Consequences and dilemmas in therapeutic relationships with families resulting from mandatory reporting legislation

Mandatory reporting legislation has been adopted in every state to insure the protection of children from maltreatment. These statutes have become a significant factor in the lives of mental health professionals who work with children and families. Thirty psychotherapists who had made a recent report of child maltreatment on a client in treatment were interviewed about their experiences with reporting and the consequences of reporting for therapeutic relationships. Several potentially problematic consequences and dilemmas were identified by the therapists, including immediate and long-term effects on the therapeutic alliance and course of therapy, and conflicts of interest in working with children and families.     

Order in the Steinhaus case

In April 1986, one-month-old Lance Tyler Steinhaus sustained serious injuries, attributed to abuse by his father, that left him comatose. His mother and his physicians agreed that he should not be treated aggressively. The Redwood County (Minnesota) Welfare Department obtained a temporary order restraining withdrawal of Lance's antibiotic therapy. Lance's mother and Dr. David Steinhorn, a pediatrician, appealed to the County Court to dissolve the temporary injunction. Judge George I. Harrelson in this decision denied their request on the grounds that both state and federal law establish that infants with life-threatening conditions have a right to medically-indicated treatment and that Lance Steinhaus had such a right because he was in a "vegetative state" rather than technically "comatose." [Editor's note: After conducting another hearing on Lance's neurological status, the court ruled on 18 October that Lance was irreversibly comatose and ordered only "comfort care."]