|INTERVIEWING TIP OF THE MONTH
# 12 February 2001
Helping Patients Who Are Somaticizing to Discuss Psychiatric Symptoms
TISA Description of the Problem: Obviously, if somaticizing patients found it easy to discuss psychiatric symptoms, they would not be using somaticization as one of their main defenses. The trick is to help these patients naturally move into a description of their psychiatric symptoms, without highlighting to them that a psychiatric review of symptoms is under way.
Tip: One way to help these patients feel more comfortable discussing psychiatric symptoms, such as the symptoms of depression, is to use their somatic complaints as natural bridges into their psychiatric symptoms. Examples might be as follow:
1) Clinician: With all of the pain you've been experiencing, has it been difficult to sleep?
2) Clinician: With your headaches coming almost every day for you, has the whole thing started to get you down?
3) Clinician: I know that this nausea and stomach pain has been hard to shake, has it started to wear you down so that you feel weary all the time?
Result: By using the somatic complaint itself as the initial focus for an entry into psychiatric symptoms, the interviewer can often minimize resistance with these patients.
Tip provided by:
Anthony Levinson, M.D., McMaster University, Ontario, Canada.