Chapter 8 The Clinical Interview

Assessment is closely linked with the identity of clinical psychologists – No other mental health profession incorporates assessment into their work as clinical psychologists do Clinical interviews are the most frequent assessment tool – More than any specific test – Vast majority of practicing clinical psychologists use interviews

Essential Qualities of Assessment Techniques All assessment techniques (including interviews) should have adequate: – Validity—measures what it claims to measure – Reliability—yields consistent, repeatable results – Clinical utility—benefits the clinician and ultimately the client

Validity, Reliability, and Clinical Utility

Feedback Common to all kinds of psychological assessment Provide results of tests or interviews May be face-to-face, a report, etc.

The Interviewer General skills – Quieting yourself Minimize excessive internal, self-directed thoughts that detract from listening – Being self-aware Know how you tend to affect others interpersonally, and how others tend to relate to you – Develop positive working relationships Can segue into psychotherapy Respectful and caring attitude is key

The Interviewer (cont.) Specific behaviors – Listening—the primary task of the interviewer, consisting of numerous building blocks Eye contact Body language Vocal qualities Verbal tracking Referring to client by proper name

Components of the Interview Rapport – Positive, comfortable relationship between interviewer and client – How an interviewer is with clients Technique – What an interviewer does with clients – Directive vs. nondirective styles

Specific Interviewer Responses Open-ended and closed-ended questions – Open-ended questions Allow individualized and spontaneous responses from clients Elicit long answers that may or may not provide necessary info – Closed-ended questions Allow less elaboration and self-expression by the client Yield quick and precise answers

Specific Interviewer Responses (cont.) Clarification – Question to make sure the interviewer accurately understands the client’s comments Confrontation – For discrepancies or inconsistencies in a client’s comments Paraphrasing – Restatement of client’s comments to show they have been heard

Specific Interviewer Responses (cont.) Reflection of feeling – Echo client’s emotions, even if not explicitly mentioned Summarizing – Tie together various topics, connect statements that may have been made at different points, and identify themes

Pragmatics of the Interview Note-taking – Little consensus about note-taking – Provide a reliable written record, but can be distracting to client and interviewer Audio- and Video-recording – Also provide a reliable record, but can be inhibiting to clients – Must obtain permission

Pragmatics of the Interview (cont.) The Interview Room – Professional yet comfortable Confidentiality – Explain confidentiality and its limits to clients (e.g., child abuse, intention to harm)

Types of Interviews Intake interviews – To determine whether to “intake” the client into the agency or refer elsewhere

Types of Interviews (cont.) Diagnostic interviews – To provide DSM diagnosis – Structured interviews often used Minimize subjectivity, enhance reliability SCID is an example – Currently being revised for DSM-5 Semi-structured interviews include some structure but also some flexibility or opportunities to improvise

Types of Interviews (cont.) Mental status exam – Typically used in medical settings – To quickly assess how a client is functioning at that time Crisis interviews – Assess problem and provide immediate intervention – Clients are often considering suicide or other harmful act

Cultural Components Appreciating the cultural context – Knowledge of the client’s culture, as well as the interviewer’s own culture – For behavior described or exhibited during interview Acknowledging cultural differences – Wise to discuss cultural differences rather than ignore – Sensitive inquiry about a client’s cultural experiences can be helpful