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Why is it essential to teach clinical interviewing in psychiatric training? Proposal for a course implemented at the Universidad de Valparaíso

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Observation Guidelines for the Psychiatric Interview Workshop.
ItemPerformance or attitudes
1Use of general technical resources

Perform the opening (2 to 3 minutes):

Greeting, informed consent, general information

Main discussion:

Ask an open-ended question and allow for free speech (5 to 10 minutes)

Then, complete the history of the current illness (15 to 20 minutes)

Ask about relevant history, flexibly following a thematic script (10 minutes): substance use, suicidal ideation, personal medical history (including treatments and adverse drug reactions), family psychiatric history, and other factors relevant to the reason for the visit

Conduct a targeted assessment of the patient’s cognitive function if necessary

Conclude the session:

Announce the end of the interview 5 to 10 minutes in advance

Is there any important topic that hasn’t been addressed?

Of everything we’ve discussed today, what is the most relevant—what do you really need help with?

Thank the patient for their participation

2Techniques

Manages the time allotted for the interview and uses a recording tool

Asks open-ended, closed-ended, and directive questions as needed

Does not prompt responses

Uses techniques to encourage the patient to tell their story, helps them organize their account, and facilitates recall

Makes transitions smoothly and at the appropriate time

3Rapport, Support, and Challenges in Cooperation

Maintains a supportive attitude characterized by empathetic curiosity and a “non-judgmental” approach

Addresses potentially threatening issues assertively

Handles complex situations by obtaining a history to the extent possible, such as with a crying patient, a reticent patient, a patient who talks too much, a hostile patient, a seductive patient, a malingering patient, a delusional patient, a disorganized patient, and others.

4Identification of psychopathological conditions, formulation of diagnostic hypotheses, and implementation of strategies to confirm or rule out these conditions

Psychopathological phenomena:

Identifies specific psychopathological phenomena and investigates them (immediately or later) to confirm or rule them out, assessing the presence of associated phenomena

Diagnostic hypothesis:

Formulates a syndromic diagnostic hypothesis within the first few minutes

Implements a strategy to confirm or rule out that hypothesis

Includes possible differential diagnoses or comorbidities

5Transference and countertransference

Remains calm during the interview

Manages the interview appropriately

Transference:

Recognizes the patient’s cognitive-emotional reactions toward the interviewer

Distinguishes between cognitive-emotional transference reactions and those related to what is actually happening in the interview

Countertransference:

Recognizes his own cognitive-emotional reactions to the patient

Distinguishes countertransference cognitive-emotional reactions from those related to what is actually happening in the interview

Manages these reactions in a way that facilitates (or at least does not hinder) the interview

Source: Prepared by the authors of this study.