Book
The Psychiatric Interview
The Psychiatric Interview is a posthumous book by Harry Stack Sullivan, edited by Helen Swick Perry and Mary Ladd Gawel from recordings of two lecture courses he gave at the Washington School of Psychiatry in 1944 and 1945, and published by W. W. Norton in 1954. It is the most systematic statement of Sullivan's clinical method, applying his interpersonal theory of psychiatry to the meeting between psychiatrist and patient. Sullivan defines the interview as a situation of primarily vocal, though not merely verbal, communication between two people, proceeding on a progressively unfolding expert–client basis, whose aim is to clarify the interviewee's characteristic patterns of living — those he experiences as especially troublesome or especially valuable — in a way from which he expects to benefit. The psychiatrist is an expert in interpersonal relations and a participant observer: never a neutral mirror, he is part of the field from which the data arise and must stay aware of his own share in it. Anxiety, in both participants, is the chief obstacle to learning anything: the patient's self-system mounts security operations, such as selective inattention, against whatever threatens self-esteem, and the interviewer must keep anxiety from mounting needlessly while noting where it appears. Sullivan divides the interview into four stages — the formal inception, the reconnaissance, the detailed inquiry, and the termination or interruption — and treats the technique of each: how to manage transitions between topics, how to use the developmental history from infancy through adolescence as a frame of reference for the inquiry, how to recognise the signs and patterns of mild and severe mental disorder, and how to close with a summarising statement, a prescription of action and an assessment of their likely effect. A final chapter takes up problems of communication. The book became a classic of interpersonal psychoanalysis and a standard text on psychiatric interviewing.
Main ideas
- The psychiatric interview is an interpersonal situation: primarily vocal communication between two people on an expert–client basis, aimed at clarifying the patient's characteristic patterns of living to the patient's benefit.
- The psychiatrist is an expert in interpersonal relations and a participant observer, never a detached mirror: the data of psychiatry arise in the field between interviewer and interviewee, so the interviewer must keep track of his own part in what happens.
- How things are said matters as much as what is said: tone, pace, pauses, emphasis, digressions and inconsistencies are among the interviewer's main evidence.
- Anxiety is the central force in the interview: the self-system's security operations, including selective inattention and parataxic distortion, work against the interview's aim, and the interviewer must avoid provoking needless anxiety while learning from where it arises.
- The interview unfolds in four stages: the formal inception, in which the patient is received and states why he has come; the reconnaissance, a rough sketch of who he is and his social and personal history; the detailed inquiry, in which tentative impressions are tested and filled out; and the termination or interruption.
- Transitions between topics are a technical instrument: smooth, accented or abrupt shifts let the interviewer steer the conversation, ease or deliberately raise anxiety, and keep the patient oriented to what is being asked and why.
- The developmental history, from infancy through childhood, the juvenile era, preadolescence and adolescence, serves as the frame of reference for the detailed inquiry, showing where the patient's interpersonal development was impeded.
- Mental disorders, mild and severe, are approached as recognisable patterns of interpersonal living whose signs show themselves in the interview, rather than as fixed disease entities.
- An interview should end deliberately: with a final statement summarising what has been learned, a prescription of action the patient can realistically carry out, an assessment of their likely effect on his life, and a formal leave-taking, so that the patient leaves with something of value.
What it shows
Harry Stack Sullivan introduced Participant observation
Sullivan made the psychiatrist's participation in the interpersonal situation the root premise of psychiatric method, and worked it out for clinical practice in his lectures on the psychiatric interview.