Conflicting Parents, a 14-Year-Old, and a Records Demand
A 14-year-old girl has been in therapy for three months at a Maryland group practice. Her parents divorced two years ago and share joint legal custody; the custody order contains no restriction on either parent's access to health information. The father signed the consent for treatment. In session the girl discloses that she has been cutting her thigh, has had two episodes of binge drinking, and is dating a 15-year-old girl; she begs the therapist not to tell her mother, who she says is 'always critical' and would 'make everything worse.' The mother now emails demanding the complete record and specifically asks whether the daughter is sexually active and whether she has been self-harming. The father sends a separate email saying he does not want the mother to receive anything. The therapist has not yet responded to either parent. The practice director wants the therapist to handle it without involving the practice's attorney.
1. Who may consent to treatment and who may access the record? How should the therapist respond to each parent?
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The client is the 14-year-old, but the parents are the legal decision-makers. With joint legal custody, both parents generally have authority to consent to treatment and to access the minor's health information unless the custody order says otherwise. The therapist should first obtain and read the custody order, confirm that the father's consent was valid, and check the practice's intake documents. The therapist should not promise the daughter blanket confidentiality; at the start, the therapist should have explained that parents may have access and that safety information will be shared. Now the therapist should respond to both parents in writing: to the mother, acknowledge the request but explain that the therapist is reviewing the record and the custody order; to the father, explain that joint legal custody generally gives both parents access and that the therapist cannot withhold records solely because he objects. The therapist should offer a treatment summary and a family meeting, and should release only the minimum necessary. If the parents' conflict makes release harmful, the therapist should seek legal advice or a court clarification rather than choosing sides.
2. How should the therapist handle the disclosures of self-harm, alcohol use, and the 15-year-old partner?
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Self-harm and binge drinking are safety issues, not ordinary secrets. The therapist should assess the cuts: depth, infection, suicidal intent, frequency, and whether the daughter has a plan. If the risk is imminent, the therapist must involve the parents and emergency services even over the daughter's objection. If the risk is ongoing but not imminent, the therapist should develop a safety plan, discuss how and when to inform the parents, and document. The sexual relationship with a 15-year-old is not automatically reportable child abuse in Maryland; the therapist should assess for coercion, exploitation, age difference, and whether the daughter is safe. The therapist should not disclose the daughter's sexual orientation to the mother as a behavior issue; that would be unnecessary and damaging. If there is any indication of abuse by an adult or an older adolescent, the therapist must report under Family Law Article §5-704 and §5-705. The therapist should also address alcohol use and consider a referral for substance use assessment.
3. The mother threatens to file a Board complaint and demands the full record that day. What should the therapist do?
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When parents conflict, the therapist's job is to follow the custody order and the law, not to become an advocate for either parent. The therapist should document the mother's demand, the father's objection, the custody order language, and the clinical reasoning for what is released. The therapist should not release the full record the same day. A reasonable response is: 'I have received your request. Because the records contain sensitive information and there is a dispute between legal custodians, I am reviewing the custody order and will respond within a specified time.' The therapist should provide a summary, redact third-party information, and avoid process notes that could harm the child. If the mother files a Board complaint, the therapist should keep the record intact and respond truthfully; a complaint is not a reason to alter records or to release more than is required. If the parents cannot agree, the therapist may ask them to obtain a court order or to agree on a neutral summary.