A look at “Ethical considerations in LGBTQI+ clinical care” by Thomas G. Plante (2026)
Most therapists would describe themselves as LGBTQIA+ friendly. But being friendly and being ethical aren’t quite the same thing. This short American paper, by a psychologist and ethics specialist, walks through the core principles of the American Psychological Association’s ethics code and asks what each one means in practice with LGBTQIA+ clients. It uses brief, invented case examples to bring them to life.
What it argues
Informed consent. Clients should understand what they’re signing up for, including where the evidence for an approach is still developing. The author notes that some aspects of gender-affirming medical care for younger people are areas where the evidence is still being debated, which makes clear, honest consent especially important.
Avoiding harm. Practitioners must never use discredited approaches such as conversion practices, and must stay alert to how their own actions might cause distress.
Competence: “staying in one’s lane.” Well-meaning therapists can still fall short. In one example, a psychologist is warm and supportive about a client’s sexuality but knows nothing about his Vietnamese Catholic background. The result is awkward, alienating conversations, and a client who wonders whether to stay in therapy. The lesson is to notice the whole person, including the intersections of their identities, and to seek consultation or training when out of your depth.
Keeping advocacy and therapy separate. In another example, a psychologist deeply involved in LGBTQIA+ advocacy encourages teenage clients towards particular choices. One feels pressured and becomes more distressed. The point is that therapists, whatever their views, must never impose their personal or political agendas on clients. The client’s own pace and choices come first.
Respect and justice. Every client deserves dignity, privacy and self-determination, and fair access to good care.
A grain of glitter ✨
This is a clear, practical primer, and its reminder that therapists’ own views must stay out of the driving seat applies to everyone, whichever direction those views lean. But it’s a commentary based on an American ethics code rather than research, and its case examples are invented illustrations, not real data.
Some readers may feel that its framing of gender-affirming care as “polarizing”, and its example of an over-zealous affirming therapist, gives more weight to one kind of risk than others. The paper doesn’t offer an equivalent example of harm caused by a therapist who is dismissive or hostile towards a client’s identity, which research suggests is far from rare (see “‘They Must Be Sick’: How Therapists See Non-Monogamous Clients” and “Mostly Good News (With Some Glitches): Queer Clients’ Experiences of Therapy”). Equally, others will welcome its call for caution. It’s a short paper, so it offers principles rather than detailed guidance.
Why this matters
If you’re LGBTQIA+ and seeking therapy, you’re entitled to a therapist who respects your autonomy, understands the different parts of who you are, is honest about what the evidence does and doesn’t say, and never pushes you in a direction that isn’t yours. A good therapist is curious about your identity. They don’t take charge of it.
Every unicorn gallops at its own pace. A good therapist runs alongside; they don’t hold the reins.