Therapeutic Confidentiality and the Provision of Psychological ...

unless there are over-riding concerns about the welfare and safety of the
child concerned. Considering the needs of the child as the primary
patient or client, independently of parental concerns or claims to
involvement, will inevitably raise tensions and challenges to healthcare
practitioners, particularly where services are provided on the basis of
partnership with families. Counsellors need to be continually alert to the
potential for conflict of interests between child and parents, which will
require provision for a distinctly child-centred, rather than family-based,
service. This tension will become increasingly difficult to operate, given
the strong and mounting pressures for information sharing about children
within multi-disciplinary teams such as Child and Adolescent Mental
Health Service (CAMHS) teams.
The proliferation of information sharing mechanisms currently at work, in
terms of CAMHS, child protection teams, Connexions Services and
Youth Offending Teams, all point towards the difficulties of preserving the
client’s right to confidentiality, where the child or young person is the
focus of concern by a range of practitioners with a common professional
agenda. The right of the individual child to confidentiality needs vigilant
protection, subject to the necessary limitations of a binding statutory duty
on professional to disclose information, the client’s own disclosure made
via informed consent, and risk of significant harm to self or others.
Research carried out for the current review of the Mental Health Act
illustrates, even if only anecdotally, that parents and children have
contrary and conflicting expectations of what a ‘confidential’ counselling
service actually means. For parents, it refers to a transparent and
accessible service 8 . For children as consumers, it means protection of
sensitive confidential information from access by other parties, including
parents if necessary 1 . These conflicting expectations are not easily
reconciled. The law concerning counselling children and young people is
clearly complex. Yet it offers increased possibilities for working with the
child as the client, based on the Gillick principle. This approach demands
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