The psychiatric interview: A philosophical problem?

The psychiatric interview is obviously a crucial step in the overall clinical process. Notwithstanding this truism, a cursory review of the literature reveals that a majority of authors and researchers are more interested in “what” should be assessed than “how” the assessment should be conducted. One reason for this neglect may be that the skill in asking questions and listening to answers is taken for granted as a commonplace habit of everyday life (Lazarsfeld 1935). Another cause may be the assumption that interviewing is an art that cannot be taught but only acquired (MacKinnon and Michels 1971). A third, and perhaps more profound, possibility could be that a critical reappraisal of interview principles and skills may become a rather puzzling enterprise requiring us to re-think some of the basic tenets of psychiatry as a science. Studies concerned with the methodological problems of the psychiatric interview mirror a vexed question within the community of mental health professionals (Othmer and Othmer 2002; Shea and Mezzich 1988): Is the psychiatric interview a technique designed to objectively and reliably elicit signs and symptoms that allow nosographical diagnosis, or is it a special instance of interpersonal rapport exploring personal problems, including the problems that arise in this rapport and especially those connected to affective involvement? Attempts to answer this question have cemented a dichotomy between structured and symptom-oriented approaches, on the one hand, and free format and insight-oriented interview styles, on the other (eg, Shea 1988). What is lacking most in studies of both approaches is an analysis of the …