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The Psychotherapist Association for
Gender & Sexual Diversity

[please see also: Terms/Privacy Policy]

(approved January 11, 2015)

GAYLESTA, The Psychotherapist Association for Gender and Sexual Diversity, is an organization of mental health professionals who come from a variety of professional backgrounds and with a wide range of clinical specializations. Gaylesta's charter includes:

  • promoting awareness of mental health issues specific to lesbian, gay, bisexual, trans, queer, intersex, questioning and asexual (LGBTQIQA) populations,
  • developing an exchange of information related to the field of mental health for LGBTQIQA persons,
  • promoting awareness among mental health workers of cross cultural issues such as race/ethnicity, age, ability, nationality, sexual orientation, gender and class, and
  • offering a special resource to the community through the services of our members.

Gaylesta offers an on-line referral service for the public seeking LGBTQIQA-sensitive/LGBTQIQA-competent psychotherapists (both licensed and pre-licensed, whose credentials have been verified by Gaylesta). Our members offering clinical services include marriage and family therapists, social workers, professional clinical counselors, psychologists and psychiatrists.

All psychotherapists are fundamentally bound by both law and the professional ethical standards of their credential. There are many professional organizations to which therapists may belong, depending upon their credential. Each has its own Code of Ethics. Gaylesta does not seek to duplicate the codes of each credential in its own Code of Ethics. Rather, the Gaylesta Code highlights those issues of specific relevance to psychotherapists working with LGBTQIQA clients, and includes items which may not be explicitly specified elsewhere. In many cases, codes of ethics extend applicable laws and licensing board requirements by defining guiding principles and standards of professional behavior for association members. In cases where the standards defined by this Code of Ethics are more rigorous than those defined by law, Gaylesta clinicians agree to adhere to this higher standard.

Some of the key principles that guide codes of ethics have specific applications with regard to working with LGBTQIQA populations. One basic guiding rule is that the therapist makes every effort to be of benefit and avoid doing harm to those with whom they work. To do so, psychotherapists must do their best to ensure that they work within the realm of their professional competence with respect to populations served and services offered. Their professional work should be guided by established information and defined best practices. Psychotherapy relationships must be based on respect for all clients, honoring their integrity, and taking care to avoid any undue influence on clients due to the power of their role.

 To be of professional assistance to any LGBTQIQA clients, psychotherapists must not pathologize sexual orientation/gender identity. Variations in sexual orientation are not indicative of any mental health disorder; nor are variations in gender identity. Gaylesta clinicians recognize sexual orientation and gender identity as existing within a non-binary spectrum.

Furthermore, we recognize that mental health professionals have special knowledge of human behavior and how people experience themselves in the world. Psychotherapists have a special responsibility with respect to the use of those skills. As individuals, mental health professionals are obligated to benefit the welfare of all, to principles of social justice and to protecting the dignity and worth of others. They must never participate in any activities that may be abusive, harm or take advantage of any person for the gain of others. This Code of Ethics presumes a worldview of human rights based on the integrity of the individual. We must be mindful of the history of physical, sexual and psychological oppression of LGBTQIQA individuals over time and place, internationally as well as within the United States. Our sensitivity to the multiple forms and settings of such abuse underscores the principle that the use of humiliation, force and coercion is unethical and can never be accepted as tools of change or benefit to others. Such unacceptable abuse may extend to cruel, degrading or inhumane treatment of others, which is tantamount to torture and is never acceptable or defensible.

BEST PRACTICES: Gaylesta clinicians follow best practices in psychotherapy with respect to affirming variations of sexual orientation and gender identity, with both minor and adult clients. Gaylesta clinicians acknowledge societal and familial pressures that may privilege or disparage specific orientations or identities. They encourage open discussion of sexual orientation and gender identity.

THE USE OF DIAGNOSIS: Psychotherapists are trained and may be required to provide diagnoses for clients. However, clinicians recognize and are sensitive to historical and social prejudices in the misdiagnosis and pathologizing of individuals and groups including but not limited to sexual orientation/gender identity.

Clients come to us with issues embedded in a social and cultural context, and therapists must be sensitive to those linkages. Neither sexual orientation nor gender identity is a disorder, but clients may suffer from the psychological impact of minority stress (e.g., rejection, victimization, harassment or discrimination on the basis of sexual orientation, gender variance, gender, race/ethnicity, and class).

CONVERSION EFFORTS: Gaylesta clinicians do not engage in those practices known as sexual orientation/gender identity conversion efforts. Clinicians do not claim or teach that the sexual orientation and/or gender identity of clients/patients, students, supervisees, employees or colleagues is a disorder, superior or inferior to heterosexual norms and/or that these identities can or should be changed by a therapist. Providing treatment on this basis is professionally unethical and immoral.

The research literature on determinants of a variety of markers of psychological distress (e.g., depression, social anxiety, suicide attempts, elevated substance use) among sexual minority youth and adults point to social stigma, victimization, ostracism by family and peers, and the internalization of negative beliefs and prejudicial attitudes toward sexual minorities and trans persons. The internalization of negative beliefs about sexual minorities and gender variance appears to be particularly pernicious, yet this is the very basis of conversion efforts. Rather than affirming the identity of gender variant and sexual minority clients, beliefs that they are flawed are reinforced. Individuals are pressured to reject, devalue or suppress core aspects of self and constrict their behavior and emotional expression to "acceptable" norms.

Advertising regarding LGBTQIQA treatment modalities. Clinicians do not mislead clients with advertising that claims that therapists can alter and/or change clients' sexual orientation and/or gender identification.

CLIENT AUTONOMY: Gaylesta clinicians respect their clients' autonomy in all aspects of the expression of their sexual orientation and/or the gender identity. This standard requires that:

  • Clinicians do not attempt to influence the alteration of, or endorse the external alteration of the sexual orientation and/or the gender identity or expression of clients, patients, students, supervisees, employees or colleagues, otherwise known as sexual orientation change efforts (SOCE).
  • Clinicians respect client autonomy with regard to gender variance, i.e. gender identification not limited to a male/female binary construct.
  • Clinicians respect client autonomy with regard to use of self-descriptive pronouns.
  • Clinicians respect client autonomy with regard to clothing and other forms of gender expression.
  • Clinicians respect client autonomy with regard to sexual and relational practices, including but not limited to monogamy, polyamory, kink, BDSM.

INFORMED CONSENT: The issue of informed consent is a key part of the code of ethics of various professional associations of psychotherapists, and those codes of ethics recognize that certain classes of clients/patients may be unable to freely provide such consent. An individual may feel pressured by potential rejection by peers, family and community to try to change his or her sexual orientation or fit others' norms of gender identity. While minors have been acknowledged by legal protections as especially vulnerable to such pressures, these factors are true for adults as well. Freely given "informed consent" is questionable when a client has both experienced and internalized social stigmatization and rejection. All Gaylesta psychotherapists should be attuned to how particular clients may be vulnerable to these concerns.

Furthermore, informed consent requires that the client be made aware of the efficacy and potential risks/harm vs. benefits of any given psychotherapeutic technique – as well as available alternative therapy options.

AVOIDING ABUSE OF POWER IN PSYCHOTHERAPY: In all professional codes of ethics, the special relationship of psychotherapist and client, the power of the clinician's role, and its potential for abuse are of critical concern. The vulnerability of LGBTQIQA clients to specific abuses by psychotherapists must be noted.

As noted above, the psychotherapist may impose or reinforce culturally-prevalent norms and moral beliefs about sexual orientation and/or gender variance upon clients. Special consideration must be given to not only the psychotherapist's personal beliefs, but to a potential to fail to explore any client psychotherapy goals which may be determined by familial, religious or other social pressures.

In that regard, psychotherapists must also be careful about the potential for reinforcing stigmatizing beliefs (as well as providing inappropriate therapy) by defining all presenting problems of the client as a consequence of their sexual orientation or gender identity.

In some cases, LGBTQIQA psychotherapy clients may be vulnerable to seeking the approval from a therapist that has not been available to them from other sources. Psychotherapists must be careful of any potentially exploitative behavior with clients in psychotherapy, especially with respect to sexual behavior and relationships.

Under no circumstances do psychotherapists engage in sexual activities or sexual contact with current clients, whether such contact is consensual or forced. Nor do therapists engage in such behavior with those whom they know to be current clients' relatives or other persons with whom clients maintain a close personal relationship. Therapy is never to be terminated with a client to circumvent this ethical rule. Due to the potential for sexual exploitation, there should be no sexual activity or sexual contact with former clients; nor with current supervisees, students, trainees, colleagues over whom the mental health professional holds professional authority, or other subordinates. Psychotherapists do not provide any therapy to those with whom they have ever had a prior sexual relationship.

CULTURAL COMPETENCE: Psychotherapists recognize that there are limits to their professional competence, and should operate within those boundaries. These recognizable limitations include those of cultural competence. As with any social/cultural group, therapists should make every effort to be culturally competent to work with their clients.

This requires an understanding that LGBTQIQA clients come from diverse and often intersecting backgrounds in terms of race/ethnicity, age, ability, body size, nationality, and class, where they may experience special stressors and may utilize special resources based upon their sexuality/gender nonconformity.

Understanding of this intersectionality necessitates (but is not limited to):

  • Knowledge of the potential social pressures -- including varieties and degrees of social discrimination -- that may be part of LGBTQIQA clients' histories and impact their sense of self. Psychotherapists should be aware of the ways in which such social pressures and forms of discrimination vary and are impacted by race/ethnicity, age, ability, body size, nationality and class – in both an additive and interactive fashion.
  • Awareness of the diversity of sexual histories that may be experienced by LGBTQIQA clients, and the need for careful exploration (rather than assumptions) regarding the meaning or impact of particular sexual experiences and relationships.
  • Awareness of some of the heightened vulnerability of LGBTQIQA persons to specific problems, and the special determinants that may heighten such vulnerability (e.g., drug abuse within certain sexual subcultures).
  • Recognition of the potential interpersonal dynamics created when families of LGBTQIQA persons become aware of their sexuality/gender nonconformity. Such dynamics may be influenced by nationality, race/ethnicity and religious beliefs.
  • Awareness of particular support resources that may be less accessible to certain subgroups of LGBTQIQA clients (e.g., families of origin for youth who are sexual minority and/or gender variant).
  • Awareness of special sources of strength or resilience potentially available to LGBTQIQA clients.
  • Awareness of and respect for the variations in healthy intimate relationships among LGBTQIQA persons.
  • Knowledge of available mental health, social, medical and other community resources (both from local organizations or services, and those accessed via other sources, such as the Internet) serving LGBTQIQA populations.
  • Understanding of the special circumstances and challenges that may be experienced by sexual minority and gender variant youth.

In all cases, it should be understood that "cultural competence" is an ongoing process that requires a commitment to continuing education about the issues faced by LGBTQIQA persons.

 NOTE:  This Code of Ethics is meant as a specific standard to be upheld by Gaylesta clinicians, but we also offer it as a resource to all those concerned with working with LGBTQIQA populations.