Chapter 8

Page 2:

• Assessment is closely associated with the identity of clinical psychology

  • Clinical psychologists incorporate assessment into their training and work more than other mental health professionals

  • Assessment techniques should possess validity, reliability, and clinical utility

• Validity measures if a technique measures what it claims to measure

• Reliability measures if a technique yields consistent, repeatable results

• Clinical utility measures if a technique is helpful to the clinician and the client

Page 3:

• Feedback is a common element in psychological assessment

• Clinical psychologists use a variety of assessment methods, but rely most frequently on the clinical interview

• The person conducting the interview is the most pivotal element

• General skills are important for interviewers, including quieting oneself, being self-aware, and developing positive working relationships

Page 4:

• Validity is the extent to which an assessment technique measures what it claims to measure

• Reliability is the extent to which an assessment technique yields consistent, repeatable results

• Clinical utility is the extent to which an assessment technique improves delivery of services or client outcome

• Interviewers should quiet themselves to focus on listening to clients

• Interviewers should be self-aware of how they affect others and how others relate to them

Page 5:

• Skilled interviewers are cognizant of their unique traits and consider their effect on the interview process

• Good interviewers develop positive working relationships with clients through attentive listening, empathy, respect, and cultural sensitivity

Page 6:

Specific Behaviors of Effective Interviewers

• Listening is a primary task of the interviewer

  • Listening can be broken down into attending behaviors

• Eye contact is important for attentive listening and communication

  • Culture plays a role in the meaning of eye contact

• Body language should be attentive and culturally appropriate

• Vocal qualities of language are important for conveying appreciation

• Verbal tracking involves repeating key words and phrases back to the client

• Referring to the client by the proper name is essential

  • Misusing names can jeopardize the sense of comfort with the interviewer

• Observing client behaviors provides important information to the interviewer

Page 7:

Importance of Cultural Variables in Listening

• Cultural differences affect eye contact, physical touch, and personal space

• Culturally competent interviewers need to be aware of these differences

Components of the Interview

• Rapport refers to a positive relationship between interviewer and client

• Good rapport leads to more disclosure and investment from the client

• Efforts to enhance rapport include putting the client at ease, acknowledging the unique situation of the interview, and following the client's lead in language

Page 9:

• Matching client's language and metaphors can help establish rapport

  • Use visual terminology for clients who use visual imagery

  • Use tactile words for clients who use tactile metaphors

• Communication differences across cultures

  • Different communication behaviors among different ethnicities

    • Speaking volume: Asian Americans and Hispanic Americans speak more softly than whites

    • Speaking speed: Whites speak more quickly than some other cultural groups

    • Eye contact: African Americans maintain more direct eye contact when speaking, while whites do the opposite

    • Gaze: Native Americans display an indirect gaze, while Asian Americans avoid eye contact with higher-status individuals

    • Response time: African Americans and whites respond quickly, while Native Americans, Asian Americans, and Hispanic Americans may have a mild delay

  • Differences in speaking style between men and women

    • Men use talk to assert themselves and promote their ideas, while women use talk to build rapport and sustain relationships

    • Women value self-disclosure for closeness, while men believe it increases vulnerability

Page 10:

• Directive versus nondirective styles of interviewing

  • Directive style: asking specific questions to get targeted information

  • Nondirective style: allowing the client to determine the course of the interview

• Both styles have their advantages and disadvantages

  • Directive style can provide crucial data that clients may not otherwise discuss

  • Nondirective style can provide information that interviewers may not know to inquire about

• Balance and versatility are important in interviewing technique

  • Allow clients to speak freely at the beginning of the interview

  • Become more directive later in the session to gather specific information

Page 11:

• Specific interviewer responses

  • Open- and closed-ended questions

    • Open-ended questions allow for individualized and spontaneous responses

    • Closed-ended questions yield quick and precise answers

  • Clarification questions

    • Purpose is to ensure accurate understanding of client's comments

    • Enhance interviewer's ability to "get it" and show active listening

  • Other categories of interviewer responses include confrontation, paraphrasing, reflection of feeling, and summarizing

Page 12: Metaphorically Speaking If You’ve Taken Multiple-Choice, True/False, and Essay Exams, You Understand Open- and Closed-Ended Interview Questions

• Difference between multiple-choice/true-false (MC/TF) exams and essay exams

  • MC/TF questions target specific information with restricted responses

  • Essay exams allow for more unrestricted responses and choice in what is important

• Closed-ended interview questions are similar to MC/TF questions

  • More targeted and elicit brief, pointed responses

• Open-ended interview questions are similar to essay exam questions

  • Less focused and allow for more free-form responses

• Advantages and disadvantages of MC/TF and essay exams from the teacher's perspective

• Advantages and disadvantages of open-ended and closed-ended interview questions from the interviewer's perspective

• Possibility of combining the two types of questions

Page 13: An important note about clarification

• Sometimes it's better to wait than to immediately demand clarification

• Novice interviewers may interrupt the client at inopportune moments, particularly during emotionally laden events

• Example of Dr. Palmer interviewing Austin and interrupting him during a description of a car accident

• Risk of coming across as insensitive to the client's emotional experience

• Importance of waiting to clarify later when the client is less emotional

Page 13: Confrontation

• Confrontation used when there are discrepancies or inconsistencies in a client's comments

• Similar to clarifications, but focus on contradictory information

• Example of interviewer confronting Brianna about contradictory statements about body image

Page 13: Paraphrasing

• Used to assure clients that they are being accurately heard

• Restating the content of clients' comments using similar language

• Example of paraphrasing Brianna's statement about bingeing when alone

Page 14: Reflection of Feeling

• Used to acknowledge and echo the client's emotions

• Makes clients feel that their emotions are recognized

• Example of reflecting Brianna's feelings of embarrassment about bingeing

Page 14: Summarizing

• Used to tie together various topics and identify recurring themes

• Provides a comprehensive understanding of the client's comments

• Example of summarizing Brianna's acknowledgement of her bingeing and purging problems

Page 14: Conclusions

• Conclusions made by the interviewer at the end of the interview

• Can take different forms depending on the type of interview and client's problem

• May involve summarization, initial conceptualization, specific diagnosis, or recommendations

Page 14: Pragmatics of the Interview

• Decisions made by the interviewer before the client arrives for the interview

• Involves the setting and professional behaviors during the interview

Note Taking

• Little consensus among clinical psychologists about note taking during interviews

• Some psychologists write profusely during interviews, while others take no notes at all

• Reasons for taking notes:

  • Written notes are more reliable than memory

  • Clients may expect the interviewer to take notes and may feel their words will be forgotten if notes are not taken

• Drawbacks of taking notes:

  • Can be a distraction for both the interviewer and the client

  • Some clients may feel that the interviewer's notebook is an obstacle to rapport

• Middle ground approach: jotting down essential highlights without disrupting the conversation or attention towards the client

• Wise to explain note-taking behavior to clients, enhancing rapport

• Empirical studies on note taking have mixed results

• Quality of the relationship between interviewer and interviewee may depend on the note-taking condition

Audio and Video Recordings

• Alternative to written notes

• Requires written permission from the client

• Provides a full record of the session

• Can hinder openness and willingness to disclose information

• Explanation of rationale and intended use of the recording is appreciated by the client

In My Practice

• Initially prioritized comprehensive note taking, but it proved costly in terms of rapport

• Clients questioned if the interviewer was even listening

• Intently listening without taking notes also prompted questions from clients

• Middle ground approach of occasional note-taking while maintaining eye contact with the client

• Disadvantages of the middle ground approach: clients become aware of when the interviewer chooses to write

• Explaining the decisions about note taking to clients is beneficial and shifts the focus to the interview content

The Interview Room

• Tremendous variability in the rooms where clinical psychologists conduct interviews

• Size, furnishings, and decor may differ

• Balance between professional formality and casual comfort is ideal

• Room should convey the message that the clinical interview is a professional activity with warmth and comfort as high priorities

Page 17:

Reasons for and against note taking during clinical interviews

• Seating arrangements in interview rooms can vary, such as psychoanalytic arrangement, face-to-face, chairs at an angle, etc.

• The design and decor of the interview room can influence the client's impression and comfort.

• Orderly and "soft" offices are preferred over messy and "hard" offices.

• Spacious and uncluttered offices are rated more positively.

• Personal items in the office can influence the content of the interview and should be avoided.

• Confidentiality is important in clinical interviews, and clients may have misconceptions about it.

• Psychologists should explain confidentiality policies to clients and correct any misconceptions.

Page 18:

Types of interviews

• Clinical interviews can take different forms depending on the situation.

• Intake interviews are used to determine if the client needs treatment and what form of treatment is needed.

• Diagnostic interviews are used to assign DSM diagnoses to the client's problems.

• The questions in a diagnostic interview can directly reflect the diagnostic criteria or be more flexible.

• Structured interviews have a predetermined sequence of questions and are usually diagnostic.

• Unstructured interviews involve improvised questions based on the interviewer's judgment.

• Structured interviews have advantages in producing reliable diagnoses based on DSM criteria.

Note: The transcript continues beyond page 18, but it exceeds the 2000 token limit.

Page 20:

• Structured interviews are more empirically sound than unstructured interviews

  • Standardized and uncomplicated in terms of administration

• Disadvantages of structured interviews

  • Rigid format inhibits rapport and client's opportunity to elaborate

  • Don't allow inquiries into important topics not directly related to DSM criteria

  • Require a comprehensive list of questions, lengthening the interview

• Structured interviews have become more accepted and preferred in recent years

• Prominent structured interview: Structured Clinical Interview for DSM-5 Disorders (SCID)

  • Comprehensive list of questions directly asking about specific symptoms of disorders

  • Modular design allows interviewers to choose relevant modules for a particular case

  • Separate version for assessing personality disorders (SCID-PD)

• Some psychologists use structured interviews regularly, while others use unstructured interviews regularly

• Partially structured or semistructured interviews blend both approaches

  • Unstructured segments at the beginning to allow clients to describe the problem and relevant history

  • Succession of targeted questions to address specific diagnostic criteria

Page 21:

• Mental Status Exam

  • Used in medical settings to quickly assess client's current level of functioning

  • Does not delve into personal history or determine a DSM diagnosis definitively

  • Yields a brief paragraph capturing psychological and cognitive processes at the time

  • Categories typically covered: appearance, behavior/psychomotor activity, attitude toward interviewer, affect and mood, speech and thought, perceptual disturbances, orientation to person, place, and time, memory and intelligence, reliability, judgment, and insight

  • Lack of standardization leads to variation in questions asked within categories

• Crisis Interviews

  • Special type of clinical interview for urgent problems

  • Designed to assess and provide immediate intervention

  • Can be conducted in person or over the phone

  • Establishing rapport and expressing empathy are key components

  • Suicide prevention contracts may be used, but their effectiveness is questionable

  • Contracts may unintentionally communicate a lack of concern for the client's well-being

Page 22:

• Research on the use of suicide prevention contracts suggests they may have unintended negative effects

• Crisis interviews involve both assessment and immediate intervention

• Unique challenges for the interviewer

• Provide an immediate, legitimate alternative to suicide

• Contracts may communicate a focus on legal liability rather than the client's well-being

Page 23: Assessing Suicidal Risk

• Psychologists have suggested "commitment to treatment" statements as an alternative to promises not to engage in suicidal behaviors.

• When interviewing an actively suicidal person, five specific issues should be assessed:

  • How depressed is the client?

  • Does the client have suicidal thoughts?

  • Does the client have a suicide plan?

  • How much self-control does the client currently appear to have?

  • Does the client have definite suicidal intentions?

Page 23-24: Cultural Components

• All human behaviors take place in a cultural context, so it is important for interviewers to retain this perspective.

• Interviewers should possess knowledge about their own culture as well as their clients' culture to understand the meaning of interview material within the appropriate cultural context.

• Interviewers should not overpathologize behaviors, thoughts, or emotions that may be normal in a different cultural context.

• Interviewers should make adaptations to cultural expectations or norms during the interview.

• Acknowledging cultural differences openly can enhance rapport and increase the client's willingness to share information.

• It is appropriate for the interviewer to inquire directly about cultural background to become more informed about the client's perspective.

• Interviewers should seek other sources of information about specific cultures to increase their cultural awareness.

Page 24: Example of Cultural Consideration

• Example of Paula, a Jewish mother, being interviewed by Dr. McMillan, a Catholic psychologist.

• Dr. McMillan needs to recognize the significance of the bar or bat mitzvah in Jewish culture and to Paula in particular.

• Dr. McMillan should have some idea of the meaning that Jews attach to the bar or bat mitzvah but not assume that Paula's individual views are necessarily prototypical.

Page 25: Summary of the Clinical Interview

• The clinical interview should be reliable, valid, and clinically useful.

• Skillful interviewers establish rapport, attend to subtle aspects of communication, and use specific interviewing techniques.

• Pragmatic issues such as note taking, recording, interview room setup, and confidentiality should be considered.

• Clinical interviews can be categorized as intake interviews, diagnostic interviews, mental status exams, or crisis interviews.

• Structured clinical interviews have strong reliability and validity but may sacrifice rapport, while unstructured clinical interviews are more client-directed but have weaker reliability and validity.

• Semistructured interviews strike a balance between structured and unstructured approaches.

• Cultural issues should be appreciated and acknowledged in all clinical interviews.

Page 26:

Main Ideas:

• Importance of self-awareness in clinical interviews

• Different client-therapist pairings and cultural influences on eye contact and body language

• Direct versus indirect questioning for different clinical problems

• Taking notes during a clinical interview

• Acknowledging cultural differences between the psychologist and the client

Supporting Details:

• Self-awareness is described as an important general skill for interviewers (p. 26)

• Steps for clinical psychologists to become more self-aware are not mentioned in the transcript

• Issues of culture can influence the meaning of eye contact or body language in different ways for different client-therapist pairings (p. 26)

• Examples of client-therapist pairings and cultural influences on eye contact or body language are not provided in the transcript

• Direct questioning may be best suited for specific clinical problems, but the transcript does not specify which ones (p. 26)

• Indirect questioning may be best suited for specific clinical problems, but the transcript does not specify which ones (p. 26)

• The decision to take notes during a clinical interview is not discussed in the transcript (p. 26)

• The reasons for taking or not taking notes during a clinical interview are not provided in the transcript

• Openly acknowledging cultural differences between the psychologist and the interview client may be necessary in certain situations, but the transcript does not specify when (p. 26)

Page 27:

Main Ideas:

• No main ideas are mentioned on this page.

Page 28:

Main Ideas:

• Links to additional resources related to assessment and clinical psychology

Supporting Details:

• Links to the Assessment journal, Journal of Clinical Psychology, Journal of Contemporary Psychotherapy, and Psychological Assessment are provided (p. 28)

• The study site at edge.sagepub/pomerantz5e offers additional learning tools such as self-quizzes, eFlashcards, culture expert interviews, demonstration videos, full-text SAGE journal articles, additional web resources, and mock assessment data (p. 28)

Page 29:

Main Ideas:

• No main ideas are mentioned on this page.

• Key Vocabulary and Phrases for Pages 2-29:

  • Assessment

  • Clinical psychology

  • Mental health professionals

  • Validity

  • Reliability

  • Clinical utility

  • Assessment techniques

  • Clinical interview

  • Feedback

  • Identity

  • Training

  • Work

  • Incorporate

  • Techniques

  • Measures

  • Consistent

  • Repeatable

  • Helpful

  • Clinician

  • Client

  • Attending behaviors

  • Eye contact

  • Body language

  • Vocal qualities

  • Verbal tracking

  • Misusing names

  • Observing client behaviors

  • Cultural variables

  • Rapport

  • Disclosure

  • Investment

  • Visual terminology

  • Tactile words

  • Communication differences

  • Speaking volume

  • Speaking speed

  • Eye contact

  • Gaze

  • Response time

  • Speaking style

  • Directive style

  • Nondirective style

  • Open-ended questions

  • Closed-ended questions

  • Clarification questions

  • Confrontation

  • Paraphrasing

  • Reflection of feeling

  • Summarizing

  • Commitment to treatment statements

  • Mental status exam

  • Crisis interviews

  • Suicide prevention contracts

  • Cultural components

  • Diagnostic interviews

  • Structured interviews

  • Unstructured interviews

  • Semistructured interviews

  • Note taking

  • Audio and video recordings

  • Interview room

  • Seating arrangements

  • Design and decor

  • Confidentiality

  • Intake interviews

  • DSM diagnoses

  • Structured Clinical Interview for DSM-5 Disorders (SCID)

  • Personality disorders

  • Middle ground approach

  • Crisis intervention

  • Suicidal risk assessment

  • Commitment to treatment statements

  • Cultural context

  • Overpathologize

  • Adaptations

  • Cultural background

  • Cultural awareness

  • Jewish culture

  • Catholic psychologist

  • Reliability

  • Validity

  • Pragmatic issues

  • Self-awareness

  • Direct questioning

  • Indirect questioning

  • Supporting details

  • Additional resources