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48. Fictionalized Case: Working With a Minor Who is Using THC

In this episode of Colleague Down the Hall, a group of my colleagues discuss the complexities and ethical considerations in adolescent therapy, particularly in a case involving cultural factors, parental skepticism towards mental health treatment, and the issue of confidentiality regarding a client's substance use. We delve into the importance of understanding family dynamics, addressing cultural aspects, and navigating the delicate balance between maintaining client confidentiality and ensuring the client's well-being, especially when substance use is involved. This case presents the challenges therapists face in making informed decisions that respect the client's autonomy while considering the broader context of their family and cultural background.

 

“I think also in here is the inherent systemic racism that dad has experienced his whole life and wants his son to do really well in a society where you're constantly swimming upstream, no matter how hard you work. So I wonder how much is just pure concern and love for his son, that they really want, that's really important to help them have every opportunity. Because I mean, we all want that for our children. But when you're in a society that you recognize puts limits, just by virtue of your skin color, that I think that would be, I mean, I can only speak as an outsider, but I could see how that could really drive you to drive your kid. Because you really want them to have that opportunity and to be able to achieve”- Lise

 

Key points from this episode:

 

  • Challenges of Therapy with Adolescents: The case of 16-year-old Paul highlights the complexities of working with adolescents in therapy, especially when there is parental skepticism towards mental health treatment.
  • Cultural Considerations: Paul's identity as an African American male is relevant, influencing both the therapist's approach and the parents' perception of therapy. There is an emphasis on understanding and addressing cultural factors in therapy.
  • Parental Attitudes and Family Dynamics: Paul's parents' views on mental health and therapy, along with their high expectations and perceived judgment, significantly impact Paul's situation and his progress in therapy.
  • Confidentiality and Ethical Dilemmas: The therapist faces a dilemma regarding whether to disclose Paul's marijuana use to his parents, weighing the importance of confidentiality against the potential risks of substance use.
  • Therapeutic Progress and Skills: Paul has shown progress in managing his anxiety through various therapeutic techniques, such as mindfulness and Cognitive Behavioral Therapy (CBT).
  • Consultation and Peer Support: The therapist seeks advice from colleagues, demonstrating the value of professional consultation and peer support in navigating complex cases.
  • Documentation Practices: The importance of careful and thoughtful documentation in therapy is discussed, considering legal and ethical implications.