Dear Dr. Wes & Kendra: My boyfriend has been having problems with depression. He's 16 and agreed to see a therapist. But in the first session she told him that if he talked about anything having to do with drugs or alcohol, she'd have to tell his parents because that's illegal. So now he doesn't want to tell her anything. Let's just say he needs to talk about that stuff, but he won't if she’s going to rat him out. Isn't that illegal for her to violate his confidentiality, or at least not very professional?
Kendra: If she believes your boyfriend could be harming himself or others by his alcohol or drug use, such information should be told to his parents. Otherwise, the clinical couch should be like Vegas: what’s said there stays there.
The definition of a therapist, according to Merriam-Webster, is “a person who helps people deal with mental or emotional problems by talking about those problems.” How could she do that if she is preventing those problems from coming to the surface? If your boyfriend is simply engaging in weekend partying completely isolated from his depression, the therapist has no need to make matters worse by sharing that information. Although I don’t personally condone alcohol or drug use, weekend drinking is common among my peers and rarely has long-term harmful effects.
Kudos to your boyfriend for deciding to talk through his depression, but his current therapist may not be suited to help him do so. If your boyfriend were dealing with depression due to his parents' treatment of him and using drugs and alcohol to cope with it, it would be impossible to help him address his problem by tattling.
Help your boyfriend put to good use whatever therapist he sees. If his parents are only willing to pay for this therapist, then advise him to focus only on his depression and disclose carefully. On the plus side, because she informed your boyfriend early on about her disclosure policy, he knows what he can and can’t reveal. If his parents are open to changing therapists, suggest he confide fully in one who will keep reasonable confidences.
Either way, be careful not to get drawn into being the therapist yourself. Just stick to being his supportive girlfriend.
Wes: For the most part, if his parent signs your boyfriend in for therapy, the therapist can legally disclose this information until age 18. If the boyfriend is over 13, however, state statutes allow him to sign himself in and generally have greater control of his records.
Every therapist must establish “informed consent,” including explaining the limits of confidentiality in writing and verbally, just as this therapist has done. If your boyfriend agrees to be seen under these conditions, then the therapist is acting ethically by disclosing these “illegal things.” However, that same state law and commonsense say that your boyfriend can refuse treatment and cannot be compelled to participate without a court order.
As for those limits, any therapist is obligated to prevent imminent risk of harm, meaning it’s going to happen and it's going to be very dangerous or life-threatening. Knowing a minor is about to commit an armed robbery or shoot himself would demand disclosure. The same is true of child abuse, which has to be reported to social services or law enforcement.
From a therapeutic standpoint, however, defining harm as any drug or alcohol use is a pretty sketchy proposition. Defining it as “anything illegal” is even more so. Getting arrested is not imminent risk of harm. It might even be instructive for your guy. And when it comes to sex, many teens are at risk of harm— if you define STIs or pregnancy as harmful. I do.
Yet, I’ve rarely disclosed such things without the client’s approval, either because the client agrees or he or she solves the problem by agreeing to drive sober or practice safer sex. If that doesn’t work and the risk increases, I’d call the parents to protect the client.
In this case, however, Kendra is right. No meaningful therapy can occur because the limit has been set at a point that prevents disclosure of core issues. Your boyfriend is unlikely to confide because the therapist has, for all intents and purposes, instructed him not to.
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