One of the questions I am frequently asked as a coach (sometimes several times a week!) is this: what is the age of consent is for therapy? Can minor’s consent to their own therapy? Do parents have a right to access their child's record? The most important thing you need to know regarding this topic for your ASWB exam is this: the age of consent varies state to state. In some states, a child as young as 12 can consent to their own therapy. In other states, however, even a 17-year-old minor cannot be seen for therapy without parental consent.
Age of Consent
What many people are unaware of is the fact that the LMSW and LCSW exams are not state specific. These exams are administered not by your state boards, but by the ASWB, and are the same across the country. The LCSW exam given in New York will be the same one given in Florida, Texas, California, Hawaii, and so on. Because this is a national exam, it doesn't test you on specific state laws. It does, however, recognize that some laws vary state to state (like the age of consent for treatment and at what age parents can access their child's records).
Because the age of consent for therapy varies state by state, if you get a question about this and there is an answer to follow local laws/jurisdictional regulations, that is a really good answer option to consider. The way I look at it is this: on the exam you’re never not going to follow the law. Let’s take a look at how a question testing your knowledge of minor consent for therapy could show up on the exam:
Age of Consent Practice Question
A 16-year-old girl and her parents are referred to a social worker by the child’s pediatrician for concerns around social anxiety and depression. The family resides in a state where parental consent is required for treatment of anyone under the age of 18. What is BEST practice for the social worker during the initial session with the girl and her parents?
A. Obtain written consent from the parents and discuss with the daughter how confidentiality will be maintained.
B. Obtain written consent from the parents, obtain verbal consent from the daughter, and discuss confidentiality considerations with both the parents and daughter.
C. Obtain written consent from the parents, obtain verbal consent from the daughter, and discuss with the parents how confidentiality will be maintained due to the daughter’s age.
D. Obtain written consent from the daughter, obtain verbal consent from the parents, and discuss confidentiality considerations with both the parents and daughter.
(scroll below to view the answer and rationale)
The Correct Answer is B
A is incorrect because while we do want to obtain consent from the parents, we don’t ever want to only discuss how confidentiality will be maintained; rather, we also want to discuss the very real limits of confidentiality. Additionally, this answer fails to acknowledge the parents right to having some information about progress in therapy as the ones who consented to treatment. C is incorrect because, again, we cannot simply keep all things confidential for a minor if the parents are the one who consented to therapy. There are limits to confidentiality and the parents have the right to some information about their child's progress in therapy. D is incorrect because written consent is needed from the parents since they live in a state where parental consent is required for therapy with minors.
B is our best answer because it does three important things: 1. It acknowledges that the parents are the ones who need to formally complete consent forms. 2. It also has the daughter provide verbal consent for her therapy. While this is not required, it is best practice. 3. It has the social worker discuss confidentiality considerations with both the parents AND the daughter, which is crucial when working with minors (especially teens!). This discussion can include both what will be kept confidential between the minor and the therapist and what will be shared with the parents and why. When working with minors and their parents, this is always a discussion you want to have at the very beginning of therapy with both parties present so that everyone is on the same page. This way there (hopefully!) won't be any surprises for the parents or the teen when something is (or is not) shared.
Masters and Clinical Exam Preparation
Were you aware that consent laws vary state to state and that this is a national exam, or did you learn something new today? To learn more about minor consent to therapy and how it could show up on the exam (as well as how to respond to other state-specific topics when they show up on your test), sign up for one of our programs today! Here at Therapist Development Center, we have helped THOUSANDS of masters and clinical level social workers pass their ASWB exams with confidence. Check out some of the testimonials from the thousands of real social workers like you who used our ASWB exam preparation programs to successfully prepare for and PASS their exams.
I choose B. It was tricky though. I did not guess but approached it from a best practice perspective. I approached it as if I was working with a teen how I would involve them in the process and ensure their confidentiality.
Still somewhat confused as to why we would need verbal consent from the daughter since the parents signed all consent forms. This was a very tricky component of the question with that information in the stem. Is this verbal consent from the daughter to speak with parents???
I'm quick when answering questions and after re-reading the vignette and answers, I decided to chose B.
Hi Donna, The verbal consent from the teen refers to verbal consent to participate in therapy. While not required, this would be best practice to get verbal consent from the teen in addition to the formal written consent from the parents.
you need verbal consent from the daughter which is also called assent. For working with minors, you need consent from the parent plus the assent from the daughter since she is the client. Also, you would want to inform both the parent and the daughter to discuss confidentiality since you the therapist can engage in treatment and it helps with communication effectively in sharing information to the parent and the daughter. Also, it helps with the therapeutic alliance as the best practice.
Great I answered that one correctly. I also feel getting verbal from teen iets her know she is part of the process and helps her feel nvited as well.
I choose B, because it made sense to me. However, in the explanation part, it states that we share w/ both client and parents what info. will be kept confidential and what will be share, Can you give some examples please?
This is really going to vary hugely clinician to clinician and will depend on the age of the child/teen. For teens, you would want to discuss things like whether sexual activity (or what type of sexual activity) that is disclosed by the teen will be shared with the parents; whether alcohol or drug use will be shared (for some clinicians, any alcohol or drug use may be shared, for others it may depend on the age of the teen along with whether additional dangerous behavior-like driving intoxicated-is occurring, as well as what specific substances are used).