Dear Therapist:

My 18-year-old son is currently seeing a therapist which was recommended by his rosh reshiva. Even though we are paying for the therapy our only interaction with the therapist is to arrange for payment. My son doesn't want us to speak to the therapist and when we have called the therapist, he doesn't want to speak to us either. How are we supposed to help our son if we have no idea what is going on with him? It also seems very unfair that we should be paying for this therapy and not entitled to know anything that is going on. Is this even legal? In addition, we feel there are important things that the therapist should be aware of regarding our son and we have no idea if he knows about them. I have heard that some therapists will "listen" to parents without giving information but our son’s therapist doesn't even want to do this. Being that I can't discuss this with the therapist I am reaching out to the panel to see if you can offer any insight, explanations, or strategies regarding this matter. Thank you.

Response:

I don’t know what the reasons are for the recommendation that your son seek therapy. You seem to be indicating that you don’t know the reason either. Perhaps your son’s rosh yeshiva picked up on an issue that is more obvious in a social setting. Perhaps your son approached his rosh yeshiva for help dealing with something that troubles him. Regardless, it seems like he is going to therapy willingly. It also seems that he wishes to keep his information private.

There are a few reasons that a therapist would not speak with a client’s parents (or anyone else for that matter) without consent from the client. With regard to sharing information, there can be legal, ethical, and therapeutic consequences. These areas can combine in interesting and interrelated ways.      

Ethically, one could argue that it is not appropriate to share private information with someone else, unless the benefit outweighs the risk. From a legal perspective, health care information is highly confidential, and can only be released under very specific circumstances (for instance, the clear sense that the person will cause imminent harm to self or others). There are times when ethics appear to point in one direction, while legality points in another.

Ethics and legality aside, an essential and fundamental reason for confidentiality is the efficacy of the therapy process. Without the assurance of privacy, clients are less likely to be open and honest about their feelings and needs. Additionally, without a sense of mutual respect and a connection between the client and therapist, the therapeutic relationship is likely to suffer. When we have a sense that our therapist is warm, understanding, empathic, genuine, and supportive, this can go a long way toward development of a strong therapeutic relationship.

Generally speaking, the most significant factor leading to successful treatment is the therapeutic relationship. This has been shown in multiple studies and meta-studies, and is true for a variety of reasons. The therapeutic relationship has been shown to be the most significant indicator of successful treatment regardless of the particular therapeutic modality. In order for your son to properly gain from therapy, he needs to feel comfortable with the therapist as well as with the therapy process.

I certainly understand your sense of unfairness. You are paying for something that you don’t understand, and you have no idea whether it is working. You don’t know if you’re getting your money’s worth. This can certainly be frustrating. However, bear in mind that your son seems to feel that he has a problem and is willing to work on it. Furthermore, he is unlikely to continue with a therapist whom he believes is not helping him.

I don’t know to what degree your son discusses his therapy sessions with you. I assume that you know when his sessions occur. Perhaps he shares some basic information with you; perhaps he doesn’t feel comfortable discussing it at all. It is likely that the more uncomfortable he is, the more important confidentiality is to the therapeutic alliance—and therefore to the therapy process.

I don’t know the circumstances surrounding the therapist’s decision not to obtain information without disclosing any. This depends on a few factors. If you want to convey information with your son’s knowledge, I imagine that the therapist would discuss this with him and, if agreed to, would schedule a session or a phone call with you.

Family members sometimes want to impart information but do not want the client to know. If you want to discuss things without your son’s knowledge, this can add a problematic wrinkle to the situation. If the therapist were to withhold from your son the fact that he spoke with you, this could lead to challenges. If your son were to discover that this conversation occurred, it could cause irreparable harm to the therapeutic relationship. Even if he were not to find out, the therapist would always need to be cognizant of what he could and could not say—and how to present certain ideas. This would undoubtedly affect the therapist’s genuineness, one of the tenets of a good therapeutic relationship.

It is a parent’s instinct to help their children. We want to do what we can to make their lives better. I would caution you to be aware of two things. Firstly, we need to focus on long-term gains without getting hung up on the short-term. If your son does not appear—at least outwardly—to be gaining from his therapy sessions, this does not mean that in the long run he will not be happier and better adjusted for it. Secondly, remember that your focus is on your son’s wellbeing—not on your own. Do not let your ego get the better of you. If part of the reason that you are upset is that “it is my right as a parent,” or “I’m paying for it!” try not to allow this to affect your decisions.

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

  Woodmere, NY

  adjunct professor at Touro College

  Graduate School of Social Work

  author of Self-Esteem: A Primer

  www.ylcsw.com / 516-218-4200

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