Counseling Minors and Confidentiality

Confidentiality is a crucial part of counseling. Clients have to believe that they can tell me practically anything and it won’t be repeated to anyone, including their parents.

All of my clients know that everything they tell me stays  between us except:

• If they tell me they plan on killing themselves or someone else
• If they tell me that are being abused
• If I am court ordered to release information, and because I work in a school
• If they have drugs or weapons on campus.

Also, because I work primarily with juveniles, I leave a little wiggle room by saying I will also report anything “life threatening” which may not include marijuana or alcohol use, but may include intravenous drug use or meeting adults online.

Even with these rules of confidentiality, teens will still inevitably tell me things that need to be reported to their parents, the school, law enforcement or child protective services.

More often than not, the child already knows this before they tell me so they aren’t usually upset when I have to make that phone call.

The problem generally comes from parents, who may not understand confidentiality. They think that their child is in counseling and as the counselor, I should tell them any and everything their child is doing and can get testy when I have to explain to them that confidentiality doesn’t work that way and that it’s actually illegal for me to tell them any information that doesn’t fall under the exceptions above, without their child’s permission.

I understand these rules and have worked within the confines of them for many years, even when I am hearing information that I wish I could tell parents. Information I actually knew would help the situation, if the parents knew.

For instance, last year a young lady was devastated when she went to a friend’s party and got raped by him and four guys she didn’t know. She was in tears when she confided in me and after calming her down, I practically begged for her to give me the name of the guys, some who went to the same school as her, or to report it to law enforcement.I gently repeated this request each session as we processed the trauma.

I offered to go with her to make the report, but she was adamant about not telling me any identifying information. She told me that she was scared that they would come after her if she told. No amount of me trying to convince her worked and at the end of it all, I had to allow her to make that decision she will have to live with for the rest of her life.

As much as I wanted to report that crime to law enforcement and her parents, I couldn’t. I had no identifying information, she wasn’t abused by a caregiver or someone in authority and she wasn’t a danger to herself or others so my hands were tied. All I could do was try to help her get through the emotional and psychology pain she was feeling. She went through a period of deep depression and eventually transferred schools.

I have had teens who have had abortions and miscarriages without their parents ever knowing they were pregnant. Kids who have battled substance and alcohol abuse right under their parents noses.

I always strongly encourage my teenage clients to involve their parents in their treatment though family counseling, but most teenagers are hesitant to let their parents know the things they do when they are not looking, or think that their parents will just be angry, judgmental or not listen if they do open up.

I usually only do a couple of family sessions a month and those usually happen after emergencies such as suicidal thoughts, severe panic attacks that require medical attention or another extreme circumstance  that causes the parents to be concerned.

That’s usually when, with the child’s permission, I feel like I can finally truly help them without restraints. Trying to help a child solve a problem that need parental involvement, when they don’t want the parent to be involved is truly handicapping.

However, this is usually also the time when parents get upset that I knew about the abortion, or the drug use, or the date rape that they didn’t know about, months sometimes even years before.

I let them know about the confidentiality regulations set by the Health Insurance Portability and Accountability Act (HIPPA) that prevented me from giving them that information, even when it was valuable information about their own child.

Most parents calm down once they realize that without the confidentiality between their child and myself, it would have been unlikely that their child would have told any trusted adult and received at the minimal, mental and emotional support as well as guidance and encouragement.

Some minors want help or at least to talk about issues in their lives that are concerning them, but will only do so if they know that their parents will not be notified. Not all parents are supportive and some parents could use the information to further cause damage to their child, knowingly or not.

Take for instance a girl I know who is scared of her father who has a past history of physical abuse against her. He’s told her that if he ever finds out she is having sex he will kick her out on the streets. Yet, she is having sex and thinks she may be pregnant. Should I risk her losing her housing in order to tell her father that she may be pregnant?

I believe breaching confidentiality, while it will give parents more information about their child, it is less likely to truly make a difference if that child just learns to hide their problem or not admit or talk about their problem anymore, resulting in them getting less help.

I definitely understand when parents are frustrated with confidentiality when it comes to their children, which is why I always encourage open communication and family therapy, but most kids I deal with would never want their parents to know their issues and unless it’s something that puts them or someone in immediate danger, my hands are usually tied pretty tight.