Should a 15-Year-Old Girl Be Accompanied by a Relative During Psychiatric Intake if She Doesn't Want Them Present?
No, the 15-year-old should be interviewed alone if she expresses discomfort with her relative's presence, as an individual interview with an adolescent is essential and allows her to freely discuss conflicts not easily divulged with parents present. 1
The Essential Nature of Individual Adolescent Interviews
The American Academy of Child and Adolescent Psychiatry explicitly states that an individual interview with an adolescent is essential, with its importance increasing coincident with the child's increasing age. 1 This is not optional for adolescents as it is for younger children.
- Interviewing the adolescent alone allows her to freely discuss conflicts that may not be easily divulged with parents present, and this is particularly true with adolescents. 1
- Individual interviews help adolescents share their history more freely, and confidentiality should be maintained wherever possible. 1
Respecting Adolescent Autonomy and Confidentiality
The guidelines are clear about respecting the adolescent's developmental stage and desire for privacy:
- As the child becomes an adolescent, confidentiality becomes more complicated, and the adolescent's desire for confidence is respected unless an issue of dangerousness precludes maintaining confidentiality. 1
- The adolescent should understand what information will be shared with the guardian and what will remain confidential, respecting her preferences unless significant safety risks arise. 2
Recommended Interview Structure
While both family and individual components are valuable, the structure should accommodate the adolescent's expressed preference:
- Begin by conducting a portion of the intake with the family present to gather collateral history and observe family interactions. 1, 3
- Then transition to interviewing the 15-year-old alone, which is the essential component for adolescent assessment. 1
- Consider a separate parent interview without the adolescent present to allow parents to freely discuss their relationship and provide differing views. 1
Critical Confidentiality Framework
Establish clear boundaries at the outset:
- Parents should be made aware that the adolescent will have confidential time, and information will only be shared if there are safety concerns such as suicidal ideation or dangerousness. 1
- Document your confidentiality discussion and the adolescent's capacity to participate meaningfully in her care. 2
Common Pitfalls to Avoid
- Do not insist on the relative's presence simply because she is a minor—this violates the guideline that individual adolescent interviews are essential. 1
- Do not refuse to see the patient because the guardian is absent or unwilling to participate; assess the adolescent's capacity for meaningful participation in her care. 2
- Do not maintain rigid interview structure when the adolescent's discomfort with family presence is evident—flexibility is key to establishing rapport and obtaining accurate information. 1, 3
When Family Presence Is Required
The only exceptions where you would override the adolescent's preference are:
- Immediate safety concerns such as acute suicidal ideation or severe medical instability that require surrogate decision-making. 2
- Legal custody issues where the parent must provide consent for treatment initiation. 1
- When the adolescent lacks decision-making capacity for the specific clinical matters at hand. 2
Practical Implementation
- Plan for 1-2 hours total, allocating time for both family observation and essential individual adolescent interview. 1, 3
- Use a comfortable room that facilitates rapport and privacy for the individual portion. 1, 3
- When family members fail to attend despite requests, proceed with interviewing the adolescent alone while remaining attentive to the absence and its meaning. 1, 2