Why I No Longer Treat Minors

I used to work with a lot of children and teens.  But I will no longer see minors.  The reason?  The State of California’s laws about confidentiality. 

Unlike other States, parents of youth 12-and-over may have no access to their child's therapy. In fact, the parents don't even have to know about the therapy.  And even though the parents are legally and financially responsible, they may not be informed of behavior that is putting their child at risk.

What do I mean?  Here's an example.

Let’s take Nora, a 13 year old girl.  She has decided to contact a therapist for counseling.

The parents have to be notified and must give their permission, right?  No.  Since she’s over 12, she can consent on her own.

Nora tells the therapist that she’s having physical problems after getting on the birth control pill.  She’s gained a lot of weight, has migraines. and is much angrier and irritable.

Her worried parents have taken her to doctors for exams and tests.  But since Nora refuses to tell the doctors about the birth control pills, the physicians are puzzled.

Nora also confides in therapy that she’s secretly dating a boy who is 16.  He has introduced her to hard drugs, including LSD.  After taking it once, she’s feeling more anxious, even paranoid.

The therapist is between a rock and a hard place.   If she doesn’t inform the parents and something awful happens to their child, they could sue her.  But if the therapist talks to them, the therapist could be disciplined by the licensing board for breaking confidentiality.

This situation is also stressful personally for the therapist. Not telling the parents feels unethical. And the therapist cares about Nora, but is powerless to protect her.

Now there are times when a therapist can and must break confidentiality, such as an imminent suicide or homicide risk. However, those situations are rare.  

But if a tween or teen discloses drug use, STDs, even taking puberty blockers to change her gender, the parents may get left out of the mix. Not only is this silence enabling, but it is potentially dangerous to the youth.

In my view, parents should be involved in their child's therapy and informed of risky behaviors, the kind that Nora is involved in. Parents are the parents.

So because of the laws in California, I will no longer work with minors. I am unwilling to be put into legal jeopardy, as well as be unable to protect young clients when need be.

What do I say to California parents who want to bring their 12-and-over child to therapy?  Educate yourself about the laws and be mindful of the limits that you will have to information.  

Weigh the pros and concerns, and consider another option (eg your child talking to a trusted relative) before taking her to therapy.