- xviii, 661 p.
Cote : WM 141 M158p 2006
Entretiens (Psychiatrie) ; Maladies mentales - Diagnostic ; Relations médecin-patient
Interviewing and communication skills are rightly assuming a prominent position in medical education. UK postgraduate trainers will soon be responsible for assessing trainees' communication skills, even though they may have had little or no training themselves. Therefore, books such as this appear timely and welcome, although it is unusual for the second edition of a book to be published 35 years after the first. For a book about communicating, however, the title is somewhat misleading. It appears to have been written primarily for clinicians assessing patients with a view to offering psychodynamic psychotherapy.
The book is divided into four main parts which cover general principles, major clinical syndromes, special clinical situations and technical factors affecting the interview. Most of the book focuses on clinical syndromes, with chapters on, for example, the narcissistic patient and the psychotic patient. Each chapter has a similar structure of characteristic clinical features, differential diagnosis, defence mechanisms and developmental psychodynamics, followed by ‘the management of the interview'.
This is a large book, written by three wise men with a wealth of clinical experience. It is filled with helpful nuggets of advice. For example, the chapter on the obsessive–compulsive patient beautifully describes the diverting tactics patients use to avoid directly answering questions, with useful suggestions on how to counter them.
The parts on the management of the interview are the most rewarding to read, particularly the section on discussion of suicide with patients with depression. Given the title, I expected more emphasis on basic communication skills, such as question style and responding to cues. There was discussion of listening and facilitation, but in the main the focus was more on psychoanalytic understanding. The occasional excerpts of dialogue were excellent, but it would have benefited greatly from many more of these valuable illustrations.
The book is written in a flowing style with long paragraphs taking up a whole page. Nowadays, however, with short attention spans and many books having attractively laid-out chapters filled with bullet points and coloured boxes, I wonder how many trainees will actually read a book like this.
For clinicians negotiating the early stages of assessment and engagement in psychodynamic psychotherapy, it is no doubt an extremely useful book, but probably not the first choice for those wishing to purchase a more comprehensive book on general psychiatric interviewing. Libraries should definitely have a copy for people to dip into for helpful tips on specific clinical presentations.
Finally, there was a long wait for this second edition and I wonder whether we will still be undertaking standard psychiatric assessments 35 years from now.
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