The patient sitting in front of me is sobbing as she describes her battle with depression and her suicide attempt tonight. I fight the urge to start counseling her, and continue to ask questions. This is one of the hardest parts of the work I do, to not feel compelled to go into the helper mode.
A huge difference between providing counseling and clinical interviewing is that the interview process is a controlled situation with a format that includes a series of questions investigating the patient’s presenting issues. When a clinician that works in this environment attempts to provide counseling, the relationship between the counselor and patient changes. The patient sees the clinician as a helper instead of staying focused on the presenting problem and treatment goals. Often, I am fighting not to switch into counselor mode by trying to help resolve a presenting issue. I have to admit, I don’t always succeed at this, and there have been plenty of times where I have spent more time than the 30 minute interviewing process to allow the patient to tangent from my questions and use the session in a therapeutic manner. The issue with this is that there is never enough time for the person to process what they discussed, and that person can potentially leave the assessment feeling worse than when they came in.
When interviewing a patient, the main goal is to explain and describe in severity the patient’s signs and symptoms and be able to justify the treatment recommendation that I am providing. My supervisor explains our role as an investigator; I get the who, what, when, where, why, and how. With this information, I then decide what treatment is most suitable for that patient. Here is where the consultation with the hospital psychiatrist comes in. Because the psychiatrist is not available to see the patient, he or she is relying on an accurate assessment from the clinician to assure a precise treatment recommendation.
Ultimately, the interview helps people who don’t know where or how to get help get appropriate referrals. It is also where people who are at risk to harming themselves or others, or unable to care for themselves can be assessed and find inpatient treatment.
Maureen Werrbach is a counselor who works at a hospital and provides clinical assessments in the areas of mental health and substance abuse.