Counseling Minors and Confidentiality

Little-boy-shhhh-cropped-300x297Confidentiality 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.

Human Rights Violations, Psychological Damage and Caster Semenya

Most of us know Mokgadi Caster Semenya as the South African middle-distance runner who’s gender came into question after she blew away her competition during the women’s 800 meters at the 2009 World Championships with a then world record time of 1:55.45.

I remember when her gender came into question first in the media, then among my peers who insisted due to Semenya’s masculine appearance, voice and astonishing athletic feats, that she had to be a man, or at the minimum, not all woman.

The International Associate of Athletics Federation (IAAF) reported that they had to investigate Semenya after she made improvements in both her 800 and 1500 meter times by 8 seconds and 25 seconds respectfully, improvements in performance that usually arouse suspicions of performance enhancement drugs (PEDs) use. At this time, the IAAF also tricked Semenya and performed a gender test without her permission, something she confirmed during an interview with NBC before her Olympic race in London. Semenya stated that she knew she was being tested for PEDs, something she was used to, but didn’t know she was going through a gender test until the testing became more of a violation, poking and probing in areas she knew weren’t part of any PEDs test she had ever been through.

If this is true, which various sources confirm, it is a violation of her human rights. Furthermore, she had to seek the legal services of Dewey & LeBoeuf who are acting pro bono to make sure her legal, human and civil rights will not be further violated.

After more gender tests and speculation over her eligibility to compete as a woman, the IAAF finally cleared her in July 2010 to return to competition as a woman and has yet to release their findings from her gender tests. Since her medical records are private, it may never be known if much of the embarrassment and scrutiny Semenya was subjected to was all for nothing, but one would suspect that if the IAAF had enough evidence to suggest Semenya wasn’t “technically” a woman, they would have released it.

I have to imagine that this young lady, at the time this all began she was only 18, suffered imaginable psychological damages having the world not only question who she was as a person, but to be examined like an animal with the world waiting for the results.

Since returning to international racing Semenya hasn’t been her self. During her 800 race in the London Olympics she got silver after trailing most of the race and only running hard towards the end to secure a second place finish. Many commentators, sport analyst and spectators commented that Semenya seemed to lose the race on purpose, saying that she didn’t seem tired after the race, much like she had in an earlier international race where she got a silver. If this is true, it is sad, but can you see why someone who previously fell under world scrutiny after finishing first, would purposely opt out of being in that position again.

In an interview after the race, Semenya stated that her head just wasn’t into it. This is the Olympics, what professional athlete’s head is not into their Olympic event? Maybe one who had her human rights violated and was kept out of competition while the IAAF tried to verify her gender which indeed caused an untold amount of psychological damage.

In that same interview with NBC, Semenya asked the interviewer, Mary Carillo how she would feel if she was subjected to the same scrutiny while the world watched through a microscope and the interviewer had no response. Semenya stated “you might even think about taking a suicide” which to me suggests at some point, Semenya did indeed think about committing suicide.  I am so glad that she was strong enough, confident enough and resilient enough to overcome that destructive and irreversible thought. Now if only her psychological damages can be healed enough where she can feel free to race at her best and win without fear of once against being cast into the world spotlight for anything other than being one of the best women 800 meters runners ever.