The Psychiatric Interview
The Psychiatric interview is the most important component of a full psychiatric evaluation. The style, format, and duration of the interview is subject to change depending upon the context and the setting.
Safety, Setting, and Positioning
Safety. Most psychiatric interviews will take place in an office, clinic, hospital room, day room/ common room, or jail cell. Regardless of the location, the most important consideration prior to starting any interview is safety. While it is tempting to assume patients will remain calm and cooperative during the interview, it is not a safe assumption. While the majority of patients suffering with mental illness are not violent and will not become violent, it is always better to be safe than sorry. Regardless of setting, be sure you think about your safety and the safety of those around you (including your patient).
Confidentiality. Do your best to interview patients in a quiet calm place away from other patients. The psychiatric interview can be a very personal and emotional experience. Patients may reveal very personal information and/or confide in you. Providing a safe place for patients to feel safe during their most vulnerable moments is of upmost importance to create and maintain a strong therapeutic alliance. While some settings may be limited in terms of space or areas to interview, every attempt should be made to find a safe quiet place to talk.
Before introducing yourself. Before approaching a patient, assess safety by asking staff, if available, about the patient’s behavior and whether they have any safety concerns. If there is a concern for safety, consider being extra safe by politely requesting security or additional staff to be present with you during the interview. This will ensure your safety, the safety of the patient, and the safety of the staff. There is nothing more devastating than being in a room with a violent or agitated patient with no help around!
The approach. When approaching the patient, approach with a calm demeanor and at a slight angle from the front. Never approach a patient quickly, aggressively, or directly in front of them as this can be perceived as threatening. Keep your hands in front of you with your palms open so the patient can see them. Never approach with your hands behind your back. Always keep at least a legs length from the patient at all times. While making eye contact is important, making eye contact for too long can be perceived as threatening.
Don’t block the exit. When interviewing a patient in a room, position yourself in the room such that you are not blocking the exit as this can make patients feel trapped. On the other hand, never put yourself in a position where the patient is between you and the exit. See the diagrams below for safest positioning. If interviewing in an open area position yourself in such a way that you have a clear view. Never interview a patient where either of you are cornered against a wall and never interview with your back exposed to the open room. If activity is going on behind you, position yourself in such a way that you would be able to see someone approaching in your peripheral vision.
Sit or stand? Follow the patients lead. If the patient is sitting, do not interview the patient by standing over them. Find a chair and stay at eye level. If the patient doesn’t want to sit and prefers to stand, then stand at a safe distance and do not sit. Sitting with a patient sends the message “I am not a threat and I am here to listen because I care about you.” Even if you only speak for a few minutes, studies have shown that patients perceive a length of time much longer than was actually spent.
This is the safest office set-up: