Letter to a Stepdaughter’s Therapist: Is the Letter Confidential?

Reader’s Question

My husband’s ex-wife started taking my 15 year old step daughter to see a therapist. My husband would take his daughter to every other appointment. I was asked to come in and meet with the therapist and my husband joined us. At the end of the meeting I was asked to come back again in the future. I had not gone back yet for another meeting. We just recently had a questionable abuse situation with the ex-wife and stepdaughter and I wrote a letter to the therapist, telling her that I was very concerned. She shared my letter with the ex-wife and the step daughter. I assumed this information would be confidential. Was I wrong to expect confidentiality, or was she out of line for sharing any information that I gave her? I never signed a release of information form.

Our Consulting Clinical Psychologist’s Reply

This situation gets ethically and legally confusing. From a professional standpoint, the primary issue is who is the patient? In this situation, the legal patient is the 15 year-old stepdaughter and as her mother has legal custody, they are the legal/ethical patient. The legal right of confidentiality belongs to the patient — not the therapist or anyone else. In this situation, you and your husband have no expectation of confidentiality. This is especially true if there is reason to believe that child abuse is involved. In issues of suspected child abuse, the therapist is legally required to address the concerns — even to the point of violating confidentiality. In these situations, the therapist is legally required to act, with or without a signed release of information. Keep in mind, as you are not the legal patient, there is no issue related to a release of information.

Overall, you were not wrong for expressing your concerns to the therapist. As the situation involved possible child abuse, the therapist was not wrong in sharing the information with the mother and stepdaughter. The therapist was not wrong in not informing you of her intention to share the concerns with the mother and stepdaughter. Nobody did anything wrong. All these decisions were done in the best interests of the child — which is the legal guideline. Everyone was ethical and legal — it’s just a very sticky situation. I would hope the therapist would help mend any misunderstanding that may have arisen in this situation. It is hoped that everyone would focus on helping the stepdaughter, perhaps enlisting all adults in the situation to work together with the common goal of helping the stepdaughter.

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