Child intake - Parent Confidentiality in Separation and Divorce
Going through a divorce or separation can be a difficult transition for both parents and their children. Relationships, routines, and responsibilities undergo significant changes during this time and many parents want to support their children through these changes by seeking professional help. However, before obtaining psychological services for a child, parents should understand how divorce or separation can affect the way in which psychologists practice.
Who consents to treatment and why is this important?
When providing a psychological service, psychologists need to obtain the consent of the service’s participant. This means that a client fully understands what the service is, its benefits and risks, the consequences of not receiving it, what withdrawing consent mean and the limits of client confidentiality. The latter refers to the expectation that information shared by the clients during psychological treatment, and details of treatment itself, remain private.
Obtaining consent is different when clients are under 18 years old. With young children legal consent is sought from the parent seeking the psychological treatment on their behalf (the accompanying parent), although the clinician will also ensure that the child can safely express their desire to participate or withdraw from treatment. In older children, the capacity to give consent varies on a much more individual basis. At Picton Psychology, parental consent to treatment is required regardless of the child’s maturity, other clinics may follow a different protocol.
Due to the variable nature of consent with children, the confidentiality of their treatment records is also impacted. Psychologists must balance the needs of the child, the responsibilities of the parent and the clinical relationship when issues of confidentiality arise. If the client is not mature enough to give consent, their records can be accessed by the parent or guardian who consents on their behalf. However, acceding to all parent requests for clinical information without regard to the child’s privacy may erode trust between the child and the psychologist. Given the importance of consent, it is critical that the psychologist clearly explain to clients all issues of consent, confidentiality and disclose before embarking on treatment.
The first session usually involves both the child and their parents, so that the clinician can go through everything with all the relevant parties present. Building an effective client-therapist relationship involves gaining and maintaining trust. To do this, Picton Psychology encourages parents to support their child’s therapeutic journey by trusting the psychologists clinical judgement. This means, not every detail of what their child shares with their psychologist will be disclosed. But as psychologists are mandatory reporters, disclosure to parents will be made if a child is at risk of harm or at risk of harming others.
To build a sense of privacy, psychologists also make sure to check in with children regarding what they want their parents to know. Children are usually happy to make a list of ideas or practical suggestions to share with their parents during session. This usually relate to a child wanting more independence, like a later bedtime or being allowed to walk to school. It’s important to check with the child what information they would like to be shared with their parents, otherwise they may lose their trust with the psychologist.
What happens when my partner and I are in conflict?
Psychologists who are asked to provide treatment for a child will usually try to obtain the consent and involvement of both parents if the child is not mature enough to consent on their own. Under ordinary circumstances, however, consent from both parents is not legally required.
The ending of a marriage or serious relationship with children can change the requirements for parental consent to treatment, depending on the current relationship between the parents and whether the judiciary system is involved. The process of divorce or separation may include obtaining court orders to formalise agreements between parents regarding child custody, responsibility for major like decisions (health, education, and religion) and financial arrangements.
If there are court orders specifying that only one parent is responsible for making health decisions, parental consent to treatment can only be obtained from that parent even if the other parent is the one to engage or contract the psychologist. However, the confidentiality of the child’s health records is only similarly restricted if the orders specify that only one parent has access. The orders may set out equal access or they may not specify access rights at all. If this is the case, conflict between parents over the child’s clinical information cannot be navigated by the psychologist alone and they will need to seek legal advice. Before an informed decision is made, the psychologist will need to proceed under the assumption that the non-accompanying parent can access the records if requested.
If the responsibility for health decision has been specified as equal or if there are no court orders regarding this responsibility, the psychologist must discuss the potential involvement of the non-accompanying parent before treatment can begin. This is because the law recognises that, unless specified otherwise, both parents have equal decision-making responsibility with regards to the child. As a result, the consent of one parent does not prevent the other parent from seeking information about the treatment or objecting to the treatment entirely. If the former occurs, the psychologist is obliged to provide the relevant information. If the latter occurs, the psychologist may have to cease treatment until the parents reach an agreement or until the Court issues orders on the matter.
To ensure that consent is obtained responsibly and ethically, the psychologist who is asked to provide services will need to have a complete understanding of the parental relationship before they can begin. This means the psychologist will need to know about any court orders that are in place or are being decided upon, what terms the parents are currents on and what issues have caused (or are likely to cause) disagreement between the parents.
When gathering background information in an initial session, the psychologist focuses on who lives in the household, how the parents are communicating and what their access arrangements are, and if there are any issues in the family dynamics between siblings or parents and children.
Talking with the parents provides the psychologist with the framework of the family structure. It is an opportunity to explore any emotional issues potentially impacting the child. Following the parent-only session, the psychologist gains the child’s perspective in a one-to-one play-based session to explore family relations and feelings.
While ideally both parents will attend feedback sessions, Picton Psychology acknowledges that it is more common for parents to attend separately to discuss their child’s progress and future goals. Parents may be worried about how their child’s therapy will affect their post-separation relationship. As the goal is to support the child, only relevant information is shared in feedback sessions. If the child tells the psychologist that they really like it when Dad reads them bedtime stories, but he doesn’t do it for very long, or that they want to visit their favourite park with him more often, the psychologist will only be telling Dad about this.
