A 16-year-old you are seeing for counseling has disclosed that she's been sexually intimate with her 22-year-old boyfriend and does not want you to tell her parents.
Analyzing and deducing the scenario, the first issue is that the 16-year-old client is a minor, who is below the legal age of eighteen years. The second and central issue is that she is engaged in a sexual relationship with a boy older than her (22 years) –which is a legal offense. Finally, since the client-counselor confidentiality constrains a therapist, the fact that the teenager asks me not to tell her parents presents an ethical quagmire. The fundamental precept regarding the dilemma here is whether the need to protect the minor supersedes or transcends the ethical standard of client-counselor confidentiality.
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As such, in dealing with the scenario above, both ethical standards and state law will guide solving the issue. According to Brooks et al. (2013), the American Counselling Association (ACA) maintains that the counselor’s primary responsibility is respecting the client’s privacy and dignity, and that trust is the cornerstone of the counseling relationship whereby confidential information should not be disseminated without the client’s consent without sound legal or ethical justification. ( https://www.counseling.org/docs/default-source/vistas/minors-rights-to-confidentiality-when-parents-want-to-know-an-ethical-scenario.pdf?sfvrsn=12 ). This ethical standard was developed in 1961, revised in 2005 and updated in 2014.
Thus, because the client is a minor and is under the parent’s protection, I am ethically bound to report the teenager’s sexual relationship with an elderly guy to the parents as a way of protecting her. However, the information shared should only go as far as the sexual relationship is concerned and nothing beyond that. Nonetheless, due to the respect of confidentiality and consensual ability of the minor, I will first give her the chance to tell her parents, failure to which, I will step in. This is because I am bound by the ACA ethical codes to ensure the welfare of the client.
Legally, statutory rape laws maintain that an individual is guilty and culpable by merely engaging in a sexual relationship with a minor below the age of consent (18), and this does not require any evidence of force or coercion because the adult is considered to be in a position of power over the minor ( https://blogs.findlaw.com/blotter/2014/07/is-sex-between-minors-a-crime.html ). The law was developed in the 1970s and was revised in the 80s and has since faced exclusive revisions in different states which set different consent ages. The law is meant to protect the minor, and further, the adult is as well responsible for protecting the minor.
Thus, the sexual relationship in the scenario between the client and the 22-year-old boy is against the laws, and I have the legal responsibility to report the relationship to relevant authorities.
The parents of a 13-year-old child you are counseling are worried about the child's increasing "isolation" and "secrecy" and want to know what he has been talking about during the counseling sessions
Analyzing the scenario, it is evident that this is an ethical dilemma or issue. However, both ethical standards and state laws will apply. The dilemma is informed by the client-counselor confidentiality as specified by the ACA that obligate me to respect the client’s right to privacy, yet the parents as the legal guardians of the minor demand to know the details of the counseling sessions. Here, since the patient is a child and is incapable of providing informed consent, I have the responsibility to the parents to proffer to them the information they need regarding the child. However, this should not be in the form of telling on the child, which could ruin the therapeutic progress of the child or relationship with me.
Essentially, neither confidentiality nor privacy is an autonomous right afforded to minors. The law, according to Behnke & Warner (2002) state that minors, especially under the age of 18, cannot generally consent to treatment, their parents or guardians consent on their behalf. ( http://smhp.psych.ucla.edu/qf/confid_qt/Confidentiality_in_treatment_adolescents.pdf ). Though the law traces its roots back in England, it was not until the 19 th century that the sovereign United States promulgated the consent laws. These later faced reforms in the 20 th century (1920s), especially regarding consent age and most states have further updated and revised the law independently since 2008.
In this regard, the 13-year-old is considered the patient, but the parents are the clients, and therefore, I must maintain a relationship with both. Because the law requires the parents to have access to the child’s treatment, I have a legal obligation to tell the parents what is bothering their child and why he is secretive and isolated. However, as per the APA ethical standards, proper clinical treatment requires respecting the minor’s privacy and independence as a developmental process. Though this contradicts the law, the child’s psychological welfare is of salience above all. As such, the parents need to respect his/her privacy and wait for the child to make the first step of socializing and opening up to them, no matter how long it takes.
The teacher of a 9-year-old child you're seeing in family therapy requests feedback about how the child is progressing.
Contemplating the scenario, this is an ethical issue, particularly regarding jurisdiction, and as such, ethical standards will apply. In essence, the counseling services I provide for the child are family-based and not school-based, and as such, the teacher has no jurisdiction regarding the details of the therapy sessions. I have to protect and respect the clients’ and child’s privacy or confidentiality as per counseling ethical guidelines. However, the teacher in this scenario is not requesting for details of the treatment but rather the progress of the child. Since school and the teacher form the psychosocial environment of the child central to his or her development, it is prudent to inform the teacher of the child’s progress in general terms without specifics. Further, I will advise the teacher on what stressors to avoid, and if at all, the child requires special treatment from the rest. However, this will not be done without the consent of the child’s parents.
As a professional courtesy, informing the teacher regarding the child’s progress could be useful in treating the child because this way, I can control the child’s school environment in addition to his or her home environment and thus bolster the child’s health outcome. In essence, having access or managing the child’s psychosocial settings can not only empower him or her but also protect the child, thereby positively boosting his psyche towards a healthy and social life.
References
Behnke, S. H., & Warner, E. (2002). Confidentiality in the treatment of adolescents. Monitor on Psychology , 33 (3), 44. http://smhp.psych.ucla.edu/qf/confid_qt/Confidentiality_in_treatment_adolescents.pdf
Brooks, B., Fiedler, K., Waddington, J., & Zink, K. (2013). Minors’ rights to confidentiality, when parents want to know: An ethical scenario. ACA VISTAS Online , 26 . https://www.counseling.org/docs/default-source/vistas/minors-rights-to-confidentiality-when-parents-want-to-know-an-ethical-scenario.pdf?sfvrsn=12
