Incest and professional boundaries: Confidentiality versus mandatory reporting

Ethical Issues in Counseling Adult Survivors of Incest

“…This dilemma may be further compounded by the possibility that the child(ren) in contact with the abuser will be further harmed, through retaliation by the abuser or other family members or by protective services that are overburdened, underfunded, and inefficient (Courtois, 1988). Consistent with the principle of nonmaleficence, in such circumstances the practitioner may be best advised to determine as accurately as possible the potential risk to all parties and to base his or her actions on clear knowledge of state laws and local child protection services and the procedures followed in cases of child sexual abuse (Butz, 1985;Courtois, 1988;Serrano & Gunzburger, 1983;Thompson, 1990). A decision to report may have to be orchestrated in such a way as to minimize the risk to the client and to the children the practitioner is attempting to protect.…”

“…Where there is risk of physical or psychological damage, nonmaleficence must take precedence over fidelity and autonomy (Kitchener, 1984;Thompson, 1990). For the cycle of abuse to be stopped, the abuse must be reported (Herman, 1981;Serrano & Gunzburger, 1983;Van Eenwyk, 1990). If the counselor clearly informs the client at the outset of treatment about the limits of confidentiality, however, a promise is not broken when abuse is reported.…”

“…Ethically and legally, the counselor is bound by the principle of nonmaleficence and the avoidance and prevention of further harm to the child (Kitchener, 1984;Koocher, 1976;Serrano & Gunzburger, 1983;Thompson, 1990;Weinstock & Weinstock, 1989). If abuse is disclosed or suspected, the counselor is required to report it to the appropriate child protection authorities, under the assumption that such reporting ultimately protects the child.…”