Young people are often in a very different mental space than adults, due to the developmental and social specifics of adolescence. There are psychological changes, such as changes in attachment to their parents and cognitive development. These can have a huge impact on adolescents emotionally, and can be very distressing, so it is often extremely beneficial for a young person to come for counselling, to explore their feelings with an adult who is not their parent or carer.
There are often counselling resources available to the child in school, or a referral for counselling can often be made through your doctor. However, for various reasons, including long waiting-lists and privacy, many young people and/or parents prefer to seek private counselling.
My experience of working with young people in schools and in private practice since 2010 has been extremely rewarding. Many young people benefit greatly from counselling, the consequences of which include higher attendance and achievement at school, as well as better relationships with friends and family. But working with young people as a private practitioner does throw up some challenges, which are important for parents to consider.
When a young person comes to see a counsellor, it is likely that there will be some level of parental involvement in the process. A referral will very often come from the parent, who has concerns about their child. This means that the parent will have to agree to their child having a confidential relationship with the therapist (which the parent will be to some extent excluded from).
Confidentiality is of great importance in any therapeutic relationship. However, this becomes more complicated when working with young people. The BACP states that careful thought needs to be given when working with young people as to their capacity to give informed consent to a confidential relationship (sometimes referred to as ‘Gillick Competency’).
It is important that, when working with any child or adolescent, the counsellor can asses whether the young person has sufficient understanding of what they are agreeing too.
These questions need to be asked:
* Can the young person understand the question being asked of them?
* Does the young person have a reasonable understanding of
* What information might be shared?
* The main reason or reasons for sharing information?
* The main implications of sharing that information, and not sharing it?
* Can the young person:
* Appreciate and consider the alternative courses of action open to them?
* Weigh up one aspect of the situation against the other?
* Express a clear personal view on the matter?
Once these points are considered, I can make a decision about whether this young person is able to give informed consent to the counselling. It is of vital importance that the young person wishes to speak to a counsellor and that young person is agreeing to enter into counselling voluntarily, rather than because the parent, or other party, believes the young person "needs counselling". Confirming the young person's wishes to enter into counselling and obtaining informed consent is my main purpose in the free 30 minute Introduction Session. This session also gives the young person the opportunity to decide if they think I'm someone they'll feel comfortable talking to.
It can seem threatening to a parent, to have their child talk to somebody else, so it is also important that I establish a relationship and communication with the parent that puts them at ease. After all, in private practice, the parent is usually the one paying, and they can choose to cut the therapeutic ties at any time!
The free 30 minute Introduction Session is also an opportunity to meet with the parent face-to-face and give the parent a clear idea of what they are committing to. If the parent is the one paying, then a financial contract will be made with them. This is separate from the counselling contract made with the young person.
There can also be a use for family sessions, where the parent is brought into the process. This will only happen when I feel, and after consulting with my supervisor, that it will be in the young person’s best interests and only with the young person's consent. It is important to emphasise that all family contact in the therapy must have the wellbeing of the young person as the focus.
It’s extremely important to be aware of risk when working with young people and know where the boundaries are in terms of confidentiality. A young person is likely to lose trust in the counselling relationship if their counsellor overreacts about a risk that the young person does not think is significant. However, it would be dangerous to not pick up on a risk that might cause significant harm to the client.
The Ethical Framework for the Counselling Professions
(http://www.bacp.co.uk/events/learning_programmes/ethical_framework/documents/ethical_framework.pdf ) commits members to put our clients first, stating:
We will give careful consideration to how we manage situations when protecting clients or others from serious harm or when compliance with the law may require overriding a client’s explicit wishes or breaching their confidentiality. (Good Practice, Point 9)
In schools, there are safeguarding procedures in place, which commits the counsellor to report to the school’s Safeguarding Officer concerns about a child being at risk, as well as, when the counsellor believes it in the child’s best interests, to report information disclosed by the young person. The school will decide whether and how to take these reports further. These limits to confidentiality are made explicit in contracting with the young person at the very start of the counselling relationship.
In my private practice, I establish a clear counselling contract with the young person, clearly explaining the limits to confidentiality. This will help the young person to understand the boundaries of what they know they can tell me in confidence, and what will be taken further.
The counselling contract clearly explains to the young person that, when I have concerns about their safety, and feel they are at risk, or if they disclose information to me that needs to reported by law, my first point of contact will be my clinical supervisor and I will seek his advice and guidance with regards to whether and to whom any report should be made. Such discussions in supervision will fully explore the possible consequences for the young person and the counselling relationship, with clear focus on what is in the young person’s best interests. These deliberations are also informed by the following:
Significant harm. What constitutes significant harm with reference to the Children Act 1989. The term, ‘significant harm' is explained in The Social Worker's Guide to Children and Families Law as follows:
The statutory definition in the Children Act 1989 states that 'harm' means ill-treatment or impairment of health and development. Ill-treatment includes sexual abuse and forms of ill-treatment which are not physical, thus including emotional abuse. Physical abuse itself is not explicitly included, but this is taken as read. 'Health' includes both physical and mental health, and 'development' includes physical, intellectual, emotional, social and behavioural development.
To assess whether health or development are being significantly impaired the Act tells us to compare the health or development of the child in question 'with that which could reasonably be expected of a similar child'.
The definition of harm also includes 'impairment suffered from seeing or hearing the ill-treatment of another'.
Public interest. Counsellors are required by law to report information that is deemed to be in the public interest, For more information, see The National Counselling Society’s Safeguarding Policy: https://www.nationalcounsellingsociety.org/have-a-concern/safeguarding-policy/
It is important that there is clear communication with the parent regarding confidentiality, so that there is an understanding of the process, and to let them know that I will be transparent with the young person about any contact I have with the parent after the therapy has started. This helps protect confidentiality and establish the young person’s trust in the counselling relationship, and is in accordance with The Ethical Framework for the Counselling Professions (http://www.bacp.co.uk/events/learning_
When the safeguarding of our clients or others from serious harm takes priority over our commitment to putting our clients’ wishes and confidentiality first, we will usually consult with any client affected, if this is legally permitted and ethically desirable. We will endeavour to implement any safeguarding responsibilities in ways that respect a client’s known wishes, protect their interests, and support them in what follows. (Good Practice, Point 10)