The right of "confessional" secrecy.

[Quantum Quack]

This is currently an area of some vexation for me. The right to secrecy where a person hangs out a sign that says "confide in me".

This was and is present in the situation of a Church confessional and the the rooms of most Doctor surgeries and psychological service providers. [similar but worse]


I will use an extreme example as part of a some what dialectic approach to try and unravel the ethical intricacies involved.

"A person [councilor] advertises a service that maintains secrecy of any thing discussed or confessed to. He does so purely for the purpose of providing ["outreach"] advice and guidance and healing to wards what would be considered as a better path.

A client presents himself to the service and confesses to horrendous crimes, crimes that would make most persons ill to think about.
Including ongoing activities involving victims immediate conditions and welfare.

That is to say he is currently committing ongoing crimes against other persons

The client has come to the councilor to seek help to change so that he may eventually cease his criminal activity.

The councilor has now got information that may do a number of things.
1] Provide the service he offers regarding guidance, advice and healing.
2] Provide police with a way to stop the ongoing nature of the crimes.
3] Provide police with the identity of the perpetrator.
4] ....and no doubt other alternatives.

The contract between the councilor and the client is one that is not binding by most laws yet the councilor has offered services on proviso that information is retained as secret [in all contexts]

Accordingly the councilor cannot use any of that information for outside the office use. He cannot secretly undermine his clients confidence.
The information is considered "privileged" and therefore entirely confidential.

The councilor has received appropriate remuneration for his services.

What obligations does the councilor face.

• to the client
• to society
• to the victims, past present and future
• to himself.

Given the nature of the contract between the councilor and the client is there any way the contract can be ethically breeched?

 

[Jeeves]

The contract cannot be ethically breached.
If someone knowingly and willingly takes the role of confidential counselor, s/he is also knowingly and willingly taking on the moral burden this role may sometimes present.

In most cases, there is no conflict: the client's welfare is the counselor's only concern, and the client's secrets neither hurt other people nor contravene the law. In the unusual case where the client's secret is harmful to another person, society at large, or the counselor's personal convictions, the counselor has to decide: Which is the greater wrong, to keep the secret and harm someone else or to betray the client and break one's own promise? There is no way to escape this with ethical purity intact.

Counselors are not the only people who face such choices; everyone has moral dilemmas. We choose, and pay the price.

 

[scheherazade]

Indeed.

When it comes to 'secrets' and confidentiality, there is a fine line to tread.

In personal matters, I will distance myself from others who may be acting immorally but not illegally, and I will neither accept their confidences or discuss them with others, and such action alone usually clues others to question and look where I choose not to go.

Professionally, I work with a considerable amount of confidential information, which is sensitive but not in the category mentioned above.

When it comes to being in possession of information that relates to past, present or future harm to self or others, there is a duty to take it forward to the appropriate venue, no matter that it be vexing to one's spirit.

It is, indeed, a tough job, but one that absolutely requires doing.

Just look at how nasty things get when someone becomes a 'whistle-blower'. Though there is legislation in place to protect the individual, they are still subject to devastating public scrutiny and often their personal life and/or career suffers as a result.

There is an underlying current of fear throughout our society that prevents many people from becoming more proactive on moral and ethical fronts.

Most people are happy to pay 'lip service' but far fewer want to get 'involved' or take any action.

Just my thoughts on the matter.....

 

[Quantum Quack]

The contract cannot be ethically breached.
If someone knowingly and willingly takes the role of confidential counselor, s/he is also knowingly and willingly taking on the moral burden this role may sometimes present.

In most cases, there is no conflict: the client's welfare is the counselor's only concern, and the client's secrets neither hurt other people nor contravene the law. In the unusual case where the client's secret is harmful to another person, society at large, or the counselor's personal convictions, the counselor has to decide: Which is the greater wrong, to keep the secret and harm someone else or to betray the client and break one's own promise? There is no way to escape this with ethical purity intact.

Counselors are not the only people who face such choices; everyone has moral dilemmas. We choose, and pay the price.

I think there is point that you have made that needs extrapolating...

Notion:
"As being a voluntary member of a society we have fundamental or primary contract ["duty of care" perhaps] towards that society"

Which stands as a "superior" contract to any other contract we may enter, hence the various laws regarding entering into "illegal" contracts makes them nul and void.

hmmmmm...something to chew on for a bit..

 

[Asguard]

actually you have made huge errors in your initial post (at least errors in how it works in Australia). Firstly anyone who works in public service (pollies, public servants), anyone who works in health (including vollies and students), anyone who works in education (same again), anyone who works with children (ditto) and anyone who is a member of a religious organisation including priests and lay people authorised by the church to do church work are AUTOMATICALLY MANDITORY REPORTERS FOR CHILD ABUSE. This includes being required to do training in reporting and what to look for and have an apsolute legal duty to report (a couple of paramedics were fired and will never work again AND were charged because they failed to report suspected child abuse in the NT, they couldnt be bothered because it was the end of there shift). Furthermore there is no "hersay" restrictions on reporting, if someone says they have or are abusing a child, if a child tells you someone is abusing them, if you suspect abuse from your own gut OR if someone tells you they think someone else is being abused you have an apsolute legal duty to report it.

Now where health is concerned there is another stipulation on medical in confidence. If you are an imidiate danger to self or others then there is no confidence. For instance if you tell a psych that your going to kill yourself and they belive this is an iminate threat then they can break confidence and tell your parents, tell your partner, children, or take direct action such as commiting you, whatever they feel is the best course of action to protect you. Same goes if your a threat to another person, you can be commited or reported to police, the threat can be told to a third party if nessary.

Now churches may have different rules, i belive lawyers also have a duty to break confidence if they know about an ongoing crime but bells would know better than me about that.

 

[Quantum Quack]

scheherazade,

There is an underlying current of fear throughout our society that prevents many people from becoming more proactive on moral and ethical fronts.

I guess a lot of people fear complexity and placing themselves in vexatious positions.

It is indeed an essential part of any society to weigh up it's reactions to those who seek help regarding serious issues that have profoud effect on that society.
As mentioned in the earlier posts a way out for the councillor may be the very reason he is offerring the outreach in the first place. That being the well fare of that society.

In modern "corrections" systems one of the ideals is to incarcerate an individual so that they are able to be quarantined from society and offered support to change thus providing immediate benefit to society [ security] and simultaneously offering "change" support to the "client".

The problem, however is that the councillor is only attracting the client because of the strict confidentiality offerring with out which the client would never have presented to the councillor.
So maybe it comes down to "the best of a bad deal" or "making the best of a bad situation" type result?
It may also be worth considering that the issue of "trust" both of "self" and "others" is a key issue that may be fundamentlaly driving the criminal activity in the first place. To breach that trust may possibly only reinforce the clients self justification for his activities IMO.

 

[Quantum Quack]

actually you have made huge errors in your initial post (at least errors in how it works in Australia). Firstly anyone who works in public service (pollies, public servants), anyone who works in health (including vollies and students), anyone who works in education (same again), anyone who works with children (ditto) and anyone who is a member of a religious organisation including priests and lay people authorised by the church to do church work are AUTOMATICALLY MANDITORY REPORTERS FOR CHILD ABUSE. This includes being required to do training in reporting and what to look for and have an apsolute legal duty to report (a couple of paramedics were fired and will never work again AND were charged because they failed to report suspected child abuse in the NT, they couldnt be bothered because it was the end of there shift). Furthermore there is no "hersay" restrictions on reporting, if someone says they have or are abusing a child, if a child tells you someone is abusing them, if you suspect abuse from your own gut OR if someone tells you they think someone else is being abused you have an apsolute legal duty to report it.

Now where health is concerned there is another stipulation on medical in confidence. If you are an imidiate danger to self or others then there is no confidence. For instance if you tell a psych that your going to kill yourself and they belive this is an iminate threat then they can break confidence and tell your parents, tell your partner, children, or take direct action such as commiting you, whatever they feel is the best course of action to protect you. Same goes if your a threat to another person, you can be commited or reported to police, the threat can be told to a third party if nessary.

Now churches may have different rules, i belive lawyers also have a duty to break confidence if they know about an ongoing crime but bells would know better than me about that.

Asquard, Thanks for your post and you are totally correct except for this:

The contract between the councilor and the client is one that is not binding by most laws yet the councilor has offered services on proviso that information is retained as secret [in all contexts]

However you have brought to the fore the issue, that the coucillor, by "Holding" himself out in this manner is actually committing a crime himself as the laws quite clearly in most cases indicate "mandatory reporting".

Example:
When a Husband confides in wife about his criminal activity [for example: Homicide"] she would be acting illegally as sort of "accomplice" by NOT reporting his activity and so on...
Yet the vexation is that the Husband would not have confided in his wife if he knew she would report him thus excluding himself from help to reform.

 

[Quantum Quack]

A situation that comes to mind is:
"Due to the stigma associated with mental health issues a vast majority of people will not go to councillors and discuss how to improve their prognosis until it is way too late for them to"
Example:
Currently the WHO's stats on global mental health may be tremendously understated due to the "fear" of societal "persecution" associated with those fearing for their own mental health.
As in most cases any reported suicidal tendancy requires reporting or action so those that are seriously considering suicide will not present for counciling and allow the problem to "fester" in their individual isolation instead.

 

[Asguard]

oh no, medical in confidence IS protected by law. The privacy act is VERY specific about medical infomation and psychs are even more protected (my psycologist is part of the same company as my GP, in the same building but where the GP patient records are electronic and avilable to all the GPs in the clinic the psych records are PAPER and kept by the indervidual psycologist and are unable to be transfered even from one to another.

You must have a dam good reason to break confidence and manditory reporting of child abuse is one. However you are NOT allowed to tell the anyone that you are reporting because that could put the child in more danger.

Breaking confidence for iminate threat is a little different. For instance we picked up a pt who had vollentarly called ASIS (no NOT the secret inteligence service, but the fact they have the same acroynim isnt really good for the paranoid peoples mental health) to have a chat. They told him they wouldnt have him detained and the next min there were 2 cops at the door to detain him under the mental health act. Should he have been detained? maybe, he seemed ok when we had him but that was hours after the initial detention. However i dont belive they should have lied to him because now he wont trust them, the cops, the ambos or the rest of the mental health services again. There by doing more harm than good.

Im not black and white on this, i work in health and these issues are about as grey as you can get. Its all about harm minimisation and you do the best you can with each pt as they present

 

[Quantum Quack]

They told him they wouldnt have him detained and the next min there were 2 cops at the door to detain him under the mental health act. Should he have been detained? maybe, he seemed ok when we had him but that was hours after the initial detention. However i dont belive they should have lied to him because now he wont trust them, the cops, the ambos or the rest of the mental health services again. There by doing more harm than good.

agrees!
And this is the point of this thread I guess.
They have clearly stated "amnesty" and yet immediately violated that trust.
And regarding "Paranoia" the issue of "trust and confidence" is paramount.

btw All crimes are medical or mental health issues IMO ....That includes the crime of "seriously oppressive societies" [hard to explain that one...eh]
Which is in part the underlying premise of behind why I posted this thread.

 

[Tiassa]

Client Privilege is Not Absolute

I did find a website discussing client privilege in California:

Psychological practice uses the word privilege to describe the legal right of keeping your clinical records confidential. (In California, this right is established in CA Evidence Code § 1014.) Because this right, in the strict legal sense, is thought of as a “thing,” psychological practice talks about “holding” the privilege. So who holds it?

Well, as I said earlier, you, the client, do. You hold the privilege of knowing and telling about your life, and you hold the privilege of determining what happens to your clinical records.

But your psychotherapist also knows about your life. Quite a bit in fact. Not just what’s in your chart, but everything you say and everything in between, including the simple fact of your being a client. Therefore, according to the principle of confidentiality, your psychotherapist is required to hold the privilege for you—even after therapy has terminated. This means that nothing he or she knows about you can be told to anyone else without your permission. Period. Not even the fact that you’re a client. That’s why you have to sign a Release of Information (ROI) form to have your psychotherapist give any information about your case to any other person, such as a physician.

• • •​

Criminal Activity. “What if I have committed a crime?” some individuals ask. Well, even criminal activity is protected by psychotherapeutic confidentiality. So you can relax, if that happens to be your particular concern—unless, of course, you are still engaged in criminal activity which jeopardizes the life or safety of others, and you reveal the details of this activity in psychotherapy. Such a case could fall under one of the exceptions to confidentiality (see below).


Suicide. “What if I talk about suicide? Not that I plan to kill myself, but sometimes I think about suicide. If I tell you about these thoughts, will you put me in hospital?” is a common concern. Actually, the issue here is whether there is a reasonable suspicion that you are likely to kill yourself. So just thinking about suicide doesn’t necessarily warrant any extreme action on the part of the psychotherapist. A good psychotherapist should know how to spot the difference between fantasy and real danger and should know how to work clinically with all your fantasies, however dark and fearful.

• • •​

Exceptions to Confidentiality

In California law, there are several exceptions to the confidentiality of psychotherapy (see the details of these laws, below).

Three of these exceptions to confidentiality concern harm to self or others:

• Where there is a reasonable suspicion of child abuse or elder adult physical abuse;

• Where there is a reasonable suspicion that you may present a danger of violence to others;

• Where there is a reasonable suspicion that you are likely to harm yourself unless protective measures are taken.

In all of the above cases, the psychotherapist is either allowed or required by law to break confidentiality in order to protect you, or someone you might endanger, from harm.​

You should also understand that if the issue of your psychological treatment is raised during the course of a lawsuit, your psychotherapist might be forced by the court to reveal the details of your treatment (per CA Evidence Code § 1016). In such a case, if your psychotherapist receives a subpoena from an attorney to provide copies of your clinical records, the psychotherapist must claim privilege for you (per CA Evidence Code §1015), and you

• may waive privilege and allow the psychotherapist to provide the subpoenaed information; or

• may invoke privilege and refuse to allow the release of information. In this case, the trial judge will determine whether your psychotherapist must release information—and the judge can issue a court order which your psychotherapist must obey, despite your protests.​

​

These are the basics for one state in the Union, but they don't seem much different from what I know of Washington state's laws. Indeed, I don't think they're that much different than any state's.

There is, in fact, a threshold beyond which confidentiality privilege is not applicable.

Famously, O.J. Simpson allegedly confessed to the murders of Nicole Brown and Ronald Goldman in a jailhouse conversation with Rosie Grier, a former pro football player who became a minister after retiring from the game. Though Simpson later claimed that he never confessed to anything, the issue was settled for the trial court's purposes when Judge Lance Ito denied prosecutors' requests to investigate the 1994 conversation.

The threshold seems to include confessions of crimes past, with certain exceptions. Many do wonder if murder should be among them, or if, perhaps, had the Simpson prosecution team actually obtained a record of the Grier confession, whether the evidence would and should be admissible.

But, in the end, client privilege is not absolute. There are, indeed, ethical ways—and legal obligations—to break that confidence.
____________________

Notes:

Richmond, R. L. "Confidentiality". A Guide to Psychology and its Practice. (n.d.) GuideToPsychology.com. June 2, 2011. http://www.guidetopsychology.com/confid.htm

 

[Quantum Quack]

I did find a website discussing client privilege in California:

Psychological practice uses the word privilege to describe the legal right of keeping your clinical records confidential. (In California, this right is established in CA Evidence Code § 1014.) Because this right, in the strict legal sense, is thought of as a “thing,” psychological practice talks about “holding” the privilege. So who holds it?

Well, as I said earlier, you, the client, do. You hold the privilege of knowing and telling about your life, and you hold the privilege of determining what happens to your clinical records.

But your psychotherapist also knows about your life. Quite a bit in fact. Not just what’s in your chart, but everything you say and everything in between, including the simple fact of your being a client. Therefore, according to the principle of confidentiality, your psychotherapist is required to hold the privilege for you—even after therapy has terminated. This means that nothing he or she knows about you can be told to anyone else without your permission. Period. Not even the fact that you’re a client. That’s why you have to sign a Release of Information (ROI) form to have your psychotherapist give any information about your case to any other person, such as a physician.

• • •​

Criminal Activity. “What if I have committed a crime?” some individuals ask. Well, even criminal activity is protected by psychotherapeutic confidentiality. So you can relax, if that happens to be your particular concern—unless, of course, you are still engaged in criminal activity which jeopardizes the life or safety of others, and you reveal the details of this activity in psychotherapy. Such a case could fall under one of the exceptions to confidentiality (see below).


Suicide. “What if I talk about suicide? Not that I plan to kill myself, but sometimes I think about suicide. If I tell you about these thoughts, will you put me in hospital?” is a common concern. Actually, the issue here is whether there is a reasonable suspicion that you are likely to kill yourself. So just thinking about suicide doesn’t necessarily warrant any extreme action on the part of the psychotherapist. A good psychotherapist should know how to spot the difference between fantasy and real danger and should know how to work clinically with all your fantasies, however dark and fearful.

• • •​

Exceptions to Confidentiality

In California law, there are several exceptions to the confidentiality of psychotherapy (see the details of these laws, below).

Three of these exceptions to confidentiality concern harm to self or others:

• Where there is a reasonable suspicion of child abuse or elder adult physical abuse;

• Where there is a reasonable suspicion that you may present a danger of violence to others;

• Where there is a reasonable suspicion that you are likely to harm yourself unless protective measures are taken.

In all of the above cases, the psychotherapist is either allowed or required by law to break confidentiality in order to protect you, or someone you might endanger, from harm.​

You should also understand that if the issue of your psychological treatment is raised during the course of a lawsuit, your psychotherapist might be forced by the court to reveal the details of your treatment (per CA Evidence Code § 1016). In such a case, if your psychotherapist receives a subpoena from an attorney to provide copies of your clinical records, the psychotherapist must claim privilege for you (per CA Evidence Code §1015), and you

• may waive privilege and allow the psychotherapist to provide the subpoenaed information; or

• may invoke privilege and refuse to allow the release of information. In this case, the trial judge will determine whether your psychotherapist must release information—and the judge can issue a court order which your psychotherapist must obey, despite your protests.​

​

These are the basics for one state in the Union, but they don't seem much different from what I know of Washington state's laws. Indeed, I don't think they're that much different than any state's.

There is, in fact, a threshold beyond which confidentiality privilege is not applicable.

Famously, O.J. Simpson allegedly confessed to the murders of Nicole Brown and Ronald Goldman in a jailhouse conversation with Rosie Grier, a former pro football player who became a minister after retiring from the game. Though Simpson later claimed that he never confessed to anything, the issue was settled for the trial court's purposes when Judge Lance Ito denied prosecutors' requests to investigate the 1994 conversation.

The threshold seems to include confessions of crimes past, with certain exceptions. Many do wonder if murder should be among them, or if, perhaps, had the Simpson prosecution team actually obtained a record of the Grier confession, whether the evidence would and should be admissible.

But, in the end, client privilege is not absolute. There are, indeed, ethical ways—and legal obligations—to break that confidence.
____________________

Notes:

Richmond, R. L. "Confidentiality". A Guide to Psychology and its Practice. (n.d.) GuideToPsychology.com. June 2, 2011. http://www.guidetopsychology.com/confid.htm

Do you think a judicial system can become "the Councillor" by proxy yet one who has significant let us say "councilling methods, including incarceration and in the USA in some states an dother parts of the world, the death penalty?

What I am suggesting is that the "councillor" is not in isolation and has a support network behind him [ legal "coucilling" - "rehab" system ] and that he may under certain circumstances pass the buck to those "more qualified" to deal with extreme situations.

However this still does not address the fundamental issue of "trust" implicitly stated as suggested by the thread OP before presentation by the client to the councillor "holding out" that trust.

 

[Quantum Quack]

I recall having a conversation with a lady here in Melbourne who was a part of an organised criminal syndicate. She started to talk in detail about her and their activities and I had to tell her to stop as she was placing a vexation upon me. She was presuming confidentiality. I understood that she was in error in that presumption and had to inform her that what she was talking about may not be held in trust.

The trust issue is not only about providing trust but also declaring when the presumption of trust is in error.

In the thread OP the councillor in question clearly states absolute confidentiality [ in all contexts and with out exception]
which of course is not commonly available world wide....
How many councillors discuss the limitations of their confidentially agreements I wonder and act to stop a client when the client is presuming confidentiality that doesn't exist? [thus avoiding the accusation of "entrapment"]

 

[Asguard]

so you think that there should be no ability to break confidence?
sure thats one position, its not one i surport after watching 2 of my friends comit suicide and having been suicidal myself.

As for child abuse you want to argue that the protection of children is less important than privacy? i doubt you will find much surport for that position but you can argue that

 

[Quantum Quack]

so you think that there should be no ability to break confidence?
sure thats one position, its not one i surport after watching 2 of my friends comit suicide and having been suicidal myself.

As for child abuse you want to argue that the protection of children is less important than privacy? i doubt you will find much surport for that position but you can argue that

I am not suggesting a belief in any particular POV but are attempting to develop one.

In the OP case the councillor would attempt to negotiate other avenues for the client to take up.
For example: Suicide: seek suicide prevention councilling etc etc but never breach the trust offered originally.

The councillor would provide knowledge of alternatives etc etc...How to break the cycle of depression and how to acknowledge publically that depression was an issue. But still not break the "trust" in the mean while.\He may act as a "negotia-tive gateway" to encourage the client to seek more orthadox approaches to the issues. For example: seek medical help so that appropriate medications can be provided. yet informing the client that the "trust" is not extended to those he may go to on the councillors advise.

 

[Asguard]

I recall having a conversation with a lady here in Melbourne who was a part of an organised criminal syndicate. She started to talk in detail about her and their activities and I had to tell her to stop as she was placing a vexation upon me. She was presuming confidentiality. I understood that she was in error in that assumtion and had to inform her that what she was talking about may not be held in trust.

The trust issue is not only about providing trust but also declaring when the presumption of trust is in error.

In the thread OP the councillor in question clearly states absolute confidentiality [ in all contexts and with out exception]
which of course is not commonly available world wide....
How many councillors discuss the limitations of their confidentially agreements I wonder and act to stop a client when the client is presuming confidentiality that doesn't exist?

there are certain times when its not in the best interests of either the patient or another to break confidence and it can be important that the patient not know about it. In the case i stated it can be argued that as its a phone call that the patient could run before he could be detained, as i said my feeling was that was unnessary but i didnt have the pt till the next day and i had him in a semicontroled enviroment, they had to make the decision in the most uncontroled and acute enviroment and so i err on there side even though at the time i felt it the wrong decision.

In the case of threat to others, put yourself in this situation. Your pt tells you that they are going to kill there nextdoor nabor because they work for the CIA (or are an alien or whatever). What do you do? well thats instant grounds to detain under the mental health act but if it was on me yes i would tell the nabor. Would i tell the pt that i was doing this? depends on why they are going to kill them, psycotic break sure once they are treated its no issue. if it was for another reason then no i might not.

As for children its mandiated that you DONT reviel that your going to report, to anyone except your boss (assuming its a pt, not an internal matter). This is to protect the child, your not even allowed to tell the child that your reporting or the parents even if they are uninvolved. Family services will deal with that

 

[Asguard]

I am not suggesting a belief in any particular POV but are attempting to develop one.

In the OP case the councillor would attempt to negotiate other avenues for the client to take up.
For example: Suicide: seek suicide prevention councilling etc etc but never breach the trust offered originally.

The councillor would provide knowledge of alternatives etc etc...How to break the cycle of depression and how to acknowledge publically that depression was an issue. But still not break the "trust" in the mean while.\He may act as a "negotia-tive gateway" to encourage the client to seek more orthadox approaches to the issues. For example: seek medical help so that appropriate medications can be provided. yet informing the client that the "trust" is not extended to those he may go to on the councillors advise.

see the issue is that the whole health service runs under EXACTLY the same rules. So where a clincial psycologist may well be able to use suicide prevention methods and treat directly, an ambo or st john volly (ie those dealing in the acute area) or nurse in an acute setting may well have more limited skill set to deal with the situation themselve. However that is only suicide.

 

[Quantum Quack]

As for children its mandiated that you DONT reviel that your going to report, to anyone except your boss (assuming its a pt, not an internal matter). This is to protect the child, your not even allowed to tell the child that your reporting or the parents even if they are uninvolved. Family services will deal with that

The problem is that most paedophiles know the law all too well as do most professional criminals.

One of the biggest problems and obviously a societal welfare tradeoff of mandatory reporting:
For an active paedolphile to seek help, the law of mandatory reporting forces the paedophile underground and away from any help thus the serious offendors have little support to facilitate reform and ultimately the children continue to suffer.

Presumption: that the paedophile may wish to reform.
Presumption : That paedophilia is treatable and rehabilitation is possible.

 

[Asguard]

you made a massive jump there, sexual abuse is the SMALLEST group of child abuse. Neglect is the largest, along with emotional abuse. The next is physical abuse.

These are what we deal with most often, child sexual abuse is something most health proffessionals will never see but neglect? its sadly quite common

 

[Quantum Quack]

you made a massive jump there, sexual abuse is the SMALLEST group of child abuse. Neglect is the largest, along with emotional abuse. The next is physical abuse.

These are what we deal with most often, child sexual abuse is something most health proffessionals will never see but neglect? its sadly quite common

Dare I suggest that the reason sexual abuse of children [ not just paedophila per-se - which is a persistant pre-occupation] is so often ignored is because it is endemic in the global community generally and only severe cases come to the professions attention and nearly always too late. Which is also very sad...