Tag Archives: LGBTQ Issues

LGBTQ Issues

Conversion therapy: Learning to love myself again

By Luke Romesberg February 27, 2017

When I was 14, I came out as gay to my parents. I was confident in my decision and felt ready for the world to meet the real me. Many argue that I was too young, but I had recognized and understood my feelings for a very long time. I just needed everyone else to catch up.

I was raised Catholic — not strict Catholic, but Catholic nonetheless. I attended church with my mother every Sunday, and also catechism class before or after Mass. My father always stayed home. He is Lutheran but quit practicing many years ago. Regarding politics, my parents were, and are, Republican. As with religion, my mother took an active role in this area. I grew up in a small town in Pennsylvania, made up mostly of middle-class Caucasians, and always had dreams of leaving for a large city.

Athletics were a large part of my childhood and adolescence. Ice hockey, football, baseball, soccer — if it was available, my father had me involved. As it turns out, I was not bad at athletics, but not fantastic either. My academics were much more important to me. This seemed to be a source of disappointment for my father, which I believe fractured our relationship at that time. Technology also fascinated me. I spent much of my time playing video games and surfing the internet. The internet would become one of my only outlets during some of the most painful times in my life.

 

Coming out

Despite aspects of my upbringing that many would regard as combative to the LGBTQ community, my hopes for coming out remained positive. I devised a plan. Being a millennial, my instinct was to scour the internet for thoughtful ways to reveal my identity to my parents.

After much research, I decided a letter and CD would suffice. I wrote a long, detailed composition explaining many aspects of my identity that I had kept hidden. I expressed my feelings that I was a Democrat, was done playing sports in high school and identified as part of the LGBT community. By the time my parents were reading it, I would already be at a friend’s home, where I planned to stay for a few days (also noted in my letter).

Feelings of pride and happiness surrounded me. At the same time, anxiety consumed me. I was nervous yet ready. I assumed that revealing my identity would be the most awkward aspect of coming out. Little did I know then that those feelings of awkwardness would only increase for many years.

My perfect coming-out plan crashed and burned one fateful night. During a shopping trip, I purchased a baby pink, size-small T-shirt. I loved that shirt. I would likely still be wearing that shirt if my mother had not thrown it away — and if I could still fit into a size small — but that is another story for another day.

The shirt was flamboyant. That was my goal. I felt comfortable in my identity and was ready not just to come out, but to burst out. I had been stifled in a world of sports and overt masculinity for years. This pink shirt gave me hope. It would be the catapult to my coming out.

The shirt forced people to make assumptions about me, and I welcomed them. What I had not considered, however, were the assumptions my parents were making. The sight of me wearing this vibrant shirt triggered something in them. They became more inquisitive and increasingly watchful. They asked questions: What are you doing? Where are you going? Why do you spend so much time on the computer? Who are you talking to? Who are you texting? So. Many. Questions.

Something changed. We all knew something was different, but nobody vocalized it.

Everything came to a head one night when my father walked into my bedroom holding my pink shirt. With some colorful and hurtful language, he told me the shirt made me “look” gay. His anger seemed to grow with every passing statement.

My anger also grew. I walked to my bookshelf, snatched the letter hidden within a book, and threw it at him. My parents would never receive the CD.

I watched as my father’s anger turned to sadness. He read the letter, and tears formed in his eyes. To this day, I have seen him cry only twice — at his father’s funeral and on this night.

This is when my mother entered the room. “What’s going on?” she asked, concerned. My father handed her the letter. She cried. She screamed. She shouted, “Oh, my God!” Repeatedly. She paced around the house. My father was practically frozen.

I remember feeling upset, but nowhere near their level. What had just happened? Was this really that terrible? To my parents, it was.

My mother rushed to my grandparents’ home, only three houses away. She informed them of the situation. I wasn’t present, so I can only imagine the state of panic that immediately filled the home. My grandparents on my mother’s side held even more intense religious and political views. This was not looking good for me.

I went to sleep that night, tears in my eyes and nervous to attend school the next day. What I had thought would be an awkward, yet happy, moment with my parents turned out to be anything but.

 

Conversion therapy

I revealed my sexual orientation on a Tuesday. By Friday my parents had arranged a meeting with a therapist. They told me he was a religious counselor. This seemed frightening already. He was going to “fix” me. He would make everything “better.”

I didn’t understand exactly what this meant. I didn’t need fixing. I was fine with my identity. I thought maybe my parents needed fixing.

Given that my town was so small, meeting with a conversion therapist was going to be an ordeal in and of itself. My mother’s sister, who had been informed of the situation, located a counselor. They told me he was “the best.” His office was in Philadelphia, nearly six hours’ distance from my hometown. My parents demanded that I miss school on Friday. Despite my protests, we would make the trip to Philadelphia together to meet him.

My memories of this initial session are blurry, although I remember being hounded with questions. Was I ever sexually assaulted? No. Had I ever experimented with same-sex partners? No. Was I happy with my body? No. I was 14 years old and going through puberty. Of course I wasn’t happy with my body.

The questions continued. Did I want to be straight? “Yes,” I answered, even though my brain was saying, “No. Hell no.” I wondered, “Who is this man? What do these questions have to do with my sexual orientation? What is he going to do to me? How is this stranger going to help me change something that I do not want to change?”

Over the course of the next year, I would be a participant of conversion therapy. My sessions were weekly phone conversations that cost my parents a small fortune. The sessions began as an hour in length and then decreased to 30 minutes. As I “improved,” my sessions decreased further to an hour every two weeks and, eventually, to 30 minutes every two weeks. The sessions would occur until I was healed of all of my sexual orientation issues. I was going to emerge a heterosexual young man.

My body was a frequent topic in our sessions. My therapist seemed obsessed with it. I was ordered to take off my shirt and look in the mirror. He would then say, “Please describe what you see. Tell me what parts of your body make you insecure.”

I told him that my stomach was a source of insecurity. He encouraged me to describe it. Allow me to repeat: I was a teenager. My body was changing daily. Many teenagers are insecure about their bodies. The last thing they want to do is discuss the details of these changes with a strange man on the phone.

Nevertheless, my therapist told me that my insecurities were likely negatively impacting my feelings of masculinity. My low levels of masculinity were a reason that same-sex attractions were occurring.

“Same-sex attractions.” He always said that. It was a way to pathologize my feelings. This term was used to separate me from my identity. I was not to refer to myself as “gay.” I was not gay. I was suffering from same-sex attractions.

This is where he first began to break me down. He created some cracks, which would only grow in time.

During the course of therapy, my life at home was changing rapidly. I was now being watched. I was forced to defend all of my actions. I was no longer allowed to watch certain TV shows. If anything surrounding the LGBTQ community was mentioned, I was never allowed to watch that show again. My parents began searching my phone records and forced me to call every number they did not recognize while they listened. They found and called a suspicious number only once but, thankfully, he immediately hung up and blocked my number.

My text messages were read. All of my contacts were questioned. My instant messaging account was reviewed. My computer was moved to the living room. When I used it, my mother would attempt to catch me doing something wrong. She caught me talking to a guy once, but I cut the computer’s power before she could read the conversation. My parents seemed to blame technology for making me gay. My mother once accused me of looking at a stranger the wrong way and swore that I secretly knew him.

I also had to clarify to my mother that I was not a pedophile and had no interest in children. I was no longer allowed to hang out with girls. My former best friend became less than an acquaintance. My parents condemned me for going shopping. I was allowed to wear only certain clothes.

Everything about my life that had once been comforting was stripped away. I was being forced back into the closet. My love for myself was disappearing.

As therapy continued, the therapist informed me that the combination of a “sports dad” and an “overbearing mother” were additional reasons that I was suffering from same-sex attractions. On a related note, he told me that my volatile relationship with my father and my noninterest in sports also contributed to my same-sex attractions. My father and I were instructed to spend more time with each other. Father and son bonding time would surely change my sexual orientation.

My father and I awkwardly began attempting to hang out. We would go out to eat, go to the mall, go see a movie. You know, a stereotypical girls’ night out.

My therapist even suggested that we try more “masculine activities,” such as visiting the batting cages (something I still despise) or throwing a football. One night, my father and I went to see King Kong together as a supposedly masculine activity. At the end of the movie, I left in tears, crying at King Kong’s tragic death. I doubt that is what either my father or the therapist had in mind.

Despite some setbacks, I was making “progress.” I informed my therapist that I was going through a gray area regarding my sexual orientation. This was all nonsense of course. I was still just as gay as ever; I was just telling him otherwise.

I told the therapist my gray area consisted of a lack of sexual attraction to either sex. He informed me this was normal and represented the lessening of my same-sex attractions.

Little did he know that most of my responses could now be credited to Google. That is the power of technology and the internet. I had researched and became an expert on conversion therapy. I now told him everything he wanted to hear. As a result, I was able to trick him into believing that I was changing.

Therapy continued. I was making strides, leaps and bounds even. I was moving quickly. I was turning into a proud heterosexual. In reality, nothing about my sexual orientation was actually changing. But my previous feelings of comfort and confidence were gone. I felt trapped. My parents and therapist analyzed everything I did. Being the authentic me was no longer an option. I was a stranger in my own body. My insecurities grew. My feelings of self-doubt and depression increased. I was forced back into the closet. The love I had for my identity vanished.

Therapy ended roughly a year after it began. I was “cured.” I finally felt a taste of freedom.

However, despite no longer having to deal with my therapist, my parents now believed I was “fixed.” I feel as though they were in denial, just as I was pretending to be straight. We were all lying to one another, and we secretly knew it.

Everything was not fine. I was still gay. My parents knew it. I knew it too, but we were now back to square one. The next four years proved to be draining. Coming out once was difficult enough, but now I had to find the courage to come out again.

 

Life after conversion therapy

When I was 17, my parents seemed either in complete denial about my sexual orientation or had silently accepted that I was likely going to remain my gay self. Either way, we had not engaged in an actual conversation regarding my sexuality.

Eventually, I began working for a major political campaign in the Democratic primary race in 2008. Here I would meet many like-minded individuals and fellow members of the LGBTQ community. I even met a guy with whom I would have a short-term relationship while he stayed in town for the primary. After many years of feeling trapped and questioned for my every move, I had finally found what I considered a safe zone, an oasis.

My parents weren’t supportive of the Democratic Party and didn’t approve of my volunteerism, but at least they couldn’t accuse me of things when they knew where I was. I began heading to the campaign office almost every day. The office officials quickly promoted me from volunteer to intern, which ultimately helped in my college searches and even landed me a scholarship. This was an extremely positive experience for me. I enjoyed my time spent there and met amazing people who provided me with feelings of inspiration, confidence, courage and, above all else, hope. The love I once had for myself began growing again.

Armed with my newfound positivity and support system, I was ready to once and for all set the record “straight” on my same-sex attractions. I arrived home from a particularly good night at the campaign office. My father was watching television but eventually began making his way to bed.

I stopped him as he headed up the stairs. I told him that “it” was out. I no longer cared. There was nothing they could do to upset me or tell me who I was. I was probably smirking when I told him.

My father’s face twisted. He didn’t say much but did mention being nervous and embarrassed about what everyone else would think. I didn’t care what anybody else thought. I had just come out — again.

This time it was different. I was older. I was more mature. There would be no argument. I loved myself again.

Over the course of the next few months, I began coming out to others, including my close friend. In midsummer, I put my “status” on Facebook. I received messages from concerned classmates and family members: “Your Facebook has been hacked!” I told them, no, it was true. I was gay. I was no longer afraid to reveal it.

I received unwavering support. People sent me positive messages. I entered my senior year of high school with the support of so many. My love for myself blossomed. I was back to my old self. My parents began adjusting too.

I would go on to college in Pittsburgh to study journalism. However, I would quickly change my major to psychology. My time in conversion therapy provided only one positive quality: It lit a flame in my heart and created a burning passion for caring and providing for the LGBTQ community.

I knew I wanted to make a difference. I wanted to be on the other side of this battle. I wanted to do the complete opposite of what my therapist had done for me.

Over time, my parents grew and changed as well. They found love too. Now they accept and support me in all of my decisions. It is truly amazing how things can change.

 

Today

In 2013, I moved to Chicago, where I would eventually receive my master’s degree in counseling and become a licensed professional therapist. Immediately after, at the age of 24, I entered a doctoral program in counseling education and supervision. This leads me to where I am today — and to the ultimate point of this story.

It is essential that the effects of conversion therapy are made widely known. I believe this subject is still in need of increased awareness. Many do not understand how harmful conversion therapy is, and others are entirely unfamiliar with it. Even though my experience with this “therapy type” was not nearly as severe as what others have gone through, it still caused issues that I had to battle.

I was ultimately able to make it through the difficult times these events caused, but many others in my situation do not. As reported by an American Psychological Association task force, people who have gone through conversion therapy face 8.9 times the rates of suicidal ideation, 5.9 times higher rates of depression and are three times as likely as their peers to engage in the use illegal substances and risky sexual behaviors. These statistics simply cannot be ignored. The issues listed are all too familiar for me, even with my somewhat minimal exposure to conversion therapy. It took years of personal reflection and growth, finding forgiveness toward my family, and learning to love myself again to overcome the damages caused by this so-called “therapy.”

As counselors, it is imperative that we do not impose our own value system on our clients. We must always work to ensure that we do not commit any acts of maleficence. Conversion therapy is, without doubt, an act of maleficence. If we find ourselves disagreeing with someone’s sexual orientation, it may be time to take a step back and evaluate our own principles, morals and why we chose to enter this field.

It is our job to know and understand the facts behind conversion therapy. It is not our job to tell people how to live or to attempt to change a client. Rather, we must always work with our clients to support them in their true identities.

 

 

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Luke Romesberg is a doctoral student in the counselor education and supervision program at the Chicago School of Professional Psychology. He is a licensed professional therapist and certified alcohol and other drug abuse counselor. His areas of specialization are LGBTQ issues, addictive behaviors and behavior issues in youth. Contact him at lwr4409@ego.thechicagoschool.edu or on Twitter @LukeRomesberg.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The path forward: A counselor’s coming out in counselor education

By Jack D. Simons November 22, 2016

businessman with a rainbow necktie, with a slight vignette addedTo be who you are, you don’t have to wait a lifetime.

I knew at age 5 that I was attracted to the same gender. This realization occurred during a time when, in my mind, it was not OK to be gay. I just couldn’t see it. It wouldn’t get better.

I grew up in the Midwest during the AIDS generation. People were dying, and the media portrayed the so-called “plague” as horrific. This definitely impacted me, including how I thought of myself and who I was. The advent of AIDS changed the lives of millions. Sexuality, for many, was no longer the same.

It was also during this time that I witnessed my uncle die of AIDS, shortly after the death of my great-grandfather. My uncle was gay, and he was just beginning life with his partner. He had moved to Portland to work as a musician and a nurse, but shortly thereafter he died. His life had been cut short by a condition that could not be cured.

How challenging it was for me as a teenager to see this while also questioning my own sexuality. Unfortunately, I never got to talk to my uncle about his life, but I wish that I had. Instead, I just asked myself, “Why would I live a life like his if I could die?” Being gay wasn’t an option that I wanted, so I did not accept myself for many years. I became one of those men who married a woman and started a family, thinking that my same-sex attractions would go away.

Well, it didn’t. I had just done what I thought I was supposed to do. I didn’t tell anyone in my family that I was gay until my early 30s.

Remaining in the closet comes at a cost. It depleted me of energy and compromised my health, which is not uncommon for those who come out later in life. I was unable to live a life congruent with my values, and others were hurt. This upset me.

While in my Ph.D. program, I decided to take active steps toward authenticity, whatever the cost. I asked myself how I could be a role model in counselor education if I wasn’t true to myself. How could I be vital and thrive in the world if I was inauthentic? How could I look my daughter in the eye in good faith?

I knew the answers, and they were all the same. I could not bear to continue to live an inauthentic life. I told my family members and close loved ones about what I was going through. It wasn’t easy, but I began to meet others like me and build a support system. Ultimately, I disclosed at work, which is a key milestone. Those who stood by me during this time are now some of my closet friends and colleagues.

I am grateful that I have been able to come out and live an authentic life. My education played a part in this. I am fortunate to teach and inspire others. Over the past two years, I completed my dissertation, taught, and worked on research and community events that I felt were important. As a former school counselor, it has also been exciting for me to see how the field of school counseling has become more inclusive of LGBTQ+ people, or those perceived to be (note: LGBTQ+ is an umbrella term that aims to capture all sexual and gender minority groups).

I thank everyone who has challenged me to be myself. Without this support, I may not have fully come out. I also know that if I had had more visible role models (like I am trying to be now) when I was younger, I would have accepted myself sooner.

 

Final thoughts

For those who haven’t yet come out, for whatever reason(s), don’t lose hope. There is time to work toward authenticity. It just takes longer for some. The experience has been hard for me, but it has gotten better.

If you wish to come out but you don’t think you can do it on your own, seek support. Some people might find this difficult, but I have always said that nothing of value is easy. This might be the time for you. If, however, you just want to learn more about LGBTQ+ communities, I recommend that you reach out to these communities and ask questions to make new friends or professional contacts.

In addition, I encourage counselors and counselors-in-training who have limited experience in working with LGBTQ+ communities to attend workshops and to reflect on their own sexual identity development. LGBTQ+ communities are very diverse, so there are many people to learn about, to learn from, to draw strength from and to stand tall with. If you see me, say hi!

 

Select resources

  • The AIDS Generation: Stories of Survival and Resilience by Perry N. Halkitis (2014)
  • Transgender Explained for Those Who Are Not by Joanne Herman (2009)
  • The Five Secrets You Must Discover Before You Die by John B. Izzo (2008)
  • “Coming out in mid-adulthood: Building a new identity” by Lon B. Johnston and David Jenkins, in the Journal of Gay & Lesbian Social Services, Volume 16, Issue 2, 2004
  • Outing Yourself: How to Come Out as Lesbian or Gay to Your Family, Friends and Coworkers by Michelangelo Signorile
  • Wood, A. M., Linley, P. A., Maltby, J., Baliousis, M., & Joseph, S. (2008). “The authentic personality: A theoretical and empirical conceptualization and the development of the Authenticity Scale” by Alex M. Wood, P. Alex Linley, John Maltby, Michael Baliousis and Stephen Joseph, in the Journal of Counseling Psychology, Volume 55, No. 3, 2008

 

 

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Jack D. Simons is a core faculty member in the counseling program at Mercy College in Dobbs Ferry, New York. Contact him at jsimons1@mercy.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

A systemic perspective for working with same-sex parents

By Amanda C. DeDiego September 28, 2016

According to census data, there were roughly 125,000 same-sex couples raising approximately 220,000 children in the United States in 2010. Since that time, increasing numbers of same-sex couples have declared committed partnerships, capturing the attention of policymakers and bringing the issue of legal recognition of same-sex partnerships to the forefront of politics.

In 2015, the U.S. Supreme Court heard the landmark case of Obergefell v. Hodges and ultimately declared it unconstitutional for any state to deny marriage licenses to same-sex couples. In doing so, the Supreme Court said that rights historically awarded to married partners, including adoption rights, must be extended to same-sex couples. Although state legislation traditionally branding-images_twodadsdetermines specific limitations to adoption rights awarded to married couples, under Obergefell v. Hodges, said spousal rights must apply to all couples equally.

This past summer, a federal court judge ruled adoption by same-sex couples legal in all 50 states. However, judges who make decisions to award parental rights can still create more stringent guidelines or additional hurdles for same-sex couples. So although this ruling is monumental in taking strides toward equality, it does not eliminate subtle discrimination experienced by same-sex couples seeking adoption rights.

As institutional and legal barriers to same-sex marriage and parenthood continue to diminish, counselors are increasingly called on to provide support for same-sex couples who are establishing legally recognized families. CACREP (Council for Accreditation of Counseling and Related Educational Programs) accreditation standards require programs to provide counseling students with training for supporting various issues in diverse relationships and families. However, more training and awareness are needed to properly prepare counselors to offer support specifically for same-sex couples and families.

For many years, same-sex couples could not find appropriately trained counselors to provide family and couples therapy. Now same-sex couples feel welcomed and have more referral options for counseling, but counselors still often lack specific training in best practices for supporting these couples and families headed by same-sex parents. Considering the systemic influences that affect same-sex couples, a counseling approach that also considers the systemic context is ideal.

Structural family therapy

Structural family therapy (SFT), developed by Salvador Minuchin, offers a means for counselors to address systemic issues in various contexts. The SFT approach is empirically validated and offers a map for counselors to conceptualize a family system on the basis of the roles the family members play. In addition to examining the family as a system, SFT takes into account the greater societal contexts that have an impact on the family.

Minuchin based his theory on the assumption that each family member plays a role within the family. Using Minuchin’s therapeutic approach, a counselor observes patterns in the family’s interactions to determine the hierarchy within the family system. Subsystems such as spousal, parental and sibling may also be present within the family. Any imbalance in the power, boundaries or roles within the family represents dysfunction in the system.

The goal of SFT is to adapt the structure of the family to the needs of its members to improve the function of the family system. This goal is accomplished in three phases:

1) Joining with the family

2) Enacting interactions within the therapy environment to observe family member roles

3) Creating unbalance to expand current roles, introduce boundaries and accommodate the needs of the family members in the system

As part of the SFT process, the counselor “joins” the family system to correct dysfunction. Minuchin described “joining” as the process of the counselor being accepted by the family to create a therapeutic bond. The trust gained in the joining process creates a therapeutic system that lasts the duration of the counseling relationship. The counselor works to help the family establish clear roles, while deconstructing power within the family system and subsystems. The goal is to create a functional hierarchy that meets the needs of family members.

One advantage to using SFT with same-sex parents is that this approach considers larger systemic influences on the family. Counselors working with same-sex couples may need to address unique systemic challenges. Thus, it is important to raise awareness in the counseling community about such issues so that we can address biases, practice awareness of issues facing the population and have a broad societal view of the family system and societal challenges impacting families with same-sex parents.

The road to parenthood

Traditional conception of children is not an option for same-sex couples. Thus, the road to parenthood for these couples is often emotional, complicated and challenging.

Some of these couples may already have children from previous relationships. SFT provides guidelines for work with blended families, but in many respects, same-sex couples have unique challenges in establishing family systems. In the past, many states would not recognize the adoption of children within same-sex partnerships. For same-sex partners with children from previous relationships, this meant that only the biological parent was able to serve as the legal guardian of these children. This created stress and conflict within relationships because the biological parent’s current partner was left without any legal rights as a parent. Not having legal guardianship of a child can cause same-sex partners to feel unclear about their parental identities. In turn, this may result in conflict within the partnership or struggles to establish a parenting relationship with children.

Egg donation and surrogacy: Not all couples have biological children from previous relationships, but the issue of legal co-guardianship is persistent regardless of how same-sex partners become parents. Same-sex couples may choose to pursue parenthood through surrogacy or through in vitro fertilization using a sperm or egg donor. In both cases, couples must choose which partner will be allowed to have the biological identity as the child’s parent. Because state laws have not always recognized the adoption rights of same-sex couples, the biological parent of the child often maintains all legal rights of guardianship.

Considering recent court rulings, the nonbiological parent may now seek status as a legal guardian. However, this parent may have experienced a lack of power in the family for some time because he or she was previously unable to identify as either a biological or legal parent.

Additionally, decisions must be made regarding the degree to which surrogates or sperm/egg donors will be included in and involved with the family. Thus, these family systems will potentially have multiple layers and subsystems, meaning that the same-sex partners may experience additional stress as they navigate choices concerning the level of connection to donors and surrogates.

Traditional adoption: The Supreme Court ruling in Obergefell v. Hodges acknowledged the possibility of same-sex couples facing continued institutional barriers, specifically naming instances of adoption agencies affiliated with religious organizations denying child placements for these couples. This past summer, a federal judge ruled a state ban on same-sex marriage to be unconstitutional, thus eliminating some systemic barriers to parenthood. Although overt discrimination in denying same-sex couples opportunities for adoption was eliminated, subtle discrimination that reinforces heterosexist standards of parenthood can still force same-sex couples to face stigma and additional stress during the adoption process. Same-sex couples have traditionally encountered legal obstacles, high standards for approval and long waiting periods to become adoptive parents. Historically, these institutional barriers have been substantial, causing many same-sex couples to turn to the foster care system in their pursuit of parenthood.

Foster to adopt: Foster care agencies often permitted same-sex couples to serve as foster parents, but there was always the question of whether the court system would subsequently deny these couples the option to legally adopt. This was often confusing and emotionally distressing for couples hoping to start families and gain the identity of parents. The Supreme Court has addressed these legal barriers, but it is unclear at this point what institutional and social barriers will remain for same-sex foster parents seeking legal adoption.

Additionally, same-sex couple foster parents may experience a lack of institutional support in preparing foster children for placement with a gay or lesbian couple. Thus, the adjustment to the placement can be more stressful for both the couple and the child. Couples may also experience subtle discrimination and a lack of sensitivity regarding pronoun use in record-keeping (for example, suggesting a father and mother caring for children, as opposed to two mothers or two fathers).

Systemic challenges

In addition to the typical stresses associated with blended families or adoptive parenting relationships, same-sex couples often feel that they must fight to gain recognition in their identities as parents, both legally and socially. This can create high levels of stress within these partnerships.

In 1979, Urie Bronfenbrenner discussed various social and political systems that influence individuals as members of society, including those individuals navigating marriage and parenthood. In addition to considering the legal and institutional challenges faced by same-sex couples in gaining identity as parents, counselors using SFT must consider the influences of the societal systems to which these clients belong. Unfortunately, discrimination and systemic challenges are still present after same-sex couples become parents, and counselors may need to help families navigate additional systemic challenges in raising children.

Institutional and legal challenges: Same-sex couples have long faced institutional barriers in gaining validation and recognition of their partnerships and marriages. Obergefell v. Hodges awarded the right to marry to same-sex couples and extended historically implied rights to same-sex couples who marry. However, states reserve the ultimate power to choose which rights to award (and to what degree) to married couples, including taxation, sharing of property and legal adoption. These discriminatory barriers exist beyond the courts. Among the institutional challenges that present struggles for same-sex couples attempting to establish family systems are division of work, parental leave and guardianship rights in caring for children.

Same-sex couples may experience challenges in deciding how to adapt their work schedules when raising children because of less employer flexibility, especially in the case of gay men. Thus, one partner may become the “breadwinner,” establishing greater financial power within the relationship. Given that legal adoption is not always permitted for nonbiological parents in a same-sex partnership, gaining access to a child’s medical or school records may also be a challenge.

In addition, same-sex couples often face challenges simply in finding a residence for their families. Research shows that landlords have traditionally assumed that same-sex couples will be troublesome tenants. Given limited choices for renting property, one partner may then become the legal owner of the couple’s purchased property. Particularly if this partner is already identified as the breadwinner of the family or the biological parent of the couple’s child, this situation can create a further imbalance of power within the parental subsystem.

Social challenges: Beyond institutional challenges, same-sex parents also experience subtle discrimination in social groups. Same-sex parents may not feel that they fit within traditional parenting roles and thus may not feel as accepted in social groups with heterosexual parents. Socially, same-sex parents can be the targets of hypercriticism for their parenting decisions by heterosexual parents.

Criticism and rejection are not isolated only to social groups. Families of origin may also express disapproval of same-sex couples becoming parents. Ultimately, same-sex couples may feel like outsiders in both social and familial groups, thus creating another source of conflict within the partnership.

Given that they are raising children in a heterosexual-centered society, same-sex parents may lack role models for navigating decisions as parents. When combined with social invalidation, this can leave same-sex parents feeling alone and lost.

Finding social support provides comfort for parents and children who are experiencing hyperawareness of the dominant heterosexual culture. Thus, same-sex parents often seek to create a new “family of choice” for social support. Same-sex parents often worry that their children will be subjected to heteronormative standards and social expectations in school. Children who have same-sex parents may experience discrimination or bias in social groups. Having the social support of other same-sex couples makes it easier for parents and their children to cope with discrimination and heterosexual norms.

Considerations for practice

Under SFT, the counselor joins with the family, becoming a part of the system instead of being a bystander to the process. Once this happens, the counselor will address issues of power, hierarchy, boundaries among family members and rules within the family system. The focus on family roles allows the counselor to adapt to the family system beyond traditional gender roles, which makes SFT ideal for work with same-sex couples and their families. Same-sex couples lack the traditional “mother” and “father” role within the family, so couples establish parenting identities based on their unique family system.

To determine the structure of the family system, a counselor must observe patterns of behavior among family members. In many cases, the lack of traditional gender roles among same-sex couples creates opportunities for greater balance in home and work responsibilities and egalitarian roles in parenting. Same-sex couples often experience greater fluidity and equality in parenting responsibilities than do heterosexual couples. Thus, decision-making in distribution of power within the partnership becomes more intentional.

The more gender-fluid roles of parents in same-sex families may challenge a counselor’s fundamental views of family. Thus, a counselor working with a same-sex couple must be aware of personal biases, or else the counselor may project gender labels onto family members. In addition, in recognizing one parent as more nurturing, it would be important not to automatically project onto the other parent the label of disciplinarian, especially considering the complementary function of parents under SFT. Instead, realize that gender fluidity in parenting roles means that same-sex parents may be sharing aspects of roles as both nurturer and disciplinarian.

In part because families with same-sex parents may not always receive support from biological family members, it is common for these parents to include neighbors or other social supports in their definition of the family system. The SFT approach allows for a more flexible definition of family. Thus, same-sex parents can invite social supports beyond the biological family to participate in family therapy. A large piece of SFT involves examining the authority exercised with children. This provides the counselor with insight regarding the hierarchy within the family system. Remembering that social supports may become an influential part of same-sex families, the counselor should remain open to considering the authority of nonparental figures within the family system.

Counselors must practice awareness of societal influences on families because these challenges often affect the balance of power within the family. Although societal issues may not be the presenting issue within the family, the influence of societal systems is always present. Additionally, counselors must practice ongoing reflection to be aware of biases in their work with this population. Working to eliminate subtle discrimination in the counseling environment — for instance, by creating gender-neutral intake forms — can create a welcoming environment for same-sex couples and their families.

Conclusion

SFT provides a framework to conduct counseling that considers systemic influences on families with same-sex parents. Recognizing the systemic and social barriers that same-sex parents face is a huge first step. Counselors must be aware of their own biases regarding their views of families when working with same-sex parents. In joining with the family system, counselors should be cautious not to assign gender roles to family members. Counselors also must be open to including social supports outside of the immediate family in the counseling relationship.

By practicing awareness of systemic barriers facing same-sex couples and being open to unique family systems, counselors can provide much-needed services to these now legally recognized partners who are navigating the road to parenthood and parenting in a heteronormative world.

 

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Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

Amanda C. DeDiego is an assistant professor of counseling at the University of Wyoming. She is a national certified counselor and has clinical experience in school, grant program, community and private practice settings with diverse client populations. Contact her at adediego@uwyo.edu.

Letters to the editor: ct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The relationship as client

By Laurie Meyers September 22, 2016

Among the most common difficulties that bring couples to counseling are infidelity, financial problems, sex and intimacy issues, parenting challenges and ongoing tensions with the in-laws. Each of these problems has its own unique characteristics, but according to couples counselors, they tend to share a similar root cause — namely, lack of communication. The challenge for couples counselors (and their clients) is to identify how communication went awry — or if it ever truly existed in the first place — and then work to reestablish it.

Couples counseling is fundamentally different from individual counseling, says Paul Peluso, past president of the International Association of Marriage and Family Counselors, a division of the American Counseling Association.

“Too often, counselors think that couples counseling is ‘individual counseling times two,’ and they conduct individual counseling with each person, while the other partner observes,” Peluso says. “That really isn’t couples counseling. Instead, with couples counseling, you have not just branding-images_inkhearttwo perspectives in the room that you have to balance, but you have the … relationship that you are working with. In fact, it is the couple’s relationship that technically is your client, not the individuals in the couple.”

Having a relationship as the client instead of an individual makes it much more challenging to build a therapeutic alliance, says Barbara Mahaffey, a licensed professional clinical counselor and ACA member who practices in Chillicothe, Ohio. The relationship is not just an entity, but rather two separate people who have different thresholds for opening up and trusting, she explains. Couples also come in with different goals and expectations. Mahaffey, who specializes in counseling couples and families, says her task as a counselor is not just to address these goals and expectations, but to help the couple discover how they can reconcile their personal expectations and establish new goals that will allow them to move forward as partners.

“Couples will come in and want to fight over who is right and who is wrong in the relationship,” Peluso says. “It is the couples therapist who has to sell the idea that no one is wholly ‘right’ or wholly ‘wrong.’ Paradoxically, neither is to blame and both are to blame — in the technical sense — for the state of the relationship at the same time. Both have played a role in setting up the conditions for the relationship. So the focus is on how each person’s behavior and reactions to [the] other affect the couple’s relationship. If each person wants to be in the relationship, then they have to take responsibility for how their behavior impacts the health of the relationship. And this is very different than individual counseling.”

Confronting infidelity

Unfortunately, the catalyst that most often pushes couples into a counselor’s office is also one of the most difficult issues to move past.

“The single most common issue that brings couples into therapy is infidelity,” says Peluso, a licensed marriage and family therapist (LMFT) who has written several books about both infidelity and couples counseling. “Over the last 20 years, researchers have demonstrated that this is the most common presenting concern, and if it is not revealed initially, it is often disclosed in the course of couples therapy. Infidelity can take many forms, from sexual to nonphysical intimacy, and it now includes relationships online.”

“In terms of who cheats, researchers have found that women are just as likely as men to participate in infidelity,” Peluso continues. “As a result, practitioners have to know how to deal with the complex and often devastating issues that accompany infidelity. Unfortunately, when couples counselors are asked about it, they overwhelmingly say that it is the topic they feel least prepared to treat.”

Amber Lange, a licensed professional counselor who owns and practices at Bedford Health, a group practice in Lambertville, Michigan, can attest to the high demand for infidelity counseling. Her practice has become known for specializing in issues surrounding infidelity and betrayal. Initially, the sheer need for counselors knowledgeable about and willing to tackle this particular relationship threat astounded her. “I’ll never be out of a job [as an infidelity specialist],” she says ruefully.

Among couples for whom the act of infidelity is fresh, the nonoffending partner is typically experiencing acute stress and may even have symptoms that resemble posttraumatic stress disorder, Lange says. The offending partner, on the other hand, is typically feeling beaten down because he or she has repeatedly been asked blunt questions that shine a direct light on his or her indiscretions: What did you do? Where? How much money did you spend?

In cases in which the infidelity is years in the past, the core counseling issue more often involves a lingering lack of trust, Lange says. “The nonoffending partner [may have] forgiven the offending partner, but they have never rebuilt trust,” she explains. “So the nonoffending partner is hypervigilant about trust and the [possibility of the] offending partner reoffending.”

If the act of infidelity is recent, Lange helps the couple work through their “why, who, where, how” stage. “I talk about the idea of how you can’t ‘unknow’ something once you know it,” says Lange, a professor of counseling at Capella University. “There’s a lot of knowledge that you can gain that may further traumatize you, such as the sexual positions that your partner was in with someone else.”

Clients may also wonder if their partner did things with another person that the nonoffending partner refused to do. If this information is disclosed, Lange explains, it can lead the nonoffending partner to do things he or she is uncomfortable with in an attempt to please the offending partner.

Instead of attempting to get answers to questions that can further damage the relationship, Lange encourages the nonoffending partner to ask structured questions such as: When did you start having sex? When did you stop? Did you have unprotected sex? These types of questions provide information that the nonoffending partner needs to know, Lange says.

The next phase of Lange’s therapeutic approach involves narrative therapy. As part of this stage, Lange might ask couples who delayed getting therapy after the infidelity to briefly touch on information about the affair as a way to see if there are lingering questions. This process also helps Lange to assess the strength of the couple’s bond.

The story of ‘us’

Regardless of whether the couple is confronting a recent infidelity or the infidelity happened years in the past, constructing the story of their relationship represents the core of the healing process, according to Lange. Couples build the narrative to gain a clearer understanding of how and when the cracks in their relationship developed, she explains. They talk about the beginning of their relationship and explore how they interacted. Were they friends and true partners? What happened that started pulling them apart?

“Life” — deaths, births, work, money and so on — is usually the answer to that second question, Lange says. In addition, people typically change over time, which further alters the nature of the relationship, she notes. All of these factors in combination can make a relationship vulnerable to disruption. Add in misperceptions and unmet expectations, and once tiny relationship fissures can turn into large cracks that cause couples to drift apart.

Among the most common life events that can start to pull some relationships apart is the birth of a child, Lange says. “Before the birth, couples were able to spend all their time and energy and money on each other. After the birth of a child, ideally, you love that child and invest all of that [time, energy and money] in parenting and child rearing — which is not bad, but [couples] come into my office, and they haven’t been on a date in three years.”

In addition to not making time for the romantic relationship, the couple may be trapped in patterns that are actively pulling them apart, Lange says. “You’ve been great parents, but the mother is staying home or working and raising kids at the same time, the father is working and overworking to pay for the mortgage and save for retirement — those kinds of things can hurt a relationship,” she says.

When a couple stops talking to each other, it creates a gap, and it is tempting to fill that gap with other people or activities, Lange notes. Partners may begin to betray each other in different ways, whether it is spending time on social media instead of with each other, watching pornography or working long hours, she says. “In the process, we’ve let the relationship go awry,” Lange observes.

But this risk of unraveling is not exclusive to couples with children. Those who get married or enter into domestic partnerships too quickly upon meeting or when they are very young are also particularly vulnerable, Lange says. For example, those who form romantic relationships in their teens or early 20s are in the midst of experiencing significant personal development. This may not happen at the same rate for both partners, eventually leaving them feeling as if they don’t know each other, Lange explains. Likewise, people who get married or form a domestic partnership in the matter of a few weeks have not typically had enough time to establish a strong base of friendship. Over time, it’s not uncommon for them to realize that they don’t even like each other, Lange says.

Lange asks clients not to make a decision about whether to stay together until after they have gone through the process of identifying what went wrong. Then, if they choose to stay together, Lange helps them start to discuss how to protect the relationship going forward. This typically includes setting aside time to talk with each other more frequently, being intentional about making time for dates and even going on vacations without the kids. But it also involves each partner identifying the behaviors in which he or she engages that play a role in pulling the relationship apart.

For example, Lange recounts something that a client recently shared. “One of the things that I have recognized about myself over the past six months is that I tend to withdraw,” the client told her. “When my partner and I got into an argument, I went away, slept in the kids’ room and wouldn’t talk. I would work 85 hours a week. Even when I wasn’t in the office, I was checking my email.”

In essence, Lange says, the client just wasn’t “there” in the relationship. Other people do the same thing by burying themselves in hobbies such as sports or scrapbooking. As a result, they end up spending more time with friends or with hobbies than they do with their partner and family, Lange says.

The process of building the couple’s story in counseling and finding the cracks and vulnerabilities is a long one. For the first four to six weeks, when a couple is still going through the initial trauma phase of the infidelity, Lange has them come to counseling every week. Once a couple moves on to the storytelling stage, she has them come to counseling only about once per month, in part because she feels that much of the processing and healing needs to take place between sessions as the couple slowly rebuilds the relationship.

“They have to have time to figure out things … how to be in relationship, how to recreate their friendship and how to build [new] good memories,” Lange says. During the process of rebuilding the relationship, trust is also being reestablished and forgiveness is being granted. Then the couple can move forward, she explains.

Ideally, the couple will also identify potential problem areas and reach compromises on how to address those issues. For example: “You say I can’t work 90 hours a week, but we need money, so how are we going to figure that out? … This is [our] story. Here’s the way we go forward. Here’s what we need to do.”

Symptom vs. problem

Brian Canfield, a past president of ACA, also says that infidelity is the event that most commonly brings couples into his office. But he believes infidelity is always indicative of other underlying problems in the marriage or relationship.

“I view an affair not as the problem but as a symptom,” he says. “An affair is like malarial fever. It’s uncomfortable, but it’s not the fever itself that’s going to kill you — it’s the disease.”

Canfield believes that if a counselor addresses the underlying issue first, it will help to stabilize the couple, which will then allow them to deal with the ramifications of the infidelity. “You [the counselor] have to assess if there is a commitment and desire to save the relationship,” says Canfield, an LMFT whose practice has offices in Louisiana, Arkansas and Florida. “Trust and betrayal, that’s not where you put the spotlight. The trust will return once you stabilize the relationship.”

Canfield starts by asking the couple what they want out of the counseling process and their relationship as a whole. “What would you like to see happen? If it is possible to salvage the marriage, would you be willing?” Canfield asks. “A lot of people want to know why [the affair happened], but here is where we are. Where do you want to be? If you were going to redesign marriage, how would it look?”

Canfield says financial difficulties are the most common underlying issue that couples bring into his office. In his experience, there is so much shame surrounding finances that most couples would rather talk about the details of their sex lives than money. He frequently encounters situations with couples in which one partner has been maintaining a hidden bank account or run up the balance on their credit cards without the other partner knowing. He tells couples that part of the counseling process involves full disclosure.

“A lot of couples are in tremendous denial,” Canfield says. “They don’t know how much debt they are in, what their bills are or have a good picture of how much income they are bringing in.”

Sometimes people feel entitled or convince themselves that it’s OK to buy what they want regardless of how it affects their spouse or partner. They tell themselves that they work hard and that they deserve it. Canfield sees part of his role as helping to bring clarity to these situations to encourage better choices.

“The other spouse may say that if this doesn’t change, I will exit the marriage for my own survival. Which circumstances are more important? Keeping the marriage or continuing to spend?” he asks.

Canfield doesn’t try to play the part of financial adviser to couples (although he does recommend that couples seek professional financial advice elsewhere if needed). Instead, he helps couples recognize their need to possess a clear picture of their financial situation and to develop a reasonable budget.

“It’s a matter of priorities and trade-offs,” he says. “The key as a couples counselor is to have the couple work together as a team. Most couples, when they work as a team, can find common ground.”

Canfield emphasizes that as a couples counselor, it’s not up to him to dictate how much a couple will spend on their priorities. Instead, his focus is simply on making sure that they have agreed on a plan going forward.

Once the underlying issues have been addressed, Canfield helps the couple deal with what he calls the “moral disparity” in a relationship in which infidelity has occurred. The nonoffending partner may feel like he or she has the higher moral ground, but to move forward, the couple must try to reach a “mutual amnesty,” Canfield says.

This involves a delicate balance. Canfield tries to make the couple aware that the infidelity occurred because of the underlying problems — to which they both contributed — that were straining the relationship. However, he always makes it clear that it is not the fault of the nonoffending partner that the other partner cheated. Yes, they both contributed to the relationship’s problems, but the offending partner chose to act out by having an affair.

Matters of miscommunication

Mahaffey, an associate professor of human services technology at Ohio University–Chillicothe, finds that relationship difficulties usually involve a significant degree of miscommunication, which is exacerbated by a number of factors. She helps couples understand how communication can get mixed up by explaining the pieces of a “miscommunication model” that she has devised.

Mahaffey starts by asking both partners to list all of the traits they possess that are different from their partner’s traits. She then takes these lists and draws two people facing each other. This represents two people talking, whereas the lists represent their different — and sometimes conflicting — points of view. Mahaffey often also draws a “family rule book” between the two figures. This represents how a person’s family of origin can affect the way he or she interprets interactions with a partner. Mahaffey often asks couples about their family backgrounds and experiences to illustrate the influence of the family of origin.

Mahaffey will then ask both partners to think about all the times they asked for something and didn’t receive what they wanted from their partner. As they voice these details, it’s not unusual for one partner to exclaim, “You never said that!” Typically, the case is not that either partner is lying, Mahaffey says. Rather, it’s that one of the partners has not been phrasing the requests in a way that effectively communicates what he or she needs, Mahaffey explains. She also informs the couple that humans think at about 500 words per minute but cannot speak more than 125 words per minute, meaning there is ample opportunity for the intended message to get lost.

Other complicating factors in communication include different coping styles (such as one member of the couple shutting down verbally or retreating physically or emotionally during times of stress), the fact that women often process information differently than men and the daily anxieties of life, Mahaffey says. For example, it’s hard for a couple to communicate effectively when one or both partners are stressed about finances, work or the car breaking down.

The last part of Mahaffey’s model entails explaining how words themselves — or how people define them — can get in the way. For example, Mahaffey might ask a couple, “What’s the definition of love? Is it that supper is on the table when I come home? Or liking to snuggle? Or texting 60 times a day?”

At this point, Mahaffey has the couple use “I” statements and talk about what needs they feel are being unmet. One partner might say, “I like to have help with housework.” The other partner might note that the request usually comes during a football game or while engaged in something else that he or she enjoys doing. At this point, Mahaffey might ask if the partner would be willing to provide help either before or after the game. This exercise highlights just one example of an area of possible compromise. The larger point is that the couple needs to sit down and talk about what they need from each other and how those needs can be met, Mahaffey says.

Intimate partner violence 

All counselors, but couples counselors in particular, should be looking for signs of intimate partner violence (IPV) among their clients, asserts Ryan Carlson, an ACA member and couples counselor who has done research on screening methods for IPV.

Because IPV is such a prevalent societal problem, all counselors — knowingly or unknowingly — will encounter clients who have experienced or are currently experiencing violence at the hands of their partners, Carlson says. According to data gathered in 2011 and published in 2014 by the Centers for Disease Control and Prevention, more than 1 in 4 women and more than 1 in 10 men in the United States have in their lifetime experienced sexual violence, physical violence or stalking by an intimate partner.

Providing counseling in the presence of such interpersonal violence can be dangerous, not just to the victim but also to the counselor, says Carlson, a licensed mental health counselor practicing in Columbia, South Carolina. That is a primary reason it is important for counselors to be alert to the signs of IPV and to have a protocol to follow should a client be a victim.

Perhaps the most beneficial thing counselors can do is to get connected to the people Carlson calls the “real experts” on this issue — those who work at local domestic violence shelters. “Most of what I have learned [about IPV] has come from domestic violence advocates,” he acknowledges.

Not only can these advocates help counselors assess whether it is safe to work with a couple in which IPV is a reality, but they also stand ready to assist clients who are looking for help, says Carlson, an assistant professor of counselor education at the University of South Carolina.

Carlson says he uses the term IPV because it is more inclusive than domestic violence. There is an IPV continuum, and domestic violence is on the extreme end of the spectrum, representing the most severe cases that involve, as Carlson puts it, “power and control,” as opposed to nonlethal violence or verbal abuse. From Carlson’s perspective, it is not safe to try to conduct counseling in those cases involving power and control.

Carlson advises counselors to use a formal screening tool for IPV at intake but says there are other red flags to look for, including a client’s unwillingness to take responsibility for actions. “Control over finances or transportation is [also a] red flag,” he continues. “Is one partner restricting access to cell phones, finances, the car, who the other partner can interact with? … Look for body language. Does one partner consistently look to the other when they answer questions? Is it permission seeking? Is there inconsistency in their answers? For example, as part of a meeting to determine whether or not a couple would want to participate in a research study I was doing, I asked about income. The husband gave me an answer, but when I met with the wife separately, she said the husband wasn’t really working and that she wasn’t allowed to talk about that.”

This one disparity turned out to be an indication of severe domestic violence. Carlson followed his protocol and was able to get help for the victim.

What does a protocol look like? Carlson says he has a formal memorandum of understanding with the local domestic violence shelter saying he can call at certain hours when he has a need for consultation. The memorandum also states that he will not provide identifying information about the client, only basic relevant information. This includes the presenting problem and any context he feels is important. The consultant can then advise him on whether the couple’s case might be a power-and-control situation. In those instances, Carlson must find a way to offer help to the victim without tipping off the partner who is engaging in the abuse.

With all of the couples Carlson counsels, his regular practice is to meet briefly with each individual separately at the beginning of each session. This is primarily so that he can get each partner’s point of view independently on the difficulties the couple is experiencing, but it also provides him with a chance to provide contact information for the domestic violence shelter if circumstances warrant. Carlson and the partner who is the target of the abuse may even call the shelter together.

In some cases, however, the victim of the abuse is not ready to leave the relationship. Carlson say many counselors may have a hard time relating to that. “We think we need to get the person out of the relationship immediately, but [we] need to do it safely,” he cautions

The victim has typically been living under abusive circumstances for years and may not yet have reached a crisis point, Carlson explains. Again, he uses consultation with his domestic violence resources to help him navigate this terrain. Regardless of whether the victim is ready to leave, Carlson says the average counselor should not try to continue providing services in these power-and-control cases. Telling the couple that he feels this particular modality will not work for them has proved to be a successful way of terminating treatment without escalating the problem of abuse, he says.

Lynn Linde, senior director of the ACA Center for Counseling Practice, Policy and Research, adds the caveat that counselors should make sure their states do not require them to report suspected cases of IPV under mandated reporting laws.

There are IPV cases for which Carlson thinks couples counselors are qualified to help. These involve lower lethality or “situational couple violence” (as opposed to one partner begin generally aggressive outside of the relationship as well). In such instances, a couple’s arguments may get out of hand and they may engage in behaviors such as pushing or throwing things at each other. “This can be dangerous, but it’s not as dangerous as choking or using a weapon,” Carlson says. However, he says, it is important for the couple to acknowledge that this behavior is unhealthy and to show a willingness to learn more appropriate ways to interact. It’s also essential that neither partner is afraid of the other, Carlson stresses.

In contrast, partners who engage in power-and-control tactics usually show little or no remorse and may exhibit antisocial-type behavior, Carlson explains. In fact, he says, studies have shown that when engaging in the abuse, these types of offenders typically experience a drop in heart rate rather than an escalating heart rate that is typically associated with anxiety over one’s situation or actions. Carlson also notes that whereas research indicates that men are almost always the perpetrators of power-and-control types of IPV, situational IPV is gender neutral.

None of this information constitutes a foolproof method for deciding whether it is safe for a counselor to work with a couple with a history of IPV. That’s why Carlson continues to do research on screening methods that are better at identifying the presence of violence among couples and where on the spectrum of severity that violence falls.

“Getting it wrong can be very dangerous,” Carlson concludes.

Counseling LGBTQ couples

Although the issues that bring lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ) couples into counseling are generally the same as those that affect heterosexual couples, the legalization of same-sex marriage has raised some issues unique to LGBTQ relationships, say counselors who work with this population.

“There is a tremendous validation both from the legal system and from society upon their relationships,” says John T. Super, an LMFT who is also a clinical assistant professor of counselor education at the University of Florida. “This validation can provide an emotional confidence or boost surrounding a same-sex relationship that lessens the perceived stigmatization that has occurred. Additionally, since the Supreme Court decision [legalizing same-sex marriage], we have seen a large number of those in long-term relationships choosing to marry and report feeling equality to traditional marriages.”

Although the Supreme Court’s decision is a huge advancement for the LGBTQ community and has given many couples the opportunity for which they have long waited, actually getting married has not been absent of negative consequences for some couples, says Super, a member of ACA. “Clients have explained [that] when they announced their marriage … it was in many ways similar to the coming-out process in that those who are choosing to marry and are in same-sex relationships may face resistance from friends and family as they legalize the relationship,” he explains. “I have heard clients say that their friends and family accepted their relationship, but when they choose to marry, the thought of the same-sex couple entering into a legal marriage is a line the friends or family are not comfortable crossing.”

Counselors have an important role in helping same-sex couples navigate the resistance they may face when they decide to get married, agrees Joy Whitman, a past president of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling, a division of ACA. Amidst the joy of getting married, there may be feelings of hurt and loss from being rejected all over again by certain individuals or segments of society, she says. Counselors can help couples grieve and process this loss.

According to Whitman, who previously worked as a couples counselor, marriage can also exacerbate a common problem in same-sex relationships: unequal comfort levels with being “out.” Marriage can make the partner who is less “out” feel especially vulnerable, she explains.

Counselors should also be aware that for the first time, LGBTQ couples are facing divorce, Whitman says. Not only is this a new experience, but the need in many cases to stand up in court and disclose intimate relationship details can be particularly disconcerting for clients in same-sex relationships, she says.

Super and Whitman also note that counselors need to be aware of the generation gap among different LGBTQ couples. “Couples who are in their 20s experienced a very different level of social acceptance than couples in their 50s or older,” Super points out. “This generational difference can be important to understand when determining the levels of internalized oppression the individual or couple has experienced.”

Despite these issues and other issues that are specific to the LGBTQ community, Super and Whitman emphasize that couples counseling is couples counseling. Peluso, an associate professor of counselor education at Florida Atlantic University, agrees.

“In many respects, the practice of couples counseling shouldn’t change that much,” he says. “Focusing on the relationship means taking the relationship as it is created by the partners involved. The only judgment that the couples counselor is making is, ‘Is this healthy for you right now?’ and then seeing how the couple can change that. That is fairly universal.”

 

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Additional resources

To learn more about the topics addressed in this article, see the following select resources offered by the American Counseling Association.

 

Books (counseling.org/bookstore)

Podcasts (counseling.org/continuing-education/podcasts)

  • “Love and Sex and Relationships” with Erica Goodstone

Webinars (counseling.org/continuing-education/webinars)

  • “Crazy Love: Dealing With Your Partner’s Problem Personality” with W. Brad Johnson
  • “The Secrets to Surviving Infidelity” with Scott Halzman

VISTAS Online articles (counseling.org/continuing-education/vistas)

  • “Five Counseling Techniques for Increasing Attachment, Intimacy and Sexual Functioning in Couples” by Elisabeth D. Bennett, Jaleh Davari, Jeanette Perales, Annette Perales, Brock Sumner, Gurpreet Gill & Tin Weng Mak
  • “Helping Couples Reconnect: Developing Relational Competencies and Expanding Worldviews Using the Enneagram Personality Typology” by Thelma Duffey & Shane Haberstroh
  • “Loving Kindness Meditation and Couples Therapy: Healing After an Infidelity” by Laura Cunningham & Yuleisy Cardoso
  • “Supporting Same-Sex Couples in the Decision to Start a Family” by Debbie C. Sturm, Erika Metzler Sawin & Anne L. Metz
  • “Working With Intercultural Couples and Families: Exploring Cultural Dissonance to Identify Transformative Opportunities” by Cheryl L. Crippen
  • “Working With Sexual Addictions in Couples Therapy” by Sara L. Wood

Practice Briefs (counseling.org/knowledge-center/practice-briefs)

  • “Counseling Couples With a Trauma History” by Catherine J. Brack & Greg Brack

ACA Divisions

  • The International Association of Marriage and Family Counselors helps develop healthy family systems through prevention, education and therapy (see iamfconline.org).
  • The Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling seeks to promote greater awareness and understanding of LGBT issues and improve standards and delivery of counseling services provided to LGBT clients and communities (see algbtic.org).

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editorct@counseling.org

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

 

License to deny services

By Laurie Meyers June 27, 2016

In April, the Tennessee Legislature passed a bill, which the state’s governor then signed into law, allowing counselors to refuse to see any client if counseling that client involves “goals, outcomes or behaviors that conflict with the sincerely held principles of the counselor or therapist.”

The law, which is in direct opposition to the ACA Code of Ethics, was pushed through despite the concerted efforts of the American Counseling Association, the Tennessee Counseling Association (TCA) and other opponents. Even more alarming is that the legislation could represent only the beginning of efforts to pass similar laws in other states.

In response to the controversial law, the ACA Governing Council made the decision to move the Branding-Images_sky2017 ACA Conference & Expo out of Nashville and relocate it to San Francisco.

“We agreed it was important to move the conference because the Tennessee governor signed a bill into law that attacked our code of ethics and allowed counselors to refuse services to clients in the Tennessee communities based on their religious and personal beliefs,” explains Thelma Duffey, whose term as ACA president ends July 1. “We believed it was important that ACA take a public and powerful stance in opposition to this bill, and relocating provided us with this opportunity. We also believed it was important that we communicate our support to our members who voiced deep concerns about continuing to hold the conference in Tennessee in light of the new law. And, ultimately, we made the move based on our long-held belief of nondiscrimination and our commitment to advocacy for all people.”

The intent of Tennessee’s law is to allow counselors to discriminate against potential clients who identify as lesbian, gay, bisexual or transgender (LGBT), says ACA CEO Richard Yep. “This [is] a full-frontal attack on specific populations that some very conservative right-wing groups in the United States want to exclude from mental health services that they desperately need,” he says. “The new law will permit a counselor to reject an individual simply because of that provider’s beliefs and values. ACA and its code of ethics are very clear that counselors do not bring those beliefs and values into a counseling relationship.”

In addition to being unethical, the law is harmful to those looking for help, Yep emphasizes. “For someone seeking the services of a mental health provider to be told that because of who they are, a service provider will not work with them sends an incredibly negative message of exclusion, bigotry and discrimination,” he says.

Counseling in the crosshairs

When the Supreme Court ruled in June 2015 that states must recognize the validity of same-sex marriage, it marked a significant step forward in the fight for equal rights for LGBT individuals. At the same time, it also served as a clarion call to those determined to continue discriminatory policies and attitudes.

Currently, there are nearly 200 pieces of proposed anti-LGBT legislation in the United States. Like the Tennessee law, many of these proposed pieces of legislation — and other laws that have already been passed — were born partly in reaction to the Supreme Court’s decision, notes Perry Francis, who served as chair of the Ethics Revision Task Force for the 2014 ACA Code of Ethics. ACA believes that conservative politicians and lobbying groups focused on Tennessee and the counseling profession in large part because of a prior legal case, Ward v. Wilbanks.

In 2009, a counseling student named Julea Ward was dismissed from the counseling program at Eastern Michigan University (EMU) for refusing to counsel a gay client. Ward then filed suit against EMU in U.S. District Court, asserting that the university’s counseling program violated her rights to free speech and freedom of religion. In 2010, a U.S. District Court judge granted summary judgment in favor of EMU.

Ward was represented by the Alliance Defending Freedom (ADF), a nonprofit law firm that Art Terrazas, ACA’s director of government affairs, describes as the conservative equivalent of the American Civil Liberties Union. ADF is connected to the Family Research Council, a conservative lobbying organization. These organizations influence the Family Action Council of Tennessee, whose president, David Fowler, is a former Tennessee state senator who was a driving force behind Senate Bill (SB) 1556 and House Bill (HB) 1840. A group of conservative state legislators sponsored the bills, which eventually became the law signed by the governor.

The counseling profession also made an inviting target because the ACA Code of Ethics explicitly focuses on protecting clients by not imposing a counselor’s viewpoint, explains Lynn Linde, ACA’s senior director for the Center for Counseling Practice, Policy and Research. Linde, an ACA past president who also served on the Ethics Revision Task Force, notes that this focus on the client is unique to ACA. Although other organizations’ ethics codes implicitly prohibit mental health professionals from imposing their personal beliefs on clients, she says, the ACA Code of Ethics is explicit in this prohibition.

The legislation was introduced in the Tennessee Senate in January and passed with very little discussion, according to TCA President Kat Coy. It then moved on to the Tennessee House of Representatives. At that point, TCA rallied its members to contact their legislators to express their opinions on the bill, Coy says.

As the legislation was being debated in the Tennessee House, TCA and ACA worked together to provide expert testimony on the harmful nature of the bill and to educate individual legislators about the counseling profession, its code of ethics and the danger the legislation posed to those seeking mental health services in Tennessee. Although the law states that any counselor who turns away a client because of personal beliefs must give the client a referral, Linde notes that Tennessee has a critical shortage of mental health professionals. That raises questions about whom a counselor can refer to if he or she is the only mental health professional within 150 miles and, more important, where prospective clients are supposed to go to get the help they need, she says.

Linde and others testified about the harm this could do to potential clients. In the process, they also tried to clear up some mistaken beliefs that Tennessee legislators held. For example, Lisa Henderson, who chairs TCA’s public policy committee, says one of the first arguments she encountered was that because Tennessee is a sovereign state, it would not be dictated to by the federal government. Henderson had to explain that ACA is a professional organization that is not connected in any way to the federal government.

Linde and others testified that ACA’s opposition to the legislation was not about controlling individual counselors but rather concern for the harm that could be done to prospective clients. In addition, the law would be in direct opposition to the ACA Code of Ethics, which all member counselors are obliged to follow. Many states — including Tennessee — base their licensure standards of practice all or in part on the ACA ethics code.

An ethical dilemma

A common claim by those who support the law is that by asking counselors not to impose their beliefs on clients, the ACA Code of Ethics is actually demanding that counselors give up certain personal beliefs. That is an incorrect assumption, Linde says.

“Nobody is asking us to give up who we are the moment we walk into a counseling session,” she emphasizes. Counselors do not have to change their beliefs, but they must not impose those beliefs on clients, she continues.

“We, as professional counselors, seek to engage our clients in a genuine, thoughtful, caring relationship,” says Francis, a professor of counseling and coordinator of the counseling clinic in the College of Education Clinical Suite at EMU. “In order for me to connect to a client, I need to know who I am and what my personal values are so that I can be genuine in the room. At the same time, the profession is saying to counselors that you also enter the room with the values of the counseling profession, which are clearly delineated in the code of ethics.”

Francis says a counselor’s responsibility is spelled out in the ACA Code of Ethics in Standard A.4.b. (Personal Values): “Counselors are aware of — and avoid imposing — their own values, attitudes, beliefs and behaviors. Counselors respect the diversity of clients, trainees and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.”

Many of those who supported Tennessee’s “sincerely held principles” legislation asserted that ACA changed its code of ethics regarding counselors’ personal values during the 2014 revision in response to Ward v. Wilbanks. Francis and Linde say that assertion is false.

“We clarified what has [long] been there,” Linde says. From the 1988 version onward, the ethics code has stated that counselors can refer clients only when a client is no longer progressing, when the counselor’s services are no longer required because the client has met his or her goals or when counseling no longer serves the client, Linde explains.

Anticipating that some might try to argue that a counselor who holds views diametrically opposed to what the client believes is not “competent” to counsel that client, the 2014 revision of the ethics code clarified the issue of referral, Linde and Francis explain. Standards A.11.a. and A.11.b. were added to further delineate what constitutes competency.

v A.11.a. (Competence Within Termination and Referral): “If counselors lack the competence to be of professional assistance to clients, they avoid entering or continuing counseling relationships. Counselors are knowledgeable about culturally and clinically appropriate referral resources and suggest these alternatives. If clients decline the suggested referrals, counselors discontinue the relationship.”

v A.11.b. (Values Within Termination and Referral): “Counselors refrain from referring prospective and current clients based solely on the counselor’s personally held values, attitudes, beliefs and behaviors. Counselors respect the diversity of clients and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.”

In addition, Standard A.4.b. was expanded to include the necessity of obtaining training and multicultural competency, Francis says.

Linde says ACA’s official position is that although counselors in Tennessee are now legally able to refer clients on the basis of personal beliefs, that action still goes against the profession’s code of ethics. Accordingly, ACA will still sanction any member who engages in such behavior, Linde emphasizes. This also applies to counselors-in-training at university or college programs.

Linde testified in detail for legislators on the issue of competence. “Counselors can’t refer due to client characteristics,” she says. “It’s on [the counselor] if you come from another country and I don’t know anything about you or your culture. I have to educate myself on your culture.”

However, if a client comes to a counselor with a problem or issue that the counselor is not qualified to treat based on his or her individual scope of practice, then referral is appropriate. For example, Linde says, a client might present to a counselor for treatment of depression. In the course of therapy, the counselor might realize that the heavy drinking the client is engaging in is due to a chronic substance abuse problem, not just self-medication. Unless the counselor is specially credentialed to provide substance abuse counseling, the counselor would be operating outside of his or her scope of practice to offer those services. In this case, the counselor should instead refer the client to another counselor who is qualified to provide in-depth substance abuse services.

Values clash

Henderson, a private practitioner in the Nashville area, says that when she met with individual legislators about the “sincerely held principles” bills, it appeared that some of them already had their minds made up. When presented with the ethics testimony, she says, many of these legislators argued that it was impossible for counselors to separate themselves from their beliefs. They also rejected a primary counseling value of putting clients first, Henderson says.

“I kept reminding them that these are complex issues,” says Henderson. She points out that even though it takes years to become a professional counselor, the legislators were making decisions about the counseling profession based on a few hours’ worth of knowledge gleaned in hearings and meetings.

EventhoughDuring efforts to defeat the legislation, Henderson acknowledges that she also encountered some counselors in Tennessee who supported it. The most common reason given was the counselors’ religious beliefs, she says. For example, one counselor told Henderson that he could not separate his religious beliefs from his counseling values. So, if a client came to him for treatment of alcoholism and wanted to use harm reduction, the counselor — who believes it is wrong to drink or take drugs — would only agree to treat using complete abstinence. Another counselor said she would not be able to counsel someone committing adultery unless that person pledged to end the adulterous relationship.

Francis says another common explanation or justification for values-based referrals is that a counselor who has a conflict with a client’s lifestyle or choices might not provide the best service or even cause harm. “This is a perfectly valid concern and is upheld in the ethics,” he says. “We don’t want to cause harm. We don’t want to put the client in any sort of jeopardy.”

However, Francis explains, the flaw in that reasoning is in assuming that the problem resides with the client. Instead, it is the counselor who needs to make adjustments and seek supervision, consult with trusted colleagues or get additional training to better serve the client.

Ultimately, it is those seeking mental health services who will be harmed by the passage of the legislation. “In rural Tennessee, or anywhere in the state that is listed as a mental health shortage area, there simply are not enough providers,” says Catherine B. Roland, who begins serving as ACA president July 1. “So, if a counselor is allowed to pick and choose who they will see simply due to a strongly held belief or value, those most in need of services will have nowhere to turn.”

The law is also written very broadly, which leaves it open to individual interpretation, Terrazas notes. “Initially the bill covered religious beliefs, but the wording was changed to ‘sincerely held principles,’ which could be broadened to include almost anything that a counselor disagrees with,” he says.

Duffey agrees. “People seeking mental health services can potentially be affected in any number of adverse ways as a result of this law,” she says. “For one, they are now aware that a law exists that protects counselors from working with them if the counselors’ beliefs conflict with who they are. That is profound. In a time where so much progress is being made with respect to equality and human rights, this bill may bring a painful resurgence of old feelings of rejection and discrimination and feelings of social exclusion.”

Current and future implications

Although those who defend the law often cite religious concerns for doing so, TCA leaders say many of their members who are Christian counselors have vowed not to use the law to discriminate.

In fact, other counselors have cited their religious beliefs as a reason not to discriminate. “[The Tennessee law] is an affront to the heart of Christianity,” says Ryan Thomas Neace, an ACA member and counselor practitioner in St. Louis. “The Scriptures reveal that those whom the religious folks said weren’t towing the line — not observing religious rituals or laws, not living up to sexual and moral purity codes by having sex too much or with the wrong people or drinking too much, etc. — those people were often far more hungry for genuine, transformative encounter than the religious folks themselves. This is why Jesus kept their company so much.”

Neace, who has been practicing for almost 14 years, cites his experience as an example of how harmful the law is to clients and to the counseling profession’s ideals. “By the time many of my LGBTQ+ clients show up at my office, they’ve already been hounded by unsupportive, and often abusive, friends, family, religious communities and sadly, professionals,” he says. “This law makes the sacred space that we offer as counselors less sacred and less spacious.”

There are already many barriers that discourage potential clients from reaching a counselor’s office, Neace says, and research suggests that LGBT individuals face even more obstacles. In Neace’s opinion, the obstacles the Tennessee legislation has erected for LGBT clients “are perhaps more akin to land mines.”

Unfortunately, Neace says, some counselors don’t seem to comprehend the precedent — and the slippery slope — that this law sets. “In a more long-term sense, it literally opens the door for clients to be denied therapy if they in some way represent an affront to anything counselors sincerely or principally believe,” he says. “This actually could, in my case, extend to me as a Christian. Someone could refuse to see me because of my religious beliefs. It’s hard to understand that religious folks who back this bill don’t see that it ushers in opportunities for the very persecution they hope to avoid.”

Keith Myers, a licensed professional counselor and ACA member, wrote an opinion piece for USA Today in May in which he highlighted some of the potential consequences of the law that its advocates might not have anticipated. “Imagine that Joe, a veteran who served our country faithfully, comes to counseling at a rural Tennessee practice,” Myers wrote. “He talks about his strong opinions concerning the Islamic State terrorist group and ways the military should be intervening. His male counselor happens to be a pacifist. This counselor has strong feelings against any kind of war or any type of military intervention against ISIL. Before the new law, he would have felt obligated to help Joe. Now, he refers Joe to another counselor 25 miles away from where Joe resides. Joe becomes angry and ultimately avoids getting help. The harm has been done.”

Henderson has already seen an effect. “After the news broke that the bill had been signed into law, one of my own clients asked if I would continue to see her now that I don’t have to,” Henderson recounts. “And this is a person who I already have an existing relationship with.”

One of Henderson’s counseling colleagues shared another story related to the passage of the law. During a client intake, the client asked questions about how the counseling process worked but also asked how long it would be before the counselor might decide not to work with the client any longer. The client wanted to know what he would do if that happened.

Counselors who practice in other states might question why they should be overly concerned about what is happening in Tennessee. “Quite simply, if it can happen in Tennessee, it can happen in any state in the union, making it an issue for all counselors,” Roland says. “One only needs to realize that the anti-LGBTQ legislation in so many states continues to grow. Those who believe in an anti-LGBTQ agenda are passionate and are using the legislatures and courts in this country to make their voices heard. ACA stands in support of the counseling profession and the consumers who seek our services — all consumers.”

The law could also contribute to misperceptions that go beyond what is happening in Tennessee. “This bill is problematic for counselors who hold religious beliefs and also support our code of ethics,” Duffey says. “The discussions around this issue can create misunderstandings and generalizations, with suggestions that faith-based counselors are, in principle, discriminatory. This is, of course, unfair and inaccurate, and runs the risk of creating division where it doesn’t exist.”

Terrazas says there is a danger that similar legislation could be proposed in other states and notes that ACA Government Affairs is maintaining a very watchful eye.

Seeking solutions

With the “sincerely held principles” legislation being signed into law in Tennessee, what happens next? ACA and TCA are taking a number of steps.

“We are certainly starting to pick up the pieces of what has transpired over the past several months and focusing on the future,” Coy says. “We are aware that there are varying opinions in Tennessee, and we will need to navigate through all of that in the coming months. Our ultimate goal shall remain meeting the needs of our membership and focusing on the needs of our clients.”

At July’s state leadership institute, TCA plans to focus on educating its members about what happened and encouraging them to in turn educate the public on the issues, Coy says. TCA’s annual conference in November will be devoted in part to additional education and training and to deciding what the association’s next steps should be.

When she was interviewed near the end of May, Coy said the rest of TCA’s plan of action was under development. “We will be sending out a survey to membership asking them what they want,” she said. “Our initial ideas will be training in the form of webinars, single-event training opportunities, podcasts, training bulletins and continued membership development.”

On the national level, Terrazas says that ACA Government Affairs is encouraging counselors in all states to get to know their legislators. The purpose is not only for counselors to be aware of what bills are being proposed in their states but also to educate legislators about counseling and what counselors do, he says.

The ACA leadership also wants counselors in Tennessee to know that even though the 2017 ACA Conference is being relocated from Nashville, the association is not abandoning the state’s practitioners. “ACA stands ready to assist with grassroots advocacy and to provide materials to Tennessee counselors who seek resources that will help the public policy officials understand the deleterious effects of this new law on the citizens of Tennessee,”
Yep says.

“We will continue to work with our colleagues in Tennessee in hopes that this law can be overturned,” Roland says. But she also offers a caution: “We cannot for a moment forget about the other 49 states where efforts like these can arise quickly and without notice.”

Despite the potential damage caused by the “sincerely held principles” law in Tennessee, Duffey believes the counseling profession will eventually emerge stronger than ever. “I absolutely believe we will ultimately be stronger as a result of our decision [to relocate the ACA Conference] and the unity we are experiencing through this advocacy,” she says. “I have been heartened by the outpouring of support for the Governing Council’s decision and by the appreciation of those members who courageously shared their stories and concerns. In fact, people who often vigorously debate other issues have come together on this one — in support, with clarity and with a sense of pride.”

 

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Does the ACA Code of Ethics trump discriminatory institutional policies? Read the July issue of the Journal of Counseling & Development, featuring three articles in the special Trends section that discuss the ethical issues raised by the practice of accrediting counseling programs at colleges and universities that use statements in their Codes of Conduct that are nonaffirming of LGBT individuals.

 

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Laurie Meyers is the senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

Letters to the editor: ct@counseling.org