Assessment in Clinical

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Mr. Abdul RAFFAY Saleem

Lecturer, Psychology Department
(LGU)
 Class Discussion

• Q. Why do we conduct Clinical Interview ?

 Clinical Interview
Imagine that you are a psychologist
and a client comes to see you.
• Just looking at her, you can't tell
what's wrong with her or why she has
come to your office.

• For the purpose of knowing what’s

wrong with the client we conduct
clinical interviews.
WHAT IS CLINICAL INTERVIEW?

• A clinical interview is a conversation between a

psychologist and client that is intended to help the
psychologist diagnose and treat the patient.

• It is a tool that helps psychologists and researchers to

make an accurate diagnosis of a variety of mental
illnesses, such as obsessive-compulsive disorder (OCD),
Depression or Anxiety etc.
The focus of an interview depends on the
interviewer’s theoretical orientation.
Interviews can be either unstructured or
structured:
In unstructured interviews, clinicians ask
open- ended questions.
In structured interviews, clinicians ask
prepared questions, often from a published
interview schedule.
• Its wide range of applications and
adoptability make it a major instrument
Semi Structured Interview

• A semi-structured interview is a meeting where the

interviewer asks open-ended questions, instead of
following a strict and formalized list of questions.
 IMPORTANT THINGS TO KNOW
ABOUT CLINICAL INTERVIEWS
1. It is not a cross-examination but rather a process during which the
interviewer must be aware of the client’s voice intonation (rise and fall
of voice), rate of speech (words spoken per minute), as well as non-
verbal messages such as facial expression, posture, and gestures.

2. Although it is sometimes used as the sole method of assessment, it is

more often used along with several other methods.

3. It serves as the basic context for almost all other psychological

assessments.

4. It is the most widely used clinical assessment method.

 GENERAL SKILLS of Clinical
Psychologist
• Quieting yourself – minimize excessive internal, self-
•
directed thought that cause distraction 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. - respecting and caring
attitude is key.
 SPECIFIC BEHAVIORS of Clinical
Psychologist
• Eye contact

• Body language

• Vocal qualities

• Verbal tracking

• Referring to the client by the proper name

• Open ended Vs close ended questions

• BODY LANGUAGE
• General rules; face the client, appear attentive, minimize
restlessness, display appropriate facial expressions and so on.

• VOCAL QUALITIES
• Use pitch, tone, volume, and fluctuation to voices to let clients know
that their feeling and words are being deeply appreciated.

• VERBAL TRACKING
• Ensure clients that they have been accurately heard.
• Monitor the train of thought of client, if able to shift topics smoothly
rather than abruptly.
Referring to the client by the proper name

• Misuse of names in this way may seems disrespectful and be received as

micro-aggression

• Open-ended questions

- Allow spontaneous responses from clients.

- Elicit long answers that may or may not provide necessary

info.
• Close-ended questions
 TYPES OF INTERVIEWS IN CLINICAL
PSYCHOLOGY
• Some important forms of interview are:

1. The intake admission interview.

2. The case history interview.
3. Mental status examination interview.
4. The crisis interview.
5. Diagnostic interview.
6. Structured interview.
 1. THE INTAKE ADMISSION
INTERVIEW
● According to Watson; “The Intake Admission interview is
usually concerned with clarification of the patient’s
complaints, the steps he has taken previously to resolve his
difficulties and his expectances in regard to what may be
done for him”.

● Main Purpose: To develop a better understanding of the

patient’s symptoms or concerns in order to recommend the
most appropriate treatment or intervention plan.

● In any setting, the initial interview attempts to evaluate the

patient’s situation as efficiently as possible.
● Basic question to be dealt with : “Why is the patient
here? i.e., what does he says is the matter with him?

● Important but secondary questions involve information

about previous hospitalization, the name of his doctor(s),
what the patient expects from treatment and his
availability for treatment.
● Guards against common mistakes at the time of
admission.

● Every patient may not be able to state coherently

the nature of his trouble, but even the unclear
replies can be highly revealing.

● The diagnostic and treatment session comes at

some time after the intake interview, but it has a
profound effect on the quality and duration of
treatment.
 2. CASE HISTORY INTERVIEW
• In many hospitals and clinics, the intake or admission interview is
followed immediately by the personal and social history interview,
usually conducted by the same person.
• Sources of information other than the patient himself such as
information from friends, relatives, hospital, military, and other
records are also utilized when completing a personal and social history
report.
• The purposes: to gather information which will be helpful in diagnosing
and treating the patient’s disorder.
• In most instances a standardized form or social history guide of some
sort is used.
 CASE HISTORY INTERVIEW
● The typical information obtained includes material on the patient’s
early life, with particular attention paid to family relationships
and general environment.
● Also included are data on the patient’s educational and
vocational history, his habits, recreations, etc.

● Because much of this information can be obtained only by direct

questioning, some patients can lie or feel threatened, but the
clinician should check other information sources as well.
 3. MENTAL STATUS EXAMINATION
INTERVIEW
• Often a mental status examination interview is conducted to
screen the patient’s level of psychological functioning and
the presence or absence of abnormal mental phenomena
such as delusions, hallucinations, delirium, or dementia.

• It includes a brief evaluation and observation of the patient’s

appearance and manner, speech characteristics, mood,
thought processes, insight, judgment, attention,
concentration, memory, and orientation.
• Examples:
• Mental status interviews typically include questions and tasks to determine
orientation to time (e.g., “what day is it? What month is it?), place (e.g., Where
are you now? Which hospital are you in?”), and person (“who am I?)
• In order to access Long Term Memory, you may ask questions from history or
patient’s own childhood history i.e. who is the president of United States?”)

• Also, the mental status interview asses short term memory (e.g. “I am going to
name three objects I’d like you to try and remember: dog, pencil, and vase”)
and attention- concentration (e.g., “count down by 7s starting at 100. For
example 100, 93, and so forth”).

• MSE can be structured as well as unstructured.

 4. THE CRISIS INTERVIEW
• A crisis interview occurs when the patient is in the middle of a
significant and often traumatic or life threatening crisis such as in an
emergency situation.

• The nature of the emergency dictates a rapid, “get to the point” style of
interview as well as quick decision making in the context of a calming
style.
• For example, it may be critical to determine whether the person is at
significant risk of hurting him- or herself or others.
• The interviewer may need to be more directive (e.g.,
encouraging the person to phone the police, unload a
gun, provide instructions to induce vomiting, or step
away from a tall building or bridge);

• Break confidentiality if the person (or someone else, such as

a child) is in serious and immediate danger; or enlist the help
of others (e.g., police department, ambulance).
 5. THE DIAGNOSTIC INTERVIEW
• The purpose of the screening or diagnostic interview is to assist the clinician in his
attempt to understand the patient.

• May involve a general screening task, or a clear, more specific diagnostic purpose.

• To provide DSM diagnosis

• Structured interviews are often used
• to minimize subjectivity, enhance reliability
• SCID ( Structured Clinical Interview for DSM-5) is an example
• Currently being revised for DSM-5
 6. STRUCTURED INTERVIEW
• In an effort to increase the reliability and validity of clinical interviews, a
number of structured interviews have been developed.
• These interviews include very specific questions asked in a detailed flow
chart format.
• The goal is to obtain necessary information, to make an appropriate
diagnosis, to determine whether a patient is appropriate for a specific
treatment or research program, and to secure critical data that are
needed for patient care.
 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 client’s cultural experiences can be helpful.
 Advantages of Clinical Interviews
The main advantages of interviews are:
They are useful to obtain detailed
information about personal feelings,
perceptions and opinions.
They allow more detailed questions to
be asked.
They usually achieve a high response
rate.
Respondents' own words are recorded.
Ambiguities can beclarified and
 Disadvantages of Clinical Interviews

They can be very time-consuming:

setting up, interviewing, transcribing,
analyzing, feedback, reporting
Different interviewers may
understand and
transcribe interviews in different ways.
They can be costly.
 Class Task

• According to you which Interviewing technique is

best and why ?