Ethical Issues Working With LGBT Clients Cathy Hanville, LCSW

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Overview of Ethical Issues

✤ APA Guidelines for Psychological practice working with Lesbian, Gay, Bisexual Clients

✤ APA Guidelines for Psychological practice working with Transgender and Gender Non-Conforming Clients

What will be covered

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APA Guidelines for Psychological practice

working with LGB Clients

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American Psychological Association. (2012). Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients. American Psychologist, 67 Vol 1, 10-42. doi: 10.1037/a0024659

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In 2012 the APA issued some specific guidelines for working with LGB clients. There are 16 Guidelines which will be discussed in the following slides. The link to the full article is in the Recommended Reading page of

the course.

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Guidelines for Psychological Practice With Lesbian, Gay, and Bisexual

Clients. American Psychological Association January 2012

American Psychologist

© 2011 American Psychological Association Vol. 67, No. 1, 10 – 42

http://www.apa.org/pubs/journals/features/amp-a0024659.pdf

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“Guideline 1. Psychologists strive to understand the effects of stigma (i.e.,prejudice, discrimination, and violence) and its various contextual

manifestations in the lives of lesbian, gay, and bisexual people.”

This is the reason I have included information both on discrimination and on laws that negatively affect LGBT people. It is important to understand the role these things have on the well being of LGBT people.

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“Guideline 2. Psychologists understand that lesbian, gay, and bisexual orientations are not mental illnesses.”

Homosexuality was removed from the Diagnostic and Statistical Manual (DSM) in 1973.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4695779/

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“Guideline 3. Psychologists understand that same-sex attractions, feelings, and behavior are normal variants of human sexuality and that efforts to change sexual orientation have not been shown to be effective

or safe.”

There is an additional handout on Sexual Orientation Change Efforts (SOCE) which addresses issues in regards to conversion or reparative therapies.

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“Guideline 4. Psychologists are encouraged to recognize how their attitudes and knowledge about lesbian, gay, and bisexual issues may be

relevant to assessment and treatment and seek consultation or make appropriate referrals when indicated.”

When working with any diverse group it is important to have done your own work on privilege and to be sure to have some additional training on working with that group.

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“Guideline 5. Psychologists strive to recognize the unique experiences of bisexual individuals.

Bisexuals often get lost in trainings on LGBT issues. It is important to recognize that their experiences may be different.

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“Guideline 6. Psychologists strive to distinguish issues of sexual orientation from those of gender identity when working with lesbian,

gay, and bisexual clients.”

Sexual orientation and gender identity are different concepts and it is important not to conflate them in your work with LGBT clients.

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“Guideline 7. Psychologists strive to be knowledgeable about and respect the importance of lesbian, gay, and bisexual relationships.”

Relationships in the LGBT community may or may not look different from those in the heterosexual community. It is important to ask questions about who their family is and honor the answer.

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“Guideline 8. Psychologists strive to understand the experiences and challenges faced by lesbian, gay, and bisexual parents.”

LGBT parents will face different obstacles from straight parents including many legal obstacles if their children are adopted or need to be adopted by a second parent.

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“Guideline 9. Psychologists recognize that the families of lesbian, gay, and bisexual people may include people who are not legally or

biologically related.”

Many LGBT people have “chosen” families and it is important to have an understanding of who those people are for your clients.

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“Guideline 10. Psychologists strive to understand the ways in which a person’s lesbian, gay, or bisexual orientation may have an impact on his

or her family of origin and the relationship with that family of origin.”

Many LGBT people may be estranged from their families or origin or have tension as a result of their identities. It is important to be aware of this and assist clients in coping with any impacts.

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“Guideline 11. Psychologists strive to recognize the challenges related to multiple and often conflicting norms, values, and beliefs faced by lesbian, gay, and bisexual members of racial and ethnic minority

groups.”

One of the aspects of my affirmative counseling handout is understanding intersexuality. LGBT clients of different racial and ethnic backgrounds may face different challenges.

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“Guideline 12. Psychologists are encouraged to consider the influences of religion and spirituality in the lives of lesbian, gay, and bisexual

persons.”

Many LGBT people are connected with organized religion or have their own spiritual beliefs. It is always good to explore these as a potential supportive resource for clients.

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‘Guideline 13. Psychologists strive to recognize cohort and age differences among lesbian, gay, and bisexual individuals.”

Age can play an important role in how LGBT people experience themselves. Older LGBT people have often faced more discrimination and may be more isolated.

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“Guideline 14. Psychologists strive to understand the unique problems and risks that exist for lesbian, gay, and bisexual youths.”

LGBT youth continue to be disproportionately homeless and are at a higher risk for suicide. Family rejection increases that risk substantially.

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“Guideline 15. Psychologists are encouraged to recognize the particular challenges that lesbian, gay, and bisexual individuals

with physical, sensory, and cognitive–emotional disabilities experience.”

LGBT people still may have issues with different disabilities and their experiences getting treatment for this disabilities may be different than those for heterosexual people.

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“Guideline 16. Psychologists strive to understand the impact of HIV/AIDS on the lives of lesbian, gay, and bisexual individuals and

communities.”

While HIV/AIDS is not usually the immediate death sentence it used to be it has profoundly affected the LGBT community in both positive and negative ways.

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“Guideline 17. Psychologists are encouraged to consider the impact of socioeconomic status on the psychological well-being of lesbian, gay,

and bisexual clients.”

Socioeconomic status always is relevant to mental health well being.

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“Guideline 18. Psychologists strive to understand the unique workplace issues that exist for lesbian, gay, and bisexual individuals.”

In 28 states it is still legal to fire someone because they are LGB and in 30 states it is legal to fire someone because of gender. That can greatly affect how a person experiences their workplace.

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“Guideline 19. Psychologists strive to include lesbian, gay, and bisexual issues in professional education and training.”

When doing training it is important to bring LGBT issues into the training.

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“Guideline 20. Psychologists are encouraged to increase their knowledge and understanding of homosexuality and bisexuality through continuing

education, training, supervision, and consultation.”

It is important to continue to get trainings and other support as needed when working with LGBT people.

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“Guideline 21. In the use and dissemination of research on sexual orientation and related issues, psychologists strive to represent results

fully and accurately and to be mindful of the potential misuse or misrepresentation of research findings.”

When involved in research it is important to make sure LGBT people are represented fairly.

APA Guidelines for Psychological practice

working with TGNC Clients

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American Psychological Association. (2015). Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. American Psychologist, 70 (9), 832-864. doi: 10.1037/a0039906

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In 2015 the APA issued some specific guidelines for working with TGNC clients. There are 16 Guidelines which will be discussed in the following

slides. The link to the full article is on the Recommended Reading page of the course.

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“Guideline 1. Psychologists understand that gender is a nonbinary construct that allows for a range of gender identities and that a

person’s gender identity may not align with sex assigned at birth. “

Your TGNC clients they will have a wide variety of identities. It is important to understand the language used and have accepted that

people have identities that may not align with what society says they should be. It is also important to allow your client to self-

identify in the ways they need to and allow for that to change over time.

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“Guideline 2. Psychologists understand that gender identity and sexual orientation are distinct but interrelated constructs.“

Many people conflate sexual orientation and gender identity. They are very separate identities though there can be some

intersectionality between them. Do not make assumptions.

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“Guideline 3. Psychologists seek to understand how gender identity intersects with the other cultural identities of TGNC people.“

In the affirming counseling with TGNC handout/video, I talk more in depth about intersectionality. It is important to have cultural

competence with gender, sexuality, race, ethnic background, and religion because each of those identities will overlap with gender

identity.

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“Guideline 4. Psychologists are aware of how their attitudes about and knowledge of gender identity and gender expression may affect the

quality of care they provide to TGNC people and their families.”

This is very important. Our biases can easily come up with any work we do with clients. It is very important to have done your

own work around privilege and gender identity.

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“Guideline 5. Psychologists recognize how stigma, prejudice, discrimination, and violence affect the health and well-being of TGNC

people.“

I included a presentation on discrimination faced by TGNC people as part of this class because minority stress can and does

affect the well being of our clients. Many times people are diagnosed with mental health issues that are really a response to their environment. As a result of the violence and stigma many TGNC clients face you will see many clients that have trauma

histories that you need to be able to address.

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“Guideline 6. Psychologists strive to recognize the influence of institutional barriers on the lives of TGNC people and to assist in

developing TGNC-affirmative environments.“

This is why you need to be very aware of the message your office, website, marketing materials, and paperwork send. You need to use inclusive

language and have an affirming website and office. Have someone review it to look for areas in which it can be improved.

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“Guideline 7: Psychologists understand the need to promote social change that reduces the negative effects of stigma on the health and

well-being of TGNC people.“

Many therapists do not see social change as part of their work. However, if you work with TGNC clients it has to be. It is our job to

advocate and try and make things better for all TGNC people.

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“Guideline 8. Psychologists working with gender-questioning and TGNC youth understand the different developmental

needs of children and adolescents, and that not all youth will persist in a TGNC identity into adulthood.”

Gender Spectrum is a great resource for working with youth. It is included in the recommended reading section. It is very important to

understand youth development and how to work with families to support their children in their gender expression which may or may

not continue into adulthood.

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“Guideline 9. Psychologists strive to understand both the particular challenges that TGNC elders experience and the resilience they can

develop. “

This country’s attitudes towards TGNC people has improved some in recent years. But TGNC elders have lived many years in extreme fear and with few resources. Therapists need to have an understanding of that to work effectively with them. I have also

included an article on working with TGNC elders in the recommended reading section.

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“Guideline 10. Psychologists strive to understand how mental health concerns may or may not be related to a TGNC person’s gender identity and the psychological effects of minority stress.”

As discussed previously, some TGNC people may be diagnosed with anxiety or depression or other mental health issues that are more

related to minority stress than to an actual diagnosis. Psychological stress is no inherent for TGNC people. It is important to diagnosis appropriately and work to end stigma. I have included a link to an article on microaggressions in the recommended reading section.

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“Guideline 11. Psychologists recognize that TGNC people are more likely to experience positive life outcomes when they receive social support or

trans-affirmative care.”

This may seem self-evident but many TGNC people have had prior traumatic experiences with the healthcare system. It is our job to end that cycle and make sure we make referrals to places/providers that

provide affirmative care. We also need to help them create social supports for themselves as appropriate.

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“Guideline 12. Psychologists strive to understand the effects that changes in gender identity and gender expression have on the

romantic and sexual relationships of TGNC people.”

As the prior guideline said acceptance is a part of a successful outcome for TGNC people. Part of that may be navigating their intimate

relationships and how partners respond to any change in identity a person may make. It is also important to respect clients that choose not

to make any changes in order to maintain their relationships.

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“Guideline 13. Psychologists seek to understand how parenting and family formation among TGNC people take a variety of forms.”

Families are made up of all sorts of shapes and sizes. LGBT people have long created their own chosen families. It is our job to make sure our

clients have adequate support in their lives and to support their families whatever they look like.

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“Guideline 14. Psychologists recognize the potential benefits of an interdisciplinary approach when providing care to TGNC people and

strive to work collaboratively with other providers.”

Many of our clients will need other support such as medical providers. It is important for therapists to develop relationships with these providers when they can in order to collaborate on care when

possible.

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“Guideline 15. Psychologists respect the welfare and rights of TGNC participants in research and strive to represent results accurately and

avoid misuse or misrepresentation of findings.”

If we do research or refer clients to research projects we need to do so ethically. If we see research that misrepresents TGNC people we

should challenge it whenever possible.

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“Guideline 16. Psychologists Seek to Prepare Trainees in Psychology to Work Competently With TGNC People.”

If you are supervising trainees/interns you need to make sure that they can work with TGNC competently and ethically.