The rights of the child in psychotherapy

A brief historical perspective on the development of the concept of children's rights provides the background from which to delve into their rights when in psychotherapy. After centuries of the systematic ill-treatment of children, the emergence of an empathic ethos that pervaded Western society in the eighteenth century ushered in a new attitude of social reform. Social progress over the next two centuries culminated in the United Nations Convention on the Rights of the Child. The modern concept of the rights of the child and application of the best-interest-of-the-child standards in child care is evident in four areas of child psychotherapy: informed consent; recognition of the difference between the child's withdrawal of consent to further therapy and resistance in therapy; the need to distinguish between "difficult to treat" and "unsuitable for treatment" cases; and empathic listening. However, mounting evidence that dysfunctional families cause increasing vulnerability of the child to future mental disorder places an obligation on the therapist to recognize the interlocking psychopathology and needs of both parents and children for therapy. Finally, the effect on child psychotherapy of "managed care" in the United States, which threatens to transform a best-interest-of-the-child standard to a "minimum-interest-of-the-child" one as a socially regulated form of restrictive care, contravenes the child's right to optimal care. Principles relating to the well-being of the child in psychotherapy are offered to counter this trend.