Therapy with minors and how information is shared

Legal Issues

Often families come to therapy during a crisis such as divorce. When I work with a child to offer support during a parent's divorce, it is often a parent's desire that our work together or a child's challenges with a parent be shared in court. In California a child holds his or her own privilege and that privilege cannot be breached except under special circumstances. Those circumstances include if the minor is a danger to themselves or others, the minor knows of a child, dependent adult or elder person being abused or neglected, or by the order of a judge.

Confidentiality is both a legal and ethical duty not to share information about the patient with third parties without the signed authorization of the patient or unless disclosure is required or permitted. Privilege (e.g., psychotherapist-patient and other recognized privileges) involves the right and duty to withhold testimony or records in a legal proceeding. In California the minor is the holder of their own privilege and parents cannot waive privilege for court proceedings. A judge may order privilege waived in certain situations. However, if a family is wanting a therapist to help them through the process for custody, it is important to seek out a therapist who works in this capacity from the start. It is against the regulations of my license to begin a relationship based on treatment with a minor and subsequently make any recommendations on custody.

At times, families will subpoena me for court. Because my role is for treatment and not custody disputes, I try to make it well understood prior to starting treatment that I do not want to be involved in court proceedings and will not be willing to go to court. If I am subpoenaed for court I charge $500 per hour, including travel time.

Parent Communication

I value communication with parents, even with the privilege involved in working with a minor. I am happy to discuss the broadly what we talk about in session, the tools that I am working on with your child, and if there is any issue that I have concerns about. Sometimes there is not much to share. In working with children, especially with younger children in play therapy, the work is done through play and therefore hard to quantify or express. However, you will know if the therapy is working if the issues of concern are resolving. With older children, adolescents and teens I encourage client to express concerns directly to the parent if the environment is healthy enough for them to do so. At times I may suggest a parent meeting to collaborate on treatment goals and ways to help support the child. I prefer not to discuss child concerns at the time of the session in order to help the child feel in control of the session and not feel embarrassed or defensive about recent challenges. I prefer and encourage email communication about things that arise between sessions so that I can bring them up in a therapeutic manner after allowing the child time to bring issues up on their own.