To best understand how to assist counselors, we need to address the ways that helpers are supported. The field of counselor education and supervision is composed of educators and practitioners who express support for clinical competence for practice and educational programs. The Association for Counselor Education and Supervision (ACES) is the entity that encourages program development for counseling education. ACES aligns with the 2016 Standards established by the Council for the Accreditation of Counseling and Related Educational Programs (CACREP). CACREP promotes equity, diversity and inclusion in ethical practice, advocacy, leadership and academics. Multiculturalism and diversity are broad topics with specific implications that are included in CACREP’s standards.
In a 2019 article, “An interdisciplinary ecological framework: Intervention for LGBTQ interpersonal violence,” published in the International Journal of Bullying Prevention, Sharon Bruner and colleagues suggested that CACREP-accredited CES programs intend to explore ethical considerations for serving diverse groups. Pointedly, CES promotes helping licensed professional counselors (LPCs) better serve minority populations. Bruner and colleagues asserted that one challenge CES encounters in effectively supporting clinicians and counselor educators is that the ethical views of LPCs related to serving sexual and gender minority youth (SGMY) are virtually unknown. This lack of data prevents the development of appropriate counselor and educator supports.
Jared Rose and associates, in their 2019 article “Association for Lesbian, Gay, Bisexual, and Transgender Issues in Counseling’s best practices in addressing conscience clause legislation in counselor education and supervision,” published in the Journal of LGBT Issues in Counseling, contended that although CES literature speaks to SGMY views of ethical factors, current journal articles that express LPC views are missing. As the authors highlighted, SGMY harms are increasing because of an apparent lack of clinical competence and awareness on the part of LPCs.
Pointedly, discovering what LPCs are thinking about ethical consideration for serving SGMY might help clinicians and educators overcome inadequacies and increase therapeutic progress for SGMY clientele. One might wonder why this specific qualitative data is missing from the current CES literature base.
Continuing education, politics and religion
First, CES programs lack awareness and training opportunities that might better equip LPCs for serving SGMY. The abundant choices for continuing education (CE) allow precedence of preference and exclusions of convenience. In other words, as health policy specialist Sari Reisner indicated in a 2015 volume of The Milbank Quarterly, clinicians often seek out enriching CE based on their historical interests. Therefore, sometimes established therapists decline new CE options because the information is perceived as extremely unfamiliar. Paradoxical to CE purposes, new ideas for CE are ignored for decades before becoming widely embraced, despite being based on cutting-edge research findings.
Second, Reisner suggested that some clinicians are closed-minded concerning nontraditional sexual and gender identifiers. Reisner implied that some LPCs are completely refusing services to SGMY based on political and religious beliefs. Although LPCs have a right to refuse service based on scope of practice considerations and conflicting personal beliefs, the 2014 ACA Code of Ethics sets clear referral standards. Reisner purported that the problem exists because some LPCs are not referring out at all, denying SGMY counseling access and violating professional ethics guidelines. Reisner continued pointing out that some of these same clinicians are not returning phone calls, emails or similar communications from SGMY inquiring about services.
Manivong Ratts and colleagues, in their 2016 article for the Journal of Multicultural Counseling and Development, “Multicultural and Social Justice Counseling Competencies: Guidelines for the counseling profession,” discussed CES pedagogical development that would more effectively support educators, counselors and counseling students. Intriguingly, they suggested appropriate communications and referral practices as part of the need for specific counselor training and curricula topics. Notably, CACREP-accredited CES programs would benefit from hearing what a thorough cross-section of the LPC population thinks about ethics for providing services to SGMY and the implications for practice and accessibility standards.
Why and how
Ratts and team suggested that clinicians and educators would benefit from knowing more about LPCs’ views concerning ethics implications for serving SGMY. In turn, SGMY clientele might benefit too. After all, as Reisner indicated, increased counselor effectiveness often leads to individuals’ substantial therapeutic progress.
Reisner and Ratts and colleagues encouraged future studies to focus on LPCs’ views regarding ethically serving SGMY. Furthermore, Reisner and Ratts and colleagues explained that the lack of LPC data incidentally helps maintain the status quo, highlighting that some SGMY clients are underserved, neglected or ultimately denied access to counseling services. In addition, these authors implied that poor access conditions enable less than adequate clinical services and increase SGMY harms such as homelessness, substance use, severe mental health symptoms and suicides.
However, based on information from existing CES research, the above indications are primarily derived from SGMY’s perspectives, not the perspectives of counselors. Although this synopsis includes some related professionals’ views on ethics considerations for serving SGMY, it excludes LPCs’ views. Reisner and Ratts and colleagues suggested that including LPCs’ ideas about ethics and counseling SGMY might expand ethical practices for clinicians, advance CES program development, and reduce serious SGMY harms. Arguably, knowing more about what LPCs think might save lives. At the very least, counselors and educators would be assisted, thereby more effectively supporting LPCs and CES.
It is likely that the majority of ethical dilemmas and the lack of adherence to ethics standards have more to do with LPCs not being equipped with the necessary awareness and training than it is a total lack of regard for SGMYs’ needs based on extreme political or religious beliefs. For the most part, counselors become professional helpers because they really want to help others. In fact, most counselors, educators and counseling students seek to better understand people and topics with which they aren’t initially familiar.
Outliers exist, however, and it is questionable whether LPCs would admit to feeling ill-equipped regarding awareness, training, referral standards or anything else. Perhaps simply asking LPCs questions about their experience serving SGMYs would produce more qualitative data that might help colleagues and inform CES program development. Direct ethics inquiries can be avoided while still gathering valuable information from LPCs. Of course, as mentioned previously, some clinicians might benefit from a thorough review of referral standards regardless of whether they are equipped or willing to counsel SGMY.
Ethical considerations and future research
Regarding the future research and need for focused studies, Myra Parker and team in their article, “Beyond the Belmont principles: A community‐based approach to developing an indigenous ethics model and curriculum for training health researchers working with American Indian and Alaska Native communities,” in the journal American Journal of Community Psychology, underscore that clarity of rationale for conducting research is paramount for research ethics. Furthermore, Parker suggests that a sufficient need for research precludes approval by institutional review boards. Indicatively, the need for knowing more about LPCs’ views is established: Educators, clinicians and clients are likely to benefit from simply knowing LPCs’ views about ethics factors for counseling SGMY.
Basically, the lack of information — a condition of the status quo that prevents best clinical practices — can be solved by ethically and responsibly gathering that data. LPCs’ views can be acquired without any significant risks to people, especially considering that qualitative interviews can be conducted via online videoconferencing platforms. These facts are essential for research protocol, as established by a 1978 National Commission’s publication, the Belmont Report, similarly discussed by Parker.
Identifying the research need and rationale for gathering new information, one might consider the immediacy of the need. LPCs lack training and awareness, which are incidentally enabling poor counseling conditions for SGMY. Who will step up to the plate and perform the needed studies? Delaying the suggested research would perhaps be the most unethical option.
Above all, knowing LPCs’ views about ethics for counseling SGMY would help people. Notably, the importance of assisting helpers should not be underestimated. As Lorelli Nowell related in 2017 in The International Journal of Qualitative Methods, the nature of helping others is draining and often leads to burnout. Similarly stated, if research is left undone, then the indicated problem continues. Consequently, the established need also would persist. Ultimately, the result would be that people suffer.
Pointedly, if the need persists, then LPCs would continue to be ill-equipped for best practices for counseling SGMY, and the indicated harms would continue. Incidentally, progress for LPCs and CES would be thwarted. On the other hand, as Ratts and colleagues indicated, if future studies address LPCs’ views of ethics for counseling SGMY, then the stated harms would be likely to decrease, and clinicians and educators would be better supported than they are now.
New information from LPCs regarding ethical implications for counseling SGMY would likely present new theoretical considerations. Plus, new factors for theory might produce new ways for using interventions. For example, from a social constructivist view, collaborating with peers leads to solutions for interpersonal problems and personal growth.
Additionally, mindfulness interventions such as meditation practice might prove helpful in clinical sessions with individuals experiencing social rejection or low self-esteem due to sexual or gender identity challenges. In his 2019 article in The Counseling Psychologist, Ezra Morris supported this idea, suggesting that opportunities like these might be prime opportunities for theory and intervention advancements. For example, because mindfulness-based practices originate from constructivist tenets, Morris suggested that new applications inform educators of novel program developments. Furthermore, new application opportunities would potentially help the broad human services field, affecting change throughout various helping professions and grassroots humanitarian centers.
Because CES supports counselors’ competence for practice and educational programs, drawing parallels from ethics and counseling SGMY to practice standards for serving other minority groups is appropriate for the field’s growth. For example, future studies could address LPCs’ views concerning marginalized groups such as those convicted of violent crimes or those who do not have health insurance. The subjects for consideration for future research focuses are nearly unlimited.
Of course, existing CES research should continue to guide future studies. Perhaps articles such as this one will trigger renewed interest in significant research gaps. First things first: helping LPCs to help SGMY helps CES and the broad human services field. The first step is finding out counselors’ views of ethics and serving SGMY.
Theodore “Ted” Carroll and spouse, Tanya Carroll, operate a private practice in Spokane, Washington, that serves individuals, couples/families and children. Ted is a CES doctoral candidate with Capella University. His research specialization is counseling sexual and gender minority youth. Contact him through the Actualize Psylutions website.
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.