As an adult, you have a right to expect absolute privacy and confidentiality in therapy. Without your explicit consent, the therapist is prevented by law from discussing with anyone else information you share during your sessions. State and federal case law defines the circumstances in which confidentiality can be breached. The most common circumstances include:

• Third-party insurance reimbursement

• Collection of debt

• Defense of malpractice or professional complaint

• Danger to self or others

• Abuse of children, elderly, or mentally or physically handicapped

• Abuse by a medical professional

For minor children, that same sense of privacy does not exist. As a parent, you legally have a right to know what is discussed in each session and to see your child's file if you want to. Clinically, especially if the child is older, it is important for the therapist to be able to develop a relationship that feels safe, trusting, and open, and will not be compromised by what the parents need, feel, and want. Some children, as they reach eight or nine years old, crave a sense of autonomy and independence from parents and will not talk unless they feel there is confidentiality and privacy. You might consider not asking for information about your child's therapy unless you have a specific concern. For example, if your child is not making progress or you believe she might be suicidal, definitely approach the clinician. In fact, you can confirm, up front, with your child's therapist that if your child reveals a potential threat to herself or someone else, the therapist will alert you immediately as required by the law. This way you do not need to wonder; you are assured your child's therapist is sharing the most important information as it comes up. Another example might be, you do not need to know that your son has a crush on the fourteen-year-old daughter of your best friend, but you do need to know if he feels anxious upon arriving at school because a group of bullies has been hanging out at the front door and intimidating him. As children move toward adolescence, this need increases. Few things carry such potential to disrupt treatment as an adolescent's feeling that what he discussed with his therapist in session is shared without his knowledge. Many therapists address this concern directly in the first session. A patient bill of rights should be posted in your doctor's office, and you will be given a confidentiality document, with your rights on it, to sign as well.