The Psychiatric Interview: Settings and Techniques
The interview is the principal means of assessment in clinical psychiatry. Despite major advances in neuroimaging and neuro-chemistry, there are no laboratory procedures as informative as observing, listening to, and interacting with the patient, and none as yet are more than supplementary to the information gathered by the psychiatric interview.
Psychiatric interviews are analogous to the history and physical in a general medical assessment, and they share the ma-jor features of other types of medical interviews (Mackinnon and Yudofsky, 1986); they systematically survey subjective and objec-tive aspects of illness, and generate a differential diagnosis and plan for further evaluation and treatment. They differ from other medical interviews in the wide range of biological and psychoso-cial data which they must take into account, and in their attention to the emotional reactions of the patient and the process of inter-action between the patient and interviewer. The nature of the in-teraction is informative diagnostically and is a means of building rapport and eliciting the patient’s cooperation, which is especially important in psychiatry (Reiser and Schroder, 1980). The style and content of a psychiatric interview are necessarily shaped by the in-terviewer’s theory of psychopathology (Lazare, 1973). Thus, a bio-logical theory of illness leads to an emphasis on signs, symptoms and course of illness; a psychodynamic theory dictates a focus on motivations, attitudes, feelings and personal interactions; a behav-ioral viewpoint looks at antecedents and consequences of symp-toms or maladaptive behaviors. In past times, when these and other theories competed for theoretical primacy, an interviewer might have viewed exploration from a particular single perspective as adequate. However, modern psychiatry views these perspectives as complementary rather than mutually exclusive, and recognizes the contributions of biological, intrapsychic, social and environ-mental factors to human behavior and its disorders (Leigh and Reiser, 1992b). The interviewer, therefore, faces the task of under-standing each of these dimensions, adequately surveying them in the interview, and making informed judgments about their relative importance and treatment implications (Shea, 1990).
The written psychiatric database, the mental organization which the interviewer maintains during the interview, and the structure of the interview itself may differ considerably from one another. The written psychiatric database is an orderly exposition of information gathered in the interview, presented in a relatively fixed format. The mental organization of the interviewer consists of questions and tentative hypotheses. It evolves flexibly over the course of the interview, and is determined by the goals of the in-terview and emerging information which indicates needed areas of focus (Lazare, 1976).
The third structure is that of the interview itself. While guided by general principles of interviewing, this structure is the most flexible of the three, being determined not only by the purpose of the interview and the type of problem which the patient presents, but also by the patient’s mode of communication and style of inter-action with the interviewer. Thus, the interviewer must hold his/her own structure in mind while responding flexibly to the patient.