For therapy to be optimally effective, a person must be able to disclose their thoughts, feelings, experiences, and behaviors without fear of judgment. They must also be confident that their therapist will not share this information with third parties. The ability to be vulnerable in therapy can support a strong therapeutic alliance and can help a person recover more quickly. For minors, however, the right to privacy in therapy is limited.
Legally speaking, people under the age of 18 do not typically have a right to confidentiality in therapy. However, some therapists ask parents to agree to the therapist’s confidentiality rules before they will treat the client. Additionally, though minors do not have a legal right to privacy from their parents, their right to privacy from third parties (employers, advertisers, etc.) is similar to that of adults.
Therapeutic confidentiality is key to effective treatment for numerous reasons, including building and preserving a strong therapeutic alliance. The benefits of confidentiality include:
A child or adolescent has little reason to disclose information they don’t want shared with their parents if there is no guarantee of confidentiality. But often, the information they don’t want disclosed is the information that is most important for them to discuss in therapy.
If a child cannot safely disclose whatever they want, the therapist may not have enough information to know what kind of help the child needs.
Not all parents have unconditional love for their child. For example, some parents may abuse or disown a child for their sexual orientation or behavior. If this information is disclosed, it could make a client vulnerable to unkind or abusive treatment.
Confidential information can be used for a wide range of purposes—bullying, marketing, even stealing a person’s identity. So even when a minor has no right to confidentiality from a parent, they still have a right to privacy from third parties.
Some parents may worry that “secrets” will undermine their relationship with their child. But when a child can openly discuss their feelings in therapy, their relationship with others, including their parents, may improve.
In some contentious custody cases, a court may appoint a lawyer for the child—often called a guardian ad litem—to represent the child’s best interests. Depending on the case, the state, and the court’s order, that lawyer may get to determine whether and when parents can view information about mental health treatment.
“Because I work with many high-conflict divorce families, many of the children and teens I see in therapy have their own minor's counsel. When a minor has their own attorney, this lawyer holds the privilege for the child's therapy, and they often work with me to help keep emotional safety a priority for the child's counseling. Even when a parent is pressuring me for information, I am able to refer them to the minor's counsel, who will work to protect the child’s confidentiality,” says Lois Nightingale, PhD, a marriage and family therapist from Yorba Linda, California.
One of a therapist’s most important ethical duties when treating minors is to discuss confidentiality concerns with the parent(s) and the child. The therapist should be clear about the law and their own confidentiality policies. Some important topics to discuss include:
When a therapist believes a child is in danger, they typically have a legal duty to disclose certain information, even when the child otherwise has a right to confidentiality. For example, mandated reporters must disclose suspected child abuse to child protective services. Likewise, a therapist must act to protect the child if they believe the child may engage in self-harm or hurt others.
Even when a therapist must act to protect a child, the therapist must use a conservative approach, disclosing only that information which is absolutely necessary and disclosing only to the appropriate person or persons. For example, if a therapist fears a child may be planning a school shooting, the therapist may be required to notify police or school authorities. However, the therapist would still be required to protect the confidentiality of other treatment details, such as the child’s sexual orientation or history of abuse.
The duty to warn others when a client poses an imminent threat can present several ethical dilemmas. Therapists should ensure they understand state laws and their licensing board’s ethics rules. Knowledge about one’s responsibilities can make decisions easier during a crisis.
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