Key Takeaways

• Children and teens have an ethical right to confidentiality in therapy, but the legal rules vary based on age and state.

• Therapists balance parental involvement with the need for a trusting relationship between themselves and the child.

• Understanding confidentiality can help you support your child’s therapy without unintentionally undermining their sense of safety.

As a parent, you may understandably be interested in what your child is talking about in therapy. Therapists have the legal obligation to protect their clients’ confidentiality, but when it comes to patient-therapist confidentiality for children and teens, the issue can become a bit more complex.

Minors do have an ethical right to confidentiality, but the laws around it can differ significantly based on the state as well as the child’s exact age and what they’re coming into therapy for. As a parent, you may wonder how much your child’s therapist is able to share with you and whether confidentiality means you’ll be kept totally out of the loop.

In this blog, we’ll go over what confidentiality really means in child therapy — and what to expect when your child begins treatment.

General principles of therapist-patient confidentiality

First, let’s talk about what, exactly, “confidentiality” is. Confidentiality is a right that all healthcare patients have to privacy. In the United States, it’s a legally protected right (barring a few exceptions, which we’ll explore later). 

The Health Insurance Portability and Accountability Act (HIPAA) sets legal standards for how healthcare professionals need to protect your medical information. Exact HIPAA guidelines can vary by state.

What confidentiality means in therapy

Therapy is an especially vulnerable space, even within healthcare. People often share things with their therapist that feel private and personal — they may even be talking about things that they’ve never shared with anyone else. But all therapists have the legal obligation to keep these things private.

Therapists are well-trained in confidentiality laws. Not only do they follow HIPAA guidelines, but they also have their own ethical considerations for how to protect your right to privacy.

Besides the few exceptions, everything that’s shared in therapy is kept private. This includes (but is not limited to):

• The fact that you’re in treatment at all

• Your diagnoses

• Medications you take

• Drug use, including illegal drugs

• Criminal behavior (unless you threaten to cause bodily harm to someone)

• Results of pregnancy tests

Legal and ethical considerations for minors

When it comes to minors in therapy, the guidelines can get a little trickier. Parents may understandably want to know what’s going on with their children, for example, if they’re using drugs or having unprotected sex. 

The laws around this are complex and often depend on the state and your child’s age. On top of the laws, however, most therapists have their own ethical guidelines regarding what they will and won’t share with their minor children’s parents.

Confidentiality should be one of the first things you talk about with your child’s therapist in the first session. 

Confidentiality for children vs. teens vs. young adults

The exact laws around confidentiality for minors depend on the child’s age, the state laws, and the therapist’s license type and ethical guidelines (for example, this might differ between psychologists and counselors).

Children

Children under the age of 14 typically can’t consent to mental health treatment in most states. This means that they’ll need your legal signed consent, as their parent, to receive therapy at all. Because they’re not consenting to their own treatment, they often don’t have the legal right to privacy. 

But that doesn’t mean that the therapist will share everything with you — therapists have their own ethical guidelines to consider as well. The therapist may ask you to sign their own written agreement about their practices around confidentiality with children.

Teens

Many states allow teens over the age of 14 to receive specific health services, including sexual health and mental health, without parental consent. That means that a teen can sign to their own treatment without asking their parents for permission.

Usually, this also means that teens who consent to their own treatment have the right to confidentiality. But the law gets murkier in this area. For example, some states allow teens to consent to their own substance use treatment, but may also allow/require providers to inform parents of any positive drug tests.

If you’re a teen or a parent who’s wondering about exactly what information will be kept private, you should go over this specifically with your therapist.

Young adults

As soon as a teen turns 18 years old (19 in the states of Alabama and Nebraska), they’re considered an adult in the eyes of the law. It doesn’t matter if the young adult continues to live at home with their parents — they still have the full right to privacy. 

For a therapist to release any information about the young adult’s sessions — or even the fact that the young adult is in treatment with them — the young adult themselves will need to sign an official medical release form.

When can a therapist break confidentiality?

For both children and adults, there are limits to confidentiality. While most things shared in therapy will be kept private, exceptions include:

Threats of harm to self or others

If a therapist has a reasonable suspicion that their client will harm themselves or others, then they will break confidentiality to keep people safe. This may include reporting their clients to crisis services or warning law enforcement.

Mandated reporting for abuse and neglect

All medical professionals, including mental health therapists, are mandated reporters of child and elder abuse. That means if they have any reasonable suspicion that a child or older adult is being abused or neglected, they must report it to authorities.

Court-ordered disclosures

Sometimes, the court system may subpoena therapists and/or their records. For example, if a person is being accused of a violent crime and their mental health history is relevant, then their medical records may be shared. But therapists cannot break confidentiality even if you commit a crime if their records are not officially subpoenaed. 

Parental access to therapy information

Regardless of the law, therapists will generally maintain all of their clients’ right to privacy, including minor clients. That doesn’t mean that you’ll be left out completely; parental involvement is an important part of child therapy.  

It’s understandable to want to know what’s going on with your child, but confidentiality is often an essential part of building a strong therapeutic relationship. Your child may not be able to build trust with their therapist if they believe nothing they say is private.

Even in cases where you have the legal right to know everything that your child talks about in session (and your child’s therapist is willing to share that information with you), it’s important to weigh the disadvantages vs. the benefits. Will your child feel betrayed or lose trust in you and/or their therapist if they know their therapist is sharing information with you? Will this affect how willing your child feels to go to therapy and how much they benefit from it?

One thing a therapist cannot ethically do is lie to their clients about their right to confidentiality. So your child’s therapist cannot tell your child that their information will be kept private, only to break their trust and share information with you. 

The conversation around confidentiality is one that will involve the therapist, you, and other legal guardians (if you’re the one consenting to your child’s treatment), and your child themselves. It’s important for everyone to be on the same page.

Get child therapy with Emora Health

Therapy can be life-changing for children and teens, especially when they’re given the space to build a safe and trusting relationship with their therapist. While it’s natural to want to be in the loop, respecting confidentiality is often a key part of making therapy successful.

At Emora Health, our licensed child and teen therapists are experienced in balancing privacy with healthy parent involvement. You’ll stay informed and supported — and your child will get the space they need to feel safe and grow.

Ready to get started? Sign up today to match with a therapist who’s the right fit for your family.

Sources

Division, D. C. (2021, June 29). HIPAA & your health rights. HHS.gov. https://www.hhs.gov/programs/hipaa/index.html

Sharko, M., Jameson, R., Ancker, J. S., Krams, L., Webber, E. C., & Rosenbloom, S. T. (2022). State-by-State variability in adolescent privacy laws. PEDIATRICS, 149(6). https://doi.org/10.1542/peds.2021-053458

Staff, L. a. R. A. (2005, June 21). A matter of law: privacy rights of minor patients. https://www.apaservices.org. https://www.apaservices.org/practice/business/legal/professional/minor-privacy