The Patients' Practises Disclosing Subjective Experiences in the Psychiatric Intake Interview

In psychiatric diagnostic interviews, a clinician’s question designed to elicit a specificsymptom description is sometimes met with the patient’s self-disclosure of theirsubjective experience. In shifting the topical focus to their subjective experiences, thepatients do something more or something other than just answering the question.Using conversation analysis, we examined such sequences indiagnostic interviews inan outpatient clinic in Finland. From 10 audio-recorded diagnostic interviews, we found45 segments where medical questions were met with patients’self-disclosures. Weshow four sequential trajectories that enable this shift oftopic and action. There arefour possible trajectories: (1) the patient first answers the medical question and theclinician acknowledges this answer, whereupon the patientshifts to a self-disclosure oftheir subjective experience; (2) the patient first gives themedical answer but shifts toself-disclosure without the clinician’s acknowledgementof that answer; (3) the patientproduces an extensive answer to the medical question and, inthe course of producingthis, shifts into the self-disclosure; (4) the patient doesnot offer a medical answer butdesigns the self-disclosure as if it were the answer to the medical question. We argue thatin the shifts to the self-disclosure of their subjective negative experience, the patients takelocal control of the interaction. These shifts also embody aclash between the interactionalprojects of the participants. At the end of the paper, we discuss the clinical relevance ofour results regarding the patient’s agency and the goals of the psychiatric assessment.