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Interviews and Clinician Ratings

  • Importance of Client Interviewing

    • Therapists often engage clients in conversation about their behaviors and thoughts.
    • Questions focus on:
    • Client's feelings about symptoms.
    • Client's future aspirations (weeks or months ahead).
    • Interviews can be:
    • Unstructured: Conversation flows naturally.
    • Structured: Follows a specific set of questions aimed at diagnostic criteria.

  • Structured Interviews

    • Typically utilized for assessing depressive and bipolar disorders.

    • Key structured interviews include:

    • Schedule for Affective Disorders and Schizophrenia (SADS)

      • Utilized primarily for adults.
      • Reference: First, Williams, Karg, & Spitzer (2015).

    • Structured Clinical Interview (SCID)

    • Schedule for Affective Disorders and Schizophrenia for School-Age Children

      • Used specifically for children.
      • Reference: Bergman, Maayan, Kirkham, Adams, & Soares-Weiser (2015).

    • Severity Assessment Tools

    • Brief Psychiatric Rating Scale.

    • Hamilton Rating Scale for Depression.

      • Reference: Biancosino, Picardi, Marmai, Biondi, & Grassi (2010); Bech, Paykel, Sireling, & Yiend (2015); Sajatovic & Ramirez (2012).

    • Hamilton Rating Scale for Depression (Excerpt from Table 7.11)

    • Instructions: Select the number that corresponds to the statement describing the patient.

    • Categories and Descriptors:

      1. Depressed Mood
      • 0: Absent
      • 1: Indicated only on questioning
      • 2: Reported verbally
      • 3: Communicated non-verbally (facial expressions, posture, etc.)
      • 4: Primarily expresses these feelings spontaneously.
      1. Feelings of Guilt
      • 0: Absent
      • 1: Self-reproach, feels he has let people down
      • 2: Ideas of guilt or ruminations
      • 3: Views illness as punishment; delusions of guilt
      • 4: Hears accusatory voices or sees threatening hallucinations.
      1. Suicidal Ideation
      • 0: Absent
      • 1: Feels life isn't worth living
      • 2: Wishes for death or has thoughts of death
      • 3: Suicidal thoughts or gestures
      • 4: Attempts at suicide (serious attempt rates 4).
      1. Insomnia
      • Measurements for early, middle, and late insomnia vary accordingly from absent to serious difficulties with falling asleep.
      • Reference: Hamilton M. (1967)
      • Sampling and Development of constructs and interpretations within the context of mood syndromes.

Katey's Clinical Assessment

  • Katey’s therapist implements the Hamilton Rating Scale for Depression, noting key concerns:

    • Depressed mood and persistent feelings of sadness.
    • Sleep difficulties (restlessness and constant thoughts hindering sleep).
    • Anxieties regarding her ability to work and experiences of agitation.
    • Significant observations:
    • Katey expressed bleakness in her statements.
    • Although struggling, she did not express a strong desire for death but did contemplate life's worthiness.

  • Excerpt from Katey's Interview

    • Dialogue Observations:
    • Katey: "Yeah, I just find it so hard to get up in the morning sometimes."
    • Therapist: "What do you think about in the morning?"
    • Katey: "How hard the day will be…it just seems so overwhelming at times."
    • Therapist: "Do you think about ways you can cope with events during the day?"
    • Katey: "I don't really see the point. What difference does it make?"

  • Topics Common in Unstructured Interviews

    • Assessments typically include discussions on:
    • Past and present mood symptoms.
    • Possible risk factors (e.g., interpersonal or cognitive factors).
    • Medical and treatment history of the client.
    • Ongoing problems and any comorbid diagnoses (e.g., other psychological disorders).
    • Motivation for change and engagement in treatment.
    • Evaluation of social support systems.
    • Inquiry into suicidal thoughts and actions.

  • Therapeutic Considerations

    • Therapists must recognize that clients may communicate differently based on their emotional state:
    • Clients may express information in a biased manner, reflecting symptoms such as depression or mania.
    • Building rapport is essential for effective communication and intervention.
    • Nonverbal Cues to Assess:
      • Reduced facial expressions and poor eye contact.
      • Slow movements and muted affect.
      • Low energy levels and minimal positive affect (smiles/laughter).
      • Reference: Annen, Roser, & Brune (2012).

Self-Report Questionnaires

  • Purpose of Self-Report Questionnaires

    • Used to capture severe changes in emotions and thoughts experienced by clients.
    • Clients rate symptoms and provide insights into their feelings and behaviors.

  • Prominent Self-Report Measures

    • Beck Depression Inventory-II:
    • Evaluates:
      • Negative attitudes about oneself.
      • Level of functional impairment.
      • Physical symptoms related to depression.
    • A child-friendly version is available, including selected items outlined in Table 7.12.
    • Beck Hopelessness Scale:
    • Measures pessimistic outlook concerning the future.
    • Strong correlation with suicidal behavior.
      • Reference: Spokas, Wenzel, Brown, & Beck (2012).
    • Automatic Thoughts Questionnaire-Revised:
    • Assesses negative thought patterns prevalent in those experiencing depression.

  • Sample Items from the Children's Depression Inventory

    • Example Statements:
    • Responses about feelings:
      • "I am sad once in a while."
      • "I am sad many times."
      • "I am sad all the time."
    • Responses regarding suicidal thoughts:
      • "I do not think about killing myself."
      • "I think about killing myself, but I would not do it."
      • "I want to kill myself."
    • Responses about love and support:
      • "Nobody really loves me."
      • "I am not sure if anybody loves me."
      • "I am sure that somebody loves me."
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