Nr548 nr 548 exam 2
1. Psychiatric interview: the process by which psychiatric assessment is
conduct- ed
-primary tasks
•building a therapeutic alliance between the PMHNP & client
•obtaining a database of psychiatric info about the client
•establishing a dx
•negotiating a tx plan
2. Therapeutic Alliance: a feeling that you should create over the
course of the diagnostic interview, a sense of rapport, trust, and
warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
•begins during the initial or opening phase of the interview
,-fundamental component of successful therapy
•Without trust, adherence to treatment recommendations may be
compromised
•interview may not elicit the information needed to formulate an
appropriate dx & plan of care without rapport & trust
3. Creating rapport: tips: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
4. How to approach threatening topics (sensitive/embarrassing material): -
-Normalization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
,-Use Familiar Language When Asking about Behaviors
5. Normalization: Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or
understandable response to a mood or situation
•ex: Sometimes when people are very depressed, they think of hurting
themselves. Has this been true for you?
2.Begin by describing another patient (or patients) who has engaged in
the behavior, showing your patient that she is not alone
•ex: I've talked to several patients who've said that their depression
causes them to have strange experiences, like hearing voices or
thinking that strangers are laughing at them. Has that been happening
to you?
, 6. Symptom Expectation: communicate that a behavior is in some way
normal or expected
-Phrase your Q's to imply that you already assume the patient has
engaged in some behavior and that you will not be offended by a
positive response
-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of
hopelessness. You suspect suicidality, but you sense that the patient
may be too ashamed to admit it. Rather than gingerly asking "Have you
had any thoughts that you'd be better off dead?" you might decide to
use symptom expectation. "What kinds of ways to hurt yourself have
you thought about?"
*reserve this technique for situations in which it seems appropriate
7. Symptom Exaggeration: suggesting a frequency of a problematic
behavior that is higher than your expectation, so that the patient feels
1. Psychiatric interview: the process by which psychiatric assessment is
conduct- ed
-primary tasks
•building a therapeutic alliance between the PMHNP & client
•obtaining a database of psychiatric info about the client
•establishing a dx
•negotiating a tx plan
2. Therapeutic Alliance: a feeling that you should create over the
course of the diagnostic interview, a sense of rapport, trust, and
warmth
-most important goal of the interview process
-the cooperative working relationship between the therapist and client
•begins during the initial or opening phase of the interview
,-fundamental component of successful therapy
•Without trust, adherence to treatment recommendations may be
compromised
•interview may not elicit the information needed to formulate an
appropriate dx & plan of care without rapport & trust
3. Creating rapport: tips: -Be Yourself
-Be Warm, Courteous, and Emotionally Sensitive
-Actively Defuse the Strangeness of the Clinical Situation
-Give Your Patient the Opening Word
-Gain Your Patient's Trust by Projecting Competence
4. How to approach threatening topics (sensitive/embarrassing material): -
-Normalization
-Symptom Expectation
-Symptom Exaggeration
-Reduction of Guilt
,-Use Familiar Language When Asking about Behaviors
5. Normalization: Introducing Q with some type of normalizing statement
-two principal ways to do this:
1. start the question by implying that the behavior is a normal or
understandable response to a mood or situation
•ex: Sometimes when people are very depressed, they think of hurting
themselves. Has this been true for you?
2.Begin by describing another patient (or patients) who has engaged in
the behavior, showing your patient that she is not alone
•ex: I've talked to several patients who've said that their depression
causes them to have strange experiences, like hearing voices or
thinking that strangers are laughing at them. Has that been happening
to you?
, 6. Symptom Expectation: communicate that a behavior is in some way
normal or expected
-Phrase your Q's to imply that you already assume the patient has
engaged in some behavior and that you will not be offended by a
positive response
-high index of suspicion of some self-destructive activity
-Ex: patient is profoundly depressed and has expressed feelings of
hopelessness. You suspect suicidality, but you sense that the patient
may be too ashamed to admit it. Rather than gingerly asking "Have you
had any thoughts that you'd be better off dead?" you might decide to
use symptom expectation. "What kinds of ways to hurt yourself have
you thought about?"
*reserve this technique for situations in which it seems appropriate
7. Symptom Exaggeration: suggesting a frequency of a problematic
behavior that is higher than your expectation, so that the patient feels
