Article By: Dr. Martha Durham
Contributing Writer

When you bring your child into therapy, you both enter a relationship with me. My goal is
to develop a therapeutic relationship with your child. Still, you are a part of that
relationship as well. The relationship we build requires an explicit contract. It is not a
friendship or family relationship. It should, however, feel like a healthy, effective
relationship; and that should feel close and friendly. If the boundaries of the relationship
are explained and understood, things can be straightforward. A healthy therapeutic
relationship is so important that psychologists and other types of mental health
providers are ethically and legally bound to maintain client confidentiality. Confidentiality
ensures that clients feel safe to say anything.
Understanding the differences between a therapeutic relationship and a friendship is
important. Friends and family might want you to be happy, feel good, and like them.
They might stay silent when they think you are wrong because they do not want to fight
with you. Conversely, they might be in a bad mood, boss you around, and pick a fight
with you. Friends and family are great people but may be biased. They may want you to
live your life in a way that makes them comfortable, and that may not be right for you.
In contrast, in a therapeutic alliance, the focus must be on what is best for clients. I
need to model a healthy, effective relationship that is often caring, friendly, nurturing,
and everything we want from our friends and family. However, in therapy, sometimes my
job requires me to bring up subjects that may be difficult. Clients need to feel safe to tell
me anything. That information can cause them to be vulnerable to me. Children need to
build trust and allow themselves to be vulnerable, just like adults. A solid therapeutic
relationship is the only way a child or adult can feel safe enough to be vulnerable.
Vulnerability is the key to healing, and vulnerability requires trust.
In developing a solid relationship, your child may want to tell me things they do not want
to say to you. If what they tell me is not dangerous and does not violate your family
rules, then I want them to feel safe to do that. You, of course, need to approve what can
be confidential and what must be shared for your child's safety. I am a parent, too, and
like you, I expect providers to respect my family's rules. Confidentiality is important
because I will know your child's and your family's information; and you need to trust me
to guard your privacy. You need to understand that I will never use personal information
in a way that might harm or judge them.
So, what do I mean by “dangerous” and "family rules?" In an initial session, I talk to
parents and children to discuss what can be kept confidential between their child and
me. Things that should not be confidential include anything that can result in serious
physical, mental/emotional harm to your child. We also define what can and cannot be
kept confidential from parents. For example, if there is a strict no-smoking policy in a
family, and a child client mentions smoking, the parents must know. Talking about those
rules together helps kids understand the rules. Parents are always welcome and
included in therapy with an understanding that the work is with their child. Parenting is
an important part of therapy, so it is important to keep parents involved.

What I Should and Should Not Do in a Therapeutic Relationship
I should be on time. I should keep appointments and keep them the same. Emergencies
happen for everyone, but consistency and stability are essential in therapy. I should get
to know your child and your family history appropriately. I should guide sessions using
those details, but I expect my client to participate and share. I should let you know if I
am not well trained in an issue (for example, Attention Deficit Hyperactivity Disorder) If
I'm not, I should refer you to a specialist therapist. I should keep us on track and work
toward our established goal. I should know when we are at the end of our working
relationship and have helped your child. You understand that effectively ends our
therapy. If new issues arise, I should welcome you and your family back to treatment.
I should rarely self-disclose, and only if it helps with therapy. Occasionally, clients,
especially children, want to know personal details. On a case-by-case basis, I make
choices about those questions. Some details that are not too personal are okay to share
if they help clients trust. If clients ask too many personal questions, this may be an
attempt to avoid therapy.
I should not gossip or share inappropriate personal details, and I should not let my
issues impact the work we do. If I am having overwhelming issues, I am responsible for
handling them privately and rescheduling if necessary. I should not come into your world
like a family member or close friend. I should not be at parties or special events, with a
few particular exceptions that are determined on a case-by-case basis. For example, I
worked with a high school-aged client without family support. One parent was
disengaged, and the other parent died when my client was a young child. One evening,
my client reached out and was terrified. She needed to go to the hospital for a severe
medical issue. I met her at the ER, walked her through the process, and waited with her.
Would I do that again? In that specific set of circumstances, I would. I have never had to
do that again.
What are you responsible for in our relationship?
It is my job, not yours, to teach you and your child the rules of our contract and how to
keep the boundaries of our relationship. It is your job to understand that not being
friends or family is best for you and your child and allows clients to reach their full
potential. I will do everything I can to keep our relationship healthy and effective. It's a
business relationship that is compassionate, empathetic, and helpful. It is also
sometimes difficult, stressful, and anxiety-provoking because we dig into painful areas
sometimes, which is hard for children and adults. Clients might wonder if we can
genuinely care about them if this is a business. The answer is YES! I provide a service
that makes me feel I contribute positively to the world. There is something in it for me. It
feels good to help others reach a goal, heal, gain confidence, and grow. When clients
have reached that goal, it is time to stop therapy, and that is sometimes sad for us like a
graduation can be.