This article details the current knowledge regarding the provision of culturally appropriate career services to gay and lesbian clients. It is divided into 5 parts: history and context for the delivery of career counseling services to gay and lesbian clients, counselor self‐preparation for working with gay and lesbian clients, client‐focused interventions useful for counseling with gay and lesbian clients, program‐focused interventions useful for addressing the special issues that this group presents, and appropriate advocacy or social action interventions. Issues of multiple cultural identities and the intersection of lesbian and gay issues with race and ethnicity are also addressed.
The authors focus on the special issues involved in providing counseling to aging gay men regarding sex and intimacy. Although the stresses of aging experienced by gay men are similar to those of heterosexual men, older gay men face issues of a stigmatized sexual orientation, invisibility, negative stereotypes, and discrimination regarding aging.
The previous six chapters provide the context in which ethical issues in HIV-related psychotherapy arise. Understanding the complexity of sorting through the dynamics of personal responses to clients and to ethical, legal, cultural, and end-of-life aspects of this work is really only the first step toward effective clinical practice. Knowing when an obligation to others overrides confidentiality or determining the benefit of becoming more personally involved with a client requires a systematic model that minimizes decisions contaminated by countertransference issues that could pose a danger to clients and others (Barret, 1996). This chapter introduces the reader to a systematic decision-making model and then applies that model to a case that involves an HIV-positive client who is having anonymous, unprotected sexual encounters.
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MAJOR ETHICAL ISSUE HIGHLIGHTED IN THE CASEClinicians routinely report that one of the major challenges they face in working with clients with HIV disease is knowing when to take suicidal thoughts seriously and whether to intervene once the decision to commit suicide has been made. This situation is particularly complex when ending life seems rational and extending a life that will be filled with suffering seems unjustifiable. Case law that addresses this issue has not been made, and society seems mixed in its attitude toward physician-assisted suicide when death is imminent. CASE PRESENTATION (BY BOB BARRET)Phil is a 37-year-old African American who is at the end stage of HIV disease. He has been in and out of the hospital four times in the past 6 weeks, and he is losing strength rapidly. His physician has told him that although he may lose his mobility, he could live for "some time" or he could 299
The cultural world of the Two Spirit, the traditional role of Native individuals believed to possess both male and female spirit, is explored in both "old ways" and current-day experiences. Cultural beliefs and meanings around sexual identity are discussed from a Native perspective with recornrnendations for counseling Two Spirit clients.El rnundo cultural del Doble-espiritu, el rol tradicional de indigenas que se creia que poseian espiritus masculinos y ferneninos, se explora en forrnas tradicionales y experiencias actuales. Creencias culturales y significados acerca de la identidad sexual se analizan desde una perspectiva indigena con recomendaciones para el asesorarniento de clientes Doble-espiritu.merican society is founded on the philosophical basis of Cartesian thought that classifies people, things, places, and experiences into dichotomous A categories that are assigned values such as goodlbad, happy/sad, right/ wrong, goodlevil, and so forth (Wilson, 1996). Many of our dominant social institutions such as religion, media, politics, and so on reinforce the notion of absolute dichotomies. Specifically, with regard to gender and sexuality, one is either/or, malelfemale, gay/straight. However, as Tafoya (1997) noted, "most Native communities tend not to classify the world into the concrete binary categories of the Western world-goodlbad, right/wrong, male/female, gay/ straight-but rather into categories that range from appropriateness to inappropriateness, depending on the context of the situation'' (p. 2). Tafoya went on to say, Native American concepts usually prefer circles to lines. If one takes the line of a male/ female, gaylstraight, and bends it into a circle, there are an infinite number of points. Just so, there are theoretically an infinite number of possible points of gender and sexual identity for an individual that can shift and differ over time and location. (p. 8) With the Native American emphasis on the concept of the circle, within Native culture what would otherwise be perceived as opposites or dualities on a lin-
The authors discuss ethical and professional issues regarding group counseling and argue that it is challenging to meet or exceed the standards established by the American Counseling Association's Council for the Accreditation of Counseling and Related Education Programs for teaching principles and theories, leadership skills, and group counseling methods for effective group practice. This task is especially difficult for counselor education programs that do not have doctoral students who can provide instruction and group leadership. The authors present a model involving 2 courses that allow for mastery of skills and solve practical dilemmas of providing an experiential group experience and leadership opportunities.
This articleis a final response by the authors to S. M. Donaldson'scomments (1998) on their article, "Spiritual Experiences of Gay Men and Lesbians." The original article focused on the experiences and spiritual issues of self-identified gay men and lesbians.In his commentary on our article (Barret & Barzan, 1996), Donaldson (1998) accuses us of committing the crime of intolerance (p. 88). He goes on to make a number of inferences from our work and then issues his commentary on the basis of his own inferences. He speaks as if his interpretation of what we wrote is, in fact, what we wrote. And therein lies the major shortcoming of his comments. We would like to take this opportunity to render a quick response to his critique.The purpose of our original article was to assist counselors working with men and women who are in the process of embracing (or who already embrace) a gay or lesbian identity, and who also wish to integrate that identity with some sort of explicit spirituality: those who want to be "simultaneously gay and spiritual" (p. 4). This is the context in which everything was written and in which the article should be read and interpreted. The original article was not the place for a discussion of the causes of sexual orientation or for an expose on their mutability. Such discussion was irrelevant to the issue. Nor was it a place for a discussion of how to counsel men and women who want to change their sexual orientation, or how to counsel lesbians and gay men who do not wish to acknowledge an explicit spiritual component to their lives. Because this is clear in the original article, we can only assume that Donaldson has either misread the article or has a personal agenda motivating his response to it. His accusations that we are intolerant fly in the face of the text in the original article, and we cannot understand how or why such an accusation could be made.
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