A thorny issue that arises time and time again occurs when a teenager undergoes treatment for a health or mental health problem. Dr. Klass discussed this problem earlier this week over at the New York Times from a medical perspective, but the same confidentiality challenges a doctor faces are also faced by therapists.
Doctors and therapists have what is called doctor-patient confidentiality — anything told to the doctor or therapist is protected by that right. But since only adults can enter into contracts, these kinds of rights are not absolute and often are not extended automatically to teens and adolescents. There are no black and white answers, unfortunately, regarding this issue. Teenagers are right to feel uncomfortable with outright disclosure to a professional they’re uncertain they can trust.
Experts say the middle-school years are particularly challenging. “It’s a fine balance because it’s developmentally appropriate for kids to want to develop some autonomy and it’s the time when they should be developing at least in part a private and confidential relationship with a physician,” said Dr. Carol A. Ford, director of the adolescent medicine program at the University of North Carolina, Chapel Hill.
“Middle school is really when you see a lot of variation in pubertal development and cognitive development and social development,” Dr. Ford went on. “A 12-year-old who looks like an 18-year-old — you can’t assume they think like an 18-year-old. You can’t assume their skills of negotiating the world are related to their physical maturity.”
Here’s what you can do if you’re a teen or adolescent faced with this situation, where you feel like you need to disclose something to your doctor or therapist, but are uncertain whether they will keep your information confidential.
- Ask the professional whether they share confidential information with your parents. Most professionals will answer with specific areas where they would be required by law to do. Some professionals may go further and tell you upfront they will share other behaviors they feel are important for your parents to know about (such as drinking or using drugs).
- Ask the professional what types of information they feel they would need to share with your parents. Get as specific an answer as you can from the professional, so if you tell them something they haven’t mentioned, they can’t blindside you with a disclosure you hadn’t expected.
- Tread gingerly with the information you share. You don’t need to blurt out everything, all at once (although that is often the human tendency to do so). Take your time, share a little, and gauge the reaction of the professional. If you feel that the information is safe with him or her, continue to share.
- Remember, some sensitive information may be critical to your treatment. A doctor may not be able to accurately diagnose a medical or health problem if you’re withholding an important piece of possibly-embarrassing information. A therapist also may not be able to help you much if you’re leaving out a big event or factor that might be contributing to your current feelings. You have to balance confidentiality concerns with actually getting help for your concern.
- Most professionals are cool with most information. Teens regularly engage in behavior that parents wouldn’t approve of if they knew — drinking alcohol, experimenting with drugs, engaging in unsafe sex. These are not earth-shattering revelations to most professionals, who’ve heard virtually all of them before. So while it’s a huge deal to you, it may not really be as big a deal to the professional (most of whom would keep such information confidential), but may be important to helping you get treated appropriately. For instance, many medications should not be mixed with alcohol or certain drugs; failing to share such information with a doctor could result in unwanted and possibly serious side effects.
- Most professionals won’t judge or lecture you. A doctor or therapist is first and foremost there to help you. So while they may say a word or two about whether you’re making the best decisions in your life with certain disclosures, most will respect that you are a young adult finding your way in the world and not judge your behaviors.
Compromises are usually easy reached in these situations, as illustrated by the article:
One of my colleagues had a story: a 13-year-old girl who was drinking and stealing from her parents’ liquor cabinet. “She did admit that to me,” the pediatrician said. “She was doing it by herself, not a good sign, not social drinking.”
The child did not want her mother to know, and the pediatrician, who had known her since infancy, negotiated a compromise: the doctor would advise the mother that the girl needed counseling, and as long as she went to counseling, and discussed the drinking and her underlying issues with the counselor, the pediatrician would not tell her mother about the liquor.
While not ideal, such a compromise maintains the client’s confidentiality while also trying to ensure she seeks help for the problem (which could be an early indicator of a serious alcohol problem).
Teenager confidentiality is an important issue, but one usually not given much thought by rushed professionals whose own parental biases might be to err on the side of disclosure. So I was glad to see this article on this often-overlooked concern.
Read the full article: 18 and Under – What to Do When the Patient Says, “Please Don’t Tell Mom”