Case Reflection: Ethical Practice with Young People and Children

1. Case scenario

A 14-year-old adolescent, “Alex”, presents to IEMT therapy following parental separation and escalating anxiety in school (frequent panic attacks, avoidance, low mood). Alex attends therapy with parental consent but expresses discomfort about parents knowing everything discussed in-session. They report fear of "causing more trouble" at home and in school.

2. Ethical dilemma

Balancing confidentiality and safety:

Alex wants parts of their therapy conversations confidential from parents.
As a minor, parental awareness and consent are legally required.
The practitioner must also ensure immediate safeguarding if Alex mentions serious self-harm, suicidal intent, or risk to others.

3. Reflection questions

Consent & capacity:
- How do we assess whether Alex understands what they’re consenting to?
- What should be included in the consent process when a parent and child are involved?
Confidentiality boundaries:
- Which aspects of Alex’s sessions can remain confidential?
- In what cases should confidentiality be ethically breached (e.g., harm to self or others)?
Dual attendance:
- When is it appropriate to include parents in sessions?
- How is Alex’s autonomy respected in shared or split sessions?
Safeguarding duty:
- What should a practitioner do if Alex reveals suicidal ideation or mentions self-harm?
- Which safeguarding protocols (e.g., NSPCC, local children’s services) apply?
Developmental considerations:
- How do you adapt explanations and interventions to Alex’s cognitive, emotional, and social development stage?

4. Ethical principles & guidelines

Informed consent: Explain therapy purpose, structure, limits of confidentiality and parental rights in age-appropriate language. Ensure Alex understands and agrees.
Maximising welfare / Do no harm: Monitor for risk, seek supervision, and engage safeguarding services if needed.
Confidentiality limits: Clearly communicate what will be shared with parents and what will remain private, unless urgent risk is disclosed.
Best interests of the child: Always centre Alex’s welfare, voice, and developmental context.
Safeguarding and reporting: Follow statutory requirements: Children Act 1989 (UK); consult with child protection agencies as needed.

5. Key learning points

Consent is relational and developmental: Children’s capacity evolves with age—tailor consent to both age and understanding.
Confidentiality is nuanced: Younger clients need protected spaces—clarify exactly which parts of therapy stay confidential and which must be shared for safety.
Child-centred communication: Use language that’s clear, non‑threatening, and sensitive to adolescent perspectives.
Safeguarding is proactive: Ongoing monitoring for suicidal ideation, self-harm, or safeguarding concerns is vital—don’t wait for full disclosure.
Reflective balance: Continually assess when to involve parents, when to safeguard autonomy, and when to escalate concerns.

6. Suggested actions

7. Case application: what went well & what could improve

✅ Strengths: Alex felt heard and respected; the therapist successfully navigated confidentiality boundaries.
⚠️ Challenges: Defining boundaries sometimes felt awkward—especially with overlapping parental and therapeutic needs.
📌 Improvements: Introduce ad-hoc check-ins about consent and confidentiality; keep dynamic documentation and revisit safety protocols.

8. Practitioner reflection

How did I assess and support Alex’s evolving consent capacity?
When did I act out of concern for Alex's welfare, and how did I explain that to them?
What insights did I gain about involving parents in adolescent therapy?
What supervision or policy changes would help with future cases involving minors?