Am J Psychiatry 1981; 138:421-428
Copyright © 1981 by American Psychiatric Association
The initial encounter: what to do first?
A Margulies and LL Havens
The first interview presents dilemmas to the psychiatric practitioner. Is
he or she to concentrate in objective-descriptive fashion, observing
symptoms and signs, seeking the likely syndrome or disease concept? Is he
or she to work associatively, toward unconscious themes as developed by the
psychoanalytic schools? Would an existential approach be best, an attempt
to understand the patient's life purposes and difficulties empathically?
Alternatively, should the therapist grasp the patient's situation in
interpersonal terms? The authors suggest that these decisions are less
central than the need to establish a working relationship in order to
continue the investigation or treatment and to uncover as much as possible
of the relevant data, and that the newer schools of existential and
interpersonal psychiatry offer the critical keys to achieving this.
