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Each of the 21 new guidelines provide an update of the psychological literature supporting them, include a section on "Rationale" and "Application," and expand upon the original guidelines to provide assistance to psychologists in areas such as religion and spirituality, the differentiation of gender identity and sexual orientation, socioeconomic and workplace issues, and the use and dissemination of research on LGB issues. The guidelines are intended to inform the practice of psychologists and to provide information for the education and training of psychologists regarding LGB issues.

Guideline 1. Psychologists strive to understand the effects of stigma i. Guideline 2. Psychologists understand that lesbian, gay, and bisexual orientations are not mental illnesses. Guideline 3. Psychologists understand that same-sex attractions, feelings, and behavior are normal variants of human sexuality and that efforts to change sexual orientation have not been shown to be effective or safe.

Guideline 4. Psychologists are encouraged to recognize how their attitudes and knowledge about lesbian, gay, and bisexual issues may be relevant to assessment and treatment and seek consultation or make appropriate referrals when indicated. Guideline 5. Psychologists strive to recognize the unique experiences of bisexual individuals. Guideline 6. Psychologists strive to distinguish issues of sexual orientation from those of gender identity when working with lesbian, gay, and bisexual clients. Guideline 7. Psychologists strive to be knowledgeable about and respect the importance of lesbian, gay, and bisexual relationships.

Guideline 8. Psychologists strive to understand the experiences and challenges faced by lesbian, gay, and bisexual parents. Guideline 9. Psychologists recognize that the families of lesbian, gay, and bisexual people may include people who are not legally or biologically related.

Guideline Psychologists strive to understand the ways in which a person's lesbian, gay, or bisexual orientation may have an impact on his or her family of origin and the relationship with that family of origin. Psychologists strive to recognize the challenges related to multiple and often conflicting norms, values, and beliefs faced by lesbian, gay, and bisexual members of racial and ethnic minority groups. Psychologists are encouraged to consider the influences of religion and spirituality in the lives of lesbian, gay, and bisexual persons.

Psychologists strive to recognize cohort and age differences among lesbian, gay, and bisexual individuals. Psychologists strive to understand the unique problems and risks that exist for lesbian, gay, and bisexual youth. Psychologists are encouraged to recognize the particular challenges that lesbian, gay, and bisexual individuals with physical, sensory, and cognitive-emotional disabilities experience.

Psychologists are encouraged to consider the impact of socioeconomic status on the psychological well being of lesbian, gay, and bisexual clients. Psychologists strive to understand the unique workplace issues that exist for lesbian, gay, and bisexual individuals. Psychologists strive to include lesbian, gay, and bisexual issues in professional education and training. Psychologists are encouraged to increase their knowledge and understanding of homosexuality and bisexuality through continuing education, training, supervision, and consultation.

In the use and dissemination of research on sexual orientation and related issues, psychologists strive to represent fully and accurately and to be mindful of the potential misuse or misrepresentation of research findings. The Guidelines for Psychological Practice with Lesbian, Gay, and Bisexual Clients provides psychologists with 1 a frame of reference for the treatment of lesbian, gay, and bisexual clients 1 and 2 basic information and further references in the areas of assessment, intervention, identity, relationships, diversity, education, training, and research.

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They assist psychologists in the conduct of lesbian, gay, and bisexual affirmative practice, education, and research. The term guidelines refers to pronouncements, statements, or declarations that suggest or recommend specific professional behavior, endeavors, or conduct for psychologists. Guidelines differ from standards in that standards are mandatory and may be accompanied by an enforcement mechanism.

Thus, these guidelines are aspirational in intent. They are intended to facilitate the continued systematic development of the profession and to help ensure a high level of professional practice by psychologists. These guidelines are not intended to be mandatory or exhaustive and may not be applicable to every clinical situation. They should not be construed as definitive and are not intended to take precedence over the judgment of psychologists. Practice guidelines essentially involve recommendations to professionals regarding their conduct and the issues to be considered in particular areas of psychological practice.

Practice guidelines are consistent with current APA policy. It is also important to note that practice guidelines are superseded by federal and state law and must be consistent with the current APA Ethical Principles of Psychologists and Code of Conduct APA, b. In the years following the adoption of this important policy, the APA indeed has taken the lead in promoting the mental health and well-being of lesbian, gay, and bisexual people and in providing psychologists with affirmative tools for practice, education, and research with these populations.

These authors and others e. A revision of the guidelines is warranted at this point in time because there have been many changes in the field of lesbian, gay, and bisexual psychology. Existing topics have evolved and the literature also has expanded into new areas of interest for those working with lesbian, gay, and bisexual clients. In addition, the quality of the data sets of studies has improved ificantly with advent of population-based research.

Furthermore, the past decade has seen a revival of interest and activities on the part of political advocacy groups in attempting to re-pathologize homosexuality Haldeman, Guidelines grounded in methodologically sound research, the APA Ethics Code, and existing APA policy are vital to informing professional practice with lesbian, gay, and bisexual clients. These guidelines have been used nationally and internationally in practice and training and to inform public policy.

They will expire or be revised in 10 years from the date they are adopted by APA. The guidelines are also compatible with policies of other major mental health organizations cf. In addition, the Application section of the text was enhanced to provide psychologists with more information and assistance. There are a of indicators of biological sex, including sex chromosomes, gon, internal reproductive organs, and external genitalia. Behavior that is compatible with cultural expectations is referred to as gender-normative; behaviors that are viewed as incompatible with these expectations constitute gender non-conformity.

Gainor, Sexual orientation refers to the sex of those to whom one is sexually and romantically attracted. While these continue to be widely used, research has suggested that sexual orientation does not always appear in such definable and instead occurs on a continuum e.

Throughout this document, the term "client" refers to individuals across the lifespan. This includes youth, adult, and older adult lesbian, gay, and bisexual clients. There may be issues that are specific to a given age range, and where appropriate, the document will identify those groups. Living in a heterosexist society inevitably poses challenges to people with non-heterosexual orientations. Stigma is defined as a negative social attitude or social disapproval directed toward a characteristic of a person that can lead to prejudice and discrimination against the individual VandenBos, Herek defined heterosexism as "the ideological system that denies, denigrates, and stigmatizes any non-heterosexual form of behavior, identity, relationship, or community" p.

These challenges may precipitate a ificant degree of minority stress for lesbian, gay, and bisexual people, many of whom may be tolerated only when they are "closeted" DiPlacido, Minority stress can be experienced in the form of ongoing daily hassles such as hearing anti-gay jokes and more serious negative events such as loss of employment, housing, custody of children, and physical and sexual assault DiPlacido, According to a probability sample study by Herekantigay victimization has been experienced by approximately 1 in 8 lesbian and bisexual individuals and by about 4 in 10 gay men in the United States.

Szymanski, Kashubeck-West, and Meyer b reviewed the empirical literature on internalized heterosexism in lesbian, gay, and bisexual individuals and found that greater internalized heterosexism was related to difficulties with self-esteem, depression, psychosocial and psychological distress, physical health, intimacy, social support, relationship quality, and career development. There are ificant differences in the nature of the stigma faced by lesbians, gay men, and bisexual individuals.

Lesbians and bisexual women, in addition to facing sexual prejudice, must also contend with the prejudice and discrimination posed by living in a world where sexism continues to exert pervasive influences APA, Similarly, gay and bisexual men are not only confronted with sexual prejudice but also with the pressures associated with expectations for conformity to norms of masculinity in the broader society as well as in particular subcultures they may inhabit Herek, ; Stein, Among these factors are: race and ethnicity e.

Therefore, creating a sense of safety in the therapeutic environment is of primary importance see Guideline 4. Psychologists working with lesbian, gay, and bisexual people are encouraged to assess the client's history of victimization as a result of harassment, discrimination, and violence. Different combinations of contextual factors related to gender, race, ethnicity, cultural background, social class, religious background, disability, geographic region, and other sources of identity can result in dramatically different stigmatizing pressures and coping styles.

For example, for clients who are more comfortable with their lesbian, gay, or bisexual identity, it may be helpful for the psychologist to consider referrals to local support groups or other community organizations. For clients who are less comfortable with their non-heterosexual orientation, on-line resources may prove helpful. Psychologists are urged to weigh the risks and benefits for each client in context. Because stigma is so culturally pervasive, its effects may not even be evident to a lesbian, gay, or bisexual person. Therefore, it may be helpful for psychologists to consider the ways in which stigma may be manifest in the lives of their clients even if it is not raised as a presenting complaint.

No scientific basis for inferring a predisposition to psychopathology or other maladjustment as intrinsic to homosexuality or bisexuality has been established. Fox found no evidence of psychopathology in nonclinical studies of bisexual men and bisexual women. At the present time, efforts to repathologize non-heterosexual orientations persist on the part of advocates for conversion or reparative therapy APA, a; Haldeman, Nevertheless, major mental health organizations cf.

Moreover, an extensive body of literature has emerged that identifies few ificant differences between heterosexual, homosexual, and bisexual people on a wide range of variables associated with overall psychological functioning Gonsiorek, ; Pillard, ; Rothblum, Furthermore, the literature that classified homosexuality and bisexuality as mental illnesses has been found to be methodologically unsound. Gonsiorek reviewed this literature and found such serious methodological flaws as unclear definitions of terms, inaccurate classification of participants, inappropriate comparisons of groups, discrepant sampling procedures, an ignorance of confounding social factors, and the use of questionable outcome measures.

Although these studies concluded that homosexuality is a mental illness, there is no valid empirical support for beliefs that lead to such inaccurate representations of lesbian, gay, and bisexual people. When studies have noted differences between homosexual and heterosexual individuals with regard to psychological functioning e. These findings are consistent with an extant body of research that associates exposure to discriminatory behavior with psychological distress e. In her analysis of recent population-based studies, Cochran concluded that increased risk for psychiatric distress and substance abuse among lesbians and gay men is attributable to the negative effects of stigma.

Shidlo and Schroeder found that nearly two-thirds of their sample of psychotherapy clients reported that their therapists told them that, as gay men and lesbians, they could not expect to lead fulfilling, productive lives, or participate in stable primary relationships.

Such statements stem from a fundamental view that homosexuality and bisexuality indicate or are automatically associated with mental disturbance or dysfunction. In these cases, it is important to consider the effects of internalized stigma. Beckstead and Israel suggest a collaborative approach in establishing therapeutic goals and examining the negative effects of prejudicial beliefs. For example, Nicolosi describes a model in which male homosexuality is treated through the therapeutic resolution of a developmental same-sex attachment deficit.

Reviews of the literature, spanning several decades, have consistently found that efforts to change sexual orientation were ineffective APA, a; Drescher, ; Haldeman, ; Murphy, These reviews highlight a host of methodological problems with research in this area, including biased sampling techniques, inaccurate classification of subjects, assessments based solely upon self-reports, and poor or non-existent outcome measures.

Even the most optimistic advocates of SOCE have concluded that sexual orientation is nearly impossible to change Spitzer, and that fewer than a third of subjects in such studies claim successful treatment Haldeman, Therefore, in the current climate of evidence-based practice, SOCE cannot be recommended as effective treatment.

The potential for SOCE to cause harm to many clients also has been demonstrated. Shidlo and Schroeder found that a majority of subjects reported that they were misled by their therapists about the nature of sexual orientation as well as the normative life experiences of lesbian, gay, and bisexual individuals. Haldeman describes a spectrum of negative client outcomes from failed attempts at conversion therapy. These include intimacy avoidance, sexual dysfunction, depression, and suicidality.

Bias and misinformation about homosexuality and bisexuality continue to be widespread in society APA,a; Haldeman, and are implicated in many client requests to change sexual orientation. Tozer and Hayes found that the internalization of negative attitudes and beliefs about homosexuality and bisexuality was a primary factor in motivating individuals who sought to change their sexual orientation. Fear of potential losses e.

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Additionally, some clients report that non-heterosexual orientation is inconsistent with their religious beliefs or values APA, a; Beckstead, Psychologists are encouraged to carefully assess the motives of clients seeking to change their sexual orientation. In addition, the psychologist is ethically obliged to provide accurate information about sexual orientation to clients who are misinformed or confused APA, In providing the client with accurate information about the social stressors which may lead to discomfort with sexual orientation, psychologists may help neutralize the effects of stigma and inoculate the client against further harm.

The resolution highlights those sections of the Ethics Code that apply to all psychologists working with lesbian, gay, and bisexual older adults, adults, and youth. These sections include prohibitions against discriminatory practices e. Informed consent would include a discussion of the lack of empirical evidence that SOCE are effective and their potential risks to the client APA, a and the provision of accurate information about sexual orientation to clients who are misinformed or confused.

The policy cited above calls upon psychologists to discuss the treatment approach, its theoretical basis, reasonable outcomes, and alternative treatment approaches. Further, it discourages coercive treatments, particularly with youth.

However, for some clients, particularly those who experience religious orientation as a more salient aspect of identity than that of sexual orientation, such a transition may not be possible. It should be noted, however, that this is not the same as changing or even managing sexual orientation, but is a treatment goal established in the service of personal integration.

For a more detailed discussion of planning treatment with clients who are conflicted about sexual orientation and religious identification, see APA aBecksteadBeckstead and Morrowand Haldeman These emotional concerns may include avoidance of intimate relationships, depression and anxiety, problems with sexual functioning, suicidal feelings, and a sense of being doubly stigmatized for being gay and unable to change.

Additionally, it is important to note that SOCE participants confronting coming out as gay frequently experience problems of social adjustment due to unfamiliarity with the lesbian, gay and bisexual community. They also may need support for potential losses e. To do so, psychologists strive to evaluate their competencies and the limitations of their expertise, especially when offering assessment and treatment services to people who share characteristics that are different from their own e.

This is particularly relevant when providing assessment and treatment services to lesbian, gay, and bisexual clients. The psychological assessment and treatment of lesbian, gay, and bisexual clients can be adversely affected by their therapists' explicit or implicit negative attitudes.

For example, when homosexuality and bisexuality are regarded as evidence of mental illness or psychopathology, a client's same-sex sexual orientation is apt to be viewed as a major source of the client's psychological difficulties, even when it has not been presented as a problem Garnets et al. Moreover, when psychologists are unaware of their own negative attitudes, the effectiveness of psychotherapy can be compromised by their heterosexist bias. Since heterosexism pervades the language, theories, and psychotherapeutic interventions of psychology S.

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