A topographical model of clinical decision making and interviewing

A model linking clinical decision making, interviewing skills, and countertransference is presented. It derives from the psychoanalytical topographic model which is hierarchically organized into unconscious, preconscious, and conscious aspects of thought, feeling, and action. This model provides a format for understanding and teaching about physicians' unconscious, unrecognized responses to patients (countertransference), an important determinant of physician learning about clinical decision making and the clinical interview.