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LGBT Affirming Counselors
Counselors are expected to be ethical. They are committed to serving the lesbian, gay, bisexual and transgender community with integrity and professionalism. They adhere to codes of ethical behavior.
Ethical counselors do not consider homosexuality a choice. Nor do they consider it a disorder or a disease. They do not consider their clients sick or confused. They do not consider homosexuality unnatural or immoral. They, in fact, are proud to be allies, advocates, and activists in behalf of the issues and concerns of their LGBT students and clients.
Ethical counselors provide professional and compassionate advising, therapy, consultation, and counseling to LGBT students and clients in a manner that is respectful, affirming, supportive, and non-judgmental.
Ethical counselors assist their students and clients in the coming-out process. They want their students and clients to know that they are accepted for who they are. They can be themselves. They do not need to hide who they are. They do not need to guard their speech. They can be open about themselves and speak freely about aspects of their lives.
Ethical counselors avoid attitudes and behavior that are oppressive to LGBT persons, including homophobia and heterosexism. They are informed professionals. Their perspectives on LGBT issues are based on solid medical, psychological, sociological, therapeutic, and scientific research.
Ethical counselors are proud to label themselves as LGBT-friendly or LGBT-affirming. They would like for their clients and prospective clients to know that they will be treated with respect.
Counseling LGBT Youth
ALGBTIC: Competencies for Counseling LGBT Clients
Counseling Today Article: No
More Sitting on the Sidelines
High Beam Research: Attitudes of Counseling Students to Lesbians & Gays
Counseling Today: Connecting With Clients of Faith
Counselors for Social Justice: Statement on Sexism & Heterosexism
Adapting Counseling Skills for Multicultural & Diverse Clients
ALGBTIC: LGBT References and Resources
Unethical and Unjust Counseling Practices
Dr. Michael Chaney was the 2010-11 national President of ALGBTIC. His current message to members of the counseling profession is: "There Is No Place for Hate in A Counseling Space." In his presidential message on the ALGBTIC website, Michael Chaney (who uses the term "queer" to mean "lgbtq") focuses on "social justice issues and advocacy strategies centered on queer communities."
He goes on to say: "Over the next year, I will be putting in the spotlight some of the unethical and unjust practices currently taking place in the field of counseling such as sexual orientation change efforts and other anti-queer counseling movements. Furthermore, I will focus on bringing queer-affirmative counseling issues to the forefront."
In citing projects he intends to launch, Michael Chaney stated: "On behalf of our queer communities, an Anti-LGBT Counseling Task Force is being formed that will have several responsibilities over the next year including educating ACA members and non-members about social injustices against queer clients/students (sexual orientation change efforts and other reparative therapies), examining the current ethical codes and proposing changes to ACA Ethics Committee, and organizing events/discussions related to queer-affirmative counseling."
Counseling Today Article: No
More Sitting on the Sidelines
Research: Homonegitivity Among Alabama Counselors
ACA: Ethical Issues Related to Conversion Therapy
News: Grad Student Sues Counselor Education Program Over LGBT Views
Ethical Counseling: You Can Be Yourself With Me
Conversation Therapy or Reparative Therapy
Counseling LGBT Clients
Before beginning any treatment with an LGBT client, a therapist has the responsibility of making sure he or she is well versed on issues related to sexuality, has the skills necessary to create a positive and nonjudgmental environment, and will not feel uncomfortable discussing issues related to homosexuality. If a therapist believes homosexuality is wrong, sinful, immoral, or a mental illness, he or she should NOT work with gay clients. Refer this client to someone who is able to provide the necessary components of a therapeutic relationship.
APA: Handbook of
Counseling & Psychotherapy with LGBT Clients
Eye on Religion: Counseling Students Can't Be Bigots
Gay 365: Judge Rules Against Anti-Gay Counseling Student
Gay 365: Judge Rules Against Another Anti-Gay Counseling Student
Professional Treatment for LGBT Clients
Treatment for LGBT clients should be no
different than any other client. In terms of mood disorders, anxiety
disorders, relationship concerns, stress, and sexual issues, homosexual
clients present at about the same rate as their counterparts and
treatment should not be any different. Research has, however, shown that
depression is significantly higher among gay adolescents and that the
suicide rate is double their straight counterpart. Suicidal ideation,
depression, and anxiety are also higher among those who have not
accepted their sexuality or who struggle for acceptance with friends and
family because of their sexual orientation.
Couples therapy should be treated no different than marital therapy, aside from the obvious legal and social issues. Any bias a therapist has will be very difficult to hide when dealing with relationship issues with a gay or lesbian client. Their relationships should be treated with the same legitimacy as any committed relationship, and the therapist should be aware that like any sexual relationship, their may be intimacy concerns, fidelity issues, children, parents, and other issues that may be a part of treatment. Be prepared for this and once again, refer out if you are not able to accept and respect your client.
Understanding LGBT Clients
When working with gay and lesbian clients, it is
often important to know where your client is in terms of acceptance. If
sexuality is a presenting issue, understanding the stages is even more
important. Cass (1979) lists six stages that many homosexuals go through
when dealing with their own sexual orientation. These stages have been
widely accepted by professionals and gay men and women alike. They
(1) Identity Awareness. The point when the child or adolescent begins to realize he or she has feelings that are different from others and different from what they have been taught.
(2) Identity Comparison. The individual
begins to explore his or her feelings alone and to compare them to the
beliefs of society, parents, and peers.
(3) Identity Tolerance. During this stage,
the individual will often rebel against his or her feelings and attempt
to deny them. After all, nobody wants to be gay in a straight world.
(4) Identity Acceptance. After realizing
that sexuality is a part of who they are, they begin to embrace it,
explore their feelings and desires, and start to find a place in the
world where they are accepted and belong.
(5) Identity Pride. Often involves anger
toward parents, society, religion, or other aspects of the world that
tells them that they are bad, wrong, immoral, or mentally ill merely
because their feelings are directed toward the same sex. They embrace
the ‘homosexual lifestyle’ and explore their newfound sexuality. It is
during this stage that the gay or lesbian may start fighting against
what society has taught them.
(6) Identity Synthesis. The final stage in
which homosexuality becomes a part of who they are rather than the
defining factor. Instead of being a gay man or lesbian, they begin to
see themselves as parents, employees, leaders, teachers, supervisors,
coaches, and volunteers who just happen to be gay. In the final stage,
they are able to accept themselves more wholly rather than seeing their
sexuality as separate from the rest of who they are.
Official Statements About Reparative Therapy
The American Psychiatric Association, The American Psychological Association, The American Academy of Pediatrics, and others have denounced conversion, reparative, or reorientation therapy due to the high incidences of negative outcomes and very low and even questionable success rates.
"Confusion about sexual orientation is not
unusual during adolescence. Therapy directed at specifically changing
sexual orientation is contraindicated, since it can provoke guilt and
anxiety while having little or no potential for achieving changes in
- American Academy of Pediatrics
"For nearly three decades, it has been known that homosexuality is not a mental illness. Medical and mental health professionals also now know that sexual orientation is not a choice and cannot be altered. Groups who try to change the sexual orientation of people through so-called conversion therapy are misguided and run the risk of causing a great deal of psychological harm to those they say they are trying to help."
-American Psychological Association
"Clinical experience suggests that any person who seeks conversion therapy may be doing so because of social bias that has resulted in internalized homophobia, and that gay men and lesbians who have accepted their sexual orientation positively are better adjusted than those who have not done so."
- American Psychiatric Association
The national LGBT counseling organization, ALGBTIC, has issued their official statement of competencies for counseling lesbian, gay, bisexual, queer and questioning individuals. According to ALGBTIC's professional guidelines, competent counselors of LGBT individuals will…
Understand that biological, familial, cultural, socio-economic, and psychosocial factors influence the course of development of affectional orientations and gender identity/expressions.
Affirm that LGBQQ persons have the potential to integrate their affectional orientations and gender identity into fully functioning and emotionally healthy lives and relationships.
Identify the heterosexism, biphobia, transphobia, homophobia, and homoprejudice inherent in current lifespan development theories and account for this bias in assessment procedures and counseling practices.
Be aware of the effects internalized homophobia/biphobia/transphobia may have on individuals and their mental health.
Notice that developmental periods throughout the lifespan (e.g., youth, adolescence, young adults, middle adults, older adults) may affect the concerns that LGBQQ clients present in counseling.
Recognize how stigma, prejudice, discrimination and pressures to be heterosexual may affect developmental decisions and milestones in the lives of individuals regardless of the resiliency of the LGBQQ individual.
Know that the normative developmental tasks of LGBQQ youth, adolescence, young adults, middle adults, older adults, may be complicated, delayed, or compromised by identity confusion, anxiety and depression, suicidal ideation and behavior, academic failure, substance abuse, physical, sexual, and verbal abuse, homelessness, prostitution, and STD/HIV infection.
Understand that the typical developmental tasks of LGBQQ older adults often are complicated or compromised by social isolation and invisibility.
Understand that affectional orientation is not necessarily solid, it is or “can be” fluid, and may change over the course of an individual’s life span.
Understand that LGBQQ individuals family structures may vary (e.g. multiple coupled parenting families, polyamorous families), and they may belong to more than one group they consider their family.
Understand that an LGBQQ individual's family of origin group and/or structure may change over time, especially as it relates to the family's acceptance/rejection of the LGBQQ member, and acknowledge the impact that being rejected from one's family may have on the individual. If problems exist in the "family of origin," the individual may create a "family of choice," among supportive friends and relatives.
Understand the individual, throughout the lifespan, may or may not be "out" about their affectional orientation in any or all aspects of their life. Recognize reasons for disclosing or not disclosing an affectional orientation may vary.
Understand that coming out is an on-going and multi-layered process for LGBQQ individuals and that coming out may not be the goal for all individuals. While coming out may have positive results for a person's ability to integrate their identity into their lives thus relieving the stress of hiding, for many individuals coming out can have high personal and emotional costs (e.g., being rejected from one's family of origin, losing a job/career, losing one's support system).
Understand LGBQQ group members have the resiliency to live fully functioning, healthy lives despite experiences with prejudice, discrimination, and oppression.
Understand the importance of appropriate use of language for LGBQQ individuals and how certain labels (such as gay or queer) require contextualization to be utilized in a positive and affirming manner.
Be aware that language is ever-evolving and varies from person to person; honor labels and terms preferred by the client; recognize that language has historically been used and continues to be used to oppress and discriminate against LGBQQ individuals; understand that the counselor is in a position of power and should model respect for the individual's declared vocabulary.
Understand the history, contributions of diverse participants, and points of pride for the LGBTQIQA community (e.g., the LGBTQIQA rights movements). Be aware of current issues/struggles/victories for the LGBTQIQA community (e.g., ENDA, Marriage Equality, Don’t Ask Don’t Tell, Hate Crimes Legislation, suicides related to anti-LGBT bullying) as well as current events within the profession (e.g., students/practitioner refusing services to LGBQQ individuals, resolutions on reparative therapy, etc.).
Be aware of the social and cultural underpinnings to mental health issues (e.g. high suicide rate of LGBQQ children and adolescents, particularly in response to anti- LGBTQIQA bullying. Also be aware of how anti-gay bullying impacts children and adolescents from all communities, not just LGBTQIQA communities).
Acknowledge that heterosexism and sexism are worldviews as well as value-systems that may undermine the healthy functioning of the affectional orientations, gender identities, and behaviors of LGBQQ persons.
Understand that heterosexism and sexism pervade the social and cultural foundations of many institutions and traditions and may foster negative attitudes, overt hostility, and violence toward LGBQQ persons.
Familiarize themselves with the cultural traditions, rituals, and rites of passage specific to LGBTQIQA populations.
Recognize that spiritual development and religious practices may be important for LGBQQ individuals, yet it may also present a particular challenge given the limited LGBQQ positive religious institutions that may be present in a given community, and that many LGBQQ individuals may face personal struggles related to their faith and their identity.
Acknowledge that affectional orientations are unique to individuals and they can vary greatly among and across different populations of LGBQQ people. Further, acknowledge an LGBQQ individual's affectional orientation may evolve across their lifespan.
Acknowledge and affirm identities as determined by the individual, including preferred labels, reference terms for partners, and level of outness.
Be aware of misconceptions and/or myths regarding affectional orientations and/or gender identity/expression (e.g., that bisexuality is a “phase” or “stage”, that the majority of pedophiles are gay men, lesbians were molested or have had bad experiences with men).
Acknowledge the societal prejudice and discrimination experienced by LGBQQ persons (e.g., homophobia, biphobia, sexism, etc.) and collaborate with individuals in overcoming internalized negative attitudes toward their affectional orientations and/or gender identities/expressions.
Acknowledge the physical (e.g., access to health care, HIV, and other health issues), social (e.g., family/partner relationships), emotional (e.g., anxiety, depression, substance abuse), cultural (e.g., lack of support from others in their racial/ethnic group) ), spiritual (e.g., possible conflict between their spiritual values and those of their family’s), and/or other stressors (e.g., financial problems as a result of employment discrimination) that may interfere with LGBQQ individuals ability to achieve their goals.
Recognize that the counselor’s own affectional orientation and gender identity/expression are relevant to the helping relationship and influence the counseling process. Use self-disclosure about the counselor’s own affectional orientation and gender identity/expression judiciously and only when it is for the LGBQQ individual’s benefit.
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. These approaches, known as reparative or conversion therapy lack acceptable support from research or evidence and are not supported by the American Counseling Association or the American Psychological Association. When individuals inquire about these above noted techniques, counselors should advise individuals of the potential harm related to these interventions and focus on helping clients achieve a healthy, congruent affectional orientation/gender identity/expression.
Ensure that all clinical-related paperwork and intake processes are inclusive and affirmative of LGBQQ individuals (e.g., including “partnered” in relationship status question, allowing individual to write in gender as opposed to checking male or female).
Recognize that the individual’s LGBQQ identity may or may not relate to their presenting concerns.
Recognize and acknowledge that, historically, counseling and other helping professions have compounded the discrimination of LGBQQ individuals by being insensitive, inattentive, uninformed, and inadequately trained and supervised to provide culturally proficient services to LGBQQ individuals and their loved ones. This may contribute to a mistrust of the counseling profession.
Understand the coming out process for LGBQQ individuals and do not assume an individual is heterosexual and/or cisgender just because they have not stated otherwise. Individuals may not come out to their counselors until they feel that they are safe and can trust them, they may not be out to themselves, and this information may or may not emerge during the process of counseling. A person's coming out process is her/hir/his own, and it is not up to the counselor to move this process forward or backward, but should be the decision of the individual. The counselor can help the individual understand her/hir/his feelings about coming out and offer support throughout the individual's process.
Demonstrate the skills to create LGBQQ affirmative therapeutic environments where disclosure of affectional orientation is invited and supported, yet there are not expectations that individuals must disclose their affectional orientation.
Continue to seek awareness, knowledge, and skills with attending to LGBQQ issues in counseling. Continued education in this area is a necessity for competent counseling due to the rapid development of research and growing knowledge base related to LGBQQ experience, community, and life within our diverse, heterocentric, and ever-changing society.
Become informed (via empirical and theoretical literature and supervision/consultation with LGBTQIQA communities resources) of the spectrum of healthy functioning within LGBTQIQA communities. Appreciate that differences should not be interpreted as psychopathology, yet they often have been interpreted in harmful ways to LGBTQIQA individuals/couples/families (e.g. the history of support and use of reparative/conversion therapy within the mental health field).
Acknowledge that affectional identity, gender identity, and other intersecting identities (race, ethnicity, class, ability, age, etc.) may or may not be the presenting concern for LGBQQ individuals, but that experiences of oppression may impact presenting issue(s).
Understand that at times individuals may present more positively to counseling than their actual experiences if they have not identified the oppressions or identity-stresses they may have experienced or if they have high levels of internalized oppression. Internalized oppression presents in a variety of ways and can sometimes be difficult to identify. Some examples are: an individual who uses heterosexist language while not understanding how this correlates to low self-esteem, low desire for partners, and/or low tolerance for people of the same community; an individual believes that the stereotypes they hear about their identity are indeed true of all people of that identity; individuals feel incapable of success because they have heard so many negative things about people whose identity they share.
Recognize that there have been very limited attempts, to date, to develop LGBTQIQA norm groups for counseling assessment instruments. This lack of norm groups should prompt significant caution regarding the interpretation of assessment results across any and all domains of functioning (e.g., cognitive, personality, aptitude, occupational/career, substance abuse, and couple/family relationships).
Be aware that the counseling field has a history of pathologizing LGBQQ individuals and communities (e.g., studies of homosexuality as a “disorder" and research agendas that seek to “prove” that affectional orientation and/or gender identity/expression can be “changed”). Understand that these approaches to research and program evaluation have been deemed harmful and unethical in their research goals by professional organizations in the field.
Be aware of existing LGBQQ research and literature regarding social and emotional well-being and challenges to identity formation, resilience and coping with oppression, as well as ethical and empirically supported treatment options.
Be current and well-informed on the most recent scholarship (e.g., research studies, conceptual work, program evaluation) with LGBQQ individuals and communities.
Understand limitations of existing literature and research methods regarding LGBQQ individuals with regard to sampling (e.g., racial/religious diversity), confidentiality issues (e.g., LGBQQ youth who are not “out” to their parents and cannot seek parental consent for participating in studies), data collection (e.g., accessing samples who are not “out”), and generalizability across the distinct identities within LGBQQ identities and experiences (e.g., research on gay men may not be generalizable across lesbians or bisexual men).
Counselors for Social Justice
Research indicates the development of a healthy sexual orientation, gender identity, and gender expression is an important aspect of human development and subsequent mental health. In addition, the use of reparative therapy and transformational ministries as a part of counseling is also problematic. Using counseling as a tool to repress a person’s sexual orientation and using religion to promote certain sexualities and gender identities is unethical and potentially damaging to the mental health of the client.
The growing body of research indicating the harmful effects of sexism and heterosexism on human development and mental health signals their relevance to counselors, and is a call to action to the counseling profession. Heterosexist stereotypes can impose physiological and psychological burdens on sexual minorities of all ages and ethnic backgrounds. As social change agents, counselors would do well to adopt proactive measures that combat the harmful effects of sexism and heterosexism in
Few issues tend to spark as much debate in religious circles as matters of sexual identity. Perhaps for that reason, says Michael Kocet, president of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, many people -- including some counselors -- assume that the LGBT community as a whole dismisses the need for religion. That assumption is dangerously false, says Kocet, who has chosen "Finding the Spirit Within: Celebrating the Diversity of Spirit in the LGBTQ Community" as the theme of his presidency.
"In my opinion, religion should be a place of affirmation for people to be in touch with their spirituality," he says. "LGBT individuals often want to stay connected to their religious tradition, but they don't always feel welcome or safe. They sometimes feel alienated in their place of worship and experience homoprejudice. Sometimes, religious institutions hurt the self-worth of LGBT clients."
Some LGBT clients feel so ostracized that they leave their religion altogether or search for another religious community that is more accepting and affirming, Kocet says. "Counselors have an ability to help these clients find their own path and can point them to groups where they can integrate their two identities," he says.
At the same time, Kocet emphasizes, the client must be the one who makes the decision to explore that path of action -- not the counselor. "Some clients may be open to exploring other faith traditions than the one in which they were raised," he says, "but counselors also have to be affirming of client autonomy if they want to stay where they are. If their faith is important to them, it would be unethical for the counselor to coerce the client to choose a different religion."
ACA member Robert Brammer says LGBT clients sometimes get the sense that counselors view their religious identity as being less important than their sexual identity. "One of the problems I see is that some counselors assume LGBT clients should just abandon their religion. They don't always understand how fundamental that religious belief is to these clients," says Brammer, who recently wrote an article exploring ways to help gays and lesbians integrate their spiritual beliefs with their sexual orientation for the Journal of GLBT Family Studies. "It's probably more important as counselors to help them reconcile the dissonance they may be feeling and encourage them to seek religious guidance in addition to psychological help."
(From Jonathan Rollins / Counseling Today)
Association for Lesbian Gay Bisexual & Transgender Issues in Counseling of Alabama