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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 my 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.

Of ice buckets and Ferguson

shutterstock_145318993If you are on Facebook or on Twitter or don’t live under a rock then likely you have been either witness to or part of the ongoing cultural conversation around the ALS ice bucket challenge and the shooting of an unarmed Black teenager in Ferguson, Missouri and the resulting outcry in his community and beyond.

I was thinking about this juxtaposition today, in particular about the controversy of the juxtaposition. I’m not talking about either thing itself — people drenching themselves in ice water or a young man’s death at the hands of police — but about these two things happening at the same time and how people are managing the presence of two wildly different cultural events happening at the same time.

I’m not the only one talking about this. Orlando Jones is. And Digiday.com is. But I’m thinking more about our response to each other and what it has to say about what we need.

I have read (I’m sure you have read) racist arguments, tearful essays, hopeful blog posts. I’ve watched (and I’m sure you have watched) moving challenges, funny challenges (and of course failed challenges) and challenges starring celebrities calling other celebrities out. I’ve also watched (and I’m sure you have watched) videos of mothers testifying to the loss of their Black sons, video of people rioting, and video of people marching peacefully only to be met with violence.

I have read these things and watched these things because people have shared them on their Facebook feed.

For the most part the divide is person to person; the person who posts a challenge doesn’t post much about Ferguson and vice-versa. Sure there’s cross over but not a whole lot. (You might be seeing something different; I’d be curious to hear your thoughts.)

This is what I’ve come away with.

Life is hard, deeply deeply hard and painful and we all cope with it in the best way we can.

  • Some of us really need to see the funny ice bucket videos and laugh knowing that it’s bringing attention to a good cause.
  • Some of us really need to see people willing to engage in hard topics on fluffy social media sites, to witness their friends speaking out and risking censure.
  • Some of us go to Facebook to escape.
  • Some of us go to Facebook to be inspired.
  • Some of us go to Facebook because we’re bored during an office meeting or during a toddler’s nap and we’re just killing time.
  • Some of us do best with lots of information and discussion.
  • Some of us do best when we can ignore bad news in the places where we play.
  • Some of us do our donating anonymously and would never make a show of our donations.
  • Some of us want to feel like part of a movement, to feel something exciting happening.
  • Some of us do our political work off-line where we won’t risk relationships.
  • Some of us speak loudly, passionately and use a status update as a rallying cry.
  • And yes, some of us do things on social media to make ourselves look good without any real interest in changing the world. (Sometimes the world gets changed anyway, even if some of the people who are part of the movement are just phoning it in.)

I think mostly about how much we (each of us, individually) need each other (each of us, individually) and this is why it is so inspiring and so painful when our social media is not reflecting what we want to see in the world.

I get compassion fatigue. Sometimes when I’m having a hard week or I’m working with a client (or two or three) who’s having a hard week I just want to take Buzzfeed quizzes (by the way, I’m Fanny Price!) and read LaineyGossip.com. Other times I really need to see the passion in people whose values resonate with mine, to see their hard work and anger. I have definitely been the person posting controversial articles on Facebook and I’ve definitely been the person temporarily hiding a friend posting controversial articles on Facebook.

I personally think that the ice bucket challenge has gone viral in part because of Ferguson and because of Gaza and because of Robin Williams. I think that when we collectively get sad we desperately want to get happy and so in hard times our Facebook fills up with pictures of cute kittens and calls to action that are easy and that are part of being hopeful.

But I also get why the juxtaposition is so jarring and makes some of us angry and/or disheartened.

I see a clear divide on my own Facebook feed with very little crossover right now. I don’t pretend to know why that is individually (I have friends who are generally right in front of anti-racist rallying who have stayed mum on Ferguson; I have friends who generally decry public displays of social charity who are tossing ice water over their heads) but I think it’s because these are hard times and we are all doing the very best we can.

 

Will my child’s counselor judge my parenting?

cute daughter and dadI know that for lots of people it’s scary to bring your child to a counselor. You’re already worried about your son or daughter and then you have to bring them to a stranger in the hopes they can help. It’s never fun coming to experts and saying, “Hey, I’m stuck and I’m scared and I need help.” But it’s even harder when we’re looking for support over something as emotionally fraught as parenting. Especially since most of us already get criticism from friends or family or teachers or some know-it-all magazine or Dr. Phil.

Ugh.

I want to reassure you that I don’t look at parents with an eye to catch them out doing something wrong (and none of the child therapists I run around with do this either). I mean, I’m a parent, too, and I know how judgment feels (lousy and unhelpful) so why would I want to visit that on my clients?

Besides even if I know exactly the right way (mostly) to raise my kids that doesn’t translate to knowing exactly the right way for you to raise yours. No, I meet with parents to better understand their goals, their hopes, their values and then I mix that all up in the things I’ve learned about kids in general and their kids in particular and what the research says and some practical tips I’ve learned along the way so that together — together, mind you — we can help you build something better.

There is no one-size-fits-all for parenting. What works great for one family would never fly in another because we’re totally different people raising totally different kids in totally different circumstances.

Does that mean I won’t have opinions? Of course not. I love to have opinions and I’ll share those opinions with you but I’ll do in the context of my understanding of your unique experiences. So if I think your discipline techniques are causing you problems, I’ll tell you that but I won’t try to get you to become a totally different kind of parent. I’ll try to help you figure out ways to do things differently to help you discover your best parenting self.

I won’t judge you. I won’t sit around trying to figure out how wrong you are. (In fact, one of the most important thing I do with parents is find out what they’re doing absolutely right so they can do more of it!) I certainly won’t blame you for all of your child’s problems even though you might be blaming yourself.

I know that parents aren’t always at their best. I know that they make mistakes. I know this because I’m a parent and I make mistakes (ask my kids, I’m sure they have a list running). But I don’t believe in perfect parenting anyway; I believe in pretty darn good parenting and I believe that is plenty. I believe in celebrating your strengths and forgiving yourself your weaknesses even as you work to shore them up. I believe that chasing down perfection makes it harder for us to be pretty darn good. I will not judge you. I will be honest and encouraging and I’ll give you lots of tips. And I’ll listen a lot because I know that you are the expert even if you’re not quite sure about that just yet. I’ll help you get there.

What I’ve learned in a decade of parenting

morningbeach-insideThis post originally appeared on my old this woman’s work personal blog. I’m adding it to the site because I saw some people clicking an old link to it on a parenting forum and getting the 404 message that it was missing. I’ve now been parenting for more than one and a half decades and my toddler is now a tween, my tween is now a teen. Basically the message I have is the same: It’s OK. You’re doing OK. Go easy on yourself.

Since my kids are so far apart in age (seven years) I find myself with a whole new cohort of parenting peers. Instead of moving on to parenting a school-ager while having a preschooler like most spaced-sibling families, I’ve got a school-ager and a toddler. Unless my friends have more than two kids (kinda rare), I’m hanging with a new set of people at baby gym class, etc.

In my daughter’s rec center classes, most of the parents have kids that are younger than my oldest (not all but most) and for many of them, the toddler tumbling around is their oldest and so they are fairly new parents. Listening to them really brings it all back to me — the worry, the fretting, the rigidity, the belief that there’s one way to get it right. I remember. But in ten years of parenting and watching my friends parent their kids, I realize that all the things that used to get us worked up just aren’t as important as we thought they were. I hear them discussing the things we discussed with the same earnest conviction and it makes me … tired. I don’t want to live those debates again and I also no longer care whether or not people I like are doing things the way that I think they ought to be done. (In other words, when a woman leans across the child in her lap to speak urgently about the dangers of television I neither feel defensive nor passionate in agreement. I simply don’t care about anyone else’s television choices and I don’t care what they think about mine.)

I also have found (horrors!) that I am very much one of those women who tries not to say, “Wait and see” when someone is telling me that their child will never play computer games/eat fast food/own a Barbie. I try not to be but I can’t help it. (Never say never should be the theme song to parenthood.) I can’t help but raise an eyebrow when a passionate new parent swears s/he will never send their child to school or let them eat refined sugar. Or when they lecture another parent (as I was so happy to lecture) about the proper way to get a child to sleep through the night or learn to pick up his toys.

I hate to say it, but parenting the baby/toddler/preschooler? It’s easy. Well, easier. Why? Because their domain is so totally in your control. Yes, it’s exhausting and physically tedious and certainly a huge challenge but they get bigger and not only do they become more themselves (and less amenable) but also the rest of the world intervenes and suddenly you’re not dealing just with your inlaws, who totally don’t get this whole no refined sugar thing you’ve got going on, but with the birthday parties of friends or the Bratz fad that’s infiltrating the neighborhood. (Note from Dawn of the future. Bratz have fallen by the wayside. It’s all about Monster High these days.) I mean, when they’re preschoolers, you can keep them ignorant or else you can just come down hard and fast. Preschoolers mostly listen because what do they know? But bigger kids? They’ve got opinions and sometimes their opinions are absolutely at odds with yours.

Then there’s this other thing — people with a good kid think they’ve got the key to good parenting. I know this because I thought it myself. My oldest is a pretty good listening kid, a kid who wants to please his parents and who craves structure and I thought that was our superior parenting but the truth is, it’s him. He had and has his challenges — not sleeping through the night for the first 3.5 years, an inability to process change well or easily, a tendency to the dramatics — but he’s a pretty easy kid. We’ve parented our youngest exactly the same (mostly) and she’s a fireball of loophole seeking and arguments (but also slept through the night much earlier — go figure). We never had to childproof with him because one stern shake of the head and he’d immediately back off from whatever it was that held potential danger but our youngest has gone out of her way to find the most deadly things in our house and try ’em on for size. A “no” to her is simply a sign to wait until her parent’s back is turned and then try harder.

I love new parents. I love their shell-shocked pride and out-sized concern. I love their myopic devotion. I so remember how important every decision felt. Me and my friends, we were such intense devotees of motherhood. Oh the debates about flaxseed oil! About kindergarten curriculum! About toothbrushing and fluoride and non-punitive discipline! Oh the discussions about the right way to give compliments and the proper way to put a child to bed! And as it turns out? The choices are less important than the values that drive them. When they’re ten, no one can know that you used sun-bleached organic diapers or disposable. You can’t even tell the breastfed babies from the ones who got bottles. The homebirthed babies who ate nothing but organic for their first years are standing by the soda machine jingling their change. The daughters of feminists are putting on lipgloss; the baby boys who nursed their trucks are wrestling on the gym mat. It’s not that our choices have no impact, it’s just that the impact isn’t always what we expect.

I say this not to be discouraging but to be reassuring. It’s OK to let go of some rigidity — your good kids will be good kids even if you “slip” and let them eat jarred baby food instead of painstakingly steaming that organic potato before you run it through the food grinder. It’s the big picture stuff that matters, not so much the tiny decisions that we fret about. I’m just not all that convinced that baby signs or Ferberizing or infant toilet training are going to matter all that much by the time our kids hit their twenties. It’s more about why we do those things.

So I guess I’d say that in ten years of parenting I’ve learned that you do the things you need to do to get through the day with love and hopefully some laughter, you trust your kids (and yourself), and you let yourself have fun along the way.

When infertility support groups quit being supportive

joinhands-insideIn the spring of 2002, after three years of concentrated effort and several early miscarriages, my husband I decided that we were at the end of our fertility quest. That’s it, we told each other, let our son be an only child or maybe we’ll adopt but this is the end of the charting, the tests and the medical appointments. Our decision was precipitated by a number of different factors – my mental and physical exhaustion; the end of our insurance coverage for infertility treatment; and the toll my emotional roller coaster was having on my then 5-year old son.

I felt empowered but terrified, calm but bereft. It wasn’t an easy decision but I knew it was the right one. For the first time since we started trying for that second baby I felt in control. Even on my bad days – which still arrived with depressing regularity fueled by baby announcements, baby shower invitations or even seeing two closely-spaced siblings at the grocery store – I could finally see a time when this wouldn’t hurt so much.

I went to my secondary infertility support group with my news. A small close-knit email list made up of women who found each other on another parenting board, the women there bubbled with encouraging posts (“Your baby is just waiting for you to bring her down from heaven!”), treatment advice (“Have you talked to your doctor about the benefits of a 3-day versus 5-day transfer?”), and sympathy (“Don’t let your sister-in-law get to you; one day you’ll be nursing your own little one!”). In this cheer-leading atmosphere, my decision to stop wasn’t popular. The de facto leader of our group had herself gone to great lengths both medical and economic to give birth to her daughter. Second mortgages, intense treatment and loss had only fueled her determination. She argued with me about my decision but I remained firm. That was it. I was done.

“I guess,” she finally said. “That I wanted another baby more than you did.”

Ouch.

Infertility support groups work because for the most part everyone is on the same page (or at least a similar one). But when one member decides to call it quits it can threaten the cohesion of the group.

Looking back now, I can see why my announcement landed with a thud in the center of our virtual coffee klatch. These were women who had been told over and over again (by friends, by family and sometimes by partners) that they were being unreasonable. They needed a group that would cheer them on when other people rolled their eyes and told them to quit trying so hard. You know, “Just relax!” and all that. Now I can see how my saying “enough already”, however personal that decision was, sounded like I was just a step away from joining the critical chorus.

Still, it hurt. These were my friends and suddenly I was on the outside as they closed ranks.

My decision to quit treatment was not any better or worse than another woman’s decision to stay the course. However in the context of the list, my choice was seen in some ways as a betrayal of our group’s “baby or bust” values. It was time for me to go.

If you find that your support community is holding you back but you’re not quite ready to leave, take some time to build up a new support system that reflects the values you are trying to embrace. When I have a client who is looking to make changes in her support system, we go slow as we consider how she will find those people who will help her in her new endeavors. We also talk about how it’s hard to leave people who have been important in our lives even when their presence has clearly become more of a hindrance than a help.

Having the unbiased support of a therapist can help you make decisions that best reflect your particular situation, experience and values. If you’re local and find yourself struggling to figure out what to do next, please feel free to contact me. Maybe I can help.

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