1.02 Clinical Interviewing

🔍 Topics & Tags

#psychiatric-intake, #interviewing-techniques, #m4-pgy1

Metadata

Podcast:: Psychiatry Boot Camp
Episode:: 1.02 Clinical Interviewing
Link:: Listen on Spotify Embed: Listen on Spotify

🧠 Pre-Listening Quiz

1. Which of the following best enhances therapeutic alliance in a first encounter?
A. Leading with a detailed medication history
B. Using the patient’s preferred name and attuned body language
C. Offering interpretations before hearing the full history
D. Delaying eye contact to avoid intimidation

2. What is the most effective approach when interviewing a paranoid patient?
A. Intensify affective reflection to show empathy
B. Maintain neutrality and avoid over-alignment
C. Use self-disclosure to increase perceived trust
D. Ask them to write down their thoughts instead of speaking
3. In structuring the psychiatric ROS, which domain is commonly under-assessed?
A. Psychosis
B. Eating disorders
C. Depression
D. Anxiety

4. Which element is NOT part of a stigma-sensitive social history?
A. Asking about firearm access
B. Exploring family religious values
C. Assuming financial literacy
D. Identifying informal support systems

5. What strategy best redirects a tangential patient during the interview?
A. Silence until they redirect themselves
B. Firmly stating, “Please stay on topic”
C. Gentle interruption with a summary and a bridging question
D. Allowing the full tangent before proceeding

PublishDate:: 2023-02-15

🧠 Summary

Dr. Dana Rimmel joins Dr. Mark Mullen to guide listeners through the foundations of the psychiatric interview. They explore how to build therapeutic alliance, structure the psychiatric intake, navigate difficult encounters, and balance time while capturing a rich biopsychosocial picture. The episode offers practical techniques for new learners and reminders for experienced clinicians alike.

⏱️ Timestamps & Highlights

• 00:00 — Introduction: Why the clinical interview is overwhelming
• 02:00 — Core goals of the psychiatric interview
• 05:00 — Rapport-building: eye contact, silence, name use
• 08:45 — Strategies for guarded and paranoid patients
• 11:00 — Reflection, interpretation, and pacing
• 15:00 — Transitions and handling tangents
• 20:20 — Avoiding jargon and clarifying language
• 24:10 — Self-disclosure: use and caution
• 29:50 — Question types and time management
• 35:00 — Documentation strategies and conflicts in narrative
• 40:10 — Interviewing patients with disorganized, psychotic, or deceptive behavior
• 48:00 — Full suggested interview structure
• 51:00 — Psychiatric ROS: domains to remember
• 57:00 — Past psychiatric and family history
• 1:01:00 — Where substance use fits: ROS or social?
• 1:05:00 — How to take a rich and respectful social history
• 1:10:00 — Screening for trauma, ADLs, and meaning
• 1:17:00 — Final advice: Be real, be reflective, and practice

📝 Key Takeaways

• The therapeutic alliance starts before a word is spoken; posture, naming, and attunement shape safety.
• When patients are paranoid or guarded, neutral professionalism is often more effective than overt warmth.
• A strong interview uses transitions to maintain flow, structure to prevent overwhelm, and flexibility to meet the moment.
• Effective psychiatric ROS covers not just mood, psychosis, and anxiety—but also BPD, ADHD, eating disorders, and OCD.
• The social history should explore stigma, resources, values, safety, and lived experience—not just demographics.
• Humor, self-disclosure, and silence can be tools, but they must always serve the patient’s goals, not the clinician’s comfort.
• Deliberate practice with feedback is the surest path to becoming a skilled interviewer.

✅ After-the-Episode Review (Quiz Answers & Explanations)

1. Answer: B – Using the patient’s preferred name and attuned body language
Rapport-building in early moments depends on conveying safety, presence, and interest—subtle but powerful relational cues.

2. Answer: B – Maintain neutrality and avoid overalignment
Paranoid patients may perceive excessive warmth or mirroring as suspicious; neutrality fosters safety without threat.

3. Answer: B – Eating disorders
EDs are frequently missed unless specifically screened for; always include in ROS, especially in adolescents or patients with mood symptoms.

4. Answer: C – Assuming financial literacy
Assumptions can introduce bias. Social histories should inquire respectfully about access and understanding, not presume.

5. Answer: C – Gentle interruption with a summary and a bridging question
This affirms the speaker’s narrative while steering toward shared goals—preserving alliance while guiding the interview.

❓Review Questions

1. What are three early nonverbal strategies to build rapport?
2. How do you adapt your tone and pacing for patients with paranoia?
3. Which diagnostic areas are often omitted from a rushed ROS?
4. What does a respectful social history include that goes beyond occupation and housing?
5. How can structured transitions improve both patient experience and clinical data collection?

📚 Further Reading & Continued Learning

• Shea, S. C. (2016). The Practical Art of Suicide Assessment. Wiley.
• Carlat, D. J. (2012). The Psychiatric Interview (3rd ed.). Lippincott Williams & Wilkins.
• Gabbard, G. O. (2014). Gabbard's Treatments of Psychiatric Disorders (5th ed.). APA Publishing.
• American Psychiatric Association. (2022). Practice Guidelines for the Psychiatric Evaluation of Adults (3rd ed.).

🤖 Credits

These notes were generated using OpenAI's ChatGPT (GPT-4) model, based on transcription provided by the aTrain automated transcription platform.
Citation for aTrain:
Haberl, A., Fleiß, J., Kowald, D., & Thalmann, S. (2024). Take the aTrain. Introducing an interface for the Accessible Transcription of Interviews. Journal of Behavioral and Experimental Finance, 41, 100891. https://doi.org/10.1016/j.jbef.2024.100891