What Confidentiality Looks Like in Teen Therapy
When your teenager starts therapy, it’s natural to wonder what they’re talking about and what their therapist will tell you. As a parent, you want to know your child is safe, but counseling is also about giving a private space for teens to share their thoughts and feelings. You might wonder: Will I hear what my child talked about? Can I ask to see their therapy notes? What happens if my teen tells their therapist something concerning? It’s natural and normal to have these questions and worries, and this post will help guide you through the process. A lot of this information stands for most practitioners in most states in the U.S. because client confidentiality is protected by HIPAA, but some of the post will be specific to how we handle privacy here at Meadowlight Counseling.
Confidentiality for teens differs from confidentiality in adult therapy because parents and legal guardians have (a) an extremely important role in their child’s care and (b) a legal right to certain treatment information. It even differs from confidentiality in therapy with young children, because most of the work is being done in collaboration with parents and caregivers, so there is sometimes less expectation of privacy between child and parent. Teens, however, are a special population that require a privacy from parents as a part of healthy social and emotional development. The goal here is to create balance: parents should have the information they need to support their teen and make informed decisions about their care, while teens should have appropriate privacy to build trust and engage meaningfully in therapy.
What Are Limits of Confidentiality?
Confidentiality generally means that what your teen shares in therapy is kept private. However, this is not absolute. There are certain circumstances in which a licensed therapist is legally and/or ethically required to share information:
Safety concerns: If a therapist is concerned that your child is an immediate danger to themselves or others, the therapist is legally required to take action. This does not mean that every mention of sadness, anxiety, self-harm thoughts, or difficult emotions automatically result in parents being called. Instead, a therapist will consider the nature and severity of the concern, level of risk, protective factors, and what steps are necessary to keep the teen safe. Specifically at Meadowlight Counseling, teens are almost always encouraged to share safety concerns with their parents themselves (with help in the therapy session) so that they have a part in the process instead of feeling like the process is being done to them. We work together as a team (therapist, client, parent) to identify the concern, plan for safety, and decide on next steps for care.
Abuse and neglect: Licensed counselors are considered mandated reporters in the state of Arizona, which means that if a therapist has a reasonable suspicion that a child has been abused or neglected, they are required to make a report to the appropriate authorities.
The limits of confidentiality are discussed with families at the beginning of treatment so that parents and teens fully understand what confidentiality means before therapy gets underway.
What Will Parents Know About Therapy?
Parents often want to know what happened during their teen’s session. Did they talk about school? Sports? Friends? Home life?
In most cases, I will not provide parents with a play-by-play of their teen’s session or repeat everything their teen says in therapy. We tend to get better outcomes when teens can trust that they have space to speak openly about their lives. However, this does not mean parents are left totally in the dark.
First, you will be made aware of your teen’s mental health diagnosis (if there is one) and provided some educational information about the diagnosis. Second, you’ll be a part of your teen’s treatment planning process (goal-setting) and will be the one to sign off on the treatment plan.
I may share general information about your teen’s progress, goals, skills we are working on, recommendations about how to support your teen, and concerns that may require your involvement. If there is a significant safety concern or another situation that falls under the limits of confidentiality, I’ll involve you or other supports as needed. Whenever possible, I encourage teens to be a part of conversations about what information is shared with parents. During the times you join a session, your teen will be given the opportunity to share with you about what they’re working on and what they’re learning or finding helpful from therapy. If something important needs to be communicated, I want to help your teen develop the skills and confidence to participate in the conversation instead of feeling like they need to depend on me to share information with you.
Creating a “Zone of Privacy” for Teens
A helpful way to think about teen therapy is that the therapy room is a “zone of privacy".” Within that zone, your teen has room to talk about their thoughts, feelings, relationships, mistakes, questions, and experiences that they may not feel ready to discuss with a parent. Think back to your teen years: you probably didn’t want to share everything with your parents either. Part of healthy adolescent development is building a sense of self and identity independent of the parent/family unit, and expectations for privacy go along with that.
This private space is not meant to exclude parents or keep secrets from them. Instead, it gives teens an opportunity to develop self-awareness, practice problem-solving skills, and learn how to communicate about difficult things with the support of a trained professional who is able to remain objective. The boundaries of this privacy should always be made very clear: teens should understand their therapist can’t promise to keep information private when there is a significant safety concern, suspected abuse or neglect, or another situation that requires disclosure.
Difficult topics may come up in the course of therapy with teens, such as sex, drugs and alcohol, or self-harming behaviors. These topics do not automatically warrant a parent phone call or breaking the teen’s zone of privacy. In many cases, a therapist will discuss these topics with the teen to help the teen understand their own motivations and choices, and will encourage the teen to discuss these with parents. In cases in which the teen’s safety is at risk, parents will be notified, ideally by the teen themselves during a session. Learning that your teen is engaging in risky behavior can be upsetting, and a therapist can help you with additional resources and supports when needed. Sometimes, these additional safety risks may come with recommendations for a higher level of care, such as Intensive Outpatient or Substance Abuse programs.
What If I’m Worried About My Teen?
It’s completely understandable for parents to have questions or concerns about their teen’s therapy. If you notice significant changes in your teen’s behavior, mood, relationships, school functioning, or safety, you should bring those concerns to their therapist.
Most importantly: You do not need to know exactly what your teen says in therapy in order for us to work together as a team.
In fact, parents play an integral role in teen therapy. Depending on your teen’s needs, treatment will usually include parent check-ins (via call or joining part of a session), resources sent via email, recommendations for supporting your teen at home, and conversations about how to respond to particular concerns. My goal is not to separate parents from their teen’s treatment, but to create a therapeutic relationship where both the teen and their family can be supported.
Teen therapy works best when everyone understands the boundaries from the beginning. Your teen deserves a space where they can be honest, and you deserve to know that their therapist will take their safety seriously. Clear expectations help create the trust necessary for both. At Meadowlight Counseling, you can expect that I will involve you in treatment as a parent while keeping your teen’s mental health and treatment goals in mind.
About the Author
Marlee Gordon, LPC is a licensed professional counselor and the founder of Meadowlight Counseling LLC, a private practice in Goodyear, Arizona. Marlee has over 13 years of experience working with adolescents in educational and therapeutic settings, including school-based therapy and intensive outpatient programming for teens. She treats a wide variety of mental health concerns but focuses primarily on treating anxiety, perfectionism, life transitions, relationship challenges, and academic/athletic performance concerns.