Novice Counselor's blog

Susan called a community counseling center seeking counseling for her daughter Leah, a 15-year-old 10th grader. Susan’s concerns about Leah included poor academic achievement during the current school year and defiant behavior at home. Leah lives with her mother, her father, and one younger brother who is 11 years old. Until the current school year, Leah had been an above average student.
An appointment was made for Susan and Leah, who were both present during the intake session with Carmen, the counselor. Carmen presented the standard “declaration of practices and procedures” document used by the counseling center. Because Leah is a minor, Carmen explained the benefits of maintaining Leah’s confidentiality while also explaining Susan’s rights as the parent to know about the counseling process. Susan and Leah both agreed that the counselor would share only genenral information with Susan, and that Leah was free to discuss any aspects of the counseling process with her mother. Carmen explained the limitations to confidentiality, including (in general terms) potential harm to self or others. Carmen asked Susan and Leah if they had any questions, and then asked them both to verify that they understood the provisions of the informed consent document. Carmen asked them each to sign the document, and she gave them a copy to take with them for future reference.

Carmen began seeing Leah on a weekly basis. As counseling progressed, Leah disclosed that she felt as if her mother was trying to control her, and she resented what she considered to be her mother’s excessive involvement in her life. In today’s session, Leah revealed that she is secretly dating a boy named John who is 18 years od, and that her mother is not aware of her relationship with John. She stated that her mother does not approve of her dating. Leah added that she was considering having sex with John. In further exploring this issue, Carmen explained that counselors have a legal obligation to report situations that involve a minor having a sexual relationship with a legal adult, and that John, at age 18, was considered an adult. Leah was adamant in insisting that Carmen not tell her mother about anything whe had revealed ab out her relationship with John. She thought for a minute and then told Carmen she had a solution to the problem. She stated, “Well if I do decide to have sex with John, I just won’t tell you about it. Then you won’t have to talk to my mother.” (Herlihy & Corey, 2006)

Counseling minor clients poses many questions and ethical dilemmas concerning confidentiality. In this case, the counselor has to keep a delicate balance between disclosure and still trying to maintain the client’s trust so she will to continue with counseling. If the counselor tells the client’s mother that the client is considering having sex with an adult male, it could potentially damage the client’s trust in counseling. At the same time, if the counselor does not tell the client’s mother of the situation, the counselor could be held liable later.
According to (Beeman, Scott, 1991) the rights of adolescents to give informed consent hinge almost exclusively on their capacities to comprehend information and to render competent decisions. Furthermore, several authors have suggested that older adolescents are competent to provide informed consent for therapy decisions. A study indicated that the majority of minors were interested in participating in the planning and decision making for their treatment. They also found that the majority of minors perceived themselves as competent to participate, knew what outcomes they wanted, and followed through when given the opportunity. Three quarters of the counselors who participated in the study indicated that parents do not have free access to information regarding the therapy of their adolescent children. These same counselors also stated that limits of confidentiality were the most important aspect of informed consent from adolescents.
Respondents in the study viewed the following as more important to be provided to adolescents than to their parents: the provision of session time, place, setting, and duration; the nature of the sessions and what will take place; and the intended outcome of therapy (or goals and objectives of treatment). The therapists surveyed also considered three types of information as more important to be provided to the parents of the adolescent client than to the adolescent: financial cost, a description of the therapist’s theoretical orientation, and the therapist’s training and qualifications. (Beeman, Scott,1991)

The Novice Counselor’s opinion on how to handle the situation leans toward postponing disclosure to the parent until the issue of sexual involvement with an adult is further explored with the client. The counselor should warn the client about the possible risks and consequences of a sexual relationship. She should also alert the client that she is required by law to notify authorities (not necessarily her mother) of the fact that an adult male is in a sexual relationship with a minor. This of course may cause the client to withhold information if the relationship progresses to the sexual stage. Nevertheless, the client needs to be notified of the counselor’s legal responsibility. Which brings up another question: does the counselor need to know the name of the adult in order to make the report? What if the client refuses to disclose the name? Does that free the counselor of the responsibility to report to authorities? The Novice Counselor would consult with a legal professional.

Another venue to explore is a joint therapy with the mother and daughter to explore the daughters perception that her mother is trying to control every aspect of the daughter’s life.

References:

Beeman, David G.; Scott, Norman A.;Therapists’ attitudes toward psychotherapy informed consent with adolescents. Professional Psychology: Research and Practice, Vol 22(3), Jun 1991. pp. 230-234.

Corey, G., Corey, M., Callanan, P., (2007). Issues and ethics in the helping professions, (7th, ed). United States: Thomson Brooks/Cole.

Herlihy, B., Corey G.; ACA Ethical Standards casebook (6th edition) American Counseling Association, 2006.