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Don't ask questions

The best way to get the wrong answer is to ask a question about it.

Leston Havens was a classic teacher of psychotherapy and interviewing methods at Harvard Medical School for the last half of the 20th century.  One of his trademark ideas was that the best way to interview patients is to avoid asking questions.  When you ask questions, he'd say, patients avoid giving answers.  The more sensitive the question, the more likely you'll get a false, or at least distorted, answer.  In the first clinical interviews, questions about suicidality are among those that are most likely to lead to misinformation.  "Do you think about not being alive?"  "No" replies the patient, thinking that if he says yes, he'll get hospitalized.  Instead, Havens recommended making statements, not asking questions, and seeing how patients respond.  The introductory phrase "I suppose" or "I guess" or "I imagine" if often helpful:  "I suppose you sometimes think about not being alive these days." The patient, caught off-guard, might reply, verbally or nonverbally, in a way that raises clinical suspicion: "Not really. What do you mean?" Notice how now the patient is asking the questions, allowing the clinician to decide how to respond.  "I suppose you never think about being dead then."  Notice how the clinician now has gone to the opposite extreme, to see how the patient responds.  "Well, yeah," the patient might say unconvincingly. "Why would you want to be dead.  Everything is perfect," the clinician could say, ironically, when it's obvious everything isn't perfect.  He would be giving the patient permission to express suicidality as if it makes sense to feel that way, rather than seeing it as something to hide.  It is this kind of interchange, rather than a direct yes or no question and answer session, that is more likely to get at the truth on sensitive topics.  

For further reading:  We recommend a website set up with video and audioconferences of Haven's lectures as well as L Havens et al, Soundings: A psychological equivalent of medical percussion, Harvard Review of Psychiatry,  2001, 9:147-157

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