To Report Or Not To Report, That Is The Question

Two Column-Story Table for Second Digital Story "To Report or Not To Report That is the Question"

Title page: To Report or not to Report That Is the Question (Reporting past abuse). My 20 year old client arrives for her first appointment to discuss falling grades, conflict with her parents, a boy friend, and a lingering depression. Photo of a rather anxious young woman entering the therapy room After a short retelling of the problems that have brought her to therapy Jane states that she has never told anyone but an uncle had sexually abused her. He periodically visited her family and would “mess” with her. She disclosed that it began when she was 12 and that he had molested her on several occasions during these visits when he would come to her room in the middle of the night. Photo of sad 12 year old girl Jane states that it is a relief to tell someone and that she could never tell her family. She continued that if anyone in her family knew that it would cause a huge problem and an irreparable rift. Photo of girl and her family turning their backs to her. Jane continues to report that since her uncle moved to another state she has little contact with him. She also indicates that in the last several years she has made arrangements to be away from home when he visits. When asked she replies that she is unsure about his current contact with young children and she is surprised and anxious when she considers this possibility. Same photo fading to photo of uncle with a young girl on his lap. She concludes with a strong plea that her past abuse not be reported. Jane cries out that not only would she be devastated but that it would destroy her family and the tentative relationship she has with them. Photo of client sad and anxious. The bedrock of psychotherapy is confidentiality and all psychotherapists are trained to guard the client’s right to a confidential relationship with their therapist. If trust is broken I will violate the ethical principle of fidelity and Jane may end therapy abruptly and prematurely. I have a professional obligation to not abandon clients and this could be viewed as abandonment. Photo of Jane storming out of the therapist’s office. However, if the abuse is not reported what if other children are being abused? Again photo of young girl on uncle’s lap. California state law clearly states that I must report all reasonable suspicion of child abuse in my professional capacity as a Marriage and Family Therapist. Photo of the Welfare and Institutions Code. Ethical principles require that therapists practice nonmaleficence (which is commonly known as “do no harm”). Therapists are also expected to practice beneficence or ensure people’s well being. These principles, on occasion, compel therapists to breech confidentiality when a client’s actions pose harm to herself or others. To protect other children from harm the therapist must explore whether the client has knowledge of ongoing abuse. Since Jane is unsure the relatively unknown risk must be weighed against the possible risks to Jane if confidentiality is broken. The dilemma I am facing is a classic conflict that is difficult to resolve. I feel caught in a double bind at this point being pulled one way and then the other way. On the one hand if I fail to report this abuse I may leave other children unprotected and I recall news reports of abused and sometimes murdered children that were overlooked by many. In the case of Jane, the failure to report may cause her to feel there truly are trustworthy people and she may commit herself to therapy or there may be a different outcome for Jane. Not reporting her past abuse may simply be just colluding with her in keeping the secret giving the abuser more power over her and decreasing her autonomy. It is challenging to predict what will be in Jane’s best interest and be the best path towards her healing After a few sessions of processing the various outcomes with Jane she decides she wants to report her past abuse. I call the Children’s Protective Services in his state and an investigation is initiated. It requires many more months to process the fallout from breaking the family secret but Jane feels it is worth the hard work and she believes she made the right decision. I remember other cases and I recall various outcomes and I am reminded that it is often times impossible to persuade the client to agree to break confidentiality to protect either others or themselves. Photo of APA ethics code. Photo of a rope. Photo of discarded torn teddy bear. Photo of me on the phone and Jane in the back ground. Photo of Jane in session. Photo of me in the office thinking. As a therapist I must frequently live with the weight of ambiguity and reside in a world of shades of gray when a clear black and white answer is greatly desired.  Photo of me worried in black white. Part of the journey to more peace for me  is acceptance of the many shades of gray that are natural to life as well as to the work in a clinical setting.                 Color photo of me with more confidence and with more peace.