Dear Mother.
Dear Father.
As your daughter's therapist, there is something I need to to tell you. Because when you come to my office with your teenager, you are in pain. Your child is in pain. And something needs to be done.
I believe that the parents of my clients love their child passionately. I pass no judgment as to why your child needs therapy. (I have made my own mistakes with my teenagers, and we have all lived to survive them.) The more important question is how I can fulfill my responsibility to you once you entrust her in my care so I can help your child?
There is nobody in your daughter's life who is important as you are. Nobody. I know that. You should know that, too. But teens are simply a species unto themselves. And until they do not turn that corner into adulthood, the sane rules of of adult life just don't seem to matter to them.
And so I need to explain what happens in the therapy room. What teens need in a therapist. And why a therapist working with teenagers is often in an untenable situation, navigating between the client, the parents, and sometimes also the school and various other individuals who may be involved.
Ideally, work with a teenager, as with any child, should be a collaboration between therapist, parents, and the teen client.
Ha.
I will tell you what I say to parents of new teen clients and what happens after that.
Initially, under the best circumstances, both parents will come in with their teenager. It already gives me much information to see both parents. How they interact with each other, how they each interact with their daughter. How and where they sit; how and when they pay me. It's even better when I meet the parents before the teenager even comes in. and then in the second session, the parents come with their teenager in which most things are repeated in front of the teenager, and then I ask the parents to leave, giving me the second part of the session hearing from the teenager. Both are okay.
Once I get to talk to everyone, I will talk about confidentiality.
Here's my spiel: “Because your daughter is under 18, legally, you are allowed to know anything you wish to about her treatment.” Then I turn to the teenager, “And legally, I can talk to your parents about anything you say or do in here.” I complete my little speech talking only to the parents. “Obviously, no normal teenager is going to talk to a therapist, if they know that anything they say I can repeat to their parents. I mean, dumb a teenager is definitely not!”
So I go on to explain my system. Once this session is over, I encourage the teenager to take charge of her therapy. We will arrange together the session time and she will bring payment with her each session. If a parent feels that they need to speak to me, I will try to first contact the teenager to get a heads up, and if not, I will not engage in the conversation until the teenager meets with me and identifies exactly what I can and cannot say, with me taking notes to ensure I get that right. I will also let the teen know the approximate content of the any conversation with her parents. I explain that I must establish this kind of safety and confidentiality for the teen, because the foundation of a therapeutic alliance is trust; and without trust, little work will get done.
Parents worry when they hear this. And they have very important questions.
“What if I need to tell you something very important and it would not be in my daughter's best interests for her to know I told it to you?”
My answer? Most of the time, that is not true. If it's so important, the teen must hear it. If the teen can't hear it, then even if it's important, once I am dishonest in the relationship, the therapeutic alliance is compromised and that will undo any potential positive outcomes such revelations would effect.
“How can the therapeutic alliance be compromised if my daughter doesn't know about the conversation?”
I say, “If a child cheats on a test, and the teacher never finds out, is there no rupture to the relationship between teacher and child? Dishonesty creates ruptures even when people don't know.”
Then comes the big question. “How we will know therapy is helping our daughter if we cannot talk to you regularly?”
A parent knows therapy is working, not by what the therapist says, but by how the teens behavior improves! “You will see it,” I say. “That's how you will know.” Because if a parent is sending her teenager to therapy because of disturbing behaviors at home, at school, then the purpose of therapy is to change those behaviors. No one needs to talk about it to find out if it's happening; you can simply open your eyes and look.
Parents come in and they tell me, in front of their daughter, what a close relationship they have with their daughter. They cannot imagine talking to me will bother their daughters.
And here's the part that gets sticky. Often the parents are right. Their daughters adore them. But the first thing the teen tells me when their parents leave the room is, “Don't tell them anything I say.”
It's a teenage thing. Loving parents and yet needing their distance, their privacy, their right to therapy without parents invading their space.
I try. I really try. I try to tell the parents all of this. To say, “Allow your child the space she needs in therapy. I do not want to isolate you. There is no one who loves this kid as much as you. And I want to work with you. I will work with you. But just give this therapeutic alliance a little time to sort itself out.
“Because when your teen feels safe in therapy, when she feels she can truly trust me, then she will trust me enough that we can work collaboratively without that trust being compromised. At that point she will be okay with me talking to you whenever and she won't even bother giving me notes on what I can or cannot say. She will breezily leave it to my discretion. And she won't even check up on me anymore what her parents told me. She won't even want to waste her therapy time with discussion of that. She trust me by then. She trusts her parents. She is on her way to health.”
I once heard something beautiful. “Parents are not necessarily part of the problem; but they are the solution.”
I believe that sincerely.
So help me help your teen by insuring her privacy. If you can do that, then you will soon know all her secrets.
Thank you.
Note: This was originally published in Binah Magazine
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