Savander Enikö É, Voutilainen Liisa, Hintikka Jukka, Peräkylä Anssi
Department of Psychiatry, Päijät-Häme Central Hospital, Lahti, Finland.
School of Educational Sciences, University of Eastern Finland, Joensuu, Finland.
Front Psychiatry. 2024 Jun 21;15:1352601. doi: 10.3389/fpsyt.2024.1352601. eCollection 2024.
During psychiatric diagnostic interviews, the clinician's question usually targets specific symptom descriptions based on diagnostic categories for ICD-10/DSM-5 (2, 3). While some patients merely answer questions, others go beyond to describe their subjective experiences in a manner that highlights the intensity and urgency of those experiences. By adopting conversation analysis as a method, this study examines diagnostic interviews conducted in an outpatient clinic in South Finland and identifies sequences that divulge patients' subjective experiences. From 10 audio-recorded diagnostic interviews, 40 segments were selected where patients replied to medically or factually oriented questions with their self-disclosures. The research focus was on the clinicians' responses to these disclosures. We present five sequential trajectories that the clinicians offered third-position utterances in response to their patients' self-disclosure of subjective experiences. These trajectories include the following: 1) the clinician transfers the topic to a new concerning a medical or factual theme; 2) the clinician presents a that selects a topic from the patient's self-disclosure of a subjective experience that may orient either towards the medical/factual side or the experiential side of the patient's telling; 3) the clinician provides an of the patient's self-disclosure of his or her subjective experience from the clinician's expert perspective; 4) the clinician gives that orients mainly to a treatment recommendation or to another activity; and 5) the clinician presents a that focusses on the core of their patient's self-disclosure of his or her subjective experience from the patient's perspective. In addition, we present what these responsive practices invoke from the patient in the next turn. We argue that an awareness of these strategies facilitates both the diagnosis and an appropriate therapeutic relationship during the psychiatric assessment interview. Finally, we discuss the clinical significance of our results regarding the patient's agency and the clinician's more conscious patient-centred orientation in the psychiatric assessment procedure.
在精神科诊断访谈中，临床医生的问题通常基于ICD - 10/DSM - 5的诊断类别针对特定症状描述（2, 3）。有些患者只是回答问题，而另一些患者则会进一步描述他们的主观体验，突出这些体验的强度和紧迫性。本研究采用会话分析方法，对芬兰南部一家门诊诊所进行的诊断访谈进行考察，并识别出揭示患者主观体验的序列。从10次录音诊断访谈中，选取了40个片段，其中患者以自我表露回应医学或事实性问题。研究重点是临床医生对这些表露的回应。我们呈现了临床医生针对患者主观体验的自我表露提供第三位置话语的五条序列轨迹。这些轨迹包括：1）临床医生将话题转移到一个新的关于医学或事实主题；2）临床医生提出一个从患者主观体验的自我表露中选取的话题，该话题可能导向患者讲述的医学/事实方面或体验方面；3）临床医生从临床医生的专家视角对患者主观体验的自我表露进行解释；4）临床医生给出主要导向治疗建议或另一项活动的回应；5）临床医生提出一个从患者视角聚焦于患者主观体验自我表露核心的回应。此外，我们还呈现了这些回应性做法在下一轮中从患者那里引发了什么。我们认为，了解这些策略有助于在精神科评估访谈中进行诊断并建立适当的治疗关系。最后，我们讨论了我们的结果在患者能动性以及精神科评估过程中临床医生更有意识地以患者为中心的导向方面的临床意义。
