Chapter 13

Question 1

Who is the client in psychological services for children and adolescents?

Answer 1

• Adults usually seek therapy themselves and give informed consent
• Children and teens rarely self-refer for therapy
• Services are typically initiated by parents or other adults concerned about behaviour
• So the question remains as to whom the psych services are for - child receiving services or parents support consent

Question 2

Challenges in Identifying the Client

Answer 2

• Children may not see their behaviour as problematic
• Parents, teachers, and youth often disagree on the issue and goals (what is the problem & if that even is a problem)
• Youth may resists therapy or feel misunderstood

Question 3

Challenges in Identifying the Client - Parents as Gatekeepers

Answer 3

• Parents control access: referrals, transportation, and payment
• Their engagement affects treatment success
• Example: Parents may disengage if the therapy does not align with their views, leading to missed sessions, cancellations and withdrawing child from therapy

Question 4

Challenges in Identifying the Client - Legal and Ethical Complexities

Answer 4

• Consent laws vary by age or by capacity to understand treatment
• Psychologists must know the legal context of their practice (education on rules & child protection rules)
• Case Example: Jorge, 14, legally refused treatment despite parental concern

Question 5

Challenges in Identifying the Client - Consent, Engagement & Confidentiality

Answer 5

• Legal consent does not guarantee willingness to participate
• Confidentiality must be clearly explained at the start
• Therapists balance youth privacy with legal obligations and parental rights

Question 6

Importance of the Therapeutic Alliance

Answer 6

• Parent-therapist alliance encourages better attendance and commitment
• Youth-therapist alliance encourages better symptom and behaviour improvement
• For best outcomes, both relationships are essential for therapy to be effective

Question 7

Who Needs Services?

Answer 7

• Adolescent depression is common, with rates similar to adults but it is significantly less studied, due to both parent consent being required for youth studies
• Rates double between 13-14 and 17-18
• Depression is chronic and recurrent, linked to struggles in peer relationships, academic decline, family conflict, and higher suicide risk