In episode 288, I received a question from a younger listener coping with anxiety, depression, and more subtle forms of self-harm, who is concerned that their therapist will disclose information about their self-harm to their parents. In this post, I discuss confidentiality for minors, how to approach this with your therapist, and also talk about sharing information with your parents/guardians or loved ones.
Hey there. I have a question for you. Some background (under 18). I have a seasonal disorder that makes me get depressed and anxious. But every year it gets worse. I don’t try to self-harm but now I am doing it in other forms like taking a cold shower or hitting myself. So the question is could my therapist tell my parents that I’m self-harming in this way? Is it the same thing as cutting yourself or different? Love the podcasts and have a nice day.
This is a great question. To be honest, it’s a little bit complicated. As someone who is under 18, your rights to privacy are likely different than they would be if you were an adult because in most cases, your parent or guardian is the one consenting for your treatment. There are a bunch of complex laws governing privacy and treatment for minors. This is both at the federal and the state level, assuming you are in the US. Therefore, some of the answer to this question will depend on where you live.
In general, if you are consenting to your own treatment for some reason, such as independently seeking treatment in a state where you can do so – for instance in California, you can independently consent to treatment at the age of 12 if you are able to manage it and pay for it yourself etc. If you are an emancipated minor, the same applies. In these cases, you can consent for yourself and your parents don’t have a right to your records. In most other cases, your parents or guardians will have a right to your information. At any point, they can obtain a copy of your records and in some instances, information can be shared with them depending on the arrangement.
Now, with that said, most therapists that work with minors, especially adolescents, will have their own guidelines about privacy that they will have parents and the children agree to prior to treatment. Obviously, it is going to be difficult for you to feel totally comfortable talking about personal and private information freely if you are worried about everything just being reported back to your parents. So, many therapists will have guidelines about what is and is not shared with parents. This is something that should be discussed prior to beginning treatment and if you have questions about how your therapist plans on handling these things, please feel free to ask them. This is not a strange topic to talk about – it should be something they are used to discussing because it probably comes up a lot.
Is it still self-harm?
Now, as to the question about the specific behavior you are discussing – subtle forms of self-harm like hitting yourself or taking a cold shower, these are things that in general are not explicitly reportable. As a mandated reporter, your therapist must act upon suicidality or evidence that you are being abused. Self-harm itself can fall into a bit of a gray area because there are certainly non-suicidal forms of self-injury. It’s actually super common. If it were an adult that is hitting themselves, taking cold showers, or over-exercising, these would not be things that are reportable as long as the intention here isn’t to kill yourself. When it comes to cutting or other more violent forms of self-harm this becomes a bit more complicated because you can cause yourself serious harm even if that isn’t your explicit intent.
So for you, this is going to really come down to your particular therapist’s guidelines. I would encourage you to talk with them about these issues without being specific first. To ask about confidentiality and ask what they will be reporting and not reporting to your parents. I do this all the time with adults that I work with – talk about confidentiality broadly and give them the tools they need to decide what they are comfortable disclosing. I will pause things, talk about the circumstances that would and would not lead to breaking confidentiality, and let them know that even if they have things that fall under that umbrella we would try to work together on a solution such as voluntary hospitalization rather than an involuntary hold. You could ask your therapist about what sort of topics they would have to share with your parents or otherwise break confidentiality for. You can also ask specific questions. Like “I don’t plan on causing myself permanent harm and I don’t want to die, but I am wondering about specific behaviors and whether you would have to tell me parents about them if I bring them up.” It’s really going to be on an individual basis.
Can you talk to your parents?
Now, let me take a step back from all of this. Would it be the worst thing if your parents did find out? I know that at your age, privacy is probably really important to you and you deserve it. But in some cases, getting issues like self-harm and depression out in the open is one of the most important ways to start dealing with them. A lot of mental health issues thrive in situations where they can be kept secret. Simply having more awareness and accountability can make a huge difference. That said, I don’t know your parents. There are absolutely situations where it would not be smart to tell them things like this. If you could be punished for it in severe ways, abused, etc. then definitely you don’t need to spill your guts to them. But I want you to question the voice that tells you they can’t know about this.
It’s very similar to people that I see in my office who do have significant suicidal ideation. I will explain the limits of confidentiality to them, but also express that it can be a very important part of their journey sometimes to disclose this information and have someone help them take action. We are sort of trained to do everything we can to avoid hospitalization, but sometimes that is exactly what is called for to stabilize someone and set them on the right track. Similarly here, your instinct may be screaming at you to keep this secret, but that could also just be your mental health difficulties trying to keep themselves safe and you fearing the potential shame of having to face this with your parents.
So I hope that gives you some direction. You can’t be forced to share anything that you don’t want to share and you are allowed to have a very clear idea about the confidentiality agreement with your therapist before you say anything. I also want to say thank you for listening and I’m super proud of you for being so interested in improving yourself and taking in content for your mental health at such as young age. That’s awesome.
You can listen to this on Episode 288 of the podcast!
Thank you for the great question!
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