What is said between a counselor and an individual client is confidential, even when the client is a minor. But parents often want to be kept in the loop about their child’s progress in therapy. This can put the counselor in a tricky situation, especially when the parents want to control or influence the counseling process.
The only scenario in which counselor-client confidentiality can be broken is in situations that necessitate protecting the client or others “from serious and foreseeable harm,” such as suicidal intent. (For more on this, see Standard B.2.a. of the 2014 ACA Code of Ethics.)
Marcy Adams Sznewajs, a licensed professional counselor (LPC) who often works with teenage and young adult clients at her group therapy practice in Beverly Hills, Michigan, says she empathizes with parents who ask about what she’s covering in counseling sessions with their child. However, she finds it helpful — and necessary — to offer a firm explanation of counselor-client confidentiality whenever she begins counseling a young client.
Sznewajs says that she emphasizes to parents that she will let them know if their child discloses anything that will put the child in danger. She also makes it clear to both parties that she will only invite parents into the counseling sessions if the young client grants permission.
This conversation is often not what the parents want to hear, Sznewajs admits, but it is important because it spells out the boundaries of what the counselor is obligated to tell the parents and reassures the client that their privacy will be respected.
Sznewajs stresses to families that they all must trust the process for her work to be effective.
“It’s important for the teenager to trust an adult with these difficult thoughts and feelings, and legally and ethically I have to keep it confidential,” says Sznewajs. “I’d be doing my client a huge disservice [if I disclosed session details to the parents]. That’s not only unethical, it’s damaging — and what does it teach the kid? That this person that you’re supposed to trust, you can’t.”
The feelings behind the questions
Parents’ concerns and questions about the work their child is doing in therapy are often rooted in fear, says Martina Moore, a licensed professional clinical counselor supervisor with a mediation and counseling practice in Euclid, Ohio. Not only do parents worry that the challenging behaviors that caused their child to seek counseling, such as rule breaking, isolation, defiance or problems at school, will have negative long-term outcomes in the child’s life, but they might also feel these issues are a reflection of their parenting abilities.
“Parents sometimes have such anxiety about their children it’s [gotten] to the point where they are increasing their child’s anxiety,” notes Moore, president of the International Association of Marriage and Family Counselors, a division of the American Counseling Association.
Although Moore makes a point to validate these fears with parents, she also emphasizes that it’s good for the child to grow and build autonomy through counseling on their own. She applauds parents for seeking help while explaining that she needs the freedom to work with the child alone for the counseling process to work.
“I also spend time with parents to dig into what their fear is. They’ve come to counseling [with their child], so they must believe that there is benefit in this process,” Moore says. She emphasizes to parents that they need to trust the process. “I spend a lot of time with parents getting their buy-in,” she notes.
In addition to fear, parents may also struggle with strong feelings of shame for having a child who is engaging in risky behavior and failing to thrive.
Le’Ann Solmonson, an LPC in Texas who has extensive experience working with children and adolescents, says she makes a point to acknowledge and normalize parents’ feelings of vulnerability and worry. If appropriate, Solmonson says she will sometimes disclose that she’s experienced similar feelings when her adult children sought therapy.
“No parent is perfect, and you worry over feeling like they are talking [in therapy] about what you’ve done wrong,” says Solmonson, the immediate past president of the Association for Child and Adolescent Counseling, a division of ACA. “It’s a very vulnerable thing to have your child go to counseling. You can’t help but feel that it’s a reflection on you as a parent and feeds into fears that you’re ‘screwing your kids up.’”
Navigating the balance
Counselors often need to get creative and act diplomatically to keep parents in the loop while maintaining young clients’ confidentiality and trust.
When parents insist on being involved in their child’s counseling, Moore negotiates with both the parents and client to find a plan that they all agree on while staying within ethical boundaries.
This was the case for a teenage client Moore once counseled who had substance use disorder. The parents were worried about their child and wanted to be involved in the counseling process. Moore facilitated a discussion and, eventually, they all came to an agreement that Moore would work with the teen alone but would let the parents know whenever the client had a relapse or break in recovery, she says.
Keeping lines of communication open and having regular check-ins with parents is beneficial to the counseling process with young clients, Solmonson notes. She often prompts child or adolescent clients to identify one small thing they are comfortable sharing with their parents at the conclusion of each counseling session, such a breathing technique they learned or new words they discovered to describe their emotions. This keeps the parents in the loop while ensuring that the client maintains control over the process.
When parents are left completely in the dark about their child’s work in counseling, it can exacerbate worry, cause them to “fear the worst” and catastrophize about what the child might be saying, Solmonson adds.
Sznewajs notes that talking with young clients about keeping their parents updated also provides the opportunity to check in with the client and ask what they feel is going well. She sometimes begins by asking the client how they feel things are going in counseling and transitions to what (or if) they would want her to share with their parents about their progress.
Disclosure of life-threatening behavior
When a young client is engaging in risk-taking behaviors that are life threatening (i.e., suicidal actions, self-harm), ethically, parents need to be brought into the conversation, says Hayle Fisher, a licensed professional clinical counselor and director of adolescent services at a behavioral mental health provider in Mentor, Ohio. While this is crucial to do, it can also impair the therapeutic relationship with the teen, she adds.
Fisher finds the vignettes in the 2016 British Journal of Psychiatry article “‘Shhh! Please don’t tell…’ Confidentiality in child and adolescent mental health” particularly helpful for examples on navigating these conversations. She keeps the following notes for herself, drawn from that article, for situations when she must disclose a young client’s harmful behavior:
- Tell the client what you (the counselor) are planning on disclosing to the parents, with an emphasis on the full context of why you need to. Ask for their feedback on how they might like to edit what you plan to say.
- Talk through the potential benefits and costs of disclosing to the parents. Ask the client how they feel about the disclosure and consider their views as you move forward.
- Validate any fears the client may have about the disclosure, such as losing access to resources and freedoms, feeling blamed or ashamed, or being concerned that the police or social services will become involved.
To maintain trust and a therapeutic alliance with young clients, Fisher emphasizes that it’s important for a counselor to give the client as much control as possible over how this communication will occur. If the disclosure happens during an in-person session and the parents are nearby, she gives the client the choice to either stay in the room or step out and wait in the lobby when she invites the parent(s) in to tell them.
Fisher also gives young clients the option to tell their parents before she does. However, this is only appropriate if the client’s risk of harm is not imminent, Fisher stresses. In this scenario, she tells the client that she will call at a certain time the following day to speak with their parents, check in and provide support for the parents and client.
“This option is especially powerful,” Fisher explains, because it “reinforces the adolescent taking accountability for their actions, increases communication skills and fosters independence in the situation so they are not dependent on the counselor for navigating conflicts with their parents.”
Sznewajs also takes a collaborative approach when it’s necessary to break confidentiality to inform a client’s parent or guardian about harmful behavior or intent. She says she tries to take the client’s feelings into consideration while modeling firm boundaries.
Although not having the conversation with the parents isn’t an option, client can choose how and when it happens, Sznewajs explains. She offers to involve the parents in person, call them on the phone, do a video chat during the counseling session or wait until after the session ends.
Sznewajs says she explains to young clients: “I want to make sure you stay safe, so we have to bring your parents into this conversation.” She adds that she tries to “do it in a collaborative way, even when it [the situation] is dire.”
- Read more on this topic in the Ethics Update column in Counseling Today’s November print magazine, “Respecting clients’ rights when working with children.”
- Also, see Counseling Today’s November cover story for an in-depth exploration of counseling for parent-teen conflict.
Bethany Bray is a senior writer and social media coordinator for Counseling Today. Contact her at firstname.lastname@example.org.
Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.