The Mental-Health Interview
The conversation you have with a mental-health professional — be it a psychiatrist, psychologist, social worker, psychiatric nurse or a person with another form of training in counseling — is the single most important part of the evaluation of depression. A mental-health professional will want to find out:
- What are your problems?
- How do you experience them?
- How did they develop?
- How do these problems appear to others?
You and a mental-health professional will work as a team to define your problem. Your diagnosis depends primarily on the information that is collected from the mental-health interview.
However, the purpose of the interview is not just to come up with a diagnostic label, but to outline possible causes of depression. The interviewer will try to learn as much as possible, in the hopes that it will point the way toward helpful treatment. You can expect your mental-health provider to do the following:
Develop A Good Rapport
You should feel comfortable enough with the interviewer to talk about sensitive topics. The interviewer should create an environment that promotes talking about difficult, emotional matters. Most good mental-health professionals try to be warm and encouraging, while remaining serious, attentive and professional. Mental-health professionals have a wide variety of styles. Someone who you find congenial may make another person uncomfortable. Although you should not expect a perfect match, don't hesitate to look elsewhere if the first mental-health provider you see makes you feel ill at ease.
Ask About Your Life
Your interviewer should take the time to find out some background information about you and your condition. For example, the interviewer should ask how your depression evolved over time and what may have contributed to its development. What is going on in your life? Who is important to you? What other things do you find meaningful — work, leisure, pets, hobbies, religious commitments? What are your goals and ideals?
The interviewer will also want to know about any alcohol and drug use. Most interviewers are aware of and sympathetic with problems that arise from using substances excessively. Drinking and drug problems overlap greatly with mood disorders. They are often very difficult to talk about, but any discussion is likely to be constructive.
Assess Your Symptoms
You may have symptoms of depression such as problems with sleep, appetite or your energy level. Your mental-health provider may go through a list of symptoms of depression and find out if you have had any of them. Sometimes a written questionnaire is helpful for covering most bases. There are likely to be questions about the symptoms of other mental disorders or of medical illnesses.
Perform A Mental-Status Examination
In a mental-status examination your mental-health provider talks to you and takes note of how you appear. Does your speech flow easily and fluently or is it slow and halting? Are your expressions lively or withdrawn? People who are very depressed have a tendency to speak softly, timidly or with hesitation. Or they may walk or move slowly. They may pay less attention to how they dress or groom themselves.
Your health-care provider will pay close attention to what you are thinking about and your mood, both as you describe it and as the health-care provider observes it. Are you preoccupied with a poor self-image, being overly self-critical? Are you especially concerned with your physical health?
In addition to making these kinds of observations, your mental-health provider may give you some short memory, math and vocabulary tests, along with some general knowledge questions, to find out about your ability to concentrate, your memory or your judgment. People who are depressed may have trouble with questions like these because they have trouble paying attention or concentrating. Some people have unrealistic thoughts, for example, becoming convinced they have a fatal illness or that they are about to be fired from a job, when there is in fact no real threat. Others may become paralyzed by indecision, or they have trouble concentrating or putting their thoughts together to speak.
Your mental-health provider will want to hear specifically about any thoughts of suicide.
The Importance Of Being Thorough
Mental-health professionals are trained to ask questions that you may find surprising. For example, you may have reservations talking about other family members, childhood experiences, school and work experiences, or sexual activity. This information, however, completes the picture of what life is like for you and what the major influences have been, both genetically and in your environment.
A skilled interviewer will encourage you to talk more about some things and less about others. You may feel that the interviewer is asking good questions and pushing you gently to talk about matters that you hadn't thought were important or were reluctant to talk about. On the other hand, you may feel the interviewer is brushing past some key elements or taking you in the wrong direction.
The interview is a collaboration. You and your mental-health provider need to work together to make sure important information is discussed. If the discussion is going down the wrong path, say so.
There is rarely a perfect fit between a patient and mental-health provider, especially in the first meeting. So before you make your first appointment, think carefully about what is important to you. You'll have a better chance of explaining it clearly.