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@trustinsurance.com. 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 Insurance Program.