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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 For the Client
 Determine the nature of the  Determine appropriateness of
client’s problems services
 Determine the appropriateness  Find out about psychologist’s
of services offered fees, procedures and policies
 Define problems to be worked
on and establish goals
 Balance gathering information
with establishing rapport
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 Lay Persons
 Schedule for Affective  Diagnostic Interview
Disorders and Schedule (DIS)
Schizophrenia (SADS)
(semi-structured)
 Structured Clinical
Interview for DSM-IV
(SCID)
Mental Status Exam
General appearance and Insight and judgment
behavior Higher cognitive functioning
Speech and thought
Intelligence
Consciousness
Insight and judgment
Perception
Higher cognitive functioning
Obsession and Compulsions
Orientation Speech
Memory Orientation
Attention and concentration Mood and Affect
General information Form of Though
Intelligence
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 Closed Questions
What did you think of the Did you like the movie?
movie?

How would you describe


your relationship with Do you have a good
your parents? relationship with your
parents?
Questions
Open Questions Closed Questions
 Elicit information  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 Example
Questioning that Are you saying that….
 helps the clinician
Could you describe for
understand an
me…
ambiguous message
 Confirms the accuracy of Say what you mean
the clinician’s perception 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 What are the feelings
having about being in that go along with
class today? 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)