Preserving the Therapeutic Relationship as a Mandated Reporter

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If you find yourself a mandated reporter of child abuse and neglect and have ever had to report a client or patient with whom you have worked so hard to build rapport, the disruption of the therapeutic relationship probably appropriately concerns you. You know you have to call, and you can easily imagine that Jenga tower of rapport and trust you and your client built together toppling over completely.

Furthermore, you may already know that many cases of abuse and neglect do not spring from the woodwork, and there may be a complicated context. It may be important to you as a clinical practitioner to preserve the relationship if possible, so you can help your client and their family further.

HOWEVER: Not all is lost! In both the research, and this writer’s personal experience, The therapeutic relationship can be preserved, or the damage at least mitigated. Others have done it and you probably can too. After you accept that you need to/have to/are going to report (the definitions of abuse and neglect vary from state to state but generally follow the definitions in federal law) consider the following steps:

  • Be realistic and own your role. Be comfortable with the fact that you may damage or extinguish the therapeutic relationship. You are fulfilling your responsibilities as a mandated reporter and these responsibilities are in place to protect your client and their child. Plenty of data illustrates the importance of your mandated role. The CDC notes the stakes when they report that many incidences of abuse and neglect are not reported. In a nutshell, the importance of your therapeutic relationship does not outweigh the importance of reporting.
  • Be as honest as possible. Fulfill your responsibility to make the call, but also be responsible for informing your client, unless contraindicated. Give as much information as possible about the process, which can increase their sense of control over the process. It’s also extremely important to make sure they understand what caused the report, if you can safely do so.
  • Educate on the process. Be familiar with the process and give updates as you have them. Advise how they can advocate for themselves and use your local Child Protection agency as a resource. Provide your client information on advocating for themselves if they are concerned they will not be treated fairly.
  • Acknowledge feelings and emphasize your supportive role. You can be a mandated reporter and still available to be supportive to the client and family throughout the process. You can still listen to and reflect their frustration with the call and the process. Acknowledging feelings  is therapeutic in almost every situation. You can always acknowledge feelings without condoning specific actions.
  • Stick to your guns and do not waver on the report itself. You can acknowledge and validate frustration and still be comfortable with your call. Clarify what those criteria were that led to the call and how you can still be available to prevent them from resulting in a report in the future. The only thing more irritating than knowing someone reported you for suspected abuse or neglect may be the perception they reported you when they did not know it was required.
  • Diffuse some responsibility. If you made the call, own it but you can still spread the responsibility around. You can probably sincerely say:
    •  Law and probably agency policy requires you make the call given the previously discussed situation (what was said, what you observed)
    • Your supervisor advised you are required to make the call, if you consulted them first.
    • You consulted with other clinical team members as well, if you did so.
  • MIX AND MATCH FOR COMBO POINTS! As with many therapeutic techniques, you can use more than one of the above. Acknowledging feelings + being honest about the criteria that led to the report available for support + educating on the process = a sort of “gentle reality check”. It sounds like they are very angry about this situation, they are entitled to feel angry at you and/or the system, but the specific situation required this report.

Again, rest assured that any good faith report that you make of reasonable cause to suspect abuse or neglect always wins when compared to not reporting. You are mandated for a reason. Most reports of abuse or neglect were made by mandated reporters just like you and as noted above, the number of incidences of child abuse and neglect, and the resulting damage to those children and our society at large, already greatly outnumber the number of reports.

If the very real potential for the Child Protection System to be used as a tool of oppression concerns you, you have other options as a social worker, and these concerns should not impact your decision to make a report:

  • If prevention remains a possibility, or if you do not already reasonably suspect abuse or neglect, make sure your at-risk client is aware of the risks. A large part of this writer’s Pediatric Clinic role is advising families at risk of abusing or neglecting their children of the definitions of abuse and neglect, the mechanisms for reporting, interviewing them to identify the psychosocial context that they feel causes those risks, and connecting them with appropriate education and/or resources.
  • If you fear your client may be treated unfairly after the report, you can still be their advocate throughout the process. Share your knowledge of the process. Again, making sure they know you remain available is an important part of maintaining the therapeutic relationship.

SAFETY NOTE: Much of the above bears the assumption that you can safely discuss a report with your client. If you or your supervisor have any realistic concern about your safety, particularly if you work in the client’s home, it is okay to skip some of the above steps. While it may be better for the therapeutic relationship to be honest about making a report, since the client may be aware of you as the possible reporter from the context or reading of your non-verbal cues, as far as the therapeutic relationship goes, your safety outweighs the importance of that relationship in the same way a child’s safety does.

If you do not feel safe speaking honestly and sincerely with your client about concerns that you have for their safety or the safety of children in their care, you may not be the best therapist or social worker for them anyway. And there’s nothing wrong with that.

You can find more information child abuse and neglect, including the laws in your state, at www.childwelfare.gov.

Published by

Anthony Heard

Anthony Heard, MSW, LCSW is a pediatric social worker at the University of Illinois Hospital in Chicago with experience in trauma-informed care, child protection, and healthcare. His interests range from these areas to health psychology and chronic disease to evaluation capacity building and implementation in social service programs. View all posts by Anthony Heard

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