Issues and Ethics in Counselling Lesbian, Gay and Bisexual Individuals

Issues and Ethics in Counselling Lesbian, Gay and Bisexual Individuals

A considerable number of lesbian, gay and bisexual (LGB) people will turn to helping professionals when they need assistance with problems. Lesbians, gay and bisexual individuals experience similar problems to heterosexual clients, such as anxiety, depression, suicide ideation, alcoholism, violence, relationship problems, and anger. There are unique issues faced by LGB persons, however. This paper will summarize the major issues for which LGB individuals seek counselling and provide recommendations for counsellors.

Counselling Issues for Lesbian, Gay and Bisexual Individuals

One of the major counselling issues for LGB people is "coming out." Coming out refers to the psychological, social, and cultural process of recognizing oneself as a gay man, lesbian or a bisexual person. Coming out can also mean the intentional or unintentional disclosure of one's LGB identity to others. Some LGB people prefer to conceal their lesbian/gay/bisexual identity; they are "in the closet." They may refrain from discussing their intimate lives with others or may present themselves as heterosexual, a process referred to as "passing." Others may disclose their sexual identity in various ways to family members, friends, religious leaders, co-workers, and the general public.

The identity and disclosure process is ongoing and central to understanding the life experiences of LGB individuals, even when the problem for which a gay man, lesbian or bisexual individual is seeking counselling is not the coming out process. Depression, suicide, alcohol and other drug use, grief and loss, are but a few of the problems faced by LGB people that are related to identity and disclosure.

Another major counselling issue for LGB people is family of origin. The norms, values, and attitudes of family members may condemn or condone homosexuality. The racial, ethnic, religious, and cultural backgrounds of LGB persons are also significant with special challenges for those who are members of other oppressed groups. Supportive family members can be crucial to the positive well-being of lesbian, gay and bisexual persons. On the other hand, critical, distant, or violent reactions by family members may produce stress, grief, and alienation. There are LGB people who have been "kicked out" of their families of origin, and mourned over as if they have died.

LGB persons may request professional help when there are relationship concerns. They may come to counselling individually or as a couple. The relationship concerns may be few or many, and may centre on such areas as communication problems, sexual dissatisfaction, and differences in levels of outness of both partners. Couples who are particularly isolated from outside support may have issues around loss, grief, and isolation. A desire to find and integrate into a lesbian/gay/bisexual community may be one of the reasons for which LGB couples pursue counselling.

Recommendations for Helping Professionals

LGB clients solicit assistance from a variety of types of agencies - both public and private. Some prefer counsellors of their same gender and some may prefer to receive help from a LGB individual. However, this does not mean that heterosexual persons cannot be effective counsellors. Whatever the counselling need, therapists who listen carefully to their clients and are willing to explore their clients' concerns will be helpful helpers when counselling LGB individuals.

The following are recommendations for helping professionals in their work with LGB clients made by Elizabeth P. Cramer, Ph.D.

* Identify the coming out process with the clients, e.g., level of awareness about sexual orientation; comfort level; sexual thoughts, feelings, fantasies, and behaviors.

* Identify what the results have been of other attempts of the client to disclose sexual orientation and how the client is feeling about these disclosure experiences.

* Help clients to determine to whom they want to come out to (friend, parent, supervisor, etc.), how much they want those persons to know about them (limitations), for what reasons (motivation), when (timing), in what way (method), and how long contact with this person/group/community is likely to last (duration).

* Aid clients in assessing how much energy they are spending to not disclose to a person/group/community, determine if this has been a problem (have there been costs), and assess whether this expenditure of energy would be decreased or increased if a disclosure were to occur.

* Role-play/rehearse potential disclosure situations.

* Assess the resources/support network; strategize to build additional support if necessary.

* Explore possible positive and negative outcomes of disclosing or not disclosing, the feelings about disclosing/not disclosing, and ways to handle the outcomes.

* Explore with clients how disclosure may affect relationships with their racial, cultural, and social groups.

* Assess how disclosure may affect immediate family members (partner and children).

* Help clients to prepare for how they may understand the potential reactions of others and support those to whom they intend to disclose without compromising themselves.

* Assess if clients may be