Interviewing in Psychiatry (Interviewing skills in mental healthcare settings) Psychiatric interview

The purpose of a psychiatric interview is to establish a therapeutic relationship with the patient to collect, organize and formulate a differential diagnosis and treatment plan. A fundamental part of this interview is to establish rapport and foster a healthy healing therapeutic relationship.

History taking is the first step and interviewing skills are the most important tool to a psychiatrist. Given the nature of the discipline, most clinical diagnoses are made based on
the available information. Hence eliciting adequate information, analyzing and organizing it to reach a conclusion is a very important skill.

To be able to elicit important information the interviewer needs to know certain specific skills
1. To be able to establish a rapport
2. Empathy and listening skills
3. Interview technique

History taking is a Clinical interview, the focus of which is to obtain adequate information in order to arrive at a clinical diagnosis. There may be a lot of contextual information related to circumstances, events and psychosocial stressors which may be important to understand the person’s reaction and significance of the event but may not be relevant for clinical diagnosis. Hence the interviewer may need to filter these out. The interviewer should be non-judgmental and empathetic in approach to the interview. Certain questions may need to be asked in a specific set manner to elicit correct information and eliminate subjectivity in interview techniques and make the process of eliciting information reproducible.

The clinician needs to be mindful of the sensitive nature of this interview and provide a safe environment for the patient to reveal such deeply personal information. The clinician needs to be mindful that patients may have disagreements with the clinician’s diagnosis and recommended treatments. Nothing in medicine is more stigmatized than mental health and substance misuse, hence mental health professionals need to be sensitive about this issue.

The nature of the psychiatric interview is getting the patient’s narrative. Facilitate the patient’s narrative with compassionate listening and reflection. Mindfulness and reflection is a form of mentoring through modeling for the patient.

Establishing rapport is probably the most important step in history taking. Especially when interviewing psychotic patients with poor insight, eliciting personal information like interpersonal issues, sexual history, sexual abuse etc. Introduce yourself and set the agenda of the interview by stating that you would be asking questions to understand the reason for consultation/admission.

Address the patient by name – this is a user to gain the trust of the patient. Ensure confidentiality by making an explicit statement that information discussed with not be revealed without consent

Always interview the patient first and get her version of the history. This is also vital in cases where patients have poor insight and psychopathology involving the informants

Start with neutral questions such as occupation, education, family details, and so forth. Begin with open-ended questions such as ‘what brings you to the hospital?’

Note the presenting complaints with duration in chronological order

Elaborate on the chief complaints by directive questioning.

Use close-ended questions (Yes/No) for eliciting specific information and negative history

Use paraphrasing to make empathic statements

Follow the cues given by the patient and pick up leads for further questioning

Summarize at the end of the interview

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