Confidentiality in the treatment of adolescents

Confidentiality is the requirement that psychologists protect their client’s privacy by not revealing the contents of therapy. It is also an important tool for building effective therapeutic relationships because clients are more likely to enter therapy and to be completely honest when they know that what they say to their psychologist will not leave the therapy room. Anything a young person discloses to their psychologist is confidential and may not be disclosed to anyone without their consent. However, confidentiality is relative rather than absolute, as the psychologist may have to disclose information.

Limits of confidentiality/reasons for disclosure

Psychologists in Australia are required to abide by principles of professional conduct, responsibilities and confidentiality. These are set and monitored by the Australian Psychological Society (APS) in the Code of Ethics (2012) to protect the welfare of clients and the integrity of the profession.  The Code states that ‘psychologists must make provisions for maintaining confidentiality in the collection, recording, accessing, storage, dissemination and disposal of information including when they leave a specific work setting or cease to provide psychological services.’

Under certain circumstances, psychologists may be required to disclose confidential information. These include:

  • With the consent of the client or a person with legal authority to act on behalf of the client. For example, written consent from a client for their psychologist to disclose certain information to another health professional or their school. If the client sees the psychologist under a Mental Health Care Plan referral, the psychologist has legal obligation to send a report to the referrer on completion of the critical cause of treatment or as soon as the client discontinues treatment. The amount of detail in the report for the referring medical practitioner is not specifically mandated and the psychologist should use clinical judgement on what information is appropriate to include in the report.
  • Where there is a legal obligation to do so. This is usually if a client’s information is subpoenaed by the court. In some cases, psychologists are able to request that some of the information contained in the client’s psychological file should not be released due to the effect it may have on the client.
  • If there is an immediate and specified risk of harm to the client or an identifiable person or persons that can be averted only by disclosing information. For example child abuse or intention to commit a criminal offence.

Informed consent

Prior to providing services, psychologists must inform their clients about what to expect regarding the nature of the treatment or interaction. This includes the limits to confidentiality, rights of access to files and to whom reports will be sent. In Australia, a young person is considered capable of giving informed consent when he or she achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed. As part of the process of obtaining informed consent a psychologist determines whether the young person:

  • can understand the nature of the proposed psychological service;
  • can understand the benefits and risks of the proposed psychological service;
  • can understand the consequences of receiving or not receiving the proposed psychological service;
  • has the capacity to make an informed choice; and
  • can understand the limits to confidentiality.

If a young person is deemed by a psychologist as being capable of giving informed consent, the young person is entitled to engage and consent to receive, continue or terminate psychological services and to express wishes as to who may or may not receive any of their confidential information.

Who may seek psychological services to be provided to a young person?

The APS states that a parent with legal responsibility for a young person may contract or engage psychological services for that young person. However, when a young person is capable of giving informed consent, psychologists may only provide the psychological service with the consent of the young person. The young person is entitled to express wishes as to who may or may not receive any of their confidential information (including a parent or guardian). Psychologists respect the young person’s wishes regarding confidentiality and do not divulge any information contrary to the young person’s wishes, except in circumstances set out in the limits of confidentiality.

Can a young person access psychological services without parental consent?

Psychologists may provide psychological services to a young person without parental consent provided that the psychologist is satisfied that the young person has the capacity to give informed consent. In cases where fees are charged for the service, a young person’s entitlement may also be subject to the young person’s capacity to pay the fees. Depending on the circumstances, and if appropriate, a psychologist may encourage the young person to discuss the matter with his or her parent. In cases where the young person is not capable of giving informed consent, psychologists may only provide psychological services with the consent of the young person’s parent or legal guardian.

Confidentiality is an essential part of therapy, however it does not come without its dilemmas, especially when it comes to treating young people. Adolescents can benefit from discussing certain personal issues with a psychologist and therapy can be more beneficial if the client is open and honest. If an adolescent knows that the information they discuss with a psychologist will be passed on to their parents, they may be less likely to divulge certain information. Every situation is different and it is up to the psychologist to practice within the code of ethics and determine what is best for the client’s safety and well-being.

Authors: Melanie Green and Meggy Delaunay

References

Australian Government, Australian Law Reform Commission. Decision making by and for individuals under the age of 18. Retrieved from http://www.alrc.gov.au/

Australian Psychological Society. (2012). Code of Ethics. Melbourne.

Australian Psychological Society. (2013). Framework for the effective delivery of school psychological services. Retrieved from http://www.psychology.org.au/Assets/Files/School-psych-services.pdf

Australian Psychological Society. (2007). Guidelines on confidentiality. Melbourne.

Australian Psychological Society. (2014). Ethical guidelines for working with young people. Retrieved from http://admin.psychology.org.au/Assets/Files/EG-Young-People.pdf