Clinical Assessment Interviewing

Psychological Assessment Key activity in clinical psychology (historically)

Psychological Assessment: Overall Process I. Planning the assessment II. Data collection** (our focus) IV. Data processing V. Communicating findings

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

Goals of Psychological Assessment Classification (diagnoses) Description Prediction (true positive, false positive)

II. Data Collection** Methods Clinical interview Tests Observations Informal assessment Examination of life records

III. Data Processing Organization and interpretation of data Clinical judgment vs. statistical prediction

IV. Communicating Findings Typical Report Identifying Information Reason for Referral Background Information Behavioral Observations Assessment Results Diagnosis Interpretation Summary and Recommendations

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

Types of Interviews Intake interview Case history Diagnostic interview Mental status exam Crisis interview

Intake Interviews For the Clinician Determine the nature of the client’s 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 psychologist’s fees, procedures and policies

Case History or Psychosocial History Detailed description of the client’s background which usually includes: Birth and development Family of origin Education Employment Recreation/Leisure Sexual history Dating and Marital Alcohol and drugs Physical health

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

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)

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 Speech Orientation Mood and Affect Form of Though

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

Essential Elements of Clinical Interview Rapport Effective communication strategies

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.

Establishing Rapport Conveying acceptance, understanding and respect for the patient

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?

Questions Open Questions Elicit information Closed Questions Gather specific information

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?

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

Clarification Definition Questioning that helps the clinician understand an ambiguous message Confirms the accuracy of the clinician’s perception Example Are you saying that…. Could you describe for me… Say what you mean by…

Clarification: Purpose To encourage elaboration To check accuracy of what you heard To clear up vague messages

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?

Paraphrasing Definition: Describing the content/thoughts of the client’s 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

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 hasn’t 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 you’ve done well in school, you’ve had to work very hard.

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

Reflection Definition Describing the feelings of the client’s 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?

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

Paraphrasing and Reflection Client: Everything is humdrum. There’s 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.

Summarizing Definition: Two or more paraphrases or reflections that condense the client’s message or the session.

Summarizing: Purpose To tie together multiple elements of the client’s message To identify a common theme To interrupt excessive talking To review progress

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)