The more the know, the more empowered you’ll feel taking the therapy leap.
People asked lots of great questions about what therapy is actually like and what to expect from your therapist, and we got answers to those questions from three therapists — you can check them out here.
But we also got several questions about confidentiality, disclosure, and reporting when it comes to parents, family, and hospitalization, so we decided to reach out to a psychologist who works with young people — Dr. Barbara Nosal, chief clinical officer at Newport Academy, treatment centers for teens struggling with mental health issues, eating disorders, and substance abuse — to get some answers. Here's what she told BuzzFeed Health via email.
Quick FYI before we dive in: frustratingly, lots of the rules around confidentiality, disclosure, and consent vary by state.
And you'll see this below in Nosal's explanations. Because there are no hard and fast blanket answers that will apply to all situations, Nosal recommends doing some research to get accurate answers (that are specific to you and your state) to any questions you have about these topics. For example, Nosal says, "You can find the specifics for your state by searching online for 'age of consent in (your state)' or 'child abuse laws in (your state).' To make sure you get accurate information, refer to the state websites rather than information posted elsewhere.'"
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What sort of stuff do therapists absolutely have to tell parents/guardians about?
"Confidentiality is one of the most important aspects of building rapport with a therapist. If you cannot trust or be honest with your therapist, why would you see them? In regard to privacy and limits on confidentiality, therapists are bound by the ethical guidelines of their state license.
Practitioners are mandated to disclose information, depending upon the laws of their state, whenever there may be a serious threat of harm to self or others, or suspected neglect or abuse. For instance, typically therapists will not tell parents about situations involving consensual sex with someone of a similar age; however, depending upon the laws of the state, when there is a significant age difference or an implication that it is not consensual, the therapist is mandated by law to make a report to the state."
You can find more detailed information about confidentiality here.
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Do I need my parents’ consent to go to therapy?
"The laws vary considerably by state; in many states, minors — as young as 12 years old in California and Vermont — are allowed to consent to treatment for substance abuse and mental health. The therapist must be satisfied that a client possesses the capacity and maturity to intelligently participate in therapy and understand what they are consenting to, and the therapist is required to document the discussion in the client’s record."
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How much of the information (if any) that you have received from friends or family about the patient affects the patient’s care?
"The preference of the therapist is to receive information directly from the client. However, there are times in which the client is not available, not forthcoming with information, or not being honest. In these cases, it can be helpful to obtain information from others to improve the assessment process. A client must sign a release of information, allowing the therapist to speak to family or friends, prior to any discussion.
An exception is a situation in which, prior to the therapist-client relationship, family or friends contacted the therapist to get help for the client, at which time they provided background information. A therapist will consider the information they have provided, and they will put more value on what the client reports, since who knows you better than you!
For example, when parents call Newport Academy to determine whether residential or outpatient treatment would be most appropriate for their child, they provide detailed information about their child, most often without the child’s knowledge. When the client enters our program, we take into consideration the family’s perspective, but we conduct extensive assessments with the client to determine what the real issues are."
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If the patient doesn't want to involve anyone (like a family member, an old lover, etc.), will the therapist insist that it will help with their problem?
"It’s not a therapist’s role to insist upon or offer advice to a client. Rather, the role of the therapist is to listen and to facilitate the client gaining awareness and insight to go deeper in their journey of self-discovery. Processing events and emotions does not have to include anyone except the client and the therapist. In a typical outpatient therapy situation, it is always the client’s choice as to whether anyone else needs to be brought into the room. (This is not always true in residential treatment, however. At Newport Academy, for example, family therapy is an essential and required part of the healing process.)
No one should be afraid to seek help from a counselor or therapist because they’re nervous about being forced to involve another person."
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If I mention to my therapist that I believe I was sexually abused, will they tell my parents? I understand I'm under 18. But I just want help dealing with the long-term effects without making it a big deal.
"The therapist is not obligated to tell your parents, but they are mandated by law to report any suspected sexual abuse. Since the law specifically refers to 'suspected,' it is not up to the therapist to determine whether the abuse actually occurred. The state agency that handles suspected child abuse cases will investigate, which will include interviewing you, and possibly your parents. If you feel you need help with dealing with the longer-term effects, I would highly encourage you to be honest with your parents. When they know what happened, they are more likely to support you in getting professional help, as well as offering compassion and understanding. Your parents are there to help! I would also encourage you not to minimize what happened. Not talking about it and avoiding processing your feelings could have lasting effects on your future relationships."
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If I freak out (pull my hair and hit my head and pace around) in front of my therapist, could I get thrown in the hospital for inpatient?
"Your therapist’s primary consideration is your safety. If the symptoms you mentioned continue, they may require containment and stabilization. Depending upon the severity of the symptoms and your emotional state, your therapist may determine that you are threat to yourself or others, and ask you to go to the hospital to be evaluated by a psychiatrist. If you refuse to go to the hospital, the therapist or local law enforcement may place you on what’s called an 'involuntary hold' to transport you to the local hospital. This is not to say that you will be 'thrown in the hospital.' However, if the attending psychiatrist feels that you are at risk, they may admit you to the inpatient unit for observation and stabilization for up to 72 hours. After that time, if you remain at-risk based on their ongoing assessments, they may extend your stay. On the other hand, if you are doing better, the psychiatrist may feel that admitting you to inpatient is not warranted."
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What happens if you say you've thought about suicide? Can you have a reasonable talk about it, or do they report you immediately? And who do you get reported to?
"If you’ve had suicidal thoughts in the past, you can have a reasonable conversation with your therapist without any action being taken. I encourage you to discuss this with both your therapist and your parents, so they have a clearer understanding of what is going on with you. They are there to help.
If suicide has been more than a fleeting thought for you, you will want to let your therapist know, so you can work together on addressing the underlying issues/traumas. Your therapist may recommend an evaluation by a psychiatrist to determine whether medications might be appropriate to address any potential chemical imbalance that could be affecting your mental health.
Therapists are mandated to report to state authorities anything that threatens their clients’ physical safety, such as abuse or neglect. If you tell your therapist that you have the intent to commit suicide, as well as a plan and the means to carry it out, they are obligated to take measures to ensure your safety. However, they will not send you to the hospital for having had suicidal thoughts in the past."
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And if you need to talk to someone immediately, you can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and or the Crisis Text Line by texting HOME to 741741. Suicide helplines outside the US can be found here.
Follow along at BuzzFeed.com/MentalHealthWeek from Oct. 2 to Oct. 8, 2017.
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