Preface

It has been my experience over the years that too often words such as “unique” and “outstanding” find their ways into prefaces and introductions. In this instance, it may be justifiable to use them; I hope you will agree as you enjoy this issue of the Psychiatric Clinics of North America. Rather than give a one- or two-sentence synopsis of the articles (each author has provided a concise synopsis in the Table of Contents), the editor of the Psychiatric Clinics, Sarah Barth, suggested that in the Preface I say something about the unusual genesis of this issue that reflects its unique qualities.

Let me begin by saying that it is an honor to be guest editor of this issue of the Psychiatric Clinics of North America. I believe it is the first time in the history of psychiatry that any journal has chosen to devote an entire issue to the practical art of clinical interviewing, and it should be emphasized that this issue is about clinical interviewing, not its close cousin psychotherapy. Having had the privilege of studying interviewing for nearly 30 years, I can say that such an issue is, in my opinion, long overdue. At last, the complexities and nuances of the interviewing skills—that we all, as clinicians, know are the core of our healing art—have been given the attention they warrant in a highly respected journal. In this sense I think it may be safe to say that this issue is indeed unique.

I think this issue may be unique in yet another fashion. We wanted the articles to read with the informality of a valued clinician sharing his or her best clinical pearls, as if we were standing at the bedside of a patient on rounds or in a room with a trusted supervisor. Consequently, all the authors were asked to write their articles in an informal style using first person, exactly as they teach. Our collective goal as contributors was to create an easy-reading “book,” one that we wish had been available to us during our residencies (and afterwards as well), brimming with practical ideas and suggestions for overcoming everyday challenges written in an enjoyable and no-nonsense fashion.

The conception of the issue was unusual in another regard, also, because it is a spin-off from the Internet. Since 1999, I have had the opportunity of editing an on-line feature at the Training Institute for Suicide Assessment and Clinical Interviewing (www.suicideassessment.com) called the “Interviewing Tip of the Month.” These interviewing tips are supplied, not by myself, but by visitors to the Website and participants from my workshops on clinical interviewing. At the time of this publication there are more than 85 such clinical gems archived on this Website.

I learned so much from these tips that it struck me, “What would happen if I asked the greatest interviewers of our time to provide two or three of their best tips each?” I originally had thought of posting these tips on the Website itself but subsequently was offered the rare opportunity to do so in the Psychiatric Clinics of North America. Consequently, in Part II, “Favorite Tips from Those Who Wrote the Book,” you will find the favorite tips of some of your favorite authors covering an array of challenging interviewing tasks, from the assessment of violence and malingering to engaging difficult patients and uncovering psychotic process.

Here is where I feel the word “outstanding” can be legitimately applied, because I believe it is the first time that such a collection of interviewing experts—most of whom have, as the section title suggests, written the gold-standard books on clinical interviewing—has been assembled to provide their very best tips in a single publication, whether book or journal.

To round out the clinical thrust of the journal, there were certain particularly difficult aspects of clinical interviewing that I felt deserved a more detailed exploration. I collected these in Part I, “Innovative Strategies for Navigating Difficult Clinical Interviewing Tasks.” Some topics, such as enhancing the therapeutic alliance, were chosen (despite having an extensive literature already devoted to them) because of their key importance and because innovative developments, such as “motivational interviewing,” have opened new doorways to the art of engagement.

In contrast, other topics were chosen because so little had been written about them, despite their critical importance. Thus you will find splendid articles on how to talk with patients about their spirituality and worldview and how to engage and help the family members of those suffering from severe mental illnesses such as schizophrenia, bipolar disorder, and obsessive-compulsive disorder. These are the types of immediately practical articles that I think every psychiatric resident and mental health professional, across all disciplines, should read and savor for their wisdom. In addition I thought I would be remiss if I did not include an article on one of the difficult “clinical” tasks that we all must navigate, passing the oral boards. I believe the resulting article will prove to be a must-read for any newly minted clinician approaching this daunting rite-of-passage.

One more aspect of this issue of the Psychiatric Clinics may warrant the distinction of the word “unique.” Although this is not a journal devoted to issues related to residency training and educational technology itself, the editors of the Psychiatric Clinics have agreed to include an entire section on topics of immediate importance to residency directors and supervisors. Part III, “Training Psychiatric Residents in Clinical Interviewing: State-of-the-Art Strategies for Residency Directors and Interviewing Mentors,” focuses on practical issues related to the development of interviewing training courses and innovations in supervision such as macrotraining and facilic supervision. For nearly 20 years my friends and colleagues at the Department of Psychiatry at the Dartmouth Medical School have been vigorously pushing the envelope on methods of teaching clinical interviewing skills, and this set of four articles reflects their efforts.

Adding to this unique stance—creating an issue devoted to both the description of clinical interviewing skills and to the methods for teaching those skills—this issue of the Psychiatric Clinics of North America, which began with the Internet, ends with it as well. Three of the educational articles are to be found solely on the Web in our “Web archive.” I would like to think that these lengthy “articles” are special, because, in essence, they are monographs regarding specific supervision techniques (including a programmed text on facilic supervision that can be downloaded and given by supervisors to their psychiatric residents). Because of their length, they never would have been amenable to publication in a standard journal format, but Sarah Barth at the Psychiatric Clinics (to whom I owe a debt of gratitude) had the creativity to suggest placing them on the Web, where enough space could be devoted to the supervision techniques to make them come to life for supervisors.

Finally, I would like to thank all the authors for their time and wisdom. As with all issues of the Psychiatric Clinics, the authors are the cream of the crop. We could not have hoped for a more impressive group of master clinicians. It has been a privilege to work and to learn from all of them. In particular, I should like to thank Dr. Leston Havens, whose writings inspired and guided me back when I was a psychiatric resident in the early 1980s. I have always hoped to have the honor of being involved in a project of which Dr. Havens was a part. His wonderful article leads off our issue, and, as usual, he has produced an article at once both provocative and wonderfully practical. Enjoy!