The Ethical Compass: Navigating Law and the Science of Brain Development in Therapy for Minors
Rethinking "Mature Consent" for Minors:
According to Maryland Law:
“A minor who is 12 years old or older who is determined by a health care provider to be mature and capable of giving informed consent has the same capacity as an adult to consent to consultation, diagnosis, and treatment of a mental or emotional disorder…” ( Maryland Health-General Article § 20-104 https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghgamp;section=20-104 )
The key phrase here is: “Mature and capable of giving informed consent.”
As therapists, we understand that a 12-to-17-year-old's prefrontal cortex—the part of the brain responsible for foresight, weighing consequences, and making value-based decisions—is still developing. Neuroscience confirms these skills are under construction until the mid-20s. As neuroscientist Dr. Frances E. Jensen has shown, the prefrontal cortex—the part of the brain responsible for foresight, weighing consequences, and making value-based decisions—is still developing. Yet, some practitioners interpret this law in a way that bypasses the 'maturity' requirement They grant minors adult-level autonomy without a thorough assessment of their decision-making capacity.
The Unintended Consequences of Individual Therapy for Minors
The best intentions can lead to unintended consequences. When therapists default to an individual therapy model for minors, they risk:
Isolating the child from their family system.
Positioning the therapist as a "rescuer" rather than a facilitator of healthy relationships.
Ignoring the power dynamics that influence real and lasting change.
This approach detaches the child from their ecosystem—their family—and misses crucial opportunities for parents to repair attachment ruptures and learn new skills.
A Systems approach: A More Complex but Effective Path
A systems-based approach is admittedly more complex. It requires navigating conflict, repairing trust, and engaging multiple perspectives. But this method reflects the reality of a child's world and ultimately serves them better.
While a child's brain may not be fully mature, we also know that chronological age doesn’t guarantee maturity in adults. The challenge for us as therapists is to strike a balance between developmental science, ethics, and the law to truly serve the best interests of the child within their relational context. Importantly, in situations involving abuse, the law already provides clear procedures to ensure safety and appropriate intervention, a topic that deserves its own post.
At 3Elements Counseling, we are committed to this systems approach and specialize in family therapy. We understand the legal framework and, more importantly, the intricate family system in which a child exists. We take every ethical consideration seriously, anticipating the consequences of our clinical interventions not just for the individual, but for each member of the family, and the family as a whole.
To learn more about our relational framework and how we apply it, read our article on Family Therapy: https://www.3elementscounseling.com/blog/family-therapy-relational-framework.
