Running head: LGBT 1

LGBT

Nathaniel Herrera-Bernal

University of Phoenix

Legal and Ethical Issues in Marriage and Family Therapy

MFCC 551

JEROME LANIGAN

December 25, 2010

 LGBT

What ethical considerations are needed when working with the lesbian, gay, bi-sexual,

and transgender or LGBT population as a marriage and family therapist? When considering

taking a LGBT client one must ask themselves if you are competent to serve LGBT clients’ more

specific needs. Can a non-LGBT therapist be effective as a counselor to an LGBT client? What

role does the LGBT population have with working with a marriage and family therapist? When

working with lesbian, gay, bisexual, or transgender individuals, a therapist must evaluate if he or

she is educated enough on this culture to provide ethical therapy.

Being culturally competent is considered a mark of a good therapist, but no therapist is

competent on all cultures. This kind of therapist actively chooses to stay relevant on new and

upcoming populations in need. The gay, lesbian, bi-sexual, and transgender or LGBT population

is one of the new cultures seeking professional help in their lives. At one point being gay was

considered a DSM disorder, since the mid-1970’s being gay is no longer considered a disorder,

but there is still controversy in being transgender or having gender identity disorder is what it

would be called in the DMS IV TR. “There are two components of gender identity disorder,

both of which must be present to make the diagnosis. There must be evidence of a strong and

persistent cross-gender identification, which is the desire to be, or the insistence that one is, of

the other sex (Criterion A).” (Association, 2000, p. 576) A therapist working with transgender

clients can realistically label them having a disorder depending on their sensitivity to transgender

issues. While there is a possibility that a client can have gender identity disorder from a

traumatic situation, it is more likely that the client is confused and trying to understand why he or

she feels the way they do, and has thought about being the opposite sex which have only gotten

stronger over time. If this individual has already identified himself or herself as transgender,
then he may be seeking counseling to get the required mental health clearance for surgery to

physically resemble the sex they feel they should be. Other transgender clients seeking therapy

may be trying to gain a better understanding of whom they are, as this process can be

emotionally draining, confusing, and lonely. Discrimination is a major contributing factor to

LGBT issues, which cause depression, anxiety, low self-esteem, and poor relationships.

“Despite the fact that most psychologists report experience working with LGB clients, LGB

clients are more likely to report dissatisfaction with psychotherapy than their heterosexual peers

(Liddle, 1996).”(Lyons, Georgemiller, Worthington, Bieschke, & Dendy, 2010, p. 425) The fact

that LGBT clients are reporting more dissatisfaction than satisfaction in there therapist, can

allude to therapist that are not properly educated on the cultured of LGBT concerns, and thus not

providing effective therapy to these clients. LGBT clients are typically trying to improve their

understanding of themselves, deal with emotional traumas such as discrimination, violence, or

abandonment to name a few. LGBT clients are seeking understanding, support, acceptance, and

most of all a safe place. How can therapists increase their satisfaction level in their LGBT

clients?

When working with Lesbian, gay, bi-sexual, and transgender or LGBT clients as a

heterosexual or LGBT therapist, there are areas of focus that allow for more effective therapy.

“Therapeutic alliance. In the helpful situations, the therapeutic relationship was most frequently

characterized by safety and trust (helpful _ 42.9%, unhelpful _ 7.1%) and by being enjoyable or

including the use of humor (helpful _ 35.7%, unhelpful _ 7.1%).”(Israel, Walther, Sulzner,

Cohen, & Gorcheva, 2008, p. 364) The importance of the therapeutic alliance is key to effective

therapy with any client. LGBT clients are seeking a therapy setting that is flexible and

comfortable for them to express themselves openly, and feel safe in doing so. This article also
touched upon the importance of the agency environment, as more clients reported that a

supportive agency was helpful to them in feeling safe with going there. That private agencies, or

counselors offices provided helpful experiences, but using hospitals, or community resources

were not helpful or productive. The clients also found that when they had a say so in choosing

the therapist, it provided for more helpful therapy. In addition, the use of newer therapeutic

approaches such as humanistic, cognitive behavioral and narrative therapy provided more

effective therapy, than say psychoanalytical, or behavioral therapy. The use of therapeutic

approaches in important as being psychoanalyzed or using purely behavioral modification can

appear too ridged, and not allowing the LGBT client to express their story. Therapists should

take the time to understand who their LGBT client(s) are and what specific reasons they are

seeking therapy for.

To work effectively with Lesbian, gay, bisexual and transgender clients “How

questions are framed; what is viewed as normative; ability to empathize with

the typical life experiences of LGBT individuals; and an ability to recognize

that sexual orientation is but one element in a diversity matrix where class,

race, age, and ability status all intersect—these are all emblematic of what

constitutes technical and ethical competence in work with LGBT Patients.”

(HALDEMAN, 2010, p. 185) As clinicians we have to view, our clients are

human being, who are depressed, heterosexual, claustrophobic, lesbian,

Gay, bi-sexual, or transgender, as a part of who they are, not who they are.

As humans, we all have similar issues, and every human’s normal is

different, the client has the right to the therapist’s full ethical interest. It is

unethical for a therapist to not provide the best quality services because of
homophobia, in these situations the client should be referred to another

clinician who will not only provide adequate therapy but ethical treatment as

well. In what context does a marriage and family therapist work with gay

lesbian, bi-sexual, and transgender clients?

A basic definition of a marriage and family therapist is someone who

works with families, or married couples, now there is and will be families

seeking therapy for having a gay, lesbian, bi-sexual, or transgender family

member. However, new to this realm are LGBT couples, or LGBT married

couples who are seeking therapy to help their relationships. “Abandoning its

long-held neutrality on the marriage debate, the California Association of Marriage and Family

Therapists (CAMFT) has slowly come to disavow pro-family views and sexual orientation

therapy as "homophobic.” Instead it now warmly supports homosexuality as a "normal and

positive" variant of sexuality” (Gilbert, 2010, para. 1). With The California Association of

Marriage and Family Therapist(CAMFT) changing its view on same sex relationships, to being

normal, and healthy, and since most therapist in California are a part of CAMFT, it would be

unethical for a therapist to not provide quality responsible therapy to a Lesbian, gay, bi-sexual, or

transgender couple. Every couple deserves to be treated fair and justly, as there are unique and

common problems with both LGBT and heterosexual couples. It is unfortunate that there are

still therapists who choose licensure, choose to join professional associations, but choose to over

look the aspects of the commitment they choose. By being licensed, you treat your clients with

respect, with no judgment that affects your direction or effort in treatment. These same

principles apply to not just CAMFT, but also “The American Psychological Association, the

California Psychological Association, and the American Association for Marriage and Family
Therapy” (Gilbert, 2010, para. 4) have accepted LGBT marriage as healthy and normal. If a

therapist is unable to be non-judgmental to the point of unethical treatment to a client, the

therapist should never accepted that client and further more question why he decided to gain

licensure, to joined professional associations that he does not agree with. This just does not

apply to heterosexual therapist, if a LGBT therapist cannot be ethical with their clients due to

past transgressions, or in the case of an having prior knowledge or association of a LGBT client.

Ethics say that any prior knowledge or association with a client should prevent the therapist from

beginning a professional relationship with said client. These situations can be difficult for a

LGBT therapist as they are, and know the things a LGBT client is experiencing, but want to

provide services to the community they are a part of. Marriage and family therapist at the core

of the name are relationship builders, relationships exist in families, marriages, or couples,

whether traditional, or non-traditional.

This paper discussed ethical considerations while working as a marriage and family

therapist with the gay, lesbian, bi-sexual, and transgender population. This paper discusses what

a therapist can do to be ethically competent with the LGBT population. Ways a LGBT and non-

LGBT therapist can be effective with LGBT clients, and how in a traditional sense the term

marriage and family therapy blends with the LGBT community. The LGBT community is a

population that is seeking therapeutic care more now than ever, and there is no reason to believe

that these requests for care will lessen. While there are too many existing therapists that would

exclude the LGBT population if given the choice, it is not their choice to make. Licensed

therapists have a duty to provide safety, and no further harm to their clients whether they agree

with their life style choice or not. There will always be clients that specific therapist cannot

work with, which is okay, but that does not mean that those specific clients do not deserve to be
treated with respect, a non-judgmental approach, and either provided with quality services or

referred to someone who can.

 References

Association, A. P. (2000). Gender Identity Disorders. In Diagnostic and Statistical Manual of

Mental Disorders IV TR (pp. 576-582). Arlington, VA: American Psychiatric

Association.

Gilbert, K. (2010). Gay ‘Marriage’ Activists Forcing Pro-Family Views out of California

Therapist Association. Retrieved from

http://www.lifesitenews.com/news/archive/ldn/2010/mar/10031511

HALDEMAN, D. C. (2010). REFLECTIONS OF A GAY MALE PSYCHOTHERAPIST.

Psychotherapy Theory, Research, Practice, Training, 47(2), 177-185. Retrieved from

UOP

Israel, T., Walther, W. A., Sulzner, J. M., Cohen, J., & Gorcheva, R. (2008). Therapists’ Helpful

and Unhelpful Situations With LGBT Clients: An Exploratory Study. Professional

Psychology: Research and Practice, 39(3), 361-368. Retrieved from UOP

Lyons, H. Z., Georgemiller, R., Worthington, R. L., Bieschke, K. J., & Dendy, A. K. (2010).

Psychologists’ Competence To Treat Lesbian, Gay and Bisexual Clients: State of the

Field and Strategies for Improvement. Professional Psychology: Research and Practice,

41(5), 424-434. Retrieved from UOP