Including Parents in 'Split Alliance' with Teens Is Prudent Strategy. (Malpractice Risk Management)

Article excerpt

NEW YORK -- For psychiatrists who work with adolescents, malpractice risk management requires taking measures aimed at maintaining amicable relations with the parents as well as the patient and attention to complex confidentiality issues, Dr. Alan J. Tuckman said at the annual meeting of the American Society for Adolescent Psychiatry.

This is an area in which psychiatrists' personal beliefs and idiosyncratic clinical theories may be at odds with standard practice. "I believe very strongly that protecting yourself is much more important than maintaining some vague principle that only you may believe in," said Dr. Tuckman of New York University.

The tendency to "treat adolescent patients as if they were adults" is potentially dangerous, particularly if doing so leads a psychiatrist to maintain all confidences and avoid conversations with parents for fear of jeopardizing the therapeutic alliance. "This may be one of the most important underlying bases for malpractice actions brought by parents," Dr. Tuckman said.

If confronted by such a lawsuit, "while you may be able to find psychiatrists to testify that the adolescent alone was your patient and that the parents could not be part of the treatment, I believe you would be hard put to convince a jury of that," he said. "Jurors themselves have strong feelings about parenting and rights of parents."

It is necessary to have a "split alliance" that includes parents as well as the adolescent patient, and it is especially important to maintain communication with parents who don't initiate contact with you on their own, he said. …