When young people see counsellors and psychologists there are times when parents are included in the conversations but often the door is closed and as a parent you have to trust the professional to guide your teen. I have been lucky to find good help for my daughter, I know if I need to ask a question or bring something up that that will be ok.
Nevertheless from time to time you feel a bit left out of the loop. At times you feel like you are intruding if you ask to have a few moments to be included or ask questions, taking time from your teen’s consultation. There are times when I am tired and a bit low myself that I have self doubts that I am on the right track. If what I am doing at home is enough, or right.
Could a psychologist please give some insight as to what works best when teens are having long term counselling?
Thanks for your question. Many parents who have had young people in counselling will understand your quandary. Adolescents and young adults in particular experience a powerful drive to differentiate from the family, to attempt to eke out a space for their own identities, as they try on the mantle of adulthood. For many of them, any sense that discussions in the therapy session may be shared with others – let alone parents – could lead to their censoring their input or even refusing to attend altogether.
Conversely – and especially for therapists mindful of the powerful role families can play and the stress they undergo – parental input can be extremely valuable.
While some therapists will (unfortunately) share minimal if any information with parents, others may be more flexible. This may depend on such factors as the therapist’s professional obligations, practice models and orientation, the sensitivity of the issues being expressed by the young person, the relevance of the young person’s relationship with their parents to these, and the wishes of the young person.
Client/patient confidentiality is at the heart of the therapeutic alliance. It is a central tenet of the codes of ethical therapeutic practice. In a practical sense, it needs to be in place so that the client can feel safe enough to at first engage with and eventually trust the person assisting them: a necessary prerequisite to sharing the most sensitive and deeply held information.
Various state and territory health departments have advocated that health professionals treat information from patients as young as 14 as confidential in a range of circumstances, if the child requests this. There are limits to confidentiality, however. For example, in circumstances where a minor is seen as being at risk of harm or if other legal obligations are imposed. For psychologists, therapy generally remains confidential unless there are compelling reasons to limit it and informed consent is granted by the client to discuss information disclosed during therapy sessions.
Where does a parent fit in?
Even if you as a parent are paying for the child’s sessions, the therapist will see your child – not you – as the client. If a child is progressing well in therapy, parents who may not be receiving the kind of feedback they seek, if any, might need to consider some of the factors above and make a decision to trust the therapist’s protocols around confidentiality.
It sounds like you’ve got a good arrangement with your daughter’s therapist in this regard. Parents of minors at least have a right to ask for helpful information. Therapists will also generally encourage young people to talk to their parents about a range of issues and inform their parents of what’s happening in therapy should they choose to.
There are often very valid reasons for parents to be ‘kept in the loop’. Some therapists accommodate this is by making it very clear at the beginning of therapy and in front of the young client and his or her parents, under what circumstances (if any) information may be shared. If all parties agree to these terms, formal consent may be obtained from the client to share the information in the specified way. However, even in these circumstances, the therapist needs to be clear that the young client understands the ramifications of providing such consent.
Family systems therapists are a group who will actually make a point of involving parents and other family members wherever appropriate. In such therapy, specific agreements are reached with a number of family members around confidentiality and flexibility in relation to this. Multiple family members may even attend the same sessions.
Parents helping not hindering the process
When a young person enters therapy, it can have a range of obvious and more subtle impacts on the whole family. Once parents are clear with the therapist about the boundaries of the therapeutic process and where they may fit within it, they can assist in the following ways:
- First and foremost, ask the young person if there’s anything the parent can reasonably do to assist them at home as they undergo their process. A young person in the early stages of therapy may not have an immediate answer to this, or may even interpret the question in the wrong way, so the offer should be left open. As the young person gets a clearer understanding of the process they are in, their needs may become more apparent. Parents should be mindful that this ‘asking’ doesn’t become badgering.
- Inform the young person that the parent understands that there needs to be boundaries around the parents’ involvement and that they will adhere to these. Those boundaries can assist in clarifying the position for anxious parents and also allow the young person the space to engage in their own process. The young person may be in a position to re-negotiate the boundaries with the therapist and the family over time.
- If and when the young person wants to talk, be there to listen and care, and offer support without judgment. Patience is critical, too, as the child may sometimes find it difficult to verbalise their fears and emotions.
- Try to set aside some time to discuss your child’s worries or concerns. To minimise distractions, turn off the TV and let voicemail answer your phone calls. This will let your child know that he or she is your first priority.
- Encourage the young person to discuss their wishes as to who is and is not informed about their being in therapy with the therapist. The therapist is in a position to discuss practical and social ramifications of these wishes. Once the young person has made the decision, try to adhere to this if possible. Some requests may present some practical challenges however, and these may need to be discussed.
- Once it’s decided who is to be in the loop, enlist their involvement in support strategies identified. These key people can include your partner, other family members, trusted friends, teachers, family doctor.
- Reassure your child (if you feel that they need it) that attending therapy is not a sign of weakness or that they are ‘crazy’. Boys in particular can worry about this. Programs of therapy can be characterised as a health-related intervention or treatment, benefiting mums, dads, kids, prime ministers, stars, athletes, to name a few.
- Be prepared for and open to all types of feedback from your child and from the therapist.
- Be mindful of possible emotional vulnerability and mood swings within the young person during the time they are in therapy. Have some nurturing (as opposed to indulgent) strategies in mind to quietly provide comfort at such times.
- Subtly advise siblings and other family members to allow some ‘space’ for the emotional ups and downs referred to above.
- Be prepared that the therapeutic process may bring to the surface quite powerful emotions, and that these may sometimes be directed against those the young person ‘subconsciously’ feels safest with. That is, you, the parent. You may need to brace yourself for spurts of anger or blame. This does not mean you need to tolerate abusive behaviour however. Set limits on inappropriate or problematic responses. Just attempt to be conscious of how you communicate a boundary or a consequence at such times.
- Ask the therapist for some strategies to encourage your child’s cooperation.
- Do some research into the issue your young person is trying to address (if you are aware of what it is). Even parents who are fearful about what they might find through such research can feel more empowered, and make better decisions at home, once they have vital information. It is important to restrict such research to credible sources (the therapist, your GP, websites of authorised government agencies and reputable organisations), and to resist ‘over-interpreting’ the information you receive.
- Maintain as much of the healthy consistency, structure (and fun?) of family and household rituals as possible. This can provide a quiet compass for the whole family during turbulent times. This includes covering the basics of good nutritious food, opportunities for rest, exercise and recreation for yourself and the entire family.
- Research indicates that if parents and siblings can remain engaged with the priorities of their own lives (thereby minimising levels of obvious disruption for the collective) this benefits your young person, other family members and the family system as a whole.
- Try to be aware of any guilt or stigma you may be experiencing as a result of your child being in therapy. These are natural feelings. However parents can ‘beat themselves up’ for a range of things at times like this, and may feel that they need to hide what’s going on from the outside world. It would be helpful for you to have some support and guidance for yourself: a parent’s distress levels may be quite high at times like this.
Helping parents manage
It may well be that the issue the young person is addressing through therapy is one that parent education and support programs are available for. A young person’s anxiety, depression, drug and alcohol, other mental health conditions and behavioural problems are examples of issues where education, support and even therapy programs are available to help parents manage the situation from their end. The therapist you contact should be able to point parents to services which can provide a range of information and support around the issues your child is attempting to deal with.
Finally, a therapist will ideally be a ‘responsible’, skilled and trustworthy adult who can assist your child in instances where you for some reason may be less able to. However, you as a parent will still retain a level of insight, expertise and – above all – legal, moral or emotional responsibility for your child that no other person can hold. As such, you do have a right to make reasonable and appropriately expressed requests for information. Your child’s therapist meanwhile will do whatever he or she believes is in the best interest of their client.
Sean Panambalana, psychologist, specialist in drugs, alcohol and gambling
Our Ask an Expert Week panelists are all qualified professionals in their field. However, advice given on The Kids Are All Right website is not a substitute for direct, personal, professional counselling or psychological care, medical care and diagnosis.
All the questions from Ask an Expert Week 2013