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The Psychiatric Interview


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Table of Contents

Contributors ix Preface xi Acknowledgments xiii Chapter 1 Listening to the Patient 1 Listening: The Key Skill in Psychiatry 1 The Primary Tools: Words, Analogies, Metaphors, Similes, and Symbols 3 How Does One Hear Words in This Way? 4 Listening as More Than Hearing 6 Common Blocks to Effective Listening 7 Crucial Attitudes That Enable Effective Listening 10 Theoretical Perspectives on Listening 14 Using Oneself in Listening 16 To Be Found: The Psychological Product of Being Heard 18 Listening to Oneself to Listen Better 20 Listening in Special Clinical Situations 23 Growing and Maturing as a Listener 26 Chapter 2 Physician?Patient Relationship 31 Formation of the Physician?Patient Relationship 34 Special Issues in the Physician?Patient Relationship 42 The Physician?Patient Relationship in Specific Populations of Patients 44 Conclusion 46 Chapter 3 The Cultural Context of Clinical Assessment 47 Introduction: The Cultural Matrix of Psychiatry 47 What Is Culture? 48 Culture and Gender 50 The Cultural Formulation 51 Ethnocultural Identity 52 Illness Explanations and Help-Seeking 53 Psychosocial Environment and Levels of Functioning 55 Clinician?Patient Relationship 56 Overall Assessment 57 Cultural Competence 57 Working with Interpreters and Culture-Brokers 60 Conclusion: The Limits of Culture 62 Chapter 4 The Psychiatric Interview: Settings and Techniques 65 Goals of the Psychiatric Interview 66 The Psychiatric Database 75 Database Components 77 Mental Status Examination 81 Conduct of the Interview: Factors That Affect the Interview 83 General Features of Psychiatric Interviews 85 Chapter 5 Psychiatric Interviews: Special Populations 103 Randon Welton and Jerald Kay Psychiatric Interview in Special Circumstances 104 Psychiatric Interview in Special Patient Populations 115 Conclusions 131 Chapter 6 Formulation 135 Allison Cowan, Randon Welton and Jerald Kay Biological Contributions 136 Social Factors 138 Psychological Factors 140 Summary 146 Chapter 7 Clinical Evaluation and Treatment Planning: A Multimodal Approach 147 Psychiatric Interview 147 Identifying Information 149 Chief Complaint 149 History of Present Illness 150 Past Psychiatric History 150 Personal History 150 Family History 151 Medical History 152 Substance Use History 152 Mental Status Examination 153 Physical Examination 157 Neurological Examination 158 Psychological and Neuropsychological Testing 159 Structured Clinical Instruments and Rating Scales 159 Laboratory Assessments 159 Neurophysiologic Assessment 159 Brain Imaging 162 Special Assessment Techniques 163 Assessment of Risk 164 Suicide Risk 164 Differential Diagnosis 167 Initial Treatment Plan 170 Conclusion 171 Chapter 8 Professional Ethics and Boundaries 173 Introduction 173 Ethical Behavior and Its Relationship to the Professional Attitude 174 WPA Guidelines on Euthanasia 176 WPA Guidelines on Torture 177 WPA Guidelines on Sex Selection 177 WPA Guidelines on Organ Transplantation 177 WPA Guidelines on Genetic Research and Counseling in Psychiatric Patients 177 WPA Guidelines on Ethnic Discrimination and Ethnic Cleansing 178 WPA Guidelines on Psychiatrists Addressing the Media 178 The Coherent Treatment Frame and the Role of Therapeutic Boundaries in Effective Psychiatric Treatment 178 Boundary Violations 179 Components of the Coherent Psychiatric Frame 180 Stability 181 Avoiding Dual Relationships 182 Autonomy and Neutrality 183 Coherent and Noncollusive Compensation 183 Confidentiality 184 Anonymity 184 Abstinence 185 Self-respect and Self-protection 186 Summary 187 Index 191

About the Author

Allan Tasman, MD, is Professor and Chair of theDepartment of Psychiatry at the University of Louisville. Aninternationally known educator and psychoanalyst, he has receivednumerous national and international academic awards. He is thefounding Senior Editor of Psychiatry, an internationallyacclaimed comprehensive textbook. He is past president of theAmerican Psychiatric Association and the Pacific Rim College ofPsychiatrists. He recently completed service as Secretary forEducation of the World Psychiatric Association and now leads theWPA Section on Psychotherapy. Dr. Kay is a Fellow of the American College of Psychiatristsand Distinguished Life Fellow of the American PsychiatricAssociation and has served as the chair of the APA Committee onMedical Student Education, the Council on Medical Education andCareer Development, the Vestermark Award Board, and the Committeeon the Practice of Psychotherapy. He chairs the World PsychiatricAssociation Task Force on Undergraduate and Post GraduateCurriculum as well as the APA Committee on College Mental Health.Dr. Kay is the immediate past chair of the Psychiatry ResidencyReview Committee of the ACGME and the Founding Editor of theJournal of Psychotherapy Practice and Research and AssociateEditor of the American Journal of Psychotherapy. He haspublished extensively on the topics of medical and psychiatriceducation, medical ethics, child psychiatry, psychoanalysis,psychotherapy, the neurobiology of psychotherapy, and psychosocialaspects of AIDS and of cardiac transplantation, and has editednumerous books. Dr. Kay serves as the Associate Director of theComprehensive Neuroscience Center at Wright State University. Hereceived the 2001 APA Seymour Vestermark Award for contributions topsychiatric education. Dr. Kay's current research examines fMRI inborderline personality disordered patients with self-harmbehavior.


This book is not only a first rate introduction for psychiatric residents and medical students interested in psychiatry but arguably should be a mandatory reading for all medical students given the importance of general interviewing skills, the prominence of psychiatric issues throughout medicine, and the importance of the techniques presented for building the foundations of the physician-patient relationship. (Journal of Nervous and Mental Disease, 1 December 2014)

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