Psychotherapy or counseling with minors is quite a challenging work considering that its very nature poses many complications in many areas. There are ethical and legal issues to consider aside from protecting confidentiality for the minor client. The therapist must have acquired a comprehensive knowledge (a priori knowledge, as expected from a professional psychotherapist) with regards to the complexities involved in an issue/s he or she will be dealing with to steer clear further unnecessary complications. In the case (Case Study One) being studied, which is a treatment/counseling with a 16 year old who is going through depression, the real problem surfaced and became known only when the counseling began. The teenager’s depression was due to her previous bad experience that involved her deciding to have an abortion. She, in fact, had gone through an abortion which was apparently her solution to an already existing problem. Prior to her becoming pregnant, she, in spite of her being minor, which means under the care and supervision of her parents, has had a carefree lifestyle. Now, she isn’t alone in her predicament. Her parents and probably other close relatives are all absorbed in her difficult situation. Not for long, it will be realized that her problem is not hers alone. There are ethical principles involved in dealing with her case. First, the confidentiality of the matter. She was being treated and counseled to by the therapist because of the consent of her parents who are also not strangers to the practitioner. The situation poses a dilemma to the practitioner.
Should the therapist divulge the fact that the client has had an abortion recently? Applying ethical standards, to breach the confidentiality of things of which the counselor has become a privy to because of the client’s trust might be necessary considering the overall scenario. For one thing, the patient is still a minor. The parents must be involved in the whole process of counseling until emotional and mental healing is achieved (ASCA, A.7., A.8., and B.1, 1998). Second, another concern to be dealt with is the legal aspect of the teenager’s decision to undergo through an abortion (which she already did) which in the state where the child’s family resides, a 16 year old female does need to inform parents whether to have an abortion or not. Even in this seeming legality of the client’s decision to have undergone abortion, a higher ethical dimension could overrule the legal aspect.
Abortion is always risky to anybody who might be considering it, regardless of age (ASCA, A.7, 1998). The third concern posed by the case being considered is the probable premature termination of the therapy if the therapist proceeds to unveil the dilemma to the parents. Well, this very obvious and potential problem; although it definitely is not easy to reverse, however, the therapist is constrained by ethics to divulge to the parents what the teenager had chosen to do with her physical state. After various considerations, the therapist should proceed as planned to involve her parents regardless of risking the termination of therapy by the teenager and closing herself to further help in the future. This is because whatever the choice, whichever direction that may take them, there are still elements of risks involved. The point here is that the child’s ultimate well-being is taken into consideration, although when possible, she still retains the sense of control and autonomy with whatever options that are there for her.
In surveys conducted, there is a common sentiment by teens that eventually, when there is endangerment and/or threats that may be involved, they consent to having that confidentiality breached. They would still want their parents or caregivers to be finally involved and included in their dilemma (Isaacs & Stone, 1999). Based on this study, the minors expect that though their privacy ought to be respected, they also recognized that there are still certain limitations to this confidentiality.
At the bottom of this problem is the premise of collaboration of parents, the child, the school or other aspects of the society. What is crucial here is the time and effort expended to thoroughly explain the limitations of confidentiality and other provisions existing within the helping relationship (Isaacs & Stone, 1999). It is not foolproof and perfect but so far the best approach in every situation where minors are the primary clients.
American School Counselor Association. 1998. Ethical Standards for school counselors. Alexandria. VA: Author. Retrieved February 18, 2008. <http://www.schoolcunselor.org/content.cfm?L1=12&L2=2>
Isaacs, M.L., & C. Stone. 1999. School Counselors and confidentiality: Factors affecting professional choices. Professional School Counseling, 2(4). 258 -267. Accessed February 8, 2008. ProQuest Database.
Isaacs, M.L., & C. Stone. 2001. Confidentiality with minors: Mental Health Counselors’ attitudes toward breaching or preserving confidentiality. Journal of Mental Health Counseling. 23(4), 342-357. Accessed February 18, 2008.