Discussion on Ethics & Informed Consent for Teenage Client ✓ Solved

Discussion on Ethics & Informed Consent for Teenage Client

In this discussion, we will explore the policies and requirements related to informed consent in Virginia, especially concerning a 16-year-old Native American female client during an intake session. Informed consent is a crucial framework in counseling and therapy that upholds the ethical principle of respecting a client's autonomy while ensuring that they understand the processes involved in their treatment.

According to the laws of Virginia, informed consent must be obtained from a client prior to initiating any therapeutic services. This consent should detail the purposes, goals, techniques, procedures, limitations, potential risks, and benefits associated with counseling services (Commonwealth of Virginia, 2020). It’s important to note that a minor is defined in Virginia as any individual under 18 years, which means that parental or guardian consent is typically required for treatment (Commonwealth of Virginia, 2020). However, exceptions may arise depending on the circumstances surrounding the minor’s situation.

Counselors have a duty to protect third parties, and if a client shares any intentions to cause bodily harm to themselves or others, it is the counselor's obligation to take appropriate actions to warn or protect potential victims (Virginia Code §54.1-2400.1). Thus, in the case of our client who has previously engaged in self-harm, the counselor must handle the situation sensitively yet responsibly.

When explaining confidentiality to the client and her mother, it is critical to communicate clearly using language appropriate for their understanding. I would articulate the significance of this information as follows: “I want to go over some very important information about confidentiality and ensure you both understand. This is a safe space where you should feel comfortable sharing anything with me, and what you disclose here is confidential. However, there are three instances where confidentiality may need to be breached. First, if I have any reason to believe you might hurt yourself or someone else, I must inform the authorities. Second, if I’m required to do so by a court order, or third, if there is involvement or harm against minors, the elderly, or those with disabilities. Do you have any questions?” This approach ensures both parties feel informed and included in the conversation (Young, 2017).

In assessing the suicide risk for the client, it is important to utilize a comprehensive approach. The acronym IS PATH WARM serves as an effective screening tool, along with the SAFE-T assessment, to help evaluate suicidality (Young, 2017). Given the client’s history of self-injury and indications of sadness, it is essential that the counselor explores the nature, severity, and frequency of her suicidal thoughts and behaviors during subsequent sessions. Questions should be framed with sensitivity and empathy, allowing her to articulate her feelings without feeling pressured. For instance, I might ask, “Can you tell me more about what you mean when you say you feel ‘down’?” or “What was going through your mind when you tried to cope with those feelings?” This encourages open dialogue while gathering the necessary information.

Working with a teenager requires the counselor to maintain awareness of developmental considerations and cultural nuances. Teens often struggle with expressing their emotions clearly, necessitating a nurturing and patient approach (Young, 2017). Furthermore, as our client is Native American, cultural considerations must be highly regarded, as they may affect her perspective on mental health, help-seeking behaviors, and engagement in therapy. I would benefit from culturally-informed questions to better understand how her background influences her emotional state and coping mechanisms.

During the intake session, the mother’s presence can provide valuable insights into the client’s history, yet this should be carefully balanced so as not to inhibit the adolescent’s engagement in the counseling process. Initially, the mother's involvement is beneficial, especially in explaining informed consent and pertinent background information. However, as therapy progresses, it would be prudent to conduct sessions without the mother to allow the client to express her thoughts freely. After establishing a trusting relationship, I might explore the deeper aspects of her feelings during private sessions to encourage authenticity and self-exploration.

Ultimately, addressing the client’s “down” thoughts requires a comprehensive evaluation while providing a safe space for her to express herself. Engaging in future sessions will be vital to explore the origins and situations surrounding her emotional struggles, ensuring that we maintain an open channel of communication.

Future Considerations

As counseling progresses, it will be essential to monitor any changes in the client’s mood and coping mechanisms while reinforcing the self-regulation techniques. Collaborating with the mother, when appropriate, may help build a supportive environment for the client while maintaining boundaries. It will also be crucial to remain aware of any indicators suggesting that the client is struggling and adapting the approach accordingly. Regular assessments and revisiting the confidentiality agreement may aid in maintaining trust and rapport.

References

  • Commonwealth of Virginia. (2020). Administrative code. Virginia Law. Retrieved from [URL]

  • Young, M. (2017). Learning the Art of Helping: Building Block and Techniques. New York, NY: Pearson.

  • Klonsky, E. D., Victor, S. E., & Saffer, B. Y. (2014). Nonsuicidal self-injury: what we know, and what we need to know. Canadian Journal of Psychiatry, 59(11), 565-568.

  • National Institute of Mental Health. (n.d.). Suicide Prevention. Retrieved from [URL]

  • American Psychological Association. (n.d.). Guidelines for Adolescent Psychological Services. Retrieved from [URL]

  • Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Retrieved from [URL]

  • National Alliance on Mental Illness. (n.d.). Mental Health Information: Children and Teens. Retrieved from [URL]

  • American Counseling Association. (2014). ACA Code of Ethics. Retrieved from [URL]

  • Centers for Disease Control and Prevention. (n.d.). Youth Risk Behavior Surveillance. Retrieved from [URL]

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: APA.