From the Spring 2020 issue of The Los Angeles Psychologist

The Intersection of Ethics & Law: AB 1775 

Mary Jane Julius, Psy.D. 

A teen bounces into your office and flops down on your couch. She begins to talk animatedly about school and recent issues with her peers. After 15 minutes, she shares that a boy she likes sent her “one of those pics” and that she has texted it to her two best friends. Your client giggles. You pause and get ready to reacquaint your client with your mandatory reporting requirements. 

Most clinicians who work with adolescents have at some point had the experience of their client disclosing sexual images of peers. California Penal Code 11165.1 defines “sexual exploitation” as 

“a person who depicts a child in, or who knowingly develops, duplicates, prints, downloads, streams, accesses through any electronic or digital media, or exchanges, a film, photograph, videotape, video recording, negative, or slide in which a child is engaged in an act of obscene sexual conduct.” 

There is confusion and concern amongst mental health professionals about our mandatory reporting requirements relating to the amendments of the Child Abuse and Neglect Reporting Act (CARNA) by AB 1775. The consensus between Department of Children and Family Services (DCFS) and malpractice lawyers appears to be that adolescents’ distribution of sexual images of minors (i.e., peers) is what poses a problem. Mandatory reports can be made to law enforcement or DCFS when the clinician determines these images have been distributed, but how does this reporting affect the treatment outcome for our adolescent client? 

Many of us who work with adolescents have amended our written and oral informed consent to reflect the changes enacted by AB 1775 in 2014. The problem that often presents itself is that our adolescent clients do not recall our initial conversation about informed consent. Being seated across from an adolescent as the shock and panic registers on their face when informing them of our mandated reporting requirement after disclosure of such images is disheartening. As a clinician, I am faced with two equally unappealing options: cause my minor client harm or risk my license by ignoring my mandated duty. 

Research and brain imaging have provided us with insight into the neurobiological development of the adolescent brain. Psychiatrist Dan Siegel, M.D. has suggested that insight, empathy, and morality are shaped during adolescence. Siegel writes:

 “The reconstruction zone of the prefrontal cortex in particular means that many of the functions that this frontal area of the brain enables through its integrative role - balancing emotions, planning for the future, having insight and empathy - are more easily thrown off-line with intense emotions and peer influence. They may be more fragile, more easily disrupted, than they will be in the years ahead” (2015, p. 104). 

In light of these findings, clinicians must ask the question: how responsible can we hold an adolescent for choices made by an immature prefrontal cortex? 

As psychologists, our first and foremost ethical principle is to “do no harm.” Principle A states that “Psychologists strive to benefit those with whom they work and take care to do no harm” (APA, 2016). The effects of AB 1775 on CARNA and, subsequently, adolescents, can be very harmful. This is not to preclude that some distribution of sexual images is made with maleficent intent. And perhaps, in these cases, the mandate aligns more closely with the intent of AB 1775. In my own practice, I have found that most of the adolescent clients who have disclosed distribution of sexual images simply did not contemplate the ramifications. 

Oftentimes, adolescence is the first time a person may be entering treatment. Throughout the course of treatment, adolescents come to enjoy the gift of confidentiality. It can be a very rude awakening when they are reminded that this confidentiality is not absolute. I find myself and other colleagues reflecting on the original purpose of AB 1775 and how it conflicts with some of our most treasured ethical principles. Confidentiality is a principle that creates an environment of trust and safety between clinician and client. When law overrides that ethical principle, it undermines our credibility and rapport with clients. 

Now that we have seen the application of AB 1775, it gives us time to reflect on the impact of AB 1775’s amendment of CARNA and the therapeutic setting. Some clinicians have raised the idea of amending AB 1775 to correct what Robert Weiss, Ph.D., LCSW, once called “a well-intentioned but poorly worded law.” Time will tell whether psychologists and other mental health professionals will take up the torch to correct the juxtaposed mandates of our ethical principles and AB 1775. 

Notwithstanding, this is the law and psychologists should include this in informed consent, and adhere to the legal requirements of mandated reporting. ▲

References

American Psychological Association. (2016). Ethical principles of psychologists and code of conduct. Washington, DC: Author

Child Abuse and Neglect Reporting Act, Cal. Penal Code § 11164 et seq.

Siegel, D. (2015). Brainstorm: The power and purpose of the teenage brain. New York. Penguin Books.

Weiss R. (2015, ). Clinical alert: Where do you stand regarding imminent changes to client confidentiality (AB1775)? [Letter to the editor]. The Therapist, ? (?), ?. *