Psychiatric interview - the process by which psychiatric assessment is conducted
-primary tasks
• building a therapeutic alliance between the PMHNP & client
• obtaining a database of psychiatric info about the client
• establishing a dx
• negotiating a tx plan
Therapeutic Alliance - a feeling that you should create over the course of the diagnostic interview, a
sense of rapport, trust, and warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
• begins during the initial or opening phase of the interview
-fundamental component of successful therapy
• Without trust, adherence to treatment recommendations may be compromised
• interview may not elicit the information needed to formulate an appropriate dx & plan of care without
rapport & trust
Creating rapport: tips - -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
How to approach threatening topics (sensitive/embarrassing material) - -Normalization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
,-Use Familiar Language When Asking about Behaviors
Normalization - Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or understandable response to a mood or
situation
• ex: Sometimes when people are very depressed, they think of hurting themselves. Has this been true
for you?
2. Begin by describing another patient (or patients) who has engaged in the behavior, showing your
patient that she is not alone
• ex: I've talked to several patients who've said that their depression causes them to have strange
experiences, like hearing voices or thinking that strangers are laughing at them. Has that been
happening to you?
Symptom Expectation - communicate that a behavior is in some way normal or expected
-Phrase your Q's to imply that you already assume the patient has engaged in some behavior and that
you will not be offended by a positive response
-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of hopelessness. You suspect suicidality,
but you sense that the patient may be too ashamed to admit it. Rather than gingerly asking "Have you
had any thoughts that you'd be better off dead?" you might decide to use symptom expectation. "What
kinds of ways to hurt yourself have you thought about?"
*reserve this technique for situations in which it seems appropriate
Symptom Exaggeration - suggesting a frequency of a problematic behavior that is higher than your
expectation, so that the patient feels that their actual, lower frequency of the behavior will not be
perceived by you as being "bad."
-helpful in clarifying the severity of symptoms
*reserve this technique for situations in which it seems appropriate
, Reduction of guilt - seeks to directly reduce a patient's guilt about a specific behavior in order to
discover what they have been doing
-useful in obtaining a hx of domestic violence & other antisocial behavior
Domestic Violence
-"Have you ever been in situations where fights occurred and you were affected?"
• If patient answers "yes," you can flesh out whether role was being a witness, victim, or perpetrator
According to Peplau's Theory of Interpersonal Relations, establishing early rapport allows the role of the
nurse to evolve from stranger to: - resource person, teacher, leader, surrogate, technical expert, and
counselor
Establishing the Relationship - -Trust is essential for a therapeutic alliance
-First impressions are important
-PMHNP should take time to make introductions and ensure the client is comfortable
-Ask general questions to arrive at an empathic understanding of how the client feels
-Listen carefully and communicate an appreciation for the client's concerns
-Building a trusting relationship based on respect, kindness, and acceptance will break down barriers
and allow for client needs to be the center of the plan of care
-Being present and openly engaged will enhance the communication experience
three phases of the psychiatric interview - 1. Opening phase
2. Body of the Interview
3. Closing the Interview
Opening phase - -first 5-10 minutes
-establish rapport & therapeutic alliance
-often most important phase
• establishes the foundation
-begins with PMHNP asking "what brought you in to see me today?"
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