Case History #2

Denise is a 16-year-old white female who entered an inpatient treatment program after being hospitalized twice: once for alcohol poisoning and once after a suicide attempt. Denise’s parents are working professionals with a comfortable income and large home in the suburbs. Denise has been living at home but does not get along with her two older sisters or her younger brother. She has been habitually truant.

Denise has confided in her counselor that for some time she has been having a hard time with her attraction to and feelings about other girls. Denise characterizes her parents as homophobic and is terrified about what might happen if they find out. Once, when her father found her watching an episode of the TV program “Ellen,” he screamed at her: “Why would you want to watch that disgusting smut? I will not have that stuff in my house!”

Denise has signed a consent form permitting her counselor to speak with her parents about her substance abuse treatment.

After Denise has been in the program for a month, a staff member discovers her acting out sexually with another girl.

What legal issues does this case present?

1) Does the facility have to tell Denise’s parents about her sexual attraction to other girls? No. Denise has consented to communications with her parents about her substance abuse treatment. Denise’s fears about her parents’ reaction may be entirely realistic. Disclosure of this information to Denise’s parents at this time would certainly destroy any therapeutic relationship developing between Denise and her counselor. Such disclosure may also be a violation of professional ethics.

Now that Denise’s counselor knows Denise’s concern, she could ask her to sign a new consent form that specifically requires the program to withhold information about her sexual orientation from her parents (see exhibit 3–1).

2) Can Denise’s counselor discuss her discovery with other facility staff? Yes, the counselor can discuss her discovery with other program staff. The Federal confidentiality regulations contain an exception permitting communication of information between or among program staff members who have a need for the information in connection with their treatment responsibilities.

3) Should Denise’s counselor discuss her discovery with other staff? Yes, the counselor should tell other staff, including the program director, about her discovery. The sexual acting out may have affected either Denise or the other girl, and failure to disclose it might create a legal risk for the program.

• If one girl makes an unwanted advance to another girl, the program has a responsibility to help the victimized child. The information is important to the other girl’s treatment counselor. He or she should be working with the girl to help her cope with this experience.

• The information is also important to the program director. If the other girl was an unwilling target or participant, her parents might sue the program for failing to protect their child. Moreover, if such an incident is swept under the rug, the aggressor may act out again, in which case the program could be put in real jeopardy.

What policy issues does this case present?

1) Program rules regarding client behavior. If the program does not have rules about sex between clients, it should adopt rules now. If the program does have rules, the treatment staff and the program director should discuss whether the acting out violated any program rules and, if so, what the program should do.

2) Preventive measures. The program director should consider whether the program can take additional steps to ensure such incidents do not occur in the future.