Mental Health Professionals who Support Natasha Helfer

Wednesday, April 14, 2021

As mental health professionals, we are concerned by Natasha Helfer being called into a membership council. We have an ethical obligation to draw upon both empirical research and governing standards of care as the guiding force in our practice, independent of shifts in church attitudes on these issues. We are concerned that withdrawing Natasha’s membership will create a culture of stigma and shame for potential clients seeking therapy, and to other therapists providing culturally-competent, clinically-sound, and evidence-based care.

Ethics and Agency

When working within a Latter-day Saint cultural context, these governing standards of care compel us to assist clients in assessing their personal values (which may or may not align with church teachings) and to support client self-determination/agency as a core principle of mental health and professional ethics. 

Many of our clients ultimately choose to remain aligned with different Latter-day Saint teachings and/or levels of ongoing activity within The Church of Jesus Christ of Latter-day Saints. For these clients, such practices are congruent with their mental wellbeing. For other clients, however, distancing from religiously based ideas, influence or activity (by their own choice) can contribute to improved mental health. As mental health professionals, our ethical obligation is not to determine a client’s spiritual or religious practice. Rather, our role is to put the client’s agency and self-determination at the center of any kind of therapy, offer research based information, operate within professional standards of care, and to continue to serve each client’s mental health needs, regardless of religious activity, belief, or non-belief. 

Public Advocacy

As mental health professionals, it is also part of our professional ethics to participate in public advocacy. This advocacy serves the public good by promoting sound findings from mental health research and improving mental-health-related policies within communities and at all levels of society.

It is with these ethics and professional standards in mind that we wish to help clarify and contextualize the following objections that have been raised in response to Natasha’s use of her public voice as a mental health professional. 

Mental Health Professionals as “Stone Catchers”

You asked Natasha why her tone seemed negative at times. 

In advocating for clients, it is essential for mental health professionals to speak honestly about patterns and issues that negatively impact the mental health of clients. From a clinical and empirical standpoint, there are areas in which church practices, culture, and doctrine can be damaging to the mental health of different individuals. Speaking out about these areas is not intended as an attack on a church. This type of honest dialogue is a call to do better, so that our clients and others who often feel their mental health and well being is at odds with their faith can find healing.

There may be times when a mental health professional advocates passionately for the best mental health outcomes for clients. That passionate speech can, for some listeners, be interpreted as having a “negative tone” simply because it is a request for change, which can be uncomfortable to hear.

As Elder Renlund said in General Conference earlier this April, we can all be “stone catchers.” This is a useful analogy in therapy to help couples understand and respond to words from their partner that are difficult to hear or may feel harsh. If we listen to the emotion under the apparent “negative tone,” we can discover pain and concern for very marginalized and vulnerable people—the least of these (Matt 25:40)—who we as mental health care providers and followers of Christ, members of His church, feel called to serve and aid.

Mental Health Professionals as Safety Advocates for the LGBTQIA+ Community

You asked Natasha to explain why she stated that the church was toxic for LGBTQIA+ members and their families: 

As Mormon mental healthcare providers, we recognize that religion can offer both protection and happiness—a sense of individual mission, connection to divine parentage, purpose in difficulty, divine help and inspiration, spiritual relationships with family and leaders, the ability to endure, and community support. 

Unfortunately, our best research suggests that LGBTQIA+ individuals who grow up in our Church have a different experience than many other members. Before we share that research, we wish to note that we work with many LGBTQIA+ individuals who are committed to living the gospel of Jesus Christ, in accordance with the current positions of The Church of Jesus Christ of Latter-day Saints, no matter the personal cost. Many of these individuals seek therapy because that cost can be tremendous, and they need good support. Some research-based reasons these members need support include:

• LGBTQIA+ young adults who mature in religious contexts are at higher odds for suicidal thoughts and more chronic (lasting for more than three months) suicidal thoughts, and suicide attempts as compared to other LGBTQIA+ young adults. (1)

• “Among people who regarded religion as very important, sexual minority status was more strongly associated with suicide ideation and attempt than the associations observed among people who regarded religion as unimportant.” (2)

• LGBTQIA+ Mormon and ex-Mormon adults experience substantial spiritual trauma and PTSD symptoms related to their religious experiences. (3)

• LGBTQIA+ members of the Church appear to experience PTSD symptoms at seven times the rate of the non-LGBTQIA+ world. (4)

It is important to understand that in order to prevent suicidal ideation, suicide attempts, and chronic religious trauma, many—likely a majority—of our LGBTQIA+ members may need to withdraw from or set clear boundaries around their level of Church involvement as they figure out how to re-organize their spiritual and psychological lives in a way that allows them to reclaim spiritual principles that are meaningful to them.

While we continue to support LGBTQIA+ members of the Church who are living the gospel, it would be harmful for us to remove our mental health lens and reassure them that their best pathway to happiness will be a commitment to celibacy, for example, or a belief that their faith in the atonement of Jesus Christ should eventually lead to a change in their sexual attractions or gender identity.

It’s a painful reality that for many LGBTQIA+ individuals that their LDS church experience feels unsafe, often times including amplified experiences of bullying, social rejection, and increased experiences with Major Depression Disorder, suicidal ideation, suicide attempts, and suicide completion. The term “unsafe” is an appropriate term to use in describing many LGBTQIA+ LDS individuals' lived experience considering the realities and risks of thoughts and feelings of no longer wanting to live (suicidal ideation), attempting, or completing suicide. Natasha’s use of the word “toxic” can be better understood from a clinical lens, understanding that toxic literally means “capable of causing injury or death,” and is a devastating mental health reality for many of our LGBTQIA+ LDS members and their loved ones. 

These mental health realities are all the more urgent, as the rate at which LGBTQIA+ identification in the United States has increased over time, according to the most recent Gallup poll. (5) One in six adults in Generation Z (those born between 1997 and 2002) identify as something other than heterosexual. While Gallup is capturing a U.S. demographic and the LDS church represents a global community, it's essential to recognize that LGBTQIA+ individuals are statistically a part of our families and our congregations' members often—though they often remain silent due to the level of stigma and fear of misunderstanding they face. Our congregations include our Heavenly Parents’ children, and many are impacted, from LGBTQIA+ individuals hurting to their families and loved ones witnessing their journey. As members who have committed to mourn with those who mourn, this is an issue that should inspire and invite all members to mourn, love, and support their LGBTQIA+ community members, as well as understand the risks to safety they experience. Many are affected by the risk factors and potentially toxic consequences LGBTQIA+ individuals face, and these issues should lead everyone to usher in greater love, kindness, and support. Natasha’s work and words honor her awareness that when one suffers and is unsafe, it should impact us all to lean in, get curious, and do better. Loving and advocating for the most marginalized members of our community, including our LGBTQIA+ members, aligns with Christ’s ministry of seeking after the needs and safety of the lost sheep while leaving the ninety and nine. 

Contextualizing “Patriarchal Authority” 

You asked Natasha to explain her quote about replacing one patriarchal authority with another. 

We think it is important to clarify that this specific quote, and its larger context, does not mention “The LDS Church” or “Church Leaders.” In academic social science usage, “the patriarchy” refers to any system in which men have more power than women. In this sense, “the patriarchy” is present in almost every organization and system.

Natasha states further, “Beware of any person/organization/system that assumes they know better than you about what you need.”

This statement is in line with well-researched core principles for mental health and therapeutic best practice. Interpersonal effectiveness and self-mastery require that we be aware of our own needs, that we set boundaries with others, and that we express those needs and boundaries in ways that create opportunities for connection and belonging. (6) None of these skills are possible if we do not believe that we have personal agency and choice and accountability—if we believe, as Natasha said, that “any person/organization/system . . . know[s] better than you about what you need.” (7)

As mental health professionals, we honor that individuals may choose to be obedient to patriarchal authorities for myriad valid reasons including faith, family, loyalty, and security. The paradox between agency and obedience is an essential part of LDS doctrine, and it is this paradox that opens up a space for our clients to choose obedience from a space of discernment and stewardship over their own agency. As mental health professionals, we teach our clients that they can and should be careful about which authorities they choose to obey as a best practice essential to good mental health outcomes.

Use of “Mormon” in Professional Organizations

The term "Mormon" is understood among religion scholars to represent the broad and internally diverse religious movement that traces its roots back to Joseph Smith. The Church of Jesus Christ of Latter-day Saints is the largest and best known of dozens of organized branches of the Mormon movement. The term "Mormon" is broadly used to signify a historic and contemporary identity rooted more in genealogy, region, culture, history, and even ethnicity than it is in church membership. (8)

Health care researchers and practitioners who recognize the importance of culturally competent care often seek to build an understanding of the ethnic and religious communities they serve and in service to community health may indicate to clients their capacity to provide culturally competent care. (9) Health care researchers and clinical practitioners recognize "Mormons" in North America as sharing common cultural traits and assumptions—regardless of affiliation or church activity—that impact health and well being. (10)

Balancing Cultural Attitudes with Clinical Best Practices

You expressed concern that some of Natasha’s opinions (about pornography, masturbation) are contrary to those accepted by the church.

As mental health professionals, we employ our well-earned secular education and use research-based interventions. Such interventions and counsel usually feel clear, concise, and ethical. Sometimes, the position of the church regarding a particular matter is unclear, complicated, and shifting. Issues like birth control, divorce, and now masturbation are issues where trained and licensed LDS professionals are ethically bound to balance cultural attitudes in the church with clinical best practices.

Masturbation

Even within LDS theology, masturbation is far from being a black and white issue. “Scholarly Mormon literature offers evidence that cultural masturbation attitudes vary and have continued to change over time. The data reveals a surprising diversity among Mormon viewpoints.” (11) The Church has taken a massive step back from the idea that masturbation is sinful, as seen in the removal of the topic from the For the Strength of Youth pamphlet, as well as its removal from the list of sins in the Leadership Handbook. 

In clinical best practices, masturbation is a positive intervention and a normal part of human development. (12) The American Association of Pediatrics finds self-exploration and masturbation a normal part of development. The American Psychological Association promotes the use of self-directed masturbation as part of the reclamation of self for those who’ve been sexually abused or traumatized. The Mayo Clinic promotes the use of masturbation when treating anorgasmia in adults. (13) The American Association of Marriage and Family Therapists endorse the use of sexual agreements around masturbation as an intervention when treating sexual desire discrepancy. 

Pornography 

The topic of pornography is a complex and nuanced one in professional and religious circles alike. However, research has shown that there is more nuance than may have been thought before. For example:

• There is a correlation between religious beliefs and the perception of an individual being addicted to pornography. Research shows that many individuals perceive their use of pornography as addictive in nature due to their religious affiliation. (14)

• Pornography addiction has not been added to diagnostic manuals (such as DSM 5 and ICD 10). The language used in these forms are based on “compulsive” behaviors and not “addiction.”

In line with this research, the church has made changes like:

• Changing the wording used in Church manual in the use of “pornography habit” vs “pornography addiction.” (15)

• Agreeing that there is a need for members of the church to bring more nuance into their conversations surrounding pornography and to develop skills and insight into managing their consumption of media. (16)

• Identifying that many people may struggle to maintain their religious and sexual values when it comes to pornography, but very few of those people are truly out-of-control/addicted with their sexual behavior.

As mental health professionals, we are glad to see these changes as we draw on evidence-based research and help LDS individuals navigate this space that often creates guilt and shame. Working with LDS folks who struggle with their use of pornography requires a unique cultural competency, which Natasha consistently displays. Natasha’s approach to pornography is in line with her professional license, as well as the standards established by The American Association of Sex Educators, Counselors and Therapists. We support clients and members in the community in navigating their relationship and compulsive use of pornography to bring new insights, hope and peace. We advocate for an increased understanding of a person’s experience in sexual behavior, asking “what else is going on to affect this behavior?” to reduce shame around normative sexual development and addressing the real issues that are easily ignored by the focus on binary teachings of “porn addiction.” This helps individuals get to the root of their presenting issue of pornography thereby healing individuals and marriages across the country. For many, this leads to a stronger connection with God, their values, and sexual health.

Guidance Consistent with Church Doctrine and Policy

You asked Natasha: “Are you concerned [potential clients] could believe that guidance provided in these areas is consistent with Church doctrine and policy because it is coming from Church members who identify themselves as ‘Mormon’?” 

We are happy to read in your letter that you welcome a diversity of opinions. Mental health best practice is rooted in respecting our clients diversity of belief and experience. It is not within the scope of our professional ethics to decide what qualifies as “guidance consistent with doctrine and policy,” and while this distinction may be clear in your mind, our clients are frequently confused on this issue. When our clients are confused, our professional role is 1. To provide them with the best information we have available, based on research, and rooted in our professional ethics. 2. Help them clarify their own values, their relationships, their faith. 3. Let them decide how they wish to relate to church doctrine and policy based on their own interpretations and values.
 

It would be unethical for us to represent ourselves as representatives of the church or arbiters or “guidance that is consistent with Church doctrine and policy.” To the best of our knowledge Natasha has consistently acted in alignment with professional ethics and best practices.

Trust and Mental Health Therapy

You asked if Natasha was concerned that potential clients who are members of the LDS Church are more likely to trust her since she identifies as a Mormon therapist.

The issue of trust is a vital one to mental health therapy. Research shows that the single most important clinical factor to our client’s success is the “therapeutic alliance.” At its core this means before we can give our clients tools to improve their mental health they need to feel safe. It is for this reason that we have so many ethical standards concerning informed consent, confidentiality, and boundaries.

While it is true that mental health clients often wish to see a therapist who shares their cultural experiences or religious beliefs, it is our job as professionals to become culturally competent to meet our client’s needs no matter their beliefs, culture, or background.

Many of our LDS clients do come to us with concerns as therapists. These concerns include:

1. Concern that therapists without an LDS background spend so much time asking questions about Mormonism, the client can’t get to the work they came in for.

2. Feeling unable to bring up spiritual or religious concerns with therapists who don’t signal openness to a spiritual conversation. 

3. Clients who identify as active are concerned that if their therapist is inactive or a former member they will “try to get them to doubt/leave.”

4. Clients who identify as unorthodox, inactive, or ex-LDS are concerned the therapist may use religious language/goals, in a limiting, shaming, or harmful way. 

5. Mixed-faith families and couple clients, who are concerned that their therapist will “take sides.”

As therapists, we are likely to see clients that fit all of these descriptions, perhaps all on the same day. As Mormon therapists, we are uniquely suited to balance all of these concerns, and ethically build trusting relationships with a wide range of clients. For these reasons, it is appropriate to signal to potential clients that we are culturally competent in LDS/Mormon issues—this saves time and energy for everyone involved. Much like a Mormon Studies professor builds valid scholarship based on the quality of their research, a Mormon therapist builds trust based on the quality of our cultural competency.

It would be highly unethical and ineffective to “trick” our clients into “trusting us” with a goal of influencing them in regards to their relationship with the church or to promote values that go against (or go in favor of) church teachings.

Regardless of Natasha’s membership status, she is a leading expert on Mormon mental health issues, and it is ethically appropriate for her to label herself “Mormon” as a matter of cultural competence.

The Role of Mental Health Professionals in Supporting Individuals who Choose to Leave the Church

You asked Natasha to explain if it is appropriate to help members leave the Church.

It is appropriate to help clients in a therapeutic setting find peace in their lives, develop personal values, and act in accordance with those values. Sometimes in therapy this means that clients will leave the church, and sometimes it means they will stay. It is neither ethical nor effective best-practice for us to encourage or advocate leaving or staying. If clients decide to leave, it is appropriate as therapists to help them find support to navigate what can be a painful process.

Conclusion

We stand with Natasha in her efforts to provide professional services that are in line with best practices, cultural competency, and professional ethics. Countless individuals have benefited from her expertise. Our clients are suffering. Our clients are dying. We are deeply concerned that the excommunication of a responsible, ethical, clinically-sound Mormon therapist will create a culture of fear and shame around seeking and providing mental health care within the Mormon culture. We strongly urge you to respect the separate stewardship of our professional roles and allow Natasha to retain her membership.

1. Gibbs, J., Goldbach J. (2015). Religious Conflict, Sexual Identity, and Suicidal Behaviors among LGBT Young Adults, Archives of Suicide Research, 19:4, 472-488, DOI: 10.1080/13811118.2015.1004476.

2. Lytle, M. C., De Luca, S. M., and Blosnich, J. R. (2018). Association of Religiosity With Sexual Minority Suicide Ideation and Attempt, American Journal of Preventive Medicine, 55(4), 644 – 651. 

3. Simmons, Brian. 2017. Coming Out Mormon: An Examination of Religious Orientation, Spiritual Trauma, and PTSD Among Mormon and Ex-Mormon LGBTQIA+ Adults. University of Georgia, PhD dissertation.

4. Simmons, Brian. 2017. Coming Out Mormon: An Examination of Religious Orientation, Spiritual Trauma, and PTSD Among Mormon and Ex-Mormon LGBTQIA+ Adults. University of Georgia, PhD dissertation.

5. https://news.gallup.com/poll/329708/lgbt-identification-rises-latest-estimate.aspx

6. Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.

7. Berzoff, J. (2011). Falling Through the Cracks: Psychodynamic Practice with Vulnerable and Oppressed Populations (Illustrated ed.). Columbia University Press.

8. Most major news outlets still use the term ‘Mormon,’ study shows, despite church’s wishes. (2020, September 18). The Salt Lake Tribune. https://www.sltrib.com/religion/2020/09/18/most-major-news-outlets/

9. Park, Y. (2019). Facilitating Injustice: The Complicity of Social Workers in the Forced Removal and Incarceration of Japanese Americans, 1941–1946 (Illustrated ed.). Oxford University Press.

10. LDS Church wants everyone to stop calling it the LDS Church and drop the word ‘Mormons’ — but some members doubt it will happen. (2018, August 23). The Salt Lake Tribune. https://www.sltrib.com/news/2018/08/16/lds-church-wants-everyone/

11. Malan, M.K., Bullough, V. Historical development of new masturbation attitudes in Mormon culture: Silence, secular conformity, counterrevolution, and emerging reform. Sexuality and Culture 9, 80–127 (2005). https://doi.org/10.1007/s12119-005-1003-z

12. Strachan, E., Staples, B. Masturbation. Pediatrics in Review April 2012, 33 (4) 190-191; DOI: https://doi.org/10.1542/pir.33-4-190

13. https://www.mayoclinic.org/diseases-conditions/anorgasmia/diagnosis-treatment/drc-20369428

14. Leonhardt, N.D., Willoughby, B.J., and Young-Petersen, B. (2017). Damaged Goods: Perception of Pornpgraphy Addiciton as a Mediator Between Religiosity and Relationships Anxiety Surrounding Pornography Use. The Journal of Sex Research, Vol. 55, pgs. 357-358.

15. https://www.churchofjesuschrist.org/study/manual/help-for-me/time-to-get-over-habit?lang=eng

16. Oaks, D.H. (2015) “Recovering from the Trap of Pornography.” Ensign.

17. Oaks, D.H. (2015) “Recovering from the Trap of Pornography.” Ensign.

Authors and Editors: 

Lisa Butterworth, LCPC; Colette Dalton, LCSW; Lisa T. Hansen, PhD, LMFT; Jenny Elledge, LMFT; Sara Hughes-Zabawa, LCSW; Laura Skaggs, MS LMFT; Kristin B. Hodson, LCSW, CST; Stacey Jackson-Roberts, MSW, LCSW-C; Cami Hurst, LAMFT; Braxton Dutson, LCSW, CST; Martin Erickson, PhD, LMFT; Aimee Heffernan, LMFT, CST; Alice Roberts, LCSW; Jenny Johnson, MS, LMFT; Noelle Ihli; Amber Whiteley, Ph.D., Licensed Psychologist; Christa Baxter; Emily Summerhays; Joanna Brooks; Cici DeWaal; Gerardo Sumano; Josh Weed, LMFT