Adolescent Disclosure of Sexual Abuse in Therapy
Dr. Elena Marquez, a licensed psychologist in Denver, has been treating 14-year-old J for six sessions for generalized anxiety. J's mother consented to treatment. In session, J discloses that her 19-year-old cousin has been engaging in sexual contact with her for the past year. J says she does not want anyone told because her family will be humiliated and the cousin is 'like a brother.' J is tearful and asks Dr. Marquez to promise not to tell. Dr. Marquez knows Colorado's age of consent is 17 and that the cousin is an adult. She wonders whether the report is required given that J is not a young child, the contact was not violent, and J disclosed in therapy. She has a consultation with a colleague in three days. The mother is not in the waiting room. Dr. Marquez must decide what to do before J leaves the office.
1. Is Dr. Marquez legally required to report this disclosure? If so, to whom and under what standard? Explain how the facts affect the analysis.
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Yes. Colorado's mandatory reporting statute (C.R.S. § 19-3-304) requires licensed psychologists to report when they have reasonable cause to suspect child abuse or neglect. 'Child abuse' includes sexual abuse of a minor. J is 14; Colorado's age of consent is 17, so sexual contact between J and her 19-year-old cousin is unlawful sexual behavior and constitutes reportable abuse. The report is not discretionary because J is a teenager, because the contact was nonviolent, or because J disclosed in therapy. The standard is reasonable suspicion, not proof; Dr. Marquez must not investigate or verify. She should report promptly to the county department of human services or local law enforcement. The family's embarrassment and J's request for secrecy do not override the duty. Waiting three days for consultation would be inappropriate. Confidentiality under HIPAA and professional ethics yields to the mandatory report.
2. How should Dr. Marquez handle the disclosure in the session and document it? What should she tell J about confidentiality?
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Dr. Marquez should not promise secrecy. In developmentally appropriate language, she should remind J that what they discuss is private except when someone's safety is at risk. She should explain that she must make a report to help keep J safe, that J did nothing wrong, and that J can ask questions. She should assess immediate safety (e.g., whether J will be alone with the cousin, whether J fears retaliation) and involve J's mother as appropriate unless doing so would endanger J. She should not contact the cousin or the cousin's family. Documentation should include the disclosure in J's words, date/time, J's affect, any safety concerns, the agency contacted, the person spoken to, the report number if given, and follow-up. She should also document that limits of confidentiality were reviewed at intake and again in this session. A colleague consultation can occur after the report is made.