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Consent, Confidentiality, and Privileged Communication can be tricky concepts in the profession of counseling particularly when working with minors. FIRST, define each term. SECOND, review the two vignettes below address points A and B below. I expect you all to have healthy debate around these issues.
You may need to review laws in the state where you hope to practice as the “age of consent” may vary by state based on the chronological age of the child and/or the reason why they are seeking treatment.
1. Susie (16-years-old) and Susie’s parents came in to discuss treatment with LMFT Mark. LMFT Mark reviewed his standard informed consent with both Susie and her parents, including a section on confidentiality which briefly mentioned reasons for a breach of confidentiality including “harm to self.” After the third session, Susie admitted to LMFT Mark that she was sexually active with a few different people in her high school, and that she smoked marijuana on weekends. LMFT Mark determined that this did not rise to the level of “harm to self” worthy of a breach of confidentiality but instead he would work with her clinically. After the fifth session, she told LMFT Mark that she had been “cutting” but never near an artery. LMFT Mark again determined not to breach confidentiality. After the seventh session, Susie told LMFT Mark that she had been drinking heavily, and had started blacking out at parties, waking up in strange beds (clearly having had sexual intercourse). LMFT Mark decided to tell Susie’s parents about the drinking and blackouts.
2. LMFT Mable has been seeing Davey (5-years-old) for almost a year. Throughout the treatment, Davey has talked about his relationship with his parents and how their divorce makes him sad. Davey has indicated that while he loves his Mom, he likes spending time with his Dad more because his Dad doesn’t yell at him as much and Mom seems to always “be out.” Recently, Mom has called LMFT Mable and asked for a copy of Davey’s file so she can “use it in the custody battle.” LMFT Mable is not sure whether she is legally mandated to turn over the file to Mom. Also, she recently received a subpoena from Dad’s attorney for Davey’s file. LMFT Mable is not sure if she can legally or clinically should turn over the files.
A. Discuss whether or not, in your opinion, the therapist’s conduct is appropriate in the context of any and all laws, regulations, and ethical standards that may apply.
B. Explore any other options that are available to the therapist and any potential consequences of those options. Indicate what you believe to be the best course of action, in light of the applicable laws, regulations, and ethical standards.
