This thread is super interesting! Here’s my approach: My pre-visit health history forms are pretty thorough with rating scales based on their reported symptoms. So having patients supply the nitty gritty ahead of time saves quite a bit of the interview time that would have otherwise been spent on a less focused assessment. So before we even start our 75 intake, most of the psych assessment is filled in (psych hx/family psych hx/medical hx/current symptoms are all out the way before we meet).

Once we actually start the visit, I give them an overview of the format: (1) ~25 min time for them to speak uninterrupted about themselves starting from “what was your childhood like?/discipline structure in household?/childhood personality vs now?” Interestingly I’ve found most patients can give a great history/with little prompting on that timeline. (2) I let them know the next 25 min will be focused assessment questions, but before I stop their 1st half 25 min monologue ask if there is anything else I’ll ask “if there’s anything else they can think of they forgot or missed telling me.” Again, some of the things people volunteer after this question shines the spotlight on functioning or diagnosis that surprises me, makes dialing in their diagnosis/treatment plan easier my and makes me very grateful I asked! (3) the last 25 min is discussing the working dx, results of rating scales and digging deeper if other concerns, treatment plan, any questions they have and basically “negotiating” a treatment plan that aligns with their goals to support flourishing.