Special Assessment Techniques
In certain situations, special assessment techniques may be indi-cated in the psychiatric evaluation of patients who are unable or unwilling to cooperate. These situations include the assessment of patients who are mute, have amnesia, or intentionally provide false information. In general, special techniques are employed only after all conventional ways to obtain the necessary informa-tion have been exhausted, including the use of other informants where available and appropriate.
Hypnosis can aid in the recovery of repressed memories. For example, a patient who presents with a conversion symp-tom may be able to recall the forgotten traumatic events that precipitated it. The usefulness of hypnosis is limited by the pa-tient’s susceptibility to the procedure and by concern that the interviewer’s suggestions can produce false memories.
Another approach available for similar purposes is to use a sedative during the interview to produce disinhibition and allow the patient to speak more freely or access otherwise unavailable memories. Intravenous amobarbital sodium is the best known of the medications used for this purpose. Caution must be exercised to avoid oversedation, to monitor for side effects of the medica-tion, and to ensure that the interviewer does not inappropriately influence the patient’s answers.
The assessment of a patient who is suspected of intentionally providing false information or malingering can become uncomfortable and problematic because it may require techniques that seem at odds with the establishment of the therapeutic alli-ance. A careful assessment of the patient’s motives, confronting the patient with inconsistencies, physical assessment of implau-sible somatic complaints, and the use of other informants, prior medical records and other documents can all help establish the validity of what the patient is saying. When the case involves the commission of a crime, an assessment of the patient’s capacity to understand his or her actions may be important for the disposi-tion plan.
However, because psychiatric evaluation depends on what the patient tells the interviewer and there are few objective means of clarification, it is best for the interviewer not to be overly con-cerned about the possibility of being intentionally misled. Estab-lishing the truthfulness of the patient’s story usually takes place over an extended period.