Adolescent confidentiality is an essential issue that most health professionals need to contend with in therapeutic settings. The experience of a private and protected therapeutic space is central to the adolescent psychotherapist’s work.
As treating professionals and society, it is our responsibility to offer adolescents the best possible experience of healthcare services and in this particular instance, seeking mental health services such as therapy. An adolescents’ first experience of a therapeutic process is likely to inform their help-seeking behaviour, and it may also influence their proclivity to accessing mental health services later in life as adults when needed.
At the very heart of any therapeutic contract is the need to protect the privacy of the patient- adult or child. An adolescent has the right to confidential communication with the therapist providing their care. What this means is that some of the issues that they discuss will stay between the therapist and the adolescent, and the therapist will not disclose that information to anyone –
including the parents – unless they have been permitted by their adolescent to do so. Issues of confidentiality are worked out within the guidelines of the Code of Ethics of the Botswana Health Professions Council. When working with an adolescent, the therapist will discuss the limitations to confidentiality and explain when confidentiality will be broken. Such circumstances include when an adolescent is a risk to themselves or others, or if required by law. In all other circumstances where ethical dilemmas arise concerning disclosures, the therapist has to be guided by the ethical codes stipulated by their relevant regulating body at all times.
Developmentally, it is appropriate for adolescents to want to develop some autonomy and maintain a level of privacy, but it is also the time when they should be developing a trusting relationship with adults around them, that is, parents/parental figures and professionals. In a therapeutic relationship, the therapist offers confidentiality and the possibility of talking about issues that cannot be talked about elsewhere for fear of shocking, distressing or angering the listener and those around them.
For adolescents, in particular, fear of rejection and abandonment by those they most depend on and need is common, especially where aspects of the self that they feel to be ugly, shameful, and unacceptable are concerned (Lanyado & Horne, 2009). The therapist needs the adolescent to be open and honest to understand and treat the full range of the issues they are dealing with, and trust is what allows for this fear of rejection to be brought to therapy, where it can be thought about and metabolised, rather than feared. This form of clinical intervention is one of the more obvious ways in which the therapeutic experience provides containment of a patient’s emotional distress and pain.
As widely understood by treating professionals, adolescents may approach therapy with trepidation or outright resistance, which is at times out of fear that all of what they discuss with the therapist will be disclosed to their parents or members of their community.
The therapist has to find a balance between respecting the adolescent’s need for confidentiality with maintaining regular contact with the key adults in the adolescent’s life - parents in particular, but also teachers, social workers and medical staff.
Most therapists recognise the importance for a parent to know what their adolescent is going through in order to do their job as a parent, which is why one of the therapist’s role is to encourage, prepare and support an adolescent so that they feel safe enough to share significant issues with their parent. Therapists need to give much thought into how to protect the therapeutic space and prevent infringements from the external world as far as possible. Professionals whose own parental biases err on the side of disclosure should maintain reflexivity at all times, as this may interfere with their capacity to maintain emotional safety for an adolescent patient.
It is not far reaching to state that, concern on the part of the patient about possible confidentiality breaches and the compounding stigma that surrounds mental health in Botswana plays a significant role in a person deciding to access therapy.
It is therefore of paramount importance for psychologists, as well as members of society, to respect this very fundamental right to privacy and confidentiality, and promote the dignity of every citizen in the country when accessing mental health services.
Members of the public are advised to report any suspected or confirmed professional misconduct to the Botswana Health Professionals Council.
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