When working with adults, the rule regarding confidentiality is simple: if there is reason to believe that a client is an imminent danger to himself or someone else, this must be reported to the proper authorities. For minors, the authority in this case is usually the parents as opposed to the police or local hospital. People under 18 are not granted the same confidentiality as adults. Parents have a legal right to know what goes on behind the therapy door. That being said, at the onset of therapy I ask parents to essentially waive that right, because if a child or adolescent cannot speak freely without fear than the therapy is not going to progress very far. I always assure parents that if there is something truly important that they need to know, the information will be given to them:
“What if he says he hates me. Will you tell me that?”
“But I just couldn’t bear it if he hated me!”
“I think we can figure out a way for you to bear it. I don’t know if he hates you or not but if he does then maybe therapy will stop him from feeling that way about you.”
“What if he’s doing heroin?”
“I do not allow heroin in my office.”
“No, I mean on the streets with…with soccer hooligans. Will you tell me that?”
“Yes I will tell you that. But please understand that I will tell him all of the rules about confidentiality first because I do not want him to believe that he has been tricked into confessing something.”
“What if he’s sad? Will you tell me that?”
“You know he’s sad, that’s why you brought him here.”
“But what if he’s really, really really sad?”
“Mrs. _______, if your son is in a truly bad spot, something I can’t help him with, or anything that might involve him doing something harmful to himself, believe me both he and I will tell you immediately. Now please leave this office and peruse the fine collection of periodicals in the waiting room that have been ordered for your reading pleasure.”
At one point in my career I was working with an adolescent female who was 17 years and 10 months old. This is an awkward age for therapy because the legal ramifications are still intact for another two months, so if her overly involved parents demanded to know the minutiae of the session I would have been required to give it. An astute teenager (such as this one) would therefore simply wait until her 18th birthday to reveal anything important if she wants to keep her secrets.
Sure enough, at approximately 17 years, 11 months, 23 hours and 59 seconds of this young woman’s life I got the Drunk Dial on my voicemail:
“Dr. Rob! I just turned eighteen about…9 seconds ago and I wanted to say that I’m WASTED! I’ll probably have sex tonight too, you know, to celebrate being eighteen and all. I’m not a minor anymore, I’m…a Major! My mom will ask you details about tonight because she’s so worried about my new boyfriend with all the tattoos. But now you don’t have to tell her anything! Yes! Oh my God! You rule Dr. Rob, and thank you for all of your help. See you next week!”
I then heard a strange noise that sounded like “glecchsh,” which might have been her vomiting onto her cell phone, or possibly just her stepping in some mud.
Sure enough, my newly-crowned Adult client’s mother had questions and needed to be reminded of the rules.
“I want to know what happened at that party.”
“I’m sorry but you are going to have to ask her yourself.”
“What if she did drugs, like … LSP?”
“I believe it’s LSD. Regardless I cannot share that information.”
“But you could have shared it with me three days ago!”
“That’s so stupid. Plus I’m paying for these sessions.”
“I’m sorry Mrs. _______, but payment doesn’t give you any additional rights unless your daughter agrees. You know, lots of parents have difficulties with their child’s transition into adulthood. Maybe I can help you.”
“Help me? You’re condoning the use of LSC!”
“It’s LS…look, if you’d like any further information about your daughter’s treatment please ask her yourself. Now please leave this office and peruse the fine collection of periodicals in the…”
“Oh shut up! You will not see me again at these sessions you…you…withholder!”
Turning eighteen while you are in therapy certainly has its privileges, wouldn’t you say?
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