Techniques for the Reluctant Patient

Occasionally, you run into the ideal patient. She’s troubled and eager to talk. She briefly outlines the problems that led to her visit and then answers each of your questions in full, stopping in preparation for your next query. You find that you’ve gathered all the vital information in 30 minutes, and you have the luxury of exploring her social and developmental history deeply. You feel like a real therapist. Your mind is whirring, and you can’t wait to dust off that copy of Freud you bought the day you got into your training program but haven’t had time to look at since.

Usually, however, your patient will fall somewhere on either side of a spectrum of information flow. Either he’s not saying enough or he’s saying too much, and it’s not his fault. The average patient has no way of knowing what information is and is not important for a psychiatric diagnosis. It’s up to you to educate the patient and to steer the interview appropriately.

OPEN-ENDED QUESTIONS AND COMMANDS

You can use open-ended questions and commands to increase the flow of information. Open-ended questions can’t be answered with a simple “yes” or “no.”

What kinds of symptoms has your depression caused?

What sorts of things have you done when you felt manic?

Open-ended commands are questions altered slightly to sound more directive.

Tell me what kinds of symptoms you’ve had.

Describe for me some of the things you’ve done while you were manic.

CLINICAL VIGNETTE

The patient was a woman in her 30s who had been admitted to the hospital after an overdose. She was unhappy with the involuntary admission and initially resistant to answering questions.

Interviewer: I understand that you took an overdose of your medicine last week.

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