Therapeutic Confidentiality and the Provision of Psychological ...
Therapeutic Confidentiality and the Provision of Psychological ... Therapeutic Confidentiality and the Provision of Psychological ...
Welfare approach to counselling Under this approach, children or young people are seen largely in terms of the responsibilities held by adults for their care and protection. In school settings, counselling may sometimes only be provided with the full knowledge and agreement of parents. This may have the effect of deterring many children from approaching the counsellor in the first place, or of making them carefully edit what they say as a result. Another concern in school settings relates to counselling young people about sexuality issues. This is based on restrictions on local authorities 'promoting' homosexuality under s.28 of the (recently repealed) Local Government Act 1988. In fact, teachers' and counsellors' worries on this issue may be unfounded. A subsequent little-publicised government circular had clearly stated that s.28 "will not prevent the objective discussion of homosexuality in the classroom, nor the counselling of pupils concerned about their sexuality" (para. 20, DoE Circular 12/88). Participatory approach: Child care legislation since 1975 has developed the principle that children have a right to take part in discussions about decisions affecting their lives. This has been endorsed by s. 22 of the Children Act 1989. It is also expressed in Article 12 of the United Nations Convention of the Rights of the Child 1989, ratified by the UK in 1991. The Convention recognises the need for "the views of the child being given due weight in accordance with the age and maturity of the child." This perspective gives counsellors greater opportunity to prioritise the therapeutic relationship with the child, as distinct from subjecting it to the sometimes conflicting interests of parents, or other authorities such as schools. There may still be some instances when the counsellor may wish to override the child's wishes. This participatory approach to children's rights within counselling situations does not mean that the child's wishes 39
will prevail. It simply requires that they must be properly heard and acknowledged. Independence model A great deal of confusion and misinformation surrounds the third possible approach to counselling children. In the key Gillick case, heard in England, but carrying persuasive authority within Northern Ireland, it was held that children under the age of 16 can be provided confidential medical treatment, without first requiring parental knowledge or consent, if the doctor decides that the child is of 'mature understanding'. According to Lord Scarman, "parental right yields to the child's right to make his own decisions when he reaches a sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision." (Gillick [1986]). Gillick actually concerns two key issues, the first of which is the right to consent to medical treatment independently of parental wishes. The second, however, concerns the right to confidentiality, which is to be maintained whether or not treatment is provided, unless there are overriding child protection concerns. Based on this perspective, many voluntary organisations, such as Brook Advisory and Childline, now provide confidential counselling to the child as the client, without first requiring parental consent. Case law following Gillick (e.g., Re R 4 A11ER 177 [1991], Re W 4A11 ER CA 627 [1992]) may appear to have undermined the legal protection for counsellors working with the child as client. However, these cases primarily relate to potentially extreme and even life-threatening circumstances. This has included the refusal by a young person to take anti-psychotic medication, or to consent to medical treatment for anorexia nervosa. Despite this, the key principles of Gillick remain intact for working with the vast majority of young people under the age of 16. The Gillick principle is central, for example, to the legal and ethical basis of providing voluntary psychiatric care for young people under the age of 40
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will prevail. It simply requires that <strong>the</strong>y must be properly heard <strong>and</strong><br />
acknowledged.<br />
Independence model<br />
A great deal <strong>of</strong> confusion <strong>and</strong> misinformation surrounds <strong>the</strong> third possible<br />
approach to counselling children. In <strong>the</strong> key Gillick case, heard in<br />
Engl<strong>and</strong>, but carrying persuasive authority within Nor<strong>the</strong>rn Irel<strong>and</strong>, it was<br />
held that children under <strong>the</strong> age <strong>of</strong> 16 can be provided confidential<br />
medical treatment, without first requiring parental knowledge or consent,<br />
if <strong>the</strong> doctor decides that <strong>the</strong> child is <strong>of</strong> 'mature underst<strong>and</strong>ing'. According<br />
to Lord Scarman, "parental right yields to <strong>the</strong> child's right to make his<br />
own decisions when he reaches a sufficient underst<strong>and</strong>ing <strong>and</strong><br />
intelligence to be capable <strong>of</strong> making up his own mind on <strong>the</strong> matter<br />
requiring decision." (Gillick [1986]). Gillick actually concerns two key<br />
issues, <strong>the</strong> first <strong>of</strong> which is <strong>the</strong> right to consent to medical treatment<br />
independently <strong>of</strong> parental wishes. The second, however, concerns <strong>the</strong><br />
right to confidentiality, which is to be maintained whe<strong>the</strong>r or not treatment<br />
is provided, unless <strong>the</strong>re are overriding child protection concerns. Based<br />
on this perspective, many voluntary organisations, such as Brook<br />
Advisory <strong>and</strong> Childline, now provide confidential counselling to <strong>the</strong> child<br />
as <strong>the</strong> client, without first requiring parental consent.<br />
Case law following Gillick (e.g., Re R 4 A11ER 177 [1991], Re W 4A11<br />
ER CA 627 [1992]) may appear to have undermined <strong>the</strong> legal protection<br />
for counsellors working with <strong>the</strong> child as client. However, <strong>the</strong>se cases<br />
primarily relate to potentially extreme <strong>and</strong> even life-threatening<br />
circumstances. This has included <strong>the</strong> refusal by a young person to take<br />
anti-psychotic medication, or to consent to medical treatment for<br />
anorexia nervosa. Despite this, <strong>the</strong> key principles <strong>of</strong> Gillick remain intact<br />
for working with <strong>the</strong> vast majority <strong>of</strong> young people under <strong>the</strong> age <strong>of</strong> 16.<br />
The Gillick principle is central, for example, to <strong>the</strong> legal <strong>and</strong> ethical basis<br />
<strong>of</strong> providing voluntary psychiatric care for young people under <strong>the</strong> age <strong>of</strong><br />
40
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