In most teen therapy, the details of what a teen says stay private, while parents hear the broad picture: how treatment is going, general goals, and anything serious about safety. The exact rules depend on your teen's age, the type of care, who consented to it, and the setting. Ask the therapist to explain their approach to you and your teen together at the start.
Part of our guide: A Parent’s Guide to Child and Teen Mental Health
Clinicians are expected to talk about this up front. AACAP guidance on assessment lists confidentiality as a topic to cover with parents and to discuss with the child in developmentally appropriate terms.
If your child talks about suicide or self-harm, or you think they are in danger, call or text 988 (988 Suicide & Crisis Lifeline), call 911, or go to the nearest ER.
This article is general information from New York and federal sources. It is not legal advice. Rules vary and can change, so ask your clinician or a lawyer about your own situation.
Why teens need some privacy in therapy
Teens tend to speak more freely when they know their words will not be repeated at the dinner table. Without that trust, many will say only what is safe for a parent to hear, and the therapist will be working with half the picture. Privacy also gives a teen practice at handling their own health care. It does not shut you out. Parents usually remain an important part of care, and the differences between teen and adult therapy often come down to this balance.
What parents are usually told, and what they usually are not
| Usually shared with parents | Usually kept private unless there is a safety concern |
|---|---|
| Practical matters such as scheduling, costs and attendance | The specifics of what your teen says in session |
| General goals and whether things are moving forward | Details about friendships, crushes and everyday conflicts |
| Diagnosis and treatment recommendations, often discussed together | Thoughts or feelings about you, unless your teen chooses to share them |
| Medication recommendations, which usually need your consent | Experimentation or risk-taking the therapist judges not dangerous (practices vary) |
| Anything that raises a serious safety concern | Private writing or messages a teen chooses to show the therapist |
This table describes a common approach, and each therapist draws lines somewhat differently. Sensitive topics such as sexual health, substance use and gender identity can have their own considerations, so ask how they are handled.
When a therapist may have to share information
Danger to your teen or someone else
This is the limit parents care most about. If a therapist believes a teen is in serious danger, the plan will usually involve parents. Joint federal guidance on HIPAA and FERPA says that if a provider believes a minor presents a serious danger to self or others, the privacy rule permits disclosure to a parent or other person who is reasonably able to prevent or lessen the threat, where the provider has a good-faith belief it is necessary and it is consistent with applicable law. Therapists use clinical judgment here. Not every mention of a dark thought leads to a phone call, and an assessment of risk comes first.
New York's Mental Hygiene Law section 33.13, which governs confidentiality in licensed and state-operated facilities, also has provisions on releasing information when needed to prevent imminent serious harm, or to warn an endangered person and law enforcement when a treating psychiatrist or psychologist finds a serious and imminent danger. These provisions allow release under the conditions in the law, and they state that they do not impose an obligation to release.
Suspected abuse or neglect
New York Social Services Law section 413 makes psychologists, social workers, licensed mental health counselors, physicians and other listed professionals mandated reporters. They must report when they have reasonable cause to suspect that a child coming before them in their professional capacity is an abused or maltreated child. Therapists generally explain this limit at the outset.
Other legal situations
Court orders and certain other legal processes can also affect confidentiality. Ask your clinician how they handle those.
What New York says about records
Parents often ask whether they can see the chart. In general, New York lets a parent request access, with limits meant to protect the teen's care. Which law applies can depend on the setting.
- Licensed mental health facilities. Under Mental Hygiene Law section 33.16, a parent can ask in writing to inspect records of care for which parental consent was obtained or requested. Access can be denied if the treating practitioner decides it would harm the professional relationship with the minor, the minor's care, or the minor's relationship with the parents. A patient over age twelve may be notified of a request and, if they object, the facility may deny it after consulting the treating practitioner.
- Many other licensed health care providers. Public Health Law section 18 has similar language: a provider may deny a parent's access on those grounds, and a patient over twelve may be notified and may object. It also excludes a practitioner's personal notes and observations from patient information, under the conditions in the law. If access is denied, the person must be told about the right to a review.
- Federal privacy law. Under HIPAA, a parent is generally treated as the minor's personal representative, with exceptions, and state law controls where it speaks directly to parental access. A provider can also decline to treat a parent as a representative if there is a reasonable belief of abuse or neglect or endangerment, and professional judgment supports that decision.
So you may have some right to request records, but that is different from a right to hear everything your teen says. Asking for the full chart can also affect your teen's trust, so talk with the therapist before you request it. Often a family meeting gets you what you actually need.
When a teen consents to their own care
In New York, the consent rules for a minor's outpatient mental health care depend on the setting. Mental Hygiene Law section 33.21 and an August 2025 Office of Mental Health memo say a practitioner in a program licensed or operated by the Office of Mental Health may provide outpatient services without parental consent if the minor knowingly and voluntarily seeks them, they are clinically indicated and necessary, and a listed condition is met. Those conditions are that a parent is not reasonably available, that requiring parental involvement would harm the course of treatment, or that a parent has refused and a physician finds treatment necessary and in the minor's best interests.
Some young people under 18, such as those who are married, emancipated, or parents themselves, are not treated as minors for this purpose. Under HIPAA, a parent may not be the personal representative for care the minor lawfully consented to alone, or where the parent agreed to confidentiality between the provider and the minor. The memo notes that it does not address providers outside Office of Mental Health licensure, so what applies in a private practice may differ. Ask, and see minors and consent in New York.
How to set this up well
- Ask for a joint conversation at the start. Have the therapist explain the limits to you and your teen in the same room, so that everyone hears the same thing.
- Ask specific questions. What would you tell me about substance use? About self-harm? About sex? If you were worried about my teen's safety, how fast would I hear?
- Agree on how you will get updates. Ask how often, in what form, and whether your teen will be present or told beforehand.
- Ask about billing and portals. Claims, statements and patient portals can show that care happened and sometimes more. Ask the intake team how these work for your family.
- Share custody details. If parents are separated or there is a custody order, tell the clinician early. Who can consent and receive information may depend on it.
You can still share what you see
Confidentiality mostly limits what the therapist tells you. It does not stop you from telling the therapist what you are noticing at home. Your observations are often very useful. Tell your teen that you are doing it, so it does not feel like going behind their back.
Often the best route is through your teen
Many therapists encourage teens to share difficult things with parents themselves, sometimes with the therapist's help in a family session. If you are worried, ask the therapist: "Is there something you think my teen should tell me, and how can we get there?"
When you are worried about a specific risk
Tell the therapist right away what you are seeing. If your teen is self-harming or having suicidal thoughts, read if your teen is self-harming and teen suicide warning signs. In an emergency, do not wait to hear from a clinician. Use 988, 911 or the nearest ER.
The child and adolescent psychiatry and therapy page explains how care for teens works here, and your clinician can walk you through the practice's own privacy policies. Costs are covered on the fees and insurance page.
FAQs
Will the therapist tell me if my teen is using drugs or alcohol?
It depends on the level of risk, the setting and the rules that apply. Federal rules for certain substance use programs may also apply. Ask at the start how this is handled. This is general information, not legal advice.
Can my teen see a therapist without telling me?
Sometimes. In New York, Office of Mental Health guidance describes limited situations in which a minor can receive outpatient care without parental consent at a licensed program. Rules differ by setting, so ask the provider or a lawyer.
Do confidentiality rules change at 18?
Yes. In general, an adult controls their own health information, so parents would usually need the young adult's permission. It helps to talk about this before the birthday.
Can I read my teen's therapy notes?
You may be able to request records, but access can be limited. New York law allows providers to deny access on certain grounds, and a practitioner's personal notes are treated differently. Talk with the therapist first.
