Tag Archives: Pediatrics

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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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