FINALS CLINICAL PSYCH

Assessment

is a central and unique aspect of clinical psychology, distinguishing it from other mental health professions (psychiatry, social work, counseling, nonclinical psychology).

Validity

The extent to which a test measures what it claims to measure.

Reliability

 The consistency and repeatability of results.

Clinical utility

 The usefulness of the technique in helping the clinician and the client.

– Improves service delivery and client outcomes.

feedback

• _____ involves sharing results with clients through meetings, reports, or other formats.

• Psychologists are trained to give _____ during graduate school, and this skill develops with experience.

• _____ is generally perceived as helpful and positive by clients, even before treatment begins.
  

• Intelligence tests

• Achievement tests

• Neuropsychological tests

• Personality tests

• Specialized measures for specific variables

Clinical psychologists use various assessment tools:

clinical interview

Despite the variety of tools, the ____ is the most frequently used assessment method.

interviewer

• The ___ is the most crucial element in a clinical interview.

• A skilled ___ combines technical competence with emotional and interpersonal insight.

Quieting Yourself

• Not just talking less, but silencing internal, self-directed thoughts.

• Internal distractions (e.g., self-doubt, overthinking) can hinder effective listening.

• Example: A student interviewer like Joseph may be overly preoccupied with self-evaluation, which can distract from truly hearing the client.

Being Self-Aware

• Involves understanding how one’s personal traits and presence affect the client.

• Includes appearance, voice, body language, cultural background, and mannerisms.

• Skilled interviewers are mindful of their interpersonal impact and potential client perceptions.

Developing Positive Working Relationships

• Essential for building trust and rapport—especially since the interview may lead to therapy.

• There’s no strict formula, but key qualities include:

  • Attentive listening

  • Empathy

  • Genuine respect

  • Cultural sensitivity

• Relationships are shaped by both attitude and action of the interviewer.

1. Quieting Yourself

2. Being Self-Aware

3. Developing Positive Working Relationships

General Skills of the Interviewer

Content Validity

 Items are relevant to the subject.

Convergent Validity

– Correlates with similar tools.

Discriminant Validity

 – Doesn’t correlate with unrelated tools.

Test-Retest Reliability

– Stability over time.

Interrater Reliability

– Agreement across evaluators.

Internal Reliability

– Consistency among test items.

Listening as a Primary Task

Effective interviewing begins with attentive listening, which is built on fundamental attending behaviors.

Eye Contact

Definition: The act of intentionally meeting a client’s gaze to convey attention, presence, and empathy during communication.

Function:

• Enhances trust and rapport.

• Signals that the therapist is actively listening and emotionally attuned.

Cultural Considerations:

• Varies across cultures:

  • Too much eye contact may be seen as intrusive, confrontational, or seductive.

  • Too little may be interpreted as disinterest, avoidance, or disrespect.

Body Language

• General guidelines: face the client, appear attentive, minimize restlessness, show appropriate facial expressions.

• Misinterpretation risk without cultural awareness.

• Interviewer and client body language should be mutually understood.
  

Vocal Qualities

• Includes pitch, tone, volume, and fluctuation.

• Conveys appreciation and emotional attunement.

• Interviewers should be attuned to both their own and the client’s vocal qualities.

Verbal Tracking

• Involves repeating and weaving in the client’s words naturally.

• Helps confirm that the interviewer is following the client’s thoughts.

• Allows smooth topic transitions.

Referring to the Client by the Proper Name

• Misusing names can be seen as disrespectful or as a microaggression.

• Always ask and confirm the client’s preferred form of address.

• Using the correct name shows respect and consideration.

Observing Client Behaviors

• Client behavior during the interview provides additional context to verbal responses.

• Observations include: emotional tone, organization of thoughts, cooperation, and affect.

• These behaviors inform how the interviewer responds and interprets content.

Cultural Competence

• Cultural norms affect eye contact, physical touch, and personal space.

  • Example: Less eye contact in Chinese culture, especially between genders.

  • Physical touch more limited in Asian cultures than in European American cultures.

  • Middle Eastern and Latino/Latina individuals tend to prefer closer personal space than North Americans or Britons.

interviewers must be sensitive to these differences to build trust and understanding.

Authenticity in Attending Behaviors

• Attending behaviors should be natural and genuine.
  

• Beginners may need to practice deliberately, but with experience, these become more automatic and effective.

Rapport

• A positive, comfortable relationship between interviewer and client.

• Enhances client disclosure and investment in the interview.

• Put the client at ease early in the interview - small talk

• Acknowledge the uniqueness of the clinical interview

• Match the client’s language

How to establish rapport:

Put the client at ease early in the interview

Use brief small talk to reduce nervousness (e.g., “Did you find the office okay?”).

Acknowledge the uniqueness of the clinical interview

• Recognize the emotional difficulty and unfamiliarity of the situation.

• Show empathy and appreciation for the client’s participation.

• Invite questions to increase client comfort and sense of control.

Match the client’s language

• Mirror the client's style (e.g., use visual or tactile metaphors).

• Extend their metaphors to show understanding and build connection.

Technique

Refers to what the interviewer does (e.g., questioning style, actions).

Directive Style

• Interviewer asks specific, targeted questions.

• Gathers concrete data (e.g., symptoms, duration, frequency).

• Risk: may reduce client’s ability to express themselves.
  

Nondirective Style

• Client leads the conversation.

• Encourages open expression and rapport.

• Risk: may miss essential diagnostic information.

Balanced Approach:

• Start nondirective to let clients share freely.

• Shift to directive later to fill in diagnostic gaps.

Open-ended questions

• Encourage detailed, individualized responses.

  • Example: “What more can you tell me about the eating problems you mentioned on the phone?”

• Used in nondirective interviews.
  

Closed-ended questions

• Yield brief, specific answers.

  • Example: “How many times per week do you binge and purge?”

• Used in directive interviews.

Clarification

• Ensures the interviewer correctly understands the client’s comments.

• Communicates active listening.

• Example: “You mentioned that you started exercising excessively—do I have that right?”

Important note: Avoid interrupting during emotional disclosures; better to clarify later if the detail is non-urgent.

Confrontation

• Used when inconsistencies or contradictions arise in the client’s statements.

Example: “Earlier, you said you were happy with your body as a teen, but you also said you felt fat in high school.”

Paraphrasing

• Restates what the client has said to confirm understanding.

• Reinforces that the interviewer is listening.

• Example: Client says, “I only binge when I’m alone.” → Interviewer: “You only binge when no one else is around.”

Reflection of Feeling

• Echoes the client’s emotional state, sometimes inferred from tone or behavior.

• Helps clients feel emotionally understood.

• Example: “You don’t want anyone to see you bingeing—do you feel embarrassed about it?”

Summarizing

• Brings together key points, recurring themes, or progress made during the interview.

• More integrative than paraphrasing.

• Example: “It seems like you’re acknowledging your bingeing has become a problem, but you’re ready to work on it.”

Conclusions

• Final step in an interview; may include:

  • A summarization.

  • An initial conceptualization of the problem.

  • A diagnosis.

  • Recommendations (e.g., treatment, further evaluation).

Pragmatics of the Interview

• Interviewers make key decisions before the client arrives, including:

  • The setting of the interview

  • Professional behaviors to use during the session

Note Taking

• Definition: The practice of documenting therapy sessions.

• Varied Practices:

  • Some therapists take detailed notes during sessions (typed or handwritten).

  • Others take no notes during the session and write them afterward.

• Purpose: To track progress, ensure accuracy, and support clinical/legal documentation.

• Taking extensive notes (typed or handwritten) during the session

• Taking no notes during the session but documenting afterward

Q: What are two common note-taking practices among clinicians during sessions?

A: Notes are more reliable than memory.

Q: What is one advantage of note-taking during sessions?

A: Clients may expect notes and feel more heard when notes are taken.

Q: How can note-taking affect how clients feel?

A: It can distract the interviewer from observing client behavior.

Q: What is one disadvantage of taking notes during a clinical session?

A: It may make clients uncomfortable or reduce emotional connection.

Q: How might note-taking interfere with rapport?

A: Taking minimal notes to stay focused while maintaining rapport.

Q: What is a balanced approach to note-taking during interviews?

A: It can increase client comfort by explaining the purpose (e.g., to aid memory).

Q: How can providing a rationale for note-taking help?

A: It found no significant difference in rapport across those methods.

Q: What did one study find about rapport and different note-taking methods (paper, iPad, computer)?

A: It found lower rapport compared to no note-taking.

Q: What did another study find about rapport when using computers for note-taking?

• Client perceptions

• Interviewer’s style and communication

Q: What two factors likely influence how note-taking affects rapport?

A: They provide a full and accurate record of the interview.

Q: What is one major benefit of using audio or video recordings in clinical interviews?

A: Written client consent.

Q: What is required before recording a clinical interview?

A: It can reduce client openness and willingness to disclose personal information.

Q: What is a possible drawback of recording sessions?

A: Explain the reason for recording to the client.

Q: What is one best practice when using recordings in clinical settings?

A: How the recording will be used and when it will be destroyed.

Q: What should clinicians clarify about the use of recordings?

A: A mix of professional formality and casual comfort to promote warmth and ease.

Q: What is the ideal balance in interview room design?

A: Professionalism, while also making the client feel comfortable and at ease.

Q: What should the interview room signal to the client?

A:

• Traditional (client on couch, clinician behind)

• Face-to-face seating

• Angled seating (90° to 180°)

• With or without a desk/table between chairs

Q: What are some common seating arrangements in clinical interviews?

A: To support comfort and natural conversation.

Q: What is the goal of furniture choice in an interview room?

A:

1. Support for information gathering

2. Facilitation of rapport building

3. Privacy and freedom from interruption

Q: What key features should an interview room provide?

A:

• Orderliness (not messy)

• Soft elements (comfortable seating, rugs, art, plants, muted lighting)

• Spacious and uncluttered design

Q: According to Devlin & Nasar (2012), what features made interview rooms more preferred?

A: They were rated negatively by participants.

Q: How were "hard," institutional, and cramped offices perceived in Devlin & Nasar’s study?

A: They may undermine professionalism or evoke emotional responses that interfere with the interview.

Q: Why should clinicians avoid overly personal items in interview room decor?

A: Family photos, travel souvenirs, or emotionally charged decorations.

Q: Give examples of personal items that may be problematic in a clinical office.

A: Some believe sessions are always fully confidential without exceptions.

Q: What is one common misunderstanding clients have about confidentiality?

A: They may think their records will be shared with family or employers.

Q: What is another misconception clients may have about their records?

A:

1. When there are threats of serious harm to self or others

2. In cases of ongoing child abuse (subject to state laws)

Q: In what situations are psychologists required to break confidentiality?

A: Early in the process, before or at the beginning of services.

Q: When should psychologists explain confidentiality policies to clients?

A: Through both written and oral explanations.

Q: How should psychologists communicate confidentiality policies?

A: Both the protections it offers and its legal/ethical limitations.

Q: What should clients understand about confidentiality?

A: It is part of competent and ethical clinical practice.

Q: According to the APA (2002), why is discussing confidentiality important?

Intake Interviews

• Definition: Initial assessment to determine treatment need and facility fit

• Purpose:

  • Decide if treatment is needed

  • Identify appropriate level of care (e.g., inpatient, outpatient)

• Includes:

  • Questions about the presenting problem

  • Observation of behavior and psychiatric history

• Outcome: Treatment recommendations or referrals

• Example: Dr. Epps interviews Julia, who hears voices, assesses symptoms, observes behavior, and gives referral based on needs

Diagnostic Interviews

• Primary goal: assign accurate DSM diagnoses.

• Can follow two styles:

  • Structured Interviews: Follow a planned sequence of questions.

  • Unstructured Interviews: Improvised, flexible questioning.

Structured Interviews

• Definition: Interview with fixed DSM-based questions

• Purpose: Reduces bias, ensures consistency across clients

• Pros: Standardized, easy to follow, widely used (e.g., SCID)

• Cons: Can feel formal, may miss non-DSM info, time-consuming

• Example:

  • SCID-5: Modular, matches DSM diagnoses

  • Use anxiety section for phobias; skip irrelevant parts

  • SCID-PD: For assessing personality disorders

Unstructured Interviews

• No set questions; interviewer adapts in real-time.

• Allows exploration of unexpected or nuanced client issues.

• More dependent on clinical judgment and inference.

Semistructured or Partially Structured Interviews

• Blend of structured and unstructured approaches.

• May begin with open-ended discussion, followed by targeted diagnostic questions.

• Example: SCID includes an overview section for open-ended client input.

Mental Status Exam (MSE)

Define:

• A short, informal assessment of a person’s current mental and cognitive state

• Often used in medical or hospital settings

• Focuses on the present moment, not personal history or diagnosis

Explain:

• Gives a quick "snapshot" of how the client is thinking, feeling, and behaving

• Not fully standardized—clinicians may ask different questions

• Often done by psychiatrists, psychologists, and other health professionals

• Doesn't need special tools or manuals

• Useful for checking things like mood, memory, and awareness

Example:
Common areas assessed:

• Appearance – Is the person dressed and groomed appropriately?

• Behavior/Movement – Are they calm, restless, or slowed down?

• Attitude – Are they cooperative, defensive, or withdrawn?

• Affect & Mood – How do they feel emotionally?

• Speech & Thought – Are they speaking clearly and thinking logically?

• Perception – Are they seeing or hearing things that aren’t there?

• Orientation – Do they know who they are, where they are, and what day it is?

• Memory & Intelligence – Can they remember basic facts and think clearly?

• Judgment & Insight – Do they understand their situation and choices?

Sample questions:

• "What schools did you attend?"

• "Who’s older—you or your younger brother?"

• "Count backward from 100 by 7s"

• "Repeat these numbers after me..."

• "What’s the direction from City A to City B?"

• Appearance

• Behavior/Movement

• Attitude

• Affect & Mood

• Speech & Thought

• Perception

• Orientation

• Memory & Intelligence

• Judgment & Insight

Mental Status Exam (MSE) Common areas assessed:

Crisis Interviews

Define:

• A special kind of interview used during emergencies, like when someone feels suicidal or is at risk of harming themselves or others

• Focuses on both assessing the danger and helping right away

Example:

• A counselor on a suicide hotline talks to someone in distress

• They listen carefully, offer emotional support, and help the person think of reasons to stay safe

• Instead of just getting a promise not to die, they help the person make a plan to get professional help and stay connected to support

A: They can happen over the phone (like suicide hotlines) or in person.

Q: Where do crisis interviews usually happen?

A: They must act quickly and show care and concern.

Q: What must the interviewer do during a crisis interview?

A:

• Build trust quickly

• Show empathy

• Offer safe alternatives to suicide

Q: What are the main goals of a crisis interview?

A: It's an agreement where the client promises not to harm themselves. However, it's not always effective and can feel more like it's for legal protection.

Q: What is a "no-suicide contract"?

A: A "commitment to treatment" agreement, which focuses on helping the client recover and stay engaged in ongoing support.

Q: What is a better alternative to a "no-suicide contract"?

1. Level of depression

2. Presence of suicidal thoughts

3. Existence of a suicide plan

4. Client’s current self-control

5. Suicidal intent

Five Critical Areas to Assess in Suicidal Clients:

A: Level of depression

Q: What should you assess if the client has long-term, hopeless feelings?

A: Presence of suicidal thoughts

• Q: What should you explore in terms of how often and how strong suicidal thoughts are?

A: Existence of a suicide plan

Q: What do you call it when you examine how detailed, deadly, and possible a suicide method is?

A: Client’s current self-control

Q: What are you checking when you ask how the person handled past crises and if they could resist self-harm?

A: Suicidal intent

Q: What do you assess when you look for warning signs like giving away belongings or saying goodbye?

A: Their own and the client’s culture

Q: What must interviewers understand to interpret client behavior accurately?

A: Overpathologizing

Q: What mistake occurs when you wrongly label culturally normal behavior as abnormal?

A: Clients' cultural perspectives

Q: What should clinical psychologists appreciate to understand their clients better?

A: Modifying interview style (e.g., more small talk)

Q: What adjustment may help build rapport in a culturally sensitive interview?