Book Reviews

The following reviews are of the First Edition. (No reviews of the recently published second edition are available yet.)


CANADIAN JOURNAL OF PSYCHIATRY

June, 1989

Teachers of psychiatric interviewing have been waiting for a book like this. Up to now, the best text was Mackinnon and Michels (1), clearly out of date after 18 years. Shea’s book is in any case much better. He draws on a broad knowledge of clinical psychiatry, on a practical feeling for psychodynamics, and on crucial theorists, such as Sullivan (2) and Havens (3). The book is more than an integration of ideas from other sources, but provides a creative approach to the psychiatric interview which should provide the most seasoned clinician with new insights.

One of the themes of this book is how to be empathic and get data at the same time. Teachers, as well as Royal College examiners, know from experience how problematic this is. With many well-chosen vignettes and with a thought-out theoretical framework, Shea shows you how to do it, and how to do it within a reasonable amount of time. For this purpose, Shea has evolved some unique theoretical terminology, which helps to describe phenomena which no one has taken the trouble to observe before. He shows you how to adapt techniques for all kinds of pathology, including depression, psychosis, and various levels of personality disorder. His ways for handling resistance are deft in combining empathy and persistence. Of particular value are his ideas on the balance between open-ended and close-ended questions, and how to provide structure in a context of engagement. There is a fine chapter on the use of nonverbal communication in interviews. The book is intensely practical, with a riveting chapter on the assessment of risk for suicide and homicide. Finally, it is beautifully organized and laid out, including quotations of poetry and, some attractive illustrations.

With a book of this quality, criticism is a quibble. The one problem I had was that Shea appears to work in a clinic where treatment is available for every patient, including severe personality disorders. For differential therapeutics, including “no treatment as treatment of choice,” one has to look elsewhere (4). Reviewers have a way of telling you that a good book is essential for every psychiatric library. This time it is really true.

References

  1. Mackinnon RA, Michels R. The psychiatric interview in clinical practice. New York: Saunders, 1971.
  2. Sullivan H.S. The psychiatric interview. New York: Norton, 1970.
  3. Havens L. Making contact: uses of language in psychotherapy. Cambridge: Harvard University Press, 1986.
  4. Frances A, Clarkin J, Perry S. Differential therapeutics in psychiatry: The art and science of treatment selection. New York: Brunner/Mazel, 1984.

    J. Paris, M.D.
    Montreal, Quebec

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Hospital and Community Psychiatry

    Laurence B. Guttmacher, M.D.
    Angela K. Hodge, M.D.

This book evolved from a course on interviewing offered by Dr. Shea at the Western Psychiatric Institute and Clinic of the University of Pittsburgh. It is designed to be a practical text, synthesizing different interviewing approaches, for a wide variety of mental health professionals and students. Its secondary aim is to function as a basic guide to psychopathology.

Much of the emphasis is on the initial diagnostic interview, although some guidelines are offered for subsequent contacts. One of the book’s chief assets is its attempt to make interviewing scientific; Dr. Shea discusses and attempts to quantify such concepts as proxemics, kinesics, and paralanguage.

Yet Dr. Shea keeps the reader engaged through potentially dry territory, due greatly to his writing style. He writes well, and his use of transcripts clearly enlivens the text and serves to illustrate his concepts. He is quite willing to cite his mistakes and encourages the idea that good interviewers are made not born. He is apparently remarkably well read, as evidenced by frequent relevant quotations from such diverse sources as Alice in Wonderland and Eastern mystics. He is clearly not doctrinaire, drawing on the work of such persons as Carl Rogers, Harry Stack Sullivan, and G. I. Gurdjieff and emphasizing the need to vary approaches depending on the patient, the context of the interview, and the interviewer’s own personal style.

Dr. Shea uses a technique called facilic analysis to study and diagram the natural structure and flow of interviews. This system delineates the content regions of an interview and the techniques, including verbal and nonverbal communication, that clinicians use to move from one part of the interview to the next; it is intended to facilitate supervision. (We hope that Dr. Shea’s next book will be on clinical supervision. His techniques look fascinating, and expanded discussion would be of considerable value to students at all levels of training.)

The book is less successful when it attempts to become a general psychiatry text. This material is well enough done, but it serves to draw attention away from the book’s primary purpose, as a guide to interviewing. After all, we have a number of good general introductory texts, yet precious few of similar quality on the most basic of psychiatric skills, the interview. Also, because the first interview often lays the groundwork for subsequent contacts, more attention would have been paid to what happens after the initial interview.

This is a marvelous text on an aspect of psychiatry that often does not receive as much attention as it deserves. The two of us are at different stages in our careers, yet we both found that this book improved our interviews. We plan on incorporating it as a core text in our residency program in psychiatry. It should be of equal value for other mental health disciplines as well.

Dr. Guttmacher is director of psychiatric residency training and Dr. Hodge is associate resident in psychiatry at the University of Rochester School of Medicine and Dentistry in Rochester, New York.

September 1989 Vol. 40 No. 9 Hospital and Community Psychiatry

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Clinical Psychology Review

    Arthur Weins, Ph.D.


This is a book I wish I could have written. While there are some topics the author does not cover, for example, the burgeoning area of structured interviews, the interested reader will have to look elsewhere for information on that topic, this book can be read with interest by expert and novice alike and will be referred to often in teaching interviewing and in getting ideas on how to approach a variety of interviewing tasks. Dr. Shea views the initial psychiatric interview as a creative act and presents his orientation very well in the preface of his book. Namely, regarding the psychiatric interview he says, “It is a study of movement and change. It is unique. The circumstances, the environment, and the people can never be duplicated. Even if the interviewer and interviewee wanted to replicate their own interaction, they could not; for with each sentence their relationship has subtly changed. With each sentence they define a new phenomenon. This creativity is harnessed by two pivotal principles: (1) the patient must be powerfully engaged, and (2) a thorough and valid data base must be gathered in a limited amount of time.”

Part I of this book provides the reader with a conceptualization of the major goals of the interview with an emphasis on the interactional process between patient and clinician. The author provides a thought-provoking discussion of the engagement process, which is complemented by enlightening illustrations of nebulous clinical terms such as genuineness and empathy. Practical suggestions for analyzing and altering the interview to mesh with the specific needs of the client are provided.

Dr. Shea then delves into an analysis of the dynamic structure of the interview. The interview is broken into phases, again with an emphasis on flexibility and respect for the patient's defenses and needs. Strategies aimed at overcoming common clinical obstacles are presented through case discussions. An insightful analysis of the contributions of clinical nonverbal behaviors to the engagement process is discussed. The author also promotes a sensitivity in the clinician to the wealth of information provided by the patient’s nonverbal cues, which is a valuable assessment tool for the mental health worker at any stage of his or her training.

Part II presents an informative discussion of specific interviewing techniques designed to facilitate assessment of the affective disorders, psychotic conditions, and the personality disorders. These chapters emphasize multimodal assessment, and key concepts are illustrated with clinical vignettes. The author places a premium on utilizing the complementary assessment frameworks of the DSM-III-R, systems analysis, and the “core pains” of the patient during the clinical interview. Techniques for arriving at valid differential diagnoses and appropriate treatment options following a brief psychiatric interview are discussed at a level accessible to most clinicians.

In Part III of this book, Dr. Shea turns his attention to fine-tuning the assessment of traditionally difficult areas of the interview: the evaluation of suicidal and homicidal ideation. Again, realistic vignettes nicely illustrate the impact of common clinical errors as well as suggested solutions for the clinician. Finally, recognizing and coping with resistance is discussed with an optimistic focus on the clinician’s ability to overcome these obstacles. The emphasis on the clinician's responsibility for the content of the interview, no matter how difficult the patient, makes reading this book even more valuable to the novice.

Clinical Psychology Review, Vol. 10. pp 151-152, 1990 0272-7358/90
Printed in the USA. All right reserved. (Copyright 1990 Pergamon Press)


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