Psychiatric Interview as Therapeutic Intervention

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Psychiatric Interview as Therapeutic Intervention

• M. BOTBOL

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THE IDEA THAT PSYCHIATRIC INTERVIEW IS A
THERAPEUTIC INTERVENTION

• A banal statement, or a controversial issue?
• Has a history that is strongly linked with the
  history of the representations of psychiatric
  nosography and of models of psychiatric practices.

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Brief history of a not so common idea

• In the beginning of the 19th century Mental
  Alienation Psychiatric interview is a
  therapeutic intervention and nothing else
• In the middle of the 19th century definition of
  many different entities each of them seen as a
  natural. Psychiatric interview is nothing else
  but a diagnostic process

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• during the middle part of the 20th century the
  main concern is therapeutic to understand the
  patient. The only remaining nosographic concern
  is to differentiate between neurosis and
  psychosis
• In the next historical step differenciation is
  again a main issue. It is not that psychiatric
  interview cannot be seen as a therapeutic tool ,
  it is that this is not the main concern because
  most of the therapeutic hopes are put on medical
  approaches

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• A new psychiatric era? Psychotherapeutic
  effects of psychiatric interview are widely
  recognized
• Psychotherapy plus medication is not the addition
  of two scientific approaches, it is a completely
  new object we have to study as such.
• Much stress put on therapeutic alliance,
  subjective experience of disease and holistic
  global approach of the person

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History of the question shows us anyway that

• T - Therapeutic value of psychiatric interview
  is strongly dependant of the nosographic
  principles of the moment
• -  In its history, psychiatric interview swings
  between two polesdiagnostic and therapeutic
• - Current tendency seems to look for an
  exception in this overall swinging pattern of
  evolution
• - This may affect our current nosographic
  paradigm.

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How psychiatric interview can get a therapeutic
value in the current psychiatry?

• In our current model, psychiatric interview has
  at least three main objectives
• -         Diagnosis (including differential
  diagnosis)
• -         Prognosis (relying greatly on diagnosis
  )
• -         Therapeutic indication

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The psychiatrist will then have to adress

• -         Description of symptoms in every day
  life
• -         History of the symptoms and personal
  and familial anamnese
• -         Consequence of the disorder on personal
  functioning and social or familial context
• -         Experience of the disease in the
  patient and in his environment

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• The whole process means that the psychiatrist
  will have to enter in the private life of the
  patient
• This is possible only because the specificity of
  the patient doctor relation gives to the doctor a
  special place in the patients intimacy

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The intimate and subjective dimension of
patient-doctor relation

• Is not only a side effect of the diagnostic
  process ( something an objective diagnostic
  process should reduce as much as possible to have
  a scientific value).
• Also one of its values that has to be used by all
  psychiatrist to improve therapeutic alliance,
  therapeutic effectiveness of all type of
  treatment and, therefore, therapeutic outcomes of
  patients.

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• The problem is that, if the psychiatrist gives
  attention to the role he is taking in the patient
  affective life, he is also to develops his
  empathic capacities, that is to say , he
  increases his chances to be exposed to affective
  effects in his own affective life

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• A psychiatric theory that would limit itself to
  descriptive diagnosis of clinical categories
  leaves the psychiatrist alone to deal with his
  mixed feelings induced by his empathic exposure
• This has important consequences, even in the more
  evidence-based part of our field example of SSRI
  meta-analysis

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• To help psychiatrists to deal with the (at least
  implicit) therapeutic dimension of psychiatric
  interview is then one of the current major stakes
  for psychiatry.
• Through its focus on insight and the transference
  and conter transference, psychoanalysis is a tool
  to face this stake,
• Further it may, in some cases, help increase the
  therapeutic value of psychiatric interview