How Can You Handle Confidentiality When Working With Minors?
When it comes to the delicate balance of confidentiality in therapy sessions with minors, mental health professionals face unique challenges. We've gathered insights from therapists and clinical directors on how to navigate this complex issue. From navigating confidentiality with clear consent to catering to family dynamics, here are four expert strategies for maintaining privacy while working with young clients.
- Navigate Confidentiality with Clear Consent
- Balance Legal Rights and Therapeutic Privacy
- Build Trust with Parents and Minors
- Cater Confidentiality to Family Dynamics
Navigate Confidentiality with Clear Consent
The foundation is a clear informed consent process with both the minor and their legal guardian (usually parents). This process outlines:
* Limits of confidentiality (e.g., safety concerns)
* How information will be shared with parents
* The importance of the therapeutic relationship with the minor
A child's age and maturity level influences how much information is shared directly with them about confidentiality. Younger children may need simpler explanations, while adolescents often benefit from more detailed discussions.
The therapeutic relationship exists within a triangle: the therapist, the minor, and the parent(s). The challenge is to balance the minor's need for privacy and trust with the parent's legitimate concerns and right to be informed.
This is a very common challenge, especially in play therapy where parents might feel excluded from their child's inner world. Here's how to address it:
At the outset, be clear about the limits of confidentiality and how information sharing will occur. Explain that play therapy often involves symbolic communication, and detailed session summaries might not be helpful or accurate.
When communicating with parents, focus on the child's overall goals in therapy and their progress toward those goals. You can provide general themes that emerge in play without divulging specific details.
Periodically, offer parent-only sessions to address their concerns, provide education about play therapy, and collaborate on strategies to support the child at home.
If a child shares something they want kept private from their parents, and it doesn't fall under a safety concern, reassure the child that you'll respect their confidence while still finding ways to address the underlying issue.
If parents insist on specific details, gently but firmly explain the rationale for maintaining some privacy for the child. You might say something like, "I understand your concern, but it's important for your child to feel safe and trust me. Sharing too many details can disrupt that trust and hinder their progress."
The fine line between protecting the therapeutic relationship with the minor and maintaining a collaborative relationship with the parents requires clear communication, empathy, and a focus on the child's best interests.
Remember, each situation is unique. Open communication and a focus on the child's therapeutic needs are essential in navigating confidentiality challenges.
Balance Legal Rights and Therapeutic Privacy
When working with minors, it's important to balance the legal rights of parents with the therapeutic need for confidentiality between the child and therapist. Legally, parents have the right to know what happens in sessions if the child is under 18. However, therapy can be ineffective if the child feels everything will be reported back.
That's why, in the first session, I encourage an agreement between parents and the child, allowing me to maintain confidentiality with certain exceptions. These exceptions typically include any intention of suicide or homicide, self-harm, or disclosure of abuse. I also consult with parents about how they would like me to handle disclosures of drug or alcohol use or sexual activity. Some parents prefer to be informed, while others want their child to have a private space for these discussions. Even with an agreement, I may involve the parents if I believe the situation requires it.
Build Trust with Parents and Minors
Establishing trust with both parents and kids is tricky. Parents usually bring their kids into therapy because they don't understand what's troubling them and are naturally worried about them. This might cause them to interfere with the therapy and want to pry into how it's going or what their kids are telling me, which will erode the trust between me and the child, who will shut down and stop telling me anything. At that point, we might as well end therapy.
So, at the very beginning of the therapeutic process, I talk alone with the parent and listen very carefully and empathetically to their concerns. I make sure that we establish therapeutic goals for their child and then I explain how trust is essential to the healing process. I ask parents to trust that I will always tell them when their child is involved in or engaging in risky behaviors and to believe that no news from me is good news. I ask them not to ask too many questions of their kids, as this could be perceived as intrusive and again shut them down.
Then, I have a session with both parents and the child and go over the same information, explaining to the child that my job is, in part, to keep him or her safe and that I will always help him or her speak to a parent and find a solution to the problem together, as a group. At that point, I ask the parents to reassure the child that they won't pry into the child's 'business.' I've found that therapy with minors can't work any other way.
Cater Confidentiality to Family Dynamics
Each family has its own dynamics, so I am mindful to cater to how I handle confidentiality differently based on those dynamics. That said, I use transparency with my clients whenever possible. If I have to break confidentiality in the event of potential harm, or if a topic we are discussing feels important for guardians to be aware of, my client and I will have a conversation about that before I talk with anyone else or before we bring guardians into the session to discuss it together.
This becomes an agreement that I also make with the guardians—they will be alerted and updated as needed, but it is important for a level of trust to be built between myself and their child. Research has demonstrated the importance of the therapeutic alliance between clinician and client and its positive effect on treatment outcomes. It is my job as the clinician to foster that relationship while navigating family dynamics around my clients.