Tuesday, March 20, 2012

Magic Numbers

When it comes to age, our society is full of "magic numbers" - ages at which something changes with our rights, privileges or opportunities. I bet we all remember turning 16 (driving), and 21 (drinking). My aunt just celebrated 65, which comes with eligibility for Medicare, closely followed by social security retirement benefits. However, while we feel more excitement about some of these landmarks, they don't carry the same societal "magic" as age 18.

Sure, we look forward to getting to vote. Some people look forward to 18 because they can join the military, or legally smoke. No one really looks forward to becoming eligible for jury duty. But, all of these rights come at the age of 18 because that is the age we are considered "adults." The magic age of "majority."

While most of us hopefully realize that becoming an adult is a process rather than an occasion, the legal significance of the magic age 18 also has significance in the treatment context. I'm reflecting on this topic this week because I have a client in the intensive outpatient program who turns 18 this week. Since we are an "adult" program, we already structure it with the expectation that people are coming volutarily and responsible for their own choices. Whether she is 17 or 18 will not change our direct interventions or treatment plan. However, it will change a few things - namely that she, rather than her parents, will have to (get to) sign the legal paperwork, including consenting to treatment, and choosing to whom information can be released.

Her mother is concerned that she will not sign a release to allow us to speak with her parents. That will be up to her, of course, and I can imagine a kid who is developmentally trying to individuate from her family (and ambivalent about treatment) enjoying being able to exclude her parents from her treatment, but I hope she doesn't. I think family support can be vital in recovery, and secrecy tends to work against recovery. The parents still have some bargaining chips, of course - while the magic number says she is an adult, she is still financially dependent on her parents, and hopes to go to college in the fall. I doubt she will want to jeopardize that!

How do you think about and deal with the transition from minor to adult in your clinical work?

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