Therapy Confidentiality: What Parents Know and What Stays Private

It can be hard to be a young person in therapy. Sometimes caregivers and parents make the young person go to therapy. Sometimes the young person wants therapy, but the caregivers don’t, or the parents don’t have the resources to get therapy for the young person. But what happens when the young person finally gets into therapy, build a relationship with the therapist, and really wants to share things. Is it safe to share? Or will the therapist tell caregivers and parents everything?

Therapists are licensed professionals, and as such, governed by certain rules and codes. First there is the law (Behnke, 2002). In Arizona, the law states that caregivers and parents must consent to treatment for youth under age 18. This means that the parents have rights to the contents of treatment until the child is of age. The contents of treatment do not mean everything the client says, however. The contents of treatment are the official documents of therapy: for example the treatment plan and progress notes. The treatment plan is a document stating the goals of therapy (Marschall, 2022). The progress notes summarize each session and work towards those goals (Huber, 2022). This means that caregivers and parents are entitled to official counseling documents. The counselor does not necessarily have to tell the parents every word the young person says, however.

What do therapists have to tell parents? Well, it depends on what the therapist says he or she will tell the parents. As part of the beginning of therapy, the provider will give an informed consent (Behnke, 2022). This states the limits of confidentiality, or information that is kept private and secret. Generally, ethics codes require that session content is confidential unless there is threat of harm to self or others. This means that counselors must take to the relevant authorities if a young person reports abuse or the intent to harm others. It also means that the counselor must tell a young person’s parent or caregiver if the young person is a risk to himself or herself (eg having suicidal ideation, or using illicit drugs with a high risk of death) (Bray, 2022). In these cases, it is the obligation of the therapist to tell caregivers and clients about the risk, though still not about everything, that happens in session.

So what if the parent asks about what is happening in session? Many therapists will give a summary of learning, reminding the caregiver or parent that therapy works best when the young person has feelings of safety in session (Good Therapy, 2019). Some therapists may invite the young person to share for himself or herself about their work in therapy (the therapist may support the young person in doing so). In other cases, the therapist may invite the caregiver/parent into session every so often to recap therapeutic progress (Bray, 2022). While agreements and arrangements differ, the goal is to preserve the safety of the therapeutic relationship to promote therapeutic growth.

Safety sharing in session ultimately comes down to relationship with the therapist. Has the therapist clearly set out the limits of confidentiality for the caregiver/parent and the young person? Has the caregiver/parent agreed to the informed consent and the limits of confidentiality. Has the therapist talked to the young person and the therapist about how/she will disclose risk? These are important questions to answer. Safety is key to the therapeutic relationship and both caregivers/parents and youth need to sense it for the therapy to be effective.