groyn88 Posted May 5 Posted May 5 (edited) https://the-singapore-lgbt-encyclopaedia.fandom.com/wiki/MOH_Circular_No._43_2026_Counselling_Guidelines_for_Youths_with_Sexuality_Issues On Tuesday, 5 May 2026, the Ministry of Health sent out Circular No. 43 2026 entitled Counselling Guidelines for Youths with Sexuality Issues to the following distribution list: 1. GCEOs, GCMBs of Public Healthcare Clusters 2. CEOs and CMBs of Public Hospitals 3. CEOs, GMs and MDs of Private Hospitals 4. All Registered Doctors - via MOH Alert System Content MINISTRY OF HEALTH SINGAPORE MH 34:17/2 MOH Circular No. 43/2026 5 May 2026 Dear Colleagues COUNSELLING GUIDELINES FOR YOUTHS WITH SEXUALITY ISSUES The Ministry of Health (MOH), Ministry of Social and Family Development (MSF) and the Ministry of Education (MOE) have jointly updated the Counselling Guidelines for Youths with Sexuality Issues ("Counselling Guidelines”) (refer to Annex A). 2. The Counselling Guidelines were updated with the following considerations in mind: a. The Counselling Guidelines represent a comprehensive synthesis of international research and best practices that were adapted to align with the Singapore context. b. The Counselling Guidelines are developed in consultation with representatives from relevant professional and non-governmental bodies. c. To recognise the importance of guiding and supporting therapists in their work with youth of school-going age in the area of sexuality, especially pertaining to issues of sexual orientation and gender identity (SOGI). d. To communicate the Government’s recommended approach of adopting a neutral stance, and to avoid the premature determination of SOGI in youth. e. For therapists to maintain professionalism and objectivity in the delivery of ethical and evidence-based practice. Ministry of Health, Singapore 3. The Counselling Guidelines articulate the following key principles for counselling of youths with sexuality issues: a. Maintaining professional responsibility. It is the responsibility of Therapists/Professionals to apply their knowledge in ways that benefit and not harm their client. They should engage in evidence-informed practice, critically appraise, and incorporate sound scientific evidence into their practice while taking into consideration the client’s personal values, family, cultural and social circumstances. Therapists should also be aware of the laws of Singapore and safeguard the confidentiality of information obtained in their provision of services and be aware of its limits. b. Understanding youth sexuality. Therapists/Professionals should be knowledgeable and updated on the literature specific to youth sexuality and gender issues including the research on healthy youth development, sexual orientation, gender dysphoria, mental health challenges, social stigmatisation and other unique challenges that impact on family dynamics, and peer relationships; c. Practising objectivity. Therapists/Professionals should be non-judgmental, and not impose their own values and beliefs in session; d. Working with youth and their family. Therapists/professionals should help the young person and family navigate the complexity and sensitivities of sexual development. Therapists should facilitate open and respectful discussions with youths and their family members focusing on his or her overall adjustment and well-being. Fostering healthy family relationships is one of the most important protective factors for these youths. FURTHER INFORMATION 4. A list of Frequently Asked Questions (FAQ) can be found in Annex B. 5. For any further queries, please contact moh info@moh.gov.sg. Yours faithfully Professor Kenneth Mak Director-General of Health Ministry of Health, Singapore College of Medicine Building 16 College Road Singapore 169854 TEL (65) 6325 9220 FAX (65) 6224 1677 WEB www.moh.gov.sg Annex A: Guidelines for therapists working with youth with sexuality issues The Ministry of Health, the Ministry of Social and Family Development, and the Ministry of Education, Singapore January 2015, Revised November 2021 Purpose of Document These guidelines have been developed jointly by the Ministry of Health (MOH), the Ministry of Social and Family Development (MSF), and the Ministry of Education (MOE), Singapore. The guidelines were developed in recognition of the importance of guiding and supporting therapists1 in their work with youth of school-going age2 in the area of sexuality3, especially pertaining to issues4 of sexual orientation5 and gender identity6. The guidelines are also relevant to other social sector professionals7 who work with youth and their families. During adolescence, youth are exploring and developing their identity. As a result, youth may consult therapists for a wider range of clinical and non-clinical issues pertaining to sexuality and gender identity. For example, some may be questioning/exploring their sexuality; some have concerns regarding their sexual orientation or gender identity; and some face family/peer rejection and mental health issues. It is important to acknowledge the young person's questions, uncertainties and struggles in the area of sexuality, and give the young person and the family a safe space to explore and discuss with professionals in an environment of acceptance, compassion and neutrality. Space must be provided for these youth to ask questions, clarify and deepen their understanding of sexuality and identity development, without necessarily having therapy move towards a pre-determined direction. Sexual orientation and gender identity can exist on a spectrum and individuals may vacillate between different phases with time especially when they are still young and developing. These guidelines are written based on the principle of upholding professionalism in the provision of ethical and evidenced-based practice to our youth who are in need of support. While most of the guidelines apply in general to working with all youth facing various issues, some are specific to the needs of youth with sexuality issues. The guidelines take reference from established research studies and are adapted from other jurisdictions' guidelines, taking into consideration the cultural and social context in Singapore. 1 In this document, therapists refer mainly to counsellors and psychologists who provide counselling or psychological therapy respectively with children, youth and their families. 2 The guidelines were developed with youth in mind, but they would also be relevant to younger children who may have similar issues with sexuality. 3 In this document, sexuality refers to the whole range of sexual awareness, feelings, thoughts, desires, values, beliefs, experiences, behaviours and relationships. This includes romantic and sexual attraction, attitudes/desires about emotional and physical intimacy, sense of gender (masculinity-femininity spectrum), sexual orientation, knowledge and management of sexual desires/arousal/activity etc. 4 The term "issue" used throughout the document does not connote a disorder or a problem but describes an area of development and a range of issues that the youth is seeking counselling for. 5 Sexual orientation refers to the sex of those to whom one is sexually and romantically attracted (American Psychological Association, 2012). They may identify as LGB - Lesbian, Gay, Bisexual etc. Please note that homosexuality is no longer classified a mental illness or disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) after APA removed it from DSM-2 in 1973. 6 Gender Identity refers to the person's basic sense of being male, female or of indeterminate sex (American Psychological Association, 2009a). Gender Dysphoria (previously known as gender identity disorder) is a DSM-5 diagnosis describing a condition in which clinically significant distress is experienced related to a strong desire to be of another gender. ICD-11 has introduced Gender Incongruence as a clinical diagnosis in sexual health, and it is defined as marked and persistent incongruence between an individual's experienced gender and the assigned sex. For gender incongruence in childhood, the same definition applies, but for "pre-pubertal children" and must have persisted for 2 years. 7 Social sector professionals include social workers, case managers, youth workers, allied health workers etc., who work with children, youth and their families. Key Principles 1. Maintaining professional responsibility As professionals, it is the responsibility of therapists to apply their knowledge in ways that benefit and not harm their client or the wider society. They should engage in evidence-based practice and have the ability to find, critically appraise, and incorporate sound scientific evidence into their own practice while taking into consideration the client's personal values, family, cultural and social circumstances. Where the evidence is equivocal, therapists should exercise caution in prescribing a particular direction in terms of intervention, but instead adopt an exploratory, non-judgmental, developmentally sensitive and client-centered approach within a safe and supportive environment, being mindful to do no harm. Therapists should also be familiar with issues and limitations of confidentiality for minors and be aware of the legislations relevant to children and youth. They are to conduct themselves professionally, maintain professional integrity and perform within the boundaries of their competencies. They should exercise self-awareness in terms of their own personal values and positioning with regard to sexuality and gender issues, and recognise how these may inadvertently impact the direction, course and outcome of therapy in a particular way. 2. Understanding youth sexuality Therapists should be knowledgeable about the population that they are working with. They are to be familiar and updated on the literature specific to youth sexuality and gender issues. This includes being aware of the research on healthy youth development including youth sexuality, sexual orientation, gender dysphoria, risks and protective factors associated with different presenting issues, mental health challenges, impact of social stigmatization and other unique challenges that impact on family dynamics, peer relationships. However, it must be borne in mind that findings are equivocal and there are varying levels in the quality of research and the context in which studies8 were conducted as well as differing opinions in the interpretation of findings depending on the values held by a range of therapists, clients and cultural systems. As such, maintaining professional responsibility (as spelt out in Principle 1) should be adhered to, so as not to do any harm. The goal is to facilitate and build overall wellbeing and adjustment that includes supportive and healthy relationships, academic progress, engagement in leisure/pro-social activities, physical and mental health, good communication and self-representation skills, and goals for one's future to lead an engaged and meaningful life. 3. Practising objectivity The principle of objectivity refers to the therapist's position of being non-judgmental and not taking sides of an ideological, political, racial, or religious nature. Given the sensitivities associated with issues of sexual orientation and gender identity, therapists should be careful about not imposing their own values and beliefs in session. They are to assist the youth and family in finding answers that are most congruent with their own values and not the values of the therapist. (8 Overseas research studies are conducted in specific sociocultural contexts which may be different from Singapore's local context.) 4. Working with youth and their family Everyone has a unique perspective from which he/she views and interprets the world. Therapists recognize the youth as an individual with his/her own thoughts, beliefs, feelings and needs, while also being aware that a major source of the youth's development is intricately woven with the relationships that he/she has with key people in his/her social context (i.e. family, peer, school, workplace, community, society and culture). As such, therapists respect the worldview of the clients and their families, and do not force their own interpretation of them. Instead they recognize the issues that are important to the clients and their families, and strive to understand what drives them and how they make meaning of their experiences. They help the young person and family navigate the complexity and sensitivities of sexual development, while managing their own values and desires, emotions and needs, in an adaptive manner to their current circumstances and stage of life. Fostering healthy family relationships is one of the most important protective factors for these youths and, as such, the importance of working with family in therapy cannot be underestimated. Guidelines 1. Maintaining professional responsibility 1.1 Therapists are to fully and accurately present research findings that are based on rigorous scientific research design and be careful not to misuse or misrepresent these findings Therapists must exercise caution in their use and interpretations of current research on youths who identify themselves as gay, lesbian, bisexual, or transgender, and to take into account the complexities, context and limitations of the research (e.g. King et al., 2007; Walch et al., 2020). Currently, the research is equivocal with regards to the understanding of sexual orientation and gender identity. For example, there is no definitive evidence about the "causes" of non-heterosexual orientations or gender dysphoria, no definitive evidence about improved health outcomes for transgender youth who undergo medical/surgical treatment, and unknown systemic impact of cross-sex hormonal therapy on overall long-term health. Furthermore, research on youth and in the local context is limited. As such, therapists should exercise care when quoting from research findings. Therapists are urged to present full and accurate findings of the research including limitations of the data. In particular, research findings on LGBT adults should not be extrapolated to youth. 1.2 Therapists are to utilize accepted therapeutic approaches to interventions that minimize the risk of harm. Therapists must be familiar and be kept updated with the research development (for resources, see for e.g., Centers for Disease Control and Prevention, 2019; youth.gov, n.d.) on providing therapy to youth who experience sexual orientation and gender identity issues. When working with youths and families with these issues, therapists should address their concerns using approaches that support youth in their developmental processes and in their identity exploration, without seeking predetermined outcomes. Therapists can use existing accepted approaches to help clients deal with, for example, common co-presenting problems, including depression, anxiety, and/or unresolved distress stemming from family of origin issues, sexual and emotional abuse, relationship difficulties, and any shame, compulsive and/or addictive habits that impacts on the youth's well-being. Family therapy that provides guidance on how to facilitate healthy communication on these issues is also essential. 1.3 Therapists are to safeguard the confidentiality of information obtained in their provision of services and be aware of its limits. Therapists should be familiar with the standard confidentiality practices with minors. Issues of confidentiality are important to all clients in therapy, particularly with youths who have sexual orientation and gender identity issues. They may fear rejection and embarrassment to discuss about what they are experiencing; hence, maintaining confidentiality is important in protecting the therapist-client relationship. In the event that the youth does not wish his/her communications to be disclosed to the parent who referred the youth, then it is the duty of the therapist to resolve this conflict with the youth and the parent before proceeding with therapy. In general, when making a judgement whether to disclose the youth's information, therapists should consider the youth's best interests as paramount. However, there are a number of circumstances in which confidentiality is limited, where the health, safety and welfare of the client or someone else who would otherwise be put at serious risk, for example, in situations where the youth is acutely suicidal, engaging in risky sexual behaviours or is being sexually abused by an adult, or in situations where the law in Singapore pertaining to sexual behaviours is breached and where the therapist has a duty to report an offence committed. 1.4 Therapists should be aware of the laws in Singapore especially those governing sexual behaviours involving children and youth. Therapists are to be aware of the general legal framework and provisions for the protection of children and victims of violence, which apply to all children and youth in Singapore. Therapists should familiarize themselves with the Children and Young Persons Act (Chapter 38). The Act provides for the welfare, care and protection of children and young person who are in need of such care. Therapists also need to be aware of the Penal Code and be cognizant that a sexual act with a child (under 14 years) or youth (under 18 years) constitutes an offence and is reportable. Other legislations that may be relevant include the Women's Charter and Employment Act. 1.5 Therapists are not to use therapy as a platform for lobbying or advocacy, but to maintain professional integrity and ethical clinical practice. Therapists should not impose their own values on the client, nor should they use therapy for lobbying or advocating a cause. Such advocacy is beyond the scope of therapy and should not be carried out within the therapy context. 1.6 Therapists are to refer the youth to appropriate practitioners and agencies, should more specialised services be required. Therapists who are unfamiliar with, or who lack sufficient training in working with youth with sexual orientation or gender identity issues can increase their competencies through continuing education, training, supervision and consultation to overcome their limitations. When in doubt, seek professional consultation or make the necessary referral to a more appropriate practitioners or services (including mental health, educational and community resources). If the youth is suspected to have gender dysphoria, a referral can be made to see a psychiatrist for an assessment. Medical treatment would need to take into consideration legal age limitations, need for parental consent and availability of specific and safe treatment modalities. The latter, if not supervised or poorly supervised, could lead to severe or irreversible health complications. In such cases, a referral to medical professionals using a multidisciplinary approach is advised. 2. Understanding youth sexuality 2.1 Therapists are to be aware of the unique problems and risks that exist for youths with sexuality and gender identity issues. Youths who self-identify as gay, lesbian, bisexual, transgender have higher rates of mental health risks including chronic depression, anxiety and suicidal thoughts (Russell & Fish, 2016). Across multiple countries, LGBTQ youth report having more suicidal thoughts and suicide attempts compared to their heterosexual peers (Gambadauro et al., 2020; Huang et al., 2018; Marshall et al., 2011). Aside from negative mental health outcomes, such youth may also experience physical and verbal abuse, exposure to discrimination, social isolation, poor peer relationships, low self-esteem, weight dissatisfaction (Tankersley et al., 2021). They may engage in risk taking behaviours such as unsafe sex practices and substance abuse in their attempts to cope with feelings of isolation, loneliness and being misunderstood (Smith, Derma & Astramovich, 2005). Older children and adolescents also typically report higher rates of psychological distress compared to younger children (Tankersley et al, 2021). Therapists should seek to understand their psycho-social and cultural context, enquire about the circumstances commonly encountered by youth with sexuality or gender identity issues, and assess for risks and protective factors. A segment of these youth may be at a higher risk because they may not have developed the internal coping mechanisms or they lack social support and community to help them face these challenges. Therapists should work with youth to develop the appropriate social skills needed to initiate and maintain healthy peer friendships and romantic relationships, regardless of their sexual orientation and gender identity. 2.2 Therapists are to try to ameliorate the effects of societal stigma (i.e. prejudice, discrimination, and violence) faced by on youth with sexuality and gender identity issues, and facilitate the development of coping skills in the youth. Therapists are to understand that bullying and/or social stigmatization can cause chronic stress that contributes to emotional distress among youths in general, and more so for youths who are grappling with issues of sexual orientation and gender identity (Almeida et al 2009, Tankersley et al., 2021). Addressing peer victimization, promoting resilience and working with supportive teachers and staff can help improve the youths' well-being and lead to better school outcomes. Therapists should consider the levels of safety and social support that the youth experiences in his/her environment, and plan interventions accordingly. They are to provide an environment for the youth to safely discuss their experiences and receive their support regarding immediate problems, e.g. who and how to tell parents, lack of understanding from peers that may result in bullying behaviours, and anxiety that they may face in hostile social environment with negative social consequences. Therapists can equip the youth with skills such as help-seeking and pro-social skills to relate with peers and build a sense of belonging in the school or social community. 2.3 Therapists are to understand that sexuality and gender identity can be fluid in youth, and that premature determination of sexual orientation or gender identity should be delayed. Therapists are to understand that what youths report about their sexual orientation and gender identity may change over time. It is not uncommon for youth to develop infatuations or crushes, as adolescence is a time of self-discovery, identity formation and clarification. Such romantic infatuations may be either hetero-sex or same-sex. However, this does not equate to a fixed sexual preference or gender identity. In self-report measures of sexual orientation, responses can change over time in youths, even into their twenties (Mock & Eibach, 2012; Ott et al., 2011; Villalobos et al., 2020). This suggests that therapists must exercise caution when interpreting youths' self-reports of their sexual orientation at any point in time. Therapists should refrain from actively persuading youth to either embrace or reject their professed sexual orientation and gender identity. As such, therapists are encouraged to focus on family and peer rejection issues rather than determining current and future sexual orientation prematurely (Adelson & AACAP, 2012). When questions about the youth's future sexual orientation and gender identity arise, therapists can explore what this issue means to the youth and significant people in his/her life. Therapists should evaluate and support the youth's ability to integrate his/her sexual orientation or gender identity into his/her self-identity while developing age-appropriate capabilities such as emotional and behavioural stability, relationships, academic progress and other areas of development that prepares them to eventually function effectively as an adult (Adelson & AACAP, 2012). 2.4 Therapists are to recognize that although first sexual experiences have an impact on sexuality and gender identity, this does not equate to a fixed sexual preference or gender identity. The factors that influence sexual orientation and gender identity are complex. Therapists need to educate youth who have been involved in same-sex encounters (e.g. experimentation, victimisation) that one sexual encounter does not 'make' them lesbian, gay or bisexual (Adelson & AACAP, 2012). Although events in a person's life can be catalyst towards self-discovery, it does not in itself predetermine the youth's sexual orientation and gender identity. It is important that therapists explore further about what the experience means to the youth, address their concerns without prematurely predetermining their sexual orientation and gender identity. 2.5 Therapists are to discourage sexual experimentation for all youth. Youths who identify themselves as gay, lesbian, bisexual or transsexual have been found to more likely in engage sexual intercourse, have a higher number of sexual partners and have unprotected sex compared to their heterosexual peers (Johns et al., 2019; Kann et al., 2017). In general, therapists should discourage sexual experimentation, in light of the higher behavioural risks that these youths tend to have. Multiple studies across various countries have found that early sexual experience is associated with having more sexual partners, more casual sex, inconsistent contraceptive use, sexually transmitted infections, unintended pregnancy, amongst other findings (Magnusson, Masho & Lapane, 2012, Magnusson at al, 2019, Osorio et al, 2017, Heywood et el, Shrestha et al 2016 etc.) This holds true for all youth undergoing counselling regardless of sexual orientation and identity. Where necessary, therapists can also teach skills of assertiveness, negotiation and responsible decision-making to prevent sexual debut or further engagement in sexual activity and the onset of detrimental health outcomes. 2.6 Therapists are to be knowledgeable of the role of mass media, the internet and popular culture in shaping youth sexuality in general Therapists need to understand the role of the mass media in shaping views of youth on sexuality. They are to highlight unhealthy portrayals of sexuality in mass/social media, games and pop culture in general, for example, sexualisation of game or anime characters, use of words/memes. Therapists are to discourage all youth regardless of sexual orientation or gender identity in the use of pornography. Research has suggested an association between online pornography and risky sexual activity, early sexual debut, multiple sex partners, unprotected sex, sexually transmitted infections, and sexual aggression in youths (American College of Obstetricians and Gynaecologists, 2016; Peter & Valkenburg, 2016, Wright et al., 2020). Therapists can explore the youth's media diet, and they can engage in discussions to shape healthy/functional attitudes about the youth's sexuality, and sexual behaviours towards others. Given the ubiquity of social media and its potential dangers, therapists can also help the youth understand how to use social media safely and positively (e.g., to be aware of grooming by sexual predators, to handle cyberbullying or body shaming etc). 3. Practising objectivity 3.1 Therapists are not to impose their personal views, beliefs and values when offering professional services to youth Therapists should strive to be aware of how their own background, personal factors, cultural views, beliefs and values may influence their assessment and treatment of youth with sexual orientation issues. Without awareness, therapists may impede the progress of a client in therapy. This is especially relevant when therapists are providing assessment and therapy. Therapists should guard against any tendencies to see their job as exerting influence on their clients to adopt their values on sexual orientation or gender identity. It is not the therapist's place to persuade the youths to live according to what the therapist thinks is right or wrong. Should therapists find themselves holding biases that can have negative consequences on the therapeutic process; they should approach their supervisor or another professional to consult with. 3.2 Therapists should be open, respectful and non-judgemental in their approach It is important that therapists facilitate open and respectful discussions with the youth regarding their sexuality or gender issues, and not impose their personal views. Therapists should hold the values/needs/desires of both the youth and their family as central), while attending to the overall adjustment and wellbeing of the youth. Therapy should involve an exploration of the youth's expectations and goals (and family's expectations and goals, if the family of the youth is involved in therapy). The therapist should not influence the youth or family towards a pre-determined outcome, either according to the youth's or the parents' agenda. As the youth and his/her family will present with a diversity of problems that are coloured by his/her past and present circumstances, it is the therapist's role to listen, recognize and respect what they sees as important in their life. It means listening without judgement and being able to reflect both the content and feelings of the youth as well as his/her family. The role of the therapist is to create a safe climate for youth to examine their thoughts, feelings and actions, explore these in relation to the larger familial and social context, and eventually find answers that are most congruent with their values and beliefs. Therapists should not persuade or convince the youths or his/her family of any particular course of action to take but to help them assess their behaviour so that they can determine what is or is not working for them as an individual and family. 3.3 Therapists are to seek supervision and/to refer the youth to appropriate practitioners and agencies, should their personal or cultural values impede their work with the youth. If therapists are aware that their views, beliefs and values about sexual orientation and gender identity differ from that of the youth, they may consider the following questions. For example, how would their values influence what they might say or do? Would they encourage the youth to define their goals or are they inclined to direct them toward the goals they think they should have? If the values differed greatly, would they still be able to help the youth work towards meeting his/her goals? It is important for therapists to be honest about limitations in their work with the youth, and to seek supervision on complex cases or should their personal or cultural values impede therapy progress. If therapists are uncomfortable about the direction in therapy chosen by the client, they should seek supervision and/or refer the client to a therapist whose views are more aligned with the client and who may be a better fit for the client's needs. 4. Working with youth and their family 4.1 Therapists are to recognise parental authority and responsibility, and to respect the personal, moral or cultural values of the youth and family. Therapists are to recognise that parents are the legal/ primary guardian and first educator of their children's moral and sexual education. Therapists should accept that the youth and their family have personal values, attitudes and cultural/religious beliefs that are important to their own personal experience. There may be differing values between the youth, their family and other social systems (e.g. school). The values of all parties are to be respected and integrated into therapy as appropriate. Therapists should not persuade the youth and their family on how to value these domains but can assist them to determine their own valuations. However, if any family member reacts violently or makes threats of physical harm in response to the youth's disclosure or expression of sexuality or gender identity, action should be taken immediately to protect the youth from harm or danger. 4.2 Therapists are to facilitate the development of skills in the youth to understand and navigate different societal, familial and cultural contexts. Therapists must consider the social, cultural, and familial complexities among other aspects of the youth's experience so as to contextualize their sexual and gender identity development. They are to help the youth clarify their personal values and beliefs in relation to the values and beliefs held by their family. They are also to work with everyone in the family on developing skills to communicate and navigate differences in opinions, choices, desires, values and beliefs. Therapists may also assist youth to look beyond the current situation by encouraging future-orientation in making decisions, especially for older youths. For example, do they have life goals and related concerns in the area of higher education, National Service, career, marriage, starting a family, etc which may be impacted by decisions that are made in the present. 4.3 Therapists are to exercise neutrality in working with the youth and their family members, and to avoid taking sides. Therapists are to exercise neutrality in working with both the youth and their family, by communicating respect for differing points of view, listening to their stories and experiences with empathy, exploring their understanding of sexuality and gender identity, and encouraging questions they have about sexual orientation and gender identity. The therapist should not take sides. Where there are conflicting priorities between the youth and his/her family, the therapist should hold these priorities in equipoise (acknowledge uncertainty/tension and to keep the equilibrium of priorities). They should guide the youth and his/her family (with neutrality) to explore all available options towards an outcome that is in the best interest of the youth. 4.4 Therapists are to engage parents and family members through enabling the youth to understand the need to speak with parents and family members in their life, where possible. Strong parent-child relationship is a protective factor for the mental health and well-being of the youth. Therapists should encourage the youth to communicate with their families about their sexual orientation or gender identity issues unless it is deemed by the therapist that this would put the youth in an unsafe situation. In situations where there is potentially risk of harm to self and/or others or where the functioning of the youth is impacted, therapists are to work with the parents to ensure safety and well-being of the youth. In other situations where the law in Singapore pertaining to sexual behaviours is breached and where the therapist has a duty to report an offence committed, they are to work with parent to support the youth through the process, and to also support the parent in helping their child. References Adelson, S. L. & AACAP (2012). Practice Parameter on Gay, Lesbian, or Bisexual Sexual Orientation, Gender Nonconformity, and Gender Discordance in Children and Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 51(9), 957-974. Almeida, J., Johnson, R. M., Corliss, H. L., Molnar, B. E., & Azrael, D. (2009). Emotional distress among LGBT youth: The influence of perceived discrimination based on sexual orientation. Journal of Youth and Adolescence, 38(7), 1001-1014. American College of Obstetricians and Gynaecologists (2016). Committee Opinion, No. 653: Concerns Regarding Social Media and Health Issues in Adolescents and Youth Adults. Obstetrics & Gynecology, 127(2), e62-e65. American Psychological Association (2009a). Report of the Task Force on Gender Identity and Gender Variance. Available at: http://www.apa.org/pi/lgbt/resources/policy/gender-identity-report.pdf American Psychological Association (2012). Guidelines for psychological practice with lesbian, gay, and bisexual clients. Am. Psychol. 67 10-42. 10.1037/a0024659 Centers for Disease Control and Prevention (2019). Health Considerations for LGBTQ Youth. Retrieved November 19, 2021 from https://www.cdc.gov/healthyyouth/disparities/health-considerations-lgbtq-youth.htm Friedman, M. S., Marshal, M. P., Guadamuz, T. E., et. Al. (2011). A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. American Journal of Public Health, 101(8), 1481-1494. Gambadauro, P., Carli, V., Wasserman, D., Balazs, J., Sarchiapone, M., & Hadlaczky, G. (2020). Serious and persistent suicidality among European sexual minority youth. Plos one, 15(10), 1-11. Huang, Y., Li, P., Guo, L., Gao, X., Xu, Y., Huang, G., ... & Lu, C. (2018). Sexual minority status and suicidal behaviour among Chinese adolescents: a nationally representative cross-sectional study. BMJ open, 8(8), 1-9. Johns, M. M., Lowry, R., Andrzejewski, J., Barrios, L. C., Demissie, Z., McManus, T., ... & Underwood, J. M. (2019). Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. Morbidity and Mortality Weekly Report, 68(3), 67. Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Queen, B., ...Ethier, K. A. (2018). Youth Risk Behavior Surveillance—United States, 2017. Morbidity and Mortality Weekly Report Surveillance Summaries, 67(8), 1-114. King, M., Semlyen, J., Killaspy, H., Nazareth, I., & Osborn, D. (2007). A systematic review of research on counselling and psychotherapy for lesbian, gay, bisexual & transgender people. UK: British Association for Counselling and Psychotherapy. Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., ... & Brent, D. A. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. Journal of Adolescent Health, 49(2), 115-123. Mock, S. E., & Eibach, R. P. (2012). Stability and change in sexual orientation identity over a 10-year period in adulthood. Archives of Sexual Behavior, 41(3), 641-648. Ott, M. Q., Corliss, H. L., Wypij, D., Rosario, M., & Austin, S. B. (2011). Stability and change in selfreported sexual orientation identity in young people: Application of mobility metrics. Archives of Sexual Behavior, 40(3), 519-532. Peter, J., & Valkenburg, P. M. (2016). Adolescents and pornography: A review of 20 years of research. The Journal of Sex Research, 53(4-5), 509-531. Russell, S. T., & Fish, J. N. (2016). Mental health in lesbian, gay, bisexual, and transgender (LGBT) youth. Annual Review of Clinical Psychology, 12, 465-487. Robinson, J. P., & Espelage, D. L. (2013). Peer victimization and sexual risk differences between lesbian, gay, bisexual, transgender, or questioning and nontransgender heterosexual youths in grades 7-12. American Journal of Public Health, 103(10), 1810-1819. Smith S. D., Dermer, S. B., & Astramovich, R. L. (2005). Working with nonheterosexual youth to understand sexual identity development, at risk behaviours and implications for health care professionals. Psychological Reports, 96, 651-654. Tankersley, A. P., Grafsky, E. L., Dike, J., & Jones, R. T. (2021). Risk and Resilience Factors for Mental Health among Transgender and Gender Nonconforming (TGNC) Youth: A Systematic Review. Clinical Child and Family Psychology Review, 24(2), 183-206. https://doi.org/10.1007/s10567-021-00344-6youth.gov (n.d.). LGBT. Retrieved September 1, 2021 from https://youth.gov/youth-topics/lgbt Villalobos, M. C., Marshall, S. K., & Saewyc, E. M. (2020). 75. Adolescents' Self-Reported Sexual Orientation Identity and Sexual Attraction in Canada: Stability and Change Over Three Years. Journal of Adolescent Health, 66(2), S39. Walch, S. E., Bernal, D. R., Gibson, L., Murray, L., Thien, S. & Steinnecker, K. (2020). Systematic Review of the Content and Methods of Empirical Psychological Research on LGBTQ and SGM Populations in the New Millennium. Psychology of Sexual Orientation and Gender Diversity, 7(4), 433-454. https://doi.ora/10.1037/sad0000364 Wright, P.J., Herbenick D. & Paul, B (2020). Adolescent condom use, parent-adolescent sexual health communication, and pornography: Findings from a U.S. probability sample. Health Communication, 35 (13), 1576-1582 Appendix 1: Summary of Guidelines for Therapists Working with Sexuality Issues 1. Maintaining professional responsibility 1.1. Therapists are to fully and accurately present research findings that are based on rigorous scientific research design and be careful not to misuse or misrepresent these findings. 1.2. Therapists are to utilize accepted therapeutic approaches to interventions that minimize the risk of harm. 1.3. Therapists are to safeguard the confidentiality of information obtained in their provision of services and be aware of its limits. 1.4. Therapists should be aware of the laws in Singapore especially those governing sexual behaviours involving children and youth. 1.5. Therapists are not to use therapy as a platform for lobbying or advocacy, but to maintain professional integrity and ethical clinical practice. 1.6. Therapists are to refer the youth to appropriate practitioners and agencies, should more specialised services be required. 2. Understanding youth sexuality 2.1. Therapists are to be aware of the unique problems and risks that exist for youths with sexuality and gender identity issues. 2.2. Therapists are to try to ameliorate the effects of societal stigma (i.e. prejudice, discrimination, and violence) faced by on youth with sexuality and gender identity issues, and facilitate the development of coping skills in the youth. 2.3. Therapists are to understand that sexuality and gender identity is fluid in youth and young adults, and that premature sexual or gender identification should be delayed. 2.4. Therapists are to recognize that although first sexual experiences have an impact on sexuality and gender identity, this does not equate to a fixed sexual preference or gender identity. 2.5. Therapists are to discourage sexual experimentation for all youth. 2.6. Therapists are to be knowledgeable of the role of mass media, the internet and popular culture in shaping youth sexuality in general. 3. Practising objectivity 3.1. Therapists are not to impose their personal views, beliefs and values when offering professional services to youth. 3.2. Therapists should be client-centered in their approach services. 3.3. Therapists are to refer the youth to appropriate practitioners and agencies, should their personal or cultural values impede their work with the youth. 4. Working with youth and their family 4.1 Therapists are to recognise parental authority and responsibility, and to respect the personal, moral or cultural values of the youth and family. 4.2 Therapists are to facilitate the development of skills in the youth to understand and navigate different societal, familial and cultural contexts. 4.3 Therapists are to exercise neutrality in working with the youth and their family members, and to avoid taking sides. 4.4 Therapists are to engage parents and family members through enabling the youth to understand the need to speak with parents and family members in their life, where possible. Ministry of Health, Singapore College of Medicine Building 16 College Road Singapore 169854 TEL (65) 6325 9220 FAX (65) 6224 1677 WEB www.moh.gov.sg Annex B: Frequently Asked Questions (FAQs) 1. Who is required to adhere to the Guidelines? All professionals working with youth on sexuality and gender identity issues are strongly encouraged to adopt the Counselling Guidelines. 2. What channels of feedback are available for the Counselling guidelines? Feedback is always welcomed. They can be raised to MOH via email. 3. Will the public have access to these guidelines to ensure they are well-informed when practitioners cross their boundaries in their service? The Counselling Guidelines are intended to support therapists and sector professionals leveraging their clinical expertise to apply the principles appropriately. MSF is working with the Social Service Institute (SSI) to expand the training reach to all other professionals, to ensure that professionals are equipped to apply the key principles in the Counselling Guidelines. Practitioners providing counselling services who wish to obtain a copy of the Guidelines can reach out to MOH. Ministry of Health, Singapore College of Medicine Building 16 College Road Singapore 169854 TEL (65) 6325 9220 FAX (65) 6224 1677 WEB www.moh.gov.sg Edited May 5 by groyn88 Quote
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