Table 1 Theme Analysis

Blowing trust out of the water

Betraying trust of the therapeutic relationship

It’s a hard thing to do because you feel like you’re breeching the trust of the kid, on a lot of occasions.

Holding and balancing care

But on the other hand, knowing the mother, she was desperate to have the children back and she’s apologetic and has put a lot of things in place to avoid the situation in future around her violence. So, I’m trying to support both the children and her.

Losing the therapeutic relationship

But that was one of those times where that’s wrecked the therapeutic relationship with that family because they feel like police were called on them.

Riding the reaction wave

Managing interaction with families

You can’t just say well I think your kid is being abused and that’s the end of the consultation, I’m reporting this to the authorities. You’ve got to deal with the impact of that news… and not abandon them…it’s part of a fair degree of emotional energy to get engaged.

Personal fear of retaliation

Well, I don’t feel anonymous. Um, I always tell people that I’m going to report, um, because I don’t, I don’t want someone turning up on their doorstep and then getting all shirty with me.

Fearing retaliation from organisation

When someone is paying your fee, you’ve got to be a bit careful…if the parents are unhappy…they might take their business elsewhere and the word might get around.

Fearing retaliation from system

God forbid I break a law, it’s scary thinking about breaking laws. I don’t want to get into trouble.

Opening a hornet’s nest

Experiencing tension between professional ethics and mandatory reporting obligations

And then you make that notification and then it goes nowhere. Or, it makes things worse. But nothing changes in the meantime…Or it escalates everything but there’s no further investigation from the department and so the kid’s not happy with us because we’ve made the report and frustrated because then nothing’s changed and then who do they trust?

Fearing for young people’s safety after making a report

I’ll ring child protection…It kind of makes me feel really anxious, thinking ‘oh gosh, are they going to get the message? What are they doing? Is that young person okay?’'

Relationship between system, patients and GPs and nurses

And then I think we feel pretty helpless sometimes. Some kids are quite severely injured or killed, and there was involvement of health professionals or DOCS. And you just feel like the system is crap and what’s the point? Not what’s the point, like why should I bother? …So you report something, you put someone in danger, and then the system can’t protect them.

Battling emotions

Experiencing burnout and vicarious trauma

I said to my GP it’s up to her… she’s burnt out because it is so tough because it’s all mental health. There is sexual abuse, there are transgender issues, there are alcoholic parents; it’s a big mess and she’s just taking a lot of it on.

Building resilience

They’ve had to deal with quite so much, which is kind of inspiring in a way. I enjoy allowing them to gain inspiration from their own stories and from their own process to see what’s helped them to get through. So, I think that’s what helps to be able to continue doing that work.