“I want to tell you something, but you can’t tell anyone else, ok?”
I’ve heard this from many teens. I am ethically bound to maintain client confidentiality, including with younger clients, except in certain specific cases. Sometimes what a teen wants to share must be disclosed for safety reasons—they are suicidal, an adult is harming them. Much more often, the topic is complex and important but does not require me to break confidentiality. Sometimes I sit with an uneasy awareness of just how much parents would want to know the thing their teen is sharing with me, that I am about to keep confidential.
- “I had sex.”
- “My friends are pressuring me to drink.”
- “I’m really good at shoplifting.”
- “I’m transgender.”
With topics like this, I have two responsibilities: first, to support a kid who is dealing with something they don’t know how to handle yet, and second, to challenge the black and white thinking that leaves teens believing “my parents would never understand!” A kid who discloses something tough to a therapist is a kid who wants help from adults. The therapeutic relationship, with its promise of confidentiality, makes asking for that help a little easier.
Right now, there is a push for policies requiring school personnel to notify parents when a student discloses they are trans. Those promoting such policies present an either/or: you can either force schools to out kids immediately, or you can have activist-led schools that will keep parents in the dark. This is false, harmful, and counterproductive. Trans youth are twice as likely to attempt suicide as their cisgender peers, and suicide attempts by trans youth increase when anti-trans legislation is passed, as is happening now around the US. In the current political climate, trans youth are terribly vulnerable. School counseling staff, teachers, and other caring adults are in a position to help. Therapists and teachers understand that teens do best with healthy, loving, supportive, and accountable relationships with their parents. We understand it is almost always better to help teens figure out how to share something difficult with their parents than to condone secrecy. What the pundits don’t understand is that confidentiality allows us to do that delicate work. Not having to break confidentiality immediately means we can take the time we need to figure out how to get the teen from, “My parents cannot know about this,” to, “I think I’m ready to tell them.”
Consider two scenarios, each beginning with a student dropping in at the school counseling office:
Scenario #1
“Hey, what would happen if I told you I was trans?”
“If you told me you were trans, I’d need to share that with your parents. I’m not allowed to keep information about students’ gender identity confidential.”
“OK, well… bye!”
Scenario #2
“Hey, what would happen if I told you I was trans?”
“What would happen?”
“Yeah, like would you have to tell my dad?”
“Oh, I see. No, that’s not the type of thing I need to tell parents about. If you told me you were trans, I’d want to know how I could support you, but it would be up to you what happened next.”
“OK, well, you’re not going to believe this.”
“What?”
“I’m trans.”
“Thank you for telling me.”
(eyeroll) “Yeah.”
“What made you decide to tell me?”
“I don’t want to feel like I’m hiding who I am all the time. I just wanted to be sure you wouldn’t have to tell my parents. My dad would literally murder me if he knew.”
“Your dad would—”
“Oh my god, not like that. He just… he hates trans people.”
“He hates trans people.”
“Yeah, anytime he sees a trans person, he has to make a shitty joke, and I’m just like, ‘you have no idea what you’re talking about!’ But I can’t say anything.”
“What do you wish you could say?”
“Ugh… like shut up? Like, just stop talking. You sound so stupid, it’s embarrassing.”
“It’s embarrassing.”
“Yeah! Like, I wish I didn’t care, I wish I could just hate him and ignore everything he says, but I can’t. Isn’t that pathetic?”
“You hope he’ll change, stop making those nasty comments.”
“Right, like I said—pathetic.”
In scenario #1, my hands are tied. This student is wrestling with gender identity and feels they can’t talk to their parents about it. If they talk to me about it any further, I’ll have to tell their parents.
In scenario #2, I can do my job. From our first conversation, I understand this student is wrestling with gender identity and fears how their dad will react. I also hear they wish things could be better with their dad. Going forward, my goals with this student would be:
- Build rapport and trust so the student is comfortable coming to me for support.
- Help the student identify other safe, caring adults in their life who can help—Dad makes transphobic jokes, but what about Mom? Is there an older sibling, cousin, aunt, or uncle who might be supportive?
- Get more information about the student’s relationship with their dad: they wish things could be better and I want to help; I won’t know how to support them with that until I know more about the relationship.
- Answer the student’s questions about using a different name or pronouns in school if and when they ask. (This might be where I lose some folks, but to me it’s a safety issue: when a kid says, “I’m trans, please call me by these pronouns,” and at least some adults in their life honor the request, that kid’s risk of suicide plummets. It’s similar to respecting a student’s decision to start going by Charles instead of Charlie, except it can save their life.)
I won’t pretend that scenario #2 is guaranteed to lead to the student coming out to their dad. But my experience with teens (as well as a robust body of peer-reviewed research) tells me scenario #2 is unquestionably better for kids and parents than scenario #1.
As I shared in my previous post about youth suicide assessments, I deeply appreciate and empathize with parents’ concerns regarding confidentiality and mental health interventions. Parents want to know what’s going on with their kids, especially when it comes to mental health. That’s normal and good. This push for forced-outing policies is another example of appropriate parental concern being weaponized for politics. Of course it is scary to imagine schools keeping information from parents. But that’s not what these policies prevent.
Let’s return to scenario #2 and imagine a couple of possible outcomes:
It’s possible that, as I get to know this student better and we talk about their relationship with their dad, I get a picture of a father who mocks and belittles his kids. “My sister was so excited about being cast in the musical–she’s in the chorus; Dad was like, ‘You know that’s not a real part, right? If you did good in the audition, you’d have a real part, so stop acting like this is a big deal.'” It’s not about the transphobic jokes. “I completely bombed my math test–I studied, but this class is really hard–it was so frustrating! When I told my dad about it, he was like, ‘So you were lazy and irresponsible, and now you want me to feel sorry for you? You’re stupid, but you’re not that stupid!'” I can appreciate why this student doesn’t feel safe to come out to their dad about being trans–or to share anything personal with him. We focus on identifying other supportive adults in their family and community whom the student can safely come out to. I neither push the student to come out to their dad, nor do I declare him a lost cause.
It’s also possible that, as I get to know the student better, I see glimmers of hope that their relationship with their dad could change. We identify other supportive adults in their life, as well as working on strategies for communicating with their dad. One day, the student shares this:
“He made another stupid joke about trans people, and I just couldn’t take it anymore. I was like, ‘Dad, what is wrong with you? That’s not funny!’”
“Woah.”
“Yeah, and at first he tried to argue with me like, ‘What? Are you some kind of precious little snowflake who gets triggered by jokes?’ And I was like, ‘No, I’m just sick of it. It’s boring, and it’s cringe! I wish you could just talk to me like a normal person…’ I don’t know what happened, but it’s like a lightbulb clicked on for him.”
“He got it.”
“Yeah! I was like, ‘Dad, remember when I was 10 and I wouldn’t stop talking in a fake British accent?’ and he was like, ‘Oh no!’ And I was like, ‘Oh yeah. That’s what you’re doing.’”
“Ohhhhh! So it wasn’t that something clicked about trans people—something clicked about the way he was repeating these jokes.”
“Yeah! And he finally stopped! I’m still not ready to come out to him yet, but I feel like he really listened to me, and I never thought that would happen.”
When a kid comes out as trans, it is not an emergency. There are predictable risks, and we should take them seriously, but it is not an emergency. Allowing trans youth to seek support from other safe adults before they are ready to come out to their parents concretely reduces suicide and other mental health risks and gives them a chance to figure out how to tell their parents. Consider: if your teen is agonizing over something important and saying, “My parents would never understand!” would you rather they be venting to a peer (“Yeah, they’d probably lock you in the house forever. Your secret is safe with me!”) or a caring adult (“I hear you–you’re worried they wouldn’t understand. I’m curious what makes you think that…”)? This is not about undermining parental authority. Though I cherish the role I get to play in teens’ lives as their therapist, I know they need their parents more than they need me. Teachers understand this, too. We want kids to have the best possible relationships with their parents. We want kids to tell their parents about important things. When a kid faces something really tricky, and they don’t know how to tell their parents yet, we are in a position to help. Forced-outing policies don’t keep parents informed about their kids–they just prevent vulnerable kids from getting help.
