Moral Development, Counseling Self-Efficacy, and Counselors-In-Training Sexual Orientation Counseling Competencies
By
Melissa Gaa, MA
A Dissertation
In
COUNSELOR EDUCATION
Submitted to the Graduate Faculty of the Texas Tech University in Partial Fulfillment of the Requirements for the Degree of
DOCTOR OF PHILOSOPHY
Approved
Dr. Bret Hendricks Chair of Committee
Dr. Janet Froeschle
Dr. Amanda Williams
Dr. Mark Sheridan Dean of the Graduate School
December 2014
Copyright, 2014 Melissa Gaa
Texas Tech University, Melissa Gaa, December 2014
Acknowledgements
First, I would like to thank my family for your continued support throughout the years. Steve, I could not have done this without your consistent support during graduate school. Thank you for listening to me continuously discuss this topic and for being an ally and advocate to the lesbian, gay, bisexual and transgender (LGBT) community.
Thank you for your willingness to always help and listen when I needed you. I know how lucky I am to have a you as a life partner, and I can't imagine this journey without you.
To my daughters, Aspen and Emerson, may you always follow your dreams and let nothing stand in your way. I thank you for putting up with me working more than I should, understanding the importance of an education, and realizing the need to help others. To my parents, thank you for your never-ending support and belief in me. Your encouragement has been truly helpful in getting me to this point. To my brother, thank you for being the best big brother a girl could ask for. You are my inspiration for this dissertation and I will continue to advocate for the LGBT community as long as I am around. Thank you for your support over the years and many heated discussions on how we can change the world through advocating. You truly are an amazing person.
I thank each of my committee members, Dr. Bret Hendricks, Dr. Janet Froeschle, and Dr. Amanda Williams. Thank you for your willingness to serve on my committee, and your support and guidance. Dr. Hendricks, for all the time you have spent with me discussing this topic and dealing with my anxiety. Thank you for mentoring me through the counseling program and as a Graduate Assistant. Your pep talks and support have helped get me to this point, I am truly grateful for you. Dr. Froeschle, your support has proven invaluable to me. Thank you for the many meetings and email exchanges with me to keep me on track and focused. You are truly an inspiration and I am comforted in
ii
Texas Tech University, Melissa Gaa, December 2014 knowing you are always supportive of my endeavors. Dr. Williams, thank you for your quantitative research guidance. Your assistance proved invaluable to me. Without your help, this process would have taken longer for me to complete. You have been amazingly supportive and your guidance is beyond doubt appreciated.
Thank you to all the professors and fellow graduate students that helped me get the survey out for completion of this dissertation. Without your help, I would not be at this point. I also want to thank members of my cohort that have helped me through the past three years with the tremendous amount of support you offered. Lynn Jennings and
Nefertiti Beck, for the tireless hours you spent talking with me about being in a doctoral program, my dissertation and life in general. Nicole Noble, your help was so valuable to me through the dissertation process, and I want you to know how much I appreciate you.
The support I received from each of you has helped me get to this point, and I thank you.
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Texas Tech University, Melissa Gaa, December 2014
Table of Contents
ACKNOWLEDGEMENTS...... ii
ABSTRACT...... vii
CHAPTER I: INTRODUCTION...... 1
Background of the Study...... 1
Statement of the Problem...... 5
Purpose of the Study...... 6
Hypotheses...... 8
Theoretical Framework...... 9
Delimitations...... 10
Limitations...... 10
Assumptions...... 10
Definition of Key Terms...... 11
CHAPTER II: REVIEW OF THE LITERATURE...... 14
Introduction...... 14
Moral Development-Kohlberg...... 15
Moral Development-Graduate Students...... 17
Multicultural Competence & Training...... 19
Affirmative Counseling...... 23
Social Cognitive Theory...... 25
Self-Efficacy...... 26
Professional Counseling Organizations...... 28
Ethics...... 29
ACA Code of Ethics 2014...... 31
iv Texas Tech University, Melissa Gaa, December 2014
CHAPTER III: RESEARCH METHODOLOGY...... 35
Overview...... 35
Hypotheses...... 36
Participants...... 37
Instruments...... 38
Demographic Survey...... 38
Lesbian, Gay and Bisexual Affirmative Counseling Self-Efficacy (LGB-CSI)....38
Defining Issues Test (DIT-2)...... 40
Sexual Orientation Counselor Competency Scale (SOCCS)...... 41
Procedure...... 42
Data Analysis...... 43
CHAPTER IV: RESULTS...... 45
Introduction...... 45
Analysis of Data...... 45
Data Preparation...... 45
Descriptive Statistics...... 47
Analysis and Results...... 50
Hypothesis 1...... 55
Hypothesis 2...... 57
Hypothesis 3...... 59
Summary...... 60
CHAPTER V: DISCUSSION...... 62
Introduction...... 62
Summary...... 62
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Texas Tech University, Melissa Gaa, December 2014
Moral Development and Multicultural Competencies...... 63
Self-Efficacy and Multicultural Competencies...... 64
Moral Development and Self-Efficacy...... 66
Coursework and Training...... 67
Limitations...... 70
Implications for Practice...... 71
Recommendations for Future Research...... 74
REFERENCES...... 76
APPENDIX A
EMAIL SCRIPT ASKING FOR PARTICIPATION IN THE STUDY...... 83
APPENDIX B
DEMOGRAPHICAL INFORMATION FORM...... 84
APPENDIX C
LESBIAN, GAY & BISEXUAL AFFIRMATIVE COUNSELING SELF-EFFICACY INVENTORY (LGB-CSI)...... 86
APPENDIX D SEXUAL ORIENTATION COUNSELING COMPETENCIES SCALE...... 90
APPENDIX E
DEFINING ISSUES TEST - 2...... 96
vi Texas Tech University, Melissa Gaa, December 2014
Abstract
The current quantitative study examined aspect of counseling students' knowledge of working with lesbian, gay and bisexual (LGB) clients from training in both graduate coursework and professional development opportunities. It also examined the moral reasoning abilities and LGB counseling self-efficacy of students with any possible affects on their ability to become culturally competent counselors. The purpose of this study was to fill a void in the literature by exploring moral development and affirmative therapy of graduate counseling students and possible association of their perceived competencies when working with gay, lesbian, and bisexual clients. Participants included
78 counseling graduate students located throughout the United States. Multiple regression tests were run to examine perceived sexual orientation counseling competency with self- efficacy and moral development. The results of this study suggests higher levels of self- efficacy and development of moral reasoning lead to higher levels of perceived competency, as well as higher development of moral reasoning leads to higher self- efficacy. The study also suggest participation in one or more professional development sessions, self-efficacy increases, however participation in counseling multicultural courses is unrelated to self-efficacy.
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Texas Tech University, Melissa Gaa, December 2014
Chapter I
Introduction
Gates (2012) estimates approximately twelve million people, in the United States, identify themselves as lesbian, gay, or bisexual, (LGB). This number has increased by a million people since 2011. It is also important to consider these numbers do not include individuals who are questioning their sexuality nor individuals that do not openly identify as lesbian, gay or bisexual. With the increasing number of individuals identifying as members of the LGB community, the likelihood of having an LGB client increases as well. Knowledge of working with this community and ethical implications are essential to prevent harm to clients. It is vital that counselors in training and professional counselors have competency needed to work with this population.
Background of the Study
Typically lesbian, gay, and bisexual(LGB) are combined with transgender issues.
The literature indicates transgender individuals do share some similarities with LGB individuals, however, transgender concerns are often different than LGB issues (Bidell,
2005; Carroll & Gilroy, 2002, Mostade, 2006, O'Hara, Dispenza, Brack, & Blood, 2013).
Transgender issues deal more with gender orientation whereas lesbian, gay, and bisexual issues refer to sexual orientation. O'Hara, et al. (2013) suggest gender identity and sexual identity is commonly mistaken within helping communities because of the difference in gender identity and sexual identity. Since previous research supports separation of the two, this study will only focus on issues pertaining to the lesbian, gay and bisexual population.
Graduate counseling departments normally offer multicultural/diversity classes with a focus on multiculturalism and exploring students' own biases. More specifically,
1 Texas Tech University, Melissa Gaa, December 2014 counseling students learn to differentiate their own cultural differences and biases from clients, and how to provide adequate therapy to all populations. Furthermore, professional associations generally provide continuing education courses to enhance learning in working with specific populations. Although it can be easily assumed counselors are trained to work with many different clients, there is still disparity in competency and willingness of counselors in working with lesbian, gay, and bisexual clients.
Cultural relativism is a foundation for becoming a culturally competent counselor
(Mcauliffe, Grothaus, Jensen, & Michel, 2011). Culture is defined by Merriam-Webster
Dictionary as "the beliefs, customs, arts, etc., of a particular society, group, place, or time". Relativism is defined as describing "one's emphasis on moral rules and principles when making decisions about right and wrong" (Forsyth, O'Boyle, Jr., & McDaniel,
2008). Therefore, cultural relativism is the view that beliefs, ethics, and ideologies are relative to the individuals own social context. In other words, "right" and "wrong" are relative to the individuals cultural context. What may be viewed as morally "right" in one culture may be viewed as being "wrong" by another.
Moral development has been previously examined in studies of counseling students competencies and skills (Bidell, 2005, Eriksen & McAuiliffe, 2006). However, to date no previous study in counselor education has examined moral development in relation to lesbian, gay, and bisexual counseling competency and skills. Moral development has also been linked in previous studies to empathy (Eriksen & McAuilliffe,
2006) as well a positive association between more formal education with higher moral development (Izzo, 2000; Marnbug, 2001; Nather, 2013). According to previous
2 Texas Tech University, Melissa Gaa, December 2014 findings, a graduate student with more education should display more empathy and higher moral development in general.
Ethics and ethical codes are fundamental to the counseling profession and intertwine with individuals' moral belief systems. Professional organizations, such as the
American Counseling Association (ACA), have ethical standards set in place as a guide for counselors to adhere to when providing therapy. The ACA 2005 Code of Ethics specifically addresses topics of discrimination and prejudice against clients due to their sexual orientation (C.5). State licensing boards also have ethical codes in which practicing counselors are to abide. Counselors should know the state laws and standards and utilize them for ethical dilemmas that may arise. It is unacceptable for a counselor to claim they are unfamiliar with such standards if an ethical dilemma is presented.
With increased awareness of ethical standards and training for working with LGB clients, counselors may provide more adequate therapy. Knowledge of discriminatory language, for purposes of avoiding harm, is also helpful when working with these clients.
Counselors should approach working with LGB clients with the following in mind:
Acknowledgement of societal prejudice and discrimination and ability to
assist client/s to overcome internalized negative attitudes towards them.
Recognize their own personal beliefs and discriminations about this
population.
Familiarize themselves with the professional standards and state laws in
order to avoid ethical dilemmas when working with the LGB population.
Engage in professional development offered through organizations to have
a better understanding of helping the LGB community.
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Recognize the importance of educating students, supervisees, and other
professionals about LGB issues and working with them.
Recognize the client/s sexual orientation may not be related to their
presenting problems.
With proper training for students, through both graduate coursework and professional development, improved therapy can be provided for the LGB community.
The lack of training and discussion on this topic leads to less knowledgeable counselors, perpetuating more stereotypical ideas of LGB people, and possibly more ethical dilemmas. Most organizations provide information and presentations for working with
LGB clients at their conferences or on websites.
Lesbian, gay and bisexual affirmative therapy is relatively new in the counseling literature. Although some studies have examined LGB affirmative counseling, many of these are found in the field of psychology and marriage and family therapy. After a literature search on EBSCO, affirmative counseling research is practically non-existent in the counselor education literature. Previous studies infer a positive relationship between
LGB affirmative therapy and counseling skills and suggested a need exists for competency of LGB affirmative therapy for counselors-in-training (O'Shaughnessy &
Spokane, 2014).
More information, including techniques, is needed in graduate counseling programs if students are to successfully work with LGB clients. Graduate programs for counselors should provide sufficient information on counseling LGB clients. Many students dismiss the idea of working with this population and with sufficient discussions in classrooms, and among colleagues, students may have a more positive attitude about
4 Texas Tech University, Melissa Gaa, December 2014 working with lesbian, gay, and bisexual clients. Students should be trained in all facets of counseling when leaving their program so they are prepared to provide the highest quality care for their clients.
Statement of the Problem
Americans’ attitudes towards lesbians and gay men have become more positive over the past 30 years (Shackelford & Besser, 2007). Although attitudes have become more accepting, intolerance of the LGB community is still present among Americans. It is vital for counselors-in-training to understand their own attitudes and possible biases when working with LGB clients. It is also important to counselors-in-training to understand the societal issues LGB clients deal with on a daily basis. This knowledge allows for counselors to provide better quality therapy for their clients.
The extant literature contains limited discussions on competency of counseling graduate students when working with the LGB community. Most studies on competency of counselors in this area utilized quantitative methods to gain perspective about knowledge of working with LGB clients. Eliason and Hughes (2004) found 351 counselors in Illinois lacked general knowledge about domestic partnership, and concepts of internalized homophobia. Findings such as these are important for the profession to recognize a lack of skills may be harmful to clients and that counselor's attitudes about the LGB community may influence their ability to help.
Prejudice and biases experienced by the LGB community are different than other marginalized populations, therefore requiring specific competency about LGB clients
(Bidell, 2005, O'Hara et al., 2013). Graduate students should have the opportunity to address the needs and counseling techniques in the classroom and professional
5 Texas Tech University, Melissa Gaa, December 2014 development should bring awareness to working with LGB clients. Understanding of graduate students' moral development level and lesbian, gay and bisexual affirmative counseling competency can also help in preparing coursework and discussion on working with the LGB population. Lack of knowledge creates situations that can be harmful to clients. What counselors say and do in sessions can be crucial to the well-being of an
LGB client.
The LGB population faces challenges within society such as homophobia and heterosexist ideology. In 2010, there were 8,208 victims of hate crime in the United
States and of those 8,208 (19.3% ) victims were targeted due to sexual-orientation (Cobb,
2011). Many LGB clients are living with fear of hate crimes, derogatory comments, and constant discrimination. It is imperative for a counselor to have knowledge of the unique cultural circumstances of this group. These clients are also discriminated against in state and federal laws. With a majority of laws perpetuating heterosexist ideology, same-sex couples are not legally allowed to marry. This sort of discrimination continues to have a negative impact on the LGB community and may leave a client questioning their lifestyle. There are many underlying issues that counselors need to be aware of when a lesbian, gay, or bisexual, client enters their office.
Purpose of Study
The majority of previous studies examining counseling students working with lesbian, gay, and bisexual clients focus on competency levels, counseling interventions, and social justice (Brooks & Inman, 2013; Cannon, et al., 2012; Walker & Prince, 2010;
Boysen & Vogel, 2008; Bidell, 2005). After completing a university, online, EBSCO, search, no studies to date have explored the relationship between counselor-in-training
6 Texas Tech University, Melissa Gaa, December 2014 moral development, sexual orientation competency, and LGB affirmative therapy competency.
The purpose of this study is to fill a void in the literature by exploring moral development and affirmative therapy of graduate counseling students and possible association of their competencies when working with gay, lesbian, and bisexual (LGB) clients. More specifically, this study aims to identify if moral development and affirmative therapy are associated with sexual orientation counseling competencies of graduate counseling students. Moral development has been associated with empathy
(Eriksen & McAuliffe, 2006) therefore, this study will explore if indeed higher moral development and education plays any role in counseling competencies when working with LGB clients. Lesbian, gay and bisexual affirmative therapy will also be examined with self-efficacy and LGB counseling competencies.
This study will investigate aspects of student's knowledge from training in both graduate coursework and professional development opportunities. It will also examine moral development and lesbian, gay and bisexual affirmative counseling self-efficacy of students and how this affects their ability to become a culturally competent counselor.
This study will add to the literature concerning counseling students sexual orientation counseling competencies.
The results of this study are important to other counselor education programs in that it will identify if and how students' moral development and LGB affirmative counseling self-efficacy is associated with sexual orientation competencies as well as where training lacks in the area of teaching about working with LGB clients.
Hypotheses
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Ha1: Lesbian, gay and bisexual affirmative counseling self-efficacy and moral
development, individually and interactively, will be significant predictors of
graduate counseling students’ perceived competencies of working with lesbian, gay,
and bisexual clients.
Ho1: Lesbian, gay and bisexual affirmative counseling self-efficacy and moral
development, individually and interactively, will not be significant predictors of
graduate counseling students’ perceived competencies of working with lesbian, gay,
and bisexual clients.
Ha2: Graduate students’ moral development will be a significant predictor of lesbian,
gay and bisexual affirmative counseling self-efficacy.
Ho2: Graduate students’ moral development will not be a significant predictor of lesbian,
gay and bisexual affirmative counseling self-efficacy.
Ha3: Counseling students’ participation in one or more professional development
sessions, and/or counseling multicultural courses, will have no effect on LGB
affirmative counseling self-efficacy.
Ho3: Counseling students’ participation in one or more professional development
sessions, and/or counseling multicultural courses, will have no effect on LGB
affirmative counseling self-efficacy.
Theoretical Framework
This study will utilize Social Cognitive Theory (Bandura, 1986) as the theoretical research lens to examine counselors-in-training's moral development level, LGB affirmative counseling self-efficacy, and sexual orientation counselor competencies.
8 Texas Tech University, Melissa Gaa, December 2014
Social Cognitive Theory is a framework for examining human motivation, thought and action (Bandura, 1986). Bandura suggests behavior is learned; humans learn certain behaviors through their culture, society, school, friends, etc. An individual's moral development and self-efficacy is part of this learning process. "Social learning" is emphasized on cognitions, emotions, and contexts external to the individual (Boss,
Doherty, LaRossa, Schumm, & Steinmetz, 1993).
Some major tenets of Social Cognitive Theory are: the capability of vicarious learning, capability of self-regulation, and capability of self-reflection (Boss, et al, 1993).
Bandura suggests these capabilities to deal with various situations are referred to as self- efficacy. Social Cognitive Theory posits that individuals contextual factors influence learning experiences, which are referred to as self-efficacy. Self-efficacy may influence students' abilities to perform certain tasks. A counselor-in-training's self-efficacy may hinder working with lesbian, gay and bisexual clients. Furthermore, individuals beliefs' about certain situations or groups of people may also influence their knowledge and self- efficacy for working with others. Some individuals may have learned negative stereotypes about the LGB community before entering a counseling program. These negative prior beliefs may influence competencies and abilities of working with lesbian, gay and bisexual clients.
Delimitations
This study specifically recruited participants from Council for Accreditation of
Counseling & Related Educational Programs (CACREP) accredited programs for the purposes of homogeneity. Furthermore, CACREP requires students in these programs to
9 Texas Tech University, Melissa Gaa, December 2014 take a diversity or multicultural course and this study examined if there was any affect on competency levels after taking a diversity or multicultural course.
Limitations
The purpose of this study was to examine the development of moral reasoning,
LGB affirmative counseling self-efficacy, and sexual orientation counseling competencies of working with lesbian, gay, and bisexual clients. Participants were from
CACREP accredited graduate counseling programs in the United States, and more specifically the majority of participants were from the state of Texas (67%). Therefore, the current study was only generalizable to graduate students in this area. The results of this study cannot be applied to all graduate student across the United States, unless each state is represented. This study was based on counselors-in-trainings' self-report instruments. Thus, participants may present themselves in a more favorable manner once they are informed of the purpose of this study.
Assumptions
Research has shown a connection between multicultural coursework and competency levels (Bidell, 2012; Brooks & Inman, 2013; Dillon & Worthington, 2013;
Dillon et al., 2008; Evans & Foster, 2007; Erikson & MCAuliffe, 2006). Studies have also shown a relationship between lesbian, gay and bisexual affirmative counseling self- efficacy to competency skills (Carlson, McGeorge, & Toomey, 2013; Dillon &
Worthington, 2003; O'Shaughnessy & Spokane, 2013). This study, therefore, assumed a significant relationship between students' moral development level, LGB affirmative counseling self-efficacy and sexual orientation competencies. Second, it was assumed
10 Texas Tech University, Melissa Gaa, December 2014 that all participants in this study will be honest in their responses. It was also assumed that all participants understood the content of the questions.
Definition of Key Terms
For the purpose of this study, the following definitions are offered:
Ally: A person or group that associates with one another for a common cause or
purpose.
Bias: Prejudice, either positive or negative; against something or a person.
Bisexual: Romantic or sexual attraction to both genders, male and female.
Competency: Ability or skill to do something successfully or efficiently.
Counselor-in-training: An individual that is enrolled in a counselor education
graduate program.
Culture: Beliefs, customs, ideologies, etc., of a particular society, group, place, or
time.
Cultural Relativism: The view that no culture is superior to any other culture
when comparing systems of morality, law, etc.
Development: Significant change.
Ethics: Acceptable or good practice according to agreed-upon rules or standards
of practice, conduct or actions in relation to others established by a profession
(Cottone & Tarvydas, 2007).
Gay: Romantic or sexual attraction between two men.
Gender: Reflection of an individual's identity and expression through clothing,
behavior, and choice (Harper, et al., 2012). Gender can include androgynous,
11 Texas Tech University, Melissa Gaa, December 2014
transgender, genderqueer, gender nonconforming, male, female, and so on. It does
not necessarily match that of their sex.
Heterosexual: A term used to describe an individual who is emotionally,
physically, mentally, and/or spiritually attracted to someone of the opposite sex
(Harper, et al., 2012).
Homosexual: A term used historically to describe an individual who is
emotionally, physically, mentally, and/or spiritually attracted to someone of the
same sex (Harper, et al., 2012).
Graduate Counseling Student: An individual enrolled in a graduate counseling
program.
Intersex: An individual displaying sexual characteristics of both male and female.
Lesbian: Romantic or sexual attraction between two women.
LGB Affirmative Counseling: Therapeutic approach recognizing each lesbian, gay
and bisexual well-being and creating a supportive environment for acceptance and
growth.
Moral: Concerned with principles of "right" and "wrong" behavior.
Moral Development: Change and understanding of morality. Kohlberg (1969)
explains moral development as stages an individual falls within based on moral
reasoning.
Moral Reasoning: The process of determining right and wrong.
Queer: Individuals who identify outside the heteronormative imperative and/or
the gender binary. Queer may also connote political identity as one committed to
advocacy/activism for sexual minority rights (Harper, et al., 2012).
12 Texas Tech University, Melissa Gaa, December 2014
Questioning: Individuals unsure of their emotional, physical, mental, and/or
spiritual attraction to men or women.
Relativism: Concept that different things are true or right for different people.
Self-Efficacy: Individuals belief of own ability to complete a task and/or reach
goals.
Sex: What an individual is assigned at birth such as female, male, or intersex. A
word that is used by society to denote a person's sexual anatomy.
Sexual Orientation: Refers to an individual's emotional, romantic, and sexual
attraction to others.
Transgender: An individual's gender identity. Self-identification as a man or
woman not matching their assigned sex at birth.
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Chapter II
Review of the Literature
Introduction
The literature reviewed for this study included moral development, professional ethics, multicultural competence and training in counselor education programs, lesbian, gay and bisexual (LGB) affirmative counseling, social cognitive theory and self-efficacy.
Moral development of counselors-in-training is important to understand because there is a relationship between a students' ability to learn counseling skills and their counseling skills performance (Eriksen & McAuliffe, 2006). This study has two sections on moral development, one explaining Kohlberg's stages, and two, providing literature on previous studies conducted about moral development and graduate students. Ethics has also been examined among counselors-in-training and their ability to perform certain therapeutic tasks. Moral development and ethics provide an understanding of counselors-in-training's beliefs and possible willingness to work with certain populations.
Affirmative counseling has been examined in other fields such as counseling psychology and marriage and family therapy; however, this topic is non-existent in counselor education. Previous studies found possible relationships between LGB affirmative counseling and counselors-in-training competencies. Multicultural training is vital to the field of counselor education; therefore, it was covered in this study. Most graduate counseling programs offer coursework on multicultural topics and professional counseling organizations offer multicultural trainings. This type coursework and training is imperative for counselors-in-training to help further their education on populations
14 Texas Tech University, Melissa Gaa, December 2014 they may have little knowledge. Overall, these topics tie in together to help explain possible competencies of counselors-in-training.
Moral Development - Kohlberg
The majority of literature on moral development largely focuses on Piaget and
Kohlberg's (Kohlberg, 1976) theories. Moral development is approached by Piaget and
Kohlberg from a cognitive perspective (Cam, Seydoogullari, Cavadar, & Cok, 2012).
Piaget centered his moral development research on children by studying them through play, in order to learn more about their beliefs about right and wrong. Kohlberg (1969) modified Piaget's moral development stages creating a more complex way to understand moral reasoning through three levels and six stages.
Kohlberg's Moral Development consists of three levels, preconventional, conventional, and postconventional, and six stages with two stages at each level.
Kohlberg believed individuals progressed through the stages while some may never reach the final stage. Kohlberg's stages consist of development in both moral and intellectual domains (Eriksen, McAuliffe, 2006). These stages examine thinking that relies on external consequences for moral action and internally principled thinking.
During the first level, Preconventional, individuals follow society's rules believing in the rewards and punishment concept. Within the first level are two stages: Stage 1, punishment and obedience orientation, and Stage 2, individualism and exchange. While
Stage 1 is thought of mostly as a developmental stage for children, some adults are also capable of expressing this reasoning. At this stage, individuals see rules as fixed and absolute; whether an action is good or bad, it will result in punishment or reward. Stage
2, individualism and exchange, is when one accounts for individual needs. Reciprocity is
15 Texas Tech University, Melissa Gaa, December 2014 a factor in this stage with the best course of action being the best that will serve one's individual needs.
The second level, Conventional, is the stage at which individuals consider social order while conforming to societal expectations. There are two stages in this level: Stage
3, interpersonal relationships, and Stage 4, maintaining social order. Stage 3 is often referred to as "good boy-good girl" orientation with an emphasis on being "nice".
Individuals in this stage believe actions are for pleasing or helping others. Individuals might consider how choices influence relationships in this phase. At Stage 4, individuals shows respect for authority and maintain the law by following rules. Individuals believe in respecting authority.
During the third level, Postconventional Morality, individual's begin to identify universal moral values regardless of what group subscribes to those values. At this level an individual's judgment is based on self-chosen principles and moral reasoning based on individual rights. The two stages in this level are: Stage 5, social contract and individual rights, and Stage 6, universal ethical principles. At Stage 5, individuals recognize differing values, opinions and beliefs of others. Moral behavior, in this stage, is defined by general individual rights. Laws are still important for maintaining society, but these standards should be agreed upon by society. At Stage 6, individuals have developed their own moral guidelines regardless of what others believe. Individuals in this stage will believe in human rights, justice and equality and are prepared to advocate and/or defend these principles even if it goes against societal acceptance. Kohlberg believed that only few people would reach this stage.
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Gilligan (1982) argued Kohlberg's moral development did not consider gender differences. Kohlberg's model centers on rights and rules whereas Gilligan suggested compassion and care should be considered. Gilligan argued women are typically more compassionate and caring while men are more invested in rules. Therefore, Gilligan claimed Kohlberg's moral development was biased against women (Evans & Foster,
2000).
Moral Development - Graduate Students
Moral development offers insights into students' logic and ability to work with different populations. Current literature on moral development and counselors-in-training support the need for recognizing disparity in willingness to work with diverse populations. With further understanding of graduate counseling students' moral development level, graduate programs may better adapt their coursework to provide adequate information for working with lesbian, gay and bisexual clients.
In a previous study examining master level student's counseling skills and moral development, Eriksen & McAuliffe (2006) found a relationship between a students' ability to learn counseling skills and their counseling skills performance by examining the students' moral development. This study examined 119 graduate counseling students' development level and their ability to learn counseling skills. One finding concluded that although participants recognized multiple truths, they were not able to weigh the perspectives. This study also suggested the DIT instrument produces a higher percentage of students' ability to learn counseling skills than other admissions criteria.
Moral development is considered an aspect of socialization. (Thomas, 2005).
Some argue that people are not born with morals, rather they are learned. Children learn
17 Texas Tech University, Melissa Gaa, December 2014 to conform to beliefs and ideologies from their caregivers, culture, and community.
Moral values are standards accepted by individuals as correct. Some carry these beliefs throughout adulthood while others vary in changing their beliefs and ideas. Graduate school is a place where many may begin to question and change their beliefs and ideas.
Counseling programs may provide the opportunities necessary for allowing their students to further their knowledge on the lesbian, gay and bisexual population.
Moral reasoning focuses on what is right or obligatory in certain situations (Sias,
Lambie, & Foster, 2006). Moral reasoning is based more on weighing values than facts and influences decisions made on specific dilemmas. While moral concerns focus on fairness and justice, some individuals may have higher moral reasoning skills than others.
When counselors are working with clients, moral development may affect the therapeutic process.
Evans and Foster (2000) suggest reasoning and behavior are directly related to psychological functioning. A major tenet of cognitive development is the understanding that reasoning and behavior are related. People with lower cognitive complexity are more inclined to exhibit rigid and less adaptive behavior in problem-solving. Individuals with higher levels of cognitive development tend to exhibit more adaptive behaviors. This information can be helpful to graduate counseling programs when working with graduate students. Knowing where a student is on their cognitive level may provide professors the information necessary for presenting material on lesbian, gay and bisexual issues.
Previous studies examining moral development in college students suggest higher levels of education have a positive relationship with higher levels of moral reasoning
(Rest & Narveaz, 1994; Rest, Narveaz, Bebeau, & Thoma, 1999). In other words, moral
18 Texas Tech University, Melissa Gaa, December 2014 reasoning usually increases while an individual continues formal education (Sias,
Lambie, & Foster, 2006). Although, biased attitudes may influence treatment of diverse clients (Boysen & Vogel, 2008), previous studies indicate graduate students might have a higher level of moral reasoning; therefore, providing a more fair and justice therapeutic process.
Moral development has been associated with ethical behavior in counseling as well as in other professions including medicine and teaching (Rest et al., 1999).
Individuals with higher levels of moral development typically display higher levels of moral action than do individuals with lower levels of moral development. Graduate students displaying lower levels of moral development may require more training.
Working with lesbian, gay and bisexual clients may be more difficult for some counseling students; these students may be working on lower levels of moral development.
Multicultural Competence & Training
Multicultural competencies are defined as awareness, knowledge, and skills
(Brooks & Inman, 2013). Counselors in training are typically expected to self-reflect in order to help understand their own biases which will enhance the counselor-client relationship. Most graduate counseling programs require students to take a diversity class that focuses on multicultural issues. These classes help students develop their skills and knowledge of working with clients from different cultural backgrounds. Fuertes et al.,
(2006) suggested multicultural competence is significantly related to client satisfaction and client ratings of general counseling competency.
19 Texas Tech University, Melissa Gaa, December 2014
A plethora of research has focused on multicultural competencies of counseling graduate students. Many consider ethnicity, gender, age, self-efficacy, and experience in relation to multicultural counseling competencies (Dillon & Worthington, 2013; Dillon,
Worthington, Soth-McNett, & Schwartz, 2008; Evans & Foster, 2007; Erikson &
MCAuliffe, 2006). Previous studies have found a relationship between multicultural learning in the classroom to counseling competency skills in sessions. However, few studies have focused on competencies when working with lesbian, gay, and bisexual clients specifically.
Bidell (2012) examined multicultural and sexual orientation competencies of school counselors compared to community agency counselors. The results claimed participants in this study reported that school counselors have less multicultural and sexual orientation counselor competencies than the community agency counselors. Dillon et al., (2008) explored relationships between demographic variables such as gender, age, and sexual orientation to LGB self-efficacy. The study found higher LGB self-efficacy to be associated with gender self-definition, sexual identity commitment, and sexual orientation of the participant. These authors suggest homophobia at the micro and macro level may hinder heterosexual psychotherapists from obtaining sources of LGB self- efficacy.
Brooks and Inman (2013) examined if clinician empathy and attitudes played a role in multicultural competencies, specifically working with bisexual clients. Empathy did not show a significant predictor of bisexual counseling competency. However, the research revealed the clinician's attitudes about bisexuality contributed to bisexual counseling competency. Two types of attitudes about bisexuality were labeled, stable and
20 Texas Tech University, Melissa Gaa, December 2014 transitional. Some believed bisexual orientation to be stable, meaning it was constant while others believed it to be transitional, meaning bisexual individuals were more lucid in their identity. Brooks & Inman (2013) found that the clinicians with stable attitudes were better able to integrate conceptualization for this population.
Grove (2006) conducted a mixed-methods study to examine graduate counseling students' competencies when working with LGB clients. The qualitative results found students' attitudes about the LGB community changed once they had experience and more knowledge of the population. In other words, if a student met someone who identified as lesbian, gay, or bisexual, they learned the stereotypes were not true and had a better understanding about this population. The author also concluded that the competency skills rose in the first year of training among the graduate student participants.
Mallott (2010) suggests that a single multicultural counseling course positively affects multicultural competencies. If students are provided with information on working with lesbian, gay and bisexual clients, they may become more competent in working with this population. The more LGB issues are discussed in coursework, the more likely counselors-in-training will be prepared to work with these clients.
Lack of knowledge for working with LGBT client(s) may cause counselors in training and professional counselors to approach this issue with trepidation. Janson and
Steigerwald (2002) suggest educators and supervisors adequately address sexual orientation and professional ethics when training counselors in both university and agency settings. Dillon et al., 2008) posit training can better prepare therapists when working with LGB clients. More knowledge and discussion in classrooms on this
21 Texas Tech University, Melissa Gaa, December 2014 population may account for less hesitation by counselors to work with lesbian, gay, and bisexual clients.
The Council for Accreditation of Counseling and Related Educational Programs
(CACREP) has eight core curriculum areas with one specifically addressing social and cultural diversity. Some programs offer multicultural courses that specifically discuss cultural differences, however, many other courses address working with diverse clients within the coursework. It is important to note, not all counseling graduate programs are
CACREP accredited. Therefore, diversity might be presented in a different format.
Janson (2002) provides examples of how inadequate training in working with
LGB individuals and families can hinder the therapist-client relationship. In the example, a therapist provides counseling services for a family with a teenage son. The therapist also has individual counseling sessions with the son. In the sixth session with the son, the young man informs the therapist he is gay. Because of the lack of training in LGB issues, the therapist faces many ethical dilemmas. Janson (2002) suggest the therapist, like many therapist, may focus on the clients sexual orientation as the root of his problem and may oversee other issues in the young man's life that may be contributing factors to his depression. With the proper training, these issues could be avoided when working with
LGB individuals and families.
Bidell (2005) developed the Sexual Orientation Counselor Competency Scale
(SOCCS) to measure attitudes, skills, and knowledge of counselors working with lesbian, gay, and bisexual individuals. The SOCCS has been utilized in several previous studies examining counseling students competencies when working with lesbian, gay and bisexual clients (Bidell, 2013; Bidell, 2007; Graham, Carney, & Kluck, 2012; Rutter,
22 Texas Tech University, Melissa Gaa, December 2014
Estrada, Ferguson, Diggs, & Gregory, 2008). Bidell (2005) suggests counselors' attitudes, knowledge and skill competency is vital to providing ethical, affirmative and competent therapy to LGB clients.
Multicultural training is imperative to counseling programs. Counselors-in- training must learn to work with individuals who differ from them culturally, religiously, and ethnically. Although multicultural coursework is required by CACREP, not all counseling programs are accredited. Students may have the opportunity, outside of academia, to develop necessary skills for working with diverse populations through professional development offerings. ACA as well as state and local counseling associations continuously offer continuing education sessions for working with diverse populations, more specifically working with lesbian, gay and bisexual clients.
Affirmative Counseling
Affirmative counseling encourages clients' acceptance of themselves while attempting not to change clients. LGB affirmative counseling has been defined as
"therapy that celebrates and advocates the authenticity and integrity of lesbian, gay, and bisexual persons and their relationships" (Bieschke, McClanahan, Tozer, Grzegorek, &
Park, 2000). The majority of the literature on affirmative counseling and training is found within journals directed towards psychologist and licensed marriage and family therapists. The literature examining affirmative lesbian, gay, and bisexual counseling is almost non-existent in counselor education journals.
Perez (2007) suggest there are three core conditions for affirmative therapy: 1) therapist competence, 2) therapist affirmation of LGB culture, and 3) openness of attending to sexual orientation and identity issues. Although there are few empirical
23 Texas Tech University, Melissa Gaa, December 2014 studies of LGB affirmative therapy, some, support a need for this competency among counselors-in-training. O'Shaughnessy and Spokane (2014) conducted a study with 212 therapists-in-training and found that although general knowledge about LGB issues and awareness is increasing, they do not necessarily relate to skill. Matthews (2007) suggested utilizing LGB affirmative stance in every session because client sexual orientation is not always apparent.
Dillon and Worthington (2003) argue there is a need to further counselor competence or affirmative practice when working with lesbian, gay and bisexual clients.
These authors developed an instrument to examine LGB affirmative counseling competency; the lesbian, gay and bisexual affirmative counseling self-efficacy inventory
(LGB-CSI) (Dillon & Worthington, 2003). The LGB-CSI (2003) has been found effective in previous studies examining therapists LGB affirmative counseling (Dillon &
Worthington, 2003; Dillon et al., 2008; O'Shaughnessy & Spokane, 2013).
Dillon et al., (2008) examined sexual identity exploration, sexual identity commitment, and gender self-confidence on LGB affirmative counseling self-efficacy.
This research study surveyed 178 psychotherapist that were all members of a psychology organization. The results suggest therapists was identify as LGB have more knowledge about this population and are more likely to engage in LGB affirmative counseling professional activities. The authors suggest individual, institutional, and societal homophobia may hinder heterosexual therapists' from accessing resources of LGB self- efficacy.
24 Texas Tech University, Melissa Gaa, December 2014
Social Cognitive Theory
Many researchers applied tenets of social cognitive theory (Bandura, 1986) to
LGB affirmative therapy training (Dillon & Worthington, 2003; Dillon, Worthington,
Soth-McNett, & Schwartz, 2008; O'Shaughnessy & Spokane, 2013). This theory emphasizes social variables as determinants of behavior and personality (Thomas, 2005).
Albert Bandura not only believed children learn from social experience but also could manipulate knowledge in their minds to form new understandings (Thomas, 2005).
Social Cognitive Theory explains behavior as being shaped and controlled by environmental influences (Bandura, 1999).
Social cognitive theory takes on an agentic perspective to human development
(Bandura, 2002). How people create and effect societal norms is an important factor.
Bandura believes people learn as much through observing behaviors of others as through their own experiences (Allen, 2006). Individuals utilize information to construct their own reality and belief system. Information, regardless of negative or positive, is used to create individuals beliefs about certain situations. It is assumed that cognitive activity can be altered (Boss, et al., (1993). When an individual gains more knowledge about specific topics, they may change their belief system.
A core component of Social cognitive theory is self-efficacy. Bandura (1986) describes self-efficacy as an individual's judgment of their own capabilities to perform and/or complete and action. If an individual believes they have adequate skills to perform a task, they are more likely to complete said task. If students are provided adequate information on working with lesbian, gay and bisexual clients, they may have higher self- efficacy in providing therapy to them.
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Self-Efficacy
Counselor self-efficacy is defined by Dillon and Worthington (2003) as a counselors belief or judgment about their capability to perform a task. Bandura (1997) refers to self-efficacy as central to influence of human motivation. Bandura (1999) suggests people will have little incentive to act or face difficulties if they do not believe they are able to produce desired results. For instance, if a counselor has little confidence in working with lesbian, gay or bisexual clients, they will have less incentive to work or possibly learn more about LGB issues. The more training counselors have, the more knowledge they gain about LGB community, which may raise self-efficacy of working with them.
Bandura (1999) posits self-efficacy is constructed from four principal sources of information: (1) mastery experiences, (2) vicarious experiences, (3) social persuasion, and (4) physical and emotional state. Mastery experiences occur when individuals successfully master a problem. This success helps increase self-efficacy. Vicarious experiences take place when one observes others succeeding through sustained effort.
This helps individuals believe they also have the capacity to succeed. Social persuasion occurs when people are persuaded they have what it takes to succeed. If given support and the proper information to perform a task, individuals may exert more effort. Lastly, relying on physical and emotional states, individuals are able to judge their capabilities.
This way of altering efficacy beliefs is to reduce negative emotional states and correct misinterpretations of information. These four processes can be utilized in training to help develop higher self-efficacy when working with lesbian, gay and bisexual clients.
26 Texas Tech University, Melissa Gaa, December 2014
Dillon and Worthington (2003) suggest self-efficacy may influence counseling performance and behavior as well as the level of interest in performing specific counseling-related tasks. They suggest Social Cognitive Theory (Bandrua, 1986), offers a framework for understanding and individual's interests, goals, and performance. Through proper training of working with LGB clients, counselors-in-training have the ability to increase their awareness and self-efficacy beliefs in working with this population.
Lynch, Bruhn, and Henriksen (2013) conducted a qualitative study to examine counseling students' perceptions of their preparedness to work with lesbian, gay, bisexual and transgender (LGBT) clients. The study consisted of six straight counselor education students; these students did not identify as lesbian, gay, bisexual or transgender. Results inferred students who believed they had adequate training for working with LGBT clients, were more likely to experience greater self-efficacy about working with LGBT clients. The study also suggested individuals have more exposure LGBT issues also displayed higher self-efficacy of working with this population.
Dillon et al., (2008) posit LGB affirmative counselor self-efficacy is the extent to how confident a counselor is in their ability to perform LGB affirmative counseling.
These authors suggest LGB affirmative counseling include: advocacy skills, application of knowledge, awareness, assessment, and relationship. Advocacy skills may or may not be taught in diversity graduate counseling courses, however, (CACREP) requires advocacy to be a part of coursework in programs that have their accreditation.
Knowledge of working with LGB clients should also be discussed in counseling courses. Some programs may not provide detailed information for working with this population or may not address the topic altogether. Assessment and awareness are also
27 Texas Tech University, Melissa Gaa, December 2014 required topics under CACREP standards but may not be addressed in all programs, especially if they do not hold this accreditation. Some students may find themselves not knowing how to build a counselor-client relationship with someone identifying as lesbian, gay or bisexual.
Professional Counseling Organizations
The Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling
(ALGBTIC) offers professional counselors and counselors-in-training information on these aspects when working with LGB clients. These competencies are not just limited to lesbian, gay and bisexual individuals but also include queer, questioning, and intersex.
ALGBTIC's standards promote understanding of multicultural issues specifically pertaining to sexual minorities.
ALGBTIC offers resources, competencies and counseling information for working with the lesbian, gay and bisexual community. Their website is filled with helpful information on counseling LGB clients as well as advocating. This information is available regardless of membership and can be utilized by both counselors and counselors-in-training to learn more about working with this diverse population.
Competencies that are a suggested by ALGBTIC are a source for training, supervision and educating counselors (Harper, et al., 2012). These competencies are organized into sections in accordance with the 2009 CACREP Standards including, human growth and development, social and cultural foundations, helping relationships, group work, professional orientation and ethical practice, career and lifestyle development, assessment, and research and program evaluation. Each section provides
28 Texas Tech University, Melissa Gaa, December 2014 competencies for counselors to help understand the many facets of lesbian, gay, bisexual, queer, questioning, and intersex (LGBQQI) individuals.
Although ALGBTIC is at the national level, many states have organizations for the advocacy of LGBT individuals. For example, Texas Association of Lesbian, Gay,
Bisexual and Transgender Issues in Counseling (TALGBTIC) also offers counselors and counselors-in-training resources for working with this diverse group. They now have an annual summer workshop that supplies information for people in the counseling field to gain a deeper understanding of techniques, assessments, and current issues facing the
LGBT community. Additionally, many members of TALGBTIC present at state and local workshops and conferences throughout the year offering LGBT counseling information.
Whether at the national, state or local level, many of these organizations offer opportunities for continuing education, workshops, and sessions at conferences on learning more about working with the LGB population. Involvement with any of these organizations can help counselors further their diversity training and become better equipped with necessary skills in helping LGB clients. Furthermore, attending national, state, and local conferences where these organizations offer workshops or sessions also allow individuals the chance to learn more about current issues and techniques for working with this population.
Ethics
Professional counseling organizations promote the importance of working with diverse clients, yet some graduate programs have little training on working with the LGB community. The American Counseling Association specifically states counselors should be aware of their own personal biases and not impose their own values on clients (ACA
29 Texas Tech University, Melissa Gaa, December 2014
Codes of Ethics, 2014). Furthermore, Code C.5 in the ACA Code of Ethics (2014) affirms counselor do not discriminate based on sexual orientation (C.5.) The American
Psychological Association (APA) also has guidelines for working with LGB clients
(American Psychological Association, 2011) These guidelines encompass many factors when working with LGB clients such as relationships and families, attitudes towards homosexuality and bisexuality, issues of diversity, economic and workplace issues, and education and training.
Janson and Steigerwald (2002) posit counselors should be aware of ethical and political considerations and how these may play a role in counseling sessions with LGBT clients and their families. Counselors should be cognizant of diversity and uniqueness among families and respect personal attributes while not forcing personal beliefs and attitudes on LGBT clients/families (Janson & Steigerwald 2002). Therapists are expected to be aware of the multiplicity and competencies required of them from standards set in ethical codes. Thus, it is not acceptable for counselors to claim they are unaware of specific ethical standards in place by state laws and mainstream professional organizations.
Counselors should never have a negative effect on their clients. When a counselor refuses to see a client because of their sexual orientation, the counselor brings forth an ethical dilemma. In the case of Bruff v. North Mississippi Health Services, Inc., a counselor refused to continue sessions with a lesbian client because of the therapist's personal belief that homosexuality is against her religious values (Hermann & Herlihy,
2006). The counselor had previously held two sessions when the client felt comfortable enough to disclose her sexual orientation; the counselor then refused to continue sessions.
30 Texas Tech University, Melissa Gaa, December 2014
Hermann and Herlihy (2006) suggest this type of behavior, by the counselor, could have a negative effect on the client. In this instance the counselor is picking and choosing what she wants to discuss in therapy, therefore going against the principle of respect for autonomy.
Dermer, Smith, and Barto (2010) suggest counselors should be aware of language and terms used to describe negative attitudes towards LGB clients to prevent possible consequences in sessions. Cultural interpretations must also be considered as interactions between people and are sometimes influenced by social contexts (Marshall, 2010).
People are complex in their cultures and languages; it should not be assumed that one belief and specific terminology is accepted by all.
With adequate understanding for working with this specific population, ethical dilemmas may be avoided. Knowledge of ethical codes may stop discrimination against the LGB community by counselors. The increase of the LGB population necessitates awareness of working with this group and possible harmful effects that could be placed on clients.
ACA Code of Ethics, 2014
When working with different populations in counseling, it is important to understand the ethical codes set by state and professional organizations. These codes are in place to protect counselors and clients and are a guide to be used when ethical dilemmas arise. By knowing the codes, one can better serve clients and protect themselves from acting unethically. The ACA Code of Ethics, 2014 specifically address working with clients of different sexual orientation.
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The ACA Code of Ethics, 2014 explicitly states in A.4.b. Personal Values,
counselors are aware of -and avoid imposing- their own values, attitudes, beliefs,
and behaviors. Counselors respect the diversity of clients, trainees, and research
participants and seek training in areas in which they are at risk of imposing their
values onto clients, especially when the counselor's values are inconsistent with
the client's goals or are discriminatory in nature.
This statement clearly informs counselors of their obligation to avoid passing their bias onto clients. If a counselor believes homosexuality is wrong or sinful, they should be cognizant of this and not push their clients into the same belief system. Counselors should be understanding of their differences and provide adequate therapy without prejudice.
The ACA Code of Ethics, 2014 addresses the issue of referring or terminating clients because of personal beliefs. The ACA Code A.11.b. Values Within Termination and Referral states:
Counselors refrain from referring prospective and current clients based solely on
the counselor’s personally held values, attitudes, beliefs, and behaviors.
Counselors respect the diversity of clients and seek training in areas in which they
are at risk of imposing their values onto clients, especially when the counselor’s
values are inconsistent with the client’s goals or are discriminatory in nature.
This code clearly states counselors should not impose their own values onto clients. As with some students in the past, who refuse to counsel LGB clients, this code suggests otherwise. Counselors are to respect the diversity of others and seek training so as not to harm these clients.
32 Texas Tech University, Melissa Gaa, December 2014
Knowledge of client sexual orientation is also discussed within the Professional
Competence section of the ACA Code of Ethics, 2014. Code C.2.a. Boundaries of
Competence specifically addresses counselors practicing within their boundaries of competence. It suggests multicultural counseling competency is required and that counselors gain knowledge about differences in their own beliefs and that of their clients.
This includes personal awareness, cultural sensitivity, and learning skills important for recognizing cultural differences.
The ACA Code of Ethics 2014 states that a counselor shall not discriminate against a person because of sexual orientation. In code C.5., Nondiscrimination, it is recommended that a counselor should not discriminate against a client, student, employee, supervisee, or research participant due to their "age, culture, disability, ethnicity, race, religion/spirituality, gender, gender identity, sexual orientation, marital
/partnership status, language preference, socioeconomic status, immigration status, or any basis proscribed by law". When a counselor decides not to provide therapy for a client due to their sexual orientation, even if the counselor is qualified to help the person in the manner that is needed, the counselor is not abiding by the codes set for this field of work.
Treatment modalities which may affect the lesbian, gay and bisexual population is addressed in section C Professional Responsibility. Code C.7.a. Scientific Basis for
Treatment, states: "When providing services, counselors use techniques/ procedures/ modalities that are grounded in theory and/or have an empirical or scientific foundation."
Furthermore, code C.7.c. Harmful Practices, states: "Counselors do not use techniques/procedures/modalities when substantial evidence suggests harm, even if such services are requested."
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These two codes specifically address the use of reparative therapy (also referred to as conversion therapy) that is sometimes used as a technique for LGB clients. This type of therapy aims to change sexual orientation of a LGB person to that of a heterosexual person. There is no empirical evidence this therapy works and it has been proven to cause harm. It is also important to note the state of California has banned the use of reparative therapy for people under the age of 18. Therefore, it is also imperative for counselors to know the state laws as well as code of ethics when working with clients.
Finally, under section E Evaluation, Assessment, and Interpretation, sexual orientation is addressed. Code E.8. Multicultural Issues/Diversity in Assessment discusses assessment techniques and their effects of, "age, color, culture, disability, ethnic group, gender, race, language preference, religion, spirituality, sexual orientation, and socioeconomic status on test administration and interpretation". Counselors must understand the population they are assessing and make sure to utilize the proper assessment as to provide the best possible outcome for the client/s.
Although ethical codes cannot determine every situation, they are to be used as guides to ensure the welfare of clients. Counselors should utilize these codes to prevent harm to their clients or themselves. It is in the best interest for a counselor to know the codes to better protect themselves and provide adequate help to clients.
34 Texas Tech University, Melissa Gaa, December 2014
Chapter III
Research Methodology
Overview
The purpose of this study was to examine counselors'-in-training development of moral reasoning, lesbian, gay and bisexual (LGB) affirmative counseling self-efficacy, and sexual orientation counselor perceived competencies of working with lesbian, gay and bisexual clients. The first objective was to evaluate the relationship between graduate students' development of moral reasoning and LGB counseling self-efficacy and perceived competencies of working with lesbian, gay and bisexual clients. Based on previous studies, moral development (Eriksen & McAuliffe, 2006) and affirmative counseling self-efficacy (Matthews, 2007) have shown to influence counseling skills.
Although studies are non-existent in the counselor education literature examining these specific topics together, previous studies have shown a connection between moral development levels and self-efficacy (Rest & Narveaz, 1994; Rest, Narveaz, Bebeau, &
Thoma, 1999; Sias, Lambe & Foster, 2006). Previous studies examining moral development in college students suggest higher levels of education have a positive relationship with higher levels of moral reasoning (Rest & Narveaz, 1994; Rest, Narveaz,
Bebeau, & Thoma, 1999). In other words, moral reasoning usually increases while an individual continues formal education (Sias, Lambie, & Foster, 2006). Therefore, it is reasonable to expect a similar relationship in graduate counseling students and their moral reasoning.
Additionally, an objective of this study was to examine the influence of professional development sessions attended and number of multicultural/diversity classes
35 Texas Tech University, Melissa Gaa, December 2014 taken on LGB affirmative counseling self-efficacy. Dillon et al., (2008) posit LGB affirmative counselor self-efficacy is the extent to how confident a counselor is in his/her ability to perform LGB affirmative counseling. Self-efficacy has been shown to increase with more awareness and knowledge of certain topics (Lynch, Bruhn, & Henriksen,
2013), therefore, individuals with more training on working with LGB clients may have higher self-efficacy of working with them.
This study utilized a quantitative method for examining moral development, LGB self-efficacy and sexual orientation counselor competencies. Linear regressions were used to describe these relationships. This chapter outlines the research methodology for addressing the research questions and describes the following: hypotheses, description of participants, instruments, procedure and data analysis.
Hypotheses
The current study will address the following hypotheses:
Ha1: Lesbian, gay and bisexual affirmative counseling self-efficacy and moral
development, individually and interactively, will be significant predictors of
graduate counseling students’ perceived competencies of working with lesbian, gay,
and bisexual clients.
Ho1: Lesbian, gay and bisexual affirmative counseling self-efficacy and moral
development, individually and interactively, will not be significant predictors of
graduate counseling students’ perceived competencies of working with lesbian, gay,
and bisexual clients.
Ha2: Graduate students’ moral development will be a significant predictor of lesbian, gay
and bisexual affirmative counseling self-efficacy.
36 Texas Tech University, Melissa Gaa, December 2014
Ho2: Graduate students’ moral development will not be a significant predictor of lesbian,
gay and bisexual affirmative counseling self-efficacy.
Ha3: Counseling students’ participation in one or more professional development
sessions, and/or counseling multicultural courses, will have effect on lesbian, gay,
and bisexual (LGB) affirmative counseling self-efficacy.
Ho3: Counseling students’ participation in one or more professional development
sessions, and/or counseling multicultural courses, will have no effect on lesbian,
gay, and bisexual (LGB) affirmative counseling self-efficacy.
Participants
Participants for this study are graduate counseling students enrolled in a Council for Accreditation of Counseling & Related Educational Programs (CACREP) accredited counselor education program located in the United States. An email was sent to students in counseling graduate programs in the United States in hopes of obtaining a minimum of
67 completed surveys. Typically counseling programs only have master's and doctoral level students, however the request for participation specifically state participants need to be masters or doctoral level students. The counseling programs asked to provide participants will be from CACREP-accredited schools only because CACREP programs follow guidelines for specific information taught to students including counseling lesbian, gay and bisexual clients.
Instruments
Four instruments were used for this study: demographic survey, Lesbian, gay and bisexual affirmative counseling self-efficacy (LGB-CSI), Defining Issues Test - 2
37 Texas Tech University, Melissa Gaa, December 2014
(DIT2), and Sexual Orientation Counselor Competency Scale. A detailed description of each is presented below.
Demographic Survey. A demographic questionnaire (Appendix A) was developed specifically for use in this study. Participants were asked to provide the following information: (1) age, (2) ethnicity, (3) number of semesters in current program,
(4) number of diversity/multicultural courses taken, (5) number of professional development sessions taken, (6) and number, if any, of lesbian, gay, and/or bisexual clients worked with. The survey did not ask about participants' sex and level of education as that will be asked on the DIT2 survey.
Lesbian, gay and bisexual affirmative counseling self-efficacy (LGB-CSI).
Dillon and Worthington (2003) developed the LGB-CSI to evaluate self-efficacy to counsel gay, lesbian, and/or bisexual clients. This instruments measures participants' self- efficacy to perform LGB-affirmative counseling. Dillon and Worthington (2003) conducted five studies utilizing the lesbian, gay and bisexual affirmative counseling self- efficacy inventory (LGB-CSI).
This instrument consists of 32 items each representing a LGB-affirmative counseling behavior. Participants respond to the 32 items using a 6-point Likert Scale ranging 1 (not at all confident) to 6 (highly confident). Higher total scores on this instrument indicates higher levels of self-efficacy to counsel gay, lesbian, and/or bisexual clients. Lower scores indicate less self-efficacy to counsel gay, lesbian, and/or bisexual clients. Although the LGB-CSI evidenced high internal consistency, low test-retest reliability was found over a 2-week period. However, convergent validity was shown
38 Texas Tech University, Melissa Gaa, December 2014 through correlations with other measures of self-efficacy and attitudes towards LGB individuals. Construct validity was supported through findings of levels of self-efficacy.
The instrument consists of five subscales: application of knowledge, advocacy skills, awareness, assessment, and relationship. Questions concerning application of knowledge investigates LGB counseling knowledge through unique issues and LGB issues in psychology. For example, "How confident am I in my ability to directly apply knowledge of the coming out process with LGB clients?" is a question pertaining to application of knowledge. Advocacy skills examines the ability to identify and utilize community resources that are supportive of the LGB community. An example of this subscale is, "How confident am I in my ability to refer LGB clients to LGB affirmative legal and social supports?". Additionally, awareness examines the ability to maintain awareness of the participants' and other's attitudes towards sexual identity. For example, the instruments asks, "How confident am I in my ability to examine my own sexual orientation/identity development process". Finally, assessment is the ability to assess relevant issues and problems of LGB clients. An example of a question addressing assessment is, "How confident am I in my ability to assess the role of alcohol and drugs on LGB clients social, interpersonal, and intrapersonal functioning". Dillon and
Worthington (2011) suggest the optimal level of self-efficacy requires high self-efficacy beliefs and acquisition of knowledge. Cronbach's alpha for this instrument in the current study was r = .979.
Defining Issues Test (DIT-2). The DIT-2 instrument was developed by Rest,
Narvaez, and Thoma (1999). The DIT-2 is used to measure moral development of participants based on Kohlberg's Moral Development. The tests emphasizes cognition,
39 Texas Tech University, Melissa Gaa, December 2014 personal construction and postconventional moral thinking. The DIT-2 has been updated from the original Defining Issues Test (DIT-1). The DIT-1 has been used in studies for over 25 years and was first published in 1974 (Rest, Narvaez, & Thoma, 1999). The DIT-
2 has three changes from the original: (1) updates dilemmas and items, (2) the algorithm of indexing, and (3) an improved method for detecting unreliable participants. The entire test has also been shortened in the DIT-2 from six stories to five stories.
The DIT-2 consists of five stories that present moral dilemmas: (1) famine, a father contemplates stealing food for his starving family from a rich man, (2) reporter, a newspaper reporter has to decide on reporting a damaging story about a political candidate, (3) school board, an individual that is chair of a school board must decide on holding a contentious and dangerous open meeting, (4) cancer, a doctor must make the decision whether or not to give an overdose of painkillers to a sick patient, and (5) demonstration, college students demonstrate against U.S. foreign policy.
The participants read the stories and then answers 17 questions for each story.
Each section of questions begins with asking the participant their overall opinion about what happened in each story. For example, in the "famine" story, the participants are first asked what the man should do and if they favor the action of taking the food. Participants have three choices for their answer: (1) Should take the food, (2) Can't decide, or (3)
Should not take the food. Next there are 12 questions participants are asked to rate on a
Likert scale 1 to 5 with 1=great, 2=much, 3=some, 4=little and 5=no. For example, from the "famine" story, participants are asked to rate the importance of upholding the community's law. Next participants are asked to rank these 12 questions as to which items are most important, second most important, third most important, and fourth most
40 Texas Tech University, Melissa Gaa, December 2014 important. The test uses P-score to represent the degree at which the participant uses higher order moral reasoning. The P-score is computed on the ranking data and can range from 0 to 95. An average score for college students is in the 40s. Cronbach's alpha for this instrument in the current study was r = .642, with a test-retest being about the same.
The Sexual Orientation Counselor Competency Scale (SOCCS). The Sexual
Orientation Counselor Competency Scale, developed by Bidell (2005), examines sexual orientation competencies of counselors. This instrument measures attitudes, skills and knowledge of counselors when working with lesbian, gay and bisexual individuals. Bidell
(2005) suggests prejudice and biases are different from other ethnic minorities, thus requiring specific competencies when working with this population.
The SOCCS is a 29-item self-report survey examining counselor competency.
The 29 items are statements pertaining to participants' attitudes, skills, and knowledge of working with LGB individuals. The items are answered on a Likert Scale from 1 to 7 with 1=not at all true, 4= somewhat true, and 7=totally true. There are three subscales: attitude, knowledge, and skills. Attitude investigates participants' attitudes and prejudices about LGB individuals, knowledge is concerned with participants' understanding of mental health and social issues specific to LGB individuals and skills look at effectiveness in serving LGB individuals in an affirming manner. For example, a question pertaining to attitude on the instrument is, "The lifestyle of a LGB client is unnatural or immoral". Additionally, an example of a question concerning knowledge is,
"Heterosexist and prejudicial concepts have permeated the mental health professions".
Finally, one of the questions examining skills is, "I have experience counseling gay male clients".
41 Texas Tech University, Melissa Gaa, December 2014
The SOCCS reports an internal consistency of α=0.90, with a one-week test-retest reliability correlation of r = 0.84 (Bidell, 2005). Convergent validity was established by correlations of the three subscales to three similar measures. The Attitudes Toward
Lesbians and Gay Men (ATLG) validated the awareness subscale; The Counselor Self-
Efficacy Scale (CSES) was used to validate the knowledge and skills subscales (Bidell,
2005). Cronbach's alpha for this instrument in the current study was r = .940.
Procedure
Masters and doctoral counseling graduate students from CACREP-accredited programs were recruited for this study. An email was sent to professors in CACREP- accredited counseling programs in the southwest asking permission to forward the information to their students. Prospective participants were contacted by email (Appendix
A) and asked to contribute to this study. A separate email was sent to a counseling graduate student listserve to distribute an invitation for participation. The email included information on the purposes of the study and a link to an online survey tool hosted on a web based survey organization. It has been suggested online surveys are the best method for obtaining a large amount of information in a cost-effective manner (O'Hara et al.,
2014).
When participants clicked on the link for the surveys, it first requested them to complete an informed consent statement. No identifying information was collected. Once they agreed to participate, they were asked to complete the following surveys: demographic information, lesbian, gay and bisexual affirmative counseling self-efficacy
(LGB-CSI), Defining Issues Test - 2 (DIT-2), and Sexual Orientation Counseling
42 Texas Tech University, Melissa Gaa, December 2014
Competencies Scale (SOCCS). Incomplete forms will not be included in the data set and final analysis.
Participants were informed their participation was strictly voluntary and they could decline or withdraw at any point without penalty or prejudice. No identifying information was collected to ensure anonymity. No adverse effects or liability for participating in this study was anticipated, however contact information for the researcher will be provided if any questions arise. The consent form included the purpose of the study, explanation of taking the surveys, approximate amount of time to complete the surveys, the ability to cease participation at any time, and anonymity. Confidentiality was also be addressed. The participants were informed that only the researcher will view the answers on the survey.
Data Analysis
A power analysis was conducted utilizing an online statistics calculator (Spoer,
2008) to determine the number of participants needed for this study. The first hypothesis was addressed using a multiple regression with self-efficacy and moral development as the predictors of competency. The estimated minimum required sample size for this hypothesis resulted from an online A-priori sample size calculator for multiple regression
(Soper, 2008). Given an anticipated medium effect size (f² = .015), the desired statistical power level (.08), number of predictors (2) and probability level (0.05) the calculator yields a minimum sample size of 67 for the regression analysis.
The second hypothesis was addressed using a simple regression with moral development as the predictor of LGB affirmative counseling self-efficacy. The estimated minimum required sample size for this hypothesis resulted from an online A-priori
43 Texas Tech University, Melissa Gaa, December 2014 sample size calculator for multiple regression (Soper, 2008). With a desired medium effect size (f² = .015), the desired statistical power level (.05), number of predictors (1) and probability level (0.05) the calculator yields a minimum sample size of 54 for the regression analysis.
The third hypotheses was addressed using a multiple regression with number of professional development and/or number of multicultural courses taken as the predictors of LGB affirmative counseling self-efficacy. The estimated minimum required sample size for this hypothesis resulted from an online A-priori sample size calculator for multiple regression (Soper, 2008). Given an anticipated medium effect size (f² = .015), the desired statistical power level (.05), number of predictors (2) and probability level
(0.05) the calculator yields a minimum sample size of 67 for the regression analysis.
44 Texas Tech University, Melissa Gaa, December 2014
CHAPTER IV
Results
Introduction
The purpose of this chapter is to report a detailed description of the data and analyses conducted for this study. The results from this study are provided in the following sections: a restatement of the problem, a description of the participants, an analysis of data, and a summary of the results.
Analysis of Data
Data Preparation
Prior to the calculation of any statistics, certain steps were taken to prepare the data for analysis. These steps were as follows:
1) A total of 106 individuals participated within the survey. However, 28 respondents
failed to completely fill out the survey. These individuals were deleted from the
dataset, which resulted in a reduction of the sample size from 106 to 78. This
reduction represents a 26.4% attrition of data. It should be noted that the deletion of
data was only done for respondents who had systematic missing data. That is to say,
respondents who stopped taking the survey at a given point within the survey were
deleted from the dataset.
2) Idiosyncratic missing data was replaced via mean substitution (Allison, 2002).
Idiosyncratic missing data was only present within 12 items that comprised the
Lesbian, gay and bisexual affirmative counseling self-efficacy scale, 7 items that
comprised the Sexual Orientation Counselor Competency Scale, and Question 8
which measured how many professional development sessions a respondent attended
45 Texas Tech University, Melissa Gaa, December 2014
regarding LGB clients. The replacement of missing data for these items allowed for
the retention of all 78 respondents in the dataset.
3) The variable that represents LGB affirmative counseling self-efficacy was created via
the aggregation of 29 separate questions. The researcher decided to add the 29
questions together and then divided by 29. This strategy allowed for the original
measurement metric to be retained, which means that the average score of the lesbian,
gay and bisexual affirmative counseling self-efficacy scale can be interpreted on a 1
to 6 point scale, where 1 equals “not confident at all” and 6 equals “extremely
confident”.
4) The variable that represents counseling students’ perceived competencies of working
with lesbian, gay, and bisexual clients was created via the aggregation of 29 separate
questions. The 32 questions were added together and then divided by 29, per the
scoring instructions for the SOCCS (Bidell, 2014). This strategy allowed for the
original measurement metric to be retained, which means that the average score of the
counseling students’ perceived competencies of working with lesbian, gay, and
bisexual clients scale can be interpreted on a 1 to 7 point scale, where 1 equals “not at
all true” and 7 equals “totally true”.
5) The variable that represents moral development was operationalized via the P-score
scale. The construction of this variable was outsourced to a third party, The
University of Alabama Center for the Study of Ethical Development. The Center
owns rights to the Defining Issues Test 2 (DIT-2) and requires their own analysis of
this instrument. The analysis and P-score for this instrument was provided by The
46 Texas Tech University, Melissa Gaa, December 2014
Center for the Study of Ethical Development. The author requested more details on
the analysis of the P-score through email and was unsuccessful. No further
information on the construction of this variable is available at this time.
6) The first hypothesis proposed that moral development and self-efficacy would work
together interactively. As such, an interaction term (Agresti & Finlay, 2009) was
created to model this effect. The interaction term was created via the multiplication of
the self-efficacy scale score and the moral development P-score. The hypothesis
stated an examination of interaction between moral development and self-efficacy,
therefore, an interaction term was created.
7) The use of the interaction term described above injected multicollinearity problems
into the regression equation used to investigate hypothesis 1. Multicollinearity occurs
when two or more independent variables in a regression equation are highly
correlated (Allison, 1999), and this is a common problem with the use of
multiplicative interaction terms (Smith & Sasaki, 1979). The most viable solution to
this problem is to mean-center the interaction term and the two variables used to
create the interaction term (Smith & Sasaki, 1979). Mean-centering was therefore
used for the three independent variables in the regression equation used to investigate
hypothesis 1.
Descriptive Statistics
The sample used for this study were counselors-in-training enrolled in a Council for Accreditation of Counseling and Related Educational Programs (CACREP) counseling program. The participants had to be enrolled either full or part-time as a masters or doctoral student. Table 1 presents frequencies and percentages with respect to
47 Texas Tech University, Melissa Gaa, December 2014 the demographic characteristics of the 78 respondents in the final sample. As can be seen in Table 1, the age of half of the respondents (50.0%) falls between 25 and 34 years.
Another quarter of respondents (24.4%) are between 35 and 44 years of age. One in five respondents (19.2%) are between 18 and 24 years old. Four out of 78 respondents (5.1%) are between 45 and 54 years of age, and only one respondent (1.3%) was between the ages of 55 and 64. Table 1 further reveals that most of the respondents (80.8%) were female, and that the majority reported themselves as White (66.7%).
Table 1
Demographic Information
Variable Frequency %
48 Texas Tech University, Melissa Gaa, December 2014
Age of respondent
18 to 24 15 19.2
25 to 34 39 50.0
35 to 44 19 24.4
45 to 54 4 5.1
55 to 64 1 1.3
Gender of respondent
Female 63 80.8
Male 15 19.2
Race/Ethnicity of respondent
Asian / Pacific Islander 2 2.6
Black or African American 8 10.3
Hispanic American 15 19.2
White / Caucasian 52 66.7
Multiple ethnicity / Other 1 1.3
n=78
Analysis and Results
The current study examined aspects of student knowledge from training in both graduate coursework and professional development opportunities. It also examined self- reported development of moral reasoning and lesbian, gay and bisexual affirmative
49 Texas Tech University, Melissa Gaa, December 2014 counseling self-efficacy of students affects their ability to become a culturally competent counselor. In order to achieve these goals, the following null and alternative hypotheses were constructed:
Ha1: Lesbian, gay and bisexual affirmative counseling self-efficacy and development of
moral reasoning, individually and interactively, will be significant predictors of
graduate counseling students’ perceived competencies of working with lesbian, gay,
and bisexual clients.
Ho1: Lesbian, gay and bisexual affirmative counseling self-efficacy and moral
development, individually and interactively, will not be significant predictors of
graduate counseling students’ perceived competencies of working with lesbian, gay,
and bisexual clients.
The first hypothesis set utilizes four variables: (1) self-efficacy; (2) moral development; (3) the interaction of self-efficacy and moral development, and; (4) perceived competencies. Self-efficacy was operationalized via the lesbian, gay and bisexual affirmative counseling self-efficacy (LGB-CSI) scale. Moral development was operationalized via the defining issues test (DIT-2) P-score scale. The interaction of self- efficacy and moral development was modeled as the multiplicative outcome of self- efficacy and moral development. Finally, perceived competency was operationalized via the sexual orientation counselor competency scale (SOCC). Multiple linear regression was used to regress the dependent variable (the SOCC scale) onto the three independent predictors (the LCG-CSI scale, the P-score scale and the interaction term).
50 Texas Tech University, Melissa Gaa, December 2014
Ha2: Graduate students’ moral development will be a significant predictor of lesbian, gay
and bisexual affirmative counseling self-efficacy.
Ho2: Graduate students’ moral development will not be a significant predictor of lesbian,
gay and bisexual affirmative counseling self-efficacy.
The second hypothesis set utilizes two variables: (1) self-efficacy, and; (2) moral development. Self-efficacy was operationalized via the lesbian, gay and bisexual affirmative counseling self-efficacy (LGB-CSI) scale. Moral development was operationalized via the defining issues test (DIT-2) P-score scale. Simple linear regression was used to regress the dependent variable (the LGB-CSI scale) onto the single independent predictors (the P-score scale).
Ha3: Counseling students’ participation in one or more professional development
sessions, and/or counseling multicultural courses, will have no effect on LGB
affirmative counseling self-efficacy.
Ho3: Counseling students’ participation in one or more professional development
sessions, and/or counseling multicultural courses, will have no effect on LGB
affirmative counseling self-efficacy.
The third hypothesis set utilizes three variables: (1) self-efficacy; (2) participation in one or more professional development sessions, and; (3) participation in one or more counseling multicultural courses. Self-efficacy was operationalized via the lesbian, gay and bisexual affirmative counseling self-efficacy (LGB-CSI) scale. A respondent’s participation in one or more professional development sessions was operationalized via a single question that asked respondents to report the number of professional development
51 Texas Tech University, Melissa Gaa, December 2014 sessions they had attended. Finally, participation in one or more counseling multicultural courses was operationalized via a single question that asked respondents to report the number of counseling multicultural courses they have taken during the course of their program. Multiple linear regression was used to regress the dependent variable
(the LCG-CSI scale) onto the two independent predictors (participation in one or more professional development sessions and participation in one or more counseling multicultural courses).
Table 2 presents the means and standard deviations for all continuous variables used in the current investigation. Four of the variables (how many semesters have you been in your current counseling program; how many diversity/multicultural courses have you taken in your counseling program; how many professional development sessions have you attended regarding lesbian, gay or bisexual clients; how many clients have you worked with that identify as lesbian, gay or bisexual) are single item indicators where the respondent was asked to report an exact number of times. As such, the interpretation of the respective means reflects the average number of times the respondents in the sample engaged in a given behavior. For example, the average number of semesters respondents have been in their current counseling program is 4.72. Along these same lines, the typical respondent has only taken 1.24 diversity/multicultural courses during their counseling program. On average, respondents in the sample have only attended 1.46 professional development sessions regarding lesbian, gay or bisexual clients. Finally, the average respondent has only worked with clients that identify as lesbian, gay or bisexual
1.76 times.
52 Texas Tech University, Melissa Gaa, December 2014
Two of the remaining three means can be interpreted as a function of their respective measurement scales. The sexual orientation counselor competency scale was measured on a metric of 1 to 7, with a score of 1 equaling “not at all true” and a score of
7 equaling “totally true”. The average of 4.51 is slightly higher than the midpoint of the scale and are tending towards an answer of true. The lesbian, gay and bisexual affirmative counseling self-efficacy scale was measured on a 1 to 6 point scale, where 1 equals “not confident at all” and 6 equals “extremely confident”. The average score of
3.41 suggests that respondents are above the midpoint of the scale and tending towards feeling confident.
The metric for the variable which measures moral development, which is the P-
Score scale, is unknown. The Center for the Study of Ethical Development did not offer further information on the P-Score scale when asked about it through email. An interpretation of its mean is not possible, other than to state that higher scores suggest higher levels of moral development.
Table 2
Means and Standard Deviations, Study Variables
Variable Mean Std. Dev.
53 Texas Tech University, Melissa Gaa, December 2014
How many semesters have you been in your current 4.72 2.06 counseling program?
How many diversity/multicultural courses have you 1.24 0.71 taken in your counseling program?
How many professional development sessions have you attended regarding lesbian, gay or bisexual 1.46 1.60 clients?
How many clients have you worked with that identify 1.76 0.86 as lesbian, gay or bisexual?
P-Score scale 36.74 15.45
Sexual orientation counselor competency scale 4.51 0.94
Lesbian, gay and bisexual affirmative counseling self- 3.41 1.04 efficacy scale n=78
Table 3 below presents the Cronbach Alpha reliability coefficients for each of the three scales that were used in the current investigation. As Tavakol and Dennick (2011) note, the alpha statistic was developed by Lee Cronbach to provide a measure of the internal consistency of a scale as a function of its reliability. The measure of alpha ranges between a value of 0 and 1, with higher scores generally indicating better reliability.
Scores of .70 or higher suggest that a scale has an acceptable level of reliability
(Cronbach, 1970), although lower levels of alpha are also seen as reliable when a scale has only a few items (Tavakol & Dennick, 2011). Of the three scales presented above, two demonstrate acceptable reliability, although the P-Score scale does approach the benchmark level of acceptability of .70. The sexual orientation counselor competency scale and the lesbian, gay and bisexual affirmative counseling self-efficacy scale have very high reliability scores.
54 Texas Tech University, Melissa Gaa, December 2014
Table 3
Internal Consistency Values (Cronbach α)
Scale α
P-Score scale 0.642
Sexual orientation counselor competency scale 0.940
Lesbian, gay and bisexual affirmative counseling self-efficacy scale 0.979 n=78
Hypothesis 1
Ha1: Lesbian, gay and bisexual affirmative counseling self-efficacy and moral
development, individually and interactively, will be significant predictors of
graduate counseling students’ perceived competencies of working with lesbian, gay,
and bisexual clients.
Ho1: Lesbian, gay and bisexual affirmative counseling self-efficacy and moral
development, individually and interactively, will not be significant predictors of
graduate counseling students’ perceived competencies of working with lesbian, gay,
and bisexual clients.
A multiple linear regression was conducted to determine whether a respondent’s self-efficacy, moral development and the interaction of these two concepts predict a participant’s level of perceived competency. It should be noted that the results presented in Table 4 used the mean-centered independent variables discussed earlier in this technical report. The use of mean centered variables was predicated upon the relatively high multicollinearity present in the first regression model that did not use mean centered
55 Texas Tech University, Melissa Gaa, December 2014 variables. Multicollinearity is detected through an examination of the Variance Inflation
Factor, or VIF. The VIF for the non-centered self-efficacy scale was 6.798, while the
VIF for the P-Score scale was 12.246. The VIF for the interaction term was 22.321. A
VIF of 10 or more indicates problematic multicollinearity (Myers, 1986). Thus it was decided to mean-center all independent predictors and re-run the regression equation.
The mean-centering of the independent variables resulted in VIF values for all three independent variables of less than 2.0.
The results of the mean-centered multiple linear regression are presented in Table
4. The first parameter of interest is the F value. This statistic is an omnibus ANOVA F- test check of the overall predictive validity of the entire model. As can be seen in Table 4, the F value is statistically significant (F = 68.066; df = 3, 74; p<.001), which suggests that the overall equation is statistically significant.
The second parameter of interest in Table 4 is the coefficient of determination, also known as the R2 value. The R2 value is fundamentally the proportion of variance in a dependent variable that is associated with the variance in the independent variables in a regression equation (Allison, 1999). The R2 value is at .734, which suggests outstanding model fit. The results of the regression indicate that 73.4% of the variation in a respondent’s perceived competency is accounted for by the variation in the independent variables.
Decomposition of effects in Table 4 reveals that higher levels of self-efficacy is a significant predictor of perceived competency (B=0.708, p<.001), controlling for other variables in the equation. It was also found that as moral development increases, perceived competency will also increase (B=0.012, p<.01), net of the other predictors.
56 Texas Tech University, Melissa Gaa, December 2014
An interesting finding is present within Table 4. The interaction of moral development and self-efficacy produces a somewhat counterintuitive outcome, insofar as the interaction term is negatively related to perceived competencies (B=-0.010, p<.01), controlling for other factors in the model.
Table 4
Multiple Linear Regression of Perceived Competencies on the Various Predictors Variable B SE(B) β
Constant 1.442 0.484
Self-efficacy scale 0.708 0.057 0.779*
P-Score scale 0.012 0.004 0.200*
Interaction term -0.010 0.003 -0.171*
F 68.066*
R2 0.734
*p<.01 n=78
Hypothesis 2
Ha2: Graduate students’ moral development will be a significant predictor of lesbian, gay
and bisexual affirmative counseling self-efficacy.
Ho2: Graduate students’ moral development will not be a significant predictor of lesbian,
gay and bisexual affirmative counseling self-efficacy.
A simple linear regression was conducted to determine whether moral development predicts a participant’s level of self-efficacy. The results of the simple linear regression are presented in Table 5. The first parameter of interest is the F value. This statistic is an omnibus ANOVA F-test check of the overall predictive validity of the
57 Texas Tech University, Melissa Gaa, December 2014
entire model. As can be seen in Table 5, the F value is statistically significant (F = 6.380; df = 1, 76; p<.05), which suggests that the overall equation is statistically significant.
The second parameter of interest in Table 5 is the coefficient of determination, also known as the R2 value. The R2 value is fundamentally the proportion of variance in a dependent variable which is associated with the variance in the independent variables in a regression equation (Allison, 1999). The R2 value is at .077, which suggests relatively poor model fit. The results of the regression indicate that 7.7% of the variation in a respondent’s self-efficacy is accounted for by the variation in the independent variable.
Decomposition of effects in Table 5 reveals that higher levels of moral development will lead to higher levels of self-efficacy (B=0.019, p<.05).
Table 5
Simple Linear Regression of Self-Efficacy on Moral Development Variable B SE(B) β Constant 2.724 0.295
P-Score scale 0.019 0.007* 0.278
F 6.38*
R2 0.077 *p<.05 n=78
Hypothesis 3
Ha3: Counseling students’ participation in one or more professional development
sessions, and/or counseling multicultural courses, will have no effect on LGB
affirmative counseling self-efficacy.
58 Texas Tech University, Melissa Gaa, December 2014
Ho3: Counseling students’ participation in one or more professional development
sessions, and/or counseling multicultural courses, will not significantly predict LGB
affirmative counseling self-efficacy.
A multiple linear regression was conducted to determine whether self-efficacy is predicted by a participant’s participation in one or more professional development sessions, as well as a respondent’s participation in one or more counseling multicultural courses. The results of the multiple linear regression are presented in Table 6. The first parameter of interest is the F value. This statistic is an omnibus ANOVA F-test check of the overall predictive validity of the entire model. As can be seen in Table 6, the F value is statistically significant (F = 13.070; df = 2, 75; p<.001), which suggests that the overall equation is statistically significant.
The second parameter of interest in Table 6 is the coefficient of determination, also known as the R2 value. The R2 value is fundamentally the proportion of variance in a dependent variable which is explained by the independent variables in a regression equation (Allison, 1999). The R2 value is at .271, which suggests relatively good model fit. The results of the regression indicate that 27.1% of the variation in a respondent’s self-efficacy is accounted for by the variation in the independent variables.
Decomposition of effects in Table 6 reveals that as participation in one or more professional development sessions increases, self-efficacy will also increase (B=0.337, p<.001), controlling for the other independent predictor. Participation in one or more counseling multicultural courses is unrelated to self-efficacy.
Table 6
59 Texas Tech University, Melissa Gaa, December 2014
Multiple Linear Regression of Self-Efficacy on the Various Predictors Variable B SE(B) β Constant 2.917 0.207
Professional development 0.337 0.073* 0.520 Multicultural courses taken 0.003 0.165 0.002
F 13.07*
R2 0.271 *p<.05 n=78
Summary
This study examined counselors-in-training's moral development levels, lesbian, gay and bisexual (LGB) affirmative counseling self-efficacy, and sexual orientation counselor perceived competencies of working with lesbian, gay and bisexual clients. The study was designed to collect data from counseling students enrolled in a CACREP accredited counseling program. The hypotheses were proposed to seek a relationship between moral development and lesbian, gay and bisexual affirmative counseling self- efficacy of students and their perceived competency when working with LGB clients; and, if attending training in either required coursework or professional development opportunities affects their LGB affirmative counseling self-efficacy.
The results of this study identified four statistically significant relationships: (a) higher levels of lesbian, gay and bisexual (LGB) self-efficacy will lead to higher levels of perceived competency, (b) as moral development increases perceived competencies will also increase, (c) as moral development increases, lesbian, gay and bisexual affirmative counseling self-efficacy also increases, (d) participation in one or more professional development session concerning lesbian, gay and bisexual clients increases LGB
60 Texas Tech University, Melissa Gaa, December 2014 affirmative counseling self-efficacy. However, this study found that participation in one or more counseling multicultural courses does not affect lesbian, gay and bisexual self- efficacy.
61 Texas Tech University, Melissa Gaa, December 2014
Chapter V
Discussion
Introduction
This chapter is composed of four sections. The first section is an overview and summary of the study. The second section provides discussions of the findings.
Limitations and recommendations for future research are summarized in the third and fourth sections separately.
Summary
The purpose of the current study was to examine aspects of counseling students' self-reports from training in both graduate coursework and professional development opportunities. It also examined moral development and lesbian, gay and bisexual affirmative counseling self-efficacy of students and how it affects their ability to become a culturally competent counselor. Three hypotheses were tested in this study:
Ha1: Lesbian, gay and bisexual affirmative counseling self-efficacy and moral
development, individually and interactively, will be significant predictors of
graduate counseling students’ perceived competencies of working with lesbian, gay,
and bisexual clients.
Ha2: Graduate students’ moral development will be a significant predictor of lesbian, gay
and bisexual affirmative counseling self-efficacy.
Ha3: Counseling students’ participation in one or more professional development
sessions, and/or counseling multicultural courses, will have no effect on LGB
affirmative counseling self-efficacy.
62 Texas Tech University, Melissa Gaa, December 2014
The hypotheses of this study were analyzed by one multiple linear regression and two simple linear regressions. Results supported the following: (a) higher levels of lesbian, gay and bisexual (LGB) self-efficacy will lead to higher levels of perceived competency,
(b) as moral development increases perceived competencies will also increase, (c) as moral development increases, lesbian, gay and bisexual affirmative counseling self- efficacy also increases, (d) participation in one or more professional development session concerning lesbian, gay and bisexual clients increases LGB affirmative counseling self- efficacy.
Moral Development and Multicultural Competencies
The results of this study helped identify effects of moral development and lesbian, gay and bisexual (LGB) self-efficacy with LGB counseling competencies. Consistent with previous findings (Eriksen & McAuliffe, 2006) there is a relationship between moral development and competency levels. For example, in a previous study examining master level student's counseling skills and moral development, Eriksen & McAuliffe (2006) found a relationship between a students' ability to learn counseling skills and their counseling skills performance by examining the students' moral development. This study examined 119 graduate counseling students' development level and their ability to learn counseling skills. One finding concluded that although participants recognized multiple truths, they were not able to weigh the perspectives.
Furthermore, Previous studies examining moral development in college students suggest higher levels of education have a positive relationship with higher levels of moral reasoning (Rest & Narveaz, 1994; Rest, Narveaz, Bebeau, & Thoma, 1999). In other words, moral reasoning usually increases while an individual continues formal education
63 Texas Tech University, Melissa Gaa, December 2014
(Sias, Lambie, & Foster, 2006). Although, biased attitudes may influence treatment of diverse clients (Boysen & Vogel, 2008), previous studies indicate graduate students might have a higher level of moral reasoning; therefore, providing a more fair and justice therapeutic process.
The current study specifically examined moral development and lesbian, gay and bisexual (LGB) competencies. Previous research has studied LGB competencies with other aspects of counselors-in-training and counselor educators, however, the current study examined moral development with sexual orientation competencies. The results of this study suggests as moral development increases, perceived competency also increases.
These findings add to the counseling literature that has little information about moral development and sexual orientation counseling competencies.
Self-Efficacy and Multicultural Competencies
The results of this study indicate higher levels of lesbian, gay and bisexual (LGB) affirmative counseling self-efficacy will lead to higher levels of perceived competency.
Counselor self-efficacy is defined by Dillon and Worthington (2003) as a counselors belief or judgment about their capability to perform a task. Bandura (1997) refers to self- efficacy as central to influence of human motivation. Bandura (1999) suggests people will have little incentive to act or face difficulties if they do not believe they are able to produce desired results. For instance, if a counselor has little confidence in working with lesbian, gay or bisexual clients, they will have less incentive to work or possibly learn more about LGB issues.
Previous research examining perceptions of self-efficacy and competencies have found higher levels of self-efficacy when students are presented with materials for
64 Texas Tech University, Melissa Gaa, December 2014 learning about certain populations. For example, Lynch, Bruhn, & Henriksen (2013) conducted a qualitative study to examine counseling students' perceptions of their preparedness to work with lesbian, gay, bisexual and transgender (LGBT) clients. The study consisted of six straight counselor education students; these students did not identify as lesbian, gay, bisexual or transgender. Results indicated students that believed they had adequate training for working with LGBT clients, were more likely to experience greater self-efficacy about working with LGBT clients. The study also suggested individuals that have more exposure LGBT issues also displayed higher self- efficacy of working with this population.
Furthermore, the results of this study provided similar findings as previous studies. For example, Grove (2006) conducted a mixed-methods study to examine graduate counseling students' competencies when working with LGB clients. The qualitative results found students' attitudes about the LGB community changed once they had experience and more knowledge of the population. In other words, if a student met someone that identified as lesbian, gay, or bisexual, they learned the stereotypes were not true and had a better understanding about this population. The author also found in the quantitative results competency skills rose in the first year of training among the graduate student participants.
While the current study suggests similar findings as previous research, this study adds to the counseling literature with new information on counselors-in-training working with the lesbian, gay and bisexual community. To date, there are no studies in the counseling literature examining lesbian, gay and bisexual (LGB) affirmative counseling self-efficacy. Much of these studies exists in psychology and marriage and family therapy
65 Texas Tech University, Melissa Gaa, December 2014 journals. Furthermore, these results add to the literature because it examines lesbian, gay and bisexual (LGB) affirmative counseling self-efficacy with sexual orientation counseling competencies. To date, this information is non-existent in the counseling literature.
Moral Development and Self-Efficacy
Moral development and self-efficacy of graduate students has been examined in previous studies. However, little research in the counseling field exists examining both moral development and lesbian, gay and bisexual (LGB) affirmative counseling self- efficacy. Affirmative counseling has been examined in other fields such as counseling psychology and marriage and family therapy; however, this topic is non-existent in counselor education.
Previous research has suggested possible relationships between LGB affirmative counseling and therapists competencies. For example, Dillon et. al, (2008) examined sexual identity exploration, sexual identity commitment, and gender self-confidence on
LGB affirmative counseling self-efficacy. This research study surveyed 178 psychotherapist that were all members of a psychology organization. The results suggest therapists that identify as LGB have more knowledge about this population and are more likely to engage in LGB affirmative counseling professional activities.
Although much of the previous research on LGB affirmative counseling is mostly discussed in other counseling fields (psychology and marriage and family therapy), the current study also found a relationship between moral development and LGB affirmative counseling self-efficacy. Furthermore, much of the research on moral development within the counseling field examines many different aspect of counselors-in-training, this study
66 Texas Tech University, Melissa Gaa, December 2014 examined moral development when working with lesbian, gay and bisexual clients. The results of the current study suggest higher levels of moral development will lead to higher levels of self-efficacy. These results add to the non-existent literature on this topic in the counseling field.
Coursework and Training
This study examined if multicultural or diversity courses and/or professional development trainings concerning lesbian, gay and bisexual (LGB) had any effect on
LGB affirmative counseling self-efficacy. The results of this study suggest attending one or more professional development session increases LGB affirmative counseling self- efficacy. However, this study suggests participation in counseling multicultural/diversity courses do not increase LGB affirmative counseling self-efficacy.
There many different professional counseling organizations that offer professional development sessions at their conferences. These organizations are at the local, state, national and international level. Many of these organizations specifically offer trainings or counseling information on working with lesbian, gay and bisexual clients. For example, the American Counseling Association (ACA) has a division Association for
Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC). The state of
Texas also has a division, Texas Association for Lesbian, Gay, Bisexual and Transgender
Issues in Counseling (TALGBTIC). These organizations offer sessions at yearly conferences as well as pertinent information online. They are easily accessible for students, counselors and educators.
Similar to previous research, this study suggests more education on working with lesbian, gay and bisexual clients will increases LGB affirmative counseling self-efficacy.
67 Texas Tech University, Melissa Gaa, December 2014
Dillon and Worthington (2003) suggest self-efficacy may influence counseling performance and behavior as well as the level of interest in performing specific counseling-related tasks. Although, previous studies indicate more education increases self-efficacy in certain areas, the current studies findings suggests the education must come through professional development rather than the classroom.
This study examined counseling students enrolled in The Council for
Accreditation of Counseling and Related Educational Programs (CACREP) accredited programs across the United States. The Council for Accreditation of Counseling and
Related Educational Programs (CACREP) has eight core curriculum areas with one specifically addressing social and cultural diversity. These programs are required to provide students with a multicultural/diversity core course and these courses are required to specifically address multicultural issues.
Previous studies have found a relationship between multicultural learning in the classroom to counseling competency skills in sessions. Mallott (2010) suggests that a single multicultural counseling course positively affects multicultural competencies.
Bidell (2012) examined multicultural and sexual orientation competencies of school counselors compared to community agency counselors. The results claimed participants in this study reported that school counselors have less multicultural and sexual orientation counselor competencies than the community agency counselors.
Unlike previous research, this study found no relationship between diversity/multicultural courses and lesbian, gay and bisexual (LGB) affirmative counseling self-efficacy. Previous literature would suggest multicultural/diversity courses would increase LGB self-efficacy, however, this study did not indicate such findings. A
68 Texas Tech University, Melissa Gaa, December 2014 reason for the discrepancy in these findings may be that student that are interested in learning more about or working with lesbian, gay and bisexual clients voluntarily attend professional organization trainings on this topic. Whereas, all student in a CACREP program are required to take a multicultural/diversity class that is not voluntary. If students are not interested in learning about this population or disagree with the LGB lifestyle, or do not want to counseling this population, they may focus less when this topic is discussed in these courses. Another possibility is this topic is not discussed in depth enough for students to feel they have a grasp on working with lesbian, gay and bisexual clients, in which case programs should reevaluate how the course is taught and possibly offer more than one course that enables educators to focus more time in this area. However, it is an area of concern for educators to consider in developing multicultural/diversity courses.
Consistent with previous research examining moral development and self-efficacy to competency levels, findings of the current study indicate higher levels of moral development will lead to higher levels of perceived lesbian, gay and bisexual (LGB) counseling competencies. The current study also indicates higher levels of LGB self- efficacy will also lead to higher levels of perceived LGB counseling competency.
However, this study indicates the interaction of moral development and LGB self- efficacy is negatively related to perceived LGB counseling competencies.
Overall, these findings identify areas for possible changes in training for counseling programs. In addition, these findings add to the lack of research on moral development of counselors-in-training, lesbian, gay and bisexual (LGB) affirmative self- efficacy and sexual orientation counseling competencies.
69 Texas Tech University, Melissa Gaa, December 2014
Limitations
There are a number of limitations to the present study. The respondents were self- selected, which means the results could be biased. Respondents that have no interest in lesbian, gay and bisexual clients may have chosen not to participate in the survey. As well as, respondents that are interested in or have experience working with lesbian, gay and bisexual clients may have been more inclined to participate in the study. This study was based on counselors-in-trainings' self-report instruments. As with any study, respondents may answer questions in a more favorable way once they knew the purpose of the study.
Additionally, the instrument used to examine moral development may pose questionable outcomes from respondents. The Defining Issues Test (DIT-2) was developed based on Kohlberg's moral development model (Rest, Narvaez, and Thoma,
1999). Gilligan (1982) argued Kohlberg's moral development did not consider gender differences. Kohlberg's model centers on rights and rules whereas Gilligan suggested compassion and care should be considered. Gilligan argued women are typically more compassionate and caring while men are more invested in rules. Therefore, Gilligan claimed Kohlberg's moral development was biased against women (Evans & Foster,
2000). The majority of respondents were female (81%), therefore, it could be argued moral development of these respondents were not correctly taken into consideration.
The majority of the respondents were from the state of Texas (64%), and not every state was represented in the findings. Therefore, results of this study cannot be generalized for all CACREP counseling programs across the United States. Finally, although the present sample size met the minimal requirement (n=67) for multiple
70 Texas Tech University, Melissa Gaa, December 2014 regression analysis, the relatively small size of the students sample (N=78) represents methodological limitation. It is possible that findings for this sample lack stability and cannot represent all graduate counseling students.
Implications for Practice
Approximately twelve million people, in the United States, identify themselves as lesbian, gay, or bisexual (Gates, 2012) and this number continues to increase every year.
Given the continued increase in Americans that identify as lesbian, gay or bisexual, and the likelihood of counselors providing therapy for individuals or families from this community, there is little known about effect training for future counselors. Therefore, this study offers tentative implications for counselor educators and professional counseling organizations for training and teaching graduate students when working with this population.
First, moral development offers insights into students' logic and ability to work with different populations. According to the review of literature, Eriksen & McAuliffe
(2006) found a relationship between a students' ability to learn counseling skills and their counseling skills performance by examining the students' moral development. This study also suggested the DIT instrument (measuring moral development) produces a higher percentage of students' ability to learn counseling skills than other admissions criteria.
Based on the results of the current study, as student's moral development increased their perceived sexual orientation counseling competence also increased. The higher student's moral development, as per Kohlberg's moral development model, the more they believe they are more competent to work with lesbian, gay and bisexual clients. Counseling programs and professional organizations may take into consideration aspects of moral
71 Texas Tech University, Melissa Gaa, December 2014 development when training future counselors. With higher rates of perceived competency, students are better prepared to enter the counseling field working with diverse populations. Thus, understanding the role of moral development and competencies can help prepare counselors-in-training to become more culturally sensitive and responsive to lesbian, gay and bisexual clients.
Affirmative counseling encourages clients' acceptance of themselves while attempting not to change clients. Therefore, lesbian, gay and bisexual (LGB) affirmative counseling advocates and recognizes individuals identifying as lesbian, gay or bisexual and their relationships. Part of affirmative counseling includes the therapists skills and competence. The literature suggests counselors-in-training may have general knowledge about LGB issues, however, this does not necessarily relate to their skills (O'Shaughnessy
& Spokane, 2014). Understanding LGB affirmative counseling self-efficacy of graduate students permits educators and trainers to implement necessary techniques in the classroom and sessions. The results of this study indicate as LGB affirmative self- efficacy increases, sexual orientation counseling competencies also increase. If student have higher self-efficacy when working with lesbian, gay and bisexual clients, they are more than likely going to be more competent counselors and will be able to provide more adequate therapy to their clients. Consideration of lesbian, gay and bisexual affirmative counseling self-efficacy is a major aspect of training students that can assist educators when developing coursework and professional sessions.
Additionally, it is expected that through coursework and trainings graduate students will deepen their understanding of working with diverse populations.
Counselors-in-training are typically expected to self-reflect in order to help understand
72 Texas Tech University, Melissa Gaa, December 2014 their own biases which will enhance the counselor-client relationship.
Diversity/Multicultural courses are a core requirement of CACREP programs.
Furthermore, many professional counseling organizations offer training on working with lesbian, gay and bisexual clients. These trainings are offered through sessions at yearly conferences, online tutorials, or live webinars. The findings in this study suggests students attending trainings through professional organizations increase their lesbian, gay and bisexual affirmative counseling self-efficacy. The respondents that reported attending professional trainings also reported higher LGB affirmative self-efficacy. Again, these findings can offer direction to counseling programs by advocating for students to attend
LGB specific trainings and by offering these trainings through their program. On the other hand, the findings from this study did not show improvement of LGB affirmative self-efficacy with multicultural/diversity courses. The respondents, in this study, that had taken one or more counseling multicultural/diversity course did not improve their LGB affirmative self-efficacy. These findings can help counseling programs to better develop their multicultural/diversity courses and better prepare students to enter the field of counseling.
Finally, counselor education training programs and courses should be evaluated to ensure proper knowledge is provided to students. Some participants feel they are not given enough information in coursework to enable them to work with this community.
Programs should offer either an entire course on working with this population, or ensure enough in-depth information is presented to students. For example, courses should spend more than one or two hours discussing this topic. The need for knowledge and understanding is apparent in this study. Working with the LGB community should also be
73 Texas Tech University, Melissa Gaa, December 2014 discussed in all courses, not just diversity/multicultural courses.
There is also a need for school counseling curriculum to be evaluated. School counseling students, many times, take the same course as community mental health counseling students, however, there are specific separate courses for the two. As mentioned previously, Bidell (2012) suggested school counselors had less knowledge about multicultural and sexual orientation issues than community mental health counselors. Working with lesbian, gay, and bisexual clients should be emphasized in their programs as well.
Recommendations for Future Research
The results of this study contribute to the body of literature that addresses counseling graduate students working with lesbian, gay and bisexual clients. The research has included new information to the literature in considering moral development and lesbian, gay and bisexual affirmative counseling self-efficacy of counselors-in-training.
The current research has also suggested new findings on multicultural/diversity coursework and lesbian, gay and bisexual affirmative counseling self-efficacy. Although some findings of this study were similar to past research, much more work is needed in this area of research to replicate the findings. For instance, the current study mainly investigated variables such as moral development, lesbian, gay and bisexual (LGB) affirmative counseling self-efficacy, and attendance in multicultural/diversity courses and trainings. However, there are other significant variables to consider when examining competence and training of graduate counseling students when working with lesbian, gay and bisexual clients. These variables include: willingness to work with LGB clients, previous experience with the LGB community, personal beliefs about the LGB
74 Texas Tech University, Melissa Gaa, December 2014 community, and homophobia. In addition, a qualitative or mixed-methods research design should help researchers gain a deeper understanding of the dynamics of training counseling graduate students to work with LGB clients.
Furthermore, results from this study indicate new findings in this area of research, however, more research in this area can deepen the understanding of training and graduate programs to better prepare students to enter the counseling field. Previous research in counseling has not examined moral development with sexual orientation counseling competencies. Nor has previous research, in the counseling field, examined lesbian, gay and bisexual affirmative counseling self-efficacy. As stated earlier, other variables could be further examined in future research in this area such as: religious beliefs, willingness to work with LGB individuals and previous experience with the community. Overall, these suggestions could provide more evidence for considerations in preparing coursework and trainings for graduate counseling students.
75 Texas Tech University, Melissa Gaa, December 2014
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Appendix A
Email Script Asking for Participation in the Study
Hello,
My name is Melissa Gaa; I am a doctoral candidate in Counselor Education at Texas Tech University. I am currently recruiting graduate counseling students to participate in my dissertation study. To be a participant, you must:
Be enrolled full-time or part-time in a counseling program at college or university Be enrolled in a CACREP accredited counseling program Be a masters or doctoral student
In this study I am exploring moral development levels, lesbian, gay and bisexual affirmative counseling, and sexual orientation counseling competencies.
Participation in this study will involve taking an online surveys which includes four sections. Your participation will take 20 to 25 minutes to complete. No identifying information will be asked of you. Research participation is strictly voluntary and you may quit at any time.
This research study has been approved by the Texas Tech Institutional Review Board. This board protects the rights of individuals who participate in research. Their contact information, should you have any questions, is 806-742-2064. This study is being supervised by Dr. Bret Hendricks at Texas Tech University. He can be reached at 806- 834-1744 or [email protected].
If you are interested in participating, please click the link below: www.survey.org
Thank you for your consideration,
Melissa Gaa, MA Doctoral Candidate Counselor Education Texas Tech University
Appendix B
83 Texas Tech University, Melissa Gaa, December 2014
Demographic Information Survey
1. What is your age?
2. What is your gender?
3. Which race/ethnicity best describes you?
4. Do you identify with any of the following religions? (Please select all that apply)
Protestantism Catholicism Christianity Judaism Islam Buddhism Hinduism Native American Inter/Non-denominational No religion Other (please speficy)
5. In what state do you live?
6. How many semesters have you been in your current counseling program?
7. How many diversity/multicultural courses have you taken in your counseling program?
8. How many professional development sessions have you attended regarding lesbian, gay or bisexual clients. This includes any informative sessions through local, state or national associations such as American Counseling Association, State level Counseling Associations and regional counseling associations. This also includes and special sessions offered through your counseling program that is not considered part of your coursework.
9. If you have attended a professional development session, where was it held? Please select all that apply.
84 Texas Tech University, Melissa Gaa, December 2014
International conference National conference State conference Regional conference Through my university or college program I am not sure
10. How many clients, if any, have you worked with that identify as lesbian, gay or bisexual? (a) 0 (b) 1-2 (c) 2-4 (d) 5 or more
85 Texas Tech University, Melissa Gaa, December 2014
Appendix C
Lesbian, Gay, & Bisexual Affirmative Counseling Self-Efficacy inventory (LGB-
CSI) (Dillon & Worthington, 2003)
INSTRUCTIONS: Below is a list of activities regarding counseling/psychotherapy. Indicate your confidence in your current ability to perform each activity by marking the appropriate answer below each question ranging from NOT CONFIDENT TO EXTREMELY CONFIDENT. Please answer each item based on how you feel now, not on your anticipated (or previous) ability. I am interested in your actual judgments, so please be HONEST in your responses.
HOW CONFIDENT AM I IN MY ABILITY TO....?
1. Directly apply sexual orientation/identity development theory in my clinical practice with lesbian, gay, and bisexual (LGB) clients. not at all confident extremely confident
2. Directly apply my knowledge of the coming out process with LGB clients. not at all confident extremely confident
3. Identify specific mental health issues associated with the coming out process. not at all confident extremely confident
4. Understand the socially constructed nature of categories and identities such as lesbian, bisexual, gay, and heterosexual. not at all confident extremely confident
5. Explain the impact of gender role socialization on a client's sexual orientation/identity development. not at all confident extremely confident
6. Apply existing American Psychological Association guidelines regarding LGB affirmative counseling practices. not at all confident extremely confident
7. Use current research findings about LGB clients' critical issues in the counseling process. not at all confident extremely confident
8. Assist LGB clients to develop effective strategies to deal with heterosexism and homophobia.
86 Texas Tech University, Melissa Gaa, December 2014 not at all confident extremely confident
9. Evaluate counseling theories for appropriateness in working with a LGB client's presenting concerns. not at all confident extremely confident
10. Help a client identify sources of internalized homophobia and/or biphobia. not at all confident extremely confident
11. Select affirmative counseling techniques and interventions when working with LGB clients. not at all confident extremely confident
12. Assist in the development of coping strategies to help same sex couples who experience different stages in their individual coming out processes. not at all confident extremely confident
13. Facilitate a LGB affirmative counseling/support group. not at all confident extremely confident
14. Recognize when my own potential heterosexist biases may suggest the need to refer a LGB client to a LGB affirmative counselor. not at all confident extremely confident
15. Examine my own sexual orientation/identity development process. not at all confident extremely confident
16. . Identify the specific areas in which I may need continuing education and supervision regarding LGB issues. not at all confident extremely confident
17. . Identify my own feelings about my own sexual orientation and how it may influence a client. not at all confident extremely confident
18. Recognize my real feelings versus idealized feelings in an effort to be more genuine and empathic with LGB clients. not at all confident extremely confident
19. Provide a list of LGB affirmative community resources, support groups, and social networks to a client. not at all confident extremely confident
20. Refer a LGB client to affirmative social services in cases of estrangement from their families of origin. not at all confident extremely confident
87 Texas Tech University, Melissa Gaa, December 2014
21. Refer LGB clients to LGB affirmative legal and social supports. not at all confident extremely confident
22. Provide a client with city, state, federal, and institutional ordinances and laws concerning civil rights of LGB individuals. not at all confident extremely confident
23. Help a same-sex couple access local LGB affirmative resources and support. not at all confident extremely confident
24. Refer a LGB elderly client to LGB affirmative living accommodations and other social services. not at all confident extremely confident
25. Refer a LGB client with religious concerns to a LGB affirmative clergy member. not at all confident extremely confident
26. . Integrate clinical data (e.g., mental status exam, intake assessments, presenting concern) of a LGB client. not at all confident extremely confident
27. Complete an assessment for a potentially abusive same sex relationship in a LGB affirmative manner. not at all confident extremely confident
28. Assess for post-traumatic stress felt by LGB victims of hate crimes based on their sexual orientations/identities. not at all confident extremely confident
29. Assess the role of alcohol and drugs on LGB clients social, interpersonal, and intrapersonal functioning. not at all confident extremely confident
30. Establish an atmosphere of mutual trust and affirmation when working with LGB clients. not at all confident extremely confident
31. Normalize a LGB client's feelings during different points of the coming out process. not at all confident extremely confident
32. Establish a safe space for LGB couples to explore parenting. not at all confident extremely confident
88 Texas Tech University, Melissa Gaa, December 2014
Scoring: Application of Knowledge : items 1-13 Awareness : items 14-18 Advocacy Skills: items 19-22 Relationship : items 30-32 Assessment: items 26-29
89 Texas Tech University, Melissa Gaa, December 2014
Appendix D
S.O.C.C.S.
Instruction: Using the scale following each question, rate the truth of each item as it applies to you by circling the appropriate number. It is important to answer all questions and provide the most candid response, often your first one. LGB = Lesbian, Gay, and Bisexual.
1. I have received adequate clinical training and supervision to counsel lesbian, gay, and bisexual (LGB) clients.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
2. The lifestyle of a LGB client is unnatural or immoral.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
3. I check up on my LGB counseling skills by monitoring my functioning/competency – via consultation, supervision, and continuing education.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
4. I have experience counseling gay male clients.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
5. LGB clients receive less preferred forms of counseling treatment than heterosexual clients.
90 Texas Tech University, Melissa Gaa, December 2014
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
6. At this point in my professional development, I feel competent, skilled, and qualified to counsel LGB clients.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
7. I have experience counseling lesbian or gay couples.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
8. I have experience counseling lesbian clients.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
9. I am aware some research indicates that LGB clients are more likely to be diagnosed with mental illnesses than are heterosexual clients.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
10. It's obvious that a same sex relationship between two men or two women is not as strong or as committed as one between a man and a woman.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
91 Texas Tech University, Melissa Gaa, December 2014
11. I believe that being highly discreet about their sexual orientation is a trait that LGB clients should work towards.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
12. I have been to in-services, conference sessions, or workshops, which focused on LGB issues (in Counseling, Psychology, Mental Health).
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
13. Heterosexist and prejudicial concepts have permeated the mental health professions.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
14. I feel competent to assess the mental health needs of a person who is LGB in a therapeutic setting.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
15. I believe that LGB couples don't need special rights (domestic partner benefits, or the right to marry) because that would undermine normal and traditional family values.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
16. There are different psychological/social issues impacting gay men versus lesbian women.
Not at all True Somewhat True Totally True
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17. It would be best if my clients viewed a heterosexual lifestyle as ideal.
Not at all True Somewhat True Totally True
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18. I have experience counseling bisexual (male or female) clients.
Not at all True Somewhat True Totally True
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19. I am aware of institutional barriers that may inhibit LGB people from using mental health services.
Not at all True Somewhat True Totally True
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20. I am aware that counselors frequently impose their values concerning sexuality upon LGB clients.
Not at all True Somewhat True Totally True
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21. I think that my clients should accept some degree of conformity to traditional sexual values.
Not at all True Somewhat True Totally True
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22. Currently, I do not have the skills or training to do a case presentation or consultation if my client were LGB.
Not at all True Somewhat True Totally True
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23. I believe that LGB clients will benefit most from counseling with a heterosexual counselor who endorses conventional values and norms.
Not at all True Somewhat True Totally True
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24. Being born a heterosexual person in this society carries with it certain advantages.
Not at all True Somewhat True Totally True
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25. I feel that sexual orientation differences between counselor and client may serve as an initial barrier to effective counseling of LGB individuals.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
26. I have done a counseling role-play as either the client or counselor involving a LGB issue.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
27. Personally, I think homosexuality is a mental disorder or a sin and can be treated through counseling or spiritual help.
Not at all True Somewhat True Totally True
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28. I believe that all LGB clients must be discreet about their sexual orientation around children.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
29. When it comes to homosexuality, I agree with the statement: ‘You should love the sinner but hate or condemn the sin’.
Not at all True Somewhat True Totally True
1 2 3 4 5 6 7
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Appendix E
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