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Preschoolers have limited language and reasoning abilities However, they may be able to express preferences when choices are presented in concrete, here-and-now terms (Ferguson, 1978) Although children in middle childhood (ages 6 11) have not attained adult reasoning capabilities, research suggests they typically are able to make sensible treatment choices (Weithorn, 1983), and parents and professionals have judged the participation of children this age in treatment decisions to be effective (Taylor, Adelman, & Kaser-Boyd, 1985) The years between ages 11 and 14 are seen as transitional ones with much individual variation in cognitive development and the ability to make truly voluntary choices Pupils in this age range, like younger children, may defer to authority in decisions, or they may make choices based on anti-authority feelings.

The patient is taught skills in a weekly group which typically lasts for two hours or so. The style of the group is didactic. The room may be set out as a classroom with the skills trainers usually two facing the patients. Process issues or evident emotion are dealt with only if they threaten the running of the group. Sometimes a skills trainer may also be the therapist of one or more of the patients but this dual relationship is not dealt with in the group. The training is organised around a manual that contains handouts that may be copied freely for this purpose (Linehan, 1993b). There are four modules, emotional regulation, distress tolerance, interpersonal effectiveness and mindfulness. Each module takes several weeks to teach. Often, the mindfulness module is repeated in brief form between each of the other modules. Typically, each meeting of the group begins and ends with a mindfulness exercise.

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Minors age 14 and older typically have reasoning capabilities similar to adults, and many are capable of participating in treatment decisions as effectively as adults (Grisso & Vierling, 1978; also Abramovitch, Freedman, Henry, & Van Brunschot, 1995) Cooper (1984) proposes the use of a written therapist-child agreement as a strategy for involving minors ages 9 and older in treatment decisions Research findings not only suggest that minors have greater capacity to make treatment decisions than generally recognized in law, but that a child s participation in intervention decisions may lead to enhanced motivation for treatment, an increased sense of personal responsibility for selfcare, greater treatment compliance, and reduced rates of early treatment termination (Holmes & Urie, 1975; Kaser-Boyd, Adelman, & Taylor, 1985; Weithorn, 1983).

(1988) Phenelzine vs placebo in 50 patients with bulimia Archives of General Psychiatry, 45, 471 475 Walsh, BT, Hadigan, CM, Devlin, MJ, Gladis, M & Roose, SP (1991) Long term outcome of antidepressant treatment for bulimia nervosa American Journal of Psychiatry, 148, 1206 1212 Walsh, BT, Wilson, GT, Loeb, KL, Devlin, MJ, Pike, KM, Roose, SP, Fleiss, J & Waternaux, C (1997) Medication and psychotherapy in the treatment of bulimia nervosa American Journal of Psychiatry, 154, 523 531 Walsh, BT, Agras, WS, Devlin, MJ, Fairburn, CG, Wilson, GT, Kahn, C & Chally, MK (2000) Fluoxetine for bulimia nervosa following poor response to psychotherapy American Journal of Psychiatry, 157, 1332 1334 Wing, RR, Koeske, R, Epstein, LH.

For these reasons, Weithorn (1983) suggests practitioners permit and encourage student/client involvement in decision making within the parameters of the law and the child s capacity to participate However, psychologists must guard against overwhelming children with choices they do not wish to make for themselves Furthermore, when children are given a choice whether to participate, it is important to recognize that they may have little knowledge of, or perhaps misconceptions about, the services offered The practitioner should ensure that the pupil understands what participation means before soliciting assent so that the child can make an informed choice For example, a psychologist might ask a pupil to attend a counseling group session before making a choice about participation In sum, the decision to allow a minor child the opportunity to choose (or refuse) psychological services and participate in treatment decisions involves a consideration of law, ethical issues (eg.

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