What Are Some Ethical Considerations for Clinical Practice with LGBT Patients?

Question

Answer

Ethical considerations in clinical practice with LGBT patients, particularly in the behavioral health field, involve several key elements. Highlighted elements are the importance of informed consent, confidentiality, and appropriate therapy considerations. Here's a breakdown of these ethical considerations:

1. Informed Consent:

• Adherence to WPATH Guidelines: Follow the guidelines established by the World Professional Association for Transgender Healthcare (WPATH) for gender-affirming care.
• Gatekeeping Awareness: Avoid acting as a gatekeeper; focus on diagnosing gender dysphoria and assessing the patient's readiness for hormonal therapy or surgery.
• Psychoeducation: Provide thorough psychoeducation, ensuring patients are informed about the risks, benefits, and irreversible elements associated with gender-affirming procedures.
• Assessment of Capacity: Evaluate the patient's capacity to consent, considering factors such as intellectual disability, substance influence, cognitive disabilities, and psychosis.

2. Confidentiality:

• Respect Privacy: Keep LGBT identity confidential unless explicit permission is granted by the patient to disclose such information.
• Ask Permission: Seek permission before documenting preferred names and pronouns in medical records or disclosing this information to family members.
• Avoid Assumptions: Do not assume a patient's comfort level with disclosing their LGBT status to others. Always ask for permission.

3. Therapy Considerations:

• Reject Conversion Therapy: Emphasize the unethical and harmful nature of conversion therapy, adhering to guidelines such as those provided by the American Psychological Association (APA).
• Personal Bias Awareness: Be vigilant about personal biases that may inadvertently influence therapy and avoid promoting the idea that being LGBT is undesirable.
• Evidence-Based Practices (EBP):
  • Adapted Interventions: Use evidence-based practices adapted for LGBT individuals when available.
  • Consider Minority Stress: Integrate EBPs for minority stress when working with issues related to rejection, discrimination, or other stressors specific to the LGBT population.
  • Caution with CBT: Exercise caution when using Cognitive Behavioral Therapy (CBT) in situations where challenging thoughts may invalidate the patient's real-world experiences, such as discrimination.
• Critical Evaluation: Evaluate therapy interventions critically, ensuring that evidence-based practices are relevant and adapted to the unique needs of LGBT individuals.
• Sensitivity to Presentation: Be sensitive to the potential impact of therapy interventions on patients, particularly when dealing with issues related to gender dysphoria, sexual orientation, and minority stress.

Ethical considerations in clinical practice with LGBT patients involve respecting autonomy, maintaining confidentiality, and employing evidence-based, culturally competent interventions. Practitioners should continually educate themselves on current guidelines and strive to create a therapeutic environment that fosters trust and affirms the diverse experiences of LGBT individuals.

This Ask the Expert is an excerpt from the course, Fundamentals and Ethical Considerations of Clinical Practice with LGBT Populations: Assessment and Therapy Guidelines, presented by Giselle Levin, PsyD.