Geldard, K., Geldard, D., & Yin Foo, R. (2013.). Ethical considerations when counselling children. In Counselling children: A practical introduction (4th ed.), (pp. 16-19). SAGE.
Counselling children presents unique ethical considerations. Such considerations often don’t have a clear solution: shades of grey can be more frequent than black and white! Indeed, similar ethical considerations may require different approaches depending on the unique characteristic of the child, family and situation. The codes, frameworks, and guidelines provided by the British Psychological Society (BPS, 2002, 2009), British Association for Counselling and Psychotherapy (BACK, 2010), British Association of Play Therapists (BAPT, 2000), Australian Psychological Society (APS, 2007, 2009), and Queensland Counsellors Association (QCA, 2009) are essential starting points. Speaking with a supervisor can also be a helpful source of guidance. There are also a number of ethical decision-making models that may help when thinking through an ethical issue (e.g. Miner, 2006: Pope and Vasquez, 2007). In this chapter we aim to discuss some of the ethical considerations we have experienced when counselling children. Rather than providing solutions, we hope that this discussion will instead be an additional source of guidance and reflection during your own practice.
Our approach to counselling is based on the Sequentially Planned Integrative Counselling for Children model (the SPICC model), which we will introduce in more detail in Chapter 8. There are five phases in the SPICC model and we will discuss the ethical considerations which arise in each of these phases. The first phase in the SPICC model is that of relationship-building. This initial phase is focused on developing a positive child-counsellor relationship in which the child feels comfortable, safe, valued, respected, and free to share their story. In setting up this supportive environment, a number of ethical considerations arise.
Informed Consent
As highlighted in Chapter 1, it is generally the parents who bring the child for counselling rather than the child seeking this relationship for themselves. Hence, while obtaining informed consent from the parent/s is important, it is equally important to obtain the informed consent of the child. Indeed, both the BPS and APS stress the importance of providing children with the opportunity to understand the counselling service being offered (BPS, 2009) and to provide their consent ‘as far as practically possible’ (APS, 2007). Furthermore, including the child in the process of informed consent is a way in which to give them a voice in the process of counselling: encouraging feelings of being valued and respected. We would like to invite you to take a moment to brainstorm some factors which might impact on the process of informed consent. One factor we would like to draw your attention to in particular is the developmental level of the child: does the child have the cognitive and emotional ability to understand the nature of, and make a decision about, the counselling relationship (Lawrence and Robinson Kurpius, 2009)?
During the process of obtaining consent, another situation which may arise is when one party gives their consent but the other does not. This can raise a number of possibilities to consider! What if the child does not provide their consent but the parents are keen for their child to receive counselling? How would you proceed if the child seeks counselling, for example within a school environment, but doesn’t want their parents to know? What factors might impact on your decision? It is difficult to provide a definite answer for many of these questions as each child, family, and situation is unique and must be considered in context (Hall and Lin. 1995). However, it is important to keep in mind that the child is most likely to benefit from counselling when they enter the child-counsellor relationship voluntarily, that is, with their informed consent (Bond. 1992).
Confidentiality
It is important to be very clear about confidentiality and its limits when commencing a new counselling relationship (Mitchell et al., 2012). In particular, when working with children it is important to consider what, and how, information is shared with parents and associated parties. Additionally, it is important to keep in mind our duty to warn and reflect on how this might be accomplished while maintaining a supportive child-counsellor relationship. Our duty to warn covers risk of harm to the client or others (Mitchell et al., 2002). Many associations provide guidelines for reporting risk of harm, particularly when this concerns child abuse and neglect (e.g., APS, 2009: BPS, 2007). It is worthwhile to familiarize yourself with these guidelines along with your local legislative requirements or any organizational guidelines which apply to your counselling context. A further discussion on confidentiality regarding sharing information with parent/s is covered in Chapters 2 and 9.
Another aspect of confidentiality is the documentation of the counselling process. It is important to consider who has access to this documentation, how the documentation is protected, and how to respond to requests for documentation. It is important to ensure that any confidential client information is securely stored, including both hard and electronic copies, and accessible only to the counsellor. When a request for information is received, speaking with the child and/or parents is always a good starting point. If the request comes in the form of a subpoena or court order you may also want to seek the advice of a supervisor or lawyer. A good general rule to follow is to ‘disclose only that information which is necessary to achieve the purpose of the disclosure, and then only to people who are required to have that information’ (APS, 2007: 16). It is also important to consider what information is included in the client’s file. Information should be comprehensive and factual: free of judgmental and emotive language.
Including Family Members
Children come within a family! Therefore it is important to consider the child within the context of their family and to be aware of the possible ethical considerations which may arise. As highlighted earlier, it is generally the parent/s who initiate the child-counsellor relationship with certain goals in mind. However the child may also bring their own goals to the counselling relationship. This raises the question: who is your client? In particular, whose goals are to be followed? As highlighted in Chapter 1, it is important from the outset to be clear about the goals of the counselling relationship and to fre-quently reflect on these goals as the child-counsellor relationship develops. This process can become more challenging when there are different goals or opinions about the counselling process from different family members. How might you approach a situation where the parents have different views about what the counselling should focus on? Or if one parent does not want their child to enter a counselling relationship at all? In some situations, for example if parents are separated or divorced, one parent may not want the other to be informed about the child accessing counselling or receive limited information. On the other hand, the child may express a wish that their parent/s not be informed about certain information. How would you approach such a situation? Do the parent/s in question have a right to be informed? The APS provides some helpful guidelines around provision of counselling when a child’s parents are separated or divorced (APS, 2009), with a focus on keeping clear communication open with the child and involved parent/s.
Another consideration when working with children and their families is whether or not the presenting issue is such that counselling within the context of family therapy may be more suitable. For more information about counselling children within the context of family therapy please refer to Chapter 9.
Connecting with Associated Parties
Sometimes it is important to consult, work with, or gather information from associated parties in the child’s life such as schools, doctors, and other professionals. How might you continue to maintain the child’s sense of trust and safety with the child-counsellor relationship while making connections with associated parties? What if the child or parent/s insist that the associated parties not be contacted? Again, speaking with the child and/or parent/s first is a good starting point. Discussing the potential pros and cons of connecting with associated parties and what (and how) information is to he shared may help to find a solution the child and parents are comfortable with. This discussion may then form the foundation for obtaining the required verbal and written consent from the child and parent/s to connect with an associated party.
Once a child-counsellor relationship has been developed, the next step is maintenance of this relationship in such a way as to support increased awareness and change. The maintenance of the relationship corresponds to Phases 2 to 5 of the SPICC model (Chapter 8) during which the child increases their awareness (Gestalt Therapy), changes their view of self (Narrative Therapy), challenges any self-destructive beliefs (Cognitive Behavior Therapy, CBT) and rehearses and experiments with new behaviors (Behavior Therapy).
Boundaries and Power in The Child-Counsellor Relationship
It is the responsibility of the counsellor to maintain appropriate boundaries within the child-counsellor relationship. From the outset of the counselling process it is important that the child and parents understand the nature and limits of the child-counsellor relationship. Setting up boundaries about your role as a counsellor includes: time (for example, session length and availability outside the session); place (where the sessions take place); self-disclosure (how much disclosure is appropriate); behavior during the sessions; and appropriate touch (Gutheil and Gabbard, 1993). Maintaining clear boundaries defines the child-counsellor relationship as a professional one. While it is important for the child to feel safe and supported, the relationship remains different to a personal adult relationship.
Another consideration which falls under the boundary maintenance is that of power imbalance in the client-counsellor relationship, which can be magnified when working with children.
Power imbalances will always be present, however it is very important to reflect on and guard against the consequences of power imbalances. How can you identify when a power imbalance is impacting the child-counsellor relationship? One sign, which may indicate the impact of a power imbalance, is dependency developing within the child-counsellor relationship. The counsellor may also notice themselves becoming more directive rather than allowing the relationship to be child-led. Feelings, such as protectiveness for the client or frustration that the client isn’t ‘fitting into’ your plan, may also be indicators of a power imbalance starting to impact on the child-counsellor relationship. Such factors can lead to the child feeling disempowered with the relationship. The disempowerment can then lead to decreased effectiveness within the counselling relationship. Children may respond to power imbalances by either withdrawing or attempting to comply with what they feel is expected of them (Bond, 1992). As such, it is important to guard against the consequences of power imbalances to ensure the child doesn’t feel disempowered and to maintain the effectiveness of the counselling relationship. Indeed, the BACP guidelines highlight the importance of respecting and encouraging the autonomy of the client (BACP, 2010). How might you guard against setting up dependency and disempowerment within the child-counsellor relationship? In what ways could you encourage the autonomy of your client within the child-counsellor relationship? We believe that ongoing self-reflection is a good starting point, along with appropriate supervision. Ensuring a safe and supportive environment for the child to share within and taking your lead from the child where possible can also help to limit the consequences of power imbalances.
