10.10 Special Considerations for Adolescent Populations

Working with the adolescent population can bring up special clinical and ethical considerations, many of which go hand in hand. Some of the more pertinent ones will be discussed below. Counselors are responsible for identifying their competence in navigating them and seeking appropriate training, consultation, and supervision.

Multicultural Lens

Therapeutic judgments are always made in the context of culture. Counselors are asked to balance ethics around multicultural competence and other ethical codes. They constantly consider a cultural lens when working with clients, particularly with those who identify with diverse, historically oppressed backgrounds. They adopt an attitude of cultural humility and take steps to learn about the practices, beliefs, values, and rituals of various cultures.

In working with adolescents, counselors are on the hook for considering the family system in which the young person exists and the family’s cultural background. In traditional Westernized cultures, goals are typically related to individuation, autonomy, living independently, and building identity and self-esteem (Ford-Sori, 2015). Successful family work is measured by improved boundaries, communication, and self-differentiation, or maintaining one’s identity in interacting with others (Ford-Sori, 2015). Eastern cultures emphasize interdependence, collectivism, dependence, closeness in relationships, and firm hierarchies in society and families (Ford-Sori, 2015). Counselors work to understand the nuances of working with clients with different identities and help with referrals to other providers if clients decide to see someone else. They also engage in learning that challenges traditional, heteronormative beliefs about children, marriage, families, and relationships overall (Ford-Sori, 2015). Part of this is ongoing self-monitoring of their cultural beliefs and biases and how they influence their lens on the world and file it accordingly to prevent hindrance to client care.

Exploring Gender and Sexual Identity with Adolescent Clients

Adolescenthood can be a time of identity exploration, which can involve questions about one’s gender and sexual identity. Counselors must consider the process of identity development and associated tasks when navigating such concerns with young people (Koocher, 2003). They take care to recognize the added stressors identity questions bring. Young people may feel unsafe near usual supports such as family, friends, faith, or culture, which can contribute to isolation, internalized shame, or nuance in developing a sense of self (Koocher, 2003). They may be subject to bullying, rejection, or dismissal from peers or community leaders, which contributes to big feelings and uncertainty and is associated with higher rates of depression (Koocher, 2003). Further, counselors keep their duty to warn that close, as rates of self-harm, suicidal ideation, intent, and attempts are significantly high in this population. They engage in ongoing safety planning and involve parent(s)/ guardian(s) as needed (Koocher, 2003). Of course, counselors do not put any of this onto clients. However, they do follow them as they arise in the therapeutic process.

Divorce Situations

Counselors may find themselves working with adolescents who are navigating parental divorce. In divorce or post-divorce circumstances, parents can sometimes be engulfed in legal battles, custody hearings, visitation/ child support arrangements, and emotional turbulence (Ford-Sori, 2015). Because of their involvement with the legal system, counselors may experience opposing forces, as counseling is a collaborative system, whereas the legal system is more adversarial (Ford-Sori, 2015). Counselors advocate for their minor clients accordingly. They work to clarify their role with all family members as counselors of the young person and maintain these boundaries to promote client welfare (Ford-Sori, 2015). They may tell parents that children are harmed when caught in parental conflict (Ford-Sori, 2015). Often, people have different ideas or expectations about the counselor’s role and responsibilities than a family therapist, guardian ad litem judge, etc. (Ford-Sori, 2015).

Legal implications- Receiving a Subpoena

When counseling data is called into court, a client’s confidentiality is at risk, and the counselor must proceed carefully. Upon receiving a subpoena for an adolescent client, an astute first step is to pause. Next, counselors should engage in an ethical decision-making process to determine how to proceed, and an application of this with adolescents is detailed in box 10.4 below (Ford-Sori, 2015). Confidentiality practices are restored once legal needs are met and the relevant release of information documents has expired (Ford-Sori, 2015). When counselors are called to testify, they refrain from bringing clinical documentation into a courtroom, as doing so could lead to it being called into evidence and potential harm to their client (Ford-Sori, 2015).

Box 10.4. Ethical decision-making considerations for court orders for adolescent clients

School Setting

Counseling within the school can improve access to care for young people, add social context to their therapeutic work, and raise some interesting ethical questions. Counselors who work in a school setting must carefully safeguard client confidentiality. They work in settings with different roles and administrative duties, and they cannot confirm or deny the young person’s participation in services or divulge any information about them. They also navigate confidentiality in calling or sending passes to the student to attend their appointments, as doing so inherently confirms their participation in services. They must meet with clients in secure, confidential spaces within the school, too. Counselors are also careful about storing records safely and outside school systems so school personnel cannot access their information. If a client needs assistance with something in the school, counselors are in a unique position and can advocate for them, but they must obtain a release of information first. Further, counselors may meet with clients who know each other, are friends, or even pursue romantic relationships with each other. They must manage these dual relationships and navigate informed consent around the importance of confidentiality and the person’s own space to pursue clinical work.