Dear Members,

I present the following vignette and welcome your ideas:

A 17 y.o. male is currently in a residential treatment center (RTC) for
children, as part of his court-ordered sentence for an armed robbery he
committed late in 1996 (he and some peers robbed a woman at knifepoint).  He
has been at the RTC since 11/96 (for custodial care and ongoing evaluation),
and he could be released as early as 9/97.  He has just started seeing a
counselor at the RTC, but only on a twice-monthly basis (one session
individual, and one with his mother).  To augment this, the mother wants me
to see the young man for outpatient psychotherapy (the RTC will issue brief
passes for this purpose).

The counselor at the RTC is encouraging the mother to bring the boy to me for
the additional help, but he will require that I contact him to confirm the
dates and times of the boy's appointments.  I do not know at this point
whether or not the RTC would require reports from me for their own evaluative
purposes, although I have decided I will not work with the boy under that
sort of arrangement.  The counselor and the RTC play an integral role in
decisions involving the boy's eventual day and weekend passes, and ultimate
discharge from the RTC.

QUESTIONS:

(1)  Should I see the boy at all for ongoing psychotherapy while he is seeing
the other counselor and during his stay at the RTC?

(2)  Even if the counselor requires contact with me merely and only for the
purpose of confirming appointment dates and times, could this not be enough
to undermine the boy's sense of privacy--and therefore trust--with me, given
this context and the boy's developmental needs for autonomy and privacy?

(3)  What if I start seeing the boy, and he then decides to stop seeing me at
some point during his stay at the RTC--what is to prevent him from fearing
that information
about that fact could be used against him by his counselor and the RTC, for
"not cooperating with treatment"?  In turn, there may be "secondary gain"
attached to his seeing me, insofar as his motives for early release from the
RTC, and the fact that seeking outside, supplemental help makes him look good
in the eyes of his power-wielding counselor and RTC administrators.  This is
not to mention other matters pertaining to the blurred boundaries, such as
the potential for the boy's concern that his counselor may be jealous if he
tells me certain things which he chooses not to share with his counselor, or
vice versa (which could undermine either the treatment with the counselor,
with me--or both!).

My inclination at this time is to simply meet the boy once or twice, to
establish some contact with him so that when he is released from the RTC, he
will know that "a therapist awaits him"--if he still wishes to pursue
psychotherapy (according to his mother, he wants to find out more about why
he is so angry).

The boy comes from a background of interparental violence, father-son
violence, and both his parents have had problems with alcoholism.  I'd like
to give this young man a chance to grow, but I want to balance this with his
need for a proper psychotherapeutic environment--which I am concerned will be
difficult, if not impossible, to achieve if I see him concurrent with his
stay at the RTC.

I welcome your reactions, ideas, and suggestions.  Thank you.

David Mittelman