Interviewing Family Members and Other Informants

Interviewing a patient’s informants—that is, their family members, friends, coworkers, etc.—is such a crucial part of many psychiatric evaluations that some clinicians will not see patients unless they agree to an informant meeting at some point during the treatment. In my experience, it is not always necessary, but when I have bothered to make it happen, it has always added something of value to my understanding of patients.

Before getting into specific suggestions, I have found it useful to think about the following three goals for interacting with family members and other informants:

Let the family know they are not alone.
Provide support and allow informants to vent.
Instill hope for change (adapted from Mueser and Glynn 1999).

HOW TO BROACH THE ISSUE OF TALKING TO INFORMANTS

I usually ask something like,

“As part of my evaluation of patients, I find it helpful to talk to someone else involved in your life. Would that be okay with you?”

Most patients will agree to this, and will typically be impressed that you care enough to go that extra mile in conducting your evaluation. Assuming they agree, you should figure out who would be the best person to talk to—a parent, a significant other, a roommate, a friend, etc.

Sometimes patients will decline having an informant become part of the treatment, which is certainly their right. But it’s helpful to find out the root of their discomfort. At times, it may be that there is something they want to hide from you, such as drug use or other behaviors at odds with their recovery. But other times, the reasons are understandable.

CLINICAL VIGNETTE

I had seen a man in his 30s for a couple of years for depression, which had gradually improved with treatment but he continued to complain of not feeling very fulfilled with his life, and he qualified for the diagnosis of dysthymia. He acknowledged that one of the major issues in his life was the fact that his wife wanted to have more children but he didn’t. Several times, I had encouraged him to bring his wife into a meeting—not for couples therapy, but in order to better understand the nature of their relationship so that I could help him in therapy. He eventually said that she would be able to attend our next session. But he came alone.

“Where’s your wife?” I asked, surprised.

“I thought a lot about it, and I agreed that it might be helpful for her to come in to the session. But then I realized that this is my time with you.”

Ultimately, my ready acceptance of his decision strengthened our alliance and improved the quality of our therapy.

BE READY WITH A LIST OF QUESTIONS

Your patient has shown up with his mother as you requested. What kinds of questions are you going to ask? You may feel that the pressure is on, since this may be the only time you will have to interview the informant. Therefore, it’s best to be ready with a list of questions.

As with interviewing patients, when interviewing families you’ll want to start with an open-ended approach and then drill down to specific questions.

I’ll often start by asking, “How do you think Nancy has been doing?” Some informants will arrive brimming with a wealth of specific and useful information, but others might
answer more sparsely, with something like, “She’s been okay. Sometimes she gets nerved up, but then she takes her happy pills and seems better.”

In this case, the informant is not speaking your clinical language and needs education about the specific kind of information you are looking for.

Murray-Swank et al. recommend the following series of questions for informant interviews:

“What do you think has caused [name] to have these problems?”
“Has anybody ever given you a diagnosis for his/her problems?” (If they have been told of a diagnosis, it is useful to follow up with a question such as, “What is your understanding of what that diagnosis means?”)
“Are there things that make things better for [name]?”
“Are there things that make things worse?”

These kinds of questions allow you to teach the informant the kind of vocabulary that you will find most useful in tracking your patient’s progress.

Going back to our case of nerved-up Nancy, you might say, “I think when you said that Nancy gets ‘nerved up’, she is having what we think of as a panic attack, and that the ‘happy pill’ is Ativan, an anxiety medicine that helps her get over her panic problem.” This type of psychoeducation may ultimately help your patient understand when to use her medication appropriately because it puts her and her informant on the same page.

Specific pieces of information that you might want to obtain (depending on the specific problem) include the following: