sanctioned for “lack of integrity on LGBTQ+ matters” after publishing findings that peer pressure contributed to adolescent transgender identification.	100+ activists demanded retraction within six weeks; 2,000+ academics signed in support of the research. Springer Nature overruled its own editor and retracted the paper on a newly invented basis — the first known publisher override under direct activist pressure.
Studnicki et al. (2021, 2022, 2019) Mifepristone safety risks Charlotte Lozier Institute / Sage	Authors’ pro-life affiliations were publicly disclosed per protocol. Pro-abortion researchers with undisclosed ties to abortion providers faced no equivalent scrutiny.	Pro-abortion complaint filed targeting authors’ disclosed affiliations. Sage retracted all three studies while approving pro-abortion research from authors with undisclosed financial conflicts — conflict-of-interest rules applied in one direction only.
Coleman (2022) Critique of Turnaway Study on abortion outcomes Frontiers in Psychology	Coleman’s pro-life affiliation cited as an “undisclosed competing interest.” The reviewer approving the opposing commentary had actual undisclosed funding ties to abortion providers.	Peer-reviewed critique exposing serious methodological flaws in pro-abortion research was targeted post-publication. Critique retracted for alleged conflicts while the pro-abortion response — from a reviewer with real undisclosed funding — was allowed to stand unchallenged.

Section V: A Monopoly on Accreditation & Problems with Professional Organizations

To have a career in human services or practice as a licensed counselor, the aspiring professional must graduate from an accredited degree program. Likewise, maintaining professional licensure requires periodic completion of mandatory training. Both requirements entail mandated exposure to the same questionable ideological framework discussed above (e.g., Minnesota Statutes § 260.69, 2025; Michigan Department of Health and Human Services, 2023). The problem is that there are currently no known alternatives to a licensure track for counseling and human service professionals. In this way, non-governmental accrediting boards have a monopoly on the profession, and these bodies do not support viewpoints that are outside their definition of diversity.

Professional accrediting bodies in counseling and human services have increasingly required adherence to questionable and ideologically motivated theories and ethical frameworks. Terms like “social justice” and “diversity” give the appearance of sensitivity to individual and cultural differences found in American culture. As noted in Table 6, advocating for the field’s sanctioned forms of diversity is now a significant part of the current conceptualization of the profession and the training one will receive from an accredited school.

While understanding the impact of discrimination is a legitimate topic of instruction, such instruction should serve as a comprehensive conceptualization of the whole person (i.e., personal history, economic, familial, occupational factors). Outlining a therapeutic issue within an overarching critical or minority stress theory framework conceptualizes a person (e.g., a patient) as a perpetual victim engaged in a constant battle against a larger malevolent systemic forces (Bailey, 2020). This theoretical orientation does not easily lend itself to robust individual solutions insofar as the patient’s problem is conceived of in relationship to innate characteristics (i.e., race) and malleable identifications (i.e., transgender). This framework can offer no substantive off-ramp or productive means for healing, only tools to deconstruct social mores.

Accrediting bodies like the Council for Accreditation of Counseling and Related Educational Programs (CACREP) and the Council on Social Work Education (CSWE) suggest institutions have wide flexibility in how they choose to fulfill their diversity requirements. Experience with implementation of these standards suggests otherwise. For example, Liberty University incorporates a Biblical worldview model in their curriculum to satisfy some of the diversity mandates, yet the university is still required by accreditors to affirm concepts like “power and privilege” and “environmental justice” as a condition of accreditation.

These concepts point toward a broader systemic push to standardize social and political perspectives into clinical training (Duarte et al., 2014). Under CACREP, social and cultural diversity are key components of the standards set for all entry-level and doctoral-level programs seeking accreditation. There is no option for institutions to opt out of these requirements. Likewise, the updated 2022 Educational Policy and Accreditation Standards (EPAS) require the inclusion of anti-racism, equity, and inclusion (ADEI) as “core competencies” in their educational standards (CSWE, 2022b).

Professional Organizations and Codes of Ethics

These standards outline the extent to which viewpoint discrimination is practiced as a foundation to professionalization. Again, to be recognized as a practicing professional on licensure track, one must graduate with a degree from an accredited institution of higher learning (CACREP, 2024). Once the professional graduates and is working in the field, the ethical standards set by the professional organizations also let the professional know that certain views are not accepted in the field. These standards are supposed to govern the professional licensure per degree, yet they are not issued by government bodies. These groups are private associations that, nonetheless, have acquired immense influence over state and federal licensing regulations.

Professional organizations outline their own ethical guidelines, which are also attached to professional licensure requirements (e.g., American Psychological Association, 2024b; National Association of Social Workers, 2021; CACREP, 2025). These ethical guidelines frame how the counselor or human service professional is expected to conduct their practice or work. Over the years, professional ethical codes have shifted from merely protecting patients and promoting good practice to requiring support for ideological convictions (e.g., National Association of Social Workers, 2008). At the same time, these organizations have ignored scientific evidence and disregarded clinicians’ and clients’ sincerely held beliefs (e.g., Chiles v. Salazar, 2026; U.S. Department of Health and Human Services, 2025). For example, in 2008, the National Association of Social Workers revised its Code of Ethics to incorporate advocacy for sexual orientation and gender identity into its standards (NASW, 2008). This point in the ethical code remains despite multiple reports that gender identity should be treated as a disorder and not a human right (e.g., Bauwens, 2026a).

This trend can be seen within similar professional organizations. The American Counseling Association (ACA) writes about a counselor’s goal of “promoting social justice” and understanding the “uniqueness of people within their social and cultural contexts” (ACA, 2014, p. 3). Similarly, in 2021, the National Association of Social Workers (NASW) made another significant update to its code of ethics, adding the requirement for social workers to “take action” against oppression, racism, and discrimination, and demonstrate cultural humility by engaging in “self-correction” (NASW, 2021). The call to actively promote social justice signified a renewed focus for the profession.

Professionals are also taught to give attention to how environmental factors can be tools of oppression used against their clients. In the 2024 version of the American Psychological Association’s Ethical Codes, advocates for the “promotion of social justice” (APA, 2024). The APA also calls for psychologists to consider that their biases may produce “differential distributions of power and resources within society and [they should] strive to address such inequities when they recognize them” (APA, 2024).

To the APA’s point, professionals should address dynamics like transference (the unconscious process by which a client redirects feelings from past relationships onto the therapist) and countertransference (the therapist's own emotional reactions toward the client that may be conscious or unconscious). These dynamics are generally understood to be part of clinical work (Gabbard, 2001). Further, the Socratic aphorism “know thyself,” is widely known and practiced by competent professionals who are working to keep countertransference in check (Hayes et al., 2018). These points should be distinguished from the type of introspection that has been underscored in the latest ethical standards. Instead, the code is essentially endorsing a practice of seeking out and correcting, if necessary, personal values that are not in alignment with the profession’s ideology.

Taken together, these organizations have effectively created a barrier to practice and licensure that excludes traditional, religious, or conservative practitioners from the public square. The field and its governing bodies have systemically shifted toward an apparent regulation of the conscience. This regulation is emblematic of how providers are required to internalize and affirm specific beliefs as “reality” and as a condition of having and maintaining their license, in accordance with the definition of ethical practice (APA, 2024; NASW, 2021).

These ethics should uphold good practice, and accreditation should measure a student’s technical capabilities. Instead, the profession mandates that a student demonstrate “cultural humility” by affirming subjective gender identities or ideological frameworks like “environmental justice.” These requirements show the overreach and attempt to police the internal compass or moral convictions of a student (see Table 6).

Table 6

Ideologically Driven Priorities

Organization	Political Priorities of Professional Organizations and Accreditation Bodies
NASW National Association of Social Workers	“Social workers challenge social injustice. Social workers pursue social change, particularly with and on behalf of vulnerable and oppressed individuals and groups of people.” “NASW officially supports reproductive justice. It requires that all licensed social workers support individuals, families and communities in securing reproductive well-being.” Code of Ethics; Official Policy Statement
ACA American Counseling Association	“ACA’s commitment to diversity, equity and inclusion prescribes that we support the rights of the LGBTQ+ community and other communities minoritized based on their race, gender, religion or physical abilities.” “Recognize the emotional, psychological and sometimes physical harm that can come from engaging clients in approaches which attempt to alter, ‘repair’ or ‘convert’ individuals’ affectional orientation/gender identity/expression.” Values & Statements; Code of Ethics
APA American Psychological Association	“We believe that access to evidence-based health care is a fundamental right for everyone, and this policy reflects our commitment to promoting social justice and equity in health care.” “Psychologists are directed to advocate for accessibility and pursue treatment with social responsibility, inherent to the elements of social justice within the field of psychology.” Policy Statements
AmPsychA American Psychiatric Association	“The principles of diversity, equity and inclusion are critical to ensure that the next generation of physicians can serve the needs of evolving, diverse, underrepresented, and underserved patient populations.” DEI Statement
NAMI National Alliance on Mental Illness	“NAMI strongly opposes any policy or legislation that limits or denies access to medical or mental health care or education based on someone’s sexual orientation or gender identity.” “NAMI supports public policies and laws that work to eliminate mental health inequities perpetuated by bigotry and discrimination against LGBTQI populations.” Policy Position Statements
AMHCA American Mental Health Counselors Association	“In the wake of nationwide protests against racial injustice, and health disparities that harm Blacks and people of color, AMHCA denounces racism and reaffirms the ethical practice of non-discriminatory conduct with our clients, AMHCA initiatives, and activities.” “I will advocate for the betterment of others, for equality, inclusion, and the intrinsic dignity and the inherent rights of every person.” President’s Statement, The Advocate (Summer 2020); Clinical Mental Health Counselor Declaration (2021)
AAMFT American Association for Marriage and Family Therapy	“The cultivation of an inclusive environment without prejudice and oppression where equity, belonging, and mutual respect are intrinsic.” “AAMFT deems the practice of gender identity change efforts, whether overt or covert, as harmful, unethical, and in direct violation of the AAMFT Code of Ethics… AAMFT opposes any laws or other policies by any government at any level that bans gender-affirming care.” Code of Ethics, Core Values (eff. Jan. 1, 2026); Position Statement on Gender-Affirming Care
NBCC National Board for Certified Counselors	“Certified counselors and candidates demonstrate their commitment to ethical behaviors by demonstrating, and representing to their clients, sensitivity to multicultural issues, avoiding discrimination, oppression, and/or any form of social injustice.” Code of Ethics (2023)
CSWE Council on Social Work Education	“Social work education is grounded in the liberal arts and a commitment to anti-racism, diversity, equity, and inclusion, which together provide the intellectual basis for the professional curriculum and inform its design.” “Social workers are knowledgeable about the global intersecting and ongoing injustices throughout history that result in oppression and racism… Social workers advocate for and engage in strategies to eliminate oppressive structural barriers to ensure that social resources, rights, and responsibilities are distributed equitably.” 2022 Educational Policy and Accreditation Standards (EPAS), Competencies 2–3
CACREP Council for Accreditation of Counseling Programs	“Ethical behavior, diversity, equity, inclusion, and critical thinking are integral to counselor preparation and should be infused throughout the curriculum. Required content includes theories and models of multicultural counseling, social justice, and advocacy.” Accreditation Standards
ASCA American School Counselor Association	“Develop knowledge and understanding of historic and systemic oppression, social justice and cultural models (e.g., multicultural counseling, anti-racism, culturally sustaining practices) to further develop skills for systemic change and equitable outcomes for all students.” “Advocate for equitable, anti-oppressive and anti-bias policies and procedures, systems and practices, and provide effective, evidence-based and culturally sustaining interventions to address student needs.” Ethical Standards for School Counselors (2022), incl. Standard A.1.j
ASWB Association of Social Work Boards	“The Association of Social Work Boards commits to promoting and upholding equity and justice. In doing so, the association will hold itself accountable in denouncing racism, intolerance, exclusion, and other forms of discrimination and bias in carrying out its mission.” Anti-Racism Statement (2020)

The Costs for the Client and the Misaligned Provider: Moral Injury

Most of the issues raised here have the potential to negatively impact those who are served by the psychological and human service professions. Less discussed are the effects on those whose viewpoints have been shut out of the profession or have been coerced to practice in a way that defies reason and personal beliefs.

The concept of moral injury, related to authority bias, describes the effects of stressful situations where orders or requirements contradict the subordinate’s beliefs (Shay, 1994; Litz et al., 2009). Specifically, this injury can occur when people “perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations” (Norman & Maguen, 2026). Moral injury can occur when individuals act against their own beliefs or stay silent or fail to act in line with their beliefs. The result of following contradictory dictates can leave a person with a profound sense of shame and guilt. While it has not been widely discussed in the scientific literature, the moral injury framework can be extended to instances when mental health professionals (including academics) are told to refer someone for abortion, counsel toward gender affirmation, encourage students in the department to protest police in support of open immigration policies, or institute various DEI initiatives, for example.

Many of these examples can contradict the professional’s understanding of science and/or their sincerely held beliefs. As stated, speaking or acting against professional doctrine may result in disciplinary action, harassment, or the loss of one’s job and practice license (e.g., Shannae Anderson; U.S. Department of Justice 2026b). Staying silent also produces a moral conflict for some professionals and comes with different consequences. For example, staying silent when a teenager desires “gender affirming” surgery. During consultation, it may seem permissible in the moment, but later the client may face physical complications and psychological regret (e.g., Kiefel, 2022). The helping professional, then, must contend with being complicit in the harm done to young women like Camille Kiefel and many others. By this, the profession is both harming its clients and damaging those who work in service to the field.

Section VI: Policy and Practice Solutions

As this report has described, the counseling and human services professions suffer from viewpoint discrimination, ideologically driven standards and research, and accreditation and licensure structures that enforce conformity. These problems are deeply entrenched—one might even say systemic—showing profound ideological imbalances within the professions and the accreditation community, and they will not correct course from within. Meaningful reform requires transforming professional standards and institutions away from ideologically driven standards, ethics, research, and practices. To get the helping professions back on track, this report offers the following policy recommendations:

• Remove Barriers to Free Speech

Professional institutions have effectively conditioned licensure on adherence to certain ideologies rather than on empirical evidence, burdening clinicians’ First Amendment freedoms. To remediate this issue, Congress acts to safeguard clinicians’ protections under the First Amendment.

In Chiles v. Salazar, the Supreme Court overwhelmingly ruled that Colorado’s ban on counseling (referred to as the “Minor Conversion Therapy Law”), as applicable to a licensed therapist’s talk therapy, is an unconstitutional viewpoint restriction on free speech. The court affirmed that such a categorical prohibition would effectively subject an individual’s speech to be ideologically regulated and compelled based entirely on viewpoint (Oyez, 2026).

Building on this case, Congress can codify the Chiles ruling into law through new legislation on viewpoint diversity and neutrality. A federal law, such as a “Counselor Free Speech Protection Act”, would explicitly shield clinicians from institutional bias and administrative retaliation. The law would establish that a clinician’s license cannot be threatened, suspended, or revoked for undertaking different viewpoint-diverse-therapeutic approaches. This would hold when the client has provided informed consent and the treatment does not meet an evidence-based threshold.

Generally, licensing is a right reserved for states under the Tenth Amendment (police powers). However, state-level regulatory bodies have increasingly enabled civil liability schemes that treat departures from the professions’ sanctioned positions as malpractice. This trend has helped to create a de facto speech ban that suppresses dissenting clinical perspectives. (e.g., Sawicki, 2022). Passing a new federal statute would close this loophole that states have been using. Short of congressional action, the executive branch can act now: the Department of Justice can bring or support First Amendment challenges against state regulatory bodies that condition licensure on viewpoint conformity, consistent with Chiles, and federal health agencies can condition relevant grants on state certification that licensure standards do not discriminate based on viewpoint.

• Reform Accreditation

In the counseling and human services fields, professional standards of practice are far too often grounded in ideological commitments rather than scientific evidence. Because licensure in most states is connected to graduation from an accredited program, accrediting bodies effectively enforce ideological conformity across the counseling and human services professions (e.g., CACREP, n.d.). States should remove recognition from captured accrediting bodies and authorize alternative pathways for program accreditation. Under the Tenth Amendment, states hold the right to set licensing standards and can reclaim oversight of these bodies.

In 2025, the Texas Legislature passed Senate Bill 530 (2025), which amended the Texas Education Code and allowed for the Southern Association of Colleges and Schools (SACS) to be removed as the exclusive, recognized accrediting body in statute. Texas now offers educational institutions a choice to be accredited by other professional bodies that can be approved by the Texas Higher Education Coordination Board (THECB).

The Texas model can be replicated in other states seeking to decentralize accreditation authority (Sylvester, 2025). Through this model, institutions retain the flexibility to align with bodies that better reflect scientific evidence and protect viewpoint diversity among future professionals.

Additionally, states can direct licensing boards to require continuing education courses (CEs) on certain topics to fulfill licensing renewal requirements. For example, some states require a practitioner to have 6 hours on ethics, 4 hours on cultural diversity, or 2 hours on suicide prevention per licensing period. States can fund health educators to create (CEs) and require licensees to obtain hours on the topics discussed throughout this paper (i.e., transgender procedures, detransitioner, and post-abortive care).

• Mandating Triple-Blind Peer Reviews

As the study retractions in Table 5 have highlighted, the peer-review process can function as a tool for ideological gatekeeping rather than for ascertaining the quality of the research. The current standard, single or double-blind review, makes research vulnerable to reviewers who are susceptible to allegiance effects and pressure to conform to dominant discourse (e.g., Kuhn, 1970).

• When reviewers can identify an author or their institutional affiliation, funding source, or ideological orientation, evidence suggests those variables influence publication decisions independent of methodological merit (Zimmerman & Marcus, 2024).
• By order, Congress should condition all funding for federal research on the adoption of triple-blind peer review, which is the process of blinding the identities of authors, reviewers, and in the initial stage, the journal editors being concealed throughout the review process (Brodie et al., 2021).
• Grants administered through NIH, NSF, and other related agencies already require certain compliance (NIH, 2025). Mandating triple-blind peer review for research would create another measure of protection against ideological and politically driven research (Brodie et al. 2021).
• Compliance should be required for any journal seeking to publish federally funded research. Additionally, such journals should be required to publicly disclose any conflicts of interest among their reviewers and apply those standards evenhandedly to all findings, regardless of direction. Violations of this could result in the withdrawal of federal funds or some form of restitution, making them disqualified for future grants.

• Grant Review Reform

The Olson-Kennedy case demonstrates the stakes when federally funded research is driven by ideological commitment rather than scientific pursuit (Ghorayshi, 2024). Scientific merit must be the gold standard for the awarding of federal research grants. Grants already go through review processes intended to ensure that taxpayer dollars are consistent with the public interest (NIH, 2025). Conditioning these grants according to federal policy is nothing new, although recent oversight findings show that fiduciary compliance has too often gone unenforced (House Oversight Committee, 2026). Taxpayer dollars should be tied to a clear plan to advance psychological and human services to the public’s benefit.

• Federal review boards should therefore be subject to mandatory viewpoint diversity requirements in their composition, treating ideological and theoretical diversity as a policy goal equivalent to demographic diversity (Duarte et al., 2015). Unlike demographic preferences, which raise constitutional concerns, intellectual diversity is central to the truth-seeking function of research and serves as a quality-control mechanism.
• Mandatory rotation and term limits on review boards could address the tendency for ideologically homogeneity among reviewers and the reviewal process.
• Evidence shows that having a prior grant receipt predicts future awards independent of proposal merit, structurally foreclosing funding to researchers outside the dominant institutional tradition (Ginther et al., 2011).
• Reform therefore should include blind review of institutional affiliation during initial scoring, caps on repeat grantees within the same research area, funding for first-time investigators, and/or the requirement of full public disclosure of reviewer conflicts-of-interest. It is integral that transparency among grants and grant recipients exists, as to ensure that tax dollars are unequivocally spent toward real programs and research that will genuinely benefit the public, rather than support the continuance of a political-driven narrative.

• Restoring the First Line of Care

One question that the above recommendations cannot fully answer: even if the profession were structurally corrected, does the current system of counseling and human service professionals adequately meet the needs of millions of Americans? The answer might be found largely outside the current approach to mental health care. Religiosity in the United States is still a salient factor in Americans’ lives. Approximately 80% of respondents stated that religion is an important part of daily life (Smith et al., 2025). Roughly 25% of adults turn to religious congregations for help with their mental health challenges (Wang et al., 2003). A comprehensive review spanning over a century of data found that religious involvement and spirituality are broadly associated with lower rates of depression, anxiety, and suicide, and greater resilience (Lucchetti et al., 2021).

Furthermore, the professional mental health system is currently unable to meet the demands for services. Taken together, these factors suggest that it is time for a change and for a new approach to mental health care. That approach is set out in a companion issue brief, Community Mental Health: Restoring the First Line of Care. Link for: Community Mental Health: Restoring the First Line of Care.