The psychiatric interview

Start with the person’s account

The psychiatric interview combines information gathering with the beginning of a therapeutic relationship. An open invitation gives the person room to describe why they have come, what has changed and what they hope the consultation will achieve. The account may reveal priorities that a symptom checklist would miss.

Listening first does not mean abandoning structure. Keep a framework in mind, then return to gaps once the initial narrative is clearer. Explain transitions between subjects and clarify unfamiliar expressions rather than translating them immediately into diagnostic labels.

Move from narrative to clarification

A useful progression is broad description, a recent concrete example, then focused clarification. Establish what occurred, when it began, how often it happens, what precedes it and what follows it. Ask about the effects on daily activities and relationships alongside the symptoms themselves.

Patient and collateral accounts can add different perspectives. Record who supplied each observation, their opportunities to observe and any disagreement. A discrepancy is information to explore, rather than a reason to silently discard one account.

Develop the skill through supervision

Interviewing skill develops through observation, practice and discussion with experienced clinicians. Review whether the questions helped the person explain an experience, whether assumptions were introduced too early and whether important areas remained unexplored. A textbook supplies a framework; supervised encounters develop the judgement needed to use it well.

For your next supervision discussion

Review an interview in which the initial narrative and a later focused question gave different information. Which question helped clarify the experience, and which assumption might have narrowed the account too early?