Counselling Dilemma: An Adolescent Client
You have been counselling a family for 2 months and you have reached the end of your program with them. Both the mother and father are satisfied with the outcomes of the therapy, however their teenage son would like to continue to see you. He has specified that he would like to continue therapy about some of his own issues, but not in the presence of his mother and father. The son is aged 16.
Would you continue to work with the boy and if so, under what circumstances?
There are many factors which I would need to consider in making a decision about whether to continue to see the adolescent, as requested. Whilst legally, an adolescent of 16 years of age is permitted to attend counselling independent of their parents, it is important to consider the therapeutic issues inherent in offering that.
Adolescence is a period of great struggle. It is a period of great desire to experiment, to make new friends, try out new ways of behaving and to test the limits of authority (other people?s and their own). It is also a period of doubts and uncertainties, conflicting thoughts and behaviours. Primarily, it is a time in which the young person struggles for autonomy and independence, and thus the issue of attending therapy at this age is a particularly conflictual dilemma. In asking to attend further sessions, the adolescent client is struggling with the desire to oppose the offer of help and yet also seeks it.
If I was working with this adolescent, it would be important for me to consider how he initially came to attend counselling. If his involvement was directed by the parents, it would seem that his current request for further help is indicative of a positive step in the therapy process. It may be reflective of the adolescent?s ownership of his problems and it would therefore be useful to offer him further sessions.
In order to maximise the usefulness of any ongoing sessions with the adolescent; it is essential to meet with the family on at least one more occasion to discuss the possibility of the adolescent continuing to be seen. At this session, I would attempt to discuss:
The adolescent?s goals for further sessions.
The parents? ability and desire to support this process. This involves exploring the parents? ability to allow the adolescent to separate.
My own perspective with regards to the usefulness of ongoing work with the adolescent. Issues raised in previous sessions may have identified the need for ongoing work with the adolescent. This issue is also important with regard to the counsellor identifying the direction of ongoing work.
A plan for further sessions, ie: how many sessions, how often and whether the parents will continue to be seen as well. With regards to this latter issue, I would consider various options dependent on the parents? desire to be involved and my opinion of the need for them to be involved. I may offer a family review session on occasion, being clear that this would not involve detailed disclosure of the adolescent?s sessions, but that it would be an opportunity to discuss his progress. I may offer for the parents to be seen, concurrently by another counsellor. This enables the sessions to be kept quite separate whilst offering each member of the family the opportunity to continue.
The critical issue of maintaining and respecting the confidentiality of the therapeutic relationship with the adolescent. It is important to identify and explore how this may alter the previous relationship when I worked with all of the family members together.
If this discussion identified clear goals for ongoing sessions and indicated that the parents were able to support the adolescent?s sessions and the confidentiality of those sessions, I would continue to work with the adolescent. If this was not the case, then it might raise further issues with regards to the family?s relationships and I would offer to continue to meet with the family to further explore these.
At the age of 16 this boy has a variety of rights. He can leave school, seek benefits from the government, enter into full-time employment and enter into sexual relationships. He also has the right to enter into a counselling relationship, independently.
This age is a very crucial time in the lives of young people, particularly towards developing an independent identity. I would suggest that he should inform his parents of his desires to seek counselling, independently of them. It is important to remember that he alone can make this choice and I would not deny him counselling if he chose this path.
Young people, particularly young men, often find it difficult to open up to someone. Because I have already established a relationship with this boy, he trusts me. I would feel comfortable in continuing this relationship with him.
My first impulse in response to this question was YES! Upon reflection I discovered that I had based my response on my previous experiences working in the field of child protection, where it is common practice to work with young people of this age without the presence of a parent and in fact, is often necessary.
Further thought brought some possible issues to mind and it is these that can now be explored.
Legal aspects – according to a representative of legal services there are no legal requirement, in regards to age, for the presence, or permission, of a parent during counselling, in Queensland. This is related to therapeutic work and of course may not apply to court related issues.
Policy – if you are employed by a counselling agency, there may be policies in place regarding this issue. If you are in private practice, this may be an issue you would like to explore for inclusion in your own policies.
Confidentiality – the understanding of confidentiality remains constant across age groups – from very young children through to mature adults. That is, that confidentiality can be assured unless content of the session reveals behaviour that is harmful to the client themselves or to another person. This needs to be explained at the outset of counselling, so that the client can make choices about the information revealed. These same choices are available to a person of sixteen.
This means that should this young person?s parents ask about the boy?s sessions, it would be incumbent upon the counsellor to clarify confidentiality and to refer the parent to the son for information or for written permission for the counsellor to disclose the information.
Content – a person of this age may have concerns about almost anything! Provided the issue is within the counsellor?s range of abilities and training, there is no limit to what areas can be explored (barring of course medical concerns such as depression, mental illness, etc).
Process – 16 year olds can be great fun to work with. There is imagination, humour, sensitivity, adventure, searching and a developing person to help. An eclectic approach is really valuable here as it will provide access to a range of counselling skills that can make the most of these qualities. The building of the counselling relationship is vital, because if the connection is not there, little will be achieved. Be prepared to have fun and to grow yourself!
Accessibility – the counsellor may need to explore with this young person just how they will be able to access counselling (transport); the timing of counselling – will sessions fit with work or school time; and money – how will he be able to pay.
Supervision is a suitable venue for further exploration of this issue by counsellors. If in doubt of your decision to counsel or not to counsel, seek advice!
Great article ..thank you
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I thought Lin Fielding’s comments were valid and well set out. If a teenager wants to open up to the counsellor on any level, that can only be a good thing for the teenager and perhaps a challenge for the counsellor as long as the boundaries are set down early so there is no misunderstanding particularly about confidentiality. Teenagers have often a dramatic view of live as just about everything they do is new and exciting and yet frightening, ranging from drug experimenting, sex, driving and the like. It is important for them to talk about their feelings as not talking can lead to depression and isolationist type behaviour.