As a psychologist, confidentiality is something that I take extremely seriously. It is so serious that I could even be severely reprimanded by the Board of Psychology (the licensing board for psychologists in the State of California) if I violate the trust that is placed in me by my clients. I'll simply define confidentiality as the requirement to keep your private stuff private. There are a few limits to confidentiality and these are clearly defined. I can only break confidentiality if 1) the client is a danger to themselves (they are actively planning their own death) 2) if the client is a danger to others (this is known as "Tarasoff") in which case I have a duty to warn the intended victim and alert the authorities to prevent serious harm to another, and 3) if the client is a victim or identifies an alleged victim of child or elder abuse. Fortunately, I have only rarely had to act on any of these.

Things get a little less straight forward, though, when the client is a child. In the state of California, once a child is 12 years old, they have the right to consent to outpatient mental health services as long as they are "mature enough to participate intelligently" and "would present a danger to [themselves] or others without the mental health treatment" or is the "alleged victim of incest or child abuse" (California Family Code Section §6924) while the Health and Safety Code is a bit more broad in only requiring that the child 12 and older be mature enough to participate intelligently. This then, allows the minor privilege over their information (they get to choose whether and what I can tell their parents.) To many parents, this is quite alarming as they don't think of their child (and 12 years old is still by nearly every definition except at the ticket counter at Disneyland a "child") as able to make these kinds of decisions.

As a therapist, it is really important that minors (especially tweens and teens) feel like therapy is a safe place for them to disclose whatever is on their minds without fear of repercussions from their parents. Knowing that I, as their therapist, cannot, by standards of law and ethics of the profession tell their parents anything they say in therapy (with the exception of the three mentioned above) helps the child feel more comfortable with being completely honest. It helps build trust and allows for therapy to be beneficial.

As a parent, I know how frustrating it is to have your child hurting to the point where therapy is sought and NOT to be able to know how your child is doing! I try to explain this to the parents of the clients I see. I remember when my family switched insurance carriers and I was unable to schedule doctor appointments for my 14 year old because of similar State regulations. I was beyond frustrated by this knowing that my 14 year old would NOT make appointments for herself. It seemed like the dumbest thing in the universe (and perhaps I still feel this way a bit!) but in terms of therapy, this privacy is really important. The reason for Family Code Section §6924 is so that minors don't have to tell their parents that they are being abused, are pregnant, or any number of other serious reasons why they may seek treatment. At that tender age, having to share that kind of information with a parental figure could be enough to prevent any kind of treatment and the results can be disastrous. Even if the extreme reasons (the exceptions to confidentiality) are not at play, if a minor was forced to tell their parents about something for which they may feel they will be judged or will cause them to "get in trouble" (things like using drugs or alcohol or bullying) this can very easily prevent them from telling it at all and getting the help they need. This is why the Health and Safety Code §124260 is in place. I try, therefore, to explain to the parents that have brought their child to therapy that unless it is a serious thing that their child is talking about (one of the three reasons stated at the outset) they have to trust me with the relationship. If it is a pretty serious thing that the child is talking about but not to the level of those listed above, I will work with that child on how to tell their parents what is going on if it is appropriate. This, then, becomes a valuable life skill for them (communication skills) and I can provide the support they may require to be ready to have such a conversation with their parent or other person.

I am the parent of a high school student here in Southern California. I have a large number of clients that are high school students, some of whom go to the same school as my daughter. I have had many clients feel nervous about this fact. It is imperative that they understand, and I try to explain to and assure them that their confidentiality is of utmost importance to me. I would NEVER talk to my daughter about a client. I would NEVER talk to other parents about a client. Because of the nature of the school that my daughter attends, I frequently am on campus or at school events and could potentially "run into" a client there. This has happened to me a few times at various public establishments (especially at the Costco near my office!) When this uncomfortable circumstance occurs, two things may happen. First, I am usually so oblivious to other people while I'm out of the office that I don't even notice them! I have on a number of occasions had clients come up to me and say hello, startling me out of my reverie. The other thing that happens is that I do notice them and then it usually takes me a moment to place how I know them (because out of session, people "look different"). When this happens, I will not approach them or make any kind of contact. I usually try to go about my business and pretend I didn't see them. This is not because I'm trying to be antisocial or rude but merely because I want to prevent the possibility of them feeling like they have to come up to me to say hello or feeling uncomfortable greeting me outside of session and possibly having to explain to others they or I may be with, how they know me. It is entirely up to the client whether they want to approach me or not and either way is fine with me. It is up to the client to "break confidentiality" by approaching me. It is also up to the client, if they choose to approach me, what they want to say to me if others are present.

Being in therapy is, by definition, a vulnerable place to be so it is imperative that all clients and potential clients understand how much I appreciate this and how far I go to keep their confidentiality at all costs. I understand how important it is to the therapeutic process and therefore to helping my clients cope with the troubling situations in which we sometimes find ourselves. A really good resource for more information on this subject can be found here.