Clinical Assessment Interviewing

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Clinical AssessmentInterviewing
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Psychological Assessment

• Key activity in clinical psychology
  (historically)

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Psychological AssessmentOverall Process

• I. Planning the assessment
• II. Data collection (our focus)
• IV. Data processing
• V. Communicating findings

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I. Planning the Assessment

• Why is the person being assessed? (referral
  question)
• The goal of the psychological assessment follows
  from the referral question.

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Goals of Psychological Assessment

• Classification (diagnoses)
• Description
• Prediction (true positive, false positive)

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II. Data Collection

• Methods
• Clinical interview
• Tests
• Observations
• Informal assessment
• Examination of life records

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III. Data Processing

• Organization and interpretation of data
• Clinical judgment vs. statistical prediction

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IV. Communicating Findings

• Typical Report
• Identifying Information
• Reason for Referral
• Background Information
• Behavioral Observations
• Assessment Results
• Diagnosis
• Interpretation
• Summary and Recommendations

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Clinical Interviewing

• Clinical Interview vs. Social Conversation
• Different social roles of the two participants
• Interview usually takes place in a professional
  setting
• Interview is usually one-sided

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Types of Interviews

• Intake interview
• Case history
• Diagnostic interview
• Mental status exam
• Crisis interview

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Intake Interviews

• For the Clinician
• Determine the nature of the clients problems
• Determine the appropriateness of services offered
• Define problems to be worked on and establish
  goals
• Balance gathering information with establishing
  rapport

• For the Client
• Determine appropriateness of services
• Find out about psychologists fees, procedures
  and policies

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Case History or Psychosocial History

• Detailed description of the clients background
  which usually includes
• Birth and development
• Family of origin
• Education
• Employment
• Recreation/Leisure
• Sexual history
• Dating and Marital
• Alcohol and drugs
• Physical health

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Structured Diagnostic Interviews

• Structured Interviews specify
• Symptoms and disorders to be assessed
• Interview format
• Order of questions
• Wording of questions
• Guidelines for additional questions

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Structured Diagnostic Interviews

• Professionals
• Schedule for Affective Disorders and
  Schizophrenia (SADS) (semi-structured)
• Structured Clinical Interview for DSM-IV (SCID)

• Lay Persons
• Diagnostic Interview Schedule (DIS)

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Mental Status Exam

• General appearance and behavior
• Speech and thought
• Consciousness
• Perception
• Obsession and Compulsions
• Orientation
• Memory
• Attention and concentration
• General information
• Intelligence

• Insight and judgment
• Higher cognitive functioning
• Intelligence
• Insight and judgment
• Higher cognitive functioning
• Speech
• Orientation
• Mood and Affect
• Form of Though

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Crisis Interview

• Goal
• Resolve the problem to avoid catastrophic outcome
• Tasks
• Provide reassurance
• Assess the problem
• Explore potential resources
• Method
• Convey understanding
• Projecting a calm and confident manner

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Essential Elements of Clinical Interview

• Rapport
• Effective communication strategies

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Rapport

• The sense of mutual trust and harmony that
  characterizes a good relationship
• Rapport involves a comfortable atmosphere and a
  mutual understanding of the purpose of the
  interview.

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Establishing Rapport

• Conveying acceptance, understanding and respect
  for the patient

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Effective Communication Verbal Strategies

• Open Questions
• What did you think of the movie?
• How would you describe your relationship with
  your parents?

• Closed Questions
• Did you like the movie?
• Do you have a good relationship with your parents?

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Questions

• Open Questions
• Elicit information

• Closed Questions
• Gather specific information

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Combining Open and Closed Questions
How would you describe your marriage?
What do you enjoy about the relationship? What
are these arguments like?
Have you and your husband ever separated? How
long have you been married?
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Listening Skills

• Four Types of Responses that Convey Listening
• Clarification
• Paraphrase
• Reflection
• Summarization

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Clarification

• Definition
• Questioning that
• helps the clinician understand an ambiguous
  message
• Confirms the accuracy of the clinicians
  perception

• Example
• Are you saying that.
• Could you describe for me
• Say what you mean by

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Clarification Purpose

• To encourage elaboration
• To check accuracy of what you heard
• To clear up vague messages

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Distinguishing Content vs. Emotion An Exercise

• What thoughts are you having about being in class
  today?

• What are the feelings that go along with these
  thoughts?

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Paraphrasing

• Definition Describing the content/thoughts of
  the clients message
• Provides an opportunity for client to clarify
• Encourages client to say more about a topic
• Provides an opportunity to redirect client to
  central topic

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Paraphrasing

• Example
• Client School has always been really difficult
  for me. I really have to work hard to do well. My
  grades have always been good but it hasnt been
  easy. Not like my sister. Megan has always just
  waltzed right through school. She just reads a
  chapter once and its all there for her when test
  time comes.
• Therapist So while youve done well in school,
  youve had to work very hard.

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Paraphrasing Purpose

• To help the client focus on the content of their
  message
• To highlight content when attention to feelings
  is premature

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Reflection

• Definition
• Describing the feelings of the clients message.
• Example
• Client Since I have had the baby, my husband is
  always busy at work and I have to do everything
  by myself and it is hard to keep up.
• Therapist You are feeling overwhelmed by
  becoming a new mother?

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Reflection Purpose

• To encourage the client to express more of his or
  her feelings
• To have the client experience feelings more
  intensely
• To help the client become more aware of their
  feelings
• To help the client discriminate accurately among
  feelings

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Paraphrasing and Reflection

• Client Everything is humdrum. Theres nothing
  new going on, nothing exciting. All my friends
  are away. I wish I had money to do something
  different.
• Paraphrase With your friends gone and no money
  around, there is nothing for you to do right now.
• Reflection You feel bored with the way things
  are for you right now.

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Summarizing

• Definition
• Two or more paraphrases or reflections that
  condense the clients message or the session.

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Summarizing Purpose

• To tie together multiple elements of the clients
  message
• To identify a common theme
• To interrupt excessive talking
• To review progress

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Overview Psychological Assessment

• Planning the assessment (why is person being
  assessed?)
• Data collection (interviews, tests, observations
  etc)
• Data processing (clinical vs. statistical
  prediction)
• Communicating findings (written reports)