Great question—simply and clearly put—and I enjoy thinking about it. Thank you. I’m afraid my answer is going to be pretty long, though, because the question touches on a variety of issues.
Let’s start with the difference between secrecy and privacy. I’d like to keep my weight private. But if I wear a body stocking sometimes, that’s my secret because I’m a little ashamed about it. Someone else might not be. The contents of my email are private and I don’t want my husband to read them—even if I don’t keep any deep and dark secrets from him. My diary is private, and may contain a few secrets too; I don’t want anyone to read it. Sometimes privacy and secrecy overlap. Clearly, what’s private and what’s secret varies from one person to the next, but the development of boundaries of what is private grows with a child’s increasing independence from his or her parents. A child might ask the therapist, “Can I tell you a secret?” but really mean “Can I trust you? Can I tell you something that you will keep private?”
Privacy between people, called confidentiality when it refers to communications between therapist and client, is a prime value in therapy—the therapist under most circumstances must keep everything said in session private so the client can speak freely. This rule is a bit different when working with minors.
First off, there are legal issues which apply to minors in therapy. Minors are unable to consent to treatment; their parents consent on their behalf. There are exceptions to this (minors who are married or in the armed services), but generally anyone under the age of 18 is not legally able to make treatment decisions. A parent who consents to treatment for a minor child has the legal right to know the content of the child’s treatment. For more information, please consult this American Psychological Association page: http://www.apa.org/monitor/mar02/confidentiality.aspx. Reports on content may be more or less detailed, depending on the agreements the parents, child, and therapist have made with one another. Often, a general sense of progress or lack thereof is reported; specifics may not be.
Privacy issues in clinical practice are not as clear as the legalities are. The child needs privacy, and needs to be able to speak freely and know that the parents will not be told about what is said, in order to foster independent growth. Children’s needs for privacy grow as they mature, and the therapist might encourage the child to develop personal boundaries about what the parents (and others) should know and what they do not need to know—what should be kept private. This seems to conflict with the law.
To preserve clarity, remain within legal boundaries, and protect the child /client, therapists should make clear at the outset of treatment what the therapist’s relationship will be with the child and with the parent and how information will be shared—in short, who will know what and when. Clearly, as the child matures this will change—people need more privacy as their independence and individuality develop. When this happens, the therapist will meet with parent and child to explain that the structure previously agreed upon must be adjusted.
At the same time, the therapist cannot promise the child that all information will be kept private if it is felt helpful to the child to tell the parent. If the therapist feels the parent may harm the child as a result of information the therapist might report, the therapist should seek legal advice. The therapist is mandated to report indications of possible harm to the client or others; neglect or abuse must be reported in most states. This applies to both children and adults.
All my best,
Lynn
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