Case+11+-+Literature+Review

Case 11 - Literature Review media type="youtube" key="6zWGsVDJcnI" width="504" height="282" align="center"

The body of research surrounding ethical issues and clients who are minors is extensive to say the least. It is a body of research that spans many disciplines outside of and within the helping professions. A common consensus among most of these disciplines is that there is far too little data on counseling minors outside of the school setting (Lawrence & Kurpius, 2000). While it is understandable that a majority of the research is done in the school setting, considering this is where adolescents and young adults spend the majority of their time, it is limiting in the sense that it creates a bias in the literature for research that can be conducted in this environment. Regardless of the environment, the body of research tends to agree on several key points that influence the study of therapy with minors, those being informed consent, confidentiality, and child-abuse reporting (Lawrence & Kurpius, 2000).

Informed consent and confidentiality are at the root of this particular case study. Informed consent for minors is see as a very valuable thing in the helping fields. One study found that 70% of psychologist obtained informed consent from their clients who were minors, even when they were not required to (Beeman & Scott, 1991). The counselor in this example is struggling with whether or not to reveal a sensitive detail about her client to that client’s mother. Even though she has received informed consent from both the mother and the client, she knows that revealing it would harm the therapeutic relationship by betraying the client’s trust, but it would also prevent the counselor from suffering any legal ramifications of not disclosing required information to the parent of a minor. The research tells us that this is a very common issue for people in helping professions. A study conducted by Issacs found that in a two year span, the majority of mental health counselors encountered this exact same scenario anywhere between one and four times (2011). With this being a seemingly frequent concern amount mental health professionals it is surprising, as one researcher notes, that the 1995 ACA Code of Ethics only mentioned the word “minor” two times. In the current version the word is listed four times outside of the appendix, but this still highlights the minimal attention this group is receiving in ethical considerations (Lawrence & Kurpius, 2000).



An Australian study, one that was very similar to Issacs’, highlighted the complex nature of ethical decisions and the discrepancy that can happen between mental health professionals when faced with the decision of whether or not to break confidentiality. This particular study distributed a series of vignettes to a large group of psychologists. Each of these vignettes was varied in some way involving adolescents with risky sexual behaviors, drugs use, and alcohol use of varying degrees and intensities. The researchers found that the psychologists were only able to reach a consensus about breaching confidentiality in 16% of the cases, and not breaching confidentiality in 41% of the cases. The most shocking part, however, was that in 43% of the cases there was no consensus about whether to not it was ethically correct to break confidentiality in that particular case. Of drug use, alcohol use, and sexual behavior, the researchers had the most difficult time agreeing on the disclosure of information when it came to sexual behavior, as can be seen in this case (Duncan, 2013).

Though this number is concernedly low, we do know that there are four primary factors that influence whether or not helping professionals feel that they need to break confidentiality. These are the negative nature of the behavior, maintaining the strength of the therapeutic relationship, the riskiness of the behavior, and the legal repercussion of the action (Duncan, Williams, & Knowles, 2012). It also seems that the age of the client plays a significant factor, as one study found that there is a very strong negative correlation between the age of the client, beginning in this study at 14, and the percentage of counselors who would break confidentiality. Simply put, the older the client was the more likely the counselor was to not tell their parents about their risky behavior, no matter what it was. 

The available research makes it abundantly clear there there is little if any consensus among members of the helping professions about when exactly to break confidentiality. Variables like age of the client, type of risky behavior, and intensity of the dilemma all play a role into whether or not each individual feels justified in breaking confidentiality. As the culture of adolescence continues to evolve more research will always be needed to keep ethical considerations as up to date as possible.

References Beeman, D. G., & Scott, N. A. (1991). Therapists' attitudes toward psychotherapy informed consent with adolescents. Professional Psychology: Research And Practice, 22(3), 230-234. doi:10.1037/0735-7028.22.3.230 Duncan, R. A. (2013). Adolescents, Risk Behaviour and Confidentiality: When Would Australian Psychologists Breach Confidentiality to Disclose Information to Parents?. Australian Psychologist, 48(6), 408-419. Duncan, R. E., Williams, B. J., & Knowles, A. (2012). Breaching Confidentiality with Adolescent Clients: A Survey of Australian Psychologists about the Considerations that Influence Their Decisions. Psychiatry, Psychology & Law, 19(2), 209-220. doi:10.1080/13218719.2011.561759 Gustafson, K. E., & McNamara, J. R. (1987). Confidentiality with minor clients: Issues and guidelines for therapists. Professional Psychology: Research And Practice, 18(5), 503-508. doi:10.1037/0735-7028.18.5.503 Isaacs, M. C. (2001). Confidentiality with Minors: Mental Health Counselors' Attitudes Toward Breaching or Preserving Confidentiality. Journal Of Mental Health Counseling, 23(4), 342. Lawrence, G., & Kurpius, S. R. (2000). Legal and Ethical Issues Involved When Counseling Minors in Nonschool Settings. Journal Of Counseling & Development,78(2), 130-136. Images from: http://pixabay.com/en/library-book-britannica-reading-488678/ http://pixabay.com/en/book-library-knowledge-education-701758/