Children’s mental health issues are prevalent, yet not many people approach this issue with the seriousness it deserves. According to the CDC, most children struggle with anxiety, ADHD or behavior problems. The prevalence of mental health issues among children means the topic shouldn’t be taboo, but when discussing mental health with children, upholding ethical practices is incredibly important.
Ethics protect the welfare of both the counselor and the child. Here are some of the most important ethical considerations to keep in mind when discussing mental health with children.
Table of Contents
Respecting the Child’s Autonomy
Personal autonomy is highly valued in healthcare, and mental health is no different. Patients are encouraged, where possible, to make autonomous decisions regarding their treatment plans.
However, one might argue that this is hard to navigate when the patient is a child. This is because they may not fully understand their decisions’ consequences as they are still developing their sense of self. This does not mean that autonomy goes out the window when discussing mental health with them, however. There are several steps therapists can take to promote a child’s autonomy.
The most basic one is encouraging age-appropriate decision-making. For example, a therapist can allow the child to choose activities they would like to participate in as part of their treatment. The therapist should explain the choices beforehand to ensure the child understands the potential consequences.
Another way therapists can demonstrate respect for a child’s autonomy in therapy is by fostering trust with the child and their family. The child can openly express their preferences when the relationship is based on trust. They can also share their thoughts and feelings, making it easier for the therapist to determine what the child wants or needs.
It is possible that the child might say no to treatment once they find out the risks. In that case, the therapist has to respect that decision instead of coercing the child. Coercion would not lead to lasting changes. A better approach would be to discuss alternative treatment options with the child while trying to show them the bigger picture.
Even when explaining the risks and benefits of each treatment option, it is essential for therapists to stick to age-appropriate information. Using jargon will only further alienate the child, which can lead to resistance.
Respecting a child’s autonomy requires a delicate balance. The therapist has to provide adequate guidance and support while acknowledging that the child is still developing their sense of self.
Maintaining Confidentiality
For a breakthrough in therapy, a child should be able to freely disclose their thoughts, behavior, feelings and experiences without fear of the counselor sharing the information with someone else. However, there are some unique challenges with confidentiality when working with children. Legally speaking, children don’t have a right to confidentiality from their parents in therapy. Therefore, the therapist can uphold confidentiality by asking the parent to agree to confidentiality rules before starting sessions with the child.
Ideally, the parent has the right to ask for the child’s medical record, such as their symptoms and treatment plans. However, the therapist cannot view treatment notes unless the court orders it. Federal laws also protect minors from disclosures to third parties who are not their parents. Some states extend additional privacy protections to children. For example, minors in California can control their healthcare information when they otherwise have the right to consent to care. The counselor should follow state law if the state offers a minor more privacy rights than federal law.
It is worth noting that in some situations, the parent may not have the right to information about the minor’s treatment. These include:
- When the parent has given up their parental rights
- When a court order dictates it
- When a parent or guardian has signed an agreement to respect counselor-child confidentiality
- When the child becomes legally responsible for their care before the age of 18
The therapist is mandated to explain confidentiality laws to the parents and the child. They have to explain the circumstance under which they would break the confidentiality law, such as when they suspect child abuse or neglect. However, even when the therapist is mandated to report something, they should only share necessary information and only with appropriate parties.
The therapist should also make all parties understand the importance of open communication. When parents understand this, they can be more accommodating, encouraging children to open up more.
Using Age-appropriate Language
Therapists must be conscious of their language when counseling children since their language might be limited. It is especially important to use simple language when complex terms might throw them off. Use phrases they use in everyday conversations.
It is also worth noting that children may have shorter attention spans. Therefore, therapists have to be concise. It can also be helpful to use visual aids since children may respond better to them than words. Visual aids may include drawings, especially for younger children.
When discussing mental health with children, it is important to practice patience. They might take longer than an adult would to get a point across. The therapist can help the child open up by asking open-ended questions. It is also essential to use positive language. Being critical of a child’s feelings might discourage them from opening up.
Therapists should adjust their use of language depending on the situation, which means they need to analyze every child’s needs and abilities. By doing so, every child can feel heard, understood, and supported. A CACREP-accredited master’s in school counseling like the one offered by Walsh University online can equip a counselor with the skills needed to navigate the different situations they might encounter.
Seeking Informed Consent
Informed consent is a critical step in therapy for adults and children alike. However, obtaining consent in the case of a child client takes a different approach. In most cases, the therapist must obtain consent from the parent or guardian.
Therefore, the counselor has to explain the process to the child in the presence of their parents. Then they can respond to any concerns and obtain consent from the parent or guardian. Even though the parent or guardian gives consent, the child also needs to provide assent. That means the child agrees to take part in counseling. The therapist must document consent and assent in the child’s counseling record.
In some cases, the consent process might need to be revisited, such as when the child’s situation changes. In that case, the counselor has to inform the parent and guardian to obtain their consent as needed.
Addressing Stigma and Discrimination
Unfortunately, mental health is still a touchy subject for many people, and those seeking help – even children – face stigma and discrimination. This stems from issues such as a lack of mental health education and societal attitudes toward mental health.
These children’s peers may tease, exclude or physically attack them. Sometimes, the stigma and discrimination come from authority figures, such as a coach or teacher in school.
Therefore, counselors working with child clients have to take steps to address stigma and discrimination. They can do so in various counseling settings. An excellent place to start would be educating the children about mental health. Some children already hold negative beliefs about mental health, informed by their backgrounds. When someone educates them about what they stand to gain from mental health treatment, the stigma might diminish.
Counselors can also encourage children to develop empathy and understanding of their peers with mental issues. For example, a school counselor can organize talks to ensure all students learn to see their peers beyond their mental health issues.
It is also essential to work with parents and caregivers as they are sometimes responsible for perpetuating negative beliefs about mental health. The counselor can educate them on how they can better support their children’s mental health needs.
Most importantly, counselors have a role to play outside their offices. They can advocate for change by working with policymakers and community organizations to promote mental health awareness and reduce stigma.
Providing Accurate Information
Some people think children are not entitled to the raw truth about situations. You might hear statements like, “They are too young to understand.” While it is true that some matters might be too complex for kids to grasp, that is not a carte blanche to share inaccurate information with children, especially when it comes to mental health.
By sharing accurate information, counselors can gain the trust of children, which is a major step in therapy. Accurate information also prepares the child for what awaits them in therapy, allowing them to be psychologically prepared for treatment and increasing their participation. Moreover, providing accurate information promotes a child’s autonomy since they can make informed decisions about their mental healthcare.
Most importantly, sharing accurate information helps promote safety since children can use that information to determine whether the situation they find themselves in is safe. That makes them better positioned to avoid dangerous situations.
