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Download Jonas' Introduction to the U. By Vanessa O Really helped with my interviewing skills as an intern, and loved how he had a section on anxiety and obsessions because those were my weak spots. I also like how it gave tips, and alternative questions if you weren't eliciting any answers from the basic questions. Great for an intern. Posting Komentar.
Kamis, 26 Desember [F March - Steven T. Most helpful customer reviews 3 of 3 people found the following review helpful. See all 46 customer reviews Diposting oleh Unknown di Label: Ebooks. Great for Auditions By Amazon Customer I'm a 4th year med student who bought this book to assist with audition rotations. At least in my case, I didn't feel like my 3rd year clerkship did a very good job teaching me not just what information to get, but how to get it.
This is a great resource - easy to read, has great little tips, and helps with some of the "special situations" like how to ask psychiatric questions with kids. I feel like it has definitely improved my information-gathering skills. Too much wealth in a small book By Gibbylove as a seasoned clinician I would recommend this book to any psychologist, social worker or therapist. When one works in a fast pace like a psych emergency room this book does comes handy.
By Vanessa O Really helped with my interviewing skills as an intern, and loved how he had a section on anxiety and obsessions because those were my weak spots. I also like how it gave tips, and alternative questions if you weren't eliciting any answers from the basic questions.
Great for an intern. F i nal l y, i t i s not a psychother apy manual. Doi ng a rapi d di agnosti c assessment i sn't psychotherapy, al though you can extend many of the ski l l s used i n the fi r st i nter vi ew to psychotherapy. I hope that you wi l l enjoy thi s book and that i t wi l l hel p you to devel op confi dence i n i nter vi ewi ng. As you embar k, r emember these wor ds of Theodor e Roosevel t: The onl y man who never makes a mi stake i s the man who never does anythi ng.
G ood l uck! Don't wor r y, I di dn't wr i te thi s r evi si on just to boost sal es of the book. Nor even wor se di d I wr i te thi s r evi si on to keep up to date wi th the l atest edi ti on of the DSM DSM-IV, text r evi si on , whi ch adds l i ttl e of val ue to psychi atr i c di agnosi s, al though i t does hel p the coffer s of the Amer i can Psychi atr i c Associ ati on.
I wr ote thi s r evi si on because, dur i ng the 5 year s si nce the fi r st edi ti on of The Psychiatr ic Inter view was publ i shed, I've seen many thousands of pati ents and have had a chance to r efi ne my own i nter vi ewi ng ski l l s. And I'd l i ke to pass on some thi ngs that I've l ear ned over that ti me.
Accor di ngl y, I have made changes to most chapter s, general l y r efl ecti ng r esear ch on psychi atr i c di agnosi s publ i shed si nce I al so thought i t was i mpor tant to hi ghl i ght cer tai n content ar eas of the i nter vi ew that I have found have become par ti cul ar l y i mpor tant over ti me.
Thus, I have wr i tten new chapter s pr ovi di ng mor e detai l on the eval uati on of ADHD attenti on-defi ci t hyperacti vi ty di sor der and on deter mi ni ng whether someone i s mal i nger i ng.
Pl ease l et me know what you thi nk of The Psychiatr ic Inter view, and how you thi nk i t can be i mpr oved.
My gui di ng pr i nci pl e has been, If i t i sn't i mmedi atel y useful to someone i n the tr enches, i t shoul dn't be i n the book.
Let me know i f I've succeeded! Dani el J. Car l at M. For thi s second edi ti on, I agai n want to fi r st thank Dr. Shawn Shea, wi thout whose cl assi c textbook, Psychiatr ic Inter viewing: The Ar t of Under standing, and per sonal mentor i ng I woul d never have conceptual i zed thi s pr oject. My father, Paul Car l at, who i s al so a psychi atr i st, has bestowed upon me whatever per sonal qual i ti es have been hel pful as I wor k wi th pati ents. Hi s suppor t and gui dance thr ough a ser i es of potenti al l y hai r-brai ned ventur es have been a per petual G od-send.
Many member s of the facul ty of Massachusetts G eneral Hospi tal MG H , wher e I di d my psychi atr i c r esi dency, wer e extr emel y hel pful i n the shapi ng of the manuscr i pt. In par ti cul ar, I thank Dr. Ed Messner, whose ver y practi cal appr oach to pati ent car e was r efr eshi ng; Dr. Paul Hambur g, who taught empathy and i nnumerabl e other aspects of connecti ng wi th pati ents; Dr. Paul Summer grad, a consummate cl i ni ci an and the di r ector of the i npati ent uni t dur i ng my chi ef r esi dency, who suppor ted me i n my effor ts to cr eate an i nter vi ewi ng cour se for r esi dents; Dr.
Car ey G r oss, whose astoni shi ng abi l i ty to rapi dl y make the r i ght di agnosi s for the most di ffi cul t pati ents i s a conti nui ng sour ce of i nspi rati on; and Dr.
Anthony Er dmann, who gener ousl y contr i buted several scr eeni ng questi ons. In addi ti on, speci al thanks go to Dr. Leston Havens, at the Cambr i dge Hospi tal , who was ver y encouragi ng thr oughout thi s pr oject.
I al so thank the psychi atr y r esi dents at MG H. The PG Y-2 r esi dents of the to academi c year wer e extr emel y accommodati ng as I devel oped my i nter vi ewi ng cur r i cul um whi l e teachi ng i t; the r esi dents and psychol ogy fel l ows i n my own cl ass constantl y cheer ed me on, par ti cul ar l y Dr s.
Rober t Mul l er, psychol ogi st supr eme. I especi al l y thank Dr. Rowen Hochstedl er, my medi cal di r ector and fr i end, who i s l i vi ng pr oof that excel l ent mentor i ng can conti nue far beyond the r eaches of academi a.
Bui l d a therapeuti c al l i ance. Obtai n the psychi atr i c database. Inter vi ew for di agnosi s. Negoti ate a tr eatment pl an wi th your pati ent.
It's i mpor tant to keep thi s l ar ger goal i n mi nd dur i ng the i nter vi ew, because i f you don't, your pati ent may never r etur n for a second vi si t, and your fi nel y wr ought Di agnosti c and Stati sti cal Manual of Mental Di sor der s, Four th Edi ti on text r evi si on DSM-IV-TR di agnosi s wi l l end up l angui shi ng i n a char t i n a fi l e r oom.
The r easons for tr eatment dr opout ar e many. The upshot i s that much mor e than di agnosi s shoul d occur dur i ng the i ni ti al i nter vi ew: Al l i ance bui l di ng, moral e boosti ng, and tr eatment negoti ati ng ar e al so vi tal. The four tasks of the i ni ti al i nter vi ew bl end wi th one another.
You establ i sh a therapeuti c al l i ance as you l ear n about your pati ent. As you ask questi ons, you for mul ate possi bl e di agnoses, and thi nki ng thr ough di agnoses l eads natural l y to the pr ocess of negoti ati ng a tr eatment pl an. Build a Therapeutic Alliance A therapeuti c al l i ance for ms the gr oundwor k of any psychol ogi cal tr eatment.
Chapter 3, The Therapeuti c Al l i ance, focuses on the al l i ance di r ectl y, and Chapter s 4, 5, 6, 7, 8, 9 and 10 pr ovi de var i ous i nter vi ewi ng ti ps that wi l l hel p you i ncr ease rappor t wi th your pati ent. Obtain the Psychiatric Database Al so known as the psychi atr i c hi stor y, the psychi atr i c database i ncl udes hi stor i cal i nfor mati on r el evant to the cur r ent cl i ni cal pr esentati on.
These topi cs ar e cover ed i n Secti on II, The Psychi atr i c Hi stor y, and i ncl ude hi stor y of pr esent i l l ness HPI , psychi atr i c hi stor y, medi cal hi stor y, fami l y psychi atr i c hi stor y, and aspects of the soci al and devel opmental hi stor y. G l eani ng thi s i nfor mati on i s the substance of the i nter vi ew, and thr oughout thi s step, you wi l l have to wor k on bui l di ng and mai ntai ni ng the al l i ance. You wi l l al so make fr equent forays i nto the next task, i nter vi ewi ng for di agnosi s.
Interview for Diagnosis The abi l i ty to i nter vi ew for di agnosi swi thout soundi ng as i f you'r e r eadi ng off a checkl i st of symptoms and wi thout getti ng si detracked by l ess r el evant i nfor mati oni s one of the supr eme ski l l s of a cl i ni ci an, and one that you wi l l hone and devel op over the cour se of your pr ofessi onal l i fe.
Negotiate a Treatment Plan and Communicate It to Your Patient How to negoti ate and communi cate a tr eatment pl an i s rar el y taught i n r esi dency or graduate school , and yet i t i s pr obabl y the most i mpor tant thi ng you can do to ensur e that your pati ent adher es to whatever tr eatment you r ecommend.
If your pati ent doesn't under stand your for mul ati on, doesn't. See Secti on IV, Inter vi ewi ng for Tr eatment, for ti ps on the ar t of pati ent educati on and cl i ni cal negoti ati on. Al though thi s may seem obvi ous enough, novi ce i nter vi ewer s often l ose si ght of i t and ther efor e fai l to acti vel y str uctur e the i nter vi ew and contr ol i ts paci ng.
The r esul t i s usual l y a pani c-fi l l ed endi ng, i n whi ch 50 questi ons ar e wedged i nto the l ast 5 mi nutes. It's tr ue that ther e's a huge amount of i nfor mati on to obtai n dur i ng the fi r st i nter vi ew, and ti me may feel l i ke the enemy. Excel l ent i nter vi ewer s, however, rar el y feel r ushed. They have the abi l i ty to obtai n l ar ge amounts of i nfor mati on i n a br i ef per i od, wi thout gi vi ng pati ents the sense that they ar e bei ng hur r i ed al ong or made to fi t i nto a pr eor dai ned str uctur e.
One of the secr ets of a good i nter vi ewer i s the abi l i ty to acti vel y str uctur e the i nter vi ew i n i ts thr ee phases. Opening Phase 5 to 10 Minutes The openi ng phase i ncl udes meeti ng your pati ent, l ear ni ng a bi t about her l i fe si tuati on, and then shutti ng up and gi vi ng her a few uni nter r upted mi nutes to tel l you why she came. The openi ng phase i s based on car eful , pr ei nter vi ew pr eparati on, cover ed i n Chapter 2, Logi sti c Pr eparati ons: What to Do befor e the Inter vi ew.
Attenti on to l ogi sti cs ensur es that you wi l l be compl etel y attuned to the r el ati onshi p wi th your pati ent dur i ng the fi r st 5 mi nutes. Body of the Interview 30 to 40 Minutes Over the cour se of the openi ng phase, you wi l l come up wi th some i ni ti al di agnosti c hypotheses Chapter 19 , and you wi l l deci de on some i nter vi ewi ng pr i or i ti es to expl or e dur i ng the body of the i nter vi ew.
For exampl e, you may deci de that. You wi l l map out an i nter vi ewi ng strategy for expl or i ng these topi cs, whi ch wi l l i ncl ude aski ng about the hi stor y of the pr esent i l l ness Chapter 13 ; hi stor y of depr essi on, sui ci dal i deati on SI , and substance abuse Chapter s 21, 22, and 25 ; fami l y hi stor y of these di sor der s Chapter 16 ; and a detai l ed assessment of whether the pati ent actual l y meets DSM-IV-TR cr i ter i a Chapter s 21, 22, and 25 for each di sor der.
Closing Phase 5 to 10 Minutes Al though you may be tempted to conti nue aski ng di agnosti c questi ons r i ght up to the end of the hour, i t's essenti al to r eser ve at l east 5 mi nutes for the cl osi ng phase of the i nter vi ew.
The cl osi ng phase shoul d i ncl ude two components: a a di scussi on of your assessment, usi ng the pati ent educati on techni ques outl i ned i n Chapter 31 and b an effor t to come to a negoti ated agr eement about tr eatment or fol l ow-up pl ans Chapter Of cour se, ear l y i n your car eer, i t wi l l be di ffi cul t to come up wi th a coher ent assessment on the spot, wi thout the benefi t of hour s of posti nter vi ew super vi si on and r eadi ng.
Pr epar e the r i ght space and ti me. Use paper tool s effecti vel y. Devel op your pol i ci es. The wor k of psychol ogi cal heal i ng begi ns i n a safe pl ace, to be compar ed wi th the best of hospi tal exper i ence or, fr om an ear l i er ti me, chur ch sanctuar y.
The psychol ogi cal safe pl ace per mi ts the i ndi vi dual to make spontaneous, for ceful gestur es and, at the same ti me, r epr esents a communi ty that both al l ows the gestur es and i s val ued for i ts own sake.
A Safe Pl ace. Logi sti c pr eparati on for an i nter vi ew i s i mpor tant because i t sets up a mel l ower and l ess str essful exper i ence for both you and your pati ent. Often, trai nees ar e thr own i nto the cl i ni c wi thout trai ni ng i n how to fi nd and secur e a r oom, how to deal wi th schedul i ng, or how to document effecti vel y.
You'l l eventual l y ar r i ve at a system that wor ks wel l for you; thi s chapter wi l l hel p speed up that pr ocess. Once secur ed, di g tr enches, cal l for the caval r y, do whatever you need to do. I r emember one ear l y l esson i n thi s r eal i ty: I was 2 months i nto my trai ni ng and just fi ni shi ng super vi si on i n the War r en Bui l di ng of the Massachusetts G eneral Hospi tal MG H campus.
It was p. I z i gged and z agged ar ound staff and pati ents i n the hal l ways on thei r way to the cafeter i a and r ushed i nto the cl i ni c by My pati ent was i n the wai ti ng r oom and got a good vi ew of sweat tr i ckl i ng down my for ehead.
I scanned the r oom schedul e and found that no r ooms wer e fr ee. Pani c set i n, unti l the secr etar y poi nted out that the r esi dent who had r oom for that hour had not yet shown up. So I l ed my pati ent to , and we star ted, 10 mi nutes l ate. F i ve mi nutes l ater, ther e was a knock on the door.
I opened i t, and ther e stood the r esi dent and hi s pati ent. I r edeposi ted my pati ent i n the wai ti ng r oom and scour ed the l i st for another r oom. I won't tor tur e you wi th the r est of thi s saga. Suffi ce i t to say we wer e evi cted fr om the next r oom as wel l , and the therapy sessi on was, i n the end, onl y 15 mi nutes l ong, wi th much humi l i ati on on my par t and good-natur ed amusement on my pati ent's.
Her e ar e some ti me-honor ed ti ps on how to secur e a r oom and what to do wi th i t once you have i t:. Schedule the same time every w eek.
Tr y to secur e your r oom for the same ti me ever y week. That way you'l l be abl e to fi t i nter vi ews i nto your weekl y schedul e r outi nel y. When i t comes to psychi atr i c i nter vi ewi ng, r outi ne i s your fr i end. Psychodynami c psychotherapi sts cal l thi s r outi nethe same ti me, the same r oom, the same gr eeti ngthe frame.
Maki ng i t i nvar i abl e r educes di stracti ons fr om the wor k of psychol ogi cal expl orati on. Make your room your ow n in some w ay. Thi s i sn't easy when you onl y i nhabi t i t for a few hour s a week. The r oom wi l l feel mor e l i ke your space, and i t wi l l seem homi er to your pati ent.
By the way, i f you do put up a pi ctur e, thi nk twi ce befor e you di spl ay your fr i ends or fami l y; i t may l ead to transfer ence pr obl ems wi th some pati ents.
A rrange the seating so that you can see a clock wi thout shi fti ng your gaze too much. A wal l cl ock posi ti oned just behi nd your pati ent wor ks wel l. A desk cl ock or a wr i stwatch pl aced between the two of you i s al so acceptabl e. The object i s to al l ow you to keep track of the passage of ti me wi thout thi s bei ng obvi ous to your pati ent.
It i s al i enati ng for a pati ent to noti ce a cl i ni ci an fr equentl y l ooki ng at a cl ock; the per cei ved. You do need to moni tor the ti me, though, to ensur e that you obtai n a tr emendous amount of i nfor mati on i n a br i ef per i od.
Actual l y, keepi ng track of ti me wi l l paradoxi cal l y make you l ess di stracted and mor e pr esent for your pati ent, as you'l l al ways know that you'r e managi ng your ti me adequatel y. Protect Your Time Ti me i s but the str eam I go a-fi shi ng i n.
Thi s i s not to say that you shoul d go fl y-casti ng wi th your pati ents though you'r e usual l y fi shi ng for somethi ng or other dur i ng an i nter vi ew. Rather, you shoul d pr otect the ti me you schedul e for i nter vi ews so that i t has that same peaceful , al most sacr ed qual i ty.
A rrive earlier than the patient. You need ti me to pr epar e your sel f emoti onal l y and l ogi sti cal l y for the i nter vi ew.
Compose your sel f. Lay out whatever for ms or handouts you'l l need. Answer any ur gent messages that you just pi cked up at your message box. Br eathe, medi tate, or do a cr osswor d puz z l e or whatever you do to r el ax. I once obser ved an i nter vi ewer who was vi si bl y anxi ous.
He cr ossed and uncr ossed hi s l egs and constantl y kneaded hi s l eft pal m wi th hi s r i ght thumb. You l ook ner vous. He l aughed. Oh, I'm fi ne, he sai d. And no, thi s was not a r esi dent, but one of my pr ofessor s. Prevent interruptions. Ther e ar e var i ous ways to pr event i nter r upti ons:. Ask the cl i ni c secr etar y to take messages for you. Ask the page operator to hol d al l but ur gent pages.
Put your pager on vi brate mode and onl y answer ur gent pages. Si gn your pages out to a col l eague. Don't overbook patients. Know your l i mi ts.
At the begi nni ng, i t may take you an hour and a hal f to compl ete an eval uati on, not i ncl udi ng the wr i te-up. If so, book onl y one pati ent per 2- hour sl ot.
Obvi ousl y, your trai ni ng pr ogram won't al l ow you to mai ntai n such a l ei sur el y schedul e for l ong, but you wi l l i mpr ove and become mor e effi ci ent. Eventual l y, you shoul d ai m towar d compl eti ng the eval uati on and wr i te-up or di ctati on i n 1 hour. Leave plenty of time for notes and paperw ork. The ti me r equi r ed for paper wor k wi l l var y, dependi ng on both the setti ng and the cl i ni ci an.
The key i s to fi gur e out how l ong i t takes you and then to make r oom for i t i n your schedul e. Don't fal l i nto deni al. If you happen to be ver y sl ow at paper wor k, admi t i t and pl an accor di ngl y. I know an excel l ent psychi atr i st who has l ear ned fr om exper i ence that he has to spend 30 mi nutes on char ti ng, tel ephoni ng, and mi scel l aneous paper wor k r el ated to pati ents for ever y hour of cl i ni cal wor k he does.
If he spends 6 hour s seei ng pati ents, he schedul es 3 hour s i n the eveni ng to take car e of the col l ateral wor k. Al though hi s hour l y wage decr eases, he gai ns the sati sfacti on of knowi ng that he's doi ng the ki nd of job he wants to do.
Now, that woul dn't wor k for me. I schedul e sl i ghtl y l ess ti me wi th pati ents so that I can fi ni sh al l col l ateral wor k befor e I see my next appoi ntment. The poi nt, as Pol oni us sai d i n Haml et, i s to Know thysel f, and to thi ne own sel f be tr ue.
Ther e's l i ttl e for mal trai ni ng i n how to use these, but they ar e i ndi spensabl e when you see a l ot of pati ents ever y day. Al l of the paper tool s I di scuss bel ow ar e i n the appendi ces of thi s manual , and you ar e wel come to copy and use what you want. You mi ght fi nd al l , some, or none of them useful , or you may want to adapt them to better sui t your needs. He takes notes on i t whi l e tal ki ng to pati ents and puts i t i n hi s char t.
Advantages Use of thi s for m ensur es a thor ough data eval uati on and saves ti me, because notes can be pl aced di r ectl y i nto the char t. Disadvantages Some pati ents may be al i enated i f you seem mor e i nter ested i n compl eti ng a for m than i n getti ng to know them. Psychiatric Interview Short Form The shor t for m i n Appendi x B can be used for r ough notes when you ar e goi ng to di ctate the eval uati on or wr i te i t up i n a l onger ver si on l ater.
Advantages Thi s for m pr esents l ess of a bar r i er between cl i ni ci an and pati ent than the l ong for m and i s easy to r efer to whi l e di ctati ng. You can jot r ough notes on a bl ank pi ece of paper or not take notes at al l , i f you'r e abl e to r emember most i nfor mati on. Advantages The car d al l ows maxi mum i nteracti on between cl i ni ci an and pati ent, si nce ther e i s no for m to fi l l out. Disadvantages Requi r ed i nfor mati on i s not ful l y spel l ed out on the pocket car d, so mor e use of memor y i s r equi r ed.
Advantages The pati ent questi onnai r e al l ows mor e ti me dur i ng the fi r st sessi on to focus on i ssues of i mmedi ate concer n to the pati ent. It may hei ghten the pati ent's sense that he i s acti vel y par ti ci pati ng i n hi s car e.
Disadvantages If al l of the pati ent's answer s on the questi onnai r e ar e accepted at face val ue, i nval i d i nfor mati on may be col l ected. Some pati ents may vi ew fi l l i ng out the questi onnai r e as a bur den. Patient Handouts Pati ents usual l y appr eci ate r ecei vi ng some wr i tten i nfor mati on i n Appendi x C about thei r di sor der, and i t pr obabl y i ncr eases tr eatment compl i ance.
Advantages Pati ent handouts i ncr ease pati ents' under standi ng of thei r di agnosi s and gi ve them a sense that they ar e col l aborati ng i n thei r tr eatment. Disadvantages The handouts may pr esent mor e i nfor mati on than some pati ents can handl e ear l y i n thei r tr eatment. Infor mati on may al so be mi si nter pr eted.
You need to deter mi ne the parameter s of thi s r el ati onshi p, i ncl udi ng i ssues such as how and when you can be contacted, what the pati ent shoul d do i n case of an emer gency, who you can tal k to about the pati ent, and how to deal wi th mi ssed appoi ntments. As you face thi s ar ray of deci si ons, the fol l owi ng ti ps and i deas shoul d hel p you devi se pol i ci es that fi t your per sonal i ty and cl i ni cal setti ng.
Contacting You You defi ne the boundar i es of the cl i ni cal r el ati onshi p by setti ng l i mi ts on wher e and when pati ents can r each you. Do thi s ear l y on; i f you don't, you'l l eventual l y suffer for i t. I found thi s out the har d way wi th my ver y fi r st therapy pati ent dur i ng r esi dency. She was a year-ol d woman I'l l cal l Sal l y who had pani c di sor der and depr essi on. I fi r st met her i n the cr i si s cl i ni c, wher e she came after an upsetti ng conver sati on wi th her father.
I spoke to her for hal f an hour, and I gave her a. The next Satur day mor ni ng, over br eakfast and the paper, I got my fi r st page: Cal l Sal l y. She was i n the mi ddl e of a pani c attack, whi ch subsi ded after a mi nute conver sati on. Later that day, as I was r i di ng my bi ke, I got another page. I was somewher e on a countr y r oad i n Concor d, Massachusetts, and far fr om a phone. Ten mi nutes l ater : Cal l Sal l y. Ur gent. Over the next hour, I r ecei ved si x pages, each soundi ng mor e ur gent as the al ar med hospi tal operator added mor e and mor e punctuati on.
The l ast page r ead, Cal l Sal l y!!! Emer gency!!!!!! When I fi nal l y found a pay phone, my hear t poundi ng, Sal l y sai d, Doctor! I just had another pani c attack. I fel t the fi r st hi nt of what I l ater l ear ned was counter transfer ence. At the ti me, I cal l ed i t bei ng pi ssed off. At our next appoi ntment, after some good super vi si on, I l ai d out some gr ound r ul es.
Sal l y coul d page me onl y dur i ng the week between 8 a. Other wi se, she was i nstr ucted to go to the cr i si s cl i ni c. Thi s i n i tsel f hel ped decr ease the fr equency of her pani c attacks, because i t took away the r ei nfor cement of a phone conver sati on wi th her therapi st ever y ti me she pani cked. Suggestions Never gi ve your home tel ephone number to pati ents and consi der keepi ng an unl i sted phone number.
You may gi ve out your pagi ng number, but speci fy the ti mes when you'r e avai l abl e to be paged. Don't l et your l i fe r evol ve ar ound your pager. Tel l your pati ent what to do i f ther e i s an emer gency at a ti me when you ar e not avai l abl e for pagi ng. For exampl e, he can cal l the cr i si s cl i ni c, and you can gi ve the cl i ni c i nstr ucti ons to page you after hour s i f the on-cal l cl i ni ci an judges that the si tuati on war rants your i mmedi ate i nvol vement.
If you have a voi ce-mai l system, have pati ents r each you ther e. Your voi ce mai l i s accessi bl e 24 hour s a day, and you can check i t whenever you want and deci de who to cal l back and when. Some pati ents wi l l cal l your voi ce mai l just to be soothed by your r ecor ded voi ce. When you'r e on vacati on, I suggest you si gn your pati ents out to a cl i ni ci an you know and tr ust, rather than have them cal l the cr i si s cl i ni c dur i ng r egul ar hour s.
That way, you can ensur e that someone i s pr epar ed to deal wi th any i mpendi ng cr i ses. For exampl e, you may have pati ents. Letti ng your col l eague know about these pati ents may pr event i nappr opr i ate hospi tal i z ati on. Many cl i ni ci ans use e-mai l as a way of contacti ng pati ents. Thi s can be a ti me-saver, because you can answer qui ck questi ons wi thout bei ng at the mer cy of the avai l abi l i ty of your pati ent's cel l phone or voi ce mai l.
But agai n, wi thout cer tai n gr ound r ul es, thi s can and wi l l get out of hand. Speci fy what you ar e wi l l i ng to use e-mai l for. Typi cal l y, thi s wi l l be l i mi ted to schedul i ng changes and r equests for pr escr i pti on r efi l l s. If you star t answer i ng mor e i nvol ved cl i ni cal questi ons over e-mai l , be awar e that thi s i s par t of the medi cal r ecor d, and you shoul d pr i nt out a copy of any cor r espondence and put i t i n the char t.
Contacting the Patient Be sur e to obtai n your pati ent's var i ous phone number s e. Ask whether i t's okay for you to i denti fy your sel f when you cal l , because some pati ents don't want empl oyer s or fami l y member s to know that they'r e i n tr eatment. Obtai n number s of fami l y member s or cl ose fr i ends so that you can contact them ei ther to gather cl i ni cal i nfor mati on or i n emer gency si tuati ons.
You'l l need to obtai n your pati ent's consent for thi s ahead of ti me. Missed Appointments The usual practi ce i s to tel l pati ents that they must i nfor m you at l east 24 hour s i n advance of any mi ssed appoi ntments or they wi l l be char ged, except i n emer gency si tuati ons.
As a sal ar i ed trai nee, the fi nanci al aspects of thi s pol i cy ar en't r el evant, but ther e ar e i mpor tant cl i ni cal benefi ts. Pati ents who make the effor t to show up for sessi ons show a l evel of commi tment that bodes wel l for therapeuti c success.
Thi s pol i cy encourages that commi tment. What i f a pati ent r epeatedl y cancel s sessi ons al bei t i n ti me to avoi d payi ng?
Is i t for a l egi ti mate r eason, or i s she acti ng out some feel i ngs of anxi ety or hosti l i ty? Di d you just r etur n fr om vacati on?
If so,. One way to appr oach thi s i ssue i s head-on:. I notice that since I r etur ned fr om vacation, you've canceled thr ee sessions in a r ow. What's going on? Sometimes people get angr y at their ther apists.
Should we be going a bit mor e slowly with these issues? Be war m, cour teous, and emoti onal l y sensi ti ve. Acti vel y defuse the strangeness of the cl i ni cal si tuati on. G i ve your pati ent the openi ng wor d. G ai n your pati ent's tr ust by pr ojecti ng competence.
The therapeuti c al l i ance i s a feel i ng that you shoul d cr eate over the cour se of the di agnosti c i nter vi ewa sense of rappor t, tr ust, and war mth. Most r esear ch on the therapeuti c al l i ance has been done i n the context of psychotherapy, rather than the di agnosti c i nter vi ew. Jer ome F rank, author of Per suasi on and Heal i ng F rank and the father of the comparati ve study of psychotherapy, found that a therapeuti c al l i ance i s the most i mpor tant i ngr edi ent i n al l effecti ve psychotherapi es.
Cr eati ng rappor t i s tr ul y an ar t and ther efor e di ffi cul t to teach, but her e ar e some ti ps that shoul d i ncr ease your success. BE YOURSELF Al though ther e i s much to be l ear ned fr om books and r esear ch about how to be a good i nter vi ewer, you'l l never enjoy thi s psychi atr y racket ver y much unl ess you can fi nd some way to i nject your own per sonal i ty and styl e i nto your wor k.
He's a character, no questi on about i t. As a pati ent, you'l l mor e l i kel y l ove hi m than hate hi m, but ei ther way, what you see i s what you get. Two exampl es of Dr. Shapi r o's unor thodox styl e:. Wal ki ng down the hal l way of the i npati ent uni t, Dr.
Shapi r o spotted the pati ent he needed to i nter vi ew next. Hey, what's wrong, does your Shapiro: face hurt? The pati ent chuckl ed, and the rappor t was sol i di fi ed. The Shapi r o thumbwr estl i ng pl oy: An angr y, depr essed man was demandi ng to be di schar ged, pr ematur el y accor di ng to staff r epor ts.
Shapi r o agr eed that di schar ge woul d be r i sky, par tl y because the pati ent had devel oped l i ttl e i n the way of rappor t wi th anyone. I understand you want to be Shapiro: discharged? Of course, this place is stupid, Patient: no one's helping me. If you can beat me at Shapiro: thumbwrestling, I'll let you leave. Putting out his hand Dr.
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