I have listened to my own interview with Shawn Christopher Shea, MD more than once because I find useful points every time I listen to it again. His book is a goldmine of advanced tips on psychiatric interviewing!
Do you want to see the gist of what I learned from listening to video 4 of the interview that has Dr. Shea’s tips about interviewing paranoid patients? Here are my notes from listening again to that segment of the interview.
Disclaimer: These are my notes based on what I understood from the interview with Dr. Shea. But my notes below have not been reviewed by Dr. Shea for accuracy.
Why this is important
The habit of using empathy can sometimes be a problem because people handle empathy differently.
With paranoid patients, the last thing they want is someone inside their head. Empathic statements are likely to backfire with these patients!
Different types of empathic statements
To understand which types of empathic statements are particularly problematic with paranoid patients, we should first understand that there are two continuums of the valence of empathic statements.
1. The valence of Certainty, i.e., how certain I am that I am right.
For example, if we say: “It sounds like that is a very difficult situation,” that doesn’t imply a lot of certainty. On the other hand, saying ‘That’s a very difficult situation” does imply certainty.
There are always going to exceptions, but generally, a paranoid patient does not like certainty.
2. The valence of Intuition.
Some of the most powerful statements involve the interviewer’s ability to intuit what the person is feeling. For example, if the person describes a difficult situation at work and we say, “That sure sounds like a difficult situation at your work,” that doesn’t involve much intuition. It is largely a simple reflection of what the person said. But if we say, “It sounds like a really lonely place to work” when the patient did not use the word “lonely,” the statement is us intuiting what we think the patient feels. If our intuition is accurate, such statements are powerful and engage most patients. However, an actively paranoid patient is likely to reject this type of empathic statement.
The Paranoid Spiral
When an interviewer who uses empathic statements effectively uses them with a paranoid patient, it may bomb. This may lead this interviewer to use more empathic statements in an attempt to engage the patient. And the paranoid patient gets progressively angrier. Dr. Shea calls this the paranoid spiral.
A clue that the person may be paranoid
Sometimes we may use a relatively straightforward empathic statement early in an interview with a new patient and the person does not engage but rather denies that what we are saying is true. This can sometimes be a clue that the person may be paranoid.
Dr. Shea’s book is full of hundreds of great tips about Psychiatric Interviewing. It is truly an all-in-one book, covering a very wide range of topics. It will continue to help the reader–as a trusted guide–for many years. Click on the links below to view the book on Amazon.com.
A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals, with online video modules, Third Edition
Click on the link below to view the book on Amazon.com:
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