This document provides one model for agreement
between the therapist and the parents or guardians of a child undergoing
treatment. Such an agreement can help establish ground rules that clarify the
psychologist's role in therapy and define the limits of parental involvement. It
can also help define the conditions of the therapist's role in divorce and
custody proceedings. However, it should be seen as only an initial step in the
broader informed consent process, and it should be the basis for additional and
possibly ongoing discussion – anchored in the real world – with parents or
guardians regarding ethics, law, confidentiality, and other elements of informed
consent. We believe that the value of such dialogue, particularly in divorce and
custody scenarios, outweighs its potential to subvert the therapeutic process.
This model contract assumes theoretical and practical variance among
therapists who work with children. For example, regarding the extent to which
they emphasize the safety or autonomy of their child patients, the
safety-oriented therapist may adopt a lower threshold for informing parents of
risky adolescent behavior than an autonomy-oriented colleague. We encourage
contract modification that is consistent with the substance and process of the
work being done.
We also recognize the wide variance in state laws regarding parental access
to records. For example, any person age twelve and older can block parental
access to records in New York and Illinois. In such states, the therapist might
use the contract to obtain an adolescent client's consent to share certain
information with parents. Another variation can be signed by both parents and
the child even in states where parents have sole decision-making authority. In
those states granting confidentiality rights to adolescent patients, an
additional specific "release-of-information" agreement allowing information
exchange between therapist and parents may be needed.
The therapist should note that contract ratification, particularly the
parents' or patient's agreement to discourage subpoenas from attorneys, is not
legally binding and may not prevent a judge from issuing a subpoena. However,
sufficient anecdotal evidence suggests that such a contract discourages the
utilization of child therapists in the divorce process. The parent who willfully
violates a commitment to protect the child's privacy risks being judged as
putting his or her gain before the best interest of the child. The contract also
serves to remind the court of the strong correlation between privacy and
therapeutic effectiveness.
Note that we include an abbreviated version of the contract for those
preferring less detail in the written agreement, but we recommend its use only
if accompanied by more detailed discussions with patients/parents and detailed
notes regarding such discussion.
Finally, your constructive feedback will help us build better contracts.
Please email your comments to insurance@apait.org. And, when you hit a
snag or have a question regarding contract modification, call the Trust's
800-Advocate consultation service at 1-800-477-1200. This unique free and
confidential risk management service is available to those insured in the
Trust-sponsored Professional Liability Program.
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