What are the different types of interview techniques used in psychiatry for various patient populations, including those with severe mental illnesses, trauma, and children?

Types of Interview Techniques in Psychiatry

Psychiatric interviews should be structured according to the clinical context and patient population, with distinct approaches for family assessments, individual evaluations, emergency settings, and special populations including children, adolescents, and trauma survivors. 1

Core Interview Formats

Family Interview Technique

The family interview is the primary approach when interactional problems are suspected, requiring 1-2 hours in a comfortable room large enough to accommodate all members. 1

• Begin by addressing each family member informally at their developmental level to establish rapport, identifying family strengths and resources at the outset 1
• Conduct the interview in stages: rapport building, problem definition through history gathering, observation of family interactions, facilitation through probing questions, and summation with formulation 1
• Interview family members both together and separately—joint sessions reveal interaction patterns while individual sessions allow freer disclosure, particularly crucial for adolescents 1
• Remove potentially harmful furniture or objects for younger children and provide games or activities to facilitate rapport and decrease behavioral disruption 1

Individual Interview Technique

Separate individual interviews with the child/adolescent and parents are essential, with confidentiality maintained unless dangerousness issues arise. 1

• For younger children, maintain parental awareness of concerns; for adolescents, respect their desire for confidentiality unless safety is compromised 1
• Older children with good impulse control, adequate verbal skills, and ability to separate are amenable to individual interview; younger or developmentally impaired children need modified approaches determined with parents 1
• Use play-based techniques for younger children including drawing pictures, puppet play, and structured or free-form play sessions to facilitate communication 1

Emergency/Acute Setting Interview

In emergency settings, interview patients and caregivers both together and separately, with discussion of confidentiality limits to facilitate honest conversation with adolescents. 1

• Conduct thorough medical examination with careful evaluation for signs of self-injury or toxidromes 1
• Perform mental status examination assessing appearance, behavior, thought process, thought content (including hallucinations/delusions), mood and affect, and insight and judgment 1
• Obtain collateral information from caregivers or others with knowledge about the patient's state of mind, as patients frequently minimize symptom severity 1
• For suicidal concerns, have patient undergo personal and belongings search, change into hospital attire, and place in safe setting with close supervision 1

Structured vs. Unstructured Approaches

Structured Diagnostic Interviews

Structured interviews like the DISC, K-SADS, DICA, CAPA, and ISCA provide systematic, exhaustive exploration of disorders with fixed format and univocal question formulation, primarily used in research settings. 2

• These instruments improve reliability of data collection and interrater reliability, allowing greater homogenization of research subjects 3, 2
• The K-SADS-PL demonstrates the best test-retest reliability for anxious and affective disorders 2
• Duration ranges from 1.5 hours (ChIPS) to 4+ hours (DISC IV, ISCA), often requiring multiple sessions 2
• Despite benefits, 72.5% of psychiatrists do not use structured interviews in clinical practice due to time constraints, perception as research tools, and interference with rapport 4

Semi-Structured Clinical Interview

The informal, semi-structured interview style optimizes rapport building while allowing flexible management of simultaneous history-taking and observation of interactions. 1

• Use open rather than closed questions, maintain low level of interviewer talk with few interruptions, and employ direct requests for feelings, interpretations, and expressions of sympathy to facilitate emotional expression 5
• For telepsychiatry, adopt a more casual clinical style to optimize rapport, allowing patients to manipulate cameras and demonstrating picture-in-picture features to demystify the experience 1

Special Population Considerations

Children and Adolescents

Assessment requires multiple informants (child, parents, teachers) as agreement between sources is typically low, with children better reporting internalizing symptoms and parents better reporting externalizing behaviors. 1, 2

• Children are better informants for mental states (fears, anxiety, obsessions), while adults provide more reliable information on behavioral problems and school difficulties 2
• Use age-appropriate validated scales including SCARED, Spence Children's Anxiety Scale, or Preschool Anxiety Scale 6
• Conduct mental status examination observing appearance, contact, behavior (trembling, agitation, hypervigilance), speech patterns, and thought processes 7

Trauma and Severe Mental Illness

For trauma populations, cultural adaptation of interview techniques is essential, including consideration of local syndromes and idioms of distress. 1

• Interview style may be influenced by interviewer's gender, age, nationality, ethnicity, class, timing, location, and presence of others 1
• In cross-cultural settings, use ethnographic data to identify local syndromes before applying Western diagnostic frameworks 1

Common Pitfalls to Avoid

• Failing to address absent family members: When requested family members don't attend, this absence provides important diagnostic information about family dynamics and should be explored 1
• Ignoring discrepant reports: Low agreement between informants is expected; synthesize information by granting appropriate weight to each source based on symptom type 1, 2
• Premature termination: Acute problems like suicidal ideation may prevent systematic history gathering but provide powerful experiential process data 1
• Neglecting safety assessment: Always evaluate suicidal ideation, self-harm, harm to others, and implement harm-reduction interventions when necessary 6, 7