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Confidentiality is the word used for the privacy between you, your child, and your child’s mental health counselor. Most clinicians explain this concept with the phrase, “What you say here, stays here.”
Although there are exceptions to what a counselor can keep secret (see below), confidentiality means that no one except you, your child, people with parental rights to your child, and anyone else you specifically authorize in writing will know what you or your child say to your child’s therapist behind closed doors. In fact, your child’s counselor is not even allowed to tell anyone that your child is enrolled in counseling, even if that person specifically asks.
This means that your child’s counselor will not acknowledge you or your child in public unless you or your child acknowledge them first. Additionally, confidentiality means that if there is a person without parental rights that you want to include in, or to be aware of, your child’s therapy (such as a grandparent, teacher, pediatrician, or caseworker) you will need to fill out a specific release of information allowing your child’s counselor to talk to that person.
Limits of Confidentiality
Of course, your child’s counselor cannot prevent people from seeing you walk in and out of a counseling office, or from seeing your child’s counselor walk into and out of your home. Similarly, if your child is seen for counseling at school or a hospital, it is often unavoidable that some school or hospital personnel will know that your child receives counseling. Often in these settings, you will be asked to sign a release of information for the entire institution in which your child is receiving counseling, which will allow appropriate personnel to access necessary information about your child’s counseling.
If your child is involved with child protective services, or receives mental health services from another organization (such as therapeutic mentoring or medication management) your child’s clinician will ask you to complete a release of information so that he or she can coordinate with your child’s other providers to keep your child’s counseling relevant and monitor progress. If your child receives other mental health services at the same organization, information can be shared among providers at that organization without a written release.
Exceptions to Confidentiality
There are a handful of exceptions to confidentiality, in which your child’s counselor is required by law to disclose information to other people. These will be discussed with you during your first session, and include the following:
- Suspected child abuse
- Intent to commit suicide
- Intent to commit homicide
- Counselor supervision
- Insurance processing and auditing
- Subpoenas, court orders and police investigations
Suspected Child Abuse
All mental health counselors (and most other people who work with children for a living, such as daycare providers, teachers, and pediatricians) are considered mandated reporters. This means that they are required by law to report any suspected child abuse or neglect to the appropriate state authorities—and often the consequences for not reporting child abuse include several years in prison, hefty fines, and loss of licensure.
Additionally, many states require counselors to report suspected abuse of other vulnerable individuals, such as the elderly, the intellectually disabled, and the deaf. You can find more information on what is reportable in your state here, and read answers to commonly asked questions about child abuse reporting here.
Intent to Commit Suicide
While specific laws and procedures vary by state, clinicians across the nation are required to take appropriate precautions to prevent their clients from ending their own lives. This means that if your child states an imminent intention to commit suicide, indicates that they have a plan to do so, and reports having access to the means to execute this plan, then your child’s counselor must share this information with you and with local authorities, who will bring your child to a hospital for further assessment.
This process inevitably involves the disclosure of some of your child’s counseling information to the police and the hospital at which your child is assessed. If the hospital staff determines that your child has a current intention and accessible plan to commit suicide, your child will be required to remain at the hospital until their intentions have changed.
Of course, your child’s counselor is a trained professional and can tell the difference between true suicidality and the passing remarks about suicide that have made their way into everyday speech. Additionally, many children express hopes of dying or make vague suicidal statements that do not involve a plan or current intention, such as, “I wish I wouldn’t wake up in the morning” or “I don’t want to be here anymore.” In these cases, your child’s counselor will make a safety plan with your child, which is a list of coping strategies, helpful people, and resources that your child can use to handle the emotions driving their suicidal thinking. As a parent, you will be informed of your child’s suicidal statements and will receive a copy of your child’s safety plan to use at home if needed.
Intent to Commit Homicide
Similarly, your child’s counselor is required by law to report homicidal intentions with an accessible plan to you, the intended victim, and local authorities. This will inevitably require the disclosure of your child’s name and participation in therapy, and may result in your child being sent to a hospital for further evaluation. Out of an abundance of caution, these reports are typically made even if it seems unlikely that your child could actually carry out the plan they have stated due to their age or size.
If possible, you will be asked to eliminate your child’s access to their stated means of killing another person (such as by locking up firearms, moving knives out of reach, or preventing your child from seeing the intended victim). If it is not possible to prevent your child from killing their intended victim, your child will likely be hospitalized until their intentions change.
Counselor Supervision
Most mental health professionals are supervised by a more experienced clinician, especially if they are still working to obtain their state licensure. Supervision is a great opportunity for your child’s counselor to get ideas, advice, and a fresh perspective on his or her cases, and this will inevitably involve sharing some of the details of your child’s therapy. However, your clinician’s supervisor is bound to confidentiality in the same way your clinician is, and cannot share any information about your child’s case without your express written permission.
Insurance Processing and Auditing
If you use insurance to pay for your child’s counseling, your insurance company will have access to basic information about your child’s treatment, such as your child’s diagnosis, treatment goals, and session attendance. Most insurance companies also require therapists to provide updates every three to six months about how your child is doing, so that the insurance company can determine whether counseling is still medically necessary.
Insurance companies also conduct audits to make sure that mental health providers are completing paperwork correctly, so your child’s file may be reviewed in the course of a routine audit. Additionally, if the agency at which your child is seen still uses paper records, the employees who compile and organize those records will know some basic information about your child’s treatment.
Subpoenas, Court Orders, and Police Investigations
Mental health counselors are not exempt from subpoenas and court orders and must appear in court or provide documents as required by law. Many states, however, have special protections for therapists’ personal therapy notes, and only allow courts to request a client’s official treatment record. For this reason, most counselors use neutral, professional language in official treatment records and cite directly observed or reported evidence for all diagnoses.
Additionally, if you or your child are a missing or wanted person, your child’s counselor must cooperate with an investigation if they are approached by a law enforcement officer. If you have specific concerns about you or your child’s legal involvement, ask your child’s counselor or consult a legal professional before beginning treatment.
Many parents worry that the beginning of their child’s therapy will be the end of their family’s privacy. But rest assured that many professional ethics boards and state and federal laws are hard at work protecting the information you and your child share in session. These few exceptions to confidentiality are intended to keep your child and the public safe and ensure that your insurance money is well spent.
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