Dear Therapist:

Our 14-year-old son has been seeing a therapist for a few months on the advice of his yeshiva. Recently my husband discovered that he has started smoking. It was disappointing and confusing to us that our son told us that his therapist has known for a while that he was smoking. I am very disappointed that the therapist didn't deem this information important enough to share with us, his parents. I would like to hear your option on whether it is considered the norm for a therapist not to tell the parents this kind of information. 

Response:

As a parent myself, I definitely relate to your feelings. It can be very frustrating when something involving our kids is kept from us. As parents, we may feel that we should have as much information about our kids as possible. The sense (rightly or wrongly) is that the more information we have, the better informed our decisions will be.

However, when a teenager is seeing a therapist, this seemingly simple concept becomes somewhat murkier. For most people, the therapeutic relationship is considered sacred. If discussions between my therapist and me are not necessarily confidential, I will be hesitant to be completely open. In fact, if I think that my therapist might discuss our session content with others, even the things that are discussed can be tainted by a lack of trust. Teenagers specifically often generally feel a need for freedom and choice. A break of trust in the therapeutic relationship could easily mark the end of the relationship—and any progress previously achieved.

Certainly, smoking is problematic. I think we can agree that your son should not be smoking. The question is whether a breach of confidentiality on the part of the therapist was likely to do more harm than good. Teenagers typically are in the process of developing a sense of autonomy. This both includes the concept that they can make their own decisions, and is the time during which they make—and learn from—their mistakes.

What is it about not having been told about your son’s smoking makes you feel disappointed? Is it simply that you would have wanted to know, or do you believe that you could have done something about it? If the latter is true, what action might you have taken?  Would you have had a frank conversation with him, hoping to understand the reasons for his actions? Would you have tried to help him identify other issues possibly related to smoking? Would you have tried to get him to stop? If so, have you been able to stop him from smoking now that you know about it?

If your goals would have been to help him understand the issues surrounding his decision to smoke, these are ostensibly what you hired his therapist to do. Granted that therapists do not replace parents, but specifically with regard to identification of—and working through—issues, the client-therapist relationship is often more effective than the child-parent one. Even if you could have gotten him to stop smoking (and somehow known that he wasn’t doing so outside of your presence), would this have been enough of a victory to negate any detriment to the therapeutic alliance?

There are likely feelings and needs that underlie your son’s smoking. These may relate to his development of a sense of self and to the related need to be liked. Solving the symptom does not address the larger issue. In fact, in some cases it can lead to other, more troublesome actions. I obviously don’t know what his therapist’s rationale was, but if you trust their judgement in general, there may have been a good reason for the decision not to discuss your son’s smoking with you. If you feel that the therapist doesn’t understand your concerns or the nature of your relationship with your son, you can schedule an appointment to discuss these.

-Yehuda Lieberman, LCSW

 psychotherapist in private practice

 Woodmere, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 516-218-4200

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