Confidentiality in the Therapy Process: What to Consider When Working with Children and Adolescents?

Therapy is a safe space where an individual can share their most private thoughts and emotions. For many clients, the foundation of this trust relies entirely on the belief that everything discussed in therapy will remain confidential. Especially when working with children and adolescents, the issue of confidentiality can raise many question marks in the minds of both families and young individuals. In this article, we explain the meaning and boundaries of confidentiality in the therapy process, and how a balanced dynamic can be established with families.

Why is Therapy Built on Confidentiality?

For a client to express themselves freely, the therapist must build a "bridge of trust." The principle of confidentiality forms the very foundation of this bridge. When clients know that what they share will not be disclosed without their permission, they can voice their anxieties, fears, and thoughts much more openly.

This holds true for children and young people as well. Especially during adolescence, the need for personal space increases, and the willingness to open up is closely tied to the assurance of privacy.

Is Confidentiality More Difficult with Children and Adolescents?

Because children and adolescents have not yet achieved full autonomy, information sharing between the therapist and the family must be established in a balanced manner. Research indicates that a significant portion of young people avoid going to therapy simply due to the worry that their parents will find out what they say.

For instance, a large-scale study conducted in the US revealed that 1 in 4 girls and 1 in 3 boys experienced confidentiality concerns despite needing therapy. These rates highlight just how crucial it is for families and therapists to discuss this topic openly.

What Are the Boundaries of Confidentiality?

While confidentiality is fundamental to the therapy process, there are certain situations where a therapist is legally and ethically obligated to share information. These situations include:

• The client being at risk of harming themselves
• An intention or plan to harm someone else
• Situations that threaten safety, such as physical or sexual abuse
• When such issues arise, the therapist must share the situation with the relevant individuals or institutions. However, this disclosure is still carried out by keeping the client informed.

How is Information Sharing Balanced with the Family?

Parents naturally wonder what their children are going through and what topics are being discussed in therapy. However, respecting the privacy of an adolescent client is critical for the healthy progression of the process.

An orientation is conducted with both the family and the child at the start of therapy. Usually, an explanation similar to the following is preferred:

"What we talk about here stays between you and me. However, if a situation arises where you might harm yourself or someone else, I will need to share this with an adult. In such a case, I will talk to you first and keep you informed."

This explanation supports the child's or adolescent's sense of safety and establishes clear boundaries right at the beginning of the therapeutic process.

What Happens When Confidentiality Must Be Broken?

When information must be shared due to safety requirements, the therapist manages the process with immense care. To prevent the client from feeling betrayed, the following methods are utilized:

• The matter is explained to the client in advance.
• The information is shared in the presence of the client, or the client is actively included in the process.
• The reason why confidentiality is being broken is explained clearly.
• Great care is taken to ensure the communication remains grounded in trust.

In this way, the client's disappointment can be minimized, and potential damage to the therapeutic relationship can be mitigated.

A Common Dilemma: How Much Should We Share?

Therapists working with children and adolescents can experience occasional ethical dilemmas. For example:

• A 15-year-old youth might share that they are experiencing severe school absenteeism and sleep issues.
• A 16-year-old youth might describe struggling to cope with intense anxiety.
• An adolescent client might mention engaging in risky behaviors within their social circle.

Such situations require a careful evaluation to determine whether the family needs to be informed. The factors considered during this evaluation include:

• The frequency and severity of the behavior
• Its direct impact on the client's safety
• The risk level of the situation
• The age and developmental level of the client

Conclusion

Confidentiality in the therapy process is both an ethical and a legal principle. Especially when working with children and youth, clearly explaining the boundaries of this principle carries immense importance. When the limits of privacy are made clear, young people participate in therapy with greater confidence, leading to much more effective outcomes.

You can contact us to build healthier communication with your family and child, receive professional support, and learn more about therapeutic processes.