Psychiatric Interviewing: The Art of Understanding, 3rd Edition

A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals

Hardback includes ExpertConsult e-book with over 7.5 hours

of streaming online video and 5 bonus chapters!

5-Stars out of 5-Stars on Doody’s Core Titles List! 

“Enormously practical, elegant in execution and delightfully fun to read, every page holds clinical wisdom . . . . I have never seen such great teaching videos on eliciting suicidal ideation. “

Jan Fawcett, M.D. Professor of Psychiatry, University of New Mexico
Recipient of Lifetime Achievement Award (American Association of Suicidology)

“Throughout the text, Shea integrates cultural humility, the client perspective, clinical wisdom, and the best that research has to offer . . . . I hate to say it, but a medical doctor has written the best social work interviewing text on the market. I hope this text gets adopted in every school of social work.”

Jonathan B Singer, Ph.D., LCSW
Associate Professor School of Social Work, Loyola University Chicago
Founder and host, Social Work Podcast

“Every resident should buy and read this entire book before taking his or her first night of call. Every resident . . . . Shea’s extraordinary streaming videos will thrust this book to the forefront of web-based learning. Trust me on this point. They’re fabulous.”

James L. Knoll, IV, M.D. Professor of Psychiatry
Director of Forensic Psychiatry SUNY Upstate Medical University

             “Creating hope and healing through expert clinical interviewing.”

Critical Acclaim

Praise from across disciplines for “Psychiatric Interviewing: The Art of Understanding, 3rd Edition”

Pre-Publication Reviews

“Enormously practical, elegant in execution and delightfully fun to read, every page holds clinical wisdom . . . . I can think of no better first book for any trainee in mental health, for it is not only, in my opinion, an unsurpassed book about how to interview, it is a book about why we interview. It is a book that captures the wonderment of our work and the soul of our mission . . . . I have never seen such great teaching videos on eliciting suicidal ideation. They are a treasure, and I believe that many lives will be saved by those lucky enough to view them.”

From the Foreword by Jan Fawcett, M.D.
Professor of Psychiatry, University of New Mexico
Recipient of Lifetime Achievement Awards
from both the American Association of Suicidology
and the American Foundation for Suicide Prevention

“Both of the previous editions of Dr. Shea’s book have anchored Bryn Mawr’s advanced clinical social work practice curriculum for a generation of our master’s degree students. This third edition is a masterful integration of text and video instruction. Indeed, it represents a pedagogical leap, in which Dr. Shea brings the beginning and advanced student into the mysteries of the first encounter with his characteristic warmth, compassion, and wisdom that has so enthralled our students over the years. Only now, we can see it, not only in engaging text, but in amazingly effective video instruction and interview demonstrations, that bring to life the clinical encounter. With the publication of this book, I personally believe that Dr. Shea has cemented his standing as one of the most influential mental health educators of the 21st Century.”

James A. Martin, Ph.D., LICSW Colonel, U.S. Army (Retired)
Professor of Social Work and Social Research
Bryn Mawr College, Bryn Mawr, PA

“Insightful, wonderfully practical, and surprisingly comprehensive, Shea’s chapter on culturally sensitive interviewing in Psychiatric Interviewing: the Art of Understanding, 3rd Edition sets a new bar on effective literature on multiculturalism. Shea not only eloquently delineates important cross-cultural principles for students – while modeling numerous immediately useful questions and strategies – he provides examples of clinician/client dialogue in which the student can actually see the interviewer gracefully transforming awkward cultural disconnects. I’ve never seen anything quite like it in the clinical literature. Simply superb! PS: Year after year my master level counseling students have raved – and I mean raved – about Shea’s textbook, and this Third Edition looks to be even better! I know of no book that better prepares a student for actual clinical practice.”

Dottie R. Morris, Ph.D.
Chief Officer of Diversity and Multiculturalism,
Keene State College
Former Director of Student Affairs for the Clinical Mental
Health Counseling Program, Antioch University New England

“We have been using the second edition of this book for over a decade at our school, and it has been an indispensable resource for both our faculty and our students. This 3rd Edition has been revised and expanded including fascinating new chapters on topics such as wellness, motivational interviewing, cultural diversity and how to collaboratively talk with patients about their medications. Many of the chapters are enriched with engrossing video demonstrations. I can’t recommend this book enough. It will infuse passion and curiosity in your students. It will be a resource they will return to for learning for years to come.”

Palmira Brouwer R.N. BscN, MA (psychology)
Department of Psychiatric Nursing Douglas College, B.C. Canada

“Dr. Shea is an extremely gifted teacher, whose vibrant story-telling skills and compelling videos have led him to garnering some of the highest evaluations in the 30 year history of the Cape Cod Symposium. In short, readers are in for a rare treat when viewing the book’s video component.”

Rob Guerette, M.D.
Founder and Director of the Cape Cod Symposium

“Dr. Shea has done the impossible – written a text that works for bachelors, masters, and doctoral level social workers. Throughout the text, Shea integrates cultural humility, the client perspective, clinical wisdom, and the best that research has to offer. The accompanying videos are the most amazing instructional videos I’ve ever seen – they include mini-lectures, video of an actual client interview, and wondrously realistic role-plays (which invite you into the mind of a master) and speak directly to the content in the text. I hate to say it, but a medical doctor has written the best social work interviewing text on the market. I hope this text gets adopted in every school of social work.”

Jonathan B Singer, Ph.D., LCSW
Associate Professor School of Social Work,
Loyola University Chicago
Founder and host, Social Work Podcast

“Interviewing skills are not only indispensable, they are the rate-limiting factor in providing quality care. In the 3rd Edition of Dr. Shea’s classic text, we now have an indispensable book to match the training needs of our psychiatric residents (indeed, of our trainees in any mental health discipline). The skills delineated within these chapters should, in my opinion, be taught in all psychiatric residency programs. Every resident should buy and read this entire book before taking his or her first night of call. Every resident. In fact, I recommend reading it twice. I almost forgot to mention, Shea’s extraordinary streaming videos will thrust this book to the forefront of web-based learning. Trust me on this point. They’re fabulous.”

James L. Knoll, IV, M.D
Professor of Psychiatry Director of Forensic Psychiatry
SUNY Upstate Medical University

“Here is a book I would enthusiastically recommend to all graduate students in psychology on the art of clinical interviewing and to all faculty who teach such courses. Even the most experienced clinician will enjoy and learn much from this text. I don’t believe I’ve ever seen an author capture the pain of patients dealing with serious disorders such as major depression, schizophrenia, and bipolar disorder with such sensitivity and compassion, while transforming this understanding into easily learned questions and techniques for use in actual practice. Combine this sensitive and comprehensive approach with Shea’s skillful use of advanced technology (over 7 hours of streaming video modules and interviewing demonstrations) and you have a book, whose shelf-life will be measured not in years, but decades.”

Lawrence A. Welkowitz, Ph.D.
Co-Editor of Asperger’s Syndrome: Intervening in Clinics, Schools
and Communities
Principle Investigator: Use of iPad Assisted Learning for Autism

“While reading the pages of this wonderful book, I kept wishing I could have held this book in my hands when I was a psychiatric resident. Dr. Shea’s stand-out chapters on personality dysfunction (from DSM-5 differential diagnosis to the effective application of object relations and self psychology) are suffused with an understanding of the pain experienced by patients with personality disorders, and the confusion and intensity they can stir-up in the interviewer. Using Shea’s techniques, clinicians will feel competent at steering through the most turbulent and treacherous of interpersonal eddies in order to connect with and help these patients. Readers of this highly engaging, ground-breaking book, and viewers of its over 7 hours of stunning videos, will be able to become the clinicians their patients deserve, the ones they were meant to be.”

Laura Miller, M.D.
Medical Director of Women’s Mental Health
at Edward Hines Jr. VA Hospital.
Professor of Psychiatry,
Loyola University Stritch School of Medicine

“This edition retains all the elements responsible for the success of the earlier editions, yet is significantly expanded with ample new material in the print version, additional online material, and videos. This remains one of the premier books on the psychiatric interview.”

Doody’s 2017 Book Review Score: 97/100 – 5 Stars!
Doody’s Reviewer: Marina Bayeva, M.D., Ph.D.
Northwestern University Feinberg School of Medicine

Reviews from Journals for Previous Editions

” Using a rich palette of information from various fields, including psychoanalysis, behavioral psychology, and sociology, the author writes about the entire interview, and reveals the rich interaction that begins even before the first words are spoken . . . . . It is no surprise that this book has been well received by major psychiatric journals. However, it is always a pleasant surprise to find an engaging book that is both theoretically sound and clinically indispensable.”

Doody’s Book Reviewer

“This is a book I wish I could have written. . . . . can be read with interest by expert and novice alike.”

Clinical Psychology Review Arthur Weins, Ph.D.

“Rich in information, wisdom, humor, and charm, this book teaches not only interviewing skills but also the attitudes and behaviors that underpin the therapeutic personality and process.”

American Journal of Psychiatry

“Provides a well-balanced synthesis of many approaches from various schools of psychiatry, psychology, and counseling . . . . enjoyable and stimulating to read. . . . . written with eloquence and humor.”

British Journal of Psychiatry

“Intensely practical, with a riveting chapter on the assessment of risk for suicide and homicide. . . . . Reviewers have a way of telling you that a good book is essential for every psychiatric library. This time it really is true.”

Canadian Journal of Psychiatry

“Shea’s book, which is now in its second edition, is a valuable counter-weight to the ‘one size fits all’ approach to interviewing and eliciting data. It is an invaluable book for those training in psychiatry or other mental health professions and indeed for practicing clinicians.”

Australian and New Zealand Journal of Psychiatry

“Rich with sensitive observations and practical suggestions and enlivened by frequent examples of diagnostic interviewing.”

Transactional Analysis Journal

“A marvelous text on an aspect of psychiatry that often does not receive as much attention as it deserves.”

Hospital and Community Psychiatry

High Praise from Faculty for Previous Editions
“This beautiful and immensely useful book is a great gift. It should stand as the best starting clinical text for all mental health professionals. . . . . I predict that beginning clinicians, and many experienced ones, too, will return to this book the way people return to the books they find deepest and most evocative, reading a few pages at a time, to be savored and enjoyed, so its wisdom enters our bones.”

From the Foreword to the 2nd Edition
Leston Havens, M.D.
Professor of Psychiatry
Harvard Medical School

“This book is rich with case presentations, vivid clinical dialogues, theoretical eclecticism, personal wit, clinical acumen, and undeniable readability. I can’t think of any other book that my graduate students enjoy as much, or talk about with more enthusiasm. In my view Psychiatric Interviewing: the Art of Understanding, 2nd Edition is unequivocally the best beginning text for mental health professionals, no matter what their discipline.”

David Jobes, Ph.D.
Author of Managing Suicidal Risk, 2nd Edition
Past President, American Association of Suicidology

“Year in and year out, one of the most popular, if not most popular, required textbooks for our master level students in counseling. Superbly practical yet filled with a sense of compassion.”

Judi Durham, A.P.R.N., M.A., C.S.
Senior Associate Faculty
Antioch New England Graduate School

“A highly crafted book on interviewing which impressed me with the remarkable ways in which it is truly comprehensive. The chapter on personality assessment is a rich blend of gathering valid diagnostic data while simultaneously attending to the patient’s feelings and needs. It is a remarkable introduction to the assessment and diagnosis of personality disorders.”

Juan Mezzich, M.D., Ph.D.
Former Secretary General
World Health Organization, Psychiatric Division

“Dr. Shea deserves congratulations for writing an engaging book on a fascinating, but difficult subject. The text demonstrates the creativity and flexibility Dr. Shea values as integral to the process of interviewing. There is much here for the beginning clinician from a variety of disciplines, but the rewards for the more experienced interviewer are equally apparent. This book is not just informative, it challenges the reader to reflect on his or her own interviewing style and technique.”

Miles K. Crowder, M.D.
Coordinator for the Psychiatric Residency Training
Vanderbilt University

– Print purchase includes enhanced Expert Consult eBook with over 7.5 hours of streaming video; quickly search text, figures, references, and videos on laptops, tablets, and smart phones –

With time at a premium, today’s clinicians must rapidly engage their patients while gathering an imposingly large amount of critical information. These clinicians appropriately worry that the “person” beneath the diagnoses will be lost in the shuffle of time constraints, data gathering, and the creation of the electronic health record. Psychiatric Interviewing: The Art of Understanding: A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and other Mental Health Professionals, Third Edition tackles these problems head-on, providing flexible and practical solutions for gathering critical information while always attending to the concerns and unique needs of the patient.

Over five years in the making, this classic introduction to the art of clinical interviewing returns, updated, expanded and innovatively designed for today’s reader with over 7.5 hours of streaming video integrated directly into the text itself. Readers now also become viewers, acquiring the rare opportunity to see the author both illustrating specific interviewing techniques and subsequently discussing effective ways in which to employ them. The founder and Director of the acclaimed Cape Cod Symposium, Rob Guerette, describes Dr. Shea’s skills as a speaker as follows, “Dr. Shea is an extremely gifted teacher, whose vibrant story-telling skills and compelling videos have led to him garnering some of the highest evaluations in the 30 year history of the Cape Cod Symposium. In short, readers are in for a rare treat when viewing the book’s video component.”

Within the text, Dr. Shea deftly integrates interviewing techniques from a variety of professional disciplines from psychiatry to clinical psychology, social work, and counseling providing a broad scope of theoretical foundation. Written in the same refreshing, informal writing style that made the first two editions best sellers, the text provides a compelling introduction to all of the core interviewing skills from conveying empathy, effectively utilizing open-ended questions, and forging a powerful therapeutic alliance to sensitively structuring the interview while understanding nonverbal communication at a sophisticated level. Updated to the DSM-5, the text also illustrates how to arrive at a differential diagnosis in a humanistic, caring fashion with the patient treated as a person, not just another case.

Whether the reader is a psychiatric resident or a graduate student in clinical psychology, social work, counseling or psychiatric nursing, the updated third edition is designed to prepare the trainee to function effectively in the hectic worlds of community mental health centers, inpatient units, emergency rooms, and university counseling centers. To do so, the pages are filled with sample questions and examples of interviewing dialogue that bring to life methods for sensitively exploring difficult topics such as domestic violence, drug abuse, incest, antisocial behavior, and taking a sexual history as well as performing complex processes such as the mental status. The expanded chapter on suicide assessment includes an introduction to the internationally acclaimed interviewing strategy for uncovering suicidal ideation, the Chronological Assessment of Suicide Events (CASE Approach). Dr. Shea, the creator of the CASE Approach, then illustrates its techniques in a compelling video demonstrating its effective use in an interview involving a complex presentation of suicidal planning and intent.

A key aspect of this text is its unique appeal to both novice and experienced clinicians. It is designed to grow with the reader as they progress through their graduate trainingwhile providing a reference that the reader will pull off the shelf many times in their subsequent career as a mental health professional. Perhaps the most unique aspect in this regard is the addition of five complete chapters on Advanced and Specialized Interviewing (which comprise Part IV of the book) which appear as bonus chapters in the accompanying e-book without any additional cost to the reader. With over 310 pages, this web-based bonus section provides the reader with essentially two books for the price of one, acquiring not only the expanded core textbook but a set of independent monographs on specialized skill sets that the reader and/or faculty can add to their curriculum as they deem fit.

New and Expanded Content:

  • Expert Consult eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, figures, references, and videos from the book on a variety of devices
  • Bonus chapter on advanced aspects of cross-cultural interviewing, including approaches for recognizing clinician biases and exploring the client’s spirituality and framework for meaning
  • Bonus chapter on motivational interviewing
  • Bonus chapter on transforming patient angerand moments of potential disengagement
  • Bonus chapter for prescribing clinicians — such as psychiatrists and psychiatric nurse clinicians — on how to collaboratively talk with patientsabout their medications
  • Includes over 7.5 hoursof video illustration and instruction
  • Brings to life the pain and phenomenology of people coping with severe mental illnesses, such as schizophrenia, bipolar disorder, andmajor depressive disorder
  • An entire chapter on engaging patients with difficult personality disorders, such as borderline personality disorder and narcissistic personality disorder
  •  A new and unique chapter covering often overlooked areas, such as positive psychology and methods for uncovering client wellness and strengths
  • Extensive chapter on nonverbal communication, including the complex challenges related to interviewing on the web by text and/or tele-psychiatry
  • A comprehensive introduction to facilics (an innovative supervision system for helping clinicians learn how to transform interviews into naturalistically flowing conversations), including an interactive web-based self-learning module on facilic supervision schematics for both faculty and students
  • Practical tips for creating a good EHR/write-up, in addition to sample clinical forms for EHR/written documentation
  • specialized appendix for faculty, which includes four complete articles from the Psychiatric Clinics of North Americathat address educational topics including: effectively designing interviewing training courses and macrotraining suicide assessment skills

Foreword by Jan Fawcett, M.D. to Shea’s Psychiatric Interviewing: the Art of Understanding, 3rd Edition

 

It has been my privilege to train and supervise young mental health professionals from many disciplines for over 50 years. I can say that doing so has been one of the great joys of my life. I can also safely say that you are holding in your hands one of the most remarkable books I have had the pleasure to read in all of those years. Enormously practical, elegant in execution and delightfully fun to read, every page holds clinical wisdom.

Shea has an almost uncanny ability to genuinely perceive the complexities of clinical interviewing, while creating frameworks that illuminate, clarify, and simplify those complexities so that young clinicians can actually apply them. And he accomplishes this challenging task with a self-effacing humor and a refreshing sense of compassion that combine to shed a vibrant brilliance on our art. I can think of no better first book for any trainee in mental health, for it is not only, in my opinion, an unsurpassed book about how to interview, it is a book about why we interview. It is a book that captures the wonderment of our work and the soul of our mission.

It is also my opinion, that you are holding in your hands the textbook of tomorrow today. Shea’s graceful integration of over 7.5 hours of streaming video throughout the text provides every psychiatric resident and graduate student the chance to see a truly talented interviewer at work undertaking tasks as complex as exploring sensitive and taboo topics to uncovering suicidal ideation and intent. If this were not enough, the viewer also gets the chance to watch and hear Shea, one of the most dynamic speakers in our field today, discuss these interview excerpts, powerfully consolidating what the student has just read in the text while providing new nuances and insights not even mentioned in the text. It is a stunning wedding of innovative educational theory with  today’s revolutionary technology. As the student enters their clinical rotations, and ultimately, as they leave their residency and graduate programs to secure their first jobs, they can return to these videos, stream them on their laptops, tablets, and smart phones wherever they are and whenever they choose. The video illustrations of the book will always be available to them in the palm of their hands.

Readers of this book, whether beginning students or wizened clinicians with decades of experience, will find much that is innovative. Indeed, Shea’s innovations, in my opinion have been pivotal in shaping how interviewing is both done and taught across disciplines. I had the pleasure of running across Shea’s interviewing strategy for uncovering suicidal ideation, behaviors, and intent (the Chronological Assessment of Suicide Events – CASE Approach) years ago and promptly invited him to write an article about it in the Psychiatric Annals.

As the years have passed, the CASE Approach has become one of the most respected approaches for eliciting suicidal ideation in the world as reflected by its being chosen as a recommended strategy by the Zero Suicide Initiative and its selection for the Best Practices Registry from the Suicide Prevention and Resource Center (SPRC). In this book readers will find a remarkably compelling and practical introduction to the effective use of the CASE Approach. Shea’s subsequent video demonstrations of the CASE Approach are, in my opinion, unparalleled in the history of mental health training. I have never seen such great teaching videos on eliciting suicidal ideation. They are a treasure, and I believe that many lives will be saved by those lucky enough to view them.

I was pleased to see that Shea’s numerous other innovations are equally expertly reviewed and updated in this edition. His internationally respected supervision system for helping trainees to create fluid and naturalistic interviews, known in the clinical interviewing literature as the study of facilics, is beautifully updated in this edition, including an interactive web program. An entire chapter has been dedicated to the topic of “validity techniques,” a field of study first delineated by Shea years ago for helping patients to share sensitive and taboo material such as incest, domestic violence, substance abuse. And, as a bonus, for any clinicians who prescribe medications, there is a chapter on Shea’s Medication Interest Model (MIM) as the model is applied to psychiatric medications. If not familiar with the MIM, it is a collaborative model of talking with patients about their medications. In this chapter the reader will find over 40 specific interviewing techniques that help patients make wise decisions about whether or not medications are a good choice for them and can help clinicians to effectively motivate patient interest in using those medications once chosen. I have been intimately involved in the study and use of medications for decades, and I was fascinated by the principles and techniques delineated in this chapter. I have a feeling that the MIM will someday be as important in the field of improving medication adherence as the CASE Approach has become to uncovering suicidal ideation.

On a final note, Shea is not only a great innovator, he is a wonderful explicator of the ideas and concepts of others. In short, he is a natural born teacher. His eloquent mastery of language and his well-timed wit, brings the work of others to life for readers. Two examples will demonstrate my point. Shea has had nothing to do with the development of motivational interviewing (Chapter 22), yet his chapter on motivational interviewing is a remarkably succinct and penetrating introduction to its use. I would recommend it to anyone as a first introduction to the subject. Likewise, Shea’s introduction to object relations and self psychology (Chapter 15) is a wonderful monograph on the topic. He brings to life some of the traditionally most difficult concepts in the field of psychodynamic therapy. I feel quite confident that his chapter will delight and fascinate new trainees, who I find have a genuine hunger for learning more about psychodynamic thought.  Such students will be hard pressed to find a more practical and compelling introduction to the topic.

In closing, I have always been a believer that every minute counts in this life. I believe that if one values every moment, one essentially stretches life. I close with this thought because I realize that time is at a great premium in our contemporary lives. I just want to reassure any faculty that require this book, and any students that read it, that every minute spent in its pages will be worth it. Every minute will count. And every minute will not only benefit you but all the future patients that your caring will touch.

Jan Fawcett, M.D.

Preface

The purpose of life is to serve and to show compassion
and the will to help others. Only then have we ourselves
become true human beings.

Albert Schweitzer

It is with great pleasure and excitement that I sit down to write the Preface for the 3rd Edition of this book. Much has changed in our field since the publication of the 2nd Edition eighteen years ago – some good, some not so good. My pleasure arises, to a great extent, from the fact that the cornerstone principles of the first two editions – sensitivity and compassion – still resonate in our field today; indeed, in the age of managed care, increasing time pressures, and the advent of the electronic health record, they may play an even more important role as guideposts than ever before. Put more bluntly, many extraneous factors have been introduced into the environment of everyday clinical care that, in my opinion, make it harder to be a sensitive listener today than has been the case in all previous generations.

In this regard, the one over-arching goal of this textbook is to prepare the trainee to function effectively, and with compassion, in the hectic worlds of community mental health centers, inpatient units, emergency rooms, university counseling centers, and private practices. To accomplish this task, today’s students require the acquisition of a series of advancing interviewing skills, that must be developed sequentially throughout the years of their residency and graduate training (indeed, as an ongoing education throughout the rest of their careers). In these pages I have made my best effort to address these progressive steps in a fashion that makes their acquisition both more pleasant and more effective. I have tried to create a book that, in essence, grows with the trainee through the years of their residency or graduate program and beyond.

An attempt is made, and it will be up to the reader to decide if I was successful, to address these challenges in a refreshing, practical, and comprehensive fashion. I mention ‘comprehensive’ because I believe that a sound first textbook on clinical interviewing should be appropriately comprehensive, for if we are honest with ourselves – despite the immense importance of the topic of clinical interviewing – very few graduate students or psychiatric residents will ever buy a second textbook on the topic. Finances and time are tight commodities in our contemporary cultures.

Moreover, in an exciting fashion, the field of clinical interviewing has exploded with innovations since the 2nd Edition of this book, from the wide-spread acceptance of motivational interviewing to the numerous advances made with regard to culturally adaptive interviewing and the increased emphasis on wellness interviewing. Towards capturing this excitement, I have tried to keep intact whatever elements of the 2nd Edition reader feedback has suggested were most effective, while approaching the topics of each chapter with the same informal writing style that readers seemed to enjoy so much in the previous editions. As they say, don’t fix what isn’t broken. In addition, as with the 2nd Edition, I have given careful attention to presenting the complexities and nuances of each topic with the in-depth sophistication they warrant when training psychiatric residents and graduate students in clinical psychology, psychiatric social work, psychiatric nursing, and counseling.

Concerning the sequential skills that a new trainee must master, first, and foremost,  trainees – no matter what their disciplines – must, in their initial course on clinical interviewing, acquire a set of core interviewing skills of a surprisingly complex nature.  More specifically, the trainees must acquire and practice skills ranging from topics as diverse as conveying empathy, nurturing engagement, and sensitively structuring interviews to effectively uncovering client wellness and strengths as well as delicately uncovering the truth about sensitive and taboo topics.  All of these skills must be learned while simultaneously addressing the interplay between these skills and the complex context of cultural diversity, nonverbal communication, and the interface between the interview and collaborative treatment planning. No small task for an introductory course! Part 1 of this text – “Clinical Interviewing: the Principles Behind the Art” – was designed to meet this daunting task head-on with individual chapters addressing all of these topics.

And, here is where things get really exciting. As I mentioned earlier, many things have changed since the 2nd Edition of this book, some of which are good and, some, not so good. A truly great advance has been the ability to stream video through the web. This has revolutionized – and I mean revolutionized – how we can go about the process of training clinicians in interviewing (as well as psychotherapy). Throughout Part 1 (as well as Parts 2 and 3) nearly 8 hours of streaming video have been integrated directly into the text of the book. Now readers become viewers. After learning about specific techniques, with the mere click of a link, the reader of the accompanying e-book can view streaming video in which I am not only consolidating and elaborating on what was just read, I am demonstrating the exact same interviewing techniques with annotated video. Moreover, as Jan Fawcett noted in his Foreword to the 3rd Edition: “As the student enters their clinical rotations, and ultimately, as they leave their residency and graduate programs to secure their first jobs, they can return to these videos, stream them on their laptops, tablets, and smart phones wherever they are and whenever they choose. The video illustrations of the book will always be available to them in the palm of their hands.”

In Step 2 of their maturation as clinical interviewers, after acquiring their core interviewing skills, the trainee will encounter a new, and particularly challenging set of skills to master. Specifically the graduate student or psychiatric resident must learn how to adapt their newly acquired core interviewing skills for use in the real world of community mental health centers, inpatient units, college counseling centers, private practices, and emergency departments. In these settings, the trainees, during their clinical rotations and internships (and subsequently in their years of employment) will encounter patients suffering from a variety of painful disorders ranging from major depressive disorders, substance use disorders, PTSD, and OCD to bipolar disorder and schizophrenia.

No matter what the student’s discipline, it will be expected in the clinical settings of their eventual employment, that the newly minted clinician will understand the process of differential diagnosis (or, indeed, depending upon the clinical setting and the clinician’s role in that setting, in some cases be able to perform a differential diagnosis). To me, it is critical that such an understanding is not a cookbook process of learning a checklist of  DSM or ICD diagnoses. Instead the clinician, from his or her very first exposure to clinical interviewing, should understand that this diagnostic process must be done with great sensitivity and compassion.

This requires that a clinical interviewer understand the phenomenology and exquisite pain with which these psychopathological symptoms present themselves to each unique patient (as well as the pain of the family members who love the patient). Moreover, it is not enough to have an introduction to this phenomenology. One must understand, in a particularly sophisticated fashion, the person beneath these symptoms and be able to sensitively explore the experience and meaning of these symptoms, for they are manifested uniquely by each person and the cultural context that shapes that person.

As any faculty reading this Preface is well aware, it is not enough to merely learn what the symptoms are with regard to specific diagnostic criteria in the DSM-5. The trainee must learn how to phrase questions in such a fashion that the patient feels psychologically safe enough to comfortably share both their symptoms and the personalized pain generated by those symptoms. The difference between simply learning about psychopathology in contrast to learning how to sensitively uncover it, is not a gap – it is a giant chasm. I have seen many a student pass a course on psychopathology with flying colors and have little or no idea of how to subsequently – on a clinical ward or in an outpatient clinic – uncover this material in a compassionate fashion while garnering valid information.

Part 2 of this textbook – “The Interview and Psychopathology: from Differential Diagnosis to Understanding” – attempts to bridge this chasm. The major diagnostic categories are approached with chapters dedicated not only to sensitively performing a differential diagnosis (in which I provide numerous sample questions and illustrative interview excerpts), but with separate chapters that illustrate various questions and strategies that will take the reader into an even deeper understanding of the pain and symptoms of the person before them. You will note that careful attention is given to cultural and familial factors so that clinicians – who are interviewing a patient who comes from a different culture than the interviewer’s culture – will not mistake cultural differences as psychopathology or, on the other side of the coin, miss disorders that are unique to the patient’s cultural heritage.

Note that the 3rd Edition of this book is specifically designed to allow faculty to literally create the textbook that he or she feels is best suited for the course being taught. Thus some faculty will feel that there is time within their trainees’ first course – on core interviewing skills – to assign these chapters on the interface between the clinical interview and psychopathology. Other faculty may decide these chapters are best suited for a separate course on psychopathology. Still others may decide that one or two of the chapters are invaluable in the first course on clinical interviewing so as to ensure that the students immediately understand that their core interviewing skill will be implemented with patients in great pain and with varying disorders.

The third graduated step in the trainee’s development of interviewing skills is challenging, indeed, sometimes legitimately intimidating. The student must learn how to sensitively elicit suicidal ideation and intent as well as violent ideation and intent. Many trainees also find the mental status to be confusing and awkward to implement gracefully. These specific tasks are of such importance that separate chapters are dedicated to each of them in Part III of the book – “Mastering Complex Interviewing Tasks Demanded in Everyday Practice”.

The expanded chapter on suicide assessment in this 3rd Edition includes some of my very favorite pages in the book, which I hope you will enjoy as well. It is an introduction to the interviewing strategy for uncovering suicidal ideation, planning, intent, and actions known in the clinical literature as the Chronological Assessment of Suicide Events (the CASE Approach). It has been one of my greatest satisfactions to see the interest and adoption – both nationally and internationally – of the CASE Approach, which was first delineated in the 2nd Edition of the book.  In this expanded chapter, I have an opportunity to not only describe the updated version of the CASE Approach (for we are always improving it) but to demonstrate, via streaming video, the interview strategy in its entirety, dissecting its nuanced variations as the clinical risk of suicide presents in varying degrees of severity.

Finally, in a trainee’s fourth evolution in clinical interviewing skills, during his or her graduate program or psychiatric residency, the trainee will need to learn advanced skill sets, which are addressed in Part IV, “Advanced Interviewing & Specialized Topics”. As noted earlier in this Preface, I have tried to create a book that will grow with the psychiatric resident or graduate student as they progress through their training, while providing a reference that they will pull-off the shelf in their subsequent careers as a mental health professional.

Perhaps the most unique aspect of this 3rd Edition in this regard is the addition of the five complete chapters you will find in Part IV on Advanced and Specialized Interviewing. They appear as bonus chapters in the accompanying e-book, resulting in an ultimately flexible textbook. With over 300 pages, this web-based bonus section provides the reader with essentially two books for the price of one, acquiring not only the expanded core textbook (Parts I through III) but a set of independent monographs on specialized skill sets that the reader and/or faculty can add to their curriculum as they deem fit. Some faculty may choose to select a single chapter or two for use in their introductory course on interviewing, other faculty may recommend the chapters for use in later courses or during clinical rotations. But no matter what decision is made, for the first time ever, the web is allowing faculty to create individualized textbooks where they can flexibly select whatever chapters seem best suited to their students and the required course content.

The bonus chapters in Part IV are essentially designed as independent monographs regarding each of their topics. I would like to draw the reader’s attention to two of these advanced chapters that I think, paradoxically, despite their advanced nature in the sense of requiring a pretty good observing ego to employ their techniques, faculty might find very enticing to include as closing bonus chapters in an introductory course on clinical interviewing. Students really appreciate the usefulness of the topics.

The chapter, “Transforming Anger, Confrontation, and Other Points of Disengagement” covers all of the types of awkward moments that beginning clinicians dread such as patients confronting them on their inexperience or asking personal questions such as, “Do you believe in God?” or “Have you ever had an affair?” or a delusional patient asking, “Do you believe me?”. I tried to provide an easily understood framework for handling such questions as well as providing the beginning student with possible answers and illustrative dialogue of clinicians responding gracefully to such moments.

I also think that faculty may find that some of your beginning students will be ready to enjoy the sophisticated introduction to culturally adaptive interviewing to be seen in the chapter, “Culturally Adaptive Interviewing: The Challenging Art of Exploring Culture, Worldview, and Spirituality”. I hope that I did justice in this chapter to this very important topic. I have attempted to create a comprehensive “monograph”, that will allow a student – through the reading of a single chapter – to come away with a sound introduction to this fascinating, and critically important, area. I tried to not only describe what needs to be done during culturally competent interviewing, but I also tried to give compelling examples of dialogue that demonstrate culturally adaptive interviewing.

Two, truly advanced topics, dear to my heart and closely related to each other, also appear as bonus chapters. In this 3rd Edition, I finally had a chance to do something that I have wanted to do for years – attempt to provide, in a single chapter, a reasonably sound introduction to the highly innovative work of Miller and Rollnick – Motivational Interviewing (MI). As one would expect in this book, I focus on how the principles of MI can be employed in the initial interview.

Finally, I was able to introduce to all mental health providers, especially all those who prescribe medications (from psychiatrists to psychiatric nurse clinicians, psychiatric physician assistants, and psychiatric clinical pharmacists) the collaborative and motivational model known as the Medication Interest Model (MIM), which addresses how we can go about the complex process of talking with our patients about the possible use of medications in a truly collaborative fashion. The MIM was first introduced for use in general medicine in my book Improving Medication Adherence: How to Talk with Patients About Their Medications as applied to medications being used to treat all disease states from diabetes, hypertension, and congestive heart failure to depression and PTSD. In our bonus chapter in Part IV of this book, I have been able to create a fast-reading monograph on how the collaborative interviewing principles and techniques of the MIM can be specifically applied with patients considering psychiatric medications. I hope this monograph on the psychiatric application of the MIM will help many clinicians to help many patients for many decades to come.

I also hope that the reader enjoys this book as much as I enjoyed expanding, revising, and adding video to it. In the final analysis, interviewing should be fun. I think it is important to emphasize that this book  does not pretend to show the “correct” way of interviewing, because there is no correct way. Instead, I offer suggestions that will provide the reader with the principles to develop his or her own creative style of interviewing, always flexibly matching the interview to the needs of the patient, not to the dictates of a school of thought.

In closing, this is a book about knowledge – knowledge applied to the art of healing. In the last analysis, as students of this art, it will always remain our great privilege to ensure that the knowledge of our minds is guided by the compassion of our hearts and the wisdom of our souls. As Albert Schweitzer so elegantly stated in our epigram, it is through this art and through our desire to help others, that we ultimately find ourselves.

Shawn Christopher Shea, M.D.
July 24, 2016

Table of Contents

Part I: Clinical Interviewing: the Principles Behind the Art

  1. The Delicate Dance: Engagement and Empathy
  2. Beyond Empathy: Cornerstone Concepts and Techniques for Enhancing Engagement
  3. The Dynamic Structure of the Interview: Core Tasks, Strategies, and the Continuum of Open-Endedness
  1. Facilics: The Art of Transforming Interviews into Conversations
  2. Validity Techniques for Exploring Sensitive Material and Uncovering the Truth
  3. Understanding the Person Beneath the Diagnosis: the Search for Uniqueness, Wellness, and Cultural Context
  1. Assessment Perspectives and the Human Matrix: Bridges to Effective Treatment Planning in the Initial Interview
  1. Nonverbal Behavior: The Interview as Mime

 

Part II: The Interview and Psychopathology: from Differential Diagnosis to Understanding

  1. Mood Disorders: How to Sensitively Arrive at a Differential Diagnosis
  2. Interviewing Techniques for Understanding the Person Beneath the Mood Disorder
  3. Psychotic Disorders: How to Sensitively Arrive at a Differential Diagnosis
  4. Interviewing Techniques For Understanding the Person Beneath the Psychosis
  5. Personality Disorders: Before the Interview Begins – Core Concepts
  6. Personality Disorders: How to Sensitively Arrive at a Differential Diagnosis
  7. Understanding and Effectively Engaging People with Difficult Personality Disorders:    the Psychodynamic Lens

 

Part III: Mastering Complex Interviewing Tasks Demanded in Everyday Clinical Practice

  1. The Mental Status: How to Perform and Document It Effectively
  2. Exploring Suicidal Ideation: The Delicate Art of Suicide Assessment
  3. Exploring Violent and Homicidal Ideation: From Domestic Violence to Mass Murder

 

Part IV: Specialized Topics & Advanced Interviewing – Bonus Material Online

  1. Transforming Anger, Confrontation, and Other Points of Disengagement
  2. Culturally Adaptive Interviewing: The Challenging Art of Exploring Culture, Worldview, and Spirituality
  3. Vantage Points:  Bridges to Psychotherapy
  4. Motivational Interviewing (MI): A Foundation Stone in Collaborative Interviewing
  5. Medication Interest Model (MIM): Moving from Mere “Adherence” to Genuine Interest and Effective Use

 

Glossary & Appendices

Appendix I: An Introduction to the Facilic Schematic System – A Shorthand for Supervisors and

Supervisees (Interactive Computer Module)

Appendix II: Annotated Initial Interview (Direct Transcript of an Actual Patient Interview)

Appendix III: The Written Document/Electronic Health Record (EHR): Effective Strategies

IIIA Practical Tips for Creating a Good EHR/Written Document

IIIB Prompts and Quality Assurance Guidelines for the EHR/Written Document

IIIC Sample Written Initial Assessment (Actual document created from patient interview in Appendix II)

IIID Blank Prototypic Initial Clinical Assessment Form

Appendix IV: Specially Re-Printed Articles from the Psychiatric Clinics of North America

Group A: Three articles for clinicians and trainees on advanced clinical interviewing                                           topics

Group B: Four articles for faculty and interviewing mentors on training and supervision strategies/models

Glossary of Interview Supervision Terms

 

Video Excerpt #1

Introduction to Integrated Video: See Dr. Shea introducing the reader to the purpose and flexible use of the 7.5 hours of streaming video material innovatively interwoven throughout the text of
“Psychiatric Interviewing: the Art of Understanding, 3rd Edition.”

Video Excerpt #2

See Dr. Shea describing techniques from the internationally acclaimed interviewing strategy, the Chronological Assessment of Suicide Events (CASE Approach), which he then demonstrates. The excerpt is from Chapter 17 called “Exploring Suicidal Ideation: The Delicate Art of Suicide Assessment”.

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