The Puzzle of the Psychiatric Interview

Abstract The psychiatric interview plays a critical role in clinical assessment and therapy. Problems with assessment reliability and validity that were apparent in nosological and diagnostic discrepancies plagued the field of psychiatry historically. Technical approaches including structured interviews were developed to address these problems. Although these approaches decreased diagnostic variance, they focused narrowly on eliciting signs and symptoms conforming to previously agreed diagnostic categories, necessarily restricting the range and richness of experiences and narratives that are elicited. This restriction inhibits the utility of assessment in furthering the interpersonal rapport and exploration that is essential to the task of therapy. The author reviews critiques of technical approaches to psychiatric assessment and highlights critical, often unexamined, epistemological assumptions and questions. In light of these critiques, he proposes a phenomenological approach to psychiatric assessment focused on narratives that situate particular experiences in the broader life context. In this approach the assessor functions as a participant observer, relying on the same empathic skills that inform effective therapy. It is argued that without over turning the advances in assessment reliability gained through technical approaches to the psychiatric interview, a phenomenological approach can illuminate, enrich, and broaden psychiatric assessment, increasing its effectiveness in psychopathological understanding and in therapy.