Unlock the complex ethical considerations of counseling minors with the guidance of a special guest: Hannah Salazar, a seasoned therapist and professional school counselor who joins us to share her rich experience. Navigating the sensitive issues of consent, confidentiality, and mandatory reporting, Hannah illuminates the intricacies of these topics through the lens of a therapist working with young clients. Her wisdom provides listeners with strategies for clear and age-appropriate communication to ensure young clients are both safe and heard within the therapeutic relationship, all the while respecting the ethical codes that govern the profession.
The episode journeys through the ethical mazes faced by child counselors, exemplified by the stories of Emma and Michael, two teens wrestling with their own critical challenges. Through careful examination and empathetic dialogue, we delve into the tough decisions that therapists must make when the veil of confidentiality and client well-being are at odds. Hannah's insights, particularly her innovative approach to helping teens self-reflect, underscore the pivotal role of empathy and collaboration in therapy. For those in the field, or simply interested in the ethical dimensions of counseling, this discussion is a treasure trove of practical advice and moral guidance, reinforcing the essential nature of professional ethics and support networks for therapists.
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Unlock the complex ethical considerations of counseling minors with the guidance of a special guest: Hannah Salazar, a seasoned therapist and professional school counselor who joins us to share her rich experience. Navigating the sensitive issues of consent, confidentiality, and mandatory reporting, Hannah illuminates the intricacies of these topics through the lens of a therapist working with young clients. Her wisdom provides listeners with strategies for clear and age-appropriate communication to ensure young clients are both safe and heard within the therapeutic relationship, all the while respecting the ethical codes that govern the profession.
The episode journeys through the ethical mazes faced by child counselors, exemplified by the stories of Emma and Michael, two teens wrestling with their own critical challenges. Through careful examination and empathetic dialogue, we delve into the tough decisions that therapists must make when the veil of confidentiality and client well-being are at odds. Hannah's insights, particularly her innovative approach to helping teens self-reflect, underscore the pivotal role of empathy and collaboration in therapy. For those in the field, or simply interested in the ethical dimensions of counseling, this discussion is a treasure trove of practical advice and moral guidance, reinforcing the essential nature of professional ethics and support networks for therapists.
If you need to study for your national licensing exam, try the free samplers at: LicensureExams
This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG, CRCC, or any state or governmental agency responsible for licensure.
Linton:
Hello all you studious therapists out there and welcome to Licensure Exams Podcast. I'm your host, linton, and with me always is my co-host, stacey.
Stacy:
Hi everyone. In today's episode we're going to be talking about ethical issues that therapists face when working with clients who are minors. To help us tackle this complex topic, we have a special guest joining us from well. Usually she's in Dayton, ohio, but right this very moment she's down in Florida.
Linton:
Hot and sunny Florida.
Stacy:
I heard it. I heard it Dayton Ohio. Another person who has decided to settle in the Midwest.
Linton:
Our numbers are growing, yeah sure, sure, but nothing is growing 90 percent of the year up there in the frigid Arctic Stacey.
Stacy:
Hey, it was a bombly 35 degrees here the other day. Half the town had on t-shirts and shorts. But back to our very special guests. We give you Hannah Salazar. Welcome, hannah. Hi, thank you so much for having me as a bit of background for our listeners. Hannah is both a therapist and a professional school counselor. If that's not enough, she also tutors new therapists who are working to pass their licensure exam. For all you TikTokers out there, hannah's got a TikTok account that's great for students who are studying for their exam. Hannah, what's your handle on TikTok so that our listeners know how to find you? Can you tell us a little bit about what you share with people?
Hannah:
Yeah, sure, the handle is at the good neuron. A little tongue-in-cheek there. We got to have those good neurons. But really I started that just to help others as they're studying for their licensure exams. Then I go over the different domains. I do a weekly what the diagnosis? Where I try to just create a random narrative in my head and I'll post it on there and then we can talk about how would you treat this, what's the diagnosis and what modality would you use, what interventions would apply, just to give someone that extra bit of practice and really study tips as they sit for their exam.
Stacy:
Okay, that's great. Well, thank you, Hannah. One of Hannah's specialties is working with children and adolescents, and she's here today to give us some insight into how to approach ethical issues with this population, which is something that you'll definitely need to know about for your exam.
Linton:
That's right. As we all know, working with children and teenagers presents a unique set of challenges. Did I say that diplomatically? Let's start off broadly before looking at specific examples. Hannah, what are some of the major ethical issues therapists face when working with children and adolescent clients versus adult clients?
Hannah:
Yeah, okay, thanks guys. So yes, working with children and teens definitely comes with a unique set of challenges. For sure, the ethical issues are going to differ, primarily around the consent, confidentiality and reporting requirements. So with adults, they provide their own legal consent to enter therapy. They'll sign all the paperwork. But when you have child and adolescent, since they can't legally provide that consent until they reach age 18, you as the therapist have to obtain consent from their legal guardian, while still explaining therapy in an age-appropriate manner to the client. So it's often complicated by different family dynamics and sometimes, whether the child or the teen actually wants to be there in therapy, they can present a different whole or different set of challenges.
Stacy:
Gotcha, that definitely makes sense so far. So you mentioned confidentiality. How is that different when you're working with someone who's under the age of 18?
Hannah:
So confidentiality with minor clients definitely has more limitations, especially around abuse and neglect. The therapist we are mandatory reporters, which means that we are legally required to report suspected child abuse or neglect to authorities. So this often means, even if it's mentioned by the child in therapy, you report it. There's really no great area at all there.
Linton:
Whereas if you're working with an adult, that client, if they disclose that they're being abused, you would not report that, but would instead empower them to connect with appropriate resources and support them in safety planning. However, the ultimate decision and timeline belongs to the client.
Hannah:
Yeah right, exactly so. If an adult client discloses abuse to a therapist, confidentiality still applies, you know, bearing imminent danger of that person, obviously. But with minors, that same latitude around confidentiality and self-determination does not apply in most abuse cases, really in all of them. So this is something I tell my minor patients in our first session together. I bring it up right away so they know that my goal is always to keep them safe, even if that means I have to break our confidentiality sometimes.
Stacy:
Okay, so the significant differences between counseling adults versus minors really relate to consent and confidentiality. Which brings me to my next question how would you go about explaining confidentiality to a child or a teenager in an age-appropriate way, Hannah?
Hannah:
Yeah, so I might see something like what you say in here with me. Does not leave this room, but I do, however, have to call someone else. If you tell me someone is hurting you, or if you want to hurt yourself and plan to, or you want to hurt someone else and plan to, I will let you know if I have to do, if I have to make that call, but it is something I have to do because I want you safe and not hurting anymore. Do you have any questions about that? So that's kind of like something that I would keep very age-appropriate. I would modify as I would need to, so for younger children, I would use very basic language and help them to understand.
Hannah:
I also remind them often because kids tend to forget session to session. So, but I always really tell them beforehand. I know some clinicians are, they don't, but if a child says, hey, someone's hurting me, I remind them of our conversation and I say, hey, do you remember how I said I needed to call someone if this happened to you? This is that time now. Do you have any questions about what happens? That way it doesn't seem like I'm doing it behind their back or that I'm betraying their trust and it's really important to remain collaborative and, especially as we talk about working with teens and that whole age group, we want to make sure that rapport is still there.
Linton:
Yeah, great Thanks, hannah. Now let's transition a bit. We've got a few cases covering tricky scenarios related to ethics and child counseling.
Stacy:
All right, so let's first take a look at Emma. She's a 16-year-old high school junior who's struggling with an eating disorder and self-harm behaviors that she mostly hides from her family and friends. Her parents catch glimpses of what seems to be odd behaviors, like restrictive eating, excessive exercise and hiding her body, but Emma insists that nothing is wrong. Her parents are concerned about her, so they scheduled an intake session with you and they shared their fears that Emma could be suffering from an eating disorder or depression. Emma arrives so long to the first session, but as therapy progresses, she begins opening up about the intense pressure that she feels to be thin and popular, combined with a distorted body image. As you build rapport over subsequent sessions, emma reveals exercising for several hours and secret each night, along with cutting her wrists at times to relieve emotional pain. You've developed a good therapeutic relationship, but her parents remain unaware of the full extent of her struggles.
Linton:
Wow. Well, hannah, how would you navigate informed consent, privacy rules and disclosure requirements based on that scenario?
Hannah:
Emma's got a lot going on there. Firstly, as a therapist, I would validate Emma's courage in inviting to me. While explaining my role to her is that to ensure her safety and well-being. So, given that her self-harming behaviors, I would need to definitely inform her parents, with her permission if possible, or without her permission if she refuses. So Emma's confidentiality is limited as a minor, unfortunately, and her health is seriously being endangered by her behaviors. So I would encourage Emma to tell her parents jointly, but failing that, I would schedule an urgent session to disclose the details.
Hannah:
There's a risk that this breach of trust could harm our therapeutic alliance, but ethically it would be very necessary to do, given that the cutting behaviors are coupled with extreme caloric restriction. So that sounds harsh, but I would take more of a collaborative approach with her when possible. So I might say something like you know, hey, emma, do you remember how I talked about me to tell someone if you hurt yourself? Adding your risk meets that criteria and so does over-exercising. Would you like to help me come up with a way to tell your parents?
Hannah:
I know it'll be really hard, but I'm here with you and I would love for you to leave this conversation. I can help you write a letter you can read to them if they get upset. Just know I'm here and I want you to feel better. Plus, it'll be really helpful to have a team with us to help you more. What do you think about that? So, by phrasing it and having that type of collaborative language based in a response to what's going on with her, it helps so much that the team knows you're on their side and that you're going to trust their judgment, but also be a little forthcoming with the parents.
Linton:
Wow, so what happens if they refuse?
Hannah:
So that has happened. But if it does, it definitely does happen. I approach in a different way and I would say something like I know, I know this is scary. This has been your secret for a long time and telling our secrets feels wrong because we're afraid we're going to be in trouble or that someone is out to get us with our secrets. I promise this isn't me getting me out to get you. Can you tell me why you don't want anyone to know about these secrets? What benefits are you getting from it? A response like this enables a child to go a little deeper into their motivations and stays on the same team together. I never go directly to the parents without having these hard conversations, even if session goes a little longer than usual. It does more harm to just authoritatively or what I call parentify yourself in front of the children or the teenager. I do try my best to get permission from the teenager. Usually it works eventually and we agree on a way to tell the parents together.
Stacy:
In this case, Emma's safety has to come first, even at some possible cost to report. Is there anything else you'd like to add, Hannah?
Hannah:
Yeah, so sometimes just seeking supervision and these cases is so very helpful. It's helpful still to really understand why the hesitation or lack of motivation to tell others about the secrets. I definitely have reached out to my mentor with certain cases and we've collaborated on how to remain empathetic to a child while still holding our boundary of we have to tell someone.
Linton:
Well, that's a good point. So consulting a colleague or your supervisor is an excellent idea If you're ever in doubt. Let's explore another case that's relevant to this topic. Michael, a 14 year old male, has started coming to therapy, as his teacher suggests, due to anxiety impacting his grades and friendships. In the second session he tearfully reveals to you that he is gay, but begs for you not to tell his parents. You ask him questions about his home life and whether he feels safe with his family. Michael explains that, while he doesn't fear direct physical harm, his rather conservative religious parents have made clear statements that homosexuality is moral and unnatural. So he has this intense anxiety that if they find out they may kick him out of the house or force him into conversion therapy against his will. Can you identify any potential ethical dilemmas with this one?
Stacy:
Okay. So one that I see is that, as a therapist, you have competing obligations providing Michael with a safe space to talk about his sexual orientation versus ensuring that his parents are informed about his mental health challenges and not putting him at risk if they react really poorly to his disclosure. So how might you navigate this situation, hannah?
Hannah:
Yeah, so this is not a fun one. I've definitely experienced a lot of these types of cases in real life and, honestly, they do break my heart, and in this particular case, you always have to weigh whether or not there is immediate danger to the child. If there isn't, then you don't have to break confidentiality and you can work alongside the patient to ensure that when they're ready to tell their family that you're going to help them and be there for them. If they're never ready, then that's okay too. I definitely would ask about other support systems in their life maybe friends or siblings or cousins or aunts and uncles you know someone else to see what support they do have and how they can be transparent with them. I would also research local LGBTQIA plus youth programs that could offer support to Michael and schedule frequent check-ins. This is also why we do not allow parents to read our personal psychotherapy notes.
Stacy:
Yes, yes, excellent. Well, I think we've got time for one more case, so let's dive into Serena, who is 12 years old, and she was referred to therapy by her pediatrician due to symptoms of depression and isolation. Early in your sessions, serena eventually disclosed that her coach, vincent, had been singling her out for extra practices involving increasingly intimate physical contact, which made her really uncomfortable. While Serena insists that Vincent hasn't directly abused her, his lingering touches and requests that she keep their extra training their little secret leave her filled with anxiety. As her therapist, you have serious concerns that Vincent may be grooming Serena for sexual abuse. However, serena pleads with you not to tell anyone, for fear that she'll be pulled from the swim team and that no one's going to believe her. So how might you handle this one, hannah?
Hannah:
Seems pretty clear cut to me. So this would be one that you would have to report this to the proper authorities. Mandatory reporting laws require you to alert authorities and parents to investigate the coach's highly suspicious behavior. But further than that, despite Serena's plea for you to keep it a secret, we still have to go through with it. I would say most of the same approach to approach this with empathy and collaboration first, Because we always need to start there. Sometimes you do have to outline the dangers to the kids. I have even said you know what would you tell your best friend if this was happening to her or him? And then light love will go off and it changes to them understanding like, oh yeah, wait, this is not okay. So always, always, try to maintain a collaborative and pathetic approach when possible. Teenagers are very insightful and sometimes just need to be guided there, so her safety and protection override confidentiality here, even at some risk to your therapeutic alliance and rapport.
Stacy:
Okay, great, thank you. Now, as we wrap up, any final thoughts on additional resources or best practices for therapists who are facing ethical issues like these on the exam or in the real world.
Linton:
Well, this is one that I always suggest is don't forget the go to the code of ethics. It's a great resource to those that are studying for your exams. Thanks for joining us today, hannah, and if you're studying for your exam and need individual attention, contact Hannah at 937-932-1116 for a free 15 minute consultation. What was that number? Again, stacy.
Stacy:
All right, Hannah's number is 937-932-1116. Now, as we always say, remember it's in there.
