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Intra-familial confidentiality in adolescent psychotherapy

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Title:
Intra-familial confidentiality in adolescent psychotherapy
Creator:
Gollyhorn, Lana Fay
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English
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55 leaves : illustrations ; 28 cm

Subjects

Subjects / Keywords:
Adolescent psychotherapy ( lcsh )
Confidential communications -- Family therapists ( lcsh )
Families ( lcsh )
Adolescent psychotherapy ( fast )
Confidential communications -- Family therapists ( fast )
Families ( fast )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (leaves 54-55).
General Note:
Department of Psychology
Statement of Responsibility:
by Lana Fay Gollyhorn.

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|University of Colorado Denver
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Auraria Library
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Resource Identifier:
51820391 ( OCLC )
ocm51820391
Classification:
LD1190.L645 2002m .G64 ( lcc )

Full Text
INTRA-FAMILIAL CONFIDENTIALITY
IN ADOLESCENT PSYCHOTHERAPY
by
Lana Fay Gollyhom
BA.., Michigan State University, 1995
A thesis submitted to the
University of Colorado at Denver
in partial fulfillment
of the requirement for the degree of
Master of Arts
Psychology
2002


This thesis for the Master of Arts
degree by
Lana Fay Gollyhom
has been approved
by
Mitchell M. Handelsman
Hale Martin
Date


Gollyhom, Lana Fay (M.A., Psychology)
Intrafamilial Confidentiality in Adolescent Psychotherapy
Thesis directed by Professor Mitchell M. Handelsman
ABSTRACT
This study concerns confidentiality within a family when psychologists treat
adolescents. What types of information do psychologists, parents, and students
consider important enough for a psychologist to reveal to an adolescent clients
parents? This study measured opinions regarding what kinds of information should
be revealed to parents.
I developed a case example describing Chris, an adolescent who is seeing a
psychologist for psychotherapy. The case example describes Chris as having
moderate depression and recently experiencing increased depression and anxiety.
The experiment was a2x2x3x5 factorial design, including between
subject factors of client gender (male, female), client age (14, 17), and participant
population (psychologist, student, parent). The within subjects factor was type of
scenario (academic, sex, drugs, violence, suicide). The content of the case examples
for the participant groups (psychologists, parents, and students) differed with respect
to age, gender, and the perspective from which the participant considered the case.
m


All participants read five scenarios in which Chris reveals new information to
the psychologist. The five scenarios depicted circumstances where a psychologist
may choose to share information revealed in therapy to the adolescents parents. They
included: academic change, promiscuity, drug use, potential violence, and suicidality.
Participants rated each scenario on
a Likert scale (l=definitely yes, 5=definitely no), that asked if the psychologist
should reveal the information.
I was also interested in the types of confidentiality policies psychologists,
students, and parents would endorse for adolescents in outpatient psychotherapy. I
presented participants with four confidentiality policies, including complete
confidentiality and several types of limited confidentiality.
Parents expected more information about topics discussed in therapy than
psychologists and adolescent clients wanted to disclose. Psychologists were more
likely to maintain confidentiality for 17-year-old clients than 14-year-old clients.
In selecting confidentiality policies, psychologists were split between
complete confidentiality and a type of limited confidentiality where the adolescent is
involved in deciding what is revealed. Students preferred complete confidentiality,
while parents were split between two types of limited confidentiality providing
parents with the most information. The results suggest that parents are likely to be
disappointed with the information disclosed to them by psychologists.
iv


This abstract accurately represents the content of the candidates thesis. I recommend
its publication.
Signed
Mitchell M. Handelsman
v


DEDICATION
I dedicate this thesis to my father, John Golly horn.
vi


ACKNOWLEDGEMENT
I would like to extend my respect and gratitude to my advisor, Mitchell M.
Handelsman, for sharing his wisdom on life and his passion for teaching and research
in psychology. I also wish to thank the staff, adolescent residents, and families of
Third Way Center for lending meaning to my academic pursuit of clinical
psychology. Finally, I would like to thank the University of Colorado department of
Psychology and an anonymous donor for funding this study.
Vll


CONTENTS
CHAPTER
1. INTRODUCTION.......................................................1
Psychologists Attitudes.......................................3
Adolescent as a Special Population.............................6
Current Psychologist Attitudes.................................6
Questions for Research.........................................8
2. METHODS............................................................9
Design.............................................................9
Surveys............................................................9
Participants......................................................15
Psychologists.................................................15
Students......................................................15
Parents.......................................................16
3. RESULTS...........................................................17
Psychologists.................................................17
Students......................................................18
Parents.......................................................18
Confidentiality Ratings of the Five Scenarios.................19
Confidentiality Policy Preferences............................22
Vlll


4. DISCUSSION
.25
Confidentiality Ratings...................................25
Differences Among Groups...............................25
Differences Within Each Scenario.......................28
Psychologists More Discerning..........................29
Policy Preferences........................................30
Limitations of the Study..................................32
Suggestions for Further Research..........................34
General Conclusions.......................................35
APPENDIX
A. MAIN EFFECT OF GROUP...................................37
B. GROUP X SCENARIO INTERACTION...........................37
C. CONFIDENTIALITY POLICY PREFERENCES.....................37
D. PSYCHOLOGIST COVER LETTER..............................38
E. PSYCHOLOGIST SURVEY....................................39
F. STUDENT CONSENT........................................43
G. STUDENT SURVEY.........................................44
H. PARENT COVER LETTER....................................48
I. PARENT SURVEY..........................................49
BIBLIOGRAPHY..............................................54
IX


CHAPTER 1
INTRODUCTION
Suppose you are a psychologist seeing an adolescent for psychotherapy.
During a session the adolescent reveals information (e.g., about drug use,
promiscuity) and you are unsure whether or not you should share the information
with the adolescents parent(s). The purpose of this study was to gather information
about how psychologists handle confidentiality within a family when treating
adolescents. Because outpatient therapy with an adolescent usually involves the
adolescent client, the parent(s), and the psychologist, this study measured the
opinions of each party regarding what kinds of information should be revealed to
parents.
Typically, the information revealed by an adolescent in therapy is kept
confidential. The exceptions to this practice are determined by state statutes, the
APA Code of Ethics (1992), the professional literature base, and the standards set by
practicing psychologists. The standard exceptions to confidentiality as outlined by
the APA Code of Ethics and supported by most state law are (a) threat of harm to self,
(b) threat of harm to others, and (c) abuse of a child. Colorado state statutes provide
that a 15-year-old can consent to psychotherapy (C.R.S. 27-10-103). This statute also
advises the treating professional that he/she may or may not advise the parents of the
services provided. Colorado statute 12-43-218 provides confidentiality for persons
1


receiving psychotherapy or other mental health services. Other exceptions to
psychologists confidentiality practices within a family are addressed by a small
literature base. In the first section of this chapter, I will outline types of
confidentiality policies used in psychotherapy with adolescent clients. In the second
section, I will outline psychologists opinions about how confidentiality should be
handled within a family and what constitutes exceptions to the standard practice of
keeping most information revealed in therapy confidential. In the third section of this
chapter, I will consider adolescents as an increasingly high-risk group requiring
special consideration. Finally, I will outline the research questions that inspired my
project.
Three types of confidentiality policies are commonly cited in reference to
adolescent therapy. They include: (a) complete confidentiality, where the therapist
reveals no information to parents; (b) limited confidentiality, where the therapist
informs both the minor and parent(s) that the therapist will decide what information
should be revealed to parents. The minor would not be notified prior to information
being shared and both the minor and parents are asked to trust the therapist's
judgment as to which information is revealed vs. protected; (c) informed forced
consent, where the parents and minor are informed that information disclosed in
therapy will, for the most part, be kept confidential. The minor is informed prior to
2


information being shared with parents, but may not decide what information is shared
(Kitchener, 2000; Hendrix, 1991; Lawrence & Robinson Kurpius, 2000).
Psychologists Attitudes
My review of the literature suggests that psychologists hold divergent
attitudes regarding which type of confidentiality is best suited for adolescents in
therapy. In 1952, Wrenn, as cited in McGuire (1974), argued that minors should have
equal rights to confidentiality in therapy; thus, it would be fair to assume that he
supported complete confidentiality. Wrenn made no mention of parental access to the
information a minor reveals in therapy. Ross specifically addressed parental access,
stating that parents are willing to accept confidentiality for their adolescent in
therapy, but that this type of confidentiality leads to lack of trust on behalf of the
minor client (1958). He felt that minors were distrustful of adults and unlikely to
benefit from therapy when they constantly wondered what information was being
shared with parents. Thus, Ross supported complete confidentiality in an effort to
build a trusting therapeutic client-therapist bond. In 1966, Ross acknowledged that his
judgments regarding minors' inability to trust were not supported empirically. At this
time, Ross contended that minors value the therapist's behavior (e.g., demonstration
of genuine concern for the minor) throughout therapy more than a verbal guarantee of
confidentiality prior to the start of therapy (1966). Ross then argued that informed,
3


forced consent is preferable to his earlier contention that complete confidentiality
most suited minors in therapy.
A task force focused on confidentiality for childrens and adolescents clinical
records established a model law supporting 12-year-olds as competent to give consent
to release information (Task Force on Confidentiality of Childrens and Adolescents
Clinical Records and the Committee on Confidentiality, 1979). In doing so, they
suggested that information obtained in psychotherapy with a child or adolescent
above the age of 12 should be kept confidential unless the client gives consent. They
provided specific exceptions to this standard, including in part: those who are
present to further the interest of the patient/client..., and those to whom disclosure
is reasonably necessary for the transmission of information, or the accomplishment of
diagnosis or treatment, including... members of the clients family (p. 139).
Although this model law provides detailed information about how confidential
information should be protected and kept private, it concurrently suggests
psychologists allow parental access to this information.
Increasing support for parental access to information appears later in the
literature, though the range of how much information should be shared varies, as does
the depth of the discussion. For example, in an article discussing adolescent
confidentiality and ability to consent, Melton (1981) broached the topic of parental
access as an aside. He suggested that denying parents access to information is not
4


practical. Melton offered no justification of his statement, leaving the reader
wondering how impracticality trumps the importance of confidentiality in therapy.
Perhaps Melton felt that an adolescent's interest in confidentiality was not important
enough to warrant an adult, whether therapist or parent, being inconvenienced. Thus,
he indirectly suggested that the adolescent's parents' needs or the therapist's interests
are superior to the adolescent client's therapeutic experience.
DeKraai and Sales (1981) approached the topic from a legal perspective,
citing parent's responsibility for the safety and well being of their child as grounds for
supporting parental access to information. They argued that parents are not in a
position to protect their minor children without the information necessary to do so.
Taylor and Adelman (1989) believed that withholding information from parents can
"seriously hamper" (p. 80) the benefit a minor might receive in therapy. They
suggested that parents can provide minors with additional support and resources that
may facilitate the therapeutic process. Taylor and Adelman (1989) also contended
that keeping information from parents may serve to further divide minors and their
parents, and the minors may even use the information as a "weapon in their conflict
with parents and other authority figures.
5


Adolescents as a Special Population
In their work with adolescent sex offenders, Sherlock and Murphy (1984)
supported sharing information with multiple parties including parents, employers, etc.
in an effort to monitor the behavior of the adolescent in treatment. Their argument
was built upon the premise that sex offenders are a unique group and require special
consideration due to the implications of unsuccessful therapeutic intervention. Thus,
they were willing to sacrifice the adolescents' confidentiality in order to reduce the
risk of re-offending. They argued that monitoring behavior outside of their treatment
facility is the most effective means of assessing the effectiveness of therapeutic
intervention. This argument can also be applied to severely disturbed adolescents,
who are similarly at risk for serious if they continue violent behavior, drug use,
prostitution, or other high-risk behaviors.
Current Psychologist Attitudes
In recent years, discussions have focused on the competing interests of parents,
adolescents, and the state (DeKraai & Sales, 1991). Most of the literature suggests
striking a careful balance, prioritizing the welfare of the minor first, indirectly
suggesting psychologists consider parental, and legal obligations as secondary.
Herlihy and Corey (1982) noted that a parent's legal right to information does not
supercede the psychologist's ethical obligation to respect the minor by including
6


him/her in deciding what information to share with parents (Ledyard, 1998).
Similarly, Hendrix (1991) supported a minor's right to confidentiality as ethically
superior to the parents' legal right to know what their child is talking about in therapy.
The literature suggests that confidentiality in adolescent therapy should be
considered on a case-by-case basis. A review of the literature reveals that
psychologists are more supportive of either limited confidentiality or informed,
forced consent (Hendrix, 1991; Kitchener, 2000). In both cases, the type of
information shared depends on the psychologists professional judgment as to which
information is germane to the parents ability to fulfill their legal obligations and
responsibilities as parents. It also depends on what psychologists view as potentially
harmful enough to sacrifice an adolescents confidentiality. Suppose an adolescent
reveals information about harmful behavior other than the standard exceptions (harm
to self, harm to others, abuse of a child), such as drug use or promiscuity? Although
this behavior could increase the chance of the adolescent suffering harm or death, it
also could have minimal consequences. Although there are codes and guidelines and
theory about adolescents rights and parents interests, there appears to be little
information about the standards of practice for intrafamilial confidentiality in
adolescent therapy.
7


Questions for Research
After reviewing the literature, I asked the following question: what types of
information do psychologists view as important enough to share with parents? For
example, how do psychologists handle information about drug use, promiscuity, or
violence? An adolescent involved in the aforementioned three behaviors is likely to
increase his/her chances of harm or even death. At the same time, an adolescent may
engage in these behaviors and suffer only short-term consequences, if any. How do
psychologists balance preventing harm and honoring confidentiality? As I discussed
earlier, adolescent psychotherapy involves not only the adolescent and psychologists,
but also the adolescents parents. What are parents expecting psychologists to do
when their adolescent shares information in therapy? To what degree do parents and
psychologists share concern about the same types of information?
I developed this study to explore psychologist, student, and parent opinions about
what types of information an adolescent talks about in therapy should be revealed to
parents. I was also interested in whether adolescent gender or age relates to
psychologists judgments or parent and adolescent expectations. Finally, I was
interested in exploring what confidentiality policies psychologists, students, and
parents would endorse for an adolescent client.
8


CHAPTER 2
METHODS
Design
The experiment was a2x2x3x5 factorial design, including between subject
variables of client gender (male, female), client age (14, 17), and participant
population (psychologist, student, parent). The within subjects variable was scenario
(academic, sex, drugs, violence, suicide).
Surveys
I developed a case example describing an adolescent, Chris, who is seeing a
psychologist for psychotherapy. There were four versions of the case example; in
order to manipulate the variables of age and gender, Chris was described as either 14
or 17, male or female. The content of the case examples differed only with respect to
the aforementioned variables and the perspective from which the participant considers
the case. The case example from the psychologist survey read as follows:
Case Example:
Chris is a [14,17] year-old [male, female] client whom you are
treating for moderate depression. He/she is a [freshman, senior] who has a
9


history of better than average academic performance. Chris is also involved
in several extra-curricular activities. His/her parents own a successful
business where Chris does part-time bookkeeping. Chris had a normal
childhood with no history of psychological problems. Both parents report no
history of mental illness in their immediate families. Since the onset of
his/her depression three months ago, Chris parents are worried that his/her
depression may cause irreparable damage to Chris academic future. Chris
has been in therapy for two months. In addition to symptoms of depression,
Chris has also been experiencing mild anxiety (i.e., upset stomach, worries a
lot) related to his/her inability to successfully balance school and work
responsibilities as she/she normally does. You have established a positive
therapeutic relationship with Chris and he/she has expressed satisfaction with
therapy. Chris' depressive symptoms improved markedly during the first three
weeks in therapy. Chris experienced a setback several weeks ago when he/she
began experiencing anxiety and expressed feeling overwhelmed by parental
and self-expectations to succeed in therapy.
After reading the case example, I asked the participants to read five
hypothetical scenarios in which Chris reveals the following new information to the
psychologist:
10


Academic: Chris reveals that he/she feels overwhelmed and frustrated
by parental expectations of his/her academic performance. Chris has decided
to change his/her academic track from college prep/honors to courses geared
towards technical school. Chris knows his/her parents will not readily accept
this decision and may not support Chris in his/her efforts.
Sex: Chris reveals that he/she has been involved in casual sex at
parties. He/she reports taking the necessary precautions to prevent pregnancy
or STDs. Chris admits that these interactions provide him/her with the
acceptance, attention, and affection missing from his/her life.
Drugs: Chris reveals using marijuana 2-3 times a week after school.
This is his/her first experience with drugs other than alcohol, which he/she
uses approximately three times a month (reports 1-3 drinks in one evening).
Chris says he/she uses marijuana because it helps him/her relax and forget
about the pressures of home and school.
Violence: Chris has recently become involved in an environmental
action group. Most of the members are his/her peers, though the founders are
college-aged. The group is known throughout the community due to its well-
organized public protests and lobbying at the local level. Recently, several
members of the group have begun protests using more violent means of
11


relaying their message. Three members have been arrested for defacing
public property and two have been injured in rowdy protests.
Suicide: Chris admits he/she has often been thinking about death
lately. He/she sometimes thinks that his/her suffering would end if he/she
died in a car accident. Though he/she reports not wanting to commit suicide,
he/she sometimes feels tempted to walk in front of a moving vehicle. Chris
has no history of previous suicidal ideation and had never attempted to harm
him/her self.
After each of the scenarios, participants responded to the following questions:
Should you [the psychologist] reveal this information to Chris parents? The
participants answered on a Likert scale, (l=definitely yes, 5= definitely no) whether
the psychologist should reveal the information to Chris parents. The participants
then briefly described the basis for their decision after each of the five scenarios. The
five scenarios were balanced by order, with each scenario presented first and the four
remaining scenarios randomly assigned for a total of five variations of order. Thus,
each participant in the study was randomly assigned on of twenty case example
variations.
Finally, participants selected which one of the following types of
confidentiality they would endorse for adolescent clients:
12


Complete confidentiality in which the therapist reveals no information
to the parents except: (a) the adolescent is attending sessions and (b) the usual
exceptions such as harm to self or others.
Limited confidentiality in which the therapist informs both the minor
and the parents that the therapist will decide what information should be
reveled to parents. The minor would not be notified prior to information
being shared and both the minor and the parents are asked to trust the
therapists judgment as to which information is revealed vs. protected.
Informed forced consent in which the parents and the minor are
informed that information disclosed in therapy will, for the most part, be kept
confidential. The minor is informed prior to information being shared with
parents, but may not decide what information is shared.
Negotiated Consent in which the therapist and the parents decide in
advance which type of information will and will not be conveyed. The
negotiation is done on a case-by-case basis.
The final segment of the survey asked participants for demographic
information. I asked all participants to list their age, gender, and level of education
(high school/GED, associates, bachelors, graduate). We asked psychologist
participants to provide the number of years they have been licensed and what
percentage of their total experience they have worked with adolescents (100%, 75%,
13


50%, 25%, 0%). Students and parents reported whether or not they have ever been in
therapy. Finally, we asked parents to list the number of children they have and their
childrens ages.
14


Participants
I surveyed three samples: psychologists, students, and parents.
Psychologists
A survey, including cover letter and postage-paid return envelope, was mailed
to 500 psychologists randomly chosen from the 1970 psychologists currently licensed
by the Colorado State Board of Psychologist Examiners. The Psychologist version of
the survey presented Chris as the psychologists client and asked the psychologist
participant, Should you reveal this information to Chris parents?
Students
One hundred fifty-six students in undergraduate courses at the University of
Colorado at Denver and Metropolitan State College completed the measure. The
student participants were asked to read the case example from the perspective of
Chris and were asked, Should the psychologist reveal this information to Chris
parents?
15


Parents
I obtained parent participants in two ways: (a) Student participants who were
parents filled out the parent version of the survey, and (b) I offered the non-parent
students the option, to take a survey home to their parents. Students took home a
maximum of four surveys, each including a letter describing the study, the survey,
and a postage-paid envelope. The parent participants read the same case example
describing Chris, and from their own perspective were asked, Should the
psychologist reveal this information to Chris parents?
16


CHAPTER 3
RESULTS
A total of 354 participants completed the surveys, of which 121 respondents
were male and 230 were female. Three respondents did not indicate gender on their
surveys. Respondents ranged in age from 15-70, with a mean of 36.4 and a median
age of 35.0.
Psychologists
Psychologists completed and returned 152 (30.4%) of the 500 surveys mailed.
Twenty-seven surveys were returned with unusable data. Of the 149 psychologist
participants, 69 were male and 80 were female. They ranged in age from 30 to 70,
with a mean age of 50.0. Years licensed ranged from one to 40, with the median
number of years licensed of 17.5. The majority of respondents (62.2%) reported 25%
or less of their total clinical experience was treating adolescents. The remaining
37.8% of psychologist respondents reported 50% or more of their total clinical
experience working with adolescents.
17


Students
One hundred fifty-eight students completed non-parent surveys. Forty-two
were male and 116 were female. Their age ranged from 15-43, with a mean age of
22.0. One hundred fourteen students reported having a GED or high school diploma,
and 44 had associates, bachelors, or graduate degrees. Of the 158 students, 64
reported having had some experience in therapy.
Parents
Forty-four parents returned surveys, 10 of whom were male and 34 were
female. Parent respondents ranged in age from 26-61, with a mean age of 45.
Thirteen parents reported earning a GED or high school diploma, 31 had a bachelors
or graduate degree. Twenty-one of the 44 parent respondents reported previous
psychotherapy. Parents reported having between one and five children, with 30.6%
reporting one child, 41.7% reporting two children, and 27.8% reporting three or more
children. Respondents children ranged in age from 1-38 years old, with a mean of
17 years of age.
18


Confidentiality Ratings of the Five Scenarios
I conducted a repeated-measures analysis of variance (ANOVA) with between
subject variables of client gender (male, female), client age (14,17) and participant
population (psychologists, student, parent). The within subjects variable was type of
scenario (academic, sex, drugs, violence, suicide). The analysis revealed a significant
main effect of scenario, F (4, 333) = 84.44, p = .000. Overall, participants gave the
sex scenario the highest confidentiality rating (M = 4.21). The academic scenario was
rated the second highest, with a mean of 4.00. Confidentiality ratings above 2.5, the
midpoint, are more supportive of keeping the information private by not revealing it
to parents. Because a rating of 5.0 corresponds with a definitely no (do not reveal
information to parents), both the overall sex and academic ratings are highly
supportive of keeping the information confidential. Post-hoc analysis using
Bonferroni tests revealed no significant difference between the sex and academic
scenarios. The drugs and violence scenarios were rated third and fourth, with
confidentiality ratings of 3.64 and 3.55, respectively. Post-hoc Bonferroni tests
indicated no significant difference between the drugs and violence scenarios. Post-
hoc analysis also revealed that the academic and sex scenarios differed significantly
from the sex and violence scenarios (all post-hoc tests were Bonferroni and all
significant results were p < .05). Suicide yielded the lowest confidentiality ratings,
with a mean of 2.43. Because this rating is below the midpoint of 2.5, participants
19


were leaning towards sharing the information with parents. Post-hoc analysis further
revealed that ratings of the suicide scenario were significantly different from those of
all the other scenarios.
The ANOVA also yielded amain effect of group, F (2, 333) = 24.81,/) =
.000, such that psychologists, students, and parents differed in the amount of
information they rated as appropriate to reveal to parents. Post-hoc analysis indicated
that ratings of psychologists (M= 3.79), students (M~ 3.56) and parents (M= 2.65)
were all significantly different from each other: Parents reported wanting more
information about what is revealed in therapy than adolescents reported they are
willing to reveal and psychologists judged appropriate to reveal.
A significant Group x Scenario interaction qualified the main effects of
scenario and group, F (8, 333) = 5.19,p = .000. Respondents scenario ratings
depended on whether they were psychologists, students, or parents. Psychologists
judgments identified four significantly different scenario groups: (a) academic and
sex, (b) violence, (c) drugs, and (d) drugs and suicide. Students confidentiality
ratings revealed three different scenario groups: (a) academic and sex, (b) drugs and
violence, and (c) suicide. Parents were less clear, but essentially viewed three less
distinct groups; (a) Sex, school, violence, (b) violence and drugs, and (c) suicide.
Although parents rated violence and drugs as the same, they also group drugs with
20


suicide. See Appendix A. for a list of psychologist, student, and parents
confidentiality rating means.
Additional post-hoc analysis of the Group x Scenario interaction revealed
significant mean differences between psychologists and parents on academic, sex, and
violence scenarios. Psychologists gave higher confidentiality ratings (M= 4.47) than
parents (M= 3.40) on the sex scenario. Psychologists also gave higher confidentiality
ratings (M= 4.35) to the academic scenario than did parents (M= 3.33). Again,
psychologists confidentiality ratings were higher (M= 4.08) than parents (M= 2.77)
for the violence scenario. Parents (M = 1.93) and psychologists (M= 2.39) did not
differ on suicide, where both group supported revealing the information to parents.
Psychologist gave different ratings than students on academic, sex, and
violence scenarios. Psychologists rated academic scenarios (M = 4.35) higher than
did students (M = 3.86). Psychologists also rated sex (M = 4.47) in favor of more
confidentiality than did students (M = 4.18). Psychologists ratings for violence were
also higher, with a mean of 3.78 compared to students mean of 3.47. Students and
psychologists did not differ in confidentiality ratings of drugs and suicide. Parents
and students differed on suicide, both groups in favor of revealing the information,
but students (M = 2.61) significantly less so compared with parents (M = 1.93). See
See Appendix B. for psychologist, student, and parent scenario ratings.
21


A Group x Age interaction revealed an effect of age, but only for
psychologists, F (2, 333) = 4.30, p = .014. Psychologists who read the case example
about a 17-year-old adolescent gave a higher confidentiality rating (M= 4.05) than
psychologists who read about the 14-year-old protagonist (M= 3.52). Students with
the 14-year-old protagonist (M= 3.58) did not give different ratings than students
with the 17-year-old protagonist (M= 3.53), nor did parents with 14-year-old (M=
2.56) versus the 17-year-old protagonists (M= 2.93).
I explored whether participant gender related to confidentiality ratings and
found no significant differences between male and female participants. Participant
age did not significantly relate to confidentiality ratings. Neither parents nor
students confidentiality ratings related to previous experience in psychotherapy.
Education level of student or parent participants did not relate to confidentiality
ratings. The number of years a psychologist was licensed did not correlate with their
confidentiality ratings.
Confidentiality Policy Preferences
Participants were asked to choose one of four confidentiality policies they
would endorse for adolescents in psychotherapy. Psychologists were split between
complete confidentiality (32.0%), where the information revealed in therapy is
confidential (except harm to self or others, or abuse of a child) and informed forced
22


consent (42.6%), where most information is kept confidential and the psychologist
informs the adolescent in advance what will be revealed. Students preferred complete
confidentiality (55.1%) and limited confidentiality (19.5%), in which the minor is not
informed in advance about what would be shared with parents. Parents chose limited
confidentiality (30.3%) or negotiated confidentiality (33.3%). These differences were
significant, A"2 (6) = 47.46,p = .000. See Appendix C. for a complete listing of
psychologist, student, and parent confidentiality ratings.
I conducted a 3 x 4 x 5 repeated measures ANOVA on confidentiality ratings,
with the between subject variables of group (psychologist, student, parent), and policy
preference (complete, informed, limited, negotiated) and the within subjects variable
of scenario (academic, sex, drugs, violence, suicide). The analysis revealed a main
effect of policy, F (3, 263) = 17.08, p = .000. This result indicates that participant
policy preferences are somewhat related to their confidentiality ratings. Bonferroni
tests showed that participants who endorsed complete confidentiality gave higher
confidentiality ratings than did participants who endorsed limited, informed, or
negotiated consent.
I explored whether participant gender related to policy preference and found
no significant differences between male and female participants. Participant age did
not significantly relate to policy preferences. Parents and students policy
preferences were not related to previous experience in psychotherapy. Policy
23


preference was not related to education level of student or parent participants. The
number of years a psychologist was licensed did not correlate with their policy
preferences.
24


CHAPTER 4
DISCUSSION
Confidentiality Ratings
Differences Among Groups
Consistent with the previously discussed literature (Hendrix, 1991), psychologists
gave confidentiality ratings most supportive of maintaining confidentiality for Chris,
the adolescent described in the case example. Parents had the highest expectation of
the three groups that the psychologist should reveal information shared by Chris in
therapy. Students confidentiality ratings were in the middle; students wanted more
confidentiality than parents expected them to have and expected less confidentiality
than psychologists were willing to afford them. Parents bringing their adolescents in
for therapy are likely to be dissatisfied with the amount of information revealed to
them about the topics discussed in therapy.
Adolescents lower confidentiality ratings than psychologists suggests that
adolescents will not be surprised with the amount of information a psychologist
decides to reveal. However, lower confidentiality ratings may indicate that
adolescents want parents to be more informed and expect psychologists to help them
25


face parents with difficult information. For example, an adolescent female might be
afraid to tell parents that she is a lesbian. She might visit a psychologist with the
assumption or hope that the psychologist is more inclined to share the information
with parents and that she might have support in revealing this information.
It is also possible that adolescents do want the higher confidentiality
psychologists are willing to give but are also aware of parents expectations and see
increased confidentiality as impossible or unrealistic. Adolescents seeing a
psychologist may be caught between their parents expectations and their own
interests in confidentiality. Parents typically have power over an adolescents access
to resources, such as the means by which to attend therapy (e.g., transportation,
payment, permission) or privileges (e.g., use of a family vehicle, time with friends).
As such, adolescents may feel pressured to accommodate their parents to avoid the
consequences of their parents disapproval.
Psychologists are more willing than students and parents to keep information
about promiscuity private. This underscores psychologists overall high
confidentiality ratings and suggests that: (a) psychologists view confidentiality as
relatively more essential to the therapeutic relationship and worthy of preserving even
in some risky situations, and (b) psychologists are more confident than parents and
adolescents that the minor client revealing this type of information will not suffer
increased harm if the information is kept confidential. This result may be due to
26


psychologists experience that adolescents who reveal this type of information in
therapy work through it and benefit from the process. Or, the result could be due to
psychologists trusting their own abilities to help the adolescent and not seeking
support from other resources such as parents.
A psychologists decisions about how much and what type of information to
share with parents may affect the adolescents relationship with both the parents and
the psychologist. Without autonomy in their experience of psychotherapy,
adolescents may experience more difficulty tackling the process of individuation from
parents. On the other hand, in their quest to make life decisions and move through
emotional problems, adolescents may need the support and resources that only an
informed parent could provide.
Information shared in therapy is difficult enough to deal with in typical cases,
given the possibility of a negative outcome based on a psychologists judgment.
However, there are also circumstances where a psychologists intrafamilial
confidentiality practices may have more serious implications, such as where the
adolescent or other family members are victims of domestic violence. Suppose an
adolescent male comes from an abusive home and has recently discovered his fathers
infidelity. He knows that telling his mother will result in physical abuse from his
father, so he seeks a psychologist to talk about the issue. If the parents want
information about what is revealed in therapy, as this study suggests, then the boy
27


might agree to share information in order to avoid abuse by his father. If the mother
leams of the infidelity through the psychologist, perhaps then the boy suffers abuse
from his father as a consequence for revealing the family secret. An adolescent who
is already in distress may be further harmed because he either suffers additional abuse
or is unable to talk about the issue for fear of repercussions.
Differences Within Each Scenario
For the academic scenario, psychologists confidentiality ratings were higher
than parents and students. Students and parents did not differ significantly in their
confidentiality expectations for academic information. Psychologist, student, and
parent relatively high confidentiality ratings for this scenario appear to reflect the low
risk of harm to the adolescent. These differences suggest that when an adolescent
visits a psychologist for therapy, the parents will have a higher expectation in
knowing even benign types of information compared with the treating psychologist.
Psychologists and students did not differ in their confidentiality ratings of drugs and
suicide and both gave higher ratings than did parents. In regard to drugs this appears
to reflect a sense of trust on behalf of psychologists and students that therapy will be
beneficial in helping the adolescent with problems, and that sacrificing confidentiality
is not warranted to the degree that parents expect. Because psychologist and student
ratings are above the midpoint in favor of revealing the information, there is no
28


evidence that either group is unaware of the risk of harm. Parents are significantly
more concerned about having the information, which is consistent with their overall
expectation about knowing what their adolescent child talks about in therapy.
For the sex and violence scenarios; psychologists, students, and parents
differed significantly from one another. For both scenarios, psychologists gave the
highest rating, followed by students and then parents. Because the sex rating was the
highest overall for all three groups, it is clear that participants consider sex the most
deserving of confidentiality compared with the remaining four types of information.
Psychologists More Discerning
Psychologists were the only group to consider age an important factor when
determining intra-familial confidentiality for an adolescent in therapy. Psychologists
gave higher confidentiality ratings to the 17-year-old protagonist than to the 14-year-
old protagonist. Because parent and student judgments did not differ as a function of
age, this result may be due to psychologists experience and/or education regarding
adolescent development. Psychologists may have viewed the 17-year-old protagonist
as an adult and made decisions based on how they would treat an adult client in the
same circumstance. They may have judged a 14-year-old protagonist as at a higher
risk of harm, or a combination of increased confidentiality for the older adolescent
and concern for the younger adolescent. Psychologists may feel that parents are more
29


responsible for 14-year-olds and therefore have a greater right to information.
Because all participating psychologists were licensed in Colorado, they may have
considered the state statute (C.R.S. 27-10-103), discussed earlier, which provided 15-
year-olds with the right to consent to psychotherapy or other mental health services.
In either case, psychologist participants as a group were aware of differences between
a 17-year-old and 14-year-old adolescent and made judgments accordingly.
Psychologists making judgments based on age may provide evidence that,
although psychologists lean towards maintaining confidentiality for adolescent
clients, they also identify risk factors and make judgments in an effort to reduce harm.
A psychologist may feel that an adolescent who has otherwise resisted drugs,
violence, and sex until age 17 may be at lower risk than an adolescent who initiates
these behaviors at age 14. Perhaps an adolescent initiating these risky behaviors at
age 14 may become more entrenched in the behavior, and suffering more long-term
consequences than a 17-year-old.
Policy Preferences
Most psychologists chose informed forced consent (42.6%) or complete
confidentiality (32%) for adolescents in psychotherapy (see page 11-12 for policy
descriptions). With complete confidentiality, most of the information revealed in
therapy is kept confidential. Informed forced consent informs adolescents about
30


when and how information will be revealed to parents. These results suggest that
psychologists are likely to endorse confidentiality policies that are relatively more
empowering of adolescent clients. Psychologists may want adolescents to be more
involved in communicating the information to parents and making decisions about
therapy than their adolescent clients expect.
Most parents selected negotiated confidentiality (33.3%) and limited
confidentiality (30.3%), both of which involve the parents more than the other options
and could be argued as least empowering to adolescents. Parents appear to be
interested in having information and influencing what happens in therapy, despite
adolescents interest in the contrary.
Students favored complete confidentiality (55.1%) and chose limited
confidentiality as their second preference (19.5%). Students were clear in
communicating that they want confidentiality in therapy. Most interesting is
students second choice of limited confidentiality, which is more restrictive and
involves the adolescent less than informed forced consent. It appears that adolescents
would be satisfied when information is kept confidential, and are otherwise
uninterested in dealing with discussing how information would be shared with
parents. Adolescents may have a hands off approach to therapy, expecting less
control in therapy than psychologists are willing to afford.
31


Students endorsed the policy most supportive of confidentiality. Their choice
of limited confidentiality over negotiated or informed might also suggest that they
want to limit parents involvement or their own role in sharing information. In other
words, if the information must be revealed, they want psychologists to do the dirty
work. These adolescents may perceive themselves as on the receiving end of a
service rather than active participants.
Limitations of the Study
The most serious limitation of this study is small sample size, especially that
of the parent population. With 152 psychologists and 158 students, the 44 parents
sample was substantially smaller. Thus, this study has all of the potential problems
associated with small sample size.
Another limitation was having selected student and parent participants
through a university; therefore participants may not accurately represent the general
population. Students were all undergraduates in psychology courses and may not
even represent the interests and opinions of all undergraduate students. I also do not
know the differences between parents who agreed to participate, either parents of
students or students who were themselves parents, and the general parent population.
Psychologists who participated were volunteers self-selected from a randomly
chosen psychologist sample and I could not control who returned the surveys. As
32


such, the psychologist participants may not be representative of psychologists in the
general population.
An additional limitation of this study was the adolescent protagonist, Chris,
about whom participants made confidentiality judgments. Chriss ethnicity was not
presented, nor were socio-economic considerations included. As such, the study
focused on a mainstream (or unidentified as otherwise) adolescent visiting a
psychologist for outpatient psychotherapy. This research may not be generalizable to
confidentiality decisions that psychologists, students, and parents would make for the
non-mainstream adolescent population.
I asked student participants to make decisions from the perspective of Chris,
who was either age fourteen or seventeen. Since the student age mean was 22.0, their
responses may not be representative of responses the same students would have made
as teenagers. Thus, their perspective on confidentiality for adolescents may be
influenced by their own experience as young adults.
Another limitation was that participants made confidentiality judgments based
on a hypothetical adolescent, with limited information. I could not include all of the
information that a psychologist or parent would have about an adolescent (i.e.,
detailed childhood history, psychological evaluations) if they were making a real-life
decision. Furthermore, participants rated five separate scenarios, which all occurred
one after the next. Because these were not naturally occurring situations and all were
33


presented at the same time, participants individual scenario judgments may have
been clouded by the preceding scenarios.
Suggestions for Further Research
I would recommend further research into psychologists standards of practice
when treating adolescent clients. Most valuable would be information about how
psychologists handle their current adolescent clients and whether the psychologists
decisions relate to client outcome and perceived relationship between the
psychologist and adolescent client. Further research might include exploring other
types of information that an adolescent may talk about in therapy, such as religious
preference change, other types of illegal activity (organized crime), and revealing
family secrets (i.e., incest, substance abuse, sexual deviance). I would also be
interested in designing a similar study exploring cross-cultural implications of an
adolescent protagonist of varying ethnicities. Other variables that would be
interesting to explore are adolescents who are living at home versus independent, in
college or working, and married or single. Additionally, it might be worthwhile to
see how intrafamilial confidentiality is handled with adolescents in detention
centers/jail or residential treatment facilities.
34


General Conclusions
This study may be useful to psychologists, because it provides information
about parent and student expectations. Parents and students could benefit from this
research if psychologists use the information to make more informed confidentiality
decisions. If the results of this study are generalizable, then psychologists have more
information about psychologists standard practices in handling infrafamilial
confidentiality. Psychologists also may be able to predict what types of information
parents and adolescents expect to be revealed to an adolescent clients parent(s). As
such, psychologists might be in a better position to anticipate their clients needs and
do a better job helping adolescents and their families.
Parents may benefit from knowing that a psychologist is likely to keep the
information an adolescent reveals in therapy confidential. Parents with this
information are less likely to assume that the parent and psychologist share the same
expectations. Realizing that psychologists keep more information confidential,
parents may invest more energy into the parent-child relationship. Doing so might
encourage the adolescent to talk, instead of relying on a third party (i.e., the
psychologist) for information about what is going on in the adolescents life. This
35


could be beneficial to the parent and the adolescent, as it honors confidentiality while
also promoting improvement in parent-child communication.
This study provides initial empirical information about psychologists
standard of practice when handling confidentiality with adolescent clients. The
results suggest that psychologists support increased confidentiality for adolescent
clients and that parents are likely to be disappointed with the amount of information
disclosed to them by psychologists. Adolescents may feel trapped between their own
expectations of confidentiality and their parents interest in knowing about what goes
on in therapy. Such differences in expectations among psychologists and parents, and
adolescent clients may hinder therapy, and need to be dealt with explicitly.
36


APPENDIX
A. Main Effect of Group: Psychologist, Student and Parent Confidentiality Ratings
Psychologists Students Parents
3.79
3.56
2.65
B. Group x Scenario Interaction: Mean Scenario Ratings Within Groups
Scenario Psychologists Students Parents
1 (Academic) 4.35 a 3.86 a 3.33 a
2(Sex) 4.47 a 4.18 a 3.40 a
3 (Drugs) 3.78 3.65 b 2.42 a, b
4 (Environment) 4.08 3.47 b 2.77 b, c
5 (Suicide) 2.39 2.61 1.93 c
Shared subscripts in each column indicate means that are not significantly different.
C. Confidentiality Policy Preferences: Psychologists, Students, and Parents
Psychologists: Informed forced consent 42.6 %
Complete confidentiality 32.0%
Negotiated confidentiality 15.6%
Limited confidentiality 9.8%
Students: Complete confidentiality 55.1%
Limited confidentiality 19.5%
Informed forced consent 13.6%
Negotiated confidentiality 11.9%
Parents Negotiated confidentiality 33.3%
Limited confidentiality 30.3%
Complete confidentiality 18.2%
Informed forced consent 18.2%
37


D. Psychologist Cover Letter
June 12,2001
Dear Dr.,
We are writing to ask you to fill out a short survey as part of a masters thesis project
at the University of Colorado at Denver. It should take about 15-20 minutes of your
time. We have a very small randomly selected sample of psychologists and would
very much appreciate your participation.
We are interested in gathering information about how psychologists handle
confidentiality within a family when treating outpatient adolescents, and to assess the
confidentiality policies typically used by psychologists.
Enclosed is a survey including a vignette of an outpatient adolescent who reveals five
different types of information in therapy. We would like you to read the case
example and the five scenarios and respond to the questions that follow. We have
provided you with a return, postage-paid envelope for your convenience. Returning
the survey constitutes consent to participate. At no time do we ask for your name;
thus, your responses are totally anonymous.
We appreciate your participation in our study. Should you have questions, please
contact Lana Gollyhom at sisul@netscape.net or Dr. Mitch Handelsman at 303-556-
2672 or mitchell.handelsman@cudenver.edu. Thank you very much for your time.
Sincerely,
Lana Gollyhom
Clinical Psychology Master's Student
Mitchell M. Handelsman, Ph.D.
Professor of Psychology
CU President's Teaching Scholar
38


E. Psychologist Survey
Confidentiality in Adolescent Therapy:
SURVEY
Instructions:
The following five questions are based on the case of Chris. We realize that a
case study cannot present all of the relevant information from which to base a
treatment decision. For this survey, please use your judgment as to how you
would normally handle a similar case in your practice.
Case Example
Chris is a 14-year-old female client whom you are treating for moderate depression.
She is a freshman who has a history of better than average academic performance.
Chris is also involved in several extra-curricular activities. Her parents own a
successful small business where Chris does part-time bookkeeping. Chris had a
normal childhood with no history of psychological problems. Both parents report no
history of mental illness in their immediate families. Since the onset of her depression
three months ago, Chris' grades have slipped and she has been undependable at work.
Chris parents are worried that her depression may cause irreparable damage to Chris'
academic future. Chris has been in therapy for two months. In addition to symptoms
of depression, Chris has also been experiencing mild anxiety (i.e., upset stomach,
worries a lot) related to her inability to successfully balance school and work
responsibilities as she normally does. You have established a positive therapeutic
relationship with Chris and she has expressed satisfaction with therapy. Chris'
depressive symptoms improved markedly during the first three weeks in therapy.
Chris experienced a setback several weeks ago when she began experiencing anxiety
and expressed feeling overwhelmed by parental and self-expectations to succeed in
therapy.
Suppose in your next therapy session with Chris you encounter one of the
following five scenarios:
SCENARIO A
39


Chris reveals that she feels overwhelmed and frustrated by parental expectations of her
academic performance. Chris has decided to change her academic track from college
prep/honors to courses geared towards technical school. Chris knows her parents will not
readily accept this decision and may not support Chris in her efforts.
Should you reveal this information to Chris parents?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
SCENARIO B
Chris reveals she has been involved in casual sex at parties. She reports taking the necessaty
precautions to prevent pregnancy or STDs. Chris admits that these interactions provide her
with the acceptance, attention, and affection missing from her life.
Should you reveal this information to Chris parents?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
SCENARIO C
Chris reveals using marijuana 2-3 times a week after school. This is her first experience with
drugs other than alcohol, which she uses approximately three times a month (reports 1-3
drinks in one evening). Chris says she uses marijuana because it helps her relax andforget
about the pressures of home and school.
Should you reveal this information (i.e., marijuana use) to Chris parents?
1 2 3 4 5
Definitely Yes Definitely No
40


Briefly describe the basis for your decision:
SCENARIO D
Chris has recently become involved in an environmental action group. Most of the members
are her peers, though the founders are college-aged. The group is known throughout the
community due to its well-organized public protests and lobbying on the local level. Recently,
several members of the group have begun protests using more violent means of relaying their
message. Three members have been arrested for defacing public property and two have been
injured in rowdy protests.
Should you reveal this information to Chris parents?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
SCENARIO E
Chris admits she has often been thinking about death lately. She sometimes thinks that her
suffering would end if she died in a car accident. Though she reports not wanting to commit
suicide, she sometimes feels tempted to walk in front of a moving vehicle. Chris has no
history of previous suicidal ideation and has never attempted to harm herself.
Should you reveal this information to Chris parents?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
DEMOGRAPHIC INFORMATION
Age
41


Gender M________ F_____
How many years have you been licensed?_______
Which of the following most accurately represents the percentage of your total
clinical experience working with adolescents and their families:
_____0% (no experience with adolescents)
_____25%
_____50%
_____75%
_____100% (I have worked exclusively with adolescents and/or their families)
Which of the following most accurately describes the type of confidentiality policy
you are most likely to use for adolescent clients? (Please check the option that is
closest to your policy, and feel free to write comments below.)
_____"Complete confidentiality" in which the therapist reveals no information to the
parents except: 1) the adolescent is attending sessions and 2) the usual exceptions,
such as harm to self or others.
_____"Limited confidentiality" in which the therapist informs both the minor and the
parents that the therapist will decide what information should be revealed to parents.
The minor would not be notified prior to information being shared and both the minor
and parents are asked to trust the therapist's judgment as to which information is
revealed vs. protected.
_____"Informed forced consent" in which the parents and the minor are informed
that information disclosed in therapy will, for the most part, be kept confidential. The
minor is informed prior to information being shared with parents, but may not decide
what information is shared.
_____"Negotiated consent" in which the therapist and parents decide in advance
which type of information will and will not be conveyed. This negotiation is done on
a case-by-case basis.
42


F. Student Consent
INTRODUCTION TO STUDY
The purpose of this study is to measure opinions about how psychologists handle
some things that adolescents talk about in psychotherapy. Information revealed in
psychotherapy is typically confidential, meaning that the psychologist keeps the
client's communications private. We are interested in studying the circumstances that
may be exceptions to this practice when treating adolescents in psychotherapy.
Specifically, we are interested in what type of information is serious enough to be
revealed to the parents.
We will ask you to read a vignette about an adolescent, Chris, who reveals five
different types of information to a psychologist. Then, we ask you to imagine yourself
in the position of Chris and answer several opinion questions. Finally, we request
information about your background (e.g., age, gender). The study will take less than
20 minutes.
If you have any questions about the study, please let us know.
Thank you for participating in our study!
Sincerely,
Lana Gollyhom
Clinical Psychology Master's Student
Mitchell M. Handelsman, Ph.D.
Professor of Psychology
CU President's Teaching Scholar
303-556-2672
43


G. Student Survey
Confidentiality in Adolescent Therapy
SURVEY
Case Example
Chris is a 14-year old female client who is seeing a psychologist due to moderate
depression. She is a freshman who has a history of better than average academic
performance. Chris is also involved in several extra-curricular activities. Her parents
own a successful small business where Chris does part time bookkeeping. Chris had a
normal childhood with no history of psychological problems. Both parents report no
history of mental illness in their immediate families. Since the onset of her depression
three months ago, Chris' grades have slipped and she has been undependable at work.
Chris parents are worried that her depression may cause irreparable damage to Chris'
academic future. Chris has been in therapy for two months. In addition to symptoms
of depression, Chris has also been experiencing mild anxiety (i.e., upset stomach,
worries a lot) related to her inability to successfully balance school and work
responsibilities as she normally does. Chris has established a positive therapeutic
relationship with her psychologist and she has expressed satisfaction with therapy.
Chris' depressive symptoms improved markedly during the first three weeks in
therapy. Chris experienced a setback several weeks ago when she began experiencing
anxiety and expressed feeling overwhelmed by parental and self-expectations to
succeed in therapy.
Instructions
Suppose one of the following five scenarios occur in Chris' next therapy session with
his/her psychologist. We realize that a case study cannot present all relevant
information from which to make a decision. Please answer the questions following
each scenario to the best of your ability given the information we provide.
Remember: We would like you to answer the questions as if you are Chris, the
adolescent described in the case example.
SCENARIO A
Chris reveals that she feels overwhelmed and frustrated by parental expectations of her
academic performance. Chris has decided to change/her academic track from college
prep/honors to courses geared towards technical school. Chris knows her parents will not
readily accept this decision and may not support Chris is her efforts.
44


Should the psychologist reveal this information to Chris parents?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
SCENARIO B
Chris reveals she has been involved in casual sex at parties. She reports taking the necessary
precautions to prevent pregnancy or STDs. Chris admits that these interactions provide
him/her with the acceptance, attention, and affection missing from her life.
Should the psychologist reveal this information to Chris parents?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
SCENARIO C
Chris reveals using marijuana 2-3 times a week after school. This is/herfirst experience with
drugs other than alcohol, which she uses approximately three times a month (reports 1-3
drinks in one evening). Chris says she uses marijuana because it helps her relax and forget
about the pressures of home and school.
Should the psychologist reveal this information (i.e., marijuana use) to Chris parents?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
45


SCENARIO D
Chris has recently become involved in an environmental action group. Most of the members
are her peers, though the founders are college-aged. The group is known throughout the
community due to its well-organized public protests and lobbying on the local level. Recently,
several members of the group have begun protests using more violent means of relaying their
message. Three members have been arrested for defacing public property and two have been
injured in rowdy protests.
Should the psychologist reveal this information to Chris parents?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
SCENARIO E
Chris admits she has often been thinking about death lately. She sometimes thinks that her
suffering would end if she died in a car accident. Though she repons not wanting to commit
suicide, she sometimes feels tempted to walk in front of a moving vehicle. Chris has no
history of previous suicidal ideation and has never attempted to harm herself.
Should the psychologist reveal this information to Chris parents?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
Please fill in the blanks to the following questions:
Age:______
Gender: Male Female
46


What is the highest degree you have earned?
Graduate______________
Bachelors____
Associates___
High School/GED_______
Have you ever been in therapy? Yes____ No
Confidentiality Policies
The following are types of confidentiality policies psychologists use when treating
adolescents in outpatient therapy. Which of the following are you most likely to
support?
_____"Complete confidentiality" in which the therapist reveals no information to
the parents except: 1) the adolescent is attending sessions and 2) the usual exceptions
such as harm to self or others.
_____"Limited confidentiality" in which the therapist informs both the minor and
the parents that the therapist will decide what information should be revealed to
parents. The minor would not be notified prior to information being shared and both
the minor and parents are asked to trust the therapist's judgment as to which
information is revealed vs. protected.
_____"Informed forced consent" in which the parents and the minor are informed
that information disclosed in therapy will, for the most part, be kept confidential. The
minor is informed prior to information being shared with parents, but may not decide
what information is shared.
_____"Negotiated consent" in which the therapist and parents decide in advance
which type of information will and will not be conveyed. This negotiation is done on
a case-by-case basis.
47


H. Parent Cover Letter
Date
Dear Parent,
Your child has recently participated in an in-class survey as part of a master's thesis
project at the University of Colorado at Denver. We are writing to ask you to fill out a
short survey as part of the same project. It should take about 15-20 minutes of your
time. We have a small sample of parents and would very much appreciate your
participation. We are interested in parents opinions about how psychologists handle
confidentiality within a family when providing therapy for adolescents.
Enclosed is a survey including a vignette of an outpatient adolescent who reveals five
different types of information in psychotherapy. We would like you to read the case
example and the five scenarios and respond from a parents perspective to the
questions that follow. We have provided you with a return, postage-paid envelope for
your convenience. At no time do we ask for your name; we have no way of
identifying responses. Thus, your responses are completely anonymous, and your
responses will not be compared to those of your child.
We appreciate your participation in our study. Should you have questions, please
contact Lana Gollyhom at sisul@netscape.net or Dr. Mitch Handelsman at 303-556-
2672 or mitchell.handelsman@cudenver.edu. Thank you very much for your time.
Sincerely,
Lana Gollyhom
Clinical Psychology Master's Student
Mitchell M. Handelsman, Ph.D.
Professor of Psychology
CU President's Teaching Scholar
48


I. Parent Survey
Confidentiality in Adolescent Therapy
SURVEY
Introduction
We are interested in how psychologists deal with information that adolescents reveal
in psychotherapy. Typically, when an adolescent goes to a psychologist's office for
treatment, the information revealed in psychotherapy is kept confidential. We are
interested in the exceptions to this practice. Specifically, we are interested in what
type of information is revealed to parents vs. kept confidential. Put yourself in the
position of Chris parent, the parent of the adolescent described in the following case
example. Please read carefully.
Case Example
Chris is a 14-year-old female client who is seeing a psychologist due to moderate
depression. She is a freshman who has a history of better than average academic
performance. Chris is also involved in several extra-curricular activities. Her parents
own a successful small business where Chris does part time bookkeeping. Chris had a
normal childhood with no history of psychological problems. Both parents report no
history of mental illness in their immediate families. Since the onset of her depression
three months ago, Chris' grades have slipped and she has been undependable at work.
Chris parents are worried that her depression may cause irreparable damage to Chris'
academic future. Chris has been in therapy for two months. In addition to symptoms
of depression, Chris has also been experiencing mild anxiety (i.e., upset stomach,
worries a lot) related to her inability to successfully balance school and work
responsibilities as she normally does. Chris has established a positive therapeutic
relationship with her psychologist and she has expressed satisfaction with therapy.
Chris' depressive symptoms improved markedly during the first three weeks in
therapy. Chris experienced a setback several weeks ago when she began experiencing
anxiety and expressed feeling overwhelmed by parental and self-expectations to
succeed in therapy.
49


Instructions
Suppose one of the following five scenarios occur in Chris' next therapy session with
his/her psychologist. We realize that a case study cannot present all relevant
information from which to make a "parental" decision. Please answer the questions
following each scenario to the best of your ability given the information we provide.
Remember: We would like you to answer the questions as if you are Chris
parent.
SCENARIO A
Chris reveals that she feels overwhelmed and frustrated by parental expectations of her academic
performance. Chris has decided to change her academic trackfrom college prep/honors to courses
geared towards technical school. Chris knows her parents will not readily accept this decision and
may not support Chris is her efforts.
Should the psychologist reveal this information to you?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
SCENARIO B
Chris reveals she has been involved in casual sex at parties. She reports taking the necessary
precautions to prevent pregnancy or STDs. Chris admits that these interactions provide her with the
acceptance, attention, and affection missing from her life.
Should the psychologist reveal this information to you?
1 2 3 4
Definitely Yes Definitely No
Briefly describe the basis for your decision:
50


SCENARIO C
Chris reveals using marijuana 2-3 times a week after school. This is her first experience with drugs
other than alcohol, which she uses approximately three times a month (reports 1-3 drinks in one
evening). Chris says she uses marijuana because it helps her relax and forget about the pressures of
home and school.
Should the psychologist reveal this information (i.e., marijuana use) to you?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
SCENARIO D
Chris has recently become involved in an environmental action group. Most of the members are her
peers, though the founders are college-aged. The group is known throughout the community due to its
well-organized public protests and lobbying on the local level. Recently, several members of the group
have begun protests using more violent means of relaying their message. Three members have been
arrested for defacing public property and two have been injured in rowdy protests.
Should the psychologist reveal this information to you?
1 2 3 4 5
Definitely Yes Definitely No
Briefly describe the basis for your decision:
SCENARIO E
Chris admits she has often been thinking about death lately. She sometimes thinks
that her suffering would end if she died in a car accident. Though she reports
not wanting to commit suicide, she sometimes feels tempted to walk in front of a
moving vehicle. Chris has no history of previous suicidal ideation and has never
attempted to harm him/her self.
Should the psychologist reveal this information to you?
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2
3
4
5
Definitely Yes
Briefly describe the basis for your decision:
Please fill in the blanks to the following questions:
Age:______
Male______ Female___________
What is the highest degree you have earned?
Graduate_______
Bachelors_____
Associates____
Definitely No
High School/GED____
Have you ever been in therapy? Yes_____ No_______
Confidentiality Policies
The following are types of confidentiality policies psychologists use when treating
adolescents in outpatient therapy. Which of the following are you most likely to
support?
_____"Complete confidentiality" in which the therapist reveals no information to
the parents except: 1) the adolescent is attending sessions and 2) the usual exceptions
such as harm to sqlf or others.
_____"Limited confidentiality" in which the therapist informs both the minor and
the parents that the therapist will decide what information should be revealed to
parents. The minor would not be notified prior to information being shared and both
the minor and parents are asked to trust the therapist's judgment as to which
information is revealed vs. protected.
_____"Informed forced consent" in which the parents and the minor are informed
that information disclosed in therapy will, for the most part, be kept confidential. The
minor is informed prior to information being shared with parents, but may not decide
what information is shared.
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_____"Negotiated consent" in which the therapist and parents decide in advance
which type of information will and will not be conveyed. This negotiation is done on
a case-by-case basis.
Comments:
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