TW - self harm/suicide - Counsellor didn't tell us

[Ffffffffffucksake]

I have name changed for this. I have a teenager who has always struggled with mental health. She had counselling arranged through school earlier this year for a number of sessions which helped at the time, but I noticed she was starting to decline and get very anxious again after these sessions had finished. The deal is that you only get a set number of sessions and I think it was about 6.

It came to light a couple of months after these sessions that she had been self harming and had become suicidal (written notes to family/close friends). I found out about the self harm as I saw it and that opened up a discussion that she hadn't wanted to have with me for fear of making me upset. I discovered that she had divulged the self harm and severe anxiety to the counsellor. My child is 14.

AIBU to think this should have been reported by the counsellor to either the school or us as parents? There was no handover following these sessions and I can't help but feel that if I hadn't by chance discovered the self harm and suicidal notes that it could have been a very different story.

Does anyone know if youth counsellors are meant to report this sort of thing and what, if anything, would you do about it? Report the counsellor? Speak to them?

Thanks

but if I really couldn't convince them that it would be better for an adult to share then I still would share it
Again, that's your choice to do but unless a court agreed with you that the young person was under immediate and significant risk of harm, you could be accused of having breached their confidentiality.

1. If a young person is mature enough to understand the situation (Gillick competent), the professional must keep their information private, even from parents.
2. The professional can and must break confidentiality without the young person's consent if there is a risk of suicide, self-harm, or child abuse.
3. If a professional shares the young person's information outside of a valid safeguarding/legal framework, they can be sued for damages or face regulatory penalties.

So the counsellor upon hearing that the child had self harmed and felt suicidal should have been asking them very specific questions such as how long that was. How did they self harm and did they require medical intervention, did they have a specific plan to unalive themselves and did they still feel like that taking their live or hurt themselves.

Honestly I think counsellors arranged this way can do more harm than good.

Can you link to this guidance please?

I currently work a similar job to you for a large for-profit organisation that admittedly I am trying my best to escape from, but work is scarce.

Can you link to this guidance please?
RCM learning.co.uk/foamed/confidentiality-capacity-and-consent-in-pem/

This totally aligns with all the training I have received on this matter in my profession which involves children and confidentiality.

You understand that nursing/midwifery and psychotherapy are very different disciplines, with very different ethics around risk and confidentiality. Nurses wouldn’t hold risk in relation to self harm or suicide, but counsellors and therapists do quite routinely.

I'm not a counsellor so maybe their guidance is different but I would always, always share risk and the body that I am accredited with supports this. Being Gillick competent doesnt trump risk i would never be taken to court for sharing risk. I teach a 3 day course on preventing suicide and self harm in children and it has a whole module on sharing risk 😂

Ethical frameworks for counsellors and therapists are very different than for health staff. Their training, assessment and relationship with their client is completely different to nursing. Confidentiality is an absolute cornerstone of the work and is taken very seriously, as is risk. Whether a counsellor breaks confidentiality is guided by the contract they have with their client, the organisation they work for their policies - there isn’t one set of guidance that gives a definitive answer.

I’m a counsellor and self-harm and suicidal ideation are common presentations when people are in severe distress. We are trained to risk assess based on the client’s disclosures; how active, or not, they are in collaborative safety planning; and with due consideration for escalating factors that may mean that risk can no longer be safely managed. Non-suicidal self-injury (NSSI) is not usually a grounds for breaking confidentiality. Similar to thoughts of life not worth living; these are common and understandable when a person is suffering.

For me to even consider breaching confidentiality I would need an unshakable belief that the client has an active suicide plan with intent to carry it out immediately or imminently. Disclosing without this belief would be a breach of the BACP’s ethical principles of autonomy, beneficence and non-maleficence.

In years of practice supporting very high risk client groups, I have breached confidentiality once. That’s because it is an extremely serious step that occurs in a genuine emergency situation. My job is to hold that client and the risk, and only involve others if their life is absolutely on the line. Other than that, confidentiality holds.

Jellycatspyjamas is correct. Risk assessing adolescents is a nuanced process. Self-harm covers a host of behaviours from scratching and hitting one’s head with the palm of your hand, to deep cutting with a razor blade and burning oneself. A safety plan should be completed & emergency contacts provided, but whether or not a therapist reports this to the parents will depend upon the type, severity & frequency of the behaviour as well as a variety of other factors.

As others have stated, a very large percentage of adolescents (& adults) seeking therapy have suicidal thoughts - it’s really very common, and no experienced therapist would view this, in and of itself, as particularly alarming.

It can be really hard for young people to engage in therapy when they’re distressed. The reason a ‘one size fits all’ approach to breaking confidentiality shouldn’t happen is that when it does some adolescents will then fail to continue to share information related to risk, or will drop out of therapy altogether. And then no one knows about the risk / can support them which is, on balance, a much worse situation.

Any therapist worth their salt will of course gently encourage the young person to share self-harming behaviours with their parents themselves, & think about how their parents could support them. But if they don’t want to the therapist needs to tread carefully unless risk is serious and current.

Whilst I understand it can be alarming and upsetting for parents not to know, it's really such a finely balanced thing. But it certainly isn’t the case that it’s always in the best interests of the young person to share risk information with parents.

Different story for younger children of course, where there’s a freer flow of information between therapist & parents.

What the counsellors on this thread have said does make sense and I have decided it isn't something I will enquire about with the counsellor as a result of what I've learnt. It was devastating to discover and I guess it makes you question everything, especially when you think you know your child very well. I am glad that she felt she could tell someone and just a little surprised that the sessions didn't continue but maybe she seemed to be doing better towards the end.

Luckily I am not the type of person to react badly or angrily, I was just desperately sad and have cried a lot when I'm on my own but I think she knows now that she can tell me how bad she's feeling and if she doesn't want to I have arranged more counselling and pastoral support at school so she has lots of adults she can talk to and trust.

She did actually tell me that if she'd have thought the counsellor had to tell me, she wouldn't have told them any of the serious thoughts and self harm so I do see it from both sides. It must be a very tough job. Thanks for all the advise.

generally, self harm is actually a protective factor against suicide because the person has an outlet for their pain and suffering

No, this is not correct, and potentially dangerous. Self-harm is a risk factor for future suicide attempts and completed suicide. It must be taken very seriously. I am a consultant psychiatrist of many years, and we don’t see DSH as a protective factor at all.

Please consider not using the term 'completed suicide.' It's not a bloody video game.

As a parent going through similar experiences, I wanted to tell you that it's ok to struggle with this, and ok to feel sad for both you and your daughter. Self-harm can vary a lot in terms of how and why children do it. It is much more common now than when I was a teenager, and it's very difficult to stop children doing it if they really want to.

'I am sober' is a really good app (I agree it's quite alarming when you first see it!) and it can be really helpful for people trying to stop.

It sounds like you are really trying to support your daughter and care for her - try to do the same for yourself. It can be really hard but there is no shame in your child having mental health difficulties. The world can be really hard for teenagers.

Thank you @CoffeeCup14 for your kindness. It's so hard to know if you're doing the right thing isn’t it. Look after yourself too and sorry you're having to deal with similar.