The watchword of therapy is confidentiality. Treatment success relies on the client’s trust. But, is it wise for mental health professionals to put themselves in a situation where keeping one person’s confidence can be used against others in the room?
Imagine the following. A couple comes to marriage counseling. They have a young daughter.*
Among the concerns expressed by the pair is the woman’s father, the child’s grandfather. He has accused his son-in-law of sexually abusing the little girl.
The woman tells the therapist her dad is unreliable, prone to irrational and outrageous statements. Moreover, he holds a long-standing grudge against the person she married.
The woman dismisses the idea of abuse by her mate, supporting his denial.
Several challenging weeks into the process, the man notifies the doctor he can’t attend the next meeting. He adds that it will be fine if his spouse comes for a solo session. She wants to.
On this occasion, she utters something never said to anyone: her father molested her when she was young. Indeed, her daughter is never permitted to be alone with the grandad for this reason.
Nonetheless, she doesn’t want the husband to know. The specialist affirms his intention to keep the confession secret.
The marital sessions remain on a downward trajectory, leading to separation and a divorce filing. The estranged woman now thinks her partner did touch the daughter inappropriately, consistent with her dad’s contention. Her earlier dismissal of this possibility, she claims, was part of an attempt to save the relationship.
Adding to the dilemma, the mother now aims for sole custody of the six-year-old. She also reminds the psychologist of his promise not to discuss or report the historical violation by her father. Legal action will follow if he breaches her trust, she threatens.
In hindsight, should the counselor have agreed to the individual appointment with the wife?
The doctor is in a box. If he reveals the mother’s history of molestation by the little girl’s gramps, she will bring suit. If he does not uncover this fact, his lack of reporting what he knows permits the woman’s demonization of her spouse to appear more convincing than it otherwise would.
The law, depending on the state in question, might yet offer a remedy.
In the event the therapist’s records of the unaccompanied session are subpoenaed by the husband’s attorney, a judge might overrule the wife’s desire to maintain the information as privileged and, therefore, outside of consideration by the court in a trial.
Nonetheless, this is a cautionary tale for all marriage and family counselors. A somewhat similar problem can occur in the absence of the child custody issue.
Within couples therapy, one party might tell the therapist of an ongoing extramarital affair in an unaccompanied interview. A different conundrum would be created thereby.
If the psychotherapist informs the naive partner of the infidelity, he has breached the confidence of the adulterer. If he continues the therapy, he is violating his responsibility only to provide care if he believes it can be potentially useful.
More examples might be offered.
An unseasoned health professional can find himself in a predicament with both ethical and clinical implications
Precise guidance to prevent such difficulties is not commonly found in the ethical guidelines of the various helping professions.
Therapists, one hopes, obtain enough supervision in the practicalities of their work to avoid horror stories of the kind described above.
Most of us achieve a measure of wisdom with hard experience and training. Of course, the truth of such a statement applies to much more than what happens in the clinic.
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*This essay is based in part on “Legal and Ethical Issues for Mental Health Professionals: Revised 2020″ by Psychotherapy.net Academy.”
The second image is Der wilde Mann (the wild man) by Paul Klee.
Dr. Gerald Stein 
Holy mackerel…I cannot imagine being placed into such a situation! I guess the answer would be never to meet alone with one of the couples for a session? How would a therapist handle this if they were in this situation after meeting with one of the individuals? Cliffhanger!
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Your recommendation is probably the best. An alternative would be to obtain prior permission (in words and writing) for the therapist to share confidences under certain circumstances. In the second example, the counselor would need to end therapy, although in doing so both of the partners might question why. In the first example, he might want to reason with the spouse who he saw in solo session. And, as I suggested, hope that the lawyer for the husband is clever enough to subpoena the wife’s records from that session and that the law and the judge set aside their priviledged status.
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Is mandatory reporting required in cases of possible maltreatment? If the child is in danger of both grandpa and father, can the therapist report this case to authorities and legally break a confidence? Is individual counseling allowed in marital counseling? Would a social worker handle the therapy session different from an LPC, MFT, or psychologist? If certain secrets require mandatory reporting, then how does that affect treatment? Will the client ever trust the therapist again? From a social justice/criminal justice perspective, are not such secrets important to tell in order to avoid the harm of another and address the ongoing needs of the client? From a clinical perspective, are offenders who continue to offend treatable if they are completely honest with the therapist? It sounds like secrets make the job more challenging, but maybe they are necessary. Without telling the secrets, can anyone fully heal? This was a very thought-provoking, good post, Dr. S!
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I’ll answer only the first question. A manditory reporting requirement would probably not cover the grandfather’s abuse of the mother, since the mother is not now being abused and is an adult. She is capable of reporting it herself if she so wishes. Here is the “Illinois Manual for Mandated Reporters:” https://www2.illinois.gov/dcfs/safekids/reporting/Documents/cfs_1050-21_mandated_reporter_manual.pdf
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But could the grandfather pose a danger to the woman’s child?
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Absolutely the grandparent could do his worst once again, this time with his granddaughter. To the good, however, the wife reported that she never let her dad near the child alone.
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If the grandfather lives with them, isn’t that still considered a risk that a social worker could deem as grounds to remove the child from the home, even if the mother, with all her effort, tries to keep her daughter away from her grandfather; the mere presence of a pedophile residing in the home is danger enough and speaks to the mother’s negligence for allowing the grandfather to live with them. Isn’t that grounds enough for a social worker to remove the child and report, and in what ways would the social workers’ mandatory reporting differ from that of a conflicted psychologist, MFT, LPC, or other therapist? My concern here is the differences between manadatory reporting across various professions.
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The grandfather didn’t live with them.
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I will have to reread your post. I was trying to go off of memory. Sorry.
I hope you and your family are safe from COVID-19. Be well, Dr. S, and everybody here!
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I can’t help wondering if the outcome would be exactly the same, even if the husband was aware of the grandfather disclosure.
It’s also not entirely impossible that the woman is correct in her suspicions?
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I assume by “grandfather disclosure,” you are referring to the wife’s revelation of her historical abuse by her dad. I think the concern in a case like this is whether the mom is truthful in her accusation of abuse by her husband of her child. Surely, any decent cross-examination of her during the trial would likely focus on this question: “Were you lying before when you said you didn’t believe your husband abused your daughter or are you lying now when you say he did?” Still, you are correct, the possibility of abuse by her spouse can’t be immediately ruled out. It is also possible that her accusation is intended to get sole custody rather than to protect her daughter.
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I wonder if it would simply fall under the umbrella of safeguarding.
Woman reveals child can’t see grandparent alone because of historical abuse, therapist has concern for safeguarding of child and could legitimately disclose this without client agreement?
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Since I’m not a lawyer I can’t say I know with absolute certainty. However, my understanding is that the therapist is bound by confidentiality unless he believes the clients (in this case, the parents) are in significant danger of harm to self or others. The child is not his client in this example and he has not ever seen her or evaluated her, nor does the therapist have (it seems) sufficient information to think any harm would occur at the hands of the parents. Indeed, the therapist has reason to doubt that the father of the child is a potential danger because he knows about the wife’s changing position. Also, neither one has said they intend such harm. Moreover, the wife has already expressed concerns to the court regarding her husband’s behavior. Perhaps such court would take the action you are thinking of. If, however, the court were to appoint an attorney for the child, that lawyer might attempt to get the court’s approval for action to safeguard the child. I’m assuming he’d have to make a persuasive case for this. Again, consult a lawyer who is familiar with the applicable state law for a proper answer.
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I’m sure the complication is compounded by a legal culture, it’s easy for someone like me to say it looks more simply a safeguarding referral but it would probably be disregarded without concrete proof anyway.
First appearances seem simply… woman molested by her Dad, keeps child away from grandad for her protection. Perverted man now accuses child’s Dad of abusing her, rings warning bells that he’s thinking in those terms about the child and so she’s potentially at risk – hello safeguarding.
But like I say, I can see these things aren’t always as simple as that.
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Why would a woman allow her offender into her home? Furthermore, why would a woman allow her offender around her children, even if she claims that she keeps the child away from the offender (in this case, the child’s grandfather)? Social workers may have different mandatory reporting protocols than therapists, insofar that a the mother knowingly admitted that she knew the man whom she allowed residing with her and her daughter was a risk and she allowed that risk to be around her daughter and even her self, which is to say that the mother neglected the safety of the child. Additionally, it is quite common for sexual abuse survivors to have unsubstantiated claims of sexual victimization (i.e., no legal proof; sometimes also called unfounded claims, though “unfounded” and “unsubstantiated” could mean two different things, legally; and just because a claim is unsubstantiated or unfounded, delayed or wishy-washy, it does not mean that such victimizatin never occurred; it simply means that such victimization cannot be tried in a court of law or founded beyond reasonable doubt; in many cases, rape culture and other terms to describe the challenges of criminal sexual assault claims comprises much reasonable doubt, including victim-blaming and victm-shaming). In this case, the woman many seem wishy-washy with her answers, but that is quite common for sexual assault victims, specifically. It is also common for sexual assault victims to delay their telling of their victimization to another person for days, weeks, months, years, and decades. Therapists and other mandatory reporters should be aware of the cultural implications of sexual assault victimization disclosure, including delayed reporting, challenges with conveying secrets, challenges with mainstream society, challenges with identity politics, and challenges within institutions, including both the criminal justice system, legal system, and psychology-related fields (e.g., psychiatrists/MDs, PhDs, PsyDs, LCSWs, MFTs, LPCs, and others with legal credentials to offer clinical therapy or some other form of therapy and are also considered mandatory reporters). Confidentiality and mandatory reporting are tough things to juggle, and only a preponderance of evidence is needed (if that) to report (a madatory reporter need not have reason beyond doubt). Sometimes bias and ethics get in the way of over-reporting or under-reporting, but then again there may be differences in mandatory reporting policies across not only jurisdictions, but also across professional fields. For example, a social worker who heard this may immediately report and recuse herself from individual and/or family systems treatment providing, whereas all other therapists may find their roles to be conflicted and thus may hesitate to report.
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Again, I refer all those who have such concerns about mandated reporting, to refer to the state laws that govern and define what circumstances require reporting and what do not. You are certainly correct in your description of the effects of a trauma history on a victim of that trauma, even many years later. The therapist or school teacher or clinical social worker, however, are in different situations with respect to his/her duty to report. Example: the difference between seeing bruises on the child vs. hearing from a parent that a child not seen by the one who hears the story has been abused by another person, as in the scenario offered in this post.
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I think you are right, LovingSummer. There are risks on all sides, including preemptive vilification of someone who is not an abuser. In the era of name-calling, the problem is exacerbated.
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In family court law reviews, there’s this notion of “parental alienation,” which may include nasty allegations in custody battles. If the grandparent wants custody, or if the ex-spouse, a person involved in the custody battle may suggest that the grandparent or the ex-spouse (or both) are abusive, dangerous, mentally ill, etc. The parites may do everything in their power to alienate the child from the person trying to win the custody battle. Sometimes the ‘best interests” of the child take the child’s perspective into consideration, and sometimes it doesn’t. But even then, once a claim has been made, assuming that clients are telling the truth to their therapist (as opposed to the therapist disbelieving the client’s own victimization, which is separate from what the client may think someone else might do to her child without any proof or child’s claim of harm), then the risk is there and may warrant an investigation, the child’s temporary removal from the home, etc. The poor therapist also has the ethical issue of dealing with weather or not he or she would be willing to testify in court, which is a separate issue from mandatory reporting altogether. This situation is a major cluster f—-, LOL. I don’t know much about the legalities of it all, but reading law reviews on parental alienation have broadened my horizons.
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One can imagine all sorts of awful situations in any life and, unfortunately, too many have experienced them. Our humanity in fraught situations is tested. To live with some sort of equanimity, IMHO, one needs to take care of oneself and choose to act in whatever way we can to repair at least some small portion of the world and hold to a sense of control of those things we can control.
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What a complex situation! I wouldn’t like to be placed in such a predicament. What makes the situation even worse is that the couple’s daughter may, indeed, be at risk of familial sexual abuse.
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Indeed, Rosaliene. Who is to be trusted? Only the father has not pointed at anyone in this regard, though accusations are not the same thing as guilt.
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In those cases, if a couple sees that their relationship is in danger point due to internal issues. Then, I prefer they go for a couple therapy because in this the therapist helps them with their expertise and try to solve their issues. So that they can again enjoy and live their life happily.
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Thank you for this, relation therapy.
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