Abstract
Objective
This pilot study compared a novel communication strategy, the positive approach to the psychiatric interview, with the traditional approach to see if the positive approach can be taught to psychiatric residents; reproduced with standardized patients; measured with a structured scale, the “Positive Approach Outcome Measure,” by blinded raters; and used to improve rapport (assessed with the Bond score), a key driver of engagement.
Methods
Thirty psychiatric residents were randomly assigned to conduct two psychiatric interviews with standardized patients. The standardized patients completed the Working Alliance Inventory—Short Revised, an assessment of the therapeutic alliance. T tests and linear regression examined the effect of the training on the outcome of interest, the Bond score.
Results
The Bond scores for the positive approach group (M = 19.27, SD = 2.87) and the traditional approach group (M = 16.90, SD = 3.44) were statistically significantly different (p = 0.05). All residents trained in the positive approach received a positive score on the Positive Approach Outcome Measure while none of the traditional approach-trained residents attained the threshold. The inter-rater reliability for the blinded raters was high (0.857), as was the intra-rater reliability (1.0).
Conclusions
The positive approach can be taught to residents and reproduced consistently and was associated with improvement in a key driver of treatment engagement: rapport. The positive approach may be an important, inexpensive intervention to improve treatment engagement and ultimately treatment outcomes.
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Data Availability
The data that support the findings of this study are available on request from the corresponding author, AS. The data are not publicly available as the participants of this study did not give written consent for their data to be shared publicly.
References
Schaefer JD, Caspi A, Belsky DW, Harrington H, Houts R, Horwood LJ, et al. Enduring mental health: prevalence and prediction. J Abnorm Psychol. 2017;126(2):212–24.
Kazdin AE. Addressing the treatment gap: a key challenge for extending evidence-based psychosocial interventions. Behav Res Ther. 2017;88:7–18.
Swift JK, Greenberg RP. Premature discontinuation in adult psychotherapy: a meta-analysis. J Consult Clin Psychol. 2012;80(4):547–9.
de Haan AM, Boon AE, de Jong J, Vermeiren R. A review of mental health treatment dropout by ethnic minority youth. Transcult Psychiatry. 2018;55(1):3–30.
Olfson M, Mojtabai R, Sampson NA, Hwang I, Druss B, Wang PS, et al. Dropout from outpatient mental health care in the United States. Psychiatr Serv. 2009;60(7):898–907.
Becker KD, Lee BR, Daleiden EL, Lindsey M, Brandt NE, Chorpita BF. The common elements of engagement in children’s mental health services: which elements for which outcomes? J Clin Child Adolesc Psychol. 2015;44(1):30–43.
Cook JR, Hausman EM, Jensen-Doss A, Hawley KM. Assessment practices of child clinicians. Assessment. 2017;24(2):210–21.
O’Brien KH, Schlechter A. Is talking about what’s wrong necessarily right: a positive perspective on the diagnostic interview. J Am Acad Child Adolesc Psychiatry. 2016;55(4):262–4.
Schlechter AD, O’Brien KH, Stewart C. The positive assessment: a model for integrating well-being and strengths-based approaches into the child and adolescent psychiatry clinical evaluation. Child Adolesc Psychiatr Clin N Am. 2019;28(2):157–69.
Shin DW, Roter DL, Roh YK, Hahm SK, Cho B, Park HK. Physician gender and patient centered communication: the moderating effect of psychosocial and biomedical case characteristics. Patient Educ Couns. 2015;98(1):55–60.
American Psychiatric Association. Resident/Fellow Census, 2019. November 2020. https://www.psychiatry.org/file%20library/residents-medicalstudents/residents/apa-resident-census-2019.pdf. Accessed 28 Jun 2023.
Munder T, Wilmers F, Leonhart R, Linster HW, Barth J. Working Alliance Inventory-Short Revised (WAI-SR): psychometric properties in outpatients and inpatients. Clin Psychol Psychother. 2010;17(3):231–9.
Langer E, Russel T, Eisenkraft N. Orchestral performance and the footprint of mindfulness. Psychol Music. 2009;37(2):125–36.
Lambert NM, Gwinn AM, Baumeister RF, Strachman A, Washburn IJ, Gable SL, et al. A boost of positive affect: the perks of sharing positive experiences. J Soc Pers Relat. 2012;30(1):24–43.
Woods S, Lambert N, Brown P, Fincham F, May R. “I’m so excited for you!” How an enthusiastic responding intervention enhances close relationships. J Soc Pers Relat. 2015;32(1):24–40.
Horwitz SM, Kelleher KJ, Stein RE, Storfer-Isser A, Youngstrom EA, Park ER, et al. Barriers to the identification and management of psychosocial issues in children and maternal depression. Pediatrics. 2007;119(1):e208–18.
Fiscella K, Franks P, Srinivasan M, Kravitz RL, Epstein R. Ratings of physician communication by real and standardized patients. Ann Fam Med. 2007;5(2):151–8.
May W, Park JH, Lee JP. A ten-year review of the literature on the use of standardized patients in teaching and learning: 1996–2005. Med Teach. 2009;31(6):487–92.
Martin DJ, Garske JP, Davis MK. Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. J Consult Clin Psychol. 2000;68(3):438–50.
Acknowledgements
The New York Simulation Center for Health Sciences (NYSIM) is a NYU Grossman School of Medicine partnership with the City University of New York supporting HCP education.
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Jordyn Feingold discloses that she consults with BetterUp Coaching. She receives financial compensation from TarcherPerigee for a book she authored, Choose Growth: A Workbook for Transcending Trauma, Fear, and Self-Doubt.
Alan Schlechter receives royalties for a book he co-edited, Becoming Mindful Integrating Mindfulness Into Your Psychiatric Practice (Arlington, VA: American Psychiatric Association Publishing).
All other authors (Dr. Zabar, Dr. New, Dr. Horwitz, Dr. Reliford, Ms. Guo, and Mr. Moerdler-Green) report no financial relationships with commercial interests and declare no conflict of interest.
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Schlechter, A., Moerdler-Green, M., Zabar, S. et al. The Positive Approach to the Psychiatric Assessment: A Randomized Trial of a Novel Interviewing Technique. Acad Psychiatry 48, 47–51 (2024). https://doi.org/10.1007/s40596-023-01842-1
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DOI: https://doi.org/10.1007/s40596-023-01842-1