Ethical Issues for Children in Therapy

Informed consent

The vignette regarding ten-year-old Jimmy would need informed consent from his parents before speaking with her. Jimmy is a minor, according to the AAMFT Standard I Responsibilities to Clients, a person who is age or legally mentally incapable of giving informed consent, the marriage and family therapist must get the proper permission from a legally authorized person.  (American Association for Marriage and Family Therapy, n.d.). A marriage and family therapist will need to take the appropriate steps to avoid conditions and multiple relationships with the clients that could impair professional judgment or risk of having personal relationships. In this case, the therapist takes Jimmy in her office to speak to him one on one. Having a one on one relationship could make Jimmy believe the therapist will take his side and believe what he has to say before listening to his parents. The therapist will listen to the parents speak after the one on one, making them feel uncomfortable because they are unsure what Jimmy has said about them.

Confidentiality

The marriage and family therapist may want to talk to the parents about substance abuse going on in their home. It could entail breaking the confidentiality with Jimmy. The father offering Jimmy to join in with him to partake in using substances could be something that needs to be turned over to Child Protective Services (American Association for Marriage and Family Therapy, n.d.). The therapist is a mandated reporter; therefore, if they find reasonable cause for the child that could be hurt, it could be up to the therapist to notify the appropriate legal department. According to American Association for Marriage and Family Therapy, emotional neglect includes chronic domestic violence, allowing the child to use drugs or alcohol and withholding affection (American Association for Marriage and Family Therapy, n.d.).

In this case, according to Jimmy, his father has offered him to use substances to relieve his anxiety and depression. According to the American Association for Marriage and Family Therapy, the brain of the abused or neglected child can be as much as twenty percent smaller than a child who has not been abused or neglected (American Association for Marriage and Family Therapy, n.d.). Complex processes in the brain are dependent on nurturing and supportive interactions with the child’s primary caregiver. When they fail, the child can have behavioral, emotional, learning, and perception difficulties throughout their lives (American Association for Marriage and Family Therapy, n.d.). In the case of Jimmy, who is a ten-year-old child, complains of anxiety and depression, which are distinct disorders of children who are abused or neglected. 

The benefits of marriage and family

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The Marriage and Family therapist will allow the family unit to have a better understanding of addiction and how it affects behaviors (Zak, 2018). In this case, the therapist has become aware of family dynamics. If the maladaptive family patterns continue the use of substance abuse, the family unit should be treated for the best positive outcome. The family will need better communication skills in order to work recovery. In this case, the marriage and family therapist will need to teach the parents and Jimmy about setting boundaries. If the parents insist on using alcohol in the home, Jimmy may need to live with a relative who can care for his needs. Jimmy may have a diagnosis of Post-Traumatic Stress Disorder since he is scared of getting into an accident while his parents are under the influence of drugs or alcohol. The child may have been in the car when an accident has almost occurred or something that scared him he is recalling. The therapist can aid the family with processing the trauma through psychoeducation, skills training on how to manage distressing thoughts, feelings behaviors, and improving parenting skills and family communication (American Association for Marriage and Family Therapy, n.d.). The parents may have come from a background where drug and alcohol use was shared, and the child was allowed to use. The therapist will work with the adults to break old habits and patterns.

The therapist could help the family by developing a written contract that would focus on a substance-free home. Another type of therapy the therapist could use is Solution Focused Therapy. Solution Focused therapy focuses on solving the problems identified instead of how they developed. The therapist will allow the parents and Jimmy to observe a drug-free home. The therapist could go to the home of the family to observe behaviors in their environment. The parents could have parenting lessons on how to attend to their child’s needs, new ways to discipline and learn the different developmental phases of children. In Jimmy’s case, his father has inaccurate and unhelpful thinking processes. Children will often excuse the parent’s behaviors, which leads to silence. The therapist will work with the child to break the silence and allow the child to begin normalizing his or her feelings and reactions related to the abuse. Once a therapist can get Jimmy to this step, he will begin to gain a sense of reassurance of the chaos he is living in and teaching him, it should not be this way. Treatment can teach Jimmy new skills and work through the emotional overload to identify his anxiety and depression. It will help Jimmy facilitate a decrease in emotional activity, anxiety, fear, depression, and distorted thoughts (American Association for Marriage and Family Therapy, n.d.). At the same time, the adults will learn how to manage anger, stress, and anxiety, along with their neglectful triggers.  Family therapy is made up of a collection of therapeutic approaches that believe in the family assessment and intervention (Substance Abuse and Mental Health Services Administration (US), 2004). The family is considered a system; like any other type of system, the dynamics change when a change in the system occurs. Therapy is a place that can use the strengths of a family to change the problems in the areas that need help. Marriage and Family Therapy can help families who have substance abuse by using their strengths and resources to find ways to live without abusing substances. It also helps with the detrimental impact drugs and alcohol have caused to the family unit. Family-involved therapy helps educate families about the relationship that contributes to the continuation of substance abuse. Family therapy is limited to psychoeducation before being grouped with other family instead, it is education or therapy.

Types of assessments

           The therapist will perform a behavioral assessment that occurs on two levels. The problem analysis is to specify behavioral deficits; these are the problem areas that can change for a resolution. Functional analysis is a way to uncover the connection between behavioral deficiency along with the intrapersonal environment. The therapists will begin looking at the immediate antecedents and consequences relating to the behavior. A cognitive-behavioral assessment can be used to analyze the thoughts, attitudes, expectations, and beliefs of the family members. The therapist uses data obtained from self-report questionnaires, individual and joint interviews, and direct behavioral observation of the family’s interactions.

Conclusion

Substance abuse in any family environment impairs the physical and mental health of the people involved. In this vignette, the reader is unaware of the demographics of the parents. We are unsure if the parents have employment, are financially stable or provide a stable living environment for Jimmy. We are unaware that the parents are alcoholics or partake in social drinking. As a reader, we are getting the information from a ten-year-old boy. What we do know is the parents decided they needed to get help for Jimmy but lack recognition of where they fit into Jimmy’s troubles.

           Cognitive Behavioral Therapy (CBT) is a normal part of psychotherapy with the goal being to change the thoughts and actions based on the person’s behavior. There is also cognitive-behavioral and behavioral marriage therapy (BMT). Cognitive-behavioral therapy is the type of therapy the therapist would use to help this family. Cognitive-behavioral therapy is proven to help children who have mood and anxiety disorders (Goldenberg & Goldenberg, 2008). Cognitive therapy also helps with automatic thoughts, the underlying assumptions, and the fundamental beliefs of schemas (Goldenberg & Goldenberg, 2008).  Changing the behaviors of the parents will help relieve some of the stress Jimmy is feeling. Allowing Jimmy to talk about his fear of getting into an accident while he is riding with his parents, who are under the influence can help Jimmy work through the problem. Cognitive-behavioral therapy will allow the parents to recognize their part in Jimmy’s anxiety, depression, and fear. Working with each family member’s feelings and thoughts will allow the family members to work as a team to resolve the family system issues.

References

• American Association for Marriage and Family Therapy. (n.d.). Child Abuse and Neglect. Retrieved from American Association for Marriage and Family Therapy: https://www.aamft.org/AAMFT/Consumer_Updates/Child_Abuse_and_Neglect.aspx
• American Association for Marriage and Family Therapy. (n.d.). Code of Ethics. Retrieved from American Association for Marriage and Family Therapy: https://www.aamft.org/Legal_Ethics/Code_of_Ethics.aspx
• Goldenberg, H., & Goldenberg, I. (2008). Family Therapy: An Overview (7th ed.). Belmont, CA: Brooks/Cole.
• Substance Abuse and Mental Health Services Administration (US). (2004). Treatment Improvement Protocol (TIP). Treatment Improvement Protocols , Series, No 39.
• Zak, E. (2018, 12 8). Family therapy for substance abuse. Retrieved from Recovery: https://www.recovery.org/treatment-therapy/family/