The Foundations of Psychiatry

By Silvano Arieti | Go to book overview

CHAPTER 53

THE PSYCHIATRIC
INTERVIEW

Ian Stevenson

THE PSYCHIATRIC INTERVIEW as practiced in most American psychiatric facilities has undergone a marked change during the past 60 years. Formerly a question-and‐ answer type of interview satisfied the requirements of psychiatric interviewing, as it did and still does satisfy those of medical history‐ taking with regard to exclusively physical illnesses. But the modern psychiatric interview, although it includes questions, puts much more emphasis on a free-flowing exchange between the psychiatrist and the patient. This alteration in our practice has resulted from changes in the kinds of information we want about patients and in our ideas of how we can best obtain this information. We also have learned the limitations of verbal communications. We now notice not only what the patient says but also his manner of saying it, for this may show what his words conceal. And we have learned that, when two people talk together, what they say depends not only upon what they want to tell each other but also upon what they think about each other. In what follows I shall discuss first the information a psychiatrist usually wishes to obtain in an initial interview, next how the psychiatrist's relationship with the patient influences what the patient tells him, then the psychiatrist's optimal attitude, and finally some techniques that can increase the yield of an interview.

Both the theory and technique of psychiatric interviewing receive attention from American research psychiatrists, although not as much as they should. We may hope that from their efforts will emerge changes fully as great as those that the last 60 years have brought. This will require, among other things, that each of us challenge constantly his own habits and remain unwilling to practice, for the rest of his lifetime, only whatever his teachers have taught him.

I shall discuss the psychiatric interview chiefly with regard to the initial evaluation of a patient. Sometimes we can achieve this in one interview, but quite often we need several. Moreover, the initial interview or interviews should blend with the psychiatric exam

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