DO’S AND DON’TS FOR THE PSYCHIATRIC AND PSYCHOTHERAPEUTIC INTERVIEW:

There is no one right thing to say to schizophrenic patient. The most important job of the interviewer is to help to diminish the inner loneliness, chaos and terror that the schizophrenic patient is feeling. The challenge is to convey empathy without being regarded as being dangerously intrusive.

• Don’t try to argue or rationally persuade the patient out of a delusion. This may lead to more assertion of delusional ideas.
• Do listen. Listen to how patients experience the world. They may experience it as dangerous, bizarre , overwhelming and invasive. This may  be conveyed through their thought content. They may be angry, sad, afraid, or hopeless. They may feel that they have no privacy and no control over themselves. Try to understand what is their image of themselves.
• DO acknowledge these feelings to the patient simply and clearly. For example if the patient respond that “When I walk into a room people can see inside my head and read my thoughts”. The clinician might respond to it as “ What are your feelings then” or “How do you feel then”.
• Allow, the patient to speak. This helps the patient to feel that he is somebody important and has something important to say.
• Be flexible about interview times. If the patient can tolerate only 10 minutes , tell him that the interview will resume later.
• Be clear and reliable to the patient. This will help in maintaining trustworthiness.
• Be straightforward with a patient. Do not pretend that a delusion is actually true, but convey that delusion is actually true for the patient. If  a paranoid schizophrenic says that “people are watching me all the time and they could know what I am thinking and see what I am doing” the doctor should say that “I can understand what you are feeling but I could not see anyone here who is keeping an eye on you”
• DO pay attention, how the patient make you feel. Work over and analyze your feelings. Feel empathetic but do not get carried over by the feelings. If you feel annoyed find the reason for it.
• Don’t  automatically laugh at a patient when something is said that seems funny. Laughing at a patient can convey disrespect and lack of understanding of the underlying terror and despair that many patient’s feel.
• Do  respect a paranoid’s patient’s need for maintaining distance and control. Sometimes the paranoid patients are more comfortable when they are aloof as opposed to the expressions of warmth and empathy

Dr Smita Pandey Bhat Clinical Psychologist Gurgaon, Delhi - NCR, INDIA

dr.smitapandey@gmail.com