I have long told my counseling graduate students that the biggest problem in treating children is that they come with parents. Mental health professionals have to navigate not only the conflict between the parents but often their own difficult communication and interaction with one or both parents. Parents sometimes have undisclosed motives for bringing a child for therapy.
The therapeutic relationship might start off like this: “My husband has moved out and my child needs help with adjustment issues. I want her to get help with that and have a safe place to talk about her feelings. I think art therapy will be a good approach for her.”
Mom signs the art therapist’s informed consent documents and then relates details about the family and the child including lots of negative information about the other parent (i.e. infidelity, emotional abuse). The art therapist then begins to provide weekly art therapy sessions for the child. Mom sends several emails to the art therapist providing updates– “information you need to know and understand to help my daughter”– that contain negative information about Dad. The child also makes negative comments about Dad. Several weeks later Dad learns, perhaps through a bill sent by an insurance company, that his child has been seen multiple times by the art therapist. Now all hell breaks loose.
Dad calls the art therapist and launches into a verbal assault and demands the art therapist stop treatment and provide a complete copy of all therapy records including all communication with Mom. Dad also threatens to file complaints against the art therapist for not securing his consent for treatment.
When the art therapist contacts Mom, she insists that her child continue to receive art therapy services and objects to the art therapist providing Dad with copies of records, especially the emails she sent. To complicate things further, Mom tells the art therapist for the first that she filed for divorce and custody prior to the child’s first therapy session. She also tells the art therapist that her lawyer wants a letter they intend to use in court at a temporary custody hearing. They want the letter to set out what the child has stated about Dad and that it would not be in the child’s best interest for Dad to be allowed overnight possession of the child.
In responding to a call from the art therapist, my first question would be to ask whether parenting or custody orders had been entered by a court for this family. In this scenario, no parenting orders had been entered, in which case either parent would have the right to consent to health care services for the child. If either parent has the right to consent to treatment it would follow that either parent would have the right to revoke consent for treatment. My advice to the art therapist would be to stand down and advise both parents no further services will be provided for the child until such time as the parents both agree.
With respect to Dad’s verbal request for records, I would advise the art therapist to have Dad make a written request setting out what he is seeking and how he wants the information or records transmitted to him. Assuming the child was the sole client of the art therapist and no family counseling sessions were provided in which Mom participated, Mom would not have a right to assert any privacy rights over the emails she sent, and they would all be considered part of the child’s therapy record. Absent a risk of physical harm arising from disclosure of any information from the child’s therapy records Dad would have the legal right to copies of the child’s records, excluding psychotherapy notes if the art therapist chooses to withhold them, but including the emails Mom sent to “inform” the art therapist.
I would also advise the art therapist that the only thing she would be obligated to provide to Mom’s attorney, assuming Mom executes an appropriate release of information, would be a treatment summary or a copy of the child’s records. I would also tell her that it would be inappropriate to offer any opinions on Dad’s possession of his daughter, as she would not have an adequate basis to support such opinions.
I advise my students that a wise policy to implement once they begin practicing is to involve both parents on the front end of treatment even if the presenting parent has the independent right to consent to the child’s treatment. Exceptions to the policy can be made for specific cases such as when credible information about child abuse is presented. I further advise that before a child is ever seen, copies of current custody orders that have been entered by a court should be received and reviewed to determine each parent’s rights related to the child, especially with respect to treatment consent and access to the child’s protected health information.
I further advise students that unless both parents agree to 1) the provider, 2) treatment goal(s) and 3) treatment plan they should decline to treat the child. If the parents are in accord on all three, then a document containing this information and acknowledging agreement should be signed by both parents and the therapist.
I have learned that a parent left in the dark when a child has been treated by a mental health professional often views the provider with skepticism and distrust and working with the other parent will negatively affect their parental rights. Presenting parents are not always truthful in relating facts about the child and the family and their reasons for seeking services. The non-presenting parent might have a very different story to tell. A wise therapist will try to steer a neutral and objective path when working with the parents of child clients which starts by involving both parents from the beginning of treatment.
You can always refer to the ATCB Code of Ethics, Conduct, and Disciplinary Procedures for extensive guidelines to aid you in ethical dilemmas when it comes to practicing art therapy.
Public Member Director
Tom is a lawyer and mediator in private practice, serves on the full time faculty at Southern Methodist University teaching courses in two graduate programs and has served a previous term as Public Member Director of the ATCB.