Case Study of Sean - Chapter 11

Sean, a 15-year-old multiracial (Native American, White, and Black) male, initiated services of his own accord to manage symptoms of depression, including suicidal ideation. Sean was academically advanced for his age and excelled as an artist and skateboarder. He prided himself most on his academic success, and he aimed to graduate from high school early and attend college.

Sean had poor self-esteem and lacked a strong cultural identity. In the state where Sean resided, he could consent to treatment. He did so, stating that his father, who was his legal guardian, would not consent.

The counselor developed a strong rapport with Sean. Sean was raised in a single-parent household. Sean's father had a severe and chronic mental illness for which he received sporadic treatment, and he was currently stable. According to Sean, during his childhood he was placed in state custody for a year due to his father's alcoholism and physical abuse toward him. Sean also spent a year living in a homeless shelter with his father.

During this time, he was required to attend therapy, which he found unhelpful to his family. Sean's father believed it was yet another example of the "White man trying to destroy the Indian." Sean's siblings were all incarcerated. His grandparents experienced relocation, boarding school abuse, and slavery. Sean's immediate family was relatively isolated because of his father's outrageous behavior. Sean reported that his father would often denigrate him.

One day, Sean was limping when he arrived for a therapy session. When asked what had happened, he stated that his father had been angry with him for not doing well in his Native language class and had taken a belt to his legs and then shoved him through the screen door, breaking it. Sean further reported that his father's fits of rage were a rare occurrence (every few months) and Sean had learned to manage them by accepting the abuse.

The counselor reminded Sean of his duty to report child abuse or neglect. Sean then attempted to downplay the story, reporting that he had fallen through the door himself. Sean asked that the counselor not report the incident because he feared being taken away from his father again; Sean felt that his father depended on his care. He was also concerned that any type of investigation would disrupt his schooling and cause his grades to suffer. The counselor was conflicted about whether to report. He considered the following points:

(a) client safety, including assessment of the severity, frequency, and impact of the abuse and the vulnerability of the client;

(b) obligation to report given the state laws around child abuse and neglect;

(c) psychological benefit versus harm to the client as a consequence of reporting, including betraying the client's trust, potential family fragmentation, and loss of stability, predictability, and family social supports in the client's environment;

(d) client level of independence and maturity; and

(e) concern regarding the client, family, and community perceptions of social services as a systemic enactment of violence on families.

Sean's family had experienced generations of marginalization and victimization enacted through systems meant to uphold social policies.

The counselor consulted with several colleagues. In addition to emphasizing the legal and ethical obligations of the profession, one colleague asked, "What if something more violent or lethal were to happen to this child and you did not report? Would you be able to live with that?" The counselor decided that he could not. He talked with Sean about the need to report, encouraging Sean to report with him, but ultimately the counselor made the call.

The counselor had plans to work closely with the family if the case was investigated, to ensure that the caseworker considered the family's context and culture. He also hoped to help the adolescent develop a safety plan and build broader networks of social and cultural support while also continuing to support him in his academic strengths. However, after the counselor reported the abuse, Sean did not return to counseling.

Counseling Across Cultures (Kindle Locations 7999-8029). SAGE Publications. Kindle Edition.

1.What are the different contexts of marginalization that may have been at play in this situation? How might your experiences of marginalization influence your perspective and choice to report?

2.How well did the therapist behave in accordance with:

(a) the legal standards,

(b) the ethical standards of conduct in psychology,

(c) the ethical standards of conduct with racial/ethnic minorities and marginalized groups, and

(d) personal ethics? Where do the standards conflict or align in regard to this case?

3.How do you think the therapist's choice to report affected the client's marginalization and other issues for which he sought help in counseling? How do you think the client might have been affected if the counselor had not reported?