To Refer or Not to Refer: Exploring Family Therapists' Beliefs and Practices Related to the Referral of Lesbian, Gay, and Bisexual Clients

Abstract

This study explored how negative beliefs toward lesbian, gay, and bisexual (LGB) individuals and LGB clinical competence influenced family therapists' beliefs and practices regarding referring based on the sexual orientation of the client. The sample consisted of 741 experienced clinicians. The results of this study indicated that the majority of the participants believe it is ethical to refer LGB clients; however, most had never made such a referral. Furthermore, participants who had referred based solely on the client's sexual orientation reported higher levels of negative beliefs toward LGB individuals and lower levels of LGB clinical competence. Finally, negative beliefs toward LGB persons not only predicted the practice of referring, but also the belief that it is ethical to refer an LGB client.

Are we there yet? Faculty Members’ Beliefs and Teaching Practices Related to the Ethical Treatment of Lesbian, Gay, and Bisexual Clients

“…In particular, this group of faculty members made the argument that ethically, therapists should comply with requests from clients who are seeking to alter their sexual orientation because clients have the right to determine the focus and direction of therapy. While in principle, there might be merit to the argument of client autonomy, there are potential flaws with this notion that need to be examined (McGeorge et al., ; Trinh, Moore, & Brendel, ). For instance, clients might request that therapy be focused on something that is known to cause harm, and in such cases, therapists have a responsibility to redirect the focus of therapy in order to follow their ethical mandate to do no harm (Trinh et al., ).…”

“…Scholars who support this perspective appear to be focused on the immediate potential harm to clients, rather than the larger need for therapists to address the negative impact of their beliefs and biases on the therapy process and their responsibility to provide competent services to all clients. The second perspective, which reflects the vast majority of scholars, is that such referrals are discriminatory and harmful to LGB clients (Corey et al., ; Hancock, ; Kaplan, ; McGeorge et al., ; Remley & Herlihy, ; Shiles, ; Wilcoxon, Remley, & Gladding, ). These scholars argued that a referral based on a single demographic factor such as a client's sexual orientation is a violation of ethical codes as a similar referral based on other demographic factors (e.g., race, gender, social class) would clearly be deemed unethical (Corey et al., ; McGeorge et al., ; Remley & Herlihy, ; Shiles, ).…”

“…The second perspective, which reflects the vast majority of scholars, is that such referrals are discriminatory and harmful to LGB clients (Corey et al., ; Hancock, ; Kaplan, ; McGeorge et al., ; Remley & Herlihy, ; Shiles, ; Wilcoxon, Remley, & Gladding, ). These scholars argued that a referral based on a single demographic factor such as a client's sexual orientation is a violation of ethical codes as a similar referral based on other demographic factors (e.g., race, gender, social class) would clearly be deemed unethical (Corey et al., ; McGeorge et al., ; Remley & Herlihy, ; Shiles, ). In addition to being considered a discriminatory practice, scholars have also highlighted that when a therapist denies services to a client based on their sexual orientation, it may cause emotional harm (Corey et al., ; McGeorge et al., ; Remley & Herlihy, ) and could be experienced as “yet another form of rejection similar to what was experienced by … [the client's] family and friends” (Shiles, , p. 152).…”

“…In recent years, there has been increased attention paid in the literature to ethical issues related to competent therapy practices with lesbian, gay, and bisexual (LGB) individuals, couples, and families (Corey, Corey, Corey, & Callanan, ; Edwards, Robertson, Smith, & O'Brien, ; Kaplan, ; McGeorge & Carlson, ; McGeorge, Carlson, & Farrell, ; McGeorge, Carlson, & Toomey, ; Serovich et al., ; Shiles, ). Two prominent ethical issues related to working with LGB clients that are at the forefront of social, political, and professional discourses are the practice of reparative therapy and the referral of LGB clients based solely on their sexual orientation (Kaplan, ; Caldwell, , ; McGeorge et al., , ; Serovich et al., ). Reparative therapy, also referred to as conversion or reorientation therapy, is a practice that seeks to alter a person's sexual orientation from LGB to a heterosexual orientation and is based on the belief that an LGB sexual orientation is pathological and/or sinful (Haldeman, ; McGeorge et al., ; Serovich et al., ).…”

“…While there appears to be clarity about the ethicality and best practices in the existing literature related to these two issues (Kaplan, ; Caldwell, ; Caldwell, ; McGeorge et al., , ; Serovich et al., ), research suggests that there appears to be some ambiguity among family therapists related to the ethics of the practice of reparative therapy and the referral of LGB clients (McGeorge et al., , ). Given that faculty members are responsible for educating the next generation of family therapists, it seems important to gain insight into how they are addressing these emerging ethical issues related to the competent treatment of LGB clients within their training programs.…”