Preface

    "The purpose of life is to serve and to show compassion and the will to help others. Only then have we ourselves become true human beings."

    Albert Schweitzer, M.D.


It is with true pleasure that I sit down to write the Preface for the second edition. Much has changed in our field of mental health since the book first appeared 10 years ago—some of it good and some of it not so good. My pleasure arises from the fact that the cornerstone principles of the first edition—sensitivity and compassion—still resonate in our field today; in fact, in the age of managed care and tight time constraints, they may play an even more important role as guideposts than before.

One of my biggest pleasures over the past 10 years has been the warm reception given to the system of "facilics," introduced in the ffrst edition. Facilics has been adopted as a core component of graduate training programs across disciplines—from masters' programs in counseling and social work to psychiatric residencies. For those not familiar with it, facilics is an approach for understanding how we, as front-line clinicians, can most sensitively structure our interviews and effectively manage time constraints during the initial assessment. An innovative aspect of the facilic system is an easily learned system of schematics for supervisors to utilize while tracking the structuring and engagement strategies of the clinician. These schematics function as a supervisory shorthand and provide a direct visual platform for individual supervision and class discussion. Although developed long before the pressures of managed care, facilics has proved to be a popular method for allowing clinicians and supervisors to discover new ways of sensitively handling those very same pressures. For these reasons once again, in the second edition, facilics has been highlighted.

I have tried to keep intact whatever elements of the book the reader feedback has suggested were most effective. Indeed, other than updates to the DSM-IV, most of the chapters have relatively minor changes. On the other hand, Chapter 8 on suicide and violence assessment has been greatly expanded and introduces a new system for eliciting suicidal ideation, which I hope you will find practical and immediately useful. Furthermore, a good deal more time has been spent on practical tips and strategies for assessing violent ideation, an area of relative weakness in the first edition.

The biggest changes in the book are to be found in the appendices, in which more than 100 pages of new information appear. In speaking with readers at my workshops throughout the United States, perhaps the most common suggestion for improvement has been for the addition of an annotated transcript of an actual 60-minute intake. The second most common request has been for the inclusion of practical information on how to write up an assessment that is both clinically useful and forensically sound. Both requests have been fulfilled in the appendices of the second edition.

In addition, there is an appendix that gives specific quality assurance guidelines and "dictation prompts" for the written document. For those who like to record the initial database on a standardized clinical form, a prototypic clinical assessment form provided. There is also a copy of the actual written document derived from the database of the annotated interview itself, thus allowing the reader to see the interview unfold, in actual practice, from the first greeting of the interview to the last period in the written document.

Over the years, I have often been approached by young psychiatrists who ask whether or not the book would help them prepare for the oral boards. Although the first edition was not designed specifically for that purpose, in my heart I have always thought it would help, because I strongly believe that good clinical principles are at the core of the oral boards. In the second edition however, I can now confidently answer "yes" to this question, because I have included an entire appendix that is devoted to practical tips and strategies for passing the oral boards.

I hope that the reader enjoys reading this book as much as I enjoyed revising it. In the final analysis, interviewing should be fun. I think it is important to emphasize that this book does not pretend to show the "correct" way of interviewing, because there is no correct way. Instead, I offer suggestions that will hopefully, provide the reader with the principles to develop his or her own creative style of interviewing, always flexibly matching the interview to the needs of the patient, not the dictates of a school of thought"

In closing, this is a book about knowledge—knowledge applied to the art of healing. In the last analysis, as students of art, it will always remain our great privilege to ensure that the knowledge of our minds is guided by the compassion of our hearts.

Shawn Christopher Shea, MD

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