Chapter 6 Assessment: Interviewing and Observation INTRODUCTION TO CLINICAL PSYCHOLOGY 2E HUNSLEY & LEE PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UWO

 Interviewing and Ethics  Type of Interviews  General Issues in Interviewing  Observations  Observations: Self-Monitoring Topics

 Confidentiality: A cornerstone of psychotherapy – all information must remain private between the therapist and client  Limits on confidentiality:  Danger to self  Danger to others  Harm to children/elders  Judge superseding confidentiality (privilege)  All Canadian provinces have mandatory child protection laws Interviewing and Ethics

 Unstructured interviews: Clinician interviews the client based on a loose set of goals and questions  Open questions: allow and encourage client to answer in elaborate manner  Closed questions: Yes or no questions  Semi-structured interviews: Specific questions set by clinician (or treatment clinic) that allow some flexibility in how and what the clinician asks Type of Interviews

 Structured diagnostic interviews: Very specific format for asking questions and for determining follow up questions  Structured Clinical Interview for Axis I Disorders (SCID): Designed to cover DSM disorders  SCID-I: More comprehensive – covers all DSM disorders  SCID-CV: Only most common disorders Type of Interviews

 Structured diagnostic interviews (cont.):  Anxiety Disorders Interview Schedule (ADIS-IV): Designed to cover in more depth DSM anxiety disorders and common co-morbid disorders  Primary Care Evaluation of Mental Disorders (PRIME- MD): Brief measure used in primary care to screen for mental disorders (brevity makes it less reliable)  Dominic Interactive – developed by Canadian researchers for children aged 6 – 11 years Type of Interviews

 Attending skills: Important components of active listening  Attention to body language: eye contact, leaning forward, head nods, etc.  Absence of verbal activity  Restating what the client said and checking if that was correct  Rephrasing/clarifying  Non-direction reflection of feeling  Summarizing General Issues in Interviewing

 Focus is on the client: Clinician does not self-disclose or convey things that they are struggling with  Respectful and non-judgemental  Non-blaming stance  Cultural sensitivity  Canada is an increasingly multicultural society  Knowledge of self and own culture  Knowledge of others and differences  ‘Cultural humility’ – openness to differences (without pathologizing) General Issues in Interviewing

 Importance of defining the problem: Clients are often vague about presenting problems  Clinician must know what is normative behaviour  Questions about the frequency, duration, and intensity of the problem  Questions about the meaning of the problem  e.g., Tell me what you mean by “depressed” General Issues in Interviewing

 Importance of defining the goals for treatment: Clients often do not know what therapy can do  Goals must be important to the client  Goals must be expressed in terms of the ways people behave  Goals must be small, simple, and achievable  Goals must be in positive terms (e.g., “how would you know if therapy worked?”) General Issues in Interviewing

 Suicide assessment: Importance of asking direct questions. For example:  Specific thoughts about suicide  Past attempts  Plans for committing suicide (obtaining means)  Ever cut yourself intentionally?  What are the reasons for committing suicide  Friendship or support system in place? General Issues in Interviewing

 Interviewing couples: Importance of flexibility and interpersonal skills of the clinician to deal with two individuals; also importance of structuring and directing the interview  Interviewing families: Similar challenges as with couples – but with the difficulty of establishing rapport with many individuals at once General Issues in Interviewing

 Interviewing older adults: Knowledge of life span issues without stereotyping (possible concerns with declining health, loss of autonomy, bereavement, mortality)  Interviewing children and adolescents: Using age appropriate behaviour and language; not leading the child to an answer or response; less eye contact is often helpful; knowledge of current media/toys/games General Issues in Interviewing

 Attention to many facets of the client during the interview: (e.g., client activity level, attention span, impulsivity, tone of voice, self-reflectiveness, etc. )  Direct observations: observing the client in different environments if possible (e.g., child with ADHD at school) Observations

 Self-monitoring: Strategy for clients to write down/log information throughout the day on a particular behaviour (e.g., smoking, food intake, headache, interpersonal interaction)  Helps decrease memory errors  Provides additional information about context  Reactivity: How self-monitoring can effect the behaviour being evaluated Observations: Self-Monitoring

 Ecological Momentary Assessment: (a.k.a. experience sampling) gathering data about emotions, thoughts, behaviours or experiences through the use of a PDA, pager, or other device that prompts the user randomly throughout the day  Used in both research as well as assessment and treatment Observations: Self-Monitoring

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