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Open Collection of Student Writing (OCSW)

Ethical Decision Making in the Family Dynamic

Case:

A fourteen-year-old Caucasian female client, Abby, disclosed in a therapy session at LDS Family Services in Centerville Utah, her sixteen-year-old brother, Seth, has been coming into her bedroom at night and raping her. She has not told her parents about the abuse, and the emotional turmoil of her trauma has led her to self-injure, have suicidal ideation and has disrupted her sleep patterns. Her parents brought her to therapy initially for her self-destructive behavior and depression. She hasn’t told anyone because she is worried what will happen to her brother because he is captain of his soccer team, has a church calling and just started his first job at a grocery store. Abby feels if she tells her parents they will not believe her because Seth is the oldest of her and three other siblings. She expressed she feels embarrassed and shameful about the abuse. Abby is scarred not only by her brothers behavior, but the damage it has done to her emotional and mental wellbeing sharing that she wants to feel well again.

Due to the clients age thus being a minor, the sexual abuse carried out by her sibling must be reported to law enforcement and her parents need to be notified. Even though the client expressed fear for her brother’s consequences, reporting is mandatory by law due to the clients age. Failure to do so will allow the client to continue to be abused and will result in the clinician losing licensure and receiving a class B misdemeanor in the state of Utah. (Utah Code 62A-4a-401, et seq.: Child Abuse and Neglect Prevention and Treatment)

Alternatives:The first alternative that can be made is a separation between Abby and Seth to ensure Abby is safe in her home. This would also be done to keep the other children in the home safe as well; though, we do not know if they have been abused by Seth. As part of this alternative solution, Abby stays in the home with the parents while Seth temporarily resides in a residential treatment center for teens. Abby is given the option to continue seeing her therapist at LDS Family Services, and given the option to enter a day treatment or intensive outpatient treatment module. This would allow for a separation of the siblings, and both the victim and the perpetrator will be in a position to receive help and be under close supervision.

A second alternative that could be made is to separate the siblings by keeping Abby in the family home while she continues seeing a therapist regularly, and Seth goes to a juvenile detention center and is given a treatment plan for young sexual offenders. Allowing Abby to stay in the home will give her time to re-establish her own sense of safety and autonomy within the home. While Seth’s time in a juvenile detention center can help him to better understand the consequential fall out of his behavior. In this alternative both the victim and the perpetrator are separated and receiving help to better their environmental and emotional wellbeing.

The third alternative in this case scenario could be to send both Abby and Seth to separate residential youth treatment centers. Doing this would allow both the victim and the perpetrator distance and they would each receive treatment to aid in their healing. Abby would be under closer supervision in this setting, which would benefit in keeping her safe after having reported suicidal ideation and her known struggle with self-harm. She would be in a supportive environment to receive care and support at any time from a highly trained staff.

A fourth alternative action plan is to separate Abby and Seth by keeping Abby in the family home with her mother and younger siblings, while Seth and the father stay in a separate apartment while both the victim and the perpetrator receive help. Abby is to be given a choice for her treatment option between attending a day treatment program, or an intensive outpatient program. This would separate the siblings to discontinue the abuse and allow both the victim and the perpetrator to receive help in their recovery. Giving Abby a choice between a day treatment or intensive out patient program would allow her to have a greater say and sense of autonomy in her treatment.

In addition to any plan of action care must be given to the family outside of the victim and perpetrator role.  The effects of sibling sexual abuse can be complex and confusing to the other siblings in the family. Oftentimes, parents are so focused on addressing the immediate needs of the victimized child or the perpetrating child that they inadvertently overlook the less obvious needs of the other children who are struggling. Finding professional support for the other children in the family will equip them to know how to best process this family trauma. Because parents often respond differently to devastating situations, many marriages have crumbled due to sibling sexual abuse. Spouses must seek out the much-needed tools that will help them process and work through this immeasurable pain and suffering together. (Religion News Service) It is crucial the young perpetrator receive help to prevent future offense and treat the likelihood they are also a victim of sexual abuse. A number of studies indicate that between 30 and 70% of young abusers have been sexually abused (Johnson & Shrier, 1987; Ryanef al, 1990).

Probable Consequences:

A probable consequence on the victim of removing the perpetrator from the home to a residential treatment center, is the victim could feel guilt and shame for her brother’s separation from their family. If not monitored closely the victim’s depression could worsen as a result of the feelings of guilt and shame. With the depression worsening the client’s safety is compromised due to their mental health.

The second alternative suggests Abby stay in the family home, while Seth go to a juvenile detention center. A probable consequence of this alternative is Abby worrying she is the reason her brother is in the juvenile detention center and has a potential for the victim to magnify her guilt due to beliefs and the shame reputation of juvenile detention. This option could cause harm to the client emotionally and mentally.

The third alternative in this case scenario being to send both Abby and Seth to separate residential youth treatment centers. While this could be helpful to the client, it could also cause emotional harm being that she is being placed in a new social environment and may feel she has been further stripped of her autonomy because she has to learn and follow a new set of rules. This option may also be harmful to the victim because she may feel she is at fault for telling about the abuse and being put in a treatment center is a consequence and may interpret this option as rejection from her parents. Another probable consequence of this option is the financial strain this could put on the parents which would in turn would add to the family trauma.

Probable consequences of the fourth alternative action plan, is by taking the father out of the home with the perpetrator could influence the victim to feel her father is taking sides with the perpetrator, a strain in the parents’ marriage can result from the parents being physically separated, and relationships with the younger children and their father could be dangerously compromised. In addition to paying for treatment, the cost of the apartment would place added financial burden on the family. This option has potential to further harm the victim by removing the father from the home, theoretically damaging the quality of life due to family finance and the prospect of damage in the relationship between the victim and the father.

Resolution:

As in each of the above-mentioned action plans it is essential to have the perpetrator removed from the victim’s home to ensure the victims safety, because of this it is crucial that the victim be empowered to understand they are not at fault for their sibling’s separation from the home. I feel the best course of action for this scenario is for Seth to go to a residential treatment center for adolescents, and Abby stay in the home with the family and be given the choice of continuing with her current mode of therapy or attending a more intensive therapy program.

I would choose this as the most viable option because it gives the victim her most options after a situation where she was not allowed choice. It values the importance of the familial relationship by keeping the victim with her parents for support and allows the victim to gain a new-found safety within the home. By sending the perpetrator to a treatment center, the victim and perpetrator would be separated, and the family would be able to attend family therapy to prepare for the eventual reintegration of the family as a whole. I feel this option would be most helpful because its strong emphasis of keeping the family together; while separating the victim and the perpetrator which is a good fit for the family culturally in their religious background being members of The Church of Jesus Christ of Latter-Day Saints. This option fits well with my moral rules because it allows for both the victim and the perpetrator healing, and provides potential for the family to be strengthened.

References:

Johnson & Shrier, 1987; Ryanef al, 1990 Retrieved from:

Advances in Psychiatric Treatment (1998), vol. 4, pp. 101-107

Religion News Service Retrieved from:

Responding to sibling sexual abuse: What to do and why

Utah Code 62A-4a-401, et seq.: Child Abuse and Neglect Prevention and Treatment

***Note: the situation detailed in this essay has been fabricated for this assignment.

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