Since the decision to remove homosexuality from the list of mental disorders, most mental health practitioners have shifted their clinical focus from "the cure" of homosexuality to treating the concerns of gay and lesbian patients. Some clinicians, however, reject the mental health mainstream's view and continue to conceptualize homosexuality as a mental disorder. Their clinical theories have been incorporated into wider societal debates regarding the status of gay and lesbian people. The sexual conversion or reparative therapies they practice, however, may include routine ethical violations in the realm of improper pressure, confidentiality, informed consent, and fiduciary responsibility to the patient's best interest.
LGBT patients may want to know their therapists' sexual identities for many reasons. Case Example A third-year medical student is having a great deal of anxiety about coming out. Psychotherapeutic modalities to convert or repair Ethics gays lesbians psychologists are based on developmental theories whose scientific validity is questionable. A physician shall support access to medical care for all people. Did you know? For additional information sponsored by the APA.
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Mixed Format. It is also important to recognize that there are significant clinical differences between working with LGBTQ kids, teens, adults and seniors. A distinguished group of scholars and researchers examine Moral reasoning and the ethics of professional licensing Confidentiality in psychotherapy Fees and financial arrangements The termination and referral of clients The use of deception in research Ethnic minority issues Consent in the treatment and research of children The Handbook of Professional Ethics for Psychologists considers the Ethics gays lesbians psychologists of science and morality. Considering that the Catholic Church, conservative Jews and many fundamentalist Christians have been the most outspoken opponents of gay rights, it is perhaps not surprising that LGB people and their families identify religion as a major obstacle in accepting homosexuality, in Ethics gays lesbians psychologists themselves or a family member. Back Today. LaSala, Ph. Sexualizing Boundaries. Required Courses. Michael C. Back Psychology Today. All rights reserved. It also uses popular movies e. September 27,
At the completion of this module, the user will understand the ethical principles underlying the patient-clinician relationship in the treatment of LGBT individuals.
- The Handbook of Professional Ethics for Psychologists considers the compatibility of science and morality.
- Developed by Ofer Zur, Ph.
- Working ethically with sexual and gender minority clients requires cultural competence.
- Verified by Psychology Today.
At the completion of this module, the user will understand the ethical principles underlying the patient-clinician relationship in the treatment of LGBT individuals. The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self.
The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician. Psychiatry, as a medical specialty, subscribes to these general standards of conduct, but the unique characteristics of psychiatric practice have raised question as to how these general principles apply to our specialty.
Beginning in and revised and updated periodically since that time, the American Psychiatric Association has augmented the Principles of Medical Ethics with Annotations Especially Applicable to Psychiatry. These annotations include, among others, the following statements which are particularly relevant in the treatment of LGBT patients.
For additional information sponsored by the APA. There are several ethical issues confronting a psychiatrist in this clinical situation. First, one must clarify the psychiatrist's understanding and formulation of the patient's unhappiness about his or her homosexuality?
An underlying and related aspect of this ethical issue will be the psychiatrist's own views on whether homosexuality is pathological. A second ethical issue relates to therapies for changing sexual orientation. Are they effective? Can they cause harm?
Many individuals who experience homosexual feelings are unhappy or conflicted about them. The causes of this unhappiness include: social stigmatization, fear of rejection by family and community, loss of a desired heterosexual identity and family, and fear of religious or social condemnation, either from others or from the self.
In the past, presentations of unhappiness were automatically and mistakenly seen as intrinsic to homosexuality itself, the consequence of a pathological deviation from heterosexual development. Today, both the American Psychiatric Association and the American Psychological Association assert that homosexuality is not a mental disorder and that a patient's sexual orientation should not, in itself, be considered a focus of treatment.
Furthermore, the current scientific consensus in the mental health mainstream is that the development of sexual orientation occurs at an early age and results from a complex interaction of environmental, cognitive and biological factors. There is considerable recent evidence to suggest that biology plays a significant role in the development of a person's sexuality. While "biological" may not be a synonym for "immutable," there are a few studies as well as ample anecdotal data suggesting that efforts to change a person's sexual orientation are not benign and can be harmful.
Therefore, it is more clinically useful to formulate unhappiness about homosexual or bisexual feelings as the result of social stigmatization of homosexuality, rather than as intrinsic to a homosexual orientation. Currently, several groups claim to have success at changing sexual orientation. Operating outside the mental health mainstream, these associations are usually affiliated with religious and social conservative political organizations that oppose the cultural normalization of homosexuality and gay and lesbian civil rights.
These groups primarily offer services directly to potential patients and their families. Three significant problems with these therapies include: 1 the questionable theories of homosexuality upon which their interventions are based; 2 the questionable efficacy of the interventions; and 3 possibly damaging effects of the interventions.
As to the issue of harm caused by therapies designed to change sexual orientation--small studies of individuals who have undergone such therapies report persistent loss of the capacity for sexual responsiveness, intensification of feelings of shame, depression, feelings of failure, impairment of interpersonal relationships and a reduction in the capacity for intimacy.
A young Mormon woman suppressed her lesbian attractions throughout adolescence. She is deeply committed to her family and church, both of which condemn homosexual behavior and excommunicate gay men and women. She comes to you requesting help to become straight. Given that "reparative therapy" have not been proven to be efficacious in changing sexual orientation and that it might even be harmful, it would be ethically questionable to make a patient's achievement of a heterosexual orientation the goal of psychotherapy.
Informed consent would include explaining the current state of knowledge about efficacy and harm. This should be done in a way that is sensitive to a patient's cultural and religious values. A receptive patient could be directed to Affirmation a gay and lesbian Mormon group for peer support and guidance.
If not prepared to go in that direction, the patient can be assisted in considering the option of observing familial and religious dictates, in examining her own values and judgments, and then considering the best actions to take.
She can be helped to weigh the anticipated risks and benefits of coming out versus the risks and benefits of remaining secretive about her erotic feelings. Two parents seek psychiatric care for their five-year-old daughter who has always been a tomboy. The parents were finally prompted to seek care when she insisted on cutting off her hair braid and insisted she would grow up to be a boy. Parents bring their six-year-old son in for evaluation because he has started cross-dressing in front of school mates leading to ostracism.
The family found his dress-up games humorous and were amused by his renditions of show tunes. Given that 1 homosexuality is not a mental disorder, 2 that therapies directed at altering adult sexual orientation are ineffective and potentially harmful, and that 3 one important prospective study showed that three fourths of children with extreme gender atypical behavior grew up to be gay adolescents Green , the issue of treating children with the goal of guiding them toward a heterosexual orientation might be considered an ethical grey zone.
However, Zucker and Bradley believe it is clinically and ethically valid to treat children with GID to prevent adult transsexualism. Transsexual rights groups argue that transsexualism, like homosexuality, is a natural variant of human sexual identity expression. The ethics of "curing" children of transsexualism requires further study, particularly if there is no clear evidence that childhood interventions in GID can alter either sexual orientation or gender identity.
Zucker's and Bradley's other rationales for treatment, to reduce social ostracism and treatment of underlying psychopathology, are less ethically problematic. A 43 year-old man in a heterosexual marriage is having unprotected sex with other men. He recently learned he is HIV-positive and comes to see you about his anxieties.
You learn that he is also having unprotected sex with his wife who does not know about his HIV status or his extramarital activities. What are the ethical responsibilities of the treating psychiatrist? This case example raises ethical, clinical and legal issues. The ethical issues pit preserving patient confidentiality against a duty to warn a known individual at risk. A primary clinical responsibility is to help the patient come to terms with this new diagnosis.
He is likely to fear losing his marriage, his family and his life. He may be at risk for suicide. Hopefully, through psychotherapy, he will be able to realistically address how his condition affects his marriage and this will, in turn, lead him to inform his spouse. It is important to know what the laws regarding HIV reporting are; they vary from state to state, and may govern what options the treating physician has.
These guidelines suggest that it is ethically appropriate for a psychiatrist to inform the known partner of an HIV positive patient if doing sois discussed with the patient prior to the informing.
The psychiatrist's responsibility, however, is not fulfilled solely by informing the patient's partner. Thre is an obligation to help that patient work through the issues hindering disclosure and the life changes that are required in adapting to the diagnosis. These might include seeking evaluation and treatment for HIV, learning and using safer sex practices, and educating the patient and spouse, if appropriate, about HIV-related illnesses.
An LGBT person comes to your office for treatment. You are uncomfortable about taking the patient in to treatment and feel that you cannot provide quality care. What should you do? Section 1 of the Ethical Guidelines of the American Psychiatric Association speaks of not discriminating against patients because of their sexual orientation.
Ethical psychiatrists have two courses of action to follow. If they decide to take the patient into treatment, they must arrange for supervision by a colleague with more experience and awareness in treating LGBT patients and the issues likely to arise in their treatment. It would also be appropriate to refer patients to colleagues more comfortable with the issues that are likely to arise in the treatment of LGBT patients rather than providing a less positive treatment experience due to one's own biases or conflicts or their inexperience in dealing with such issues.
Such referral must be done with sensitivity, clarifing that it is the psychiatrist's own limitations that are the problem, not the patient. Given the lack of proven efficacy and the possibility of harm, a referral for reparative therapy would not be appropriate.
A third-year medical student is having a great deal of anxiety about coming out. The student health clinic randomly assigns her to a gay male psychiatry resident.
In her first session, she asks him if he is gay. What should he do? Traditionally, psychodynamically-oriented therapies discouraged therapists from disclosing any information about themselves to patients. LGBT patients may want to know their therapists' sexual identities for many reasons. These may include: fear of being judged, not wanting to explain oneself to an uninformed therapist, not wanting sexual identity to become a clinical issue due to the therapist's issues, etc.
In such cases, and others, an LGBT therapist's self-disclosure of sexual identity may be helpful to the patient. However, such self-disclosures require that LGBT therapists: understand the limits of how much personal information they wish to disclose be prepared to discuss, either before or after, the meaning of any disclosures to the patient be prepared to come out to the supervisor and to have a similar discussion in supervision What boundary issues commonly present for LGBT therapists working with LGBT patients?
Clinical case You discover in the early treatment of a patient that you have a few friends in common.
Can you and should you continue to treat this patient? When doctor and patient have social connections outside the therapy setting, there is the potential for conflicts of interest, concerns about confidentiality, or misuse of the clinician's privileged position.
However, in LGBT communities some social connections may be inevitable. The therapist may need to acknowledge shared social contacts and discuss with the patient whether these impair the patient's ability to be candid in treatment and the therapist's ability to maintain a therapeutic stance. The boundary issues for an LGBT therapist in this situation are similar to those that emerge among residents of a small town or members of a sub-community e.
Here, the ethical challenge is to balance the psychiatrist's community involvement with the interests of the patient's therapy. A lesbian psychiatry resident who has not disclosed her sexual orientation in her training program is assigned to treat the lesbian chair of the college LGBT group. It may be preferable or even necessary for residents in some training programs not to disclose their sexual orientation. In such situations, the resident fearing professional exposure might experience anxiety when treating LGBT patients or when presenting such cases in supervision.
Such anxiety might make it difficult to maintain an open, exploratory stance. If the resident finds herself inhibited either with the patient, her supervisor, or both, she should seek outside consultation or consider referral to another psychiatrist.
The position of most professional mental health organizations is that reparative or conversion therapy is unethical see, for example, the statements of the American Psychological Association , the American Psychiatric Association , the American Psychoanalytic Association , and the National Association of Social Workers. One could have consultations with colleagues knowledgeable in ethical issues, refer to the ethics guidelines, and consult with legal affairs consultants or and supervisors as appropriate.
You may attempt to educate the colleague about the fact that the practice of reparative or conversion therapy is highly controversial, may be unethical, and recommend reformulating the treatment plan. If you are not satisfied after the aforementioned consultations and attempts at education, and you decide to file a complaint of unethical behavior, this should be addressed to the ethics committee of the professional mental health organization of which the practitioner is a member. Section 3 of the AMA Principles of Medical Ethics states that "a physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.
However, multiple states have amended their constitutions to deny recognition of marriage between gay people. The position of psychiatrists in the military is a particularly complicated one.
Currently, the military abides by a federal "Don't ask, don't tell" law; that is, if the military command becomes aware that a member of the armed forces is gay, that member will be discharged from service.
If a member comes to see a military psychiatrist to discuss depressive or anxiety symptoms related to being a gay service person, how does the psychiatrist balance duty to the military with Section 1 of the Principles of Medical Ethics "a psychiatrist should not be a party to any type of policy that excludes, segregates, or demeans the dignity of any patient because of … sexual orientation"?
Nancy E. Encourages a questioning, critical attitude toward ethical issues and codes in an attempt to encourage active moral leadership. This case raises concerns about the way we as a society think about sex and sexual expression for gay, lesbian, and bisexual youths. Jane E. But at least as significant, this book encourages the reader to think deeply about the many complex issues that are inherent to the study of behavior and efforts to make changes in people's lives. Fruzzetti University of Nevada, Reno. Dr Michael Boyle.
Ethics gays lesbians psychologists. Recent Issues
Working ethically with sexual and gender minority clients requires cultural competence. While this column attempts to address some specific ethical issues, clinicians are advised to seek training and supervision and to develop relationships with LGBTQ people outside of the office to continue to develop cultural competence. It is also important to recognize that there are significant clinical differences between working with LGBTQ kids, teens, adults and seniors.
Most importantly, while LGBTQ is often used as an umbrella term, bisexual and transgender or gender nonconforming TGNC individuals often experience stigma from within the lesbian and gay community, which can be especially painful and further isolating. Lastly, despite the LGBTQ acronym, working with TGNC individuals requires separate training and competence than simply working with gay, lesbian, bisexual or queer clients. By now, everyone should know that sexual orientation change efforts are considered harmful and ineffective.
Many clinicians working with sexual orientation and gender identity make the mistake of assuming sexuality and gender are binary constructs. Similarly, clinicians may assume someone seeking help with gender identity issues is transitioning from male to female or vice versa, instead of possibly landing in a non-binary place of identifying as genderfluid or genderqueer, equally valid gender identities.
Monitoring countertransference about sexual content, fantasies and behaviors is another way to practice ethically with sexual and gender minority clients. People seeking help for sexual or gender identity issues need safe spaces to talk about their bodies, their attractions and sometimes their sexual experiences with others, which may feel confusing, frightening or affirming and exciting.
Clinicians who feel strong judgment or repulsion or arousal should have a place to consult with others about such reactions so that they do not interfere with the therapy. Some clients may present with other sexual interests that are foreign to a clinician, and if the topic of sexuality is already on the table, these clients may be more likely to share information about multiple partners, using sex toys or engaging in BDSM play with partners.
Developing a working knowledge and seeking consultation on such issues may be an essential part of doing ethical work with a client.
Of course, not all LGBTQ clients have these interests, and some may also present with low sex drives or low sexual interest. Who are they out to? And who are their allies? What are their relationships like with friends, family, romantic partners, work colleagues and the broader community?
An important piece of work can be helping a client to connect to online and offline LGBTQ communities for support. The Straight Spouse network can also help when a husband or wife comes out within a marriage. Other important factors to consider are other cultural variables and whether the client also has support about intersecting identities race, ethnicity, religion, disability etc. A strong awareness of minority stress and the microaggressions clients face and not enacting them in treatment is crucial.
Those seeking further information on working with TGNC individuals also may find the World Professionals Association for Transgender Health to be an extremely valuable resource. Keely Kolmes, Psy. She is co-author with Edward L. Zuckerman, Ph. Her email is drkkolmes gmail. Home About Us Media Kit. All rights reserved. Log in. Order a Appointment Calendar Today or shop our catalog. By Keely Kolmes, Psy. November 5, Take the CE Quiz Now. To learn more about this topic or to get these articles delivered to your office every other month, subscribe today!
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