Amanda W. answered • 07/23/19
Adjunct Professor of Social Work; Licensed Master Social Worker
This is a great question and a real-world example students often encounter in which our values seem to compete. As a therapist who works with adults and children of all ages, I have encountered this multiple times. This is particularly so considering my focus of practice is foster care. Many foster youth are court-ordered to therapy with the expectation that I provide progress reports regarding their mental health regularly to the court. As an added layer, there is often no way to anticipate what of my remarks could be read aloud by the court master or judge during a hearing. There is no anticipating who may be in the court room and whether or not the youth would have wanted these remarks read aloud - particularly for certain persons present to hear.
Youth face this difficulty regardless of mandated treatment and court involvement. In some cases, the parents of youth may request their record or ask the therapist to share information. The therapist must navigate this as children may not always be regarded as self-responsible. In my state, where the age of consent is 14, it is a privacy violation for me to share anything with a parent that the youth did not consent to be shared. Although this is more clear-cut when my "duties" are evoked (e.g. "duty to report"), it is not so clear cut when my duties are not legally evoked but I think parents should know about something regardless. An example of this is a youth dating another youth I know to be involved in dangerous behavior or a youth gradually showing signs of a developing eating disorder.
I navigate these issues with youth and their parents by explaining confidentiality and the limits of confidentiality before our work begins and before any information is shared. My patients cannot fully consent to sharing any information with me until they understand how that information could be used - which is why I prioritize this. For youth, I explain the limitations of confidentiality as it pertains to their various guardians and court systems. For youth-adolescents, I explain these limitations and their enhanced legal right to confidentiality in my state. However, I adapt my own practice/informed consent requirements to include that I will, and the youth agrees, tell their parents/guardian if I think they are making choices that could harm their health or safety - even if my "duties" are not evoked.
In the specific case of program involvement described above, being clear with both the youth and the program as to what I can and cannot do (as governed by my license and professional practice standard) would be paramount before I would agree to provide the service. I would require that the youth be informed that I am mandated to share certain information they share with me to the court, and what specific information this entails. I would require that they be informed of the specific consequences of sharing this information to me which I will then be required to share with the PO. The youth will have to sign informed consent documents - including a release of information - specifying that they understand these specific terms.
Additionally, I would open direct and clear dialogue with the probation program and court. I would be willing to provide the therapeutic service given the above conversation is had with the youth and the release documents are signed. I will not provide the service without evidence of the youth's informed consent (and an established expiration date for which they must re-consent). If the youth cannot be informed fully of my role and my relationship to their court programs and obligations, I cannot provide the service.
Over my years of practice, I have developed a great number of therapeutic skills that have become powerful catalysts for change. I build rapport quickly and easily. I empathize with my clients/patients. I work every day to become more appreciative, inclusive, and understanding of the people I serve. My clients/patients are able to experience change, growth, and healing because I am a sacred guardian of trust of the thoughts and experiences that scare them the most. I have become the clinician that I am today because my clients have entrusted me with their innermost thoughts and feelings which allowed me to grow my own skill set.
Thus, under no circumstances will I ever accept or perform work where these skills are used to manipulate information from clients who are unaware for the purpose of "tattling" on them to a court system. This is a form of psychological abuse and it is unethical. Regardless of what the law says, I will not perform jobs or job tasks wherein I cannot give full informed consent or treat my clients/patients with respect.
