Adolescents and therapeutic confidentiality

Consider the following situation: Yesterday I found a pill in my 17 year-old son’s backpack. My friend is a nurse and she identified the pill as a painkiller. Since my son is in therapy, I called his therapist to discuss this. I became very angry when the therapist was reluctant to even discuss my son and his progress in treatment. Since I am paying for the therapy, I believe that I have a right to know what is going on there. I am considering firing this therapist for their attitude. Any suggestions?

Finding drugs in a kid’s backpack is always a cause for concern. Wanting to communicate with his therapist seems only natural. But all therapists must protect the confidentiality of their clients, even if the parents are paying for the therapy. He is 17 and whatever he talks about in therapy cannot be revealed to parents or anyone else without a signed release of information from your son. There are good reasons for this. A young person talking about drugs or anything else must feel safe with their therapist.

Regarding your specific situation, switching therapists is probably not the answer. Your son will resent this move and any progress in treatment may be sabotaged. Keep the therapist informed by asking them to “listen” to your reports as information to further treatment. Ask your son if he will sign a release so that you can consult directly with his therapist. If you are seeing any progress in the treatment, I might apologize to the therapist if you feel you overreacted. A competent therapist will certainly understand.

Educate yourself and watch for other early warning signs of drug abuse. If your son’s grades are slipping, if he is getting into other trouble or if he is becoming secretive, consider intervening more directly by placing him in a more structured treatment program.

I hope that you are getting therapeutic support yourself. You should be very concerned and some immediate action is necessary. You need specific information and guidance on how to proceed. You may even invite your son into family therapy to discuss the issues more directly.