I often meet with parents who are surprised about the confidentiality rules regarding minors in mental health counseling. In the medical field, parents and legal guardians are granted full access to records, treatment planning, and decision making. In therapy, however, it is different for several reasons.
Child as the Client
First and foremost, it is important to understand that even though parents secure the therapist, bring the child to appointments, and are financially responsible for treatment, the child is the client. Part of the client-counselor relationship involves protecting confidentiality. Therapists who work with children should have policies in place to inform the parents of overall themes, skills, and observations from the sessions, while still honoring the confidential nature of what is specifically said or done during treatment.
One of the most significant elements of successful treatment is rapport and trust between the client and the counselor. This is even more important for children, who are compelled to protect their parents from their negative emotions. If children do not whole-heartedly believe that what they express verbally, behaviorally, and emotionally in sessions will not be shared with their parents, they will not feel comfortable or safe letting the therapist see those issues. The child must understand that the therapist can be trusted with their problems, and that it won’t negatively impact the relationship with their parents.
Allegiance with the Child
Children are far more aware and intuitive than most adults believe. If a therapist approaches the counseling process without clearly explaining that their allegiance lies with the child, kids will resist the process, remain distant, and refuse to address their issues. Further, in cases of divorce, separation, or parental discord, it must be evident that the therapist is neutrally acting in the best interest of the child. This means conducting therapy without an agenda and without an end in mind other than to see the child emerge as a more healthy and happy kid.
Of course, there are limits to confidentiality and those should always be discussed with both the parents and the child before therapy begins. Ethically and legally, a therapist is required to breach confidentiality if the child indicates that someone is hurting him or her, if the child plans to hurt him or herself or another, or if there is a subpoena from a judge court-ordering treatment records.
But barring those three limits, confidentiality remains between the child and therapist so that the therapeutic process can proceed without hindrances and barriers. When the child feels safe with the therapist and supported in treatment, better outcomes are observed.