When family members tell on each other: Dilemmas and solutions in adolescent-family therapy
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Geppert, L.
Kefer, E.
Vaka, K.
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Abstract
Clinical and ethical problems associated with therapists' knowledge (or lack of knowledge) of family secrets have long been discussed in the family therapy literature (e.g., Brown-Smith, 1998) and has been the subject of some empirical research (e.g., Vangelisti gr Caughlin, 1997). Most of this literature deals with the use of secrets to maintain power relationships and balance within distressed family systems, and how the secret can be "outed" and thus resolved in ways that benefits the family system and its members. In contrast, little attention has been paid to a related and common problem with information sharing in the child and family therapy field. This concerns the opposite, i.e., when information about family members is passed on without the knowledge or approval of the subject of the information. For example, parents often tell therapists things about their children in private. The goals of such information sharing may be many and varied, having both positive and negative intentions and consequences. This paper deals with negative aspects of such sharing and the dilemmas it can create for therapists. In 1999, the authors were involved in a professional supervision group dealing with complex child and family therapy cases seen within a large teaching hospital servicing a low SES inner city area. Struck by the amount of time we were all spending dealing with confidentiality issues, and the difficulty with which some of the disclosure problems had been managed, we decided to take a more structured approach to the problem. A literature review revealed little of help so it was decided to make a start by analysing our own problematic cases. The aim was to look for commonalities and solutions that may help us and other clinicians take a more knowing approach in the future. In this paper, we present several clinical examples of information sharing that created serious management and ethical problems for therapists. Some solutions are suggested and finally, a general framework is developed and presented for thinking about and managing these common scenarios.
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Clinical Psychologist
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4
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2
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Psychology
Cognitive Sciences