Parents of Children in Therapy

Many times a parent that has a child in therapy will want some time with the therapist to discuss their child's progress.  Although this in and of itself is not a problem, many parents go at it in a problematic way.  How a parent requests this time can say a lot about the parent.  A therapist must keep the child's best theraputic needs in mind when dealing with a parent who is requesting information.

First and foremost the limits of confidentiality between child, therapist and parent should be discussed at the beginning of the process.  Parents can be a part of the first session, or can meet with the therapist before therapy begins.  At that time, parents can address thier concerns and goals for therapy and the therapist can discuss age-appropriate expectations.  A therapist will need to reevalute the limits of their confidentiality constantly as issues arrise and children age.  The child's best interests need to be maintained.  Standard 4.01 on maintaining confidentiality does often permit paretns access to treatment records or disclosure of nformation in order to protect the child or others from harm.  Therapists need to work with parents and children to establish boundaries and to provide a trusting place for the child to feel heard and understood. 

That being said, parents need to respect the boundaries of their child's therapy.  It's not unusual for a parent to want to talk to the therapist before their child's scheduled time.  Most time they want to talk to the therapist and discuss the previous week's activities and things they want the therapist to address during thier session.  Sometimes the parent will try to do this in the waiting room.  Parents who do this are jeapardizing their child's confidentiality because other patients could be waiting and listening to the conversation.  A therapist would need to stop the parent from discussing their child in the waiting room.  Other times, a parent may insist on going into the therapy room and taking up some of their child's time with the therapist to discuss these issus.  Although they are not breaking confidentiality, they are disrespecting their childs time and theraputic space.  If a therapist would allow this, it would distort the child's freedom to begin the session on their own agenda, and could confuse the child on who the client truely is.

When a parent insists on talking to the therapist at the end of the session, it can be even more detrimental to the process.  If the therapist does allow the parent to talk to them after the session, the child can feel that everything they just told the therpist is then being relayed to the parent.  To do this, the therpist is harming the child's sense of trust.  The child could feel that the therapist is reporting to the parent and will not confide in future sessions. 

When a therapist enounters a parent who is so eager to disregard their children's boundaries, it can tell a lot about the child's environment.  For example, a parent that insists on taking up the beginning of thier child's session could have issues of envey of the attention being shown to their child by the therapist.  It could also show anxiety about the child's privacy with the therapist, possibly shedding light on the parent's own inadequecies.  Another option as to why a parent would insist on breaking through these boundaries could be that the parent is using the therapist to fulfill the role of an absent parent. 

The solution to satisfying a parent's need for time with the therapist, and not violating the child's theraputic space, is to schedule a time when just the parent can come in to discuss issues and progress.  Structuring a time that is seperate from their child's time will remain respectful to all parties involved and maintain a theraputic and safe environment for the child. 

Sources:
Decoding the Ethics Code 3rd Edition Celia B. Fisher (2013)

Ascherman MD., L.I., & Rubin MD., S. (2008) Current Ethical Issues in Child and Adolescent Psychology. Child and Adolescent Psychiatric Clinics of North America. (2008) Vol. 17, 21-35. retrieved online at http://web.up.ac.za/sitefiles/file/43/2561/childpsychotherapyethics.pdf

Nuetrality and Children

When counseling children, a therapist needs to keep many things in mind.  First it is very important to respect boundaries.  Of course it is known that therapists can not ethically or legally enter into any type of sexual relationship with a child they are counseling.  To do this would completely undermine the therapy as well as create an exploitative relationship with the child.  This would hurt the child in many ways.  Children abused by their therapist would have extreme trust issues and problems with their self-esteem, possibly for the rest of their lives.  Below is a story that shows exactly how much trouble you can get into crossing those lines with a client who is a minor:

Family Therapist Indicted on Sex Abuse Charges


That being said, many well meaning therapist have to use their best judgement to keep appropriate boundaries respected. 

Counseling children is an endeavor in and of itself, but there are some instances that challenge even the best therapist:

Preschool children may not understand boundaries and could want to do things like:

• hug the therapist
• sit on the therapist's lap
• take off their shoes, or lift their shirt or skirt
• invite the therapist into their home
• ask the therapist to attend a school function (ie. Christmas concert)

When instances like this come up the therapist must refrain from blurring the boundaries on their most influential clients.  It may be a good idea for a therapist to work with the child to discuss acceptable boundaries. 

Even older children can pose boundary challenges for a therapist by asking personal questions about their marital status, or if they have children.  These, most times, just show curiosity and a wanting to connect with the therapist.  Again, this could be an opportunity for the therapist to explore why the child would want to know these answers, without actually answering the questions. 

A therapist to a child or adolescent needs to be cognizant of the perception the child has with the therapist. By exploring the child's perception, a therapist may be able to better recognize or understand the conflict within the child.

The best way to help a child of any age is for the therapist to remain neutral.  That doesn't mean that the therapist doesn't care about the child; but more that the therapist neither accepts or condemns the child, but remains interested.  They need to use the information and find out what is motivating the child's behavior.  A good therapist will invite discussion as opposed to expressing themselves through action. 

Sources:
Decoding the Ethics Code 3rd Edition Celia B. Fisher (2013)

Ascherman MD., L.I., & Rubin MD., S. (2008) Current Ethical Issues in Child and Adolescent Psychology. Child and Adolescent Psychiatric Clinics of North America. (2008) Vol. 17, 21-35. retrieved online at http://web.up.ac.za/sitefiles/file/43/2561/childpsychotherapyethics.pdf

Taliaferra, Lanning. Broxville-Eastchester Patch. Aug 13, 2013 Family Therapist Indicted on Sex Abuse Charges. retrieved online at http://bronxville.patch.com/groups/police-and-fire/p/family-therapist-indicted-on-sex-abuse-charges

Traditional Gender Roles and Sexism

 

The very first general principal of the Ethics Code is about striving to do good and not doing harm.  One very important thing therapists need to be cognizant of is keeping an unbiased and objective mind during therapy

Every family is different!  In my house I don't cook, my husband does...and when there is a big spider - we call my 15 year old daughter to kill it. 

Some unacceptable examples of a biased therapist would be:

• Addressing the husband when discussing family finances
• Not taking serious a wife's need for help with child rearing, or only addressing the wife when speaking about child rearing
• Assuming that remaining in a marriage would be better for the woman
• Demonstrating less interest in the woman's career than the man's
• Having a double standard when addressing a woman's affair compared to a man's
• Deferring to the husband's needs over the wife's

Another example of a therapist undermining couples therapy would be a wife that is trying to challenge traditional gender roles within her marriage, and a husband who is a reluctant sexist.   If during individual therapy sessions the therapist agrees with the wife that the husband is a sexist, they have just done harm!  The therapists role is to guide both parties to a balanced alliance!

What if a couple enters therapy and one of their goals is to reinforce sexist gender roles...what can a therapist do?   The therapist should examine how to make the relationship more egalitarian.  There is a great chance that the issue at hand is just the tip of the iceberg and the real underlying issue has more to do with more fundamental issues about how the responsibilities of the relationship are defined and delegated.  It's the therapist's job to guide them to uncovering the real issues.

It is important that the therapist recognizes their own personal views on sex roles in order to avoid imposing any of their own personal views on their clients and their families. 

It is not the therapist's role to have a predetermined idea of how a family should function.


Source: Margolin, G., (1982). American Psychologist, Vol 37 (7) 788-801, retrieved online http://gsappweb.rutgers.edu/cstudents/comps/GenComps/Gen4-7_margolin_ethical.pdf

Privacy Vs. Secrets



When dealing with couples, therapists will sometimes see each individual separately. This can lead a therapist into some ethical dilemmas if the limits of confidentiality are not discussed at the onset of therapy. 

 

First - lets make clear the difference between a secret and privacy:

 

Privacy is information that one person knows and would prefer their partner doesn't know.  Private matters do not affect the relationship and can be thought of like a person's "personal space."

 

Secrets are pieces of information that one partner has that directly affects the relationship.  People can keep secrets for a number of reasons: fear, anxiety or shame.  An example of some secrets could be infidelity or addiction.  Secrets many times lead to lies.

 

 

 



 

 There are ethical ways for a therapist to approach secrets:

 

First and foremost, the therapist should address how secrets are handled in the beginning of therapy, this way everyone will be informed and will understand the policy.

 

-  One way to handle secrets is the therapist could choose to keep all secrets private.  A therapist may chose this method to ensure trust with both parties.  Choosing this option could put the therapist in a sticky situation if a secret is divulged during individual therapy and then lied about during joint sessions.  It could undermine the work of all parties to the therapy. 

 

- A second way a therapist could handle secrets is to let both parties know that all information is property of the couple.  Anything that is shared during individual meetings would be divulged during joint therapy.  Choosing this option may keep the parties from being honest and truthful, and may lead to neglecting to recognize the real relationship issues if they are never brought to light. 

 

- A third way a therapist could handle secrets is to only keep certain information confidential.  The therapist would need to consider the information and deduce some facts about the information:

1. does the secret currently affect the relationship negatively: an example of this would be if one partner currently has a substance abuse problem that the other partner does not yet recognize.
2. does disclosing the secret have a therapeutic outcome: an example of this would be if one partner discussed an affair from 10 years ago.  If it is not an ongoing thing, divulging this information may only hurt one partner and not gain any therapeutic benefit and could actually halt all movement towards relationship goals.
3. does the secret put one partner at risk if the secret is revealed: an example of this would be if one partner discusses physical abuse during individual therapy, communicating that during joint therapy could put the abused in a position for further abuse.

If the therapist believes that divulging the information would have therapeutic gain, they would urge the participant to share the secret during joint sessions so the issue could be worked through, ultimately creating a stronger relationship.  If the party is unwilling to divulge the secret, the therapist could decide to cease all therapy until both parties are truly committed to the process. 

Because this third option relies totally on the therapist's judgment, the therapist must be committed to providing an unbiased view of the value of the secret.  The therapist must truly use their professional judgement to weigh the individuals right to privacy against the safety of the relationship.

This sticky situation is a prime example of why therapists need to discuss their policies at the onset of therapy and make sure that all parties understand and agree on them, only then can therapy progress in a healthy and open manner. 



Source: Pukay-Martin, Nicole D. Ethical Considerations in Working with Couples: Confidentiality within the Couple. retrieved online http://www.e-psychologist.org/index.iml?mdl=exam/show_article.mdl&Material_ID=92

 

 

 



Abstract

This blog will discuss some issues regarding the ethics of Family and couples counseling.
 

Ethics code 10.02 states: “Therapy Involving Couples or Families – (a) when psychologists agree to provide services to several persons who have a relationship, they take reasonable steps to clarify at the outset (1) which of the individuals are clients/patients and (2) the relationship the psychologist will have with each person.  This clarification includes they psychologist’s role and the probable uses of the services provided or the information obtained.”

 

It is important that the patients have a clear understanding of their therapist’s role.  Some clients may come in as a couple or family and it would be the psychologist’s role to treat the parties as a whole.   Other times there is a specific person that is the target of the therapy and the family is there to provide support.    Also, all parties must be willing participants of the therapy.  If they are not voluntarily agreeing to participate, they cannot be a part of the therapy. 

 

The therapist must clarify:
 (a) the psychologist’s responsibilities in balancing the interests of different individuals,
(b) whether the psychologist will conduct individual or joint therapy sessions, and
(c) how often the psychologist will meet with each party. 
 

Psychologists must also make the treatment goals clear so there is no misconception between the parties.

It is also very important for psychologists to clarify how confidential information will be handled.  It is important to remember that the therapist has a legal responsibility to break confidentiality and  disclose information about child abuse, domestic violence, HIV notification, high-risk behaviors of adolescent clients and any other instances of potential harm.  

**Source: Decoding the Ethics Code (3rd Edition) - Celia B. Fisher**

The code of Ethics for marriage and family counseling can be found here:
http://www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx