web analytics

Teens and Confidentiality in Counseling

Teens and Confidentiality in CounselingParental involvement is a key ingredient in kid client success in therapy. What this looks like will depend on your child and his/her treatment plan, your practical ability to be involved (are you a noncustodial parent? Is your child receiving services at school?) and the therapist. But at the very least, you and your child’s therapist should be communicating regularly.

Depending on the child, the parents and the treatment goals, I include parents in the following ways:

  • Parents attend sessions with their child (this is common with young children and with children who are struggling with attachment);
  • Parents come in for the first or last few minutes of session;
  • Meeting with parents separately before or after the child’s session;
  • Scheduling separate sessions with parents when needed and appropriate;
  • Arranging for phone calls to check in.

I like kid feedback for how parents should be involved, particularly with teenagers who are navigating the developmentally appropriate need to separate along with the necessary support from parents. Sometimes this means helping the teen figure out how they want to talk to parents about something and then inviting parents to session to help mediate a discussion.

I go over confidentiality with parents and teens in session with the understanding that we will all respect the teen’s privacy in the counseling relationship but that the adults will keep her safety paramount in decision-making around what to share. When kids are struggling in a gray area, I always encourage them to invite parents to the discussion but I won’t go over their heads and tell secrets unless I’m concerned for their safety.

Here’s the Ohio ACLU publication about minors and their rights. The part about counseling (this is a PDF file) starts at page 40: Your Health and the Law: A Guide for Teens.

From the file:

A minor who is at least 14 years old can request outpatient care without notifying a parent as long as the treatment does not include medication. However, such care is limited to six sessions or 30 days, whichever comes first. After that, the care must stop or the parents must be informed and must consent in order for treatment to continue. During the first six sessions or 30 days, the parents will not be informed of the treatment unless the teen consents or the care provider feels the minor is likely to harm someone. Still, before the parents can be informed, the care provider must first tell the teen that the parents will be notified.

I have not had a teen call and ask for counseling on her own but I have had other loving adults (relatives or family friends) call me to find out if they can bring the teen to counseling without parental consent. I always explain how the law works and explain that except in cases where parental involvement would be dangerous to the child, it’s really best to have parents be a part of counseling.

There are guidelines around counseling teens and maintaining confidentiality. As a counselor practicing in Ohio, my ethical guidelines come from Ohio’s Counselor, Social Worker, and Marriage and Family Therapist board and┬ámy professional organization, the American Counseling Association. Both these entities recognize that teen confidentiality is a gray area. The ACA and their sister organizations for social workers and other therapists regularly publish articles and papers on the topic.
Here’s a handful for you to check out:

As you can see, there are not definitive answers because these topics are complex and so very individual. How I might, for example, handle it if a client tells me s/he is sexually active will depend on many things including but not limited to:

  • Why the teen is in counseling in the first place;
  • With whom they are being sexually active (is it consensual? Is it legal?);
  • How old the teen is (there’s a big difference between a 13 year old and a 17 year old);
  • The family’s values around sexual activity;
  • The circumstances surrounding the sexual activity (are there pressing concerns about safety?).

My first priority is always first and foremost safety but I recognize my ideas about safety may be different than the families. For example, say I learn that a 17-year old after careful consideration and planning decides to access birth control and have sex with her long-term partner. Perhaps she comes from a strict, conservative family whose religious beliefs condemn premarital sex. I am unlikely to break confidentiality under those circumstances.

I say this to encourage parents to talk to their teen’s counselor to make sure that they understand each other. If you want a counselor who would break confidentiality then I’m not the right person to work with your teen. It’s best we all know this ahead of time.

That said, I do not ever encourage teens to lie and I do not side with them against parents.

Finally, when confronted with a sticky situation I seek supervision, meaning I go to my peers and my mentors to get feedback when I’m not sure. While maintaining confidentiality about the individual and the family, I ask for help and document these efforts accordingly. It’s dangerous for any therapist to operate in a vacuum and I am fortunate to have great counselors available to me to answer questions and help me examine ethical practice as it applies to the complicated reality that is counseling kids and teens.

Good Girls and Bad Girls

Let's Talk Month at Advocates for YouthI don’t know how I missed reading Andre Dubus (the first one) all of my life but I somehow did. I recently got a copy of his Selected Stories and am trying not to lament that I spent most of my reading years not reading him and am just trying to be super happy that I’m reading him now.

There’s one story in this collection titled Graduation, which I dog-eared for this paragraph:

[S]he had learned this: you could become a virgin again. She finally understood that it was a man’s word. They didn’t mean you had done it once; they meant you did it, the lost hymen testimony not of the past but the present, and you carried with you a flavor of accessibility. She thought how much she would have been spared if she had known it at fifteen when she had felt changed forever, having focused on the word loss as though an arm or leg had been amputated, so she had given herself again, trying to be happy with her new self, rather than backing up and starting over …

Some of my clients are teenagers and some of them are teenage girls. Some of the teenagers are virgins and some are not. All of them are wrestling with their ideas about sex and sexuality. All of them are wrestling with slut-shaming, bringing me stories of bad girls who do this and good girls who do that. All of them are thinking the kind of before-after thinking described in this paragraph.

When these teen girls in particular are talking about sex, regardless of what they have or haven’t done, they tell me that they don’t believe that they will have the same rights they had as a virgin once they’ve “given in” and had sex. Some of them believe that since there is no going back, they will have to aggressively move forward.

Somehow there’s this idea that sex only matters the first time and after that you are forever sexually active whether you actually are or not.

We need to tell our kids that this isn’t true. A person can say yes once and then no every other time, whether that person is with the same partner or not. A person can say yes on Tuesday and no on Wednesday. A person can say yes to that other person but still say no to you.

Teenagers are great ones for black and white thinking. (Here’s a hand-out about this in pdf format.) Parents can help kids dismantle the boxes that label girls sluts and whores in order to create a more nuanced discussion about sexual activity, empowerment and safety.

Miley Cyrus came up in several sessions after her infamous VMA performance. The kids generally condemned her performance and we talked about this then brought it around to understanding that the way they see Miley reflects their own choices in their everyday lives. My interest was not in trying to get them to view Miley and her twerking through a particular lens; my goal was to learn more about what it might say about their day-to-day relationships with themselves and with other people.

Likely you’ve talked to your own tweens and teens about Miley. If you haven’t, you can use that pop culture event (or another, goodness knows there will be more on the horizon) to ask questions like:

  • Should other people’s assumptions affect our behavior? Should our assumptions affect other people’s behavior? Why or why not?
  • Is there room for mistakes growing up? Who gets to decide what’s a mistake?
  • Is there a difference between “sexy” and “slutty”? What are other interpretations of those two words?

Sex education is a lifelong endeavor for most of us because we are always growing and changing. Conversations with our kids should reflect this by going beyond black and white thinking to a continuum of gray. While it’s easy to have a knee-jerk reaction to teen sexuality or pop star performances, it’s better to wrestle with these issues and bring them back to the ways we all wrestle with sexuality in our own lives.

Advocates for Youth has designated October as Let’s Talk Month, 31 days to raise awareness of the importance of good, solid, truthful and empowering sex education. I wrote up a rundown of good sex education programs over at Brain Child this past Monday. You can check it out here.

Positive SSL