Clinical Interviewing
Types of Clinical Interviews
• Intake
• Case History
• Diagnostic Interview
• Mental Status Exam
• Crisis Interview
Characteristics of Clinical Interview
• Professional Nature
• Professional Setting
• One-side flow of conversation
• Goal Oriented
Intake
• What is the client’s problem?
• Can I help?
Case History
• Birth and development
• Family of Origin
• Education
• Employment
• Recreation/Leisure
• Sex
• Dating and Marital
• Alcohol and Drugs
• Health
Diagnostic Interview
• Goal: to arrive at a diagnosis
• Threats to reliability
• Diagnostic rules/system is ambiguous
• Clinicians ask different questions
• Clients give different responses
• Reliability of diagnostic interviews
• Overall percent agreement
• Kappa coefficient
• Kappa > .75 is very good
Crisis Interview
• Primary Goal: resolve the immediate problem
• Secondary Goal: refer to appropriate resources
Mental Status Exam
• Appearance and behavior
• Speech and thought
• Consciousness
• Perception
• Obsessions and compulsions
• Orientation
• Memory
• Attention/concentration
• General information
• Intelligence
• Insight and judgment
Communication Strategies
• Verbal Strategies
• Nonverbal Strategies
• Listening Skills
Verbal Strategies
• Open-ended questions
• Closed questions
• Funnel method
Nonverbal Strategies
• S – face client squarely,face the client directly
• O – adopt an open posture
• L – lean toward the client
• E – frequent eye contact
• R – relax
• Congruence
Active Listening
• Clarification
• Paraphrasing
• Reflection
• Summarization
Five Types of Interview Questions
• Open-ended -Gives patient responsibility and latitude for responding
• “Would you tell me about your experiences in the Army?”
• Facilitative -Encourages patient’s flow of conversation
• “Can you tell me a little more about that?”
• Clarifying-Encourages clarity or amplification
• “I guess this means you felt like … ?”
• Confronting- Challenges inconsistencies or contradictions
• “Before, when you said … ?”
• Direct/Close ended - Once rapport has been established and the
patient is taking responsibility
• “What did you say to your father when he criticized your choice?”
Common Interviewing Pitfalls
• The authenticity pitfall
• The jargon pitfall
• The slave-to-the-intake-form pitfall
• The diagnostic label pitfall
• The apology pitfall
• The reassurance pitfall
Diagnostic Interviewing
• Goal: classification of client and his or her problem
• Steps
• Diagnostic clues
• Diagnostic criteria
• Psychiatric history
• Diagnosis
• Prognosis
Structured Clinical Interviews
• Structured Clinical Interview
• SCID
• ADIS-IV
• Comprehensive Drinker Profile
• Improved Reliability
• Comprehensive
• Apply decision rules correctly
• Cut down on confirmation bias
Structured Interviews
• Structured Clinical Interview for DSM-5 (SCID)
• Anxiety Disorders Interview Schedule – 5th Edition (ADIS-5th )
• Comprehensive Drinker Profile (CDP)
Reliability of Diagnostic Interviews
• Overall percent agreement
• Kappa coefficient
Validity of Interview
Interviewing Children
• Developmental Considerations
• Preschool – concrete, ego-centric
• Middle childhood – increasing sophistication, can make inferences
about their own and others’ behavior, feelings etc.
• Adolescence – increasing recognition of complexity of humans
• Considerable variability
Interviewing Children: Things to consider
• Open-ended = closed mouth
• Greater reliance upon concrete questioning
• Use simple questions
• “What do you like best about school?”
• “What don’t you like about school?”
• Give praise frequently
• Use alternative stimuli
• Drawing
• Dolls
• But draw inferences cautiously
Interviewing and Cultural Diversity
“Multiculuralism is a social-intellectual movement that promotes the
value of diversity as a core principle and insists that all cultural groups
be treated with respect and as equals” (Fowers & Richardson, 1990,
p.609).
Culturally sensitive interviewing
• Be aware of one’s own cultural background and experience
• Educate oneself about the ethnic groups and cultures with whom one
works
• Modify characteristic communication style to facilitate
communication (within reason)
