pp 10 to 15 min long

10.1177/1066480703255468 ARTICLETHE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / October 2003McCurdy, Murray / FAMILY SECRET DISCLOSURE

❖ Ethics

Confidentiality Issues When Minor Children

Disclose Family Secrets in Family Counseling

Kenneth G. McCurdy

Gannon University

Kenneth C. Murray

Scioto Paint Valley Mental Health Center

The literature addressing ethical issues involved in the disclosure of

family secrets in counseling has typically focused on secrets dis-

closed by adults, ignoring the ethical issues surrounding individual

disclosure by minor children and confidentiality within the family

counseling context. This article explores family secrets, confidenti-

ality with minors, and breaching confidentiality. A case example of

an individual session disclosure with a minor child is presented

along with ethical considerations and practice recommendations.

Keywords: family counseling; confidentiality; counseling children

I ndividuals involved in family counseling have the right toconfidentiality, but do minor children within the family have that same right? Various professional counseling spe-

cialties are faced with confidentiality issues when children

and adolescents are involved in counseling including school

counselors, clinical mental health counselors, and family

counselors. Counselors are often faced with minors disclos-

ing family secrets and other controversial information during

counseling sessions. Fall and Lyons (in press) discussed the

ethical considerations of family secret disclosure from an

adult perspective and in the larger family counseling group

session context. This article continues to address a variation

of the theme of family secrets while bringing to light how

confidentiality relates to minor children expressing family

secrets during individual sessions. Confidentiality is the cor-

nerstone of the counseling relationship be it individual,

group, or family counseling (Smith, 1999). Family counsel-

ors are generally trained how to address confidentiality from

an adult perspective when it comes to the family context. How

confidentiality with minors is viewed in the family may be a

different matter, because it is not uncommon for relevant third

parties, such as parents, to request access to this information.

The literature and professional counseling ethical codes,

including the International Association of Marriage and Fam-

ily Counselors’ ethical code (International Association of

Marriage and Family Counselors, 2002) and the American

Counseling Association code of ethics and standards of prac-

tice (American Counseling Association, 1995), do not pro-

vide definitive guidance for family counselors to effectively

address confidentiality issues that arise in family counseling

involving children. The literature mainly focuses on confi-

dentiality-related in-session disclosure (Fall & Lyons, in press;

Huber, 1999; Nichols & Schwartz, 2001) and during individ-

ual sessions between an adult member of the family and coun-

selor, within the family counseling context (Corey, Corey, &

Callanan, 2002; Fall & Lyons, in press; Goldenberg &

Goldenberg, 2000; Huber, 1999; Smith, 1999). The literature

largely ignores the issue of confidentiality related to individ-

ual counseling sessions between minor children and the coun-

selor, within the context of family counseling. This article

explores confidentiality relating to minors in family counsel-

ing and processes a case example, determining the appropri-

ateness of breaching confidentiality to parents using the

IAMFC’s ethical code, the ACA code of ethics, and standards

of practice accompanied by best practice recommendations.

FAMILY SECRETS

Families come to counseling for many reasons. Generally,

there is disequilibrium in the family, in some fashion, which

contributes to the family seeking professional counseling ser-

vices. This may be voluntary or forced on them by interested

third parties such as school systems, state child welfare sys-

tems, or the juvenile court systems. Families generally have

secrets that they bring to the counseling session, which may

or may not be revealed during counseling. The literature is

393

THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES, Vol. 11 No. 4, October 2003 393-398

DOI: 10.1177/1066480703255468

© 2003 Sage Publications

The authors wish to thank Dr. Fran Steigerwald at Radford Univer-

sity and Dr. Christy Lyons at Loyola University for their assistance

in the creation and revision of this article.

replete with information on family secrets (Imber-Black,

1993; Vangelisti, 1994) and how to incorporate them in fam-

ily therapy and counseling (Brendel & Nelson, 1999; Fall &

Lyons, in press; Vangelisti, Caughlin, & Timmerman, 2001).

Unfortunately, there is a dearth of information in the literature

addressing family secrets revealed by minor children, and the

information that is in the literature often focuses on revelation

of family secrets in the family group session, not during indi-

vidual sessions with the counselor. Huber (1999) discussed

how family secrets that involve children can be critical to fam-

ily counseling and may “violate that child’s rights to a com-

plete self-definition and identity” (p. 26) if not addressed

appropriately in counseling.

Readers are recommended to review the article authored

by Fall and Lyons (in press) in the preceding volume of The

Family Journal. The July 2003 volume of The Family Journal

provides an excellent and succinct discussion of the various

types of family secrets, problems with family secrets, and eth-

ical considerations and practice recommendations to success-

fully address in-session disclosure and concomitant liability

of the family therapist. Confidentiality is not addressed in this

article because disclosure occurs in the context of the family

counseling. The importance of addressing family secrets

remains crucial, regardless of whether they are revealed dur-

ing family counseling sessions or individual counseling ses-

sions between a family member and counselor. Family coun-

selors need to remain vigilant regarding family secrets when

minor children are part of the family counseling. Minor chil-

dren are integral to the process of family counseling because

children provide valuable information about the structure and

operation of the family (Brock & Barnard, 1992). Children

may also be the revealers of family secrets. Fall and Lyons (in

press) provided solid recommendations addressing in-

session disclosures that can be used with minor children in

family counseling. If minor children disclose family secrets

outside the larger family group session, including their own

personal information that contributes to family discourse,

family counselors are often unsure how to proceed given

the uncertainty of the limits of confidentiality and minor

children.

CONFIDENTIALITY WITH MINORS

Counselors often face a dilemma when working with

minor children because there is no clear-cut rule that guides

professional counselors in working with minor children when

issues of confidentiality arise. The literature consists of con-

tradictions when addressing the limitations of confidentiality

with minors in counseling. Thompson and Rudolph (2000)

indicated that parents have the legal right to know what hap-

pens in counseling sessions with minor children. Several

other authors support this opinion (Corey, Corey, & Callanan,

2002; Lawrence & Robinson Kurpius, 2000).

Conflicting with the opinion that parents have a right to

confidential information, various other authors indicate that

minor children should be afforded confidentiality guarantees

similar to those of adults (Hendrix, 1991; Isaacs & Stone,

2001). Isaacs and Stone (1999) reported that “school counsel-

ors believe that regardless of professional ethics and rules, the

age of the child is the most significant variable in dealing with

dilemmas related to confidentiality” (p. 265). Different

employment settings for counselors have different require-

ments regarding confidentiality issues dependent on the age

of the minor child (Taylor & Adelman, 1989). Corey, Corey,

and Callanan (2002) provided a good example of this point

when they indicated that school counselors are not required

by the Federal Education Rights and Privacy Act of 1994

(FERPA) to disclose the substance of confidential counseling

sessions to parents.

Hendrix (1991) identified four general positions concern-

ing minor children and confidentiality in counseling: (a) com-

plete confidentiality with no disclosure to parents, (b) limited

confidentiality for which minors waive the right to know what

may be disclosed in advance, (c) informed forced consent

when a child is provided advanced notice that information

will be revealed to parents, and (d) no guarantees made about

confidentiality. Family counselors are ethically obligated to

inform their clients of how confidentiality is addressed at the

outset of counseling (International Association of Marriage

and Family Counselors, 2002). All of these positions have

both positive and negative consequences in family counsel-

ing, but, ultimately, family counselors are held to the standard

of doing what is in the best interest of their clients. The litera-

ture is quite specific in stating that it is essential for family

counselors to make their policy on confidentiality clear to

each family member at the outset of counseling for both fam-

ily sessions and concurrent individual sessions (Corey, Corey,

& Callanan, 2002; Kaplan, 2000; Smith, 1999).

INDIVIDUAL SESSIONS WITH MINORS

Family counselors are ethically obligated to inform their

clients of their theoretical framework, treatment approach,

confidentiality, education and professional training, and risks

of counseling (Huber, 1999; International Association of

Marriage and Family Counselors, 2002; Kaplan, 2000;

Margolin, 1982; Remley & Herlihy, 2001; Smith, 1999).

Informed consent needs to specify the family counselor’s pol-

icy in regard to individual counseling sessions with family

members and specifically with minor children. If individual

sessions are deemed appropriate, the family counselor needs

to clearly state the confidentiality policy related to individual

counseling sessions, if individual sessions are an option,

especially relating to minor children, at the outset of family

counseling.

394 THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / October 2003

Family counselors may find it necessary to conduct indi-

vidual sessions with specific family members for various rea-

sons (Kuehl, 1993). Gathering and reviewing assessment and

diagnostic information is one example of when a specific

member of the family unit, such as a minor child, may partici-

pate in counseling outside the family group session (Huber,

1999; Sporakowski, 1995). Counselors working with minor

children are encouraged to help them understand the rele-

vance and possible benefits of disclosing family secrets to

parents (Taylor & Adelman, 1989), and individual counseling

sessions with the family counselor outside of the family group

session may help motivate disclosure if in the best interest of

the minor child and family. Additionally, individual family

members may have personal issues to address outside the

context of the family (i.e., substance abuse issues, mental ill-

ness, or physical/sexual abuse history).

If family members are involved in individual counseling

with counselors or other mental health professionals other

than the family counselor, issues of confidentiality need to be

addressed related to consultation. If a family member dis-

closes a family secret to an individual counselor, the ques-

tions arise as to who then relates that information to the family

counselor and how that information will be used for the bene-

fit of the family counseling (Smith, 1999). Family counselors

will need to inform clients at the onset of counseling re-

garding their position on working with families, and they

need to obtain signed releases of information for those whose

members may already be involved in professional counseling

relationships with other counselors or mental health

professionals.

Huber (1999) discussed the importance of family counsel-

ors in addressing how family secrets involve children. Spe-

cifically, he indicated that family secrets may be quite detri-

mental to children. Consequently, individual counseling

outside of the family group session may provide minor chil-

dren with an avenue to appropriately address these secrets

with the family counselor before addressing the issues in the

larger family system. The decision to meet individually with

family members outside the family group session should not

be taken lightly, especially with minor children in light of

issues involving confidentiality.

TO BREACH OR

NOT TO BREACH CONFIDENTIALITY

Family counselors can find themselves in situations where

they are being asked to maintain confidentiality by a minor

child as a result of an individual counseling session, while at

the same time, parents are requesting the counselor to dis-

close information relayed by their child outside of the family

group session. Schmidt (2003) indicated that counselors who

work with minor children seem to have a legal obligation to

the parents and an ethical obligation to the client. Primary in

both the IAMFC ethical code (2002) and the ACA code of

ethics and standards of practice (1995) is the emphasis on

maintaining confidentiality. Breaches of confidentiality seem

to only be appropriate when client well-being is in question,

emphasizing a duty to protect, warn, and do no harm. This

seems to apply equally to adults and minors. Family counsel-

ors working with minor children need to be able to use profes-

sional judgment to determine whether or not to breach

confidentiality.

Family counselors do not have the luxury of referring to a

universal law or code of ethics that provides answers for all of

the ethical issues that can rise when working with minor chil-

dren: “Although an ethical code of conduct plays a central

role in defining a professional’s responsibilities, it is not a suf-

ficient guide” (Schmidt, 2003, p. 271). It is a counselor’s

responsibility to “understand the limits of the profession’s

standards and supplement one’s knowledge of sound ethical

and legal practices with information from many resources and

learning activities” (Schmidt, 2003, p. 271). The previously

stated four positions outlined by Hendrix (1991) can aid fam-

ily counselors in determining, before the onset of family

counseling, how confidentiality involving minor children will

be addressed in the context of family counseling. If a family

counselor agrees to maintain some level of confidentiality

with minor children, he or she will need to be able to use

sound professional judgment in deciding whether or not to

breach confidentiality and disclose family secrets to parents.

Two factors for family counselors to consider that consis-

tently mitigate decisions of whether or not to breach confi-

dentiality are age of the minor child and degree of seriousness

of the activity or behavior revealed by the minor child (Isaacs

& Stone, 1999, 2001). Counselors generally have a hierarchy

of seriousness of activities and behaviors that, when disclosed

by minor children, determine whether or not to breach confi-

dentiality. Activities and behaviors such as “smoking ciga-

rettes,” “shoplifting,” and “sneaking out of the house” are

viewed as less serious, whereas “smoking crack,” “robbery,”

and “shooting incidents” are most serious, constituting a

danger to self or other and requiring the counselor to breach

confidentiality (Isaacs & Stone, 1999, 2001). It is clear that

family members must be informed of the limits of confi-

dentiality, among other things, at the onset of family

counseling.

Informed consent generally includes informing clients of

techniques and theories used by the family counselor, risks of

counseling, limits of confidentiality, and consent to partici-

pate in counseling (Corey, Corey, & Callanan, 2002; Kaplan,

2000; Margolin, 1982; Remley & Herlihy, 2001). Family

counselors working with minor children need to clearly indi-

cate to all family members how confidentiality will be han-

dled during individual sessions, especially with the children.

The following case example and discussion explore the ethi-

cal concerns that must be considered when a minor child dis-

McCurdy, Murray / FAMILY SECRET DISCLOSURE 395

closes a family secret during an individual session and the

parents want to know what the child has disclosed to the fam-

ily counselor.

To further explore the potential conflict between ethical

confidentiality with minor children and legal responsibilities

toward parents, the following case is presented that could

pose dilemmas for family counselors.

CASE EXAMPLE

A child and family counselor has been working with a fam-

ily (mother, stepfather, and 15-year-old son) for several

months, focusing on parenting issues and some moderate

parent/child conflict. Additionally, the counselor has been

conducting individual counseling with the teenage boy regard-

ing peer relationship problems, anger management, and per-

sonal issues between the boy and his biological father.

Despite a slow start, the counselor has developed a good rap-

port with the teenager. At the very beginning, the counselor

discussed the basic limitations of confidentiality with both the

parents and young man (i.e., suicide, homicide, and child abuse).

During one particular individual session, the 15-year-old

divulges that he recently went to a neighborhood party while

on a visit with his biological father. He describes a rather wild

scene, with much underage drinking and some sexual activity.

He also discloses to the counselor that he was offered mari-

juana at the party, and he smoked some. Despite becoming

rather intoxicated, the client was able to keep his biological

father from finding out about the party. He has not told his

mother or stepfather about the incident, fearing they might

curtail his visits to his father’s home.

The counselor processes this information with the client,

discussing the potential dangers of drug and alcohol use and

the potential consequences of deceiving one’s parents. The

counselor strongly encourages the client to be honest with his

parents and tell them about the party. The client has a strong

negative reaction to that idea and refuses to even consider tell-

ing his parents.

During the next family session, the client’s mother

expresses her concern that her son is not adequately super-

vised during his visits with his biological father, who works

second shift and does not return home until midnight. The

teenage son denies this and blames his mother for trying to

stop him from seeing his father. The mother and stepfather

look to the counselor for an opinion.

CASE DISCUSSION

Obviously, the counselor would be in a very difficult situa-

tion in the above case scenario. On the one hand, the behav-

iors of the 15-year-old could reasonably be construed as “dan-

gerous,” and therefore informing the parents would be a

reasonable act of looking out for the safety and welfare of the

client. If the counselor should choose to keep this information

in confidence, he or she would be running the risk that the par-

ents might find out about the party from some other source. If

they also found out that the counselor had known of the inci-

dent and not informed them, they might feel betrayed by the

counselor.

On the other hand, the basic limitations of confidentiality

that the counselor outlined at the beginning of therapy with

the teenager included issues such as suicide, homicide, and

child abuse. The teenage client would almost certainly not

view his drug/alcohol experience in the same category as

these other safety issues and would probably view the break-

ing of confidentiality as a violation of trust by the counselor.

This would undoubtedly affect the future therapeutic rela-

tionship between the counselor and the client, both in individ-

ual and family counseling.

One could easily imagine other twists to this scenario that

would further complicate the issues. There could be unpro-

tected sex at such a party. There could be more serious drug

use (i.e., cocaine, crack, ecstasy, etc.). The biological father

might knowingly allow such behavior, considering it mere

“experimentation.” The client could be a girl instead of a boy.

The client could be an 11-year-old or a 17-year-old.

To help resolve this ethical dilemma, one can review the

IAMFC ethical code (2002) for guidance. In it, Section A.3

indicates

Unless alternate arrangements have been agreed upon by all

participants, statements made by a family member to the

counselor during an individual counseling or consulting con-

tact are to be treated as confidential and not disclosed to other

family members without the individual’s permission.

Under Section C (Exceptions to Confidentiality), however,

the IAMFC ethical code states that “members may disclose

confidences in order to prevent clearly identified bodily harm

to the client.” The definition of clearly identified bodily harm

is left ambiguous, leaving IAMFC members to “exercise pro-

fessional judgment and discretion in deciding whether an

exception to confidentiality applies in particular cases.”

One might also turn to the ACA code of ethics (1995) for

guidance, but again there is some contradiction. Section

B.2.b. (Family Counseling) states, “In family counseling,

information about one family member cannot be disclosed to

another family member without permission.” This is assumed

to include minor children. Section B.3. (Minor or Incompe-

tent Clients) states that “when counseling clients who are

minors . . . parents or guardians may be included in the coun-

seling process as appropriate. Counselors act in the best inter-

ests of the clients and take measures to safeguard confidenti-

ality.” The counselor is left to his or her own professional

judgment as to what constitutes the “appropriate” inclusion of

parents in the counseling process and what action is in the

“best interests” of the client.

396 THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / October 2003

RECOMMENDATIONS

In both the IAMFC (2002) and ACA (1995) codes of eth-

ics, the final decision about whether or not to breach confi-

dentiality when working with minors lies with the profes-

sional judgment of the counselor. Perhaps the best advice one

can glean from the ACA code of ethics (1995) is found in Sec-

tion B.1.g.: “When counseling is initiated and throughout the

counseling process as necessary, counselors inform clients of

the limitations of confidentiality and identify foreseeable sit-

uations in which confidentiality must be breached.” The fam-

ily counselor in the preceding scenario was caught in a no-win

situation precisely because he did not fully identify foresee-

able situations that might necessitate the breaching of

confidentiality.

The IAMFC code of ethics (2002) also provides some

guidance for avoiding confidentiality dilemmas. Section C.2.

(Exceptions to Confidentiality) advises that “members use

care not to explicitly or implicitly promise more protection of

confidentiality than that which exists.” Counselors should

remain aware that clients may assume that information dis-

closed in individual sessions will not be shared in family ses-

sions. Additionally, in Section E.7. (Practice Management

Concerning Confidentiality), the IAMFC code of ethics

(2002) encourages members to “utilize advice from consul-

tants and the professional literature in making a decision”

about a particular confidentiality situation. Counselors who

choose to work in a vacuum are more likely to make errors,

despite their best intentions.

Ultimately, sound professional judgment is called for

when deciding whether or not to breach confidentiality when

counseling minor children in family counseling. In addition

to the above references to the IAMFC (2002) and ACA (1995)

ethical codes, family counselors are encouraged to pay close

attention to the two factors that Isaacs and Stone (1999, 2001)

indicated consistently mitigate decisions whether or not to

breach confidentiality with minor children: age of the minor

child and degree of seriousness of the activity or behavior

revealed by the child.

The counselor who most often falters is not the one who

takes reasonable, responsible action and justifies his or her

behavior based on ethical standards and legal precedent.

Rather, the counselor who most likely errs is one who chooses

to do nothing out of fear of making a mistake (Schmidt, 2003,

p. 274).

Sound professional judgment based on unique family and

child characteristics, as well as on professional ethics, will

serve to guide family counselors in deciding whether or not to

breach confidentiality with minor children in the context of

family counseling.

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Kenneth G. McCurdyis an assistant professor of community coun- seling in the Department of Psychology at Gannon University, in Erie, Pennsylvania. He is also a licensed professional clinical coun- selor and a supervising counselor.

Kenneth C. Murrayis a child and family counselor at Scioto Paint Valley Mental Health Center in Chillicothe, Ohio. He is also a li- censed professional clinical counselor and supervising counselor.

398 THE FAMILY JOURNAL: COUNSELING AND THERAPY FOR COUPLES AND FAMILIES / October 2003