Archive for Tuesday, July 31, 2007

Therapy secrets usually sacred

July 31, 2007


Dear Dr. Wes and John: If a young man used illegal drugs and asked a therapist for help, would the therapist have to report it to the police?

Dr. Wes: An excellent question, and one that many kids wonder about. It's not just an issue of drugs, but any conduct that a person wants to discuss in therapy but doesn't really want to have shared with authority figures. It all revolves around client/therapist confidentiality, which is an issue that we take very seriously.

First let's address the easier question: Do therapists have to report drug use or other illegal behavior to the police? The answer is no. In fact, it is a violation of any client's confidentiality to contact the authorities unless the therapist believes that the client is going to do serious harm to someone, or she or he is committing child abuse. Beyond this, therapy must be based on the assumption that a client should be able to share information freely and in confidence in order for the therapist to be effective. That said, courts can and occasionally do order therapists to testify about a client or release their records. However, comments you make in therapy are considered privileged communication, and if a court tried to subpoena your records, you would ask your attorney to "invoke the privilege" in objecting to their release. Beyond this, if you have any court involvement or are in foster care, you must have a good talk with your therapist about this issue.

Disclosures to parents present a different, and even more complex, situation. The short answer here is that most therapists understand the need for confidentiality among teenagers, but they must balance this against the young person's best interests. Thus, most therapists maintain some limits on what secrets they are willing to keep. Most will discuss in your first session what they will and won't share with your parents. If a therapist doesn't make this completely clear, ASK. She or he will be glad to discuss the limits of confidentiality as she or he sees them. Generally, what is shared with your parents is up to you as long as the therapist and your parents agree on that upfront.

Rarely - and by this I mean maybe two or three times in my career - a parent will refuse to allow treatment if the teenager's records are to be kept confidential. Usually these are cases involving high-conflict divorce. Many therapists won't agree to work with a family if that is how they want to do things, because no teenager is going to open up if his or her therapist is going to take it straight to the folks. The entire point of therapy is lost.

On the other hand, if a therapist believes that a teenager is or might begin doing something extremely harmful to himself or someone else, she or he is generally obligated to violate his confidentiality. I usually explain this to families at the point we are about to split up in the first session. So far, I've not had a problem with it. However, your therapist may have a different viewpoint, and it is important to find this out before you say something that crosses the line.

Finally, a family-oriented therapist must balance confidentiality with good and honest family communication, so at times I may encourage a teen to share troubling thoughts and feelings with family members, but I will never "out" them unless they are placing themselves at risk.

John: We all have closet skeletons we'd rather not discuss. But honesty is essential when discussing problems with a therapist. Don't worry about what they will think about you. They've heard every one in the book. They are paid to help you, not judge you. But it's difficult for therapists to offer solutions if they can't know the whole problem. If you are taking a narcotic for example, you might notice its effects on your mood. But if your therapist doesn't know about this, she or he might incorrectly diagnose you with a psychological disorder.

Your physician also needs to know about any illegal drugs you take. Illegal drugs can interfere with other medications, sometimes with deadly effects. Conversations with medical personnel are usually protected by client-patient privilege as well. You might want to ask your doctor about the law and his or her policies on this matter.

I will remind you, however, that the risk of being reported by one of these figures pales in comparison to risk of facing a drug problem alone. By yourself, drug use fosters depression and may influence you to use more drugs. Counselors and psychiatrists can assist in breaking the cycle, but only if you ask first. If you have a drug habit, don't wait until it's too late to get help.

Next week: After a year on the job, we bid a fond farewell to John Murray as he leaves us for his beloved Lone Star State. In Double Take tradition, John offers his swan song with a few reflections on adolescence.

- Dr. Wes Crenshaw is a board-certified family psychologist and director of the Family Therapy Institute Midwest. John Murray is a Free State High School senior. Opinions and advice given here are not meant as a substitute for psychological evaluation or therapy services. Send your questions about adolescent issues to All correspondence is strictly confidential.


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