In the Board’s fall 2017 newsletter, I discussed guidelines that could protect a therapist when working with families of divorce. In this article, I will present a real-life example of a therapist who worked with a family of divorce and acted outside the parameters of their role as a therapist. In this example, the therapist demonstrated unprofessional conduct, incompetence, and intentionally or recklessly caused physical and emotional harm to clients. While this is based upon a complaint the Board received, the information has been changed to protect the anonymity of all involved.
A therapist worked with a married couple to help them improve communication. The couple’s therapy lasted for a few sessions, but eventually, the couple’s treatment ended and the couple divorced. Sometime after the therapy had been terminated, the mother allegedly observed behavior problems, including sexualized behaviors, from their 5-year old son after he returned from visits with his father and new stepmother. The mother contacted the therapist and began therapy sessions, along with her new husband, regarding these issues. The therapist also met with the child.
During that time, the estranged couple was going through a custody battle. The therapist’s actions concerning these therapy sessions propelled the son’s mother to submit a complaint with the Board. The complaint alleged:
• The therapist insisted that the child had seen pornography and had been exposed to inappropriate displays of sexual behavior between the father and his new stepmother, but never filed a report with the local Child Protective Services agency (CPS).
• The therapist believed the child had acted out with his stepsister and reached out to the child’s stepmother without the consent of the biological parents to notify the stepmother that her daughter may have been molested.
• The therapist told the son’s mother that a pedophile would not prey on her child because the child was not blonde or blue-eyed.
Let’s look at what happened here.
The therapist did not obtain written releases from either parent before she communicated with the stepmother. She violated Health Insurance Portability and Accountability Act (HIPAA) regulations by divulging confidential information without written consent.
Not reporting child abuse given “reasonable suspicion” is gross negligence. As a mandated reporter, you must contact CPS or the police (the police handle a report when it is out-of-home abuse). When contacting CPS, you can consult with a social worker, who can determine if a duplicate report may already have been made. The social worker will decide what needs to be done and you, as a licensed mandated reporter, must follow it. The idea is that the social worker will decide if a report needs to be filed. While you are on the phone with CPS, log in the date on a notepad, take down the name of whom you spoke with, the time the call started and ended, and what the social worker instructed you to do, especially if they had advised you that a report was not necessary. This will help protect you in case any problems arise later.
In the role as a therapist, you are not the investigator of a child abuse case or even a divorce case that does not include a child abuse allegation. That job is the purview of CPS and the court’s evaluator, if there is one. It is beyond the scope of your role with the family. Due to the therapist speaking with other extended family members and getting them involved, confidentiality was breached. Given the apparent dysfunction of this family, the lines were blurred as to who was the therapist’s patient. Originally, her clients were the biological parents and then her client was the biological parents’ child. However, she later took on the mother and her new husband, and also reached out to the stepfather’s ex-wife. This is a severe boundary violation. These actions demonstrate unprofessional conduct, incompetence, and caused emotional harm to a client.
Complex divorce cases must be handled using a very cautious and methodical approach. You must keep your boundaries clear with who is and who is not your patient. Also, remember what your role is, therapist versus evaluator; you cannot be both at the same time. If you do, it is gross negligence and incompetence and below the standard of care of a professional licensed by the Board.
Regarding the statement the therapist made where it was alleged that she told the mother and stepfather that only “blonde-haired, blue-eyed children” are the targets of pedophiles, this is gross negligence and incompetence. When dealing with suspicions of child abuse, a therapist must be very aware how powerful their words are to clients and to the seriousness of such a claim. When there is a suspicion, ensure that you are basing this on your best clinical knowledge and the facts presented. Also, only discuss this with the appropriate individuals; your clients, the client’s guardians who have proper releases, and CPS.
I hope this example helps you to rethink your approach with high-conflict families of divorce. It is important to tread very carefully in your interactions with a case involving these dynamics because they are often very volatile, even for seasoned professionals.
Should you be interested in developing your clinical skills in forensic divorce and child custody matters, there are workshops available held by some of the larger Bar associations in conjunction with mental health professionals. Good resources can be found in specialty workshops offered by the American Association for Marriage and Family Therapy (AAMFT), as well as online materials on the California Association of Marriage and Family Therapists (CAMFT) and AAMFT websites, in addition to the following organizations:
• Association of Family and Conciliation Courts (AFCC)– California Chapter: www.afcc-ca.org
• AFCC National Organization: www.afccnet.org
Terri Asanovich, LMFT, is in private practice in Sherman Oaks. She serves as a consultant to therapists and attorneys on divorce issues.
**Articles are appearing in the official State of CA licensing Newsletter**