Enikö Èva Savander1, Elina Weiste2, Jukka Hintikka3, Mikael Leiman4, Taina Valkeapää5, Erkki O Heinonen6, Anssi Peräkylä7. 1. Päijät-Häme Central Hospital, Department of Psychiatry, Lahti, Finland. Electronic address: eniko.savander@phhyky.fi. 2. University of Helsinki, Department of Social Sciences, Helsinki, Finland. Electronic address: elina.weiste@helsinki.fi. 3. Päijät-Häme Central Hospital, Department of Psychiatry, Lahti, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland. Electronic address: jukka.hintikka@phhyky.fi. 4. University of Eastern Finland, Joensuu, Finland. Electronic address: mikael.leiman@laudito.fi. 5. University of Helsinki, Department of Social Sciences, Helsinki, Finland. Electronic address: taina.valkeapaa@helsinki.fi. 6. York University, Department of Psychology, Toronto, Canada; University of Helsinki, Department of Psychology and Logopedics, Helsinki, Finland. Electronic address: erkki.heinonen@helsinki.fi. 7. University of Helsinki, Department of Social Sciences, Helsinki, Finland. Electronic address: anssi.perakyla@helsinki.fi.
Abstract
OBJECTIVE: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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. PRACTICE IMPLICATIONS: By facilitating patients' opportunities to uncover subjective experiences, it is possible to promote their individualized care planning in psychiatry.
RCT Entities:
OBJECTIVE: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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. PRACTICE IMPLICATIONS: By facilitating patients' opportunities to uncover subjective experiences, it is possible to promote their individualized care planning in psychiatry.