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Clinical Supervision: Models, Role, Legal & Ethical, & Transference
Clinical Supervision: Models, Role, Legal & Ethical, & Transference

Section 30
Using External Manipulation to Treat Children & "Battered Child Syndrome"

Question 30 | Answer Booklet | Table of Contents | Supervision
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

Environmental Manipulation Treatment Approach
"Environmental manipulation", as it is called, may be essential in the treatment of children. With some children, it is particularly desirable for your supervisee to involve the child's parents in the treatment process. As you know, therapeutic gains with the child will often be short-lived unless the parents are also able to change. A meaningful relationship with the supervisee often depends upon cooperation with the parents.

This broad treatment approach, however, raises some confidentiality issues. The supervisee, as a matter of good practice, makes clear to both the child (if he or she is old enough) and the parents the type of rapport the supervisee will have with each. The supervisee 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.

There are times, however, when it may be necessary to dismiss the parents and to rely on others. The parents may not be rational about the treatment of their child. We have all encountered parents who deny treatment to an acutely ill child or who are otherwise devastating to the child’s development.

Battered-Child Syndrome
The highly publicized "battered-child syndrome" has resulted in the passage of laws requiring that physicians and hospitals, as well as mental health professionals, 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 even rank with automobile accidents.

Many people have expressed the view that such laws would be useless without a clause protecting them from retaliation by irate parents or guardians 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 with whom?

Mental Abuse
The area of mental abuse, which may be much more devastating to the development of a child, is harder to enforce. The percentage of such cases which are 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, after all, not a tangible thing.

Consider custody cases and other cases involving minors - it is often quite difficult to establish, to the satisfaction of a 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. When making a judgment call regarding abuse or possible abuse, the rights of the child regarding confidentiality may be in conflict.

Child Abuse Law
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.

Although this law is only a partial answer to the problem of child abuse, it is helping to illuminate the startling size of the problem. 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 50/50 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.

The problem 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.

Use of a Case Study to Teach an Ethical Thought Process
I use the following case study and multiple choice answers to facilitate a supervisee’s thought process.

Susie, age 12, tells the supervisee during a session that she has been sexually abused by her father. Susie immediately breaks into tears as she fears the supervisee will report it. The first response of the supervisee should be to:
a. calm the child and ask for a further clarification of the abusive situation
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 going on

The best answer is A. The question was, "What should be your first response?" The possible case of abuse will need first to be verified. Once it is verified the steps outlined in B, C, and D can be considered.

Juvenile Court Philosophy, Mental Abuse, and Psychological Age

What Should Parents Know? Civil Parental Liability
How do you present the following legal concept to your supervisee? Parents are legally responsible for their children, and consequently, they have a legal right to know about them. This is called civil parental liability. Under the law an individual is regarded as a minor until the age of eighteen, and until that time (unless legally emancipated), parents are legally responsible for the child’s care and any misdemeanors. In therapy, however, psychological age and/or the condition of the patient rather than chronological age determines the approach the supervisee will take in dealing with parents.

The requirement that a therapist notify the parents of all minors who consult the therapist would destroy service at once. As a consequence, student health services, for example, usually treat students as though they were adults.

In addition, records of the juvenile court are not open to public scrutiny. Under traditional juvenile court philosophy, a veil of secrecy is drawn over its proceedings and records.

QUESTION 30
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 be to:
To select and enter your answer go to Answer Booklet.

 
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