Interview with key informants

The clinician will by now have made an initial assessment of the patient's problems and of the family context. The next step is an interview with one or more informants, usually family members, to corroborate the story, to fill in gaps, to determine influences impinging on the patient, and to recruit others to help. A family meeting is most effective for accomplishing these goals.

Problems may arise in trying to implement the session. The patient may oppose family members being interviewed for all sorts of reasons; for instance, symptoms have been kept secret, the patient regards it as unfair to burden others, he is ashamed of seeing a psychiatrist, he is fearful the family will be blamed, or he is suspicious of them. These concerns need ventilating, particularly if the family context is pivotal and it is likely that treatment will be enhanced by the family's involvement. The patient will agree in most cases. Where the health or safety of the patient or others is threatened, refusal may be overridden on ethical grounds. Otherwise, refusal must be respected. The question of the family session can be raised again after a more trusting therapeutic relationship has been established.

Who should be seen depends on the purpose of the interview; generally, all those living in the household and likely to be affected by the identified patient's illness. The more family factors that pertain, the more desirable the attendance by all family members. The patient's views should be sought since he will provide insight into whom he considers are key people.

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