10.3 Confidentiality, Privacy, and Privilege with Adolescent Clients
Confidentiality with Adolescent Clients
As discussed in Chapter 7, confidentiality is a foundational aspect of the therapeutic relationship that enforces ‘what happens here stays here.’ Confidentiality is an essential ethical and legal concern for counseling work and is addressed in every ethical code (English, 1990). Counselors have unique responsibilities to adolescent clients around confidentiality, as outlined in the ACA code below. Practicing confidentiality with clients reinforces all ethical pillars of counseling, including autonomy, beneficence, non-maleficence, justice, fidelity, and veracity (ACA, 2014).
Counselors have a fiduciary duty to legally uphold counselor-client privilege and protect client information as stated in state and federal statutes (English, 1990). Counselors obtain the valid release of information documents if they need to disclose or share information with other parties, such as family, probation officers, physicians, other programs or counselors, schools, etc. They can legally break confidentiality without client and family consent to fulfill mandated reporting and duty to warn requirements, as discussed in later sections.
The ACA (2014) discusses this in its ethical code:
“When counseling minor clients or adult clients who lack the capacity to give voluntary, informed consent, counselors protect the confidentiality of information received- in any medium- in the counseling relationship as specified by federal and state laws, written policies, and applicable ethical standards” (Standard B.5.a.).
Outside of counselor responsibilities and logistics, confidentiality is an essential ingredient within the helping relationship. This is especially true for adolescents in a stage of tension in developing autonomy and independence, though they remain legally dependent on their parents. Honoring confidentiality with adolescents models healthy development of individuation and enforces their right to self-determination (Ford-Sori, 2015). Counselors must prioritize the welfare of their adolescent client, and along with that is a duty to involve parents when they obtain information in counseling that indicates a threat to the person’s safety. Examples include substance use, risky behaviors, non-suicidal self-injury, suicidal ideation/ plan, concerns around eating or eating disorders, among others (Kerwin, 2015). In these situations, disclosing information to parents is indeed in the young person’s best interest. It may be good practice to safeguard confidentiality by obtaining a release of information for parents at the onset of treatment, explaining why this is necessary, how it will be used, and how it will not be used. Additionally, counselors delineate that when parents consent for adolescents to receive treatment, it does not jeopardize the client’s right to confidentiality or privacy in counseling (Kerwin, 2015).
Confidentiality is important to adolescents. Young clients must trust that what they share will be kept safe and have clarity about when information must be shared with parents to keep them safe (Koelch, 2010). If not, they could not reasonably be asked to share information, and the counseling process could put them at risk for harm. Often, adolescents talk about conflict with parents or other family members in counseling but may feel deterred from discussing this openly if they are weary of inappropriate disclosure (Koelch, 2010). For some, families knowing that they are participating in counseling can be a barrier to receiving services or even a threat to their safety (Koelch, 2010). For young people who use substances, counselors remain sensitive to the fact that any disclosure around their use could result in legal consequences, familial or social shaming, and worsening of safety and mental health symptoms (Kerwin, 2015). This means they tread thoughtfully, not avoiding the disclosure, which would constitute negligence. Above anything else, counselors always put the welfare of their adolescent clients first, communicate this, and act in ways that reinforce it.
Privacy with Adolescent Clients
Privacy has a new meaning and importance for adolescents compared to adults. For people with full legal rights and who own their data, there is a clear boundary around limitations to confidentiality and what stays between the client and counselor. With adolescents whose parents have legal responsibilities and obligations to them, client privacy becomes convoluted. Privacy is defined as “the client’s right to choose who has access to information about them,” which is nearly inapplicable to this population (Ford-Sori, 2015, pg. 451). On the other hand, counselors believe in ethics and give adolescents as much autonomy in their right to privacy as possible (Ford-Sori, 2015). Privacy is essential to adolescents and the therapeutic relationship between client and therapist, as young people are not used to a near guarantee of privacy, and sharing with parents can cause harm or increase barriers to change or care overall (Ford-Sori, 2015).
Sometimes, counselors must share information with parents to protect the child’s safety. They carefully consider what content, how much, why, and logistically when, and how it is shared with parents. The counselor communicates all of this to the adolescent client and invites them to be involved in sharing with family, as doing so can build family trust. When working with adolescent clients, counselors are called to balance many factors, including the person’s welfare, the client’s wishes, the client’s right to privacy, parent needs and rights, and the impact of the concern that brought them to counseling. The legal system or other third parties may also be involved in some situations. Counselors affirm that they will be available to help the adolescent and the family work through the disclosure (Ford-Sori, 2015). They may need to advocate for their clients by reminding parents of their courage in disclosing and highlighting trust-building (Ford-Sori, 2015). Additionally, counselors work to repair any ruptures in the therapeutic relationship when disclosing to parents.
Counselors use ethical decision-making processes to determine their boundaries in handling familial disclosures. Ford-Sori (2015) presented a framework of six different positions one could take in disclosing sensitive information to parents, as presented in Box 10.2. This is a valuable add-on for ethical decision-making, thoroughly documented in the client’s chart.
Positions for Disclosing Adolescent’s Information with their Parents
Counselors who work with adolescent clients need to be prepared to involve parents at times to promote client welfare and beneficence. Confidentiality and privacy are important factors in counseling; However, the young person’s safety is paramount. Parents also have a right to know about the safety concerns of their children. Therefore, Ford-Sori (2015) proposed a framework for counselors to disclose information from minors to their legal guardian(s) delineating 6 possible positions one could take. Counselors share options around disclosure with the client and their family during informed consent and co-create terms around how to proceed.
- Complete confidentiality- The counselor promises the adolescent client complete confidentiality with the legal exceptions of mandated reporting and duty to warn regarding homicidal or suicidality. This position creates risk for the client, their family, and the counselor.
- Mutual agreement for confidentiality- Counselors work with the client and their family to create a signed written contract detailing how information is disclosed between them. Counselors offer suggestions, though ultimately the adolescent client and their family decide the terms of disclosure. This position may leave some risk to the counselor.
- Best interest agreement for confidentiality- Counselors themselves set the limits for disclosure, though any sharing with parents is in the best interest of the adolescent client. The counselor approaches disclosure in ways that respect and maintain the therapeutic relationship, and gives the adolescent client options for being involved in the process of disclosing to parents (ie be present while counselor discloses, client discloses to parent with counselor present, client not present, etc.).
- Limited confidentiality- counselor requires adolescent client to give consent for certain things to be disclosed, and the client has some voice/ involvement/ awareness of content and process of disclosures made to parents
- Forced informed confidentiality- counselor reports they will have to share pertinent information related to client safety. The child has no say in how this is done.
- No guarantee of confidentiality- Counselors do not promise the adolescent client full confidentiality of their information, and the counselor holds the most power in determining how disclosures proceed. This position creates risk for the therapeutic relationship, the client, and the counselor.
Box 10.2. Clinical positions for Disclosing Adolescent Information with their Parents (Ford-Sori, 2015).
Privilege with Adolescent Clients
Recall that privilege is the legal ownership of one’s private data and the decision power around its use outside counseling, as discussed in Chapter 7 (Ford-Sori, 2015). A big question in working with adolescents is who controls disclosing minor information. Does the adolescent client or their parent(s)/ legal guardian(s)? These are different questions than who can legally consent to treatment, as parents consenting to treatment does not inherently necessitate that they have access or rights to disclose the adolescent’s information to themselves or other third parties. From an ethical standpoint, the best practice is to collaborate with your adolescent client and their family at the start of counseling to create boundaries and a plan for disclosure within the system (Ford-Sori, 2015). From a legal stance, counselors consult state laws for minors’ rights to privilege, knowing that most states grant it at age 16 (Ford-Sori, 2015). Counselors also obtain verbal and written consent to disclose any information.
Key Takeaways
- Counselors balance confidentiality with legal duties like mandated reporting, ensuring adolescents understand its limits during informed consent.
- Privacy is critical but limited; counselors involve adolescents in disclosure decisions to maintain trust and reduce harm.
- Ford-Sori’s six disclosure positions guide how and when to share information with parents while prioritizing client safety.
- Privilege, or ownership of counseling data, often rests with parents but varies by state law; collaboration with families is crucial.
- Ethical practice requires balancing adolescent autonomy, legal obligations, and family dynamics using clear communication and decision-making frameworks.