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Breaking confidentiality if a client has suicidal thoughts (under 16)

Hi everyone,

I need some advice for my assignment at University. I am studying clinical psychology, and I have a roleplay assignment coming up where we have to engage in therapeutic roleplay with an actor for 15 minutes.

We have been given a brief explaining the client we are meeting with is 15 years old, has suicidal ideation (thoughts regarding suicide) but denies having any plans or intent. She then regrets telling the therapist (me) and begs to keep it a secret. They are extremely worried about what their family will think and doesn't want them to worry.

My question is, do I break the confidentiality with the client as they are only 15 years old, tell their parents and possibly break the trust between me and the client which could ultimately ruin our therapeutic relationship and their chance to get better? Or, as they have no plan or intent, keep working with the client, not breaking confidentiality, and discuss with her GP, not her family.

I understand their are certain ethical requirements if there is a threat or risk that my client will harm themselves, however if there is no plan or intent does this still imply?

Thank you.
Reply 1
Original post by jessie313
Hi everyone,

I need some advice for my assignment at University. I am studying clinical psychology, and I have a roleplay assignment coming up where we have to engage in therapeutic roleplay with an actor for 15 minutes.

We have been given a brief explaining the client we are meeting with is 15 years old, has suicidal ideation (thoughts regarding suicide) but denies having any plans or intent. She then regrets telling the therapist (me) and begs to keep it a secret. They are extremely worried about what their family will think and doesn't want them to worry.

My question is, do I break the confidentiality with the client as they are only 15 years old, tell their parents and possibly break the trust between me and the client which could ultimately ruin our therapeutic relationship and their chance to get better? Or, as they have no plan or intent, keep working with the client, not breaking confidentiality, and discuss with her GP, not her family.

I understand their are certain ethical requirements if there is a threat or risk that my client will harm themselves, however if there is no plan or intent does this still imply?

Thank you.

This will all rather depend on how severely you diagnose their suicidal tendencies.

If they are evidently acutely suicidal, beneficence must be given primacy, as it should be if they are chronically suicidal, unable to control self-destructive impulses. In these cases, if you deem the threat of harm to be significant, breaching confidentiality is justifiable. However, some chronically suicidal patients may be capable of resisting these impulses, and in such situations, their autonomy must be respected.

You must also consider other external factors such as their background, family and friends, and socio-economical situation.

Simply put, there is no 'most correct' answer, but just a suitable approach. These assignments are designed to test your knowledge of ethics and how you apply it in an unfamiliar context, more so than your ultimate decision. Be sure to make sure the logic of your decisions are apparent to the observer, alongside the ethics you are considering. Just keep in mind that the successful management of a suicidal client calls for a dynamic, rather than rigid, application of ethical principles.

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