A pathopsychologist's conversation with a patient and monitoring his behavior during a study
Above we talked about that a pathopsychological study includes a conversation with a patient, often referred to as "directed", "clinical". It's easier to call it "conversation with the subject", in this case with the patient.
Conversation consists of two parts. The first part - is a conversation, in the narrow sense of the word. The experimenter talks to the patient, without conducting any experiment. The conversation can take place before or after the experimental work with the patient.
The second part of conversations is a conversation during an experiment, because an experiment is always communication with a patient. Communication can be verbal, i.e. the experimenter says something to him, points out, suggests, praises or, on the contrary, censures. But this conversation maybe not in the verbal plan, but the experimenter shows his facial expressions to the patient, whether he does good or bad; as in real life, you can shrug your shoulders, raise your eyebrows, you can look surprised, smile, frown, ie. depending on the circumstances (this is also a form of communication).
Let us dwell on those questions that concern the conversation in a narrower sense. First of all, the conversation can not be conducted "in general". It always depends on the task. The task is put mostly by the attending physician. The doctor asks to see experimentally such and such a patient, the diagnosis is not clear to him. Or, on the contrary, the patient is in the hospital for examination: labor, military, judicial. Or the doctor wants to know what is the impact of the psychopharmacological drugs that the patient takes. In these cases, the doctor puts a certain practical task before the psychologist. Corresponding to this problem, an experiment is carried out, i.e. the psychologist chooses the strategy of his actions and conversations, depending on the task that he was put to him. This is the first. But often there are cases when a doctor (if this is an inexperienced doctor) does not always put the problem before the psychologist. At times happens so, the doctor asks the pathopsychologist to look or see this, "quot; very difficult patient patient". The task has not been set, and the psychologist should study the medical history well. If you carefully read the history of a person's illness, the psychologist can understand what the task before him is. But for this you need to have knowledge in the field of the clinic. Therefore, students who undergo specialization at the department of neuro- and pathopsychology are given a course of lectures: introduction to psychiatry, introduction to neurology, introduction to clinical psychotherapy are mandatory courses with exams or tests.
After reading the medical history, having found out who is sitting in front of him, the psychologist decides, "what he will conduct the experiment for," to conduct the "narrow conversation". It should be emphasized that, first of all, she should not repeat the questions of the doctor, i.e. Do not ask such questions that the doctor asked and which are reflected in the medical history. The psychologist should not collect an anamnesis, which should be in the medical history. If this is not the case in the case history, then you should consult your doctor and probably with him to collect an anamnesis.
Specifically speaking, you should not start your conversation with the patient with questions: is there any delirium, are there hallucinations? This should not be done. If during the conversation he himself talks about this, then we should talk about it with him.
It is necessary to approach very delicately the question of his condition. If the patient is depressed, and you read about it in the medical history, you should also not start talking about his depression, but you can, as it were, "roundabout" by asking how he feels today? Is it not difficult for him to work today, because you want to test his memory.
And if a sick or a sick person answers "I'm always bad, I do not care, I do not want to do it, I do not want anything at all," then you can continue this thought: "Do not you always do anything? And how do you spend your time? What are you doing? And then the patient will start talking. Do not ask him about when his worst mood is: in the morning or in the evening? It is the duty of the doctor to ask. The psychologist should do this not directly, but as if "roundabout" by way of. But the most important thing is to know and always remember what the patient-subject is sent to you for. This applies not only to a sick person, this also applies to conversations that the psychologist conducts with a normal, healthy person to study, for example, logical abilities.
Next, always in your conversation should take into account the attitude of the patient to the situation of the experiment, to you as an experimenter. It is necessary to know the premorbid features of the patient, i.e. those features that were peculiar to the person before his illness. The psychologist should find information about this in the medical history, and not ask the patient what he was before the illness. It's another matter, when we have some scientific task before us and we should talk with his parents and colleagues in the framework of scientific problems, then it is possible, but this is another matter, now we are talking about a conversation in the conditions of practical work of pathopsychologists.