Review of the book entitled A entrevista psiquiátrica na prática clínica

BOOK REVIEW

Review of the book entitled A entrevista psiquiátrica na prática clínica

Gustavo Schestatsky

Psychiatrist

^{Correspondence}

Roger A. MacKinnon, Robert Michels and Peter Buckley

Porto Alegre, Artmed, 2007, 2ª edição

Last October the second edition in Portuguese of The psychiatric interview in clinical practice (Artmed, 2007) was launched. This book, which was originally published in 1971, is a classic text of psychiatric literature. The authors MacKinnon and Michels, now in association with Peter Buckley, are back after 35 years, with a widely renewed edition adapted to the vicissitudes of modern times.

As properly pointed out by Glen Gabbard in the introduction, this book comes at a good time. Its first edition was published at a time when formation programs for residents in psychiatry naturally contemplated a much more comprehensive understanding of the patient, aiming to know him deeper as a person. The new edition comes within a context of progressive "unlearning" of the art of a good interview. Contemporary psychiatrists are often locked in a biological reductionism, limiting their interviews to inventories of symptoms that can satisfy criteria of diagnostic manuals and, therefore, guide them to a drug prescription.

The book is structurally divided into four parts: 1) General principles; 2) Major clinical syndromes; 3) Special clinical situations; and 4) Technical factors affecting the interview.

The first part has two chapters that, although introductory, are highly relevant, since they provide the foundations of interview. Quite useful concepts and guidance are presented to the psychiatric interviewer, especially for beginners. The first chapter, on general principles of the interview, comprehensively deals with themes such as the basic characteristics of psychiatric interview, relevant aspects of psychiatric examination, as well as techniques to conduct an interview. The second introductory chapter, on general principles of psychodynamics, reveals the main authors' focus on the importance of knowledge (at least basic knowledge) of psychodynamic functioning for a successful interview. It clearly and simply approaches the basic concepts of psychodynamics and psychoanalysis, as well as psychodynamic aspects of psychopathological conditions. In addition, it presents a summary of the main psychoanalytic models of mental functioning.

The part of this book that most stands out, due to its wide comprehensiveness and relevance to the psychiatrist's everyday practice, is that including many chapters approaching the main clinical syndromes with which the interviewer is generally faced. It includes the following types of patient: obsessive-compulsive, histrionic, narcissistic, masochistic, depressed, anxious, traumatized, borderline, antisocial, paranoid, psychotic, psychosomatic, and that with cognitive deficiency. Each chapter brings notions on psychopathology and psychodynamics of the respective syndrome, essential aspects of interview conduction, as well as issues of transference and countertransference that are usually involved. As an illustration, the authors present several vignettes including clinical situations experienced by them during their psychiatric practice, both clinical and as supervisors of undergraduate psychiatrists. In that section, the reader can find a good source of guidance, which will help him obtain a better understanding and a more appropriate conduct in specific interview situations in varied conditions.

Going beyond the most classic syndromes, the chapters dealing with special clinical situations are also interesting, such as those involving patients in the emergence room, hospitalized patients and those with specific characteristics that usually differ from those of the interviewer (for example, patients from a certain religion, ethnic group, sexual orientation, and so on).

Issues that are not generally approached, but that are part of the psychiatric interviewer's everyday life, are dealt with in the last part, which is about the technical factors affecting the interview. Besides the themes that were already in the previous edition, such as notes and telephone calls, it is interesting to observe the presence of a typically contemporary situation, unimaginable at the time the first edition was published, such as e-mails. Since these are little studied issues, the authors' guidance is interesting, often based on their own clinical experience and on their accurate common sense.

In general, throughout the book the authors emphasize the essential role of the interviewer in clinical psychiatry, as well as the enormous value of psychodynamic understanding for a good conduction of the interview and for the proper establishment of therapeutic alliance. These principles can be applied to any patient, even to those who will not be psychotherapeutic patients.

Perhaps the greatest merit of this book is using a clear language, full of examples of clinical situations that can be especially useful to beginning psychiatrists. More experienced psychiatrists, especially those who did not have enough contact with psychodynamic psychotherapies during their formation, can also be benefited from this book. In many cases, readers will "see themselves" in reported situations, and will widen their range of options about how to conduct interview situations demanding more expertise.

Publication Dates

• Publication in this collection
  31 Mar 2008
• Date of issue
  Dec 2007