Ethics Values in Training of Students and the Provision of Clinical Services to LGBT Persons

In this article we discuss the rapidly changing cultural and professional landscape related to training of students and clinical services provided to lesbian, gay, bisexual, and transgender (LGBT) clients. The dramatic cultural shifts can be seen in the Supreme Court's decision to strike down the federal Defense of Marriage Act, the dismissal of an appeal of a federal district ruling regarding Proposition 8 in California, and the subsequent 5 4 ruling by the Supreme court in favor of gay marriage in June of 2015. In only a relatively few years, we have been witness to a sea change with respect to legal standing for gay couples and for associates rights in other related areas.Evangelicals remain very unlikely to favor changing laws to support same sex behavior, declining from 12% in 2003 to 5% (Barna Group, 2013) continue to support defining marriage as a commitment made between one man and one woman (which rose from 90% to 93% They continue to reject as morally unacceptable same sex marriage (Barna Group, 2013) Among the contexts in which conventionally religious mental health professionals may experience dissonance are the two areas of the training of students to work with LGBT persons in clinical practice and the provision of clinical services to LGBT persons.Psychology's Proactive Approach to Value Conflicts in TrainingThe last decade has seen an accelerated pattern of concern and attention among the mental health professions around value conflicts between trainees holding certain religious beliefs and some clients, including LGBT clients (Wise et al. 2015) In psychology, award winning papers have raised concerns about any "values based referrals" (Shiles, 2009) Hancock (2014) questions the "suitability for the profession" of trainees that cannot learn to work "competently and effectively" with clients with whom the trainee has value conflicts (p. 7) The current authors have also encountered professionals arguing that religious reservations to affirmative work with sexual minorities should be a counter indicator for admission to professional mental health training programs. The field of professional counseling has modified its ethics code to specifically proscribe values based referrals (ACA, 2014) Meanwhile, some states have passed, and others considered, legislation specifically requiring training programs in state institutions to defer to deeply or sincerely held beliefs of trainees that preclude their ability to work with a particular clinical presentation (Arizona H. B. 2565, 2011) Some of these legislative efforts (aka conscience clause legislation) have even been named after or supported by reference to high profile legal cases arising from adverse training outcomes for religiously conventional students in secular programs (Wise et al. 2015) By 2010, it appeared that the mental health professions and professionals or trainees of a conventional religious bent were heading to an insurmountable impasse.Yet some promising developments in this area have arisen. Notably, the APA Board of Education Affairs (2013, 2014) established a virtual working group (hereafter referred to as the BEA working group) to look at these issues and to provide guidance to various state associations and other interested parties. The group was formally charged with developing a statement on Restrictions Affecting Diversity Training in Graduate Education in response to conscience clause proposals. The BEA working group met for phone discussions on a variety of issues related to these topics for a few years and eventually developed a statement and some supporting materials. The group recognized that some rapprochement between multiple competing interests had to occur if a constructive path forward was to be found. The most frequent flashpoint for recent trainee value conflict and training arose from the tension between conventionally religious views of human sexuality and LGBT concerns. The group recognized that psychology's ethical ideals and a desire for an effective strategy required a respectful response to both religious liberty concerns and concerns about the welfare of sexual minorities.