ethics question

[Cayetana]

Say that you are counseling a group of teens for "anger management". One of them says in group that she is tired of her neighbor putting his hands on her when his wife isn't around, and when she gets home she is going to get her father's shotgun and blow him away. What would be the therapist's ethical resonsibility?
Thanks!

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[Neuro-Dr]

The short answer is tell your supervisor, the longer would be consult Tarisoff and state laws.

 

[toby jones]

Might be useful to assess how much it was a report of a serious intention to act rather than a matter of her venting her distress. Might also be the case that his 'putting his hands on her' without her consent is unlawful and hence she could put an end to it by informing the authorities.

 

[Therapist4Chnge]

The short answer is tell your supervisor, the longer would be consult Tarisoff and state laws.

Yup.

When in doubt..........CONSULT.

-t

 

[psych00]

Consulting would make sense, since they would probably have more experience with this kind of thing. I did clinical interviews for a while and we had to inform each person before beginning the interviews some of the exceptions to confidentiality including, if there was any abuse of a minor occurring, and any threats by the person to themself or others, then we had to notify the other person involved and the "proper authorities". Not sure what the legal conditions are in each kind of setting but, I'd say definitely you have to consult with a supervisor, make sure something related to your actions has been documented, as well as to make sure there is some kind of action taken. It could be a lose-lose situation: some abuse is going on, and/or the threat may be real, so it is better to be safe (make sure appropriate action is taken) than sorry (either violate confidentiality by disclosing the information in an incorrect way, or choosing to not report the abuse or potential for harm to others).

 

[apumic]

Yeah, I agree.

From my understanding, two major limits to confidentiality have been breached here--abuse of a minor (legally assault, if he's touching her in an unwanted fashion, potentially sexual)--and a threat of death.
That should at least be reported to your clinical supervisor, and it would make sense that they would further refer it to the authorities, since she has threatened her neighbor in therapy, and also because there is an indication that a minor may be being sexually assaulted.

 

[psychgeek]

Talking to a supervisor is a good idea if he or she is across the hall. Otherwise you would have to take action to prevent harm with or without consulting first.

 

[sunlioness]

I think the first thing to do would be to talk to her individually after group about both what exactly her neighbor is doing to her and to further assess the nature of her homicidal ideation. If she is being abused by her neighbor and she has genuine homicidal intent, both need to be dealt with immediately. The abuse must be reported to the authorities and she needs inpatient hospitalization, involuntarily if necessary. And if she has access to a gun, that gun needs to be removed from her home.

Though there is something niggling in the back of my head about that maybe the authorities may not be able to do anything about the abuse because a neighbor (unlike a parent or a teacher) isn't in a caregiver role. Nevertheless, I'd report it anyway and let them figure it out. Do this girl's parents know that she is being abused by their neighbor? I'm not saying to tell them, I'm just wondering.

 

[psych00]

Well actually, if an adult is sexually assaulting someone, it doesn't really matter what their relationship is to the teen, caregiver or not - the authorities still have to deal with a sex offender and (if the teen is a minor) pedophile/child predator/etc.

Not sure exactly how things work with the threat part...

PS- what does niggling mean?

 

[sunlioness]

No, not really. We are not legally obligated to report a case of an adult being abused. As a matter of fact, to do so against the wishes of our client would be a confidentiality violation.

nig·gle –verb (used without object), -gled, -gling. 1.to criticize, esp. constantly or repeatedly, in a peevish or petty way; carp: to niggle about the fine points of interpretation; preferring to niggle rather than take steps to correct a situation. 2.to spend too much time and effort on inconsequential details: It's difficult to be meticulous and not niggle. 3.to work ineffectively; trifle: to niggle with an uninteresting task.

 

[psych00]

Oh yeah, if it is an adult who doesn't want to report abuse then that's their own problem. If it is a minor I think you have to, unless the laws there are different from any laws that I know of. Anyway, in the case of a teenage adult I just mean that if the person wants to file a complaint/press charges that the authorities would have to follow through regardless of whether the person was a caregiver.

PS- thanks for the definition, I never heard of that lol

 

[sunlioness]

Oh yeah, I agree with you on that. If someone presses charges for something, yeah, the police have to follow through. I'm talking about our role as mandatory reporters of child abuse to child protective services. I seem to recall something that if the adult is not in a defined caregiving role (like a parent or a teacher) to the child, that the child protective people can't do anything about it. But I could be totally misremembering something. And like anything else, it's going to vary by state anyway.

You're welcome.

 

[pingouin]

Oh yeah, I agree with you on that. If someone presses charges for something, yeah, the police have to follow through. I'm talking about our role as mandatory reporters of child abuse to child protective services. I seem to recall something that if the adult is not in a defined caregiving role (like a parent or a teacher) to the child, that the child protective people can't do anything about it. But I could be totally misremembering something. And like anything else, it's going to vary by state anyway.

You're welcome.

I do forensic abuse/neglect assessments in a peds ED, and you are spot on. The key words are that the perpetrator must have "care, custody, or control" to have child protection intervention, otherwise it's just a police matter. I have worked several cases where a minor family member has been the perpetrator (and I'm talking a 6 y/o perping a 4 y/o or the like) and they will usually accept those reports for lack of supervision on the part of the parent, as well as safety issues if the perpetrator still has access to the victim.

 

[psychgeek]

I do forensic abuse/neglect assessments in a peds ED, and you are spot on. The key words are that the perpetrator must have "care, custody, or control" to have child protection intervention, otherwise it's just a police matter. I have worked several cases where a minor family member has been the perpetrator (and I'm talking a 6 y/o perping a 4 y/o or the like) and they will usually accept those reports for lack of supervision on the part of the parent, as well as safety issues if the perpetrator still has access to the victim.

True, but this does not change your duty to break confidentiality; it only changes the agency you inform.

 

[pingouin]

absolutely. I was referring to her statement regarding being a mandatory reporter to child protection agencies.