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The Diagnostic Interview

The Diagnostic Interview

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  • Welcome Introductions: Experience with therapy (personal or as therapist) What to expect: Syllabus Session 1: Introduction to Course The initial meeting Examples of first encounters Session 2: The mental status exam Session 3: Specific disorders / types of interviews Mood Disorders: Depression Session 4: Anxiety Disorders Session 5: Schizophrenia Session 6: Personality Disorders Session 7: Alcohol Problems Session 8: Drug Abuse Session 11: Sexual Dysfunctions and Deviations Session 12: Eating Disorders Session 13: PTSD Session 14: Children Session 15: Older Adults

Transcript

  • 1. Diagnostic Interviewing Session I Christopher Christian, Ph.D.
  • 2. Goals of the diagnostic interview
    • Arrive at a diagnosis
    • Develop a treatment plan
    • Establish rapport and the beginnings of a working alliance
  • 3. The role of the interviewer
    • Reassurance, understanding, and empathy
    • Suggestion and limit setting
    • Building the patient’s self-esteem
      • interpretation
  • 4. Practical issues
    • Time factors
    • Space consideration
    • Note-taking
  • 5. The patient
    • transference
    • resistance
  • 6. The interviewer
    • countertransference
    • the inexperienced interviewer
  • 7. The opening phase
    • meeting the patient
    • the development of rapport
      • Understanding the patient
      • the interviewer’s interest
      • confidentiality
      • the patient’s shame
      • uncovering feelings
  • 8. The middle phase
    • the abrupt transition
    • the patient’s personality
    • exploring the past
    • needs for reassurance
    • stimulating curiosity
    • using the patient’s words
    • open-ended questions
    • sensitive topics
    • stressing the patient
    • managing the patient’s anxiety
  • 9. The closing phase
    • the patient’s questions
    • the treatment plan
    • prognosis
  • 10. Topics to be covered in the Initial Diagnostic Interview
    • Identification of the patient
    • Clarification of the presenting complaint
    • History of main problem
    • Personal history
    • Family history
    • Medical history
    • History of prior treatments
    • Mental status examination
    • Assessment of the pre-morbid personality
    • Present circumstances
  • 11. Examples of the Initial Contact
    • Sopranos
    • Ordinary People
    • Squid and the Whale
    • Goodwill Hunting
  • 12. Assessing for Depression – Physical
    • How is your general health? Has it changed recently?
    • Has your interest in food changed?
    • Have you seen any changes in your weight?
    • How is your sleep?
      • Do you have trouble falling asleep? On how many nights a week?
      • Do you wake up in the middle of the night and have trouble falling back asleep?
      • Do you wake early and cannot fall back asleep?
      • Do you regularly nap during the day?
    • Have your bowel or bladder habits changed?
    • Has your interest in sex changed?
  • 13. Assessing for Depression – Affective
    • How are your spirits generally?
    • How did you feel about (specific event/life in general)?
    • When was the last time that you felt really down?
    • Do you get pretty discouraged? Depressed? Blue?
    • Are you feeling low/blue now?
    • Do get low/sad for long?
    • Have you felt some personal losses recently?
    • Do you think that you are more depressed in the Winter than in the Summer?
    • Have you had a time when you felt very tired or very irritable?
  • 14. Assessing for Depression – Social Functioning
    • Have you given up friendships?
    • Do you find yourself avoiding people?
  • 15. Assessing for Depression – Suicidal Ideation
    • When people are depressed they sometimes think about dying. Have you had any such thoughts lately?
    • Are there times when you wish you would not wake up?
    • Do you feel that life isn’t worth living?
    • Do you think that you would just as soon be dead?
      • Or that other people would be better off if you were dead?
    • Have you been troubled by thoughts of hurting yourself?
      • When was the last time that you thought of hurting yourself?
    • Do you think you will get well?
      • Get over this problem?
    • What do you see for yourself in the future?
    • What is the worst thing that ever happened to you?
    • What is the best thing that ever happened to you?
    • If you cld have three wishes come true, what would you wish for?
  • 16. Assessing for Depression – Self-deprecation
    • Are you hard on yourself?
    • Do you think you are a bad person?
      • Why?
    • Do you think that you have done something bad for which you cannot forgive yourself?
  • 17. Suicidal Behavior
    • Initial Inquiry:
    • You have told me about some very painful experiences. They must have been hard to bear and perhaps you sometimes thought of quitting the struggle or even killing yourself. (If this idea is accepted by the client ask about the following areas).
  • 18. Suicidal Behavior
    • Death Wishes:
      • Has it crossed your mined that you were to die that would end the pain you feel?
      • When was the last time that you wished you were dead?
      • When was the last time that you thought the world would be a better place without you?
      • Have you ever thought this way before?
  • 19. Suicidal Behavior
    • Ideation:
      • When was the first time that you thought of killing yourself?
      • When was the last time that you thought of killing yourself?
      • Do you feel that you want to die now?
      • How often do you think of suicide?
      • When you have suicidal thoughts, how long do they last?
      • What brings on these thoughts?
      • How do you feel about these thoughts?
      • Do you feel you have control over these thoughts?
      • What ends these thoughts?
  • 20. Suicidal Behavior
    • Affects and Behaviors
      • How often have you felt:
        • Lonely
        • Fearful
      • How often have you not eaten because of your mood?
        • Not slept?
        • Gotten into a physical fight?
        • Gotten drunk?
        • Gotten high?
  • 21. Suicidal Behavior
    • Motivation:
      • Why were you thinking of killing yourself?
      • Have you felt: “My life is a failure” or “My situation is hopeless.”
      • What would happen after you were dead?
      • What effect would your death have on others?
      • Under what conditions would you kill yourself?
    • De-Motivator
      • What would or does prevent you from killing yourself?