Treatment of Minors Vignettes

Catherine Atkins, JD
Deputy Executive Director
The Therapist
 March/April 2012

Four vignettes are presented below discussing hypothetical situations involving the clinical treatment of minors. We invite you to provide CAMFT with your written analysis of the legal and ethical issues evident in each of the following four vignettes and the actions taken by the therapist. In an upcoming issue of The Therapist, CAMFT will print the best overall response(s), as judged by Jill Epstein, David Jensen, Catherine Atkins, Sara Kashing, Ann Tran-Lien, and Michael Griffin. In addition, CAMFT will provide two (2) self-study continuing education units* for members who answer all four (4) vignettes. Please Note: To receive any continuing education units, you will need to answer all four vignettes.

1. Linda (12-years-old) asked LMFT Mary if she could come in for therapy to discuss her parents’ divorce. LMFT Mary decided that since Linda was 12 years old she could consent for herself. In yesterday’s session, Linda admitted that during times when she was extremely distraught about her parents’ divorce, she had taken it out on her boyfriend, Bobby (17-years-old.) She told LMFT Mary that one time she hit even him with a baseball bat causing Bobby to blackout. Because Linda is only 12 years old, LMFT Mary decided not to make a child abuse report.
2. Susie (16-years-old) and Susie’s parents came in to discuss treatment with LMFT Mark. LMFT Mark reviewed his standard informed consent with both Susie and her parents, including a section on confidentiality which briefly mentioned reasons for a breach of confidentiality including “harm to self.” After the third session, Susie admitted to LMFT Mark that she was sexually active with a few different people in her high school, and that she smoked marijuana on weekends. LMFT Mark determined that this did not rise to the level of “harm to self” worthy of a breach of confidentiality but instead he would work with her clinically. After the fifth session, she told LMFT Mark that she had been “cutting” but never near an artery. LMFT Mark again determined not to breach confidentiality. After the seventh session, Susie told LMFT Mark that she had been drinking heavily, and had started blacking out at parties, waking up in strange beds (clearly having had sexual intercourse). LMFT Mark decided to tell Susie’s parents about the drinking and blackouts.
3. Fred (8-years-old) was brought for treatment by his parents to work with LMFT Mike. Both Mom and Dad signed consent forms and said they looked forward to LMFT Mike working with Fred. After a few sessions, Fred admitted that Dad had hit him on many occasions. Accordingly, LMFT Mike made a child abuse report. The next day Dad called LMFT Mike and stated that he withdrew his consent, and that LMFT Mike could no longer see Fred. LMFT Mike believes Fred desperately needs treatment, but is afraid of Dad making a complaint against his license with the BBS.
4. LMFT Mable has been seeing Davey (5-years-old) for almost a year. Throughout the treatment, Davey has talked about his relationship with his parents and how their divorce makes him sad. Davey has indicated that while he loves his Mom, he likes spending time with his Dad more because his Dad doesn’t yell at him as much and Mom seems to always “be out.” Recently, Mom has called LMFT Mable and asked for a copy of Davey’s file so she can “use it in the custody battle.” LMFT Mable is not sure whether she is legally mandated to turn over the file to Mom. Also, she recently received a subpoena from Dad’s attorney for Davey’s file. LMFT Mable is not sure if she can legally or clinically should turn over the files.

Remember, to receive the two (2) self-study continuing education units, you must answer all four (4) vignettes. Please address the following for each vignette:

1. Discuss whether or not, in your opinion, the therapist’s conduct is appropriate in the context of any and all laws, regulations, and ethical standards that may apply.
2. Explore any other options that are available to the therapist and any potential consequences of those options. Indicate what you believe to be the best course of action, in light of the applicable laws, regulations, and ethical standards. 

We are interested in the specific reasons for any positions that you take. Mailed responses must be typed and submitted to: CAMFT, 7901 Raytheon Rd., San Diego, CA, 92111. Responses may be submitted as e-mail attachments to: vignettes@camft.org. In order to be considered, your response must be received by CAMFT on or before May 18, 2012.

Catherine L. Atkins, JD, is a Staff Attorney and the Deputy Executive Director at CAMFT. Cathy is available to answer members’ questions regarding business, legal, and ethical issues.

*BBS Provider #PCE 50