Classification & Assessment in Psychiatry · Paper A
Interview techniques
Interview technique names describe HOW a clinician moves the conversation forward, not what is being discussed. A doctor saying 'you mentioned trouble sleeping earlier, can we return to that?' is making a specific move, linking back to something the patient already said, which is a referred transition, not just a topic change. Naming the technique correctly matters as much on the exam as recognising what the patient actually said.
Core facilitative techniques include open questions (inviting narrative), funnelling (open questions narrowing to closed ones to confirm specifics), facilitation (nods, 'go on'), reflection (mirroring the patient's stated feeling), clarification and summarising. Confrontation points out an inconsistency; interpretation offers an unconscious meaning, both differ from reflection, which only mirrors what the patient already said. Take a patient who denies feeling low despite crying throughout the interview: reflection stays close to the patient's own words, while interpretation adds the clinician's own hypothesis, such as suggesting the tears reveal an unacknowledged sadness. Normalising is a distinct named technique: a statement that validates a patient's emotional reaction as an understandable, expected response, such as telling a tearful patient that it is normal to cry when discussing something painful. Validation is a related but separate technique: it explicitly acknowledges that the patient's feeling or reaction makes sense given their particular circumstances, without necessarily framing the reaction as common or expected the way normalising does. Reinforcement is an operant-conditioning mechanism, and it is the underlying principle behind praising a patient's effort or courage in disclosing something difficult. That praise acts as a distinct technique that reinforces and encourages continued openness. More broadly, any clinician response, such as attention, reassurance, or visible concern, that reliably follows a patient's report can reinforce and increase how often that behaviour is reported, independent of the clinician's intent.
An interview's content (what a patient discloses) is only half the assessment. HOW a clinician steers the conversation, which technique is used at each moment, determines whether disclosure happens at all. This concept tests whether a candidate can name the exact technique being used in a described exchange.
An interview TECHNIQUE is a specific, nameable conversational move a clinician makes to open up, narrow down, or check understanding of what a patient is saying. FACILITATIVE techniques encourage disclosure; OBSTRUCTIVE techniques (sometimes called blocking techniques) shut it down, usually unintentionally. FUNNELLING is the overall strategy of moving from broad, open questions toward narrower, closed ones as the interview progresses.
Candidates often confuse REFLECTION with INTERPRETATION, treating them as roughly the same thing. They are not. Reflection stays strictly inside what the patient has already said or shown: it adds nothing new. Interpretation adds the clinician's own hypothesis about an unconscious meaning behind the patient's words or behaviour. Suppose a patient denies feeling low despite crying throughout the interview: reflecting would be saying 'you say you're not low, but I notice you're crying': staying with the observed facts. Interpreting would be suggesting 'perhaps the tears show a sadness you haven't fully acknowledged': adding the clinician's own hypothesis.
A psychiatric interview aims to gather accurate information while doing no harm to the therapeutic relationship. Every question or response either opens the door to further disclosure or closes it. Open, non-leading techniques let the patient's own account emerge with minimal distortion; closed, leading, or judgmental techniques distort or suppress that account. Because the SAME topic (say, alcohol use) can be explored well or badly, the exam tests the technique in isolation from the subject matter.
Facilitative techniques, in roughly the order they are typically used, include: open questions (inviting a free narrative, such as 'tell me how things have been'); FACILITATION (small verbal or non-verbal encouragements, nods, 'go on', a pause, that keep the patient talking without redirecting them); REFLECTION (mirroring back the patient's own stated feeling, in their own words or close to them); CLARIFICATION (checking exactly what the patient meant by an ambiguous statement); SUMMARISING (playing back the gathered account to confirm accuracy); and FUNNELLING (deliberately narrowing from open questions to closed ones to pin down specific details, such as exact dates or doses).
Two more advanced techniques sit slightly apart: CONFRONTATION points out an inconsistency the patient may not have noticed (for example, between what they say and how they appear); INTERPRETATION offers the clinician's hypothesis about an unconscious meaning, going beyond what the patient has directly stated. A doctor who says 'you mentioned trouble sleeping earlier, can we return to that?' is using a REFERRED TRANSITION: a specific move that links back to something the patient already said, rather than an abrupt, unconnected change of subject.
OBSTRUCTIVE techniques to recognise and avoid include: LEADING questions (which suggest the expected answer within the question itself); COMPOUND questions (asking two things at once, so the patient cannot answer either cleanly); 'WHY' questions (which can feel accusatory and provoke defensiveness); and premature REASSURANCE (offering comfort before the patient has finished disclosing, which can shut down further disclosure). A clinician who asks 'you're not still drinking, are you?' combines a leading question with a compound structure, and shuts down honest disclosure just as effectively as reassuring the patient too early would.
Reflection mirrors the patient's own stated feeling; interpretation adds the clinician's own hypothesis about unconscious meaning. Clarification checks meaning without challenging it; confrontation actively points out an inconsistency. A referred transition links to something the patient already raised; an abrupt topic change does not. Facilitation opens disclosure with minimal intervention; reassurance offered too early closes it down, even though both can sound superficially supportive.
Interview technique itself is not diagnostic, but poor technique can produce a misleading history that then leads to a wrong diagnosis: for example, a leading question about mood can make a patient agree with a symptom they do not really have, contaminating the eventual diagnostic formulation. Good technique is therefore a prerequisite for accurate collection of the history, mental state examination findings, and risk assessment that any diagnosis rests on.
Structured communication-skills training, informed by frameworks such as the Calgary-Cambridge model taught widely in UK medical and psychiatric training, deliberately drills facilitative techniques and flags obstructive ones. RCPsych workplace-based assessments directly examine trainees' use of these named techniques during real or simulated interviews, which is exactly why precise terminology matters for the exam, not only for clinical practice.
When a vignette quotes a clinician's exact words, identify the technique from the STRUCTURE of the sentence (leading? compound? linking back?) rather than from the topic being discussed.
Facilitative techniques (open questions, facilitation, reflection, clarification, summarising, funnelling) open disclosure, while obstructive techniques (leading or compound questions, 'why' questions, premature reassurance) close it down, regardless of the topic being discussed.