Adolescent Psychotherapy: A Comprehensive Guide to Initial Clinical Interviews and Key Assessment Questions

Adolescence is a critical developmental stage characterized by identity exploration, peer influence, and the formation of early emotional relationships. These factors often expose adolescents to psychological stress and emotional challenges. In this context, adolescent psychotherapy serves as both a supportive and educational tool.

The initial psychotherapy session plays a dual role: it provides the therapist with essential clinical information while establishing a therapeutic alliance, which is crucial for effective treatment. According to Sommers-Flanagan & Bequette (2013), the success of the first session depends on skillfully managing five key stages: introduction, opening, body, closing, and termination.

Stages of the Initial Interview with Adolescents

1. Introduction of therapy secession

The main goal of this stage is to reduce anxiety and create a safe environment for the adolescent:

• Provide a brief, friendly self-introduction
• Explain confidentiality limits (e.g., risk of harm to self or others)
• Emphasize the supportive, non-judgmental nature of therapy

Example questions:

• “Would you prefer I mostly listen, or provide my feedback as well?”
• “What topics would you like to focus on today?”

2. Opening of therapy secession

In this stage, the therapist encourages the adolescent to share freely:

• Use open-ended and empathic questions
• Avoid excessive control to reduce resistance

Example questions:

• “What has been occupying your thoughts lately?”
• “Which area of your life would you like to explore first today?”

3. Body of therapy secession

The body of the interview is the main section, focusing on family dynamics, emotional experiences, and social relationships.

1. A) Family and Parent Relationships

• “How would you describe your relationship with your parents?”
• “How do you feel when your parents don’t seem to understand you?”
• “Who in your family provides you with the most support and security?”

1. B) Emotions and Loneliness

• “What is the hardest part of being alone for you?”
• “When do you most often feel anxious or lonely?”
• “If you have unusual or distressing experiences, could you tell me about them?”

1. C) Peer and Romantic Relationships

• “What draws you toward older peers?”
• “How would you describe your friendships with peers your age?”
• “What kind of relationship do you hope to have, and what makes you uncomfortable?”

4. Mild Interpretation and Therapist Feedback

In most initial sessions, formal interventions are unlikely. However, therapists can use mild interpretations or interpersonal feedback to strengthen the therapeutic alliance and assess how adolescents respond to the therapy process.

Example feedback statements:

• “It seems like you are very hard on yourself.”
• “When you talk about your father, I sense both love and anger.”

Example clinical dialogue (Shirk et al., 2011):

• Therapist: “How do you feel when you are really down?”
• Client: “I don’t want to talk to anyone. I just want to be left alone.”
• Therapist: “You need some space and don’t want to feel pressured.”
• Client: “Exactly.”
• Therapist: “Here, I will ask a lot about your feelings. If you ever feel pushed, could that make you not want to talk with me?”
• Client: “I don’t think that will happen because you’re not in my face. Talking helps me release stress… On days when I feel bad, I look forward to our sessions because I know you understand me.”

This approach helps both relationship-building and assessment of tolerance for feedback or interpretation during therapy.

5. Closing of therapy secession

• Summarize key points from the session
• Validate the adolescent’s effort and participation
• Ask about priorities or topics for the next session
• Encourage hope and motivation

Example question:

• “Which topic from today would you like to focus on next time?”

6. Termination of therapy secession

• End the session respectfully and clearly
• Explain the next steps if therapy continues
• Offer short-term strategies for emotional coping if needed

Key Clinical Questions for Adolescent Assessment

• What has been worrying or upsetting you recently?
• How do you feel when your parents do not seem to understand you?
• What is the hardest part of being alone?
• In your relationships with friends or others, what makes you feel happy or uncomfortable?
• Who provides the most support and sense of safety in your life?
• Which topics would you like to focus on in the next session?

The initial session with an adolescent combines clinical assessment and therapeutic relationship-building. Using open-ended questions, exploring emotional and family dynamics, and providing mild feedback or interpretations, therapists can strengthen the therapeutic alliance while gathering valuable clinical information. This structured approach lays the foundation for effective adolescent psychotherapy and helps guide future sessions.

References:

• Sommers-Flanagan, J., & Bequette, T. (2013). The initial psychotherapy interview with adolescent clients. Journal of Contemporary Psychotherapy, 43(1), 13–22.
• Shirk, S. R., et al. (2011). Sample clinical dialogue and therapist feedback