Introduction

One of the fundamental principles of therapy is confidentiality between counselor and patient.
Not only that, confidentiality is considered an integral part of all healthcare relationships. Confidentiality
is defined as an agreement between the patient and the counselor that information discussed during or
after the meeting will not be shared with other parties without the patient's permission (Wadman et al.,
2014). In adolescent health care, confidentiality is especially important. Given that psychotherapy for
adolescents with mental problems has made great progress in the last few years, ethical issues have
arisen that need to be addressed (D’Souza & D’Sousa, 2020).

Body

Adolescent psychotherapy is a complex and difficult challenge for the parties involved, but it is
important for it to be effective. The essential component to effective therapy is confidentiality between
counselor and client. This entails the client’s ability to disclose their thoughts, feelings, experiences, and
behaviors without fear of jujudgment. If the adolescent cannot safely disclose whatever they want, the
therapist may not have enough information to know what help they need. Trust needs to be established
so that the adolescent can feel safe enough to trust the freedom to reveal all without judgement,
retribution, condemnation and reprimand. Adolescents must be able to trust that he or she has enough
privacy for the process to be effective. They may not disclose vital information in therapy if they do not
perceive this privacy. They must also be sure that their therapist will not share this information with third
parties. That is what enables a strong therapeutic alliance to be built and maintained. Furthermore,
confidentiality in therapy is important because it ensures increased cooperation in treatment – often the
information they do not wish to disclose is the most important to discuss in therapy. Also, in order to
encourage the adolescent's autonomy and a more defined sense of self, treatment must respect their
independence and privacy. Furthermore, another benefit includes improving the parent-child
relationship – when a child can talk openly about his feelings in therapy, his relationship with others,
including his parents, can improve. Many adolescents do not discuss challenging topics with their
parents because they fear judgment or punishment. When parents understand the importance of open
communication, they are less likely to overreact. This can encourage better parent-child relationships.
Given the advantages described, it is clear that confidentiality in therapy is extremely important.
However, minors have a limited right to privacy and confidentiality of therapy.

The Code of the American Counseling Association (2005) states that "the primary responsibility of
counselors is to respect the dignity and promote the well-being of clients," that counselors "recognize
that trust is the cornerstone of the counseling relationship," "respect clients' right to privacy," and "do
not share confidential information without the client's consent or without a valid legal or ethical
justification". The exception is "when legal requirements require that confidential information be
disclosed" (ACA, 2005). However, legally speaking, persons under 18 years of age usually do not have a
right to confidentiality of therapy. By law, minors generally cannot consent to treatment; a parent or
guardian gives consent on behalf of minors to persons under a certain age (often 18) who are not mature
enough to make decisions about treatment. There is often misunderstanding and confusion about how
and when to offer adolescents confidential health care because of its close association with consent to
treatment Adolescent confidentiality is related to consent to treatment, but these are fundamentally
different constructs and must be understood separately from each other. Some clinicians believe that in
order to offer confidential health care to an adolescent, they must assess and document the individual as
a mature minor in the medical record. Others believe that as long as the adolescent is under the age of
18 and a parent or legal guardian signs consent for treatment, the parent or legal guardian should be
present at all medical appointments and have access to all information shared with health care
providers.

Involving parents in adolescent psychotherapy often blurs therapeutic boundaries and issues of
confidentiality. Most adolescents come with their parents to consultations and therapy sessions, so
parents feel they have a right to know what is going on in their adolescent's mind. Also, often parents
pay for the therapy and therefore expect the therapist or clinician to listen to them, as well as to disclose
everything that happens in therapy between the therapist and their adolescent. In adolescent
psychotherapy, it is important to establish a relationship both with the adolescent and with his parents
or guardians. This includes offering an explanation of how information sharing will work – what
information will be shared, with whom and when. Counselors often struggle with whether to share
information with a parent, especially when adolescents talk about activities that, while not necessarily
dangerous, are illegal, such as shoplifting, recreational alcohol use, or drug experimentation. Information
that must be disclosed is if there is a high probability of serious harm to them; that harm is most likely to
be prevented by breach of trust; that all alternatives have been exhausted; that they were given the
opportunity to make the announcement themselves; and that they were informed of the counselor's
intention to breach confidentiality. On the other hand, the psychologist may feel strongly that disclosing
the information to the parent could harm the patient or be destructive to the treatment. In this case, the
counselor's judgment will indicate to what extent the preservation of the adolescent's privacy is
essential to the treatment.

Conclusion

Confidentiality is considered an integral part of therapy. Confidentiality is particularly important for many
reasons to ensure effective treatment. For adolescents, the right to privacy and confidentiality of therapy
is limited by parental involvement. Therefore, it is important that counselors establish a relationship with
the adolescent and their parents or guardians about what information they will share. Information that
must be shared is if there is a possibility of serious harm to the adolescent or others. In all other cases,
the counselor's judgment will indicate the extent to which the adolescent's privacy is essential to
treatment.

Bibliography

American Counseling Association. (2005). Code of ethics. Alexandria, VA: Author.

Wadman, R., Thul, D., Elliott, A. S., Kennedy, A. P., Mitchell, I., & Pinzon, J. L. (2014). Adolescent
confidentiality: Understanding and practices of health care providers. Paediatrics & Child Health, 19(2),
11–14.

D’Souza, R. and De Sousa, A. (2020). Ethical Issues in Psychotherapy with Adolescents. GLOBAL
BIOETHICS ENQUIRY, 119-122.