Ethical Issues in Psychiatric and Psychological Care

Ethical issues arising in the context of psychiatric and psychological care provided to homosexual patients are similar, for the most part, to issues that arise in the context of providing care to individuals who are heterosexual. Ethical issues related to the "conversion" of homosexuals to heterosexuality arise only for those who continue to believe that homosexuality is abnormal or an illness. There is no evidence that therapy will result in long-term change in the sexual orientation of adults (Coleman). Although parents may place their children in therapy to ensure that they are or will become heterosexual, evidence indicates that such experiences may be psychologically injurious (Isay).

Nevertheless, some psychoanalysts believe that attempts to change an individual's sexual orientation are ethical as long as the individual wants that change (Nicolosi; Socarides).

Significantly, Gerald C. Davidson (pp. 97-98), one of the original pioneers of conversion therapy, ultimately concluded:

Change of orientation therapy programs should be eliminated. Their availability only confirms professional and societal biases against homosexuality, despite seemingly progressive rhetoric about its normalcy. Forsaking the reorientation option will encourage therapists to examine the life problems of some homosexuals, rather than focusing on the so-called problem of homosexuality.

It is critical that health professionals create an atmosphere in which their patient can openly discuss issues related to sexuality and sexual behavior. As with heterosexual patients, the focus should be on the patient's sexual behavior, not his or her sexual orientation. (quoted in Perrin)

Additional research is needed to address many unresolved issues. Physicians and therapists may be called on to offer their professional opinions in cases involving adoption by gay or lesbian parents. There is no evidence of mental health problems among children raised by lesbian mothers in the absence of a biological father. However, a related but relatively unexplored issue is the extent to which children may be especially vulnerable to societal stressors as a result of the societal bias against homosexuality.

Further research is needed to examine whether the sexual orientation of a clinician should be a factor in the selection of a healthcare provider, whether a provider should disclose his or her sexual orientation during the therapeutic process, and what effect the disclosure of the sexual orientation of a provider may have on the therapeutic process and its outcome.

ELI COLEMAN (1 995) REVISED BY SANA LOUE

SEE ALSO: Lifestyles and Public Health; Mental Health, Meaning of Mental Health; Mental Illness: Conceptions of Mental Illness; Psychiatry, Abuses of; Sexual Behavior, Control of; Sexual Ethics; Sexual Identity; Sexuality, Legal Approaches to; and other Homosexuality subentries

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