feel the best answer is D, ask the child in private how the cut and
the reason I feel D is the best answer is because I feel, if confronted,
Helen (the mother) may feel pressured to lie about the injury if, in fact, abuse
is involved. The best situation is to ask the child when Helen is not present.
If that was not a choice, it would be better to either extend the session and
discuss it or consider making it an agenda item at the next meeting or try to
contact Jodie, setting up a meeting without the mother.
R Slovenko in his book Psychotherapy, Confidentiality and Privileged Communication writes... Child therapy can never be a strictly two-person arrangement.
This is strikingly noted in Freud's treatment of little Hans. It was the father,
not Freud, who actually carried out the analysis. Freud himself had only one interview
with the boy, but he had frequent consultations with the father. (Freud for some
years previously had known the parents; he had treated the wife before she was
married, and the husband had attended his lectures.)
Ethics - Environmental Manipulation Treatment Approach
manipulation" as it is called, may be essential in the treatment of children.
With some children, it is particularly desirable to involve the child's parents
in the treatment process. As is well known, therapeutic gains with the child will
often be short-lived unless the parents are also able to change. A meaningful
relationship with the therapist often depends upon cooperation. The therapists
may find sensitive teachers who may be able, in consultation, to contribute effectively
to the child's treatment through the teacher-pupil relationship.
broad treatment approach, however, as you know, raises some confidentiality issues.
The therapist, as a matter of good practice, makes clear to both the child (if
he is old enough) and his parents the type of rapport he will have with each.
Confidentiality, viewed realistically, is maintained. There is no publication
to the world. The psychiatrist in this situation is working with persons who are
directly responsible for the patient and who can assist in the treatment. Parents,
after all, are legally responsible for their children.
are times, however, when it may be necessary to dismiss the parents and to rely
on others. The parents may be psychotic or otherwise disturbed. All physicians
have encountered parents who deny treatment to an acutely ill child or who are
devastating to the child.
highly publicized "battered-child syndrome" has resulted in the passage
of laws requiring that physicians and hospitals report cases of child abuse observed
in the course of their professional practice. Physical assaults on children reportedly
may be "a more frequent cause of death than such well-recognized and thoroughly
studied diseases as leukemia, cystic fibrosis and muscular dystrophy, and it may
rank with automobile accidents."
Many physicians have expressed the view
that such laws would be useless without a clause protecting them from retaliation by irate parents who are investigated. Hence, the laws that have been enacted
contain provisions protecting those reporting against any civil liability that
might arise out of compliance with the statutory requirement. By involving children,
parents, and the legal system, the question becomes where do you draw the line
of confidentiality and to whom?
make it mandatory for physicians and institutions to report physical abuse of
children to the appropriate authority.
Ethics - Mental Abuse
area of "mental abuse," which may be much more devastating to the child,
is harder to enforce. The percentage of such cases, serious in nature, can well
be imagined to be multifold the number of cases of physical abuse. However, a
law requiring the reporting of "mental abuse" may be less workable than
the "child abuse law." Mental abuse is not a tangible thing.
consider custody cases and other cases involving minors -- it is often quite difficult
to establish, to the satisfaction of the judge, that parents are so cruel to their
children as to warrant judicial action, or when such a fact is established, there
is little the court can do about it (except remove the child from custody of the
parents). While the court cannot command good parenthood, social casework in conjunction
with legal action may sometimes help.
As you know, it may happen that abusive
parents will not bring their child to therapy for fear of a report, or they may
take their child out of therapy should abuse be reported. A judgment call regarding
abuse or possible abuse, rights of the child and confidentiality often times are
Child Abuse Law
Monrad Paulsen of the Columbia Law School, commenting on the child abuse law,
points out that such laws are not enough. He observes: Mandatory
reporting is only the tip of the iceberg. The problem is whether social agencies
have the manpower to implement the reports. And, the country's social agencies
are now stretched to the limit.
do not contend that this law is even a partial answer to the problem of child
abuse. It is helping to illuminate the startling size of the problem. We think
there are many answers to the question of how to stop the problem of child abuse.
Once the child is found, it is up to the whole network of community agencies,
which exist for the protection of children, to assume their appropriate roles
in being sure that the child is kept from being either killed or maimed by any
further action on the part of his parents.
Recent reports show that there is at
least a fifty/fifty chance that a beaten child will suffer further damage if vigorous
action is not taken on his behalf. If it is necessary to remove him permanently
from his home, another home must be found. What is urgently needed now is a general
public understanding that these services must exist in every community.
of child abuse is not a simple one. Of course, if the child's parents can be rehabilitated,
every effort should be made to be sure that they receive all the help they can
use. But, the basic need is to protect the child. In this involvement of a whole
network of community agencies and removal from the home, confidentiality risks increase.
Online Continuing Education QUESTION
Susie (12 years old) tells the therapist during a session that she has
been sexually abused by her father. Susie immediately breaks into tears as she
fears the therapist will report it. The first response of the therapist should
a. calm the child and ask for a further clarification of the abusive
b. explain to the child that the therapist has no choice, and it
must be reported immediately
c. tell the child that it is for the best in
the long run, and she must trust the worker
d. explain the legal requirements
and what will probably happen to the child as a result if the abuse is currently
To select and enter your answer go to .