The Positive Approach to the Psychiatric Assessment: A Randomized Trial of a Novel Interviewing Technique

Objective This pilot study compared a novel communication strategy, the positive approach to the psychiatric interview, with the traditional approach to see if the positive approach can be taught to psychiatric residents; reproduced with standardized patients; measured with a structured scale, the “Positive Approach Outcome Measure,” by blinded raters; and used to improve rapport (assessed with the Bond score), a key driver of engagement. Methods Thirty psychiatric residents were randomly assigned to conduct two psychiatric interviews with standardized patients. The standardized patients completed the Working Alliance Inventory—Short Revised, an assessment of the therapeutic alliance. T tests and linear regression examined the effect of the training on the outcome of interest, the Bond score. Results The Bond scores for the positive approach group ( M = 19.27, SD = 2.87) and the traditional approach group ( M = 16.90, SD = 3.44) were statistically significantly different ( p = 0.05). All residents trained in the positive approach received a positive score on the Positive Approach Outcome Measure while none of the traditional approach-trained residents attained the threshold. The inter-rater reliability for the blinded raters was high (0.857), as was the intra-rater reliability (1.0). Conclusions The positive approach can be taught to residents and reproduced consistently and was associated with improvement in a key driver of treatment engagement: rapport. The positive approach may be an important, inexpensive intervention to improve treatment engagement and ultimately treatment outcomes.