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.

No abstract

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