Daily Archives: August 5, 2010

Ethical Issues to Consider When Counseling Minors


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Four ethical issues consistently emerge when one considers children as clients outside the school setting; counselor competence, informed consent and a minor’s ability to enter into a contractual relationship, confidentiality, and child abuse reporting.  (Lawrence & Robinson-Kirpius, 2000)  Although no plan of action can completely remove the possibility of a malpractice lawsuit, there are strategies that would allow us to minimize that risk.

On the subject of competence, there are specific skills and knowledge required when one intends to counsel children. Aside from familiarity with the disorders that are specific to and primary found among children (i.e., ADHD, Separation Anxiety Disorder, and RAD), being an effective counselor for children requires a foundation in theoretical models that are generally applied to children and their needs.  Examples might include theories of ego identity, moral, psychosexual, and cognitive development specific to the context of serving children.  All levels of the clinical experience need to be modified to be developmentally appropriate, including assessment, diagnosis, and treatment.  “Because minors are a special, diverse client population, ethical practice mandates distinct education, training, and supervised practice before commencing independent practice that includes minors.”  (Lawrence & Robinson-Kirpius, 2000, expression ETHICAL ISSUES)

“Informed consent involves the right of clients to be informed about their therapy and to make autonomous decisions pertaining to it.”  (Corey, Schneider-Corey, & Callanan, 2007, p. 160)  Typically, a minor can enter into a contractual agreement in one of three ways; with parental consent, involuntarily at a parent’s insistence, or by court order.  The most common scenarios involve getting parents or caregivers involved with the process.  Without that involvement, we risk being sued for failure to gain consent.  Although court ordered treatment does not typically require parental consent, it is considered best practice to inform parents as soon as it is reasonably possible.  Similarly, in the case of emergency, minors can typically provide informed consent when delay of treatment would endanger their life or health, but again, parental consent should be obtained when possible.  (Lawrence & Robinson-Kirpius, 2000)

Confidentiality is of primary concern when working with minors, primarily because inconsistencies exist where what is legally required may not coincide with what is ethically desired.  “The basic dilemma with respect to confidentiality is who is the client, the parent or the child.”  (Lawrence & Robinson-Kirpius, 2000, expression Confidentiality)  Ideally, counselors should involve parents and create a “three-way bond of trust.”  When that is not possible, or otherwise resisted by the minor in question, it is suggested that we encourage disclosure by underscoring possible benefits.  Once parental consent is obtained, it is critical that we strive to maintain balance and clearly define limits to our ability to disclose information.

Child abuse, and the reporting of that situation, is one of the most common breaches of legal and ethical standards.  “This may be because reporting abuse can disrupt not only the therapeutic relationships but also disrupt and irrevocably destabilize the family in which the abuse occurs.”  (Lawrence & Robinson-Kirpius, 2000, expression Child Abuse Reporting)  Nonetheless, reporting child abuse is mandatory in all 50 states, and should be considered as one of our primary responsibilities as practicing clinicians.

As one can surmise, there are a number of possible scenarios where ethics and legal obligations collide.  Because I am going to be entering the profession as a novice counselor, I am most concerned with the definition of “competence.”  If at that time I have any withholdings regarding working with the minor population, I would certainly seek out supervision or continuing education.  Furthermore, I can minimize the risk of working with this population by familiarizing myself with state law that pertains to informed consent with minors.  Although it is not exclusive to practicing with this population, I would attempt to keep accurate and objective records of all interactions with both the parents and the child client.

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References

Corey, G., Schneider-Corey, M., & Callanan, P. (2007). Issues and ethics in the helping professions (8th  ed.). Belmont, CA: Brooks/Cole.

Lawrence, G., & Robinson-Kirpius, S. E. (2000, Spring). Legal and ethical issues involved when counseling minors in nonschool settings. Journal of Counseling and Development : JCD, 78(2), 130-137. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=52748628&sid=1&Fmt=3&clientId=4683&RQT=309&VName=PQD

Depression – the illness that’s still taboo


Call me a glutton for punishment, but I really enjoy reading firsthand accounts of mental illness. I feel like it puts me “closer” to the people who have it.  This is one of the best firsthand accounts of depression I have read to date, I couldn’t resist the temptation to share it.

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http://www.guardian.co.uk/lifeandstyle/2010/aug/02/depression-mental-health-breakdown

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Proposition 8 (H8) – What do you do when the H8 is in your office?


On the eve of a spectacular win for the gay/lesbian bisexual population, let us consider some of the fallout for those of us who endeavor to support those populations.

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How do we as therapists come to terms with our more conservative clients?

I’m not sure how I would react if a client started “gay bashing” in my office, but it’s fair to say it would be extremely difficult for me to remain objective.  I think my reaction to the situation would probably manifest in both intentional and unintentional reactions.  Even if I said nothing, I am pretty confident that even the most indiscriminate client could tell it bothered me… especially if they knew me well (my forehead gets really flush when I get upset).  Before I jumped to the last resort, a referral, I would at least attempt to inquire what in the clients experience causes them to feel like that.  Perhaps that worldview comes as a result of a generalization based on one (or a few) bad experiences with members of the gay community?  (I digress) In any event, I would try to control my feelings as best I could, and depending on the situation and the context, I may be able to get through the session and continue to be productive in therapy.  Without a doubt, I would probably walk away from the session thinking less of my client, which is definitely not “objective” by any means.  It would suffice to say that it would probably be best for me to refer some of these clients who present this perspective.

I think the best way to make your boundaries known is during intake, since at that point the client can determine whether or not to work with you at the outset.  I think if you are anything less than “full disclosure” about your limitations from the outset, you are doing are potentially doing more harm than good.  In as much as I would like to be “a fix-all,” in most situations I don’t think I can fix that.  In the end, I think it would depend a lot on the specific situation and the history I have with the client.  I would probably react a lot differently if it was with a client with whom I had a long client-counselor relationship.  I would rather “nip that in the bud” and disclose my position right away… it seems like it would save me a lot of time and headaches.

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Are you a professional that is forced to deal with the H8?  I’d love to hear your perspective on the issue!

^CKB