Logistic Preparations: What to Do Before the Interview

The work of psychological healing begins in a safe place, to be compared with the best of hospital experience or, from an earlier time, church sanctuary. The psychological safe place permits the individual to make spontaneous, forceful gestures and, at the same time, represents a community that both allows the gestures and is valued for its own sake.

–Leston Havens, M.D. A Safe Place

Logistic preparation for an interview is important because it sets up a mellower and less stressful experience for both you and your patient. Often, trainees are thrown into the clinic without training in how to find and secure a room, how to deal with scheduling, or how to document effectively. You’ll eventually arrive at a system that works well for you; this chapter will help speed up that process.

PREPARE THE RIGHT SPACE AND TIME

Secure a Space

A space war is raging in most clinics and training programs, and you must fight to secure territory. Once secured, dig trenches, call for the cavalry, and do whatever you need to do.

I remember one early lesson in this reality: I was 2 months into my training and just finishing supervision in the Warren Building of the Massachusetts General Hospital (MGH) campus. It was 12:55 p.m., and I had a therapy patient scheduled for 1:00 p.m. in the Ambulatory Care Clinic, a building so far from Warren that it practically had its own time zone.
I zigged and zagged around staff and patients in the hallways on their way to the cafeteria and rushed into the clinic by 1:05 p.m. My patient was in the waiting room and got a good view of sweat trickling down my forehead. I scanned the room schedule and found that no rooms were free. Panic set in, until the secretary pointed out that the resident who had room 825 for that hour had not yet shown up. So I led my patient to 825, and we started, 10 minutes late. Five minutes later, there was a knock on the door. I opened it, and there stood the resident and his patient. I redeposited my patient in the waiting room and scoured the list for another room.

I won’t torture you with the rest of this saga. Suffice it to say we were evicted from the next room as well, and the therapy session was, in the end, only 15 minutes long, with much humiliation on my part and good-natured amusement on my patient’s.

Here are some time-honored tips on how to secure a room and what to do with it once you have it:

Schedule the same time every week. Try to secure your room for the same time every week. That way you’ll be able to fit interviews into your weekly schedule routinely. When it comes to psychiatric interviewing, routine is your friend. Psychodynamic psychotherapists call this routine—the same time, the same room, the same greeting—the “frame.” Making it invariable reduces distractions from the work of psychological exploration.
Make your room your own in some way. This isn’t easy when you only inhabit it for a few hours a week. Clinic policy may forbid this, or it may be impolite (e.g., if you’re using an office that belongs to a regular staff member). If possible, put a picture on the desk or the wall, bring a plant in, place some reference books on a shelf, hang some files. The room will feel more like your space, and it will seem homier to your patient. In my current office, I have a photo of my two children on my desk. In the past, I worried that this little piece of self-disclosure could cause problems with transference. Would lonely patients envy me for having a family? Would angry patients believe that I was “bragging” by showcasing my “beautiful family”? In fact, these problems haven’t occurred (at least to my knowledge)—the photo is generally a good conversation starter, and for most patients makes me seem more human and less intimidating.
Arrange the seating so that you can see a clock without shifting your gaze too much. A wall clock positioned just behind your patient works well. A desk clock or a wrist-watch placed between the two of you is also acceptable. The object is to allow you to keep track of the passage of time without this being obvious to your patient. It is alienating for a patient to notice a clinician frequently looking at a clock; the perceived message is “I can’t wait for the end of this interview.” You do need to monitor the time, though, to ensure that you obtain a tremendous amount of information in a brief period. Actually, keeping track of time will paradoxically make you less distracted and more present for your patient, since you’ll always know that you’re managing your time adequately.

Protect Your Time

Time is but the stream I go a-fishing in.

–Henry David Thoreau

This is not to say that you should go fly-casting with your patients (though you’re usually fishing for something or other during an interview). Rather, you should protect the time you schedule for interviews, so that it has that same peaceful, almost sacred quality. How to do it?

Arrive Earlier than the Patient

You need time to prepare yourself emotionally and logistically for the interview. Compose yourself. Lay out whatever forms or handouts you’ll need. Answer any urgent messages that you just picked up at your message box. Breathe, meditate, do a crossword puzzle, or whatever you do to relax.

I once observed an interviewer who was visibly anxious. He crossed and uncrossed his legs and constantly kneaded his left palm with his right thumb. Eventually the patient interrupted the interview and asked, “Doctor? Are you all right? You look nervous.” He laughed. “Oh, I’m fine,” he said. And no, this was not a resident, but one of my professors.

Prevent Interruptions

There are various ways to prevent interruptions:

Ask the clinic secretary to take messages for you.

Ask the page operator to hold all but urgent pages.

Put your pager on vibrate mode and only answer urgent pages.

Sign your pages out to a colleague.

Don’t Overbook Patients

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