Personal Statement
When I first learned how to do a psychiatric evaluation, I felt like I was learning backwards. I was expected to gather information without being told why it mattered, what to listen for, or how to recognize when something important was being missed. I learned the significance of key questions, and the consequences of not asking them, the hard way: over time, and often only after realizing I had overlooked something essential. I wish someone had shown these things to me at the start.
Very early in training, I recognized something fundamental: knowing the DSM means nothing if you can’t extract the information you need from a patient. You can memorize every diagnostic criterion, but if the interview doesn’t create space for the patient to tell their real story, if you can’t help them articulate what matters, then none of that knowledge translates into good care. That understanding is what drove me to read Shea’s Psychiatric Interviewing before I ever seriously studied the DSM. I knew the interview was the work.
When I watch trainees now, I see the same struggle I once had. They ask the baseline questions but don’t know when, or why, to go further. They collect facts but miss the story. They may feel embarrassed to probe deeper, unsure of how to challenge inconsistencies or sit with uncertainty. They try to justify a patient’s narrative instead of recognizing when something does not make sense, because they haven’t yet learned how to identify what is missing. And the hardest part: they often don’t realize what they’re not capturing.
I created this guide so that learners don’t have to figure all of this out by trial and error. I want them to sit with a patient, finish the evaluation, and know they obtained the essential information clearly, respectfully, and thoroughly. I want them to leave feeling confident in the story they can present, not uncertain or apologetic about what they might have missed.
But this guide is also something I need for myself. My natural tendency is toward complacency when I’m not consistently challenged or held accountable. I know that about myself. This guide is my attempt to maintain the constant learning and refinement that this work demands. It’s not meant to replace foundational texts like Carlat’s The Psychiatric Interview, MacKinnon’s The Psychiatric Interview in Clinical Practice, or Shea’s Psychiatric Interviewing: The Art of Understanding. It doesn’t compare to those works. But it keeps me honest. It forces me to articulate what matters, to refine my thinking, and to stay engaged with the fundamentals. Because without that external structure, I know I won’t maintain it on my own.
If I ever become overconfident, I risk becoming lax, and that can lead to real harm. Continual improvement is not optional in psychiatry. It is an ethical responsibility.
I wrote this guide because the psychiatric evaluation is not simply documentation. It is the foundation of diagnosis, treatment, and trust. When done well, it is both a clinical instrument and a profoundly human exchange.
My goal is to make the evaluation something we do with patients, not to them. To make it teachable, repeatable, and meaningful.
