What’s Confidential and What’s a Secret? Navigating “No Secrets” Policies
Curt and Katie chat about no secret policies. We look at what they are, what needs to be in these policies, how to navigate secrets in therapy, the importance of these policies in relational therapy, and the complexity of “no secrets” when working with kids and teens.
Click here to scroll to the podcast transcript.Transcript
In this podcast episode we talk about no secrets policies in therapy
In our continuing efforts to touch on all the topics that therapists need to know about, we decided to dig deeply on no secrets policies.
What is a no secrets policy?
- Typically, these types of policies are created for relational therapy
- “No secrets” means that the therapist will not keep a secret that is clinically relevant from a member of the treatment unit, even when someone contacts the therapist outside of session
- This policy needs to be understood by all the members of the treatment unit
How can therapists navigate secrets in therapy?
“[As an exception to my No Secrets policy], if there is domestic violence going on, I will absolutely work with the partner who is being battered, and helping them to determine what their safety options are in a way that helps to make sure that they’re not going to end up under some kind of peril.” – Curt Widhalm, LMFT
- If there is communication outside of therapy, it is important to hold the boundaries within your no secrets policy
- Flexibility related to when and how secrets are shared (versus rigidity and immediacy)
- Explicit discussion around exceptions of the “no secrets” policy related to intimate partner violence
- It is important to have a clinical evaluation of when and how the secret is shared into the treatment unit and whether the secret is clinically relevant to the treatment unit
- Clarify the treatment unit and clinical orientation to sort through what needs to be in your secrets policy
- Determining how not to be triangulated by members of the couple or family
What needs to be in a therapist’s secrets policy?
- Clear guidance on who is included in the treatment unit
- What secrets will be kept or not kept (e.g., intimate partner violence)
- How secrets will be handled as they come up
- Assessment of the capacity of each member of the treatment unit to participate in these conversations about confidentiality and secrets
What about no secrets when you’re working with kids and teens?
“It can be hard as a clinician in a very empathic relationship with a client to always fall back to that more behavioral…these are the rules, I got to follow them. And so I think that is a good reminder for folks…have a policy, make it very clear, make sure your folks understand it, and enforce it.” – Katie Vernoy, LMFT
- Clarity on the treatment unit (individual kid or family, etc.)
- Identifying how confidentiality is held for kids and teens
- Working with the kids and teens to plan for disclosure to caregivers
- For parents of young/school-aged children, there may be work to help caregivers to disclose information appropriately over time (thus the therapist holds the secret for a period of time)
Resources for Modern Therapists mentioned in this Podcast Episode:
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Relevant Episodes of MTSG Podcast:
Family Therapy: Not Just for Kids – An Interview with Adriana Rodriguez, LMFT
Dual Relationships – Pros and Cons
It’s the Lack of Thought That Counts: Ethical Decision Making in Dual Relationships
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com
Katie Vernoy, LMFT
Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
A Quick Note:
Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.
Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.
Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
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Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW/
Music by Crystal Grooms Mangano https://groomsymusic.com/
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe, and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm, and Katie Vernoy.
Curt Widhalm 0:16
Welcome back modern therapists, this is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast for therapists about things that go on in our practices, the things that happen in our lives. And you might be able to find out what we’re talking about today. You might not, actually.
Katie Vernoy 0:37
I’m not gonna say anything.
Curt Widhalm 0:38
No, I mean, so nobody said that we’re funny. But this is maybe our way of introducing: What about ‘no secrets’ policies?
Katie Vernoy 0:49
What about no secrets policies?
Curt Widhalm 0:52
I can’t tell you. It’s a secret.
Katie Vernoy 0:55
Yeah.
Curt Widhalm 0:56
So, I know that this is common terminology out of the couples therapy world. There’s also a myriad of other things that we’re going to get into as far as working with families, working with kids and teens. And what ends up getting communicated to their parents as part of the course of treatment. What’s interested parents versus parents who are just completely shut out. And yes, I acknowledge I’m working with your kid. And that is all contact that we can ever have. So, Katie, I know that our practices have some differences as far as the clients that we see, but what kind of secrets do you keep? Let’s dish right now. What? Tell me a secret?
Katie Vernoy 1:41
I don’t know that I actually do keep too many secrets. I mostly…
Curt Widhalm 1:46
That’s a terrible introduction as a therapist, any profession that is based on confidentiality.
Katie Vernoy 1:51
Well, no. But secrets and confidentiality are very different. Right? And so maybe that’s where we should start is confidentiality is keeping treatment content to yourself, except for the stated exceptions of child abuse, dependent adult abuse, elder abuse and suicidality, homicidality, or released information. But like, the secret is what you’re not telling your client, right? I mean, or what you’re not telling the client’s parent if they’re a child, right? So there’s that that piece of ‘no secrets’ means that you’re not keeping secrets in the treatment room. Correct?
Curt Widhalm 2:30
Well, I’m asking you, what is your policy. So this is something where…
Katie Vernoy 2:37
I wanted to define what no secrets is. So that’s what I’m saying. It’s like, well, what, what are you talking about? Some people know most people, most people know, but some people don’t.
Curt Widhalm 2:47
I think that this is an important rule number one, takeaway number one from the top of the episode here is have a clearly defined no secrets policy for your practice, whatever that may be, define it. So that way, takeaway number two, there’s only three takeaways in the whole episode. And we’re giving two of them, we’re giving two of them…
Katie Vernoy 3:08
…away for free.
Curt Widhalm 3:08
Two of them right at the top of the episode. Also, make sure that your clients understand what your policy is…
Katie Vernoy 3:14
Okay.
Curt Widhalm 3:15
…from the beginning of treatment.
Katie Vernoy 3:16
Okay, but generally, what people loosely call a ‘no secrets policy’ is I’m not going to keep secrets from the other partner or the other family member or whatever, like no secrets, broadly, is that. I think that’s not helpful for folks who haven’t created one before. And so I think the the depth of that we’re gonna go into is about how you might design your no secrets policy and what the nuance of it is, so that you can understand a more complete picture of it.
Curt Widhalm 3:48
And traditionally, and I think, you know, this is where you’re potentially going is traditionally ‘no secrets policy’ is in relational therapies. Whether it’s couples work or families work. I think it is important to point out that confidentiality for minors in those treatments is still the standard there. So, a lot of this discussion is going to focus mostly on couples and family work. We’ll talk a little bit about working with minors towards the end of the episode here. So traditionally, I think most no secrets policies boil down to: if somebody who is a part of the treatment unit makes a communication with the therapist, that that information, if clinically relevant to the treatment, needs to be shared with the entirety of the treatment unit. So, if a partner of a couple reaches out to a therapist between sessions and says, Hey, I’m having an affair. I don’t, you know, I don’t have any plans on changing what my marriage is. I also really like this affair that I’m having. I just think that it’s important for you to know as my therapist that this is something that I’m balancing out. Your ‘no secrets policy’ would be like, we got to tell your partner.
Katie Vernoy 5:07
Yeah, I don’t know that that means that you have to tell the partner immediately, or that the therapist needs to call the partner immediately and say, like, Oh, I just heard this thing. Like it, it can be. Let’s work together on how you tell your partner, what you’ve shared here.
Curt Widhalm 5:24
Okay, if I’m the hypothetical caller in this situation, to be like, Yeah, I’ll tell her in the next like, couple of presidential election cycles. Like, eventually this will come up, but not not immediately. Like, I got some stuff to figure out.
Katie Vernoy 5:43
Well, I think that’s where it gets challenging, right? Like, I think there’s that element of you need to enforce your ‘no secrets policy’ and whatever that looks like. But do you give a date? Do you just say, like, Okay, well, that’s fine. But I’m telling your partner on this date, if you haven’t said it before. I mean, like, there’s, there’s a point at which, you know, the treatment relationship starts getting really complicated, because you’re…
Curt Widhalm 6:10
Oh, absolutely.
Katie Vernoy 6:11
…the partner doesn’t know, you’re kind of in a power struggle with the other partner, because they’re not willing to tell their partner. I mean, like, it’s something where that becomes very, very challenging, I would imagine.
Curt Widhalm 6:22
So the partner…
Katie Vernoy 6:22
That’s why I don’t like to do couples work.
Curt Widhalm 6:23
…the partner shows up in session is like, I don’t know where they are, all the time. Like, they seem to just disappear for like hours on end, they turn their phone off, they stop sharing their location, like, I’m really concerned that they’re having an affair. Like, so you’re sitting there with knowledge that these fears are happening, you become complicit. It’s all of the reasons that you talked about not wanting to do this. So for these no secrets kinds of situations, it’s very important that there’s kind of some sort of structure that you follow through on. Because, again, it helps to define the unit of treatment here. If this is the couple, then you’re not just aligning with one half of the couple with this kind of information.
Katie Vernoy 7:11
Sure. And I’ve had some of my individual clients who are in couples therapy, share something with their couples counselor, and the couples counselor responds via email, and has both partners on it, right? Like, it’s, I got this information, this is my response. And so some folks are pretty, pretty, I don’t know, rigid seems like the wrong word. But pretty…
Curt Widhalm 7:38
They follow through on their policies.
Katie Vernoy 7:42
…pretty structured on it. Right? I think there there’s, there’s also the possibility of continuing to support each relationship while also implementing the policy. Right. And I think it probably is determined based on which what type of information is being shared and how that would impact the individual who shared it as well as individual who hasn’t heard it. I mean, I feel like there’s there’s potentially some artistry, on complying with your policy, enforcing your policy, and allowing for human messiness to be navigated in the interim.
Curt Widhalm 8:20
So do you have an example?
Katie Vernoy 8:23
It would just what I had said. Like talking to the partner say, this is not a secret I can keep. And they you know, and assuming that they’ve already known about the policy, they know this will be my response and talking about how do you share this with your partner. You know, you should be the one to tell them, but I will tell them. And so let’s talk through how I can support you in sharing this information, because you probably told me, because you really want your partner to know, right. So like, I think it’s, it’s getting to the place of supporting the healthiest form of communication versus you potentially being triangulated into that relationship where all of a sudden, now it’s your responsibility to tattle or not say like, it feels like you get into a very untenable situation very quickly, and are very triangulated into that dynamic of whatever’s going on.
… 9:11
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Curt Widhalm 9:13
So, at this point, I’m going to ask you, what is the the secrets policy that you have for your practice? Well, let’s start, let’s start with couples work. I know that you and I see minimal amounts of, of couples, but in the scant smattering of couples that you’ve seen across your career, what is it that you talk with them about as far as your policy on this?
Katie Vernoy 9:36
I’m not going to, I’m not going to go to the couples policy, because I feel like that’s such old, like, I don’t know what I did, and it was like 15 years ago. But I want to respond to what I do with my clients. And so I have individual clients that will bring in their partner as a collateral. And, and so I’ll, that’s that’s what I can speak to right now. And so what I do it there is I say I have a no secrets policy, you can certainly call and talk to me and give me information. But I will show, I will share that with my client. And so I’m open to receiving information. I’m open to being in conversation here. But I will not I’m not holding your information separate from my client. So I’m very clear on that.
Curt Widhalm 10:20
And I think part of what you’re alluding to there, and maybe even getting more specific of like, you are the extra to my client sessions. This is not couples work, this is still individual work, you just happen to have a guest starring role in the services.
Katie Vernoy 10:38
Yeah. But you’ve you’ve actually worked with couples more recently, what is the the no secrets policy that you have?
Curt Widhalm 10:44
I don’t have a absolute no secrets policy for couples work with me. And I’m very explicit with this at the very beginning of treatment. And my my secrets policy is I have a general no secrets policy that when there is clinically relevant information brought up by one partner or the other that needs to be addressed by the treatment unit in the reasonable subsequent number of sessions. You know, not everything needs to be brought up right this second. I want to give myself a little leeway to be able to help him. But the exception that I’m absolutely upfront about is I do not follow this policy when it comes to interpersonal violence. If there is domestic violence going on, I will absolutely work with the partner who is being battered, and helping them to determine what their safety options are in a way that helps to make sure that they’re not going to end up under some kind of peril.
Katie Vernoy 11:51
That makes a lot of sense. I can see that being if it’s just kind of like this is my policy. And it’s very specific. And not often not like just offhand. But like, this is my policy. And this is how it works. I think with many couples, they will just kind of roll right with it. But couples that do have intimate partner violence within them, that may almost immediately start some some interesting, you know, kind of clinically relevant conversation, almost from the from the top. So I think it feels like it’s pretty standard to throw that in there. It’s a really good exception. And I think it also is something that can give you a little bit more information, even right up at the top of treatment with a couple. So I like that.
Curt Widhalm 12:35
And I think it follows through on where our field is and has been for quite a while. Which is domestic violence is not one of the places where we remain neutral. And so that’s kind of where if you do have an absolute no secrets policy sort of thing, you might want to consider updating it. And because I know that a lot of us aren’t going to work with clients, who are actively, we’re not gonna work with couples who are actively engaged in domestic violence, but just being able to give yourself all of the clinically and reasonably predictable kinds of options for yourself here.
Katie Vernoy 13:14
So, that’s a no secrets policy within couples therapy. And then I talked about mine, that was kind of the ad hoc collateral therapy. The other one that’s really I think, pretty standard would be family therapy. And there’s family therapy with kids and family therapy with that adult family therapy have a great episode with Adriana Rodriguez about that. So what, you do a lot more family work with kids.
Curt Widhalm 13:39
Let’s start with the easier where everybody’s an adult.
Katie Vernoy 13:43
Okay, let’s start with it.
Curt Widhalm 13:46
So, I think it’s gonna be pretty similar to working with couples. If everybody is an adult, everybody has the capacity to consent. If a member of the treatment team or a member of the treatment unit reaches out to the therapist with clinically relevant information, it should be discussed how that is going to be brought up to the entire treatment unit.
Katie Vernoy 14:07
Yeah.
Curt Widhalm 14:08
No, no questions asked. It’s basically the same thing as working with a couple. Everybody’s adults here. We’re going to treat everybody like they’re adults.
Katie Vernoy 14:17
I want to dig into that for just a minute. Because I, as you were talking, I kind of was picturing what happens when I was, you know, doing a lot of group therapy. And I would have someone bring something up that was relevant to the group and how do we bring that back to the group. But then what about if someone is bringing something that’s clinically relevant for them as an individual, might have small ripples into the family, the family concerns, but really is maybe needing their own therapist or their own therapy session? Like it feels like there is a little bit of critical thinking that needs to happen around that. Because I could see adult, you know, kind of kids in the family coming out or sharing, you know, something that’s very difficult or something that, you know, I guess that’s actually clinically relevant to the treatment unit. But I think that there’s there are potentially things that are not completely directly relevant to the treatment unit that can be shared in that situation.
Curt Widhalm 15:22
I know the the way that a lot of these things are brought up in a lot of discussions, whether it’s law and ethics classes, or CE workshops, and those kinds of things is like, here is a three snippet vignette now make it a very complicated treatment plan on how you’re going to handle these things. And I would venture to guess that most of the time, you’re going to speak more at length with the person reaching out to you and all of those wonderful things that we wish that those those vignettes would allow for us to do. Hopefully, that is something that’s afforded between you and a person like this, that you’re bringing out, as far as how are we going to bring this up to the family unit, because we do have this policy in place. This potentially puts me in a position where I go against the policy, which is unfair to everyone in the room. And in order to be consistent with it, we need to come up with a game plan as far as what you are going to work on in individual therapy, how much and how much in depth this is going to be as far as the family treatment unit. So kind of being able to work through all of the different options. So that way, this particular member of a family can opt in in the best way that they can.
Katie Vernoy 16:36
I agree. I also think another element to this is you made it very clear in your policy, for example, is that this is clinically relevant to the treatment unit.
Curt Widhalm 16:47
Yeah.
Katie Vernoy 16:48
And so I think it’s it’s potentially, in that conversation, really sorting out what is relevant to your family, versus what do you need to take back to your individual therapist? And how do I, how do I navigate that with you? Because I think the clinical relevance here doesn’t, it is kind of where your policy gives you a little leeway in that situation, where you have an adult kid that’s telling you something that may or may not be relevant to the family, and you can give them support as a mental health provider, getting them connected to their right resources.
Curt Widhalm 17:21
Yeah, yes.
Katie Vernoy 17:23
So, I think the other the other piece to that is, my assumption is that means that you don’t work individually with members of families, in addition to doing family work.
Curt Widhalm 17:37
Not, not, no. There’s too much space for dual relationships gone bad, that can happen there. And my work subsequently, where a person in the family wants to continue working with me individually after family work is done, but it not simultaneously.
Katie Vernoy 17:56
Because I know that there are some even couples counselors that will also work with one or both partners. And so I think there’s there’s just to kind of for our, our, you know, kind of newer clinicians, there are a lot of different ways that folks handle this.
Curt Widhalm 18:10
Yes. And I would say you need to be absolutely clear at the beginning of treatment on what the treatment unit is. Because I do know, couples, counselors who work with couples, they’ll have individual sessions occasionally with each of the individual members of a couple. But it’s still about their relationship. And that is still all couples work.
Katie Vernoy 18:31
Sure. And it’s also treatment orientation, right? Like, it depends on how you work. But a ‘no secrets policy’ becomes very different when there’s also the overlay of confidentiality from individual sessions. And so I think you make it less complex, you don’t work with other members of the family at the same time. But I think that there is, there are, there are ways potentially to be able to hold that as long as you’re clear on the treatment, you know, the treatment unit, you’re clear on the work that you’re doing. And you’re clear with all the members of the policies that you hold. But, you know, because the reason I was thinking about that is is with group, I’ve had group members who worked with other therapists and also members of the group who worked with me, and so very different because these are not people that are in each other’s lives except in group. So it’s not it doesn’t have that same level. But there is that confidentiality element that can be pretty complicated when you’re working with a person in more than one setting. So it’s a whole other conversation that’s out of the scope of this one, but I feel like this is it is it can get complicated. And the concern is I think triangulation.
Curt Widhalm 19:46
Yeah. Dealing with triangulation is why you have these policies in the first place. To prevent you from being triangulated in or being triangulated in for too long. And this again comes out of family systems theories of how the relationships need to happen in those kinds of things. But part of…
Katie Vernoy 20:05
Triangulation is just a fancy way of being put in the middle.
Curt Widhalm 20:10
Yeah, yeah, more or less. Yeah. But that’s why you have these policies in the first place. Is to make it to where the difficulties and the patterns that are happening in the relationship happen in the relationship. That you’re not just kind of somebody that a couple or a family comes to and it’s just like, alright, fix our problem. This is teaching them how to change those patterns.
Katie Vernoy 20:33
It does get complex even around triangulation, because a member of the couple, a member of the family can share something and refuse to tell the family or their partner and put you in the place of being the person that has to disclose the news. And so in some ways, there are times when holding the secret keeps you out of out of triangulation. And there’s times when disclosing keeps you out of triangulation. And so I feel like there’s, it’s a very challenging situation, if you have an overly rigid policy, because your policy could be weaponized against you. I guess that’s what…
Curt Widhalm 21:13
Exactly, yeah. And again, that’s where being clear with your policy and being making sure that everybody understands that at the outset of treatment, helps to prevent a lot of this. This is that ounce of prevention is worth a pound of cure sort of stuff.
Katie Vernoy 21:33
Sure.
Curt Widhalm 21:33
Moving on, this does get a little bit more difficult when the families that you work with include minors, and children and and teenagers and that kind of stuff. And especially when information is kind of portrayed as like, these are couples relationship issues, but our unit of treatment is the entire family. So parents who are considering divorce but have been engaged in family therapy with teens or even young children around we’ll say behavior or emotional issues that are coming out to the kids. This is a lot more of where my practice is aligned. And I recognize that there are clinically relevant things that need to happen at solely a parent level, there are clinically relevant things that happen between parents and older children. This is not diminishing, that there’s clinically relevant things that happened between parents and young children, but not everybody in the room is going to have the capacity to understand or engage in all of the different levels that may arise in these various scenarios.
Katie Vernoy 22:40
And I think that is part of the work to help the parents, for example, in this this situation, to work with them on how best to disclose this information to the rest of the family. I mean, I feel like it is important information for you to have, kids aren’t ready to hear it or the parents aren’t ready to share it. Like it feels like you do have to work in the background on this. And I guess this goes to you don’t have to immediately disclose with your policy, you just you know, you’re not holding the secret for indefinitely. But to me that feels like that’s the work, right? It’s like, Hey, this is something that’s very clinically relevant. And you need to tell your kid at some point. Let’s talk about the timeline. Let’s talk about how you can get to that place. What are the best practices on how you share? Here’s my additional expertise, knowing your kid and how your family operates. Like I think that work happening separate makes a lot of sense.
Curt Widhalm 23:38
Absolutely. And part of explaining this at the beginning of treatment, especially to kids and teens is: Hey, sometimes there’s going to be conversations that we direct just back to your parents to deal with solely at a parental level. It and that’s part of the decisions that I will help make with them. But I if there are things that do need to be discussed as an entire family, I’ll be the first one to push your parents to this is a family conversation.
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Katie Vernoy 24:10
I think this can also happen in the reverse direction. I can think about a team coming out or or some something going on at a teen level or even a kid level where, you know, how they reach out to you or how that shows up. I think that’s hard. Like you know, parents potentially have more access. But a teen might have access to you even if it’s primarily family therapy and share something. And to me immediately disclosing that to the parents is also as clinically harmful as immediately disclosing divorce to kids and parents who are not ready to share. And so I think that some of that work can happen in the background. But I think this is where having consultation or some mechanism to really talk through is this Hey, the teen needs a separate individual therapist at this point. Or is this something where you can work with the teen to be able to prepare them? Right? Like, I feel like this is where the complexity of what the treatment unit is, and how you really set things up are going to depend so much on the individual case.
Curt Widhalm 25:14
Absolutely. So this, then is where when you’re working individually, with kids and teens, there’s another layer of nuance with this. And, again, from the very beginning of treatment, I implore you define who the treatment unit is, and how you’re going to be working and how you’re going to be communicating with everybody involved.
Katie Vernoy 25:41
Yeah, I mean, I think for me, when I was working with kids and teens, it was always almost immediately in the first session with everyone present, I talked about confidentiality, as well as what confidentiality I was holding for the kid, honoring parents have a right to know, but for the effectiveness of the treatment, I am going to keep confidentiality with your kiddo. Except for these things, right? Like and explaining what those are like, if you’re caught if your kids in danger, or if there’s something going on that that you need to know.
Curt Widhalm 26:12
I start off when we’ve identified that, all right, this is a person. And this gets even stronger with the laws in California here. But if it’s a minor that I’m working with, I say, You’re the minor child, you are my client. Here is what confidentiality is. Confidentiality is the guarantee of privacy except for, you know, mandated breaches of confidentiality, permitted breaches, whatever. And your parents care for you. And they’re going to want to know about treatment, or they’re going to share things about treatment from time to time, and I can’t prevent them from communicating with me. They can email me, they can leave voicemails, they can yell things at me when I come to the waiting room to pick you up. Like I will handle any of those instances by starting our session with, here’s the information that I found out from your parents. I got an email from your mom, I got a phone call from your mom about this. That way, you know what I know. And it may be something that we have to talk about, it may just be here is me sharing with you what I know, I can’t prevent people from communicating with me about it.
Katie Vernoy 27:29
Is there age at which that is not the case? Where kids are young enough where bringing that up at the top of the the session is counterproductive.
Curt Widhalm 27:41
The youngest clients that I’m working with right now are six or seven ish, and I absolutely bring that up with them.
Katie Vernoy 27:48
Okay.
Curt Widhalm 27:49
So I’m sure that there may be instances where much younger kids have this kind of stuff come up. But as it pertains to the kids that I see, in my practice, I don’t see any problem with hey, here’s just something that I know about. Now, I’m also very clear with kids and parents that I’m not a pipeline of communication from what happens in session to needing to tell parents what’s going on, this is confidentiality one on one. There may be times that I encourage the child to talk with their parents about thing. It maybe even a conversation that’s assisted by me. But there are still kind of those, hey, we want to check in on our child’s treatment without our child here conversations. My policy on that is when those are scheduled, I want to have a conversation with your child before I talk with you as parents so that way, I can talk with the kid about what they’re okay with me talking about, versus here’s what they absolutely want kept secret. So it’s it’s basically a very fluid consent or assent when it comes to kids who don’t fully understand all the complexities of this. But it’s it’s basically like a release of information just like, hey, I want to be clear with the kid before I talk with the parents of here’s what’s allowed to be talked about. I would say, the one caveat that I have to all of this is I do ask for blanket permission from kids to be like, can I talk with your parents about billing stuff without you involved in every single one of those conversations? And I’ve never had a kid be like, I refuse to let you talk with my parents totally about billing stuff.
Katie Vernoy 29:32
It’s so interesting hearing you talk about this because I feel like I have fairly similar policies, but I think it’s I haven’t worked with kids in quite some time. So this is a much older information as far as me thinking back but I feel like I was much more fluid with it. And less, I don’t even know what the right word is less detailed in that, that policy. You know, like I assumed it was assumed that the parents would be who I would be talking about billing with. And so I wasn’t getting permission from the client, you know, the 10 year old to talk to their parents about billing. You know, like, I feel like they’re there. There’s, there’s stuff where it kind of it felt like it flowed more, but I appreciate with your very clear and detailed policy that the kids feel very supported.
Curt Widhalm 30:21
Yeah. And for me, maybe part of it is just coming out of the behavioral background that I do of just kind of like, I’m going to clearly define the rules, and then we’re gonna follow the rules.
Katie Vernoy 30:32
Yeah.
Curt Widhalm 30:33
But there may be situations that come up with some kind of billing things where I don’t even absolutely follow that policy strictly. And I’m talking about things like a change of diagnosis, that might show up on a super bill that needs to warrant discussion with the child first.
Katie Vernoy 30:50
Sure.
Curt Widhalm 30:51
And I’m okay with making that not like a explicit thing very upfront, because that could be very clinically relevant material that a child is not ready to have their parents be aware of. And it reaffirms that the client is at the center of the treatment, not their parents, even if their parents are the ones paying the bills.
Katie Vernoy 31:12
I think that’s what a lot of folks get, you kind of pulled into. And maybe, I mean, we were at a time, and we’re kind of off into more confidentiality for for kids versus secrets. There’s a lot of complexity when there’s a treatment team that’s more complex, or when the unit of treatment is the kid and there’s, you know, lots of caregivers involved and there’s those types of things. And so I feel like, you know, maybe another episode on working with kids and, and the kind of the logistics around that and how to make it less onerous so more folks might get back into working with kids again. But to me, it just, it seems like there’s just a very concrete, clear way that you handle these policies. And I know, there’s been times in the past, where I’ve been a little bit less concrete, and I have gotten a little bit triangulated, or I have gotten into that complex situation. I think most of those things worked out fine. And we don’t need to go into them here. But I feel like that it can be hard as a clinician in a very empathic relationship with a client to always fall back to that more behavioral like, these are the rules, I got to follow them. And so I think that is a good reminder for folks like have a policy, make it very clear, make sure your folks understand it, and enforce it.
Curt Widhalm 32:34
If you want to further this conversation, please follow us on our social media or join our Facebook group, the Modern Therapists Group where you can talk about secrets. Well, at least ‘no secrets.’ You can talk about no secrets.
Katie Vernoy 32:52
Yeah, but don’t share confidential information in the Facebook group.
Curt Widhalm 32:54
Exactly.
Katie Vernoy 32:55
We will delete those posts.
Curt Widhalm 32:57
And if you liked the content, you want to support us, please consider becoming a patron or supporting us on Buy Me a Coffee. And until next time, I’m Curt Widhalm. With Katie Vernoy.
… 33:08
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