Ch. 8 - Clinical Interview Flashcards
T or F? No other mental health professional incorporates assessment into their work as clinical psychologists do
True SISTAH!
Clinical interviews are the most…
frequent assessment tool, more than any specific test, used by the bast majority of practicing clinical psychologists
Validity
measures what it claims to measure
Content validity
has content appropriate for what is being measured
Convergent validity
correlates with other techniques to measure the same thing
Discriminant validity
does not correlate with techniques that measure something else
Reliability
yield consistent, repeatable results
Test-retest reliability
yields similar results across multiple administrations at different times
Interrater reliability
yield similar results across multiple administrators
Internal reliability
consists of items that are consistent with one another
Clinical utility
improves delivery of services or client outcome
General skills (3)
Quieting yourself
♣ Minimize excessive internal, self-directed thoughts that detract from listening
♣ “did I ask the right question?”
Being self-aware
♣ Know how you tend to affect others interpersonally, and how others tend to relate to you
♣ You don’t know how many triggers you have, but you have to deal with it so it doesn’t interfere with client
Develop positive working relationships
♣ Can segue into psychotherapy
♣ Respectful and caring attitude is key
What is the primary task of the interviewer (specific behaviour)
Listening - consists of numerous building blocks
What building blocks make up listening? (5)
♣ Eye contact (there is an appropriate amount)
♣ Body language (face client, appear attentive, appropriate facial expressions)
♣ Vocal qualities (changing the pitch, tone and volume)
♣ Verbal tracking (repeat key words and phrases back to the client, smoothly transition from one topic to another)
♣ Referring to client by proper name
What is a rapport?
Positive, comfortable relationship between interviewer and client
How an interviewer is with clients
What is a technique?
What an interviewer does with a client
What are 2 technique styles?
♣ Nondirective: not suggesting, or having client confront, letting client sit in their own thoughts, client dictates what topics are talked about and for how long
♣ Directive: too much goal oriented counselling can almost feel like bullying, too much too fast, ask pointed questions to get the answers they need
What are 5 components to active listening?
- Open/close ended/leading questions
- Paraphrasing
- Summary
- Reflection of feelings
- Clarification/Exploration
Distinguish between open/closed ended and leading questions
Open (allows client to elaborate and go where the client want to go)
Closed ended (used less often than open ended)
Leading questions (Never do this, suggesting the answer to the question – especially important in investigating child abuse cases)
What is paraphrasing? What is a poor and good example?
Act as mirror – allowing client to hear in a different way what they just said, also the client can correct you if you’re wrong
♣ Poor: suggesting feelings that obviously are not there
♣ Good: accurately reading the emotions
What is summary?
Kind of paraphrasing but a lot more info – helpful in the beginning to keep track of how therapy is going. Nice for client to get that overview to see how far they’ve come and a reminder of what they’ve talking about
What is reflection of feelings? What is a good and bad example?
therapist is reflecting how the client is feeling – ex: “you seem to feel out of control”
♣ Poor: suggesting feelings that obviously are not there
♣ Good: accurately reading the emotions
What is clarification/exploration?
Going further/beyond what the client is giving you, helping the client delve further into things. If the client says something that is a bit conflicting – trying to get more information to see if it is a conflict.
ex: “so the relationship seems to be over?”
What are the 5 stages of the interview?
- Relationship: establish rapport (3 V’s + B)
- Story: Draw out stories, concerns, problems or issues
- Goals (client’s goals): why are we here? what does the client want at the end of this?
- Working: how are we going to solve this (different if suicidal)? Explore alternatives. Confront. Re-story (reframing - changing perspective in a way that is helpful)
- Action/Termination: (usually have something that you or your client will be doing) empowering client to go forward and act/generalize on new stories
What is the hierarchy of interview skills (go from bottom to top)
- Attending behavior (if you don’t have this, you have nothing)
- Open & closed questions (might use close ended questions if the person tends to go off on a tangent)
- Client observation skills (have to be able to react to the feel of the interview; you may be able to pick up on if they’re feeling down)
- Encouraging, paraphrasing, summarizing, reflection of feelings
What is attending behaviour?
- Orienting toward client (leaned forward and focused on the client)
- Encourages person to talk
- Let’s client know you’re listening
- Conveys empathy (think of the blink blink guy who did not convey empathy)
- Important for rapport
What are the three Vs + B of attending behaviour?
Visual eye contact Vocal qualities (lower voice) Verbal tracking Body o Face other squarely o Head nods o Open posture o Lean toward o Relaxed
Give a good and bad example of attending behaviour
Poor Example:
- Fidgeting, uninterested, relaxed posture, more interested on the room than the person
Good Example:
- Actively listening, leaned in, nodding, validating, asking questions that keep her talking, client is giving more information and more open, paraphrasing what the client said instead of asking a question to get her to elaborate and focused.
What are 3 ways you can use encouragers? what does it indicate to the client?
Verbal o Word or sounds to encourage client o Ex: “yeah”, “uh huh”, “go on”, “oh” o Used at natural break in speech Non-Verbal o Eye contact, smile, head nod Restatement o Repeat 2 or more of client’s exact words
Indicates what client is saying is important
What is a good and bad example of an encourager?
Poor Example:
- No facial expression
Good Example:
- Repeating the last word of a lot of her sentences, leaned in, nodding,
What is the purpose of open ended questions? (4)
Begin interview
Encourage elaboration (should not be talking more than the client)
Elicit specific examples
Motivate communication
What is the purpose of closed ended questions? (4)
Obtain specific information
Identify parameters of problem
Narrow topic of discussion
Interrupt an over talkative client
What is a leading question? (3)
Frowned upon
Questions where client is guided to answer
Usually Judgemental
Ex: “You always check with your doctor before this right
Paraphrasing
Rephrase the content of client’s message
What is the purpose of paraphrasing? (4)
Conveys understanding
Help client simplify, focus on crystallize what is said
Encourage elaboration
Provide a check of accuracy of your perceptions
When should we use paraphrasing? (3)
- If you have hypothesis about what’s going on
- When client is in a conflict
- When client presented lots of material & you are confused
What are the steps in rephrasing? (5)
- Recall message & restate covertly
- Identify key parts
- Select a beginning, “Sounds like…”
- Translate key content in own words
- Confirm accuracy of paraphrase
What is the purpose of a summary? (6)
- Tie together multiple elements
- Identify common theme/pattern
- Interrupt excessive rambling
- Pace a session
- Review progress
- Serve as a transition when changing topics
When should you use summary?
At the start and end of a session
What are the steps in summary?
- Recall key content & affect messages
- Identify patterns or themes
- Use appropriate sentence stem “I sense…”
- Summarize
- Assess effectiveness
What is rephrasing?
Rephrasing the affective/emotion aspect
Reflection of feeling
o Echo client’s emotions, even if not explicitly mentioned
- Ex: “you are feeling sad about this”
What is the purpose of reflection? (4)
- Feel understood
- Express more feelings
- Manage feelings
- Discriminate among various feelings
What are the steps in reflection? (7)
1. Listen closely & observe behavior o Watch nonverbal o Verbally reflect feelings back 2. Identify feeling category 3. Identify intensity 4. Match feeling and intensity of word 5. Feedback to client 6. Add component using the form o “you feel \_\_\_\_\_ because \_\_\_\_\_” 7. Check accuracy
What is the purpose of exploration/clarification ? (3)
- Encourage client elaboration
- Check accuracy of what you heard
- To clear up vague messages
What are the steps in clarification? (3)
- Identify element want elaborated
- Use stems such as “Do you mean that” or “are you saying”
- Follow up if necessary
What is empathy as Carl Roger’s said?
Client’s world as he/she sees it and experiences it
What is empathy defined as?
Experience client’s world but remain separate
How do you convey empathy? (2)
o Paraphrasing
o Reflection of feeling
What is subtractive empathy?
Give back less than or distorts
o “That’s not a very nice way to talk; you should consider his feelings too!”
o Slightly: “Seems like you’ve just given up on him. You don’t want to try anymore.”
What is Basic/Interchangeable empathy?
Interchangeable with that client says
Accurate use of the BLS = basic empathy
Not elaborating on it – not giving anything further
o “You’re discouraged and confused, you’ve worked over your issues with hum but he doesn’t seem to understand. You don’t really care”
What is additive Empathy?
Adds something beyond what the client has said
Give client something to think about, maybe reframing
o Slightly: “You’ve gone over the problem with him and again to the point that you don’t really care right now. You’ve tried hard. What does this mean to you?
What is confrontation for?
For discrepancies or inconsistencies in a client’s comments
What is confrontation?
- Not a direct harsh challenge
- Not going against the client, but with the client
- Is a supportive challenge
What does confrontation act as?
A lever for the activation of human potential
What are 6 strategies for change?
- interpretation/reframe
- logical consequences
- self-disclosure
- feedback
- information/advice/opinion/suggestion
- directive
interpretation/reframe?
- Re-story, guide the client to looks at the problem from a new perspective with a new frame of reference
logical consequences?
Look at the possible results of alternative actions, anticipation of rewards/punishments
Self disclosure?
- Interview shares brief story, thoughts or experiences - I, Me, My, + verb (think, feel, have experienced) be genuine and cautious
- Kept at a minimum
- Should be related to specifically what they needed
feedback?
- See/hear ourselves as others see/hear us, be touches as others touch us
- Focus on strengths, be concrete & specific, lean & precise, nonjudgmental, use check-point
Information/advice/opinion/suggestions:
- Attend to client, be clear specific & concrete and use check-out
- Should not suggest “you should meditate” it’s too broad, the more specific the more likely they will come back
Directive
Involve client as co-participation in strategy
Be clear & concrete, use check out
Need to make sure that the client is buying in or else they won’t do it
Note-taking
o Little consensus about note-taking
o Provide a reliable written record, but can be distracting to client and interviewer
Audio/Visual Recordings
o Also provide a reliable record, but can be inhibiting to clients
Must obtain permission
Intake Interview
To determine whether to “intake” the client into the agency or refer elsewhere
♣ A risk if the client was suicidal or family unit was at risk
Diagnostic Interview
To provide DSM diagnosis, Structured interviews often used
♣ Minimized subjectivity, enhanced reliability
♣ Semi-structured interviews include some structure but also some flexibility or opportunities to improvise
Makes it hard to form relationship since it feels robotic
Mental Status exam
o Typically used in medical settings
o To quickly assess how a client is functioning at that time
Crisis interview
o Assess problem and provide immediate intervention
o Clients are often considering suicide or other harmful act
What are 3 types of bubbles?
o Social distance (boss)
o Personal distance (friends)
o Intimate distance (partner)
What are 3 static features?
- Orientation
- Posture
- Physical contact
What are 5 dynamic facial expressions?
- Smile
- Frown
- Raised Eyebrow
- Yawn
- Sneer
What are 3 dynamic gestures?
- Regulation
- Emphasis
- Soothing gestures
What can the eye convey ?
- Feelings
- Interest
Connections
What is paralanguage?
How you say it o Speed o Tone o Pitch Interest Affect
What is silence used for? (3)
- Pausing for emphasis
- Punishment
- Uncertainty
What are the cultural components to an interview?
Appreciating the cultural context
o Knowledge of the client’s culture, as well as the interviewer’s own culture
o For behaviour described or exhibited during interview
Acknowledging cultural differences
o Wise to discuss cultural differences rather than ignore
o Sensitive inquiry about a client’s cultural experiences can be helpful
