Päijät-Häme Central Hospital, Department of Psychiatry, Lahti, Finland.
University of Helsinki, Department of Social Sciences, Helsinki, Finland.
Patient Educ Couns. 2019 Jul;102(7):1296-1303. doi: 10.1016/j.pec.2019.02.021. Epub 2019 Feb 22.
With the intention of understanding the dynamics of psychiatric interviews, we investigated the usual (DSM/ICD-based) psychiatric assessment process and an alternative assessment process based on a case formulation method. We compared the two different approaches in terms of the clinicians' practices for offering patients opportunities to reveal their subjective experiences.
Using qualitative and quantitative applications of conversation analysis, we compared patient-clinician interaction in five usual psychiatric assessments (AAU) with five assessment interviews based on dialogical sequence analysis (DSA).
The frequency of conversational sequences where the patient described his/her problematic experiences was higher in the DSA interviews than in the AAU interviews. In DSA, the clinicians typically facilitated the patient's subjective experience talk by experience-focused questions and formulations, whereas in AAU, such talk typically occurred in environments where the clinicians' questions and formulations focused on non-experiential, medical matters.
Interaction in DSA was organized to provide for the patient's experience-focused talk, whereas in AAU, the patient needed to go against the conversational grain to produce such talk.
By facilitating patients' opportunities to uncover subjective experiences, it is possible to promote their individualized care planning in psychiatry.
为了了解精神病学访谈的动态，我们研究了基于 DSM/ICD 的常规精神病评估过程和基于病例构建方法的替代评估过程。我们比较了两种不同方法在为患者提供揭示其主观体验机会方面的临床医生实践。
我们使用定性和定量的会话分析应用，比较了五例基于 DSM/ICD 的常规精神病评估（AAU）和五例基于对话序列分析（DSA）的评估访谈中的医患互动。
在 DSA 访谈中，患者描述其问题体验的对话序列频率高于 AAU 访谈。在 DSA 中，临床医生通常通过关注经验的问题和构建来促进患者的主观体验谈话，而在 AAU 中，这种谈话通常发生在临床医生的问题和构建关注非经验、医学问题的环境中。
DSA 中的互动是为了提供患者的经验为中心的谈话而组织的，而在 AAU 中，患者需要违背对话的常规来产生这种谈话。
通过促进患者发现主观体验的机会，可以在精神病学中促进针对个体的护理计划。
