Interviewing Techniques: Chapters 1 & 4

Chapter 1: Interviewing Basics

• It's primarily helping people discuss themselves.
• Begin the relationship with introductions, handshakes, and seating arrangements.
• Skip small talk; initiate with an open-ended question to encourage patient participation.
• Inform patients of note-taking; keep it brief using keywords instead of verbatim transcription
• If a patient objects to note-taking, comply with their request based on clinical judgment.

Chapter 4: Managing Early Interviews

• Minimize intrusion during the beginning phase of the interview, prioritizing active listening.
• Utilize nonverbal cues like brief pauses to allow patients time to think.
• Smiles, nods, or subtle leaning can be used, but keep it minimal
• Employ verbal encouragements such as "umm" and "hmm," but carefully avoid "yes," "right," or "good."
• Mirror the patient by repeating their last words or phrases, prompting them to elaborate.
• Provide reassurance sparingly; it builds rapport when used appropriately.
• Reassurance must be truthful, heartfelt, and relevant to the circumstance.
• It can stem from your abilities or previous experiences
• The goal is to gather necessary info for treatment planning

Chapter 5: History of Present Illness

• Transition gently from free speech into a structured exploration of the presenting illness.
• Obtain a description of symptoms, their timing, and potential contributing stressors for each identified issue.
• Begin by focusing on the current episode of illness.
• Symptoms should be viewed through a medical model and a theoretical lens.
• Capture subjective sensations, including feelings, thoughts, and behaviors.
• Clarify any descriptive terms used by the patient
• Assess vegetative symptoms relating to bodily functions influencing health and energy.
• These involve sleep, appetite, weight, energy, sexual interest, and terminal insomnia
• They're typically present in serious mental conditions
• Examine the consequences of the illness, how the mental condition impacts human interaction
• The DSM-5 definition emphasizes social consequences that affect both the individual and others.
• If legal issues arise, it often shows the illness's severity
• Establish when symptoms started and their timeline, avoid direct "when did it start" questions
• Stressors are frequently revealed during free speech; document them regardless of importance.
• Inquire about prior symptom experience to determine if there have been previous treatments
• If there has been previous treatment, get pertinent information, such as "what did you learn from therapy"
• Understand the reasons for not getting treatment before

Chapter 6: Mental Health Interview

• The history of the present illness is of utmost importance
• This is based on perspective and if there is possible danger to self, others or child abuse.
• Constantly balance information gathering with avoiding excessive detail
• Use open-ended questions for more reliable patient answers, such as "tell me about…"
• Speak in the patient's language rather than technical jargon
• Avoid using the word symptom altogether; instead, discuss thoughts, feelings, and behaviors.
• Define technical terms the patient uses to ensure a mutual understanding.
• Clarify the patient's intended meaning and directly ask if unsure
• Avoid question that begin with "why"
• Important details about symptoms include type, frequency, duration, and context
• Ask patients to define indefinite words like "seldom," "sort of," "occasionally," etc.
• Confrontations: Highlight anything needing clarification
• Approach confrontations by showing empathy
• Select words thoughtfully
• The goal of confrontation is collaboration between patient and therapist to find the truth

Chapter 7: Interviewing, and feelings

• Feelings related to the illness and the interview are significant data.
• Beginning interviewers often overlook feelings
• Interactions must be warm, caring, attentive, respectful and responsive
• Vague words are not useful
• Two strategies for eliciting emotions are direct requests, such as "how did you feel when that happened?"
• Or open-ended questions like, "could you tell me more about what that felt like to you?"
• Use empathetic reflections, immediacy, interpretation, and naming the feeling
• Address defense mechanisms, which are self-protective tools against emotions and behaviors
• Therapy involves identifying what these defense mechanisms are
• Defense mechanisms include acting out, denial, devaluation, displacement, dissociation, fantasy, intellectualization, projection, reaction formation, repression, somatization, or splitting
• Effective/adaptive responses include altruism, humor, and sublimation
• Emotional patients may feel overwhelmed, have personality disorders, family influence, anxiety or be uncomfortable with silence
• Acknowledge their emotions to reduce anxiety
• If they speak loudly, speak softly yourself
• Close-ended questions, redirection, and "time-out" options all offer potential help

Chapter 8: Personal and Social History

• Treatment involves people rather than diseases
• Comprehend the circumstances surrounding the patient's complaints
• Be healthily skeptical while gathering biographical data
• Corroborate information using external sources when possible
• Determine family dynamic and upbringing
• Uncover parents' relationships with one another
• Determine if patients have been abused; not a direct yes/no question
• Explore life as an adult, and work history
• Be aware of legal issues, religion, spirituality and social support
• Couples/Marital issues often involve money, commitment, children or family
• Recognize loss of independence and working as a unit
• If one partner has significant mental issues, it might cause difficulty
• Medical conditions might mimic mental illness symptoms, so have a PCP and regular check ups
• Ask about medical conditions directly and document all medications
• Determine personality strengths and weaknesses; avoid "why" questions
• Negative traits might include aggressiveness, anxiousness, compulsiveness, gloominess, etc.
• Personality disorders are only diagnosed when character traits are not flexible and poorly adapted to life

Chapter 9: Sensitive Subjects

• Sensitive subjects include sex, substance abuse, violence, suicide, self-harm, same-sex attraction, and conflicting thoughts/beliefs
• These can be personal and frightening to talk about
• Shed personal doubts and cast aside habits
• Discuss these topics when the time is right
• Suicidal behavior indicates risk of danger, so be aware and comfortable with asking
• Not asking means real risk
• Patient comfort comes from comfort in the interviewer
• There can be no reliance on a "no suicide" contract or absence of certain standard characteristics
• Suicidal attempts mean physical harm or death and consideration into motives
• Understand if attempts are cries for help or genuine motivation to attempt suicide
• Patients have ambivalent reactions, and attempts can be genuine cries
• Never use suicide gestures, prefer suicide equivalent
• Suicide equivalent indicates they seek reactions to suicide without attempting suicide
• Do not use "manipulative," it makes friends/family relax
• If you are a student, report patients who are a danger to themselves
• There is only a small potential for violence
• Be aware of non-verbal escalation, and monitor alarms
• There is difficulty in evaluation substance misuse, therefore encourage "loss of control"
• Street drugs issues are the potential affects with friends and family
• Approach Sex and sexuality with "let's talk about your sex life"
• Avoid loaded terms like molestation in discussions of sexual abuse
• Be careful about resurfaced trauma, and be a mandated reporter of chid abuse

Chapter 13: Clinical Interest

• Psychoses indicates hallucinations, delusions, or markedly loosened thoughts
• Organic psychosis has 3 diagnosis
• Consider medical illness or substance use
• It can be schizophrenia, and/or some sort of mood disorder
• Consider onset of disorder, and Morrison method's on disorders
• Do not affirm false beliefs
• Personality disorders must disrupt personal distress and have official categories
• Difficulty with thinking and trauma can cause cognitive problems
• Patients hide memory, so do not rely on casual discussions
• Watch for vague answers rather than surface answers
• Comorbid conditions cause anxiety
• Must talk to PCP about psychological conditions b/c physical complaints can be factors