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Confidentiality in Counseling

I recently watched a clip of a Dr. Phil episode (guilty pleasure) and found myself pretty feeling pretty heated. For clarification, Dr. Phil is not a licensed mental health care professional and therefore we remember to take all his feedback with a grain of salt. That being said, the topic was about transgender students in school and the responsibility to disclose students’ gender identity to parents. This brought up a larger conversation about confidentiality in general, especially where minors are concerned. As I’ve previously mentioned I have worked with clients as young as 3 and as old as late 80s and everywhere in between. Regardless of age my rule of thumb with confidentiality is pretty simple, your business is my business, but it’s no one else’s.

The Health Insurance Portability and Accountability Act (HIPAA) is the primary law that protects a person’s personal health information (PHI). This includes everything from your diagnosis, treatment plan, and progress, to your presence receiving treatment. Essentially, once you begin working with a counselor that counselor cannot even acknowledge that you are their client without a signed release of information (ROI) or a court order by a judge. But that’s just the law, rules around confidentiality stem even further into the ethical code that counselors agree to when they enter this profession. In fact, there is some juicy debate around this topic as many ethical codes make no exception for disclosure under a court order, meaning presumably that if ordered by a judge to disclose PHI a counselor could still lose their license for disclosure or go to jail for nondisclosure. Spicy. The reason that confidentiality is taken so seriously in this field is that in order to effectively treat clients they have to trust and be honest with their counselor. Many clients may not disclose important information to their counselor if they’re afraid that their counselor will tell someone else, like for example, their parents.

There are some exceptions to this confidentiality that most people are aware of, and it focuses on the imminent danger of harm. If a client discloses that they have a plan, intention, and means to harm themselves or others a counselor has a duty to take action necessary to protect that client and others. This could include calling that client’s emergency contact to make a plan, working with the client to admit to a behavioral hospital for a brief stay, all the way up to informing the police. Again though, I will never do any of this without first talking to the client about it – nothing I do for a client is a secret from that client. Other exceptions are made in the case of abuse of children or vulnerable adults including older adults or adults with impairments in their ability to care for themselves. Those situations would result in calls to the Department of Children and Families and I would not disclose that I made those calls to the alleged abuser, but I would discuss making those calls with the client experiencing the abuse. Beyond imminent threat or danger of harm though, the rule of thumb is not to disclose. This even includes past criminal behavior. If a client discloses to me that they broke the law at a point in the past, and no one is at risk of being harmed due to the client not being caught, the secret is safe with me.

Whenever I work with minors I make this point clear in the very first session. I will not tell your parents anything we talk about without your consent. I also tell the parents the same thing, with the additional point that they do not have the same right to confidentiality – if you email me between sessions about your child I will tell them what you said. There are many times in a counseling relationship when a person’s counselor may feel like the only safe person they have in their life to talk to. Confidentiality protects that safety and is sacred in this work.

To bring it all around back to Dr. Phil, he gave (in my opinion) pretty bad advice – suggesting that teachers, school counselors, etc. should disclose information about a student's gender identity to their parents. I disagree, especially here in Florida, I would be concerned about a child’s safety disclosing that information to the parents if they’ve elected not to for any reason. I never encourage a client to come out before they’re ready regardless and I always ask how I should refer to clients if emails to parents need to be sent. If you’re a parent reading this thinking, “well hey, I want to know what is going on with my child”, the best suggestion I can make is to help your child feel safe talking to you. I don’t revel in keeping secrets from parents. In fact, I always love when clients have a group of safe people they can be vulnerable with, especially parents. If you’re finding your child is having difficulty talking to you, perhaps that’s an area for further exploration in your own counseling. As always, I’m here to assist!

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