Academic journal article American Journal of Psychotherapy

Therapist Reporting of Suspected Child Abuse and Maltreatment: Factors Associated with Outcome

Academic journal article American Journal of Psychotherapy

Therapist Reporting of Suspected Child Abuse and Maltreatment: Factors Associated with Outcome

Article excerpt

Therapist Reporting of Suspected Child Abuse and Maltreatment:

Factors Associated with Outcome*

A mail survey of 176 mental health professionals (e.g., psychiatrists, psychologists, and social workers) known to have reported a case of suspected child abuse or maltreatment to the New York State Central Register in 1993 was conducted. Participants responded about a specific case they had reported. Positive outcomes were associated with a better quality of relationship before the report, longer length of time in treatment, and more effective therapist handling of making the report. Implications for training and research are discussed.

INTRODUCTION

Over the last 35 years, in an effort to identify and protect vulnerable children, every state in the country has enacted legislation mandating the reporting of suspected child abuse and maltreatment by designated professional groups, including mental health practitioners. While there is some variation among states, current statutes essentially provide for the reporting of suspected physical and sexual abuse, emotional maltreatment, and physical neglect to a child protective services (CPS) agency. This agency then conducts a study of the allegations and determines what actions, if any, are needed. Actions may include supportive services in the home or removal to foster care.

A prevailing view among mental health professionals (e.g., psychiatrists, psychologists and social workers) is that the legal mandate to report suspected child abuse and maltreatment involving a client has a deleterious effect on the psychotherapy relationship (1-3). Concerned about the impact of reporting on the relationship, many practitioners have failed to report at least one time in their careers (2-4). This is a vulnerable position for the child-at-risk as well as the mental health practitioner who is open to civil and criminal penalties for willful failure to report. A more complete understanding about the outcome of reporting on the psychotherapy relationship and of factors that may have bearing on the outcome could assist mental health professionals with their reporting concerns. This article reviews the research on the outcome of making a report for the psychotherapy relationship and then examines the association between outcome and specific factors in therapy.

Outcome of Reporting on the Psychotherapy Relationship

The literature about disruptions in the psychotherapy relationship associated with reporting focuses on the issue of confidentiality (2,3,5-7). The belief, evident in both the theoretical literature and the research on clinical perceptions about reporting, is that making a report breaches confidentiality, which damages the psychotherapy relationship. In contrast, research that examines the actual effects of reporting by practitioners suggests that breaching of confidentiality to make a report may not necessarily have negative repercussions for the psychotherapy relationship, and may even be positive. Harper and Irvin (8), conducted a chart review in a medical setting (N=107), examining the effects of reporting on the parents' relationship with the medical treatment team. Outcomes specific to the psychotherapy relationship were examined by Watson and Levine (9), who conducted a chart review in an out-patient child guidance clinic (N=65); Levine, Doueck and Associates (6), who conducted in-person, structured interviews with mental health professionals in a social services agency (N=30); and Steinberg, Levine and Doueck (10), who did a nationwide mail survey of psychologists (N=598). These studies found that in about 75% of the cases there was either no change or improvement in the psychotherapeutic relationship following the report as measured by indices related to patient cooperation and self-disclosure. In about 25% of the cases, terminations occurred. We (11) had similar results in a mail survey of New York State mental health professionals known to have made a report (N=176). …

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