The Assessment Interview

Clinical assessment

_________involves an evaluation of an individual’s or family’s strengths and weaknesses, a conceptualization of the problem at hand (as well as possible etiological factors), and some prescription for alleviating the problem

Purpose of assessment

• Better understanding of the client

• Ongoing process—just like in psychotherapy

Referral

• the assessment process begins with it

• Clinicialns thus begin with the _____question
  It is important that the take paints to understand precisely what the question or what _____source is seeking

How the clinician address the referral question

1. The kinds of information sought are often heavily influenced by the clinician’s theoretical commitments.

   • Information obtained may be similar, but clinicians will make different inferences from it.

2. Clients are not given the same tests or asked the same questions.

   • Assessment is not a completely standardized set of procedures

   • Clients are described in a way that is useful to the referral source (that will lead to the solution of a problem)

Assessment interview

• the most basic and the most serviceable technique used by the clinical psychologists.

• A major instrument for clinical decision-making, understanding, and prediction

• The clinical utility of the interview can be no greater than the skill and sensitivity of the clinician who uses it.

Interaction

• An interview is an_____ between at least two persons.

• Face-to-face verbal encounters or exchanges.

Done purposefully

• bearing the responsibility for keeping the interview on track and moving toward the goal.

Good interview

• carefully planned, deliberately and skillfully executed, and goal-oriented

Interview vs Tests

• Interviews are less formalized or standardized than psychological tests.

• Most interviews, however, make provision for at least some flexibility

• This flexibility gives opportunity for individualized approach that will be effective in eliciting data from a particular person/client

Art of Interviewing

• Interviewing has often been regarded as an art.

• Decisions such as when to probe, when to be silent, or when to be indirect or subtle test the skill of the interviewer.

• With experience, one learns to respond to interviewee cues in a progressively more sensitive fashion that ultimately serves the purpose of the interview.

Physical arrangements

• An interview can be conducted anywhere that two people can meet and interact.

• On some occasions, this happens by chance (e.g. an encounter with a patient on the street)

• Two of the most important consideration for interviewing:

  • Privacy

  • Protection from interruptions

• Extremely disruptive; clients may refuse to be open and responsive.

Note taking and recording

• All contacts with clients ultimately need to be documented.

• Moderate amount of notetaking (a few key phrases jotted down) will help the clinician’s recall.

• Verbatim note-taking prevents the clinician from:

  • Fully attending to the patients verbalizations

  • Observing the patient and noting subtle changes in expression/ bodily positions

• With today’s technology, it is easy to audiotape or videotape interviews.

• Most patients probably expect a certain amount of note-taking; if patient is troubled by it, it must be discussed

• It should be done openly, unobtrusively, and with the patient’s informed consent.

Rapport

• _______is a comfortable atmosphere and a mutual understanding of the purpose of the interview

• The most essential ingredient of a good interview.

• Good ______the primary instrument by which the clinician achieves the purpose of the interview.

To achieve good rapport

• attitudes of acceptance, understanding, sincerity, empathy and respect for the integrity of the patient.

• These attitudes are not techniques

• Probing, confrontation, and interviewer assertiveness may be acceptable once the rapport has been established.

• It may not be easy for all patients to accept genuine overtures in a professional relationship.

• Challenging to achieve in cases that involve more than one individual (e.g.couple/family therapy) or a unique referral source.

• With children or adolescent clients, have to establish rapport with parents

Special Consideration

• Rapport can be especially challenging to achieve in cases that involve more than one individual or a unique referral source.

• Rapport also be especially challenging when the client is aware that the imformation collected during the interview likely will be used to determine school placement, to meet employee criteria, or to formulate a legal disposition regarding child custody, legal sanctions, or maltreatment allegations.

No foolproof technique exists in establishing rapport but the following may help:

1. Make an effort to put the client at ease

2. Acknowledge the unique, unusual situation of the clinical interview.

3. Take note of their language, vocabulary.

Beginning a session

• In any interview, there must be communication.

• It is often useful to begin assessment session with a casual conversation (to relax things before plunging into the reasons for coming)

Language

• Of extreme importance is the use of ______ that the patient can understand.

• The kind of language employed should then reflect the judgement of the patient’s background, educational level, or general sophistication.

• Abandon psychological jargon so as to be understood by patients.

• Clarify the intended meaning of a word/term used by a client if there are uncertainties/alternative interpretations.

Use of questions

Maloney and Ward (1976) distinguised among several form of questions, including open-ended, facilitative, clarifying, confronting, and direct questions.

Open-ended

• Gives patient responsibility and latitude for responding

• “Would you tell me about your experiences in the Army?

Facilitative

• Encourages patient’s flow of conversation

• “Can you tell me a little more about that?”

Clarifying

• Encourages clarity or amplification

• “I guess this means you felt like … ?”

Confronting

• Challenges inconsistencies or contradictions

• “Before, when you said … ?”

Direct

• Once rapport has been established and the

  patient is taking responsibility

• “What did you say to your father when he criticized your choice?”

Silence

• _____ can mean many things: organizing thoughts, deciding what to say, showing resistance

• The clinician’s response to______should be based on the goals of the interview rather than on personal needs or insecurities.

• How the clinician ends a lengthy silence, their response should facilitate communication and understanding and not be a desperate solution to an awkward moment.

Listening

• If we are to communicate effectively in the clinician’s role, our communication must reflect understanding and acceptance.

• We cannot hope to do this if we have not been ______, for it is by____that we come to appreciate the information and emotions that the patient is conveying.

• The skilled clinician is one who has learned when to be an active listener.

Gratification of Self

• The clinical interview is not the time or the place for clinicians to work out their own problems.

• In one way or another, clinician must resist the temptation to shift the focus to themselves.

• Sometimes, patients will ask personal questions to the clincian. In general, clinicians should avoid discussing their personal lives or opinions.

The Impact of the Clinician

• Each of us has a characteristic impact on others, both socially and professionally.

• Ex. Female therapist – male client

• As a result, the same behavior in different clinicians is unlikely to provoke the same response from a patient.

• Clinicians must have a degree of self-insight or at least a mental set to consider the possible effects of their own impact before attaching meaning to the behavior of their patients

The Clinician’s Values and Background

• Clinicians must examine their own experiences and seek the bases for their own assumptions before making clinical judgements of others.

• What to the clinicial may appear to be evidence of psychopathology may reflect the patient’s culture.

Patient’s frame of reference

• If the clinician is going to be effective in achieving the goals of the interview, it is essential that he or she have an idea of how the patient views the first meeting.

• Patient’s initial perceptions and expectations.

• Ex. Distorted notion of the clinic, ashamed to seek help, pressured to seek help, seeking help arouses feelings of inadequacy thus either they respond by “clamming up” or “display a kind of bravado”.

• Other patients see the clinician as a savior.

Clinician’s frame of reference

• In a sense, the general dictum is “Be prepared”.

• Ex. Clinician should have carefully gone over existing records of the patient, check the information provided by the person who arranged the appointment, and so on.

• In addition, the clinician should be perfectly clear about the purpose of the interview.

• Remain focused and objective

• Remember, the clinician’s first obligation is to understand.

• Depending on the purpose of the interview, the clinician should also be prepared to provide some closure for the client at the conclusion of the interview.

• The clinician should be prepared to make a referral, set up another appointment, and/or provide some feedback to the client.

Varieties of Interviews

The many ________have two primary distinguishing features:

1. Differ in their purpose.

2. Can be unstructured or structured.

Intake-Admission Interview

An ______ generally has two purposes:

1. To determine why the patient has come to the clinic or hospital

2. To judge whether the agency’s facilities, policies, and services will meet the needs and expectations of the patient.

• May be conducted by the same person who later does the diagnostic interview or the test workup.

• Another function: To inform the patient of such matters as the clinic’s functions, fees, policies, procedures and personnel. – Patient’s are consumers.

Case History Interview

• The clinician is interested both in concrete facts, dates, and events and in patient’s feelings about them.

• Basically, the purpose of _________ is to provide a broad background and context in which both the patient and the problem can be placed.

• The range of material covered is quite broad - covers both childhood and adulthood, and it includes educational, sexual, medical, parental-environmental, religious, and psychopathological.

• External informants or outside sources – sometimes they are the only valid sources of useable information

Mental Status Examination Interniew

• A _____ is typically conducted to assess the presence of cognitive, emotional, or behavioral problems.

• One of the major modes of clinical assessment for a variety of mental health professionals, including psychiatrists

• Major limitation: Unreliable - because they are often highly unstructured in execution.

Crisis interview

• Purpose: to meet problems as they occur and to provide an immediate resource.

• Deflect the potential for disaster and to encourage client to enter into a relationship with the clinic or make a referral so that a longer-term solution can be worked out.

Diagnostic interview

• ______may be required by insurance companies, court proceedings or research protocols.

• Despite the availability of a wide range of structured interviews for diagnosis, it appears that few clinicians use these in everyday practice.

• Clinicans underestimated their patient’s acceptance of structured interviews (only a small proportion of patients felt “questioned out”).

Clinical interview

• a free-form unstructured interview whose content varied greatly from clinician to clinician.

Structured diagnostic interview

a standard set of questions and follow-up probes are asked in a specified sequence to ensure that all patients are asked the same questions, and makes it more likely that two clinicians will arrive at the same diagnosis of the same patient

Reliability

The _______of an interview is typically evaluated in terms of the level of agreement between at least two raters who evaluated the same patient or client.

validity

The_____ of an interview concerns how well that interview measures what it tends to measure.