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Clinical Assessment Interviewing

Clinical Assessment Interviewing. 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.

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Clinical Assessment Interviewing

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  1. Clinical AssessmentInterviewing

  2. Psychological Assessment • Key activity in clinical psychology (historically)

  3. Psychological Assessment:Overall Process I. Planning the assessment II. Data collection** (our focus) IV. Data processing V. Communicating findings

  4. I. Planning the Assessment Why is the person being assessed? (referral question) The goal of the psychological assessment follows from the referral question.

  5. Goals of Psychological Assessment • Classification (diagnoses) • Description • Prediction (true positive, false positive)

  6. II. Data Collection** Methods • Clinical interview • Tests • Observations • Informal assessment • Examination of life records

  7. III. Data Processing • Organization and interpretation of data • Clinical judgment vs. statistical prediction

  8. IV. Communicating Findings Typical Report • Identifying Information • Reason for Referral • Background Information • Behavioral Observations • Assessment Results • Diagnosis • Interpretation • Summary and Recommendations

  9. 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

  10. Types of Interviews • Intake interview • Case history • Diagnostic interview • Mental status exam • Crisis interview

  11. 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 Intake Interviews

  12. Case History or Psychosocial History Detailed 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

  13. Structured Diagnostic Interviews Structured Interviews specify: • Symptoms and disorders to be assessed • Interview format • Order of questions • Wording of questions • Guidelines for additional questions

  14. Professionals Schedule for Affective Disorders and Schizophrenia (SADS) (semi-structured) Structured Clinical Interview for DSM-IV (SCID) Lay Persons Diagnostic Interview Schedule (DIS) Structured Diagnostic Interviews

  15. General appearance and behavior Speech and thought Consciousness Perception Obsession and Compulsions Orientation Memory Attention and concentration General information Intelligence Insight and judgment Higher cognitive functioning Intelligence Insight and judgment Higher cognitive functioning Speech Orientation Mood and Affect Form of Though Mental Status Exam

  16. Crisis Interview Goal: • Resolve the problem to avoid catastrophic outcome Tasks: • Provide reassurance • Assess the problem • Explore potential resources Method: • Convey understanding • Projecting a calm and confident manner

  17. Essential Elements of Clinical Interview • Rapport • Effective communication strategies

  18. 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.

  19. Establishing Rapport • Conveying acceptance, understanding and respect for the patient

  20. 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? Effective Communication: Verbal Strategies

  21. Open Questions Elicit information Closed Questions Gather specific information Questions

  22. Combining Open and Closed Questions 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?

  23. Listening Skills Four Types of Responses that Convey Listening • Clarification • Paraphrase • Reflection • Summarization

  24. 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

  25. Clarification: Purpose • To encourage elaboration • To check accuracy of what you heard • To clear up vague messages

  26. What thoughts are you having about being in class today? What are the feelings that go along with these thoughts? Distinguishing Content vs. Emotion: An Exercise

  27. 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

  28. Paraphrasing Example Client: 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.

  29. Paraphrasing: Purpose • To help the client focus on the content of their message • To highlight content when attention to feelings is premature

  30. Reflection Definition Describing 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?

  31. 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

  32. 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.

  33. Summarizing Definition: Two or more paraphrases or reflections that condense the client’s message or the session.

  34. Summarizing: Purpose • To tie together multiple elements of the client’s message • To identify a common theme • To interrupt excessive talking • To review progress

  35. 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)

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