Challenges in Maintaining a Therapeutic Alliance: Child Welfare and Issues of Confidentiality

State law can require substance abuse treatment providers to report individuals for child abuse and neglect and to supersede Federal confidentiality laws that cover substance abuse treatment. It is critical, therefore, that admissions staff, program materials, and counselors clearly present and discuss the limits of confidentiality as regulations require. Without this explicit discussion, women in treatment may have questions and feel uneasy with regard to mandated reporting. For instance, when counselors intervene to protect a client's children, this may seem contradictory to the client and raise questions about confidentiality.

A great barrier to treatment for women is fear of losing their children, a fear that engenders intense mistrust on the part of clients who are mothers. Therapeutic alliance and trust are vital to the treatment process, yet treatment providers must protect children. To resolve this, women must understand that although providers will report their concerns for the safety of children, providers are advocates for the women and their families (CSAT 1996; Lopez 1994; U.S. Department of Health and Human Services, Office for Civil Rights 2002).