ABSTRACT

The Clinical Interview offers a new perspective on the patient encounter. Interpreting decades of evidence-based psychotherapy and neuroscience, it provides 60 succinct techniques to help clinicians develop rapport, solicit better histories, and plan treatment with even the most challenging patients.

This book describes brief skills and techniques for clinical providers to improve their patient interactions. Although evidence-based psychotherapies are typically designed for longer specialized treatments, elements of these psychotherapies can help clinicians obtain better patient histories, develop more effective treatment plans, and more capably handle anxiety-provoking interactions. Each chapter is brief and easily digestible, contains sample clinical dialogue, and provides references for further reading. These skills help clinicians practice more effectively, more efficiently, and with greater resilience. Whatever your clinical specialty or role, whether you are a trainee or an experienced clinician, The Clinical Interview offers practical wisdom and an entirely new way to think about the clinical encounter.

The Clinical Interview will be of great use to any student in a health-related field of study or a healthcare professional interested in refining their interviewing skills. It will help anyone from emergency medical technicians, nurses, and physician assistants, to nurse practitioners and physicians to build more meaningful patient relationships.

chapter |6 pages

Introduction

A New Approach to the Clinical Encounter

part I|52 pages

Building Rapport

chapter 1|3 pages

Elicit One Goal

Be More Efficient by Learning the Patient’s Agenda

chapter 2|3 pages

Validate Three Different Ways

Be Authentic in Your Validation by Expanding the Ways in Which You Can Agree With the Patient

chapter 3|3 pages

Mirror the Patient’s Language to Build Rapport

Use the Patient’s Phrasing to Avoid Misinterpretation

chapter 4|3 pages

Use the Power of “And”

Introduce “And” Rather Than “Or/But” Statements to Your Interview to Establish Rapport, Validate the Patient’s Experience, and Facilitate Change

chapter 5|3 pages

Redirect Demanding Patients

Reinforce That the Patient, Like Everyone, Is Entitled to Good Medical Care

chapter 6|3 pages

Be Silent

Use Active Silence to Support the Patient’s Emotional Expression

chapter 7|3 pages

Be Playful

Introduce Playful Irreverence to Challenge Rigidity, Signal Affection, and Build Social Connection

chapter 8|3 pages

Handle the Hollering With a Calming Question

Through Tone of Voice, Active Listening, and Setting Limits, Invite a Conversation to De-Escalate a Shouting Patient

chapter 9|3 pages

Recognize Your Own Emotions

Identify and Process Your Countertransference During the Interview to Improve the Patient’s Well-Being (and Your Own)

chapter 10|3 pages

Reflect the Patient’s Statements

Use a Well-Timed Reflection to Disrupt a Negative Thought Spiral

chapter 11|3 pages

Introduce Progressive Muscle Relaxation

Give the Patient an Active Task to Change Their Emotional Experience

chapter 12|3 pages

Use Emotional Validation to Manage Negative Countertransference

Disarm Your Negative Emotions and Humanize Your Patients

chapter 13|3 pages

Consider Fear When the Patient Is Angry

Assess What the Patient Might Be Afraid of When They Become Upset

chapter 14|3 pages

Validate the Patient’s Perspective of Where They Are Now and Where They Need to Go

Understand and Support the Patient’s Reality and Goals to Enhance Motivation for Treatment

chapter 15|3 pages

Share How You Feel

Put Your Own Feelings Into Words to Reset a Difficult Conversation

chapter 16|3 pages

Agree to Disagree

De-Escalate an Argument by Repeating This Short Phrase

chapter 17|3 pages

Be Honest About Your Limitations

Relieve Yourself of Unobtainable Expectations and Reset the Conflictual Encounter

part II|40 pages

Taking a History

chapter 18|3 pages

Be Curious

When Curious About What a Patient Has Said, Ask More Questions to Obtain Useful Information and Show the Patient That You Are Interested

chapter 19|3 pages

Prioritize Information You Need Right Now

Shift Your Line of Questioning Without Shifting the Topic

chapter 20|3 pages

Use Open-Ended Questions for Sensitive Topics

Invite Greater Honesty and Avoid a Sense of Judgment Through Open-Ended Questions

chapter 21|3 pages

Attend to Affect

Emphasize the Patient’s Emotional Words for a Richer History

chapter 22|3 pages

Validate and Move

Use Validation as a Transitional Tool in the Unwieldy Interview

chapter 23|3 pages

Write a Timeline

Organize Chaotic Histories and Validate the Patient’s Experience

chapter 24|2 pages

Ask “How Come?” Instead of “Why?”

Vary Your Phrasing Slightly to Improve the Tone of the Interview

chapter 25|3 pages

Observe Caregivers’ Nonverbal Cues

Gather Information From Caregivers to Increase Accuracy and Efficiency in the Diagnosis of Cognitive Disorders

chapter 26|4 pages

Roll With Impaired Reality Testing

Provide a Validating and Grounded Interview for Patients With Psychotic Symptoms

chapter 27|3 pages

Ask for Help Understanding

Frame an Open-Ended Question as a Plea for the Patient’s Assistance

chapter 28|4 pages

Collect the Social History First

Re-Order the Traditional Interview to Better Engage Reluctant Patients

chapter 29|2 pages

Ask About Family History

Use the Family History as a Lead-in to Sensitive Questions

chapter 30|3 pages

Wonder Aloud With the Patient

Use and Re-Use a Brief, Non-Committal Phrase to Explore the Patient’s History and Treatment Options

part III|45 pages

Making an Assessment

chapter 31|3 pages

Track Symptoms and Behaviors

Keep a Log to Aid Diagnosis and Begin Treatment

chapter 32|3 pages

Find the Key Worry

Consider the Anxious Patient’s Most Important Worry in Making the Diagnosis

chapter 33|3 pages

Consider Past Healthcare Encounters

Ask How Patients’ Past Healthcare Experiences May Inform Their Current Experience

chapter 34|3 pages

Identify What Is Solvable

Focus on Concrete Objectives That You and the Patient Can Realistically Solve Together

chapter 35|4 pages

Talk About Traits, Not Diagnosis

Think of Maladaptive Thoughts and Behaviors on a Spectrum of Normal

chapter 36|4 pages

Label the Patient’s Affect

Help Manage the Patient’s Emotional Experience by Putting It Into Words

chapter 37|3 pages

Talk About the Mind-Body Connection

Connect Psychiatric and Medical Symptoms to Encourage Openness to Mental Health Interventions

chapter 38|3 pages

Emphasize Function Over Feeling in Chronic Illness

Shift the Visit’s Focus to Capability to Reinforce the Patient’s Self-Efficacy and Agree on Achievable Outcomes

chapter 39|3 pages

Consider the Social History in Your Assessment

Apply the Social History as a Tool for Understanding the Patient’s Diagnosis and Treatment

chapter 40|3 pages

Remind the Patient What Is Not Working

Ask How the Patient Feels About Their Current Behaviors in Order to Motivate Change

chapter 41|3 pages

Ask About Medication Side Effects

Assess Experiences of Side Effects When Medications Are Seemingly Ineffective

chapter 42|3 pages

Ask the “Why” About Online Information

Focus on the Patient’s Motivations for Sharing Information Brought to the Encounter

chapter 43|3 pages

Recall the Patient’s Strengths

Consider How the Patient’s Abilities Can Be Used in the Service of Their Health

chapter 44|3 pages

Accept or Change

Simplify the Possible Outcomes to Help the Patient Stop Venting and Decide on Action

part IV|50 pages

Planning Treatment

chapter 45|3 pages

Set the Stage

Spend One Visit Preparing to Make Significant Treatment Changes

chapter 46|3 pages

Fish for Change Talk

Guide the Patient Into Talking About Behavior Change More Quickly

chapter 47|3 pages

Imagine the Future

Envision the Patient’s Healthy Life in Order to Prioritize Treatment Goals

chapter 48|3 pages

Prescribe Change

Use a Prescription Pad to Emphasize Non-Pharmacologic Interventions

chapter 49|3 pages

Ask the Patient’s Beliefs Regarding Medications

Understand What Patients Think Medications Will Do for Them to Clarify Treatment and Improve Adherence

chapter 50|3 pages

Anticipate Challenges

Be Specific in Planning Ahead and Removing Obstacles to Treatment Success

chapter 51|3 pages

Experiment With Change

Introduce Change as Something the Patient Can Simply Try Out—No Commitment Necessary!

chapter 52|3 pages

Operationalize Improvement

Be Specific With the Patient About What “Better” Means

chapter 53|3 pages

Frame Limit-Setting From the Patient’s Perspective

Consider How Setting Effective Limits Will Improve the Patient’s Care

chapter 54|3 pages

Share Difficult Decisions

Give the Patient Options When Collaborating on a Treatment Plan With Which the Patient Is Reluctant to Engage

chapter 55|3 pages

Define Efficacy for Medication Changes

Understand the Patient’s Goals and How They Will Know If a Medication Change Is Working

chapter 56|3 pages

Help Patients Resist Urges

Review How Patients Can Refrain From Acting on Unhelpful Impulses

chapter 57|3 pages

Accept Ambivalence: “It’s Okay Not to Change”

Allow Patients to Acknowledge and Accept When They Are Not Ready to Change

chapter 58|4 pages

Plan for a Crisis

Write a Three-Step Crisis Plan to Anticipate Patients’ Triggers and Coping Skills

chapter 59|3 pages

Normalize Challenges

Validate That Treatment Is Difficult for Many Patients

chapter 60|3 pages

Reinforce the Positive

Encourage Healthy Decision-Making and Adherence With Plentiful Encouragement