Clinical AssessmentInterviewing

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 Determine the nature of the

client’s problems Determine the appropriateness

of services offered Define problems to be worked

on and establish goals Balance gathering information

with establishing rapport

For the Client Determine appropriateness of

services Find out about psychologist’s

fees, procedures and policies

Case History or Psychosocial HistoryDetailed 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 Schedule for Affective

Disorders and Schizophrenia (SADS) (semi-structured)

Structured Clinical Interview for DSM-IV (SCID)

Lay Persons Diagnostic Interview

Schedule (DIS)

Mental Status Exam

General appearance and behavior

Speech and thoughtConsciousnessPerceptionObsession and CompulsionsOrientationMemoryAttention and concentrationGeneral informationIntelligence

Insight and judgmentHigher cognitive functioningIntelligenceInsight and judgmentHigher cognitive functioningSpeechOrientationMood and AffectForm of Though

Crisis Interview

Goal: Resolve the problem to avoid catastrophic outcomeTasks: Provide reassurance Assess the problem Explore potential resourcesMethod: 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

What did you think of the movie?

How would you describe your relationship with your parents?

Closed Questions

Did you like the movie?

Do you have a good relationship with your parents?

Questions

Open Questions Elicit information

Closed Questions Gather specific

information

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?

Combining Open and Closed Questions

Listening Skills

Four Types of Responses that Convey Listening

Clarification Paraphrase Reflection Summarization

Clarification

Definition

Questioning that helps the clinician

understand an ambiguous message

Confirms the accuracy of the clinician’s perception

Example

Are you saying that….

Could you describe for me…

Say what you mean 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 having about being in class today?

What are the feelings that go along with 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

ExampleClient: 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

DefinitionDescribing 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)