Psychosocial Theory

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T his Year’s diVision oF Counselling Psychology conference theme, Positive Approaches, Challenging Contexts,

provides perspective on the substantive professional gains we have achieved in creat- ing lesbian, gay, bisexual, and transgender (lGBt) affirmative psychological theory, practice, and education. it also exposes how our professional past interconnects with present psychosocial problems that continue

to vex lGBt people. lGBt individuals in both the united kingdom and united states share strikingly similar types and rates of mental health disparities and psychosocial problems. moreover, applied psychologists (i.e., counselling, clinical, education/school, and health) and other mental health profes- sionals can be one piece of the puzzle when trying to redress lGBt mental health dispar- ities. research conducted in the united

Research Paper

Mind our professional gaps: Competent lesbian, gay, bisexual, and transgender mental health services1

Markus P. Bidell

Applied psychology has a complex relationship with lesbian, gay, bisexual, and transgender (LGBT) matters. As part of the religious, legal, and scientific triumvirate, we played a central part in developing discriminatory, biased, and stereotypic perspectives castigating LGBT individuals as immoral, deviant, disordered, and even dangerous. Such perspectives not only begot and reinforced legal and social oppression, but also fuelled the creation of LGBT psychological theories and malevolent treatments – since discredited. In a historic and perhaps even redemptive reversal, professional psychological bodies now reject the notion that being LGBT is representative of a mental disorder, immorality, or social deviancy and affirm that LGBT people have a sexual orientation or gender identity that is normal, healthy, and legitimate. In fact, applied psychologists have become ardent advocates for LGBT human rights. In our post-triumvirate role, we might reason that our LGBT work is done or nearing completion with the proffering of LGBT-affirmative professional ethics, public policies, standards, and treatment guidelines. Yet LGBT individuals on both sides of the Atlantic continue to be negatively affected by alarming and disproportionate rates of serious mental health and psychosocial problems. These disparities are compounded by practitioner and trainee concerns regarding their competence with LGBT clients. Moreover, complex issues arise when applied psychologists’ personal beliefs run contrary to our professional LGBT standards of care. Based on a keynote address (Bidell, 2015) and research paper presentation (Bidell, Milton, Chang, Watterson, & Deschler, 2015) - both given at the annual conference of the British Psychological Society Division of Counselling Psychology - this paper juxtaposes our troubled past with current LGBT psychosocial issues. It weaves past with present as well as personal with professional to underscore the continued need to advance LGBT-affirmative psychological services. Keywords: sexual orientation, gender identity, LGBT counsellor competence, religious conservatism, applied psychology.

1 this paper is based on an invited keynote address (treating transgressors: our complicated relationship with lesbian, gay, bisexual, and transgender issues) and research paper presentation (examining positive patterns and current challenges: lGBt affirmative counsellor competency and training in the united kingdom) given at the annual conference of the British Psychological society division of Counselling Psychology, harrogate, uk., June 2015.

68 Counselling Psychology Review, Vol. 31, No. 1, June 2016

AuthorMarkus P. Bidell

states documents critical concerns with lGBt counsellor competence and profes- sional training. it is not uncommon for mental health providers and trainees in the united states to report being poorly trained and feeling minimally competent to work with lGBt clients (Bidell, 2014a; Bidell & Whitman, 2013; Graham, Carney, & kluck, 2012; Grove, 2009; hope & Chappell, 2015; mcGeorge, Carlson, & toomey, 2013a; o’hara, dispenza, Brack, & Blood, 2013; rock, Carlson, & mcGeorge, 2010). and those in the mental health professions can and do hold prejudicial attitudes towards lGBt people, most often based on conser- vative socio-political and religious beliefs (Bidell, 2012, 2014b; Bidell & Whitman, 2013; henke, Carlson, & mcGeorge, 2009; mcGeorge et al., 2013a; o’shaughnessy & spokane, 2013; o’hara et al., 2013).

as the 2014–2015 regent’s university london Fulbright scholar (Bidell, 2014c), i am drawing on methodology i’ve employed in the united states. over the past year, i have been examining lGBt competence and training in the British isles amongst mental health practitioners and trainees. an initial look at the data indicates that defi- ciencies and problems with mental health practitioners’ lGBt competence and train- ing are not dissimilar to those i’ve witnessed in the united states. Preliminary findings show that lGBt counsellor competence is significantly lower among more religiously conservative British mental health practi- tioners and students (Bidell, milton, Chang, Watterson, & deschler, 2015). Comparable to clinicians in the united states, i’ve found that the overwhelming majority of British trainees and practitioners (n = 196; 76.1 per cent) reported their professional education either incorporated minimal lGBt training or none at all (Bidell et al., 2015). Clearly existing research and my initial Fulbright data underscore an imperative need for applied psychologists on both sides of the pond to improve lGBt clinical competence and training.

The triumvirate: Religion, state, and science across the developmental spectrum, lGBt people in the united states and united kingdom have disproportionally high rates of serious psychosocial and mental health problems such as depression, anxiety, smok- ing, substance abuse, suicidality, discrimina- tion, and violence (Chakraborty, mcmanus, Brugha, Bebbington, & king, 2011; elliott et al., 2015; haas et al., 2010; institute of medi- cine, 2011; king et al., 2003; king et al., 2008; Warner et al., 2004). applied psychol- ogists are starting to understand these higher rates of psychosocial problems within the framework of minority stress (meyer, 2003). the minority stress model views ‘stigma, prejudice and discrimination as producing a hostile and stressful social envi- ronment that leads to poor mental health, and eventually, physical health’ (elliot, et al., 2015, p.14). lGBt minority stress is not static or isolated and can be hard to avoid. impacted broadly by psychosocial factors, it can wax and wane depending on develop- mental issues, environment, and social support. Furthermore, minority stress ‘may be complicated by additional dimensions of inequality such as race, ethnicity, and socioe- conomic status, resulting in stigma at multi- ple levels’ (iom, 2011, p.1.2).

the shared moral, legal, cultural, and scientific heritage between the united king- dom and united states likely explains why we see such common types of lGBt oppres- sion along with resultant forms of lGBt psychosocial disparities. For lGBt people in both countries, a powerful, interconnected, and synergistic structure links past to pres- ent. an omnipotent triumvirate, consisting of religious, state, and scientific institutions, has castigated lGBt people as immoral, criminal, and disordered for well over a thousand years. the roman Catholic Church was one of the earliest Western insti- tutions which not only morally condemned lGBt people, but also developed ecclesias- tic law punishing them as well. Penalties changed over ensuing centuries, ranging

Counselling Psychology Review, Vol. 31, No. 1, June 2016 69

from social to physical and included capital punishment.

as nation states in europe formed, strengthened, and even broke from rome, ecclesiastic law became the basis for anti- lGBt common law. the first British sodomy law, the Buggery act of 1533, was written when henry the Viii split from the roman Church during the english reformation. Buggery became a felony punishable by death. attempted buggery was a lesser crime with penalties ranging from imprisonment to pillory. the punishment of hanging for buggery was not lifted until 1861 with the last two British executions occurring in 1835. at the turn of the century, lGBt Britons were prosecuted using the labouchere amend- ment (Criminal law amendment act, 1885) stating lGBt behaviours were immoral and represented gross indecency.

american anti-lGBt laws have primarily been regulated through state criminal statutes under various forms of sodomy legis- lation and criminal punishments. as a former colony, america based its early lGBt legislation on British law. in most states, homosexuality was initially categorised as a felony and later re-codified as crimes against nature or acts of gross indecency. social changes starting in the late 1960s ushered in processes that began the repeal of anti- lGBt laws in the united kingdom and united states. these repeals started with the 1967 sexual offences act that decrimi- nalised homosexuality in england and Wales and continued until 2003 when the united states supreme Court in lawrence v. texas repealed the remaining 14 state sodomy stat- ues.

Classifying lGBt people as mentally disordered provided the final component to the triumvirate. influenced by social, cultural, and moral discriminatory views about lGBt people, Bayer (1987) argues that mental health professionals started ‘serving as guarantor of social order, substi- tuting the concept of illness for that of sin’ (p.10). Prevailing lGBt moral strictures and public policies largely shaped emerg-

ing theories and clinical treatments devel- oped by psychologists. lGBt people were not only immoral in the eyes of religion and criminals in the eyes of the law, but now also viewed as mentally ill by our profession. Psychiatrists and psychologists drew on their tools of nomenclature to diagnosis lGBt people as mentally disordered. in the first edition of the Diagnostic and Statistical Manual of Mental Disorders (dsm; american Psychiatric association, 1952), homosexual- ity was codified as a mental illness and cate- gorised within the sociopathic personality disturbances.

Codification of homosexuality within sociopathy strongly reinforced a view that lesbian, gay, and bisexual individuals were not only highly pathological but also extremely dangerous to society. this type of categorisation justified the development and utilisation of cruel measures to extinguish a person’s homosexuality. Psychiatrists drew on medical procedures such as electrocon- vulsive therapy (i.e., electroshock treat- ment), frontal lobotomies, and chemical hormonal castration to beat back the dangerous scourge homosexuality was thought to present. our professional prede- cessors employed psychoanalytic, behav- ioural, and cognitive psychological theories and treatments in their misguided, ill-fated attempts at curing homosexuality. Psychoan- alytical practitioners and researchers were largely responsible for the idea that same-sex attraction was an outcome of exposure to highly pathological parent-child relation- ships in early development. (Bieber, dain, & dince, 1962; socarides, 1965). they also developed psychoanalytic therapies, albeit ineffectual, to attempt curing same-sex sexual orientations (British Psychological society, 2012b).

Cognitive and behavioural psychologists transformed homosexuality from a distor- tion of the normal pattern of psychosexual development into the maladaptive behav- ioural consequence of inappropriate learn- ing and irrational fears of the ‘opposite’ sex (Bayer, 1987; Freund, 1977). the technique

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behaviourists employed most often was the coupling of same-sex thoughts and fantasies with emetics, electric shock, or other aversive conditions, followed by desensitisation procedures (i.e., termination of negative aversion stimulus with the appearance of heterosexual stimuli). in a later reflection atypical for most behaviourists engaged in conversion therapies, Freund stated:

i started a therapeutic experiment, employing aversion therapy combined with positive conditioning toward females. approximately 20 per cent of the homo- sexual males married and founded fami- lies. For some time, there seemed to be reason for guarded optimism. however, this was a long-term study, and these marriages were followed for many years. Virtually not one cure remained a cure. i am not happy about my therapeutic experiment which, if it has helped at all, it has helped clients to enter into marriages that later became unbearable or almost unbearable. Virtually all the marriages of these clients had become beset with grave problems ensuing from their homosexual- ity (Freund, 1977, p.237).

dr evelyn hooker was one of the first psychologists to conduct empirical research on nonclinical lesbian women and gay men. her landmark study (1957) examined results from three projective tests administered to 30 gay and 30 heterosexual male study participants matched along age, education, and intelligence dimensions. after blinded analysis of subjects’ responses, experts rated each participant on a 5-point adjustment scale. the independent evaluators found no differences in the adjustment levels between the two groups. Furthermore, they were not able to accurately identify which participants were gay or heterosexual. From her results, hooker concluded that homosexuality did not represent a clinical entity nor was it asso- ciated with pathology. the work of psycholo- gists like dr evelyn hooker coupled with lGBt civil rights activism forced mental health professionals to re-examine their socially constructed and biased notions

regarding the conceptualisation and treat- ment of lGBt individuals. in 1974, the american Psychiatric association voted to declassify homosexuality as a mental disor- der (Bayer, 1987). however, a new diagnosis, sexual orientation disturbance, was added and then replaced with ego-dystonic homo- sexuality in the dsm iii (american Psychi- atric association, 1980); both diagnostic categories described those individuals conflicted with having a same-sex sexual orientation. the diagnostic category was completely removed with the publication of the dsm-iii-r (american Psychiatric associ- ation, 1987).

For transgender people, a diagnostic category remains. introduced relatively late in the diagnostic statistical manual’s history, Gender identity disorder was added with the publication of the dsm-iii (american Psychiatric association, 1980). the diagnosis was revised and renamed Gender dysphoria, with the publication of the dsm-5 (ameri- can Psychiatric association, 2013). the continued inclusion of a transgender-based dsm diagnosis remains controversial. some advocates of the diagnostic category argue that needed medical treatments for trans- gender individuals might be jeopardised with a complete removal of the diagnosis from the dsm. others like myself believe the continuation of categorising non-cisgender people within a psychiatric diagnosis rein- forces and even maintains the longstanding prejudicial views that lGBt people are fundamentally abnormal and diseased. i believe healthcare policy can simply be developed to address insurance and medical coverage issues potentially resultant from the complete elimination of a non-cisgender diagnostic category from the dsm.

Mind the professional gap For those of us born in america during the 1960s, an intact religious, legal, and scien- tific triumvirate was still largely in place that socially constructed lGBt people as immoral, criminal, and mentally disordered. For example, the socially conservative state

AuthorMarkus P. Bidell

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where i grew up criminalised homosexuality until a 1972 legislative repeal. and the first edition of the dsm (american Psychiatric association, 1952) was still in use, categoris- ing homosexuality as a serious mental illness within the sociopathic personality distur- bances. Coming to terms with my sexual orientation in such an environment was chal- lenging to say the least.

By the time i entered graduate training in the early 1990s, lGBt social attitudes and policies were in flux as the old triumvi- rate began faltering and struggled to remain a cohesive front against emerging lGBt civil rights activism. it was not uncommon to be confronted with past prej- udices alongside emerging lGBt advocacy and public policy gains. so as a graduate counselling student at sonoma state university in the early 1990s, i didn’t find it odd that my professors expressed caution about potential problems i might have as an openly gay counsellor working with youth in schools. they were concerned that preju- dicial stereotypes about gay men coupled with the existence of discriminatory laws could make my work in public schools uncertain at best. Consider that it wasn’t until 2003 that the united states supreme Court in lawrence v. texas ruled that state sodomy laws were unconstitutional. said another way; i had been an assistant Profes- sor for three years by the time the supreme Court made this ruling.

Perhaps the most defining moment of my professional career happened when i began my doctoral training in combined applied psychology (counselling/clinical/school) at the university of California, santa Barbara. at the time, i couldn’t have known this expe- rience would profoundly shape not only my dissertation, but also my future scholarship and professional work. my efforts to opera- tionalise lGBt counsellor competence can be directly traced back to this pivotal experi- ence. a professor with ardent beliefs that being lGBt was morally wrong taught my first doctoral course. Furthermore, he supported using reparative or conversion

therapy typically based on conservative and fundamental religious beliefs about lGBt people. these pseudo-treatments claim out- dated psychoanalytic, cognitive, and behaviour principles can be utilised to convert lGBt people to be heterosexual and cisgender. in response, the american Psychological association and the British Psychological society have issued strong position statements condemning such pseudo-treatments as unethical and highly damaging to lGBt clients (american Psychological association, 2009; 2012; British Psychological society, 2012a, 2012b). however, when i was enrolled in dr Brown’s course at the university of California, santa Barbara in the autumn of 1996, the ameri- can Psychological association or British Psychological society had yet to issue these ethical edicts.

For one of the assignments in this profes- sor’s class, i needed to write a research paper on a topic and population of my choice. my proposal focused on lGBt adolescent career development. after i submitted my topic, the professor pulled me aside, outlined his reli- gious fundamentalist beliefs about lGBt individuals, rejected my proposal topic, and prohibited me from selecting any lGBt issues for the assignment. What i found most disquieting was witnessing how some students’ beliefs were bolstered by the profes- sor’s declaration of his conservative religious views about lGBt issues. my concerns gener- ated questions regarding the role of educa- tion and training in addressing lGBt mental health disparities. in response, i created and psychometrically established the sexual orientation Counselor Competency scale (soCCs, Bidell, 2005) for my dissertation research. drawing on the ternary multicul- tural counsellor competency model (sue, arredondo, & mcdavis, 1992), the soCCs is a self-assessment of counsellors’ lGBt-affir- mative attitudinal awareness, clinical skills, and knowledge.

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Post-triumviratism: The emergence of LGBT social science, public policy, and equality in over 20 peer-reviewed research papers, the soCCs has been a basis for not only my scholarship, but also for other researchers (Bidell & Whitman, 2013). Based on findings from these studies, important and often obvi- ous relationships regarding lGBt compe- tence have emerged. moreover, lGBt clinical and counselling competency has developed into a viable, reliable, and valid psychological construct based on the resolute rejection of the historic and biased notions stigmatising lGBt people as immoral, mentally disordered, inferior, socially deviant, or aberrant (american Psychological association, 1975; 1991; 2009; 2012; British Psychological society, 2012a; 2012b). instead, it asserts the fundamental legitimacy and equality of lGBt people. Based on this foun- dation, lGBt competent psychologists exam- ine and advance their: (a) self-awareness of personal and societal lGBt biases, stereo- types, and prejudices; (b) understanding and knowledge of lGBt life stage development, intersectionality, mental health disparities, theories, and psychosocial issues; and, (c) clinical, counselling, and psychotherapeutic skills grounded in professional ethics and lGBt psychological standards of care (Bidell & Whitman, 2013).

While it is beyond the scope of this paper to review the body of soCCs-based research (see, Bidell & Whitman, 2013), i’d like to highlight one key area, namely the relation- ship between lGBt counsellor competence and clinicians’ conservative lGBt beliefs. not surprising, mental health professionals with more conservative socio-political and religious beliefs consistently report lower levels of sexual orientation counsellor competence (Bidell, 2012, 2014b; mcGe- orge, Carlson, & toomey, 2013b; o’shaugh- nessy & spokane, 2013). in one study (Bidell, 2014b) i examined over 200 mental health practitioners, supervisors, and students to explore the impact of clinicians’ religious beliefs. my findings showed;

that significantly lower levels of lGB-affir- mative counselor competence were related to more religiously conservative counselors, even when the effects of education level, political conservatism, and lGB interpersonal contact were controlled…[and] one in three coun- selors, educators, supervisors, and trainees in this study demonstrated a significant connection between their conservative religious beliefs and sexual orientation counselor competency. (p.175)

results from my study highlight both the ongoing nature and scale of the problem. For practitioners holding beliefs that lGBt indi- viduals are immoral or sinful, tension exists between the personal and professional (Whit- man & Bidell, 2014). While this can be an ethical dilemma for clinicians, it’s quite worri- some for lGBt clients seeking mental health services. lack of sensitive, affirmative, and competent clinical services has been identi- fied as a major structural barrier that can negatively impact lGBt individuals’ health- care experiences and clinical outcomes (iom, 2011). in the united kingdom, elliot and colleagues (2015) found that lGBt indi- viduals reported significantly lower health- care provider satisfaction compared to their heterosexual counterparts. the researchers concluded that, ‘discrimination may affect the quality of care that sexual minorities receive…and some healthcare workers may be uncomfortable communicating with sexual minority patients and insensitive to their needs’ (p.10).

Personal and professional conflicts regarding ethical lGBt psychotherapy services are at the centre of legal cases involv- ing the dismissal of two united states gradu- ate school counselling students from their mental health training programs (keeton v. anderson-Wiley, 2010; Ward v. Wilbanks, 2010; Ward v. Polite, 2012). in the federal lawsuits, the former students cited their conservative Christian beliefs and argued their freedoms of religion and speech were violated when faculty upheld professional ethics regarding lGBt-affirmative clinical

AuthorMarkus P. Bidell

Counselling Psychology Review, Vol. 31, No. 1, June 2016 73

standards of care. Both cases not only connect directly to my personal experiences and professional work, they also illuminate a fundamental transformation fuelling recent advancements in lGBt equality.

in the united states and united king- dom, conservative politicians, pundits, and pastors have steadfastly drawn on the moral, legal, and scientific triumvirate to oppose, often successfully, lGBt civil and human rights. as we move into a post-lGBt triumvi- rate era where lGBt people are no longer considered immoral, mentally disordered, or criminal; opponents to lGBt equality can no longer effectively utilise the tripartite arguments of past generations. adopting different tactics, conservative individuals and organisations are trying to claim they become victims of lGBt equality, arguing infringement of their religious freedom when lGBt-affirmative laws, policies, and professional standards are adopted. as the new lGBt paradigm tilts toward equality, such objections and arguments are becom- ing untenable and ultimately unjustifiable. this progression is not confined to lGBt rights. throughout history, the strictures of the triumvirate have also been utilised in the subjugation and dehumanisation of other oppressed groups. as minoritised groups have sought civil and human rights, advance- ment must occur in the social justice discourse making it impossible to withhold human rights based on prejudicial and biased moral, legal, scientific, and social mores.

the two unsuccessful lawsuits brought by the school counselling students and the recent united states supreme Court ruling (obergefell v. hodges, 2015) legalising same-sex marriage are examples of the shift- ing landscape for lGBt equality. in the majority opinion, united states supreme Court Justice antony kennedy provides an eloquent exemplar of this paradigm shift, writing:

until the mid-20th century, same-sex inti- macy long had been condemned as immoral by the state itself in most West-

ern nations, a belief often embodied in the criminal law. For this reason, among others, many persons did not deem homosexuals to have dignity in their own distinct identity. a truthful declaration by same-sex couples of what was in their hearts had to remain unspoken…[and] the argument that gays and lesbians had a just claim to dignity was in conflict with both law and widespread social conven- tions. same-sex intimacy remained a crime in many states. Gays and lesbians were prohibited from most government employment, barred from military serv- ice, excluded under immigration laws, targeted by police, and burdened in their rights to associate…[and]…for much of the 20th century, moreover, homosexual- ity was treated as an illness…the nature of marriage is that, through its enduring bond, two persons together can find other freedoms, such as expression, inti- macy, and spirituality. this is true for all persons, whatever their sexual orienta- tion…there is dignity in the bond between two men or two women who seek to marry and in their autonomy to make such profound choices…as the state itself makes marriage all the more precious by the significance it attaches to it, exclusion from that status has the effect of teaching that gays and lesbians are unequal in important respects.

nodding to the past wrongs wrought by the moral, legal, and scientific triumvirate, Justice kennedy moves us forward and away from the viability of denying lGBt individu- als the dignity of human rights and equality based on out-dated prejudicial justifications. this ruling, along with similar historic legis- lation in the united kingdom (marriage act, 2013)  and ireland (thirty-fourth amend- ment of the Constitution Bill, 2015), under- scores the profound change occurring today. Conservative religious beliefs or morally based reasoning can no longer substantiate lGBt inequality. a paradigm shift of this magnitude has the power to change hearts, minds, and deeds. in the case of marriage

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equality, acts of lGBt transgression are rightly transformed into acts of love.

Primum non nocere: First, do no harm it’s important to acknowledge that many deeply religious applied psychologists do not harbour beliefs that lGBt individuals are sinful or immoral nor do they have any conflicts between their faith and the provision of competent lGBt psychological services. however, emerging research indicates discor- dance between personal beliefs and lGBt- affirmative counselling is not as uncommon as we might hope (Bidell, 2012, 2014b; mcGe- orge et al., 2013b; o’shaughnessy & spokane, 2013). Whilst we are now crossing a major societal and professional threshold in the advancement of lGBt equality, lGBt biases and prejudices are still reaching into today’s counselling sessions and psychological consul- tation rooms. the stakes for lGBt clients are high and even potentially catastrophic. recent research examining lGBt health disparities exposes how vulnerable lGBt people can be to minority stress and resultant mental health problems, with suicide being the most tragic consequence (Chakraborty et al., 2011; elliott et al., 2015; haas et al., 2010; iom, 2011; king et al., 2003; king et al., 2008; Warner et al., 2004).

i have contemplated my possible response if either of the aforementioned counselling students were enrolled in one of my classes. When first learning of these cases, i was torn about the decision to dismiss them. after all, expulsion is the ulti- mate action educators can take against any student. and i believe ardently in the sanc- tity of religious and speech freedoms. however, the paradigm shift fuelling historic advancements in lGBt rights is advancing my own certainty that freedom of religion and speech does not mean freedom to discriminate. more importantly, no legal or professional protections exist for applied psychologists that justify the abdication of our principle duty: first, do no harm. as such, freedom of speech and religion can never justify rejecting our ethical duty

regarding lGBt clinical and professional competence.

We remain at a professional crossroads where paradigm shifts and removal of students from programs will not eliminate dilemmas that happen when conservative personal beliefs conflict with our profes- sional lGBt ethical standards. While we cannot, and should not, dictate the personal beliefs applied psychologists hold about lGBt issues and individuals; applied psychologists must search for ways to redress our past lGBt wrongs by addressing current lGBt mental health and psychosocial disparities. multicultural training is a power- ful tool in our professional arsenal, yet its potential has not been fully realised for lGBt clinical competence. the majority of clinicians and trainees report that their professional training has not prepared them to work competently and ethically with lGBt issues and my Fulbright data under- scores this fact for practitioners and students in the united kingdom (Bidell et al., 2015; Bidell & Whitman, 2011).

We mustn’t let professional gains and societal progress regarding lGBt equality obfuscate lGBt psychosocial and mental health problems that stubbornly remain, nor our professional responsibility to do no harm. important work remains for applied psychol- ogists regarding competent and ethical lGBt psychological services – the health and well- being of our lGBt clients depend on it.

Markus P. Bidell, department of educational Foundations & Counseling Programs, hunter College of the City university of new York.

the author thanks Charles donovan for editorial support. Correspondence concern- ing this article should be addressed to markus Bidell, department of educational Founda- tions & Counseling Programs, hunter College of the City university of new York, new York, nY 10065. email: [email protected]

AuthorMarkus P. Bidell

Counselling Psychology Review, Vol. 31, No. 1, June 2016 75

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Markus P. Bidell

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