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CEFS501 Ethical and Legal Issues in Counseling

Question:

Case Study- Confidentiality Issues When Minor Children Disclose Family Secrets in Family Counseling

Individuals involved in family counseling have the right to confidentiality, but do minor children within the family have that same right? Various professional counseling specialties are faced with confidentiality issues when children and adolescents are involved in counseling including school counselors, clinical mental health counselors, and family counselors. Counselors are often faced with minors disclosing family secrets and other controversial information during counseling sessions. Fall and Lyons (in press) discussed the ethical considerations of family secret disclosure from an adult perspective and in the larger family counseling group session context. This article continues to address a variation of the theme of family secrets while bringing to light how confidentiality relates to minor children expressing family secrets during individual sessions.

Confidentiality is the cornerstone of the counseling relationship be it individual, group, or family counseling (Smith, 1999). Family counselors are generally trained how to address confidentiality from an adult perspective when it comes to the family context. How confidentiality with minors is viewed in the family may be a different matter, because it is not uncommon for relevant third parties, such as parents, to request access to this information.

Family Secrets

Families come to counseling for many reasons. Generally, there is disequilibrium in the family, in some fashion, which contributes to the family seeking professional counseling services. This may be voluntary or forced on them by interested third parties such as school systems, state child welfare systems, or the juvenile court systems. Families generally have secrets that they bring to the counseling session, which may or may not be revealed during counseling. The literature is replete with information on family secrets (Imber-Black, 1993; Vangelisti, 1994) and how to incorporate them in family therapy and counseling (Brendel & Nelson, 1999; Fall & Lyons, in press; Vangelisti, Caughlin, & Timmerman, 2001).

Unfortunately, there is a dearth of information in the literature addressing family secrets revealed by minor children, and the information that is in the literature often focuses on revelation of family secrets in the family group session, not during individual sessions with the counselor. Huber (1999) discussed how family secrets that involve children can be critical to family counseling and may “violate that child’s rights to a complete self-definition and identity” (p. 26) if not addressed appropriately in counseling.

Confidentiality With Minors

Counselors often face a dilemma when working with minor children because there is no clear-cut rule that guides professional counselors in working with minor children when issues of confidentiality arise. The literature consists of contradictions when addressing the limitations of confidentiality with minors in counseling. Thompson and Rudolph (2000) indicated that parents have the legal right to know what happens in counseling sessions with minor children. Several other authors support this opinion (Corey, Corey, & Callanan, 2002; Lawrence & Robinson Kurpius, 2000).

Individual Sessions With Minors

Family counselors are ethically obligated to inform their clients of their theoretical framework, treatment approach, confidentiality, education and professional training, and risks of counseling (Huber, 1999; International Association of Marriage and Family Counselors, 2002; Kaplan, 2000; Margolin, 1982; Remley & Herlihy, 2001; Smith, 1999). Informed consent needs to specify the family counselor’s policy in regard to individual counseling sessions with family members and specifically with minor children. If individual sessions are deemed appropriate, the family counselor needs to clearly state the confidentiality policy related to individual counseling sessions, if individual sessions are an option, especially relating to minor children, at the outset of family counseling.

Case Example

A child and family counselor has been working with a family (mother, stepfather, and 15-year-old son) for several months, focusing on parenting issues and some moderate parent/child conflict. Additionally, the counselor has been conducting individual counseling with the teenage boy regarding peer relationship problems, anger management, and personal issues between the boy and his biological father. Despite a slow start, the counselor has developed a good rapport with the teenager. At the very beginning, the counselor discussed the basic limitations of confidentiality with both the parents and young man (i.e., suicide, homicide, and child abuse). During one particular individual session, the 15-year-old divulges that he recently went to a neighborhood party while on a visit with his biological father. He describes a rather wild scene, with much underage drinking and some sexual activity. He also discloses to the counselor that he was offered marijuana at the party, and he smoked some.

Despite becoming rather intoxicated, the client was able to keep his biological father from finding out about the party. He has not told his mother or stepfather about the incident, fearing they might curtail his visits to his father’s home. The counselor processes this information with the client, discussing the potential dangers of drug and alcohol use and the potential consequences of deceiving one’s parents. The counselor strongly encourages the client to be honest with his parents and tell them about the party.

The client has a strong negative reaction to that idea and refuses to even consider telling his parents. During the next family session, the client’s mother expresses her concern that her son is not adequately supervised during his visits with his biological father, who works second shift and does not return home until midnight. The teenage son denies this and blames his mother for trying to stop him from seeing his father. The mother and stepfather look to the counselor for an opinion.

Case Discussion

Obviously, the counselor would be in a very difficult situation in the above case scenario. On the one hand, the behaviors of the 15-year-old could reasonably be construed as “dangerous,” and therefore informing the parents would be a reasonable act of looking out for the safety and welfare of the client. If the counselor should choose to keep this information in confidence, he or she would be running the risk that the parents might find out about the party from some other source. If they also found out that the counselor had known of the incident and not informed them, they might feel betrayed by the counselor.

On the other hand, the basic limitations of confidentiality that the counselor outlined at the beginning of therapy with the teenager included issues such as suicide, homicide, and child abuse. The teenage client would almost certainly not view his drug/alcohol experience in the same category as these other safety issues and would probably view the breaking of confidentiality as a violation of trust by the counselor.

This would undoubtedly affect the future therapeutic relationship between the counselor and the client, both in individual and family counseling. One could easily imagine other twists to this scenario that would further complicate the issues. There could be unprotected sex at such a party. There could be more serious drug use (i.e., cocaine, crack, ecstasy, etc.). The biological father might knowingly allow such behavior, considering it mere “experimentation.” The client could be a girl instead of a boy. The client could be an 11-year-old or a 17-year-old. To help resolve this ethical dilemma, one can review the IAMFC ethical code (2002) for guidance. 

When it comes to working with minor, what are you biggest apprehensions?

How would you work to tailor best treatment practices from adults to children/adolescents?

KL Class Reflection Question – Be prepared to discuss the assigned case study and questions during KL class.

Based on the case study in the article, do you think the counselor has the right to breach confidentiality?

What 2014 ACA Ethical Codes led you to your decision?

Which ethical decision making model could you use to help reach a final decision?

CEFS501 Ethical and Legal Issues in Counseling

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