Offering patients opportunities to reveal their subjective experiences in psychiatric assessment interviews

Abstract

Objective: With the intention of understanding the dynamics of psychiatric interviews, we investigated the usual (DSM/ICD-based) psychiatric assessment process and an alternative assessment process based on a case formulation method. We compared the two different approaches in terms of the clinicians' practices for offering patients opportunities to reveal their subjective experiences.

Methods: Using qualitative and quantitative applications of conversation analysis, we compared patient-clinician interaction in five usual psychiatric assessments (AAU) with five assessment interviews based on dialogical sequence analysis (DSA).

Results: The frequency of conversational sequences where the patient described his/her problematic experiences was higher in the DSA interviews than in the AAU interviews. In DSA, the clinicians typically facilitated the patient's subjective experience talk by experience-focused questions and formulations, whereas in AAU, such talk typically occurred in environments where the clinicians' questions and formulations focused on non-experiential, medical matters.

Conclusion: Interaction in DSA was organized to provide for the patient's experience-focused talk, whereas in AAU, the patient needed to go against the conversational grain to produce such talk.

Practice implications: By facilitating patients' opportunities to uncover subjective experiences, it is possible to promote their individualized care planning in psychiatry.

Keywords: Conversation analysis; Dialogical sequence analysis; Individualized treatment plan; Psychiatric assessment; Subjective experience; Working alliance; patient–clinician interaction.