Code of Ethics for Counselors and Marriage and Family Therapists __________________________________
bian, gay, and bisexual individuals as mentally ill due to their sexual orientation. This resolution supported dissemination of accurate information about sexual orientation, mental health, and appropriate interventions and instructed counselors to report research accurately and in a manner that minimizes the possibility that results may be misleading. The ACA found that the majority of the studies on this topic had been expository in nature and had no scientific evidence published in psychological peer-reviewed journals that stated the effectiveness of conversion therapy. They did not find any longitudinal studies conducted to follow the outcomes of those individuals who had engaged in this type of treatment. They concluded that research published in peer-reviewed counseling journals indicated that conversion therapy may harm clients. These findings bring several questions to the forefront: 1. Is a counseling professional who offers conversion therapy practicing ethically? 2. Since ACA has taken the position that it does not endorse reparative therapy as a viable treatment option, is it ethical to refer a client to someone who does engage in conver- sion therapy? 3. If the client insists on obtaining a referral, what guidelines can a counselor follow? 4. What are the conditions that allow the professional coun- selor to refer this case to another counselor? ACA committee members agreed that it is of primary impor- tance to respect the client’s autonomy to request a referral for services which are not offered by the counselor. If counselors determine an inability to be of professional assistance to clients, they avoid entering or continuing the counseling relationship. Counselors act to avoid harming their clients, trainees, and research participants and to minimize or to remedy unavoidable or unanticipated harm [10]. Referring a client to a counselor who engages in a treatment modality not endorsed by the profession may in fact cause harm, does not promote the welfare of clients, and opposes the basic purpose of the code. There is no professional training condoned by ACA, ACA, AAMFT, APA, or other prominent mental health associa- tion that would prepare counselors and therapists to provide conversion therapy. Additionally, all professional associations and related mental health agencies have spoken out against any form of conversion therapy or counseling. The counselor or therapist would be practicing outside the boundaries of their expertise because there is no professional training for conver- sion therapy. This would violate the ethics code. The ACA Code requires counselors to “recognize history and social prejudices in the misdiagnosis and determination of pathology of certain individuals and groups and the role of mental health professionals in perpetuating these prejudices through diagnosis and treatment” [10].
CASE STUDIES The following section summarizes case studies and includes legal judgements and rationales. This information should not be construed as legal reference material or guidance. Profes- sionals should always seek the assistance of their professional association and consult employing agency legal counsel for any questions regarding ethical/legal issues. REPARATIVE/CONVERSION THERAPY During the third session of counseling, a 30-year-old client reported that he was gay and stated that he no longer wanted to follow this lifestyle. He wanted to participate in conversion therapy so that he no longer felt an attraction to men. His goal was to become attracted to a woman and have a traditional marriage with children. At the suggestion of a friend, the client read about repara- tive/conversion therapy and researched the approach on the Internet. Even after his research, he was convinced this is the route he wants to take. The counselor listened and asked questions in a clinically appropriate manner. The counselor informed the client that although she felt that she could be effective in counseling with him, she could not ethically engage in reparative/conver- sion therapy and felt it would not be effective in reaching his desired goals. She explained that she could find no scientific evidence or support for the approach; she even consulted her association, who advised her that it was not a supported form of therapy. The client understood but indicated he was disappointed that the counselor could not help him through that type of counseling. He then asked for a referral to another counselor or therapist who would help him change his sexual orientation and reach his goals. Ethical question: Should the counselor make a refer- ral for conversion therapy? Analysis The ACA Ethics Committee considered many factors and arrived at a consensus opinion that addressed several sections of the Code of Ethics and moral principles of practice pre- sented in this scenario. They started with the basic goal of reparative/conversion therapy: to change an individual’s sexual orientation from homosexual to heterosexual. Counselors who conduct this type of therapy view same-sex attraction and its behavior as abnormal, unnatural, or immoral. They also believe that a change, or a “cure,” can be achieved through the use of therapy. The belief that same-sex attraction and behavior is abnormal and in need of treatment is in opposition to the position taken by national mental health organizations, including the ACA, APA, and AAMFT. The ACA Governing Council resolution specifically noted that the ACA opposes the portrayals of les-
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