The psychiatric interview plays a critical role in clinical assessment and therapy. Problems with assessment reliability and validity that were apparent in nosological and diagnostic discrepancies plagued the field of psychiatry historically. Technical approaches including structured interviews were developed to address these problems. Although these approaches decreased diagnostic variance, they focused narrowly on eliciting signs and symptoms conforming to previously agreed diagnostic categories, necessarily restricting the range and richness of experiences and narratives that are elicited. This restriction inhibits the utility (...) of assessment in furthering the interpersonal rapport and exploration that is essential to the task of therapy. The author reviews critiques of technical approaches to psychiatric assessment and highlights critical, often unexamined, epistemological assumptions and questions. In light of these critiques, he proposes a phenomenological approach to psychiatric assessment focused on narratives that situate particular experiences in the broader life context. In this approach the assessor functions as a participant observer, relying on the same empathic skills that inform effective therapy. It is argued that without over turning the advances in assessment reliability gained through technical approaches to the psychiatric interview, a phenomenological approach can illuminate, enrich, and broaden psychiatric assessment, increasing its effectiveness in psychopathological understanding and in therapy. (shrink)

1. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), anxiety and phobias are common in schizophrenia, and anxiety is often part of the dysphoric mood (A...

This article develops a phenomenological contribution to biological psychiatry. Grounded in the principles of transformation, heterogeneity, proportionality and particularity, a paradigm of phenomenological orientation allocates to biology a role different from that assumed by official Cartesian psychiatry. First, no clear definition of what is biological may be established a priori—as a general application, and useful to each and every studied phenomenon. Biology may be understood only as the experience of ununderstandable elements within consciousness, and as belonging necessarily to a whole (...) unity of conscious experience. Second, the research agenda in biological psychiatry necessarily intersects with the investigation of the particularities of each individual clinical case with its unique characteristics. Without this, the very notion of biological psychiatry becomes merely a theoretical abstraction. Finally, the continuity of the biological agenda needs to resume the construction and investigation of psychopathological categories that cohere with the reality of the mental universe. (shrink)

The focus is on the intersubjective, narrative and dialogic aspects of the clinical phenomenon of insight in psychosis. By introducing a socio-dialogic model for the clinical production of insight, it can be learned how insight, as a form of self-knowledge , is a product of the clinical interview, namely the dialogic relation between patient and clinical interviewer. Drawing upon the philosophy of Emmanuel Levinas, expressly his notion of the ethical encounter, the production of insight in the clinical interview is elucidated (...) as both a synchronic and diachronic phenomenon—a provisional form of self-knowledge based on historically-produced frames of meaning which are recalled and narrated, i.e., produced at a specific moment in time. The production of insight, based on auto-biographical memory, is ultimately a processual and transactional phenomenon which arises out of the narrative construction of experience and the dialogic negotiation of the individual's "authored" experience. This process may be understood as a synergistic dynamic between intersubjective micro-processes and symbolic macro-processes , which may, when crystallized at the individual level, precipitate a subjectively insightful account of the prodromal illness experience. (shrink)