Chapter 6 Flashcards
Ethical Issues Limiting Confidentiality
Protection from harm and when required by law
Why does protection from harm pose as an exception
Must intervene if there are credible harm risks to the client or others and has duty to report in cases like self-harm or suicide threats, harm to others, a child in need of protection from abuse/neglect, etc. (in Ontario there is a mandatory report policy that health professionals must follow for sexual abuse)
When does law pose as an exception
- Legal obligations to override confidentiality depending on who requested the intervention or assessment; if a judge, lawyer or court requested for this, they get report, but the client does not
- Psychologists in Canada do not have ‘client privileges’ like lawyers do
Unstructured interviews
- Start with “what got you here” and let the client take the lead
- Encourages natural conversation and deep exploration, while adapting to clients’ needs
- Less standardized, so less of an interrogation vibe but it is harder to compare to others clients and there is a risk of conversation going anywhere
- Features include a safe, protected, positive, and comfortable environment, with established trust and out of others’ earshot; a positive client-practitioner relationship, encouraging honest and meaningful conversation; and the gathering of pertinent information while the conversation remains open, free-flowing and with the possibility of going in depth if the client is comfortable
The Role of the Psychologist in an Unstructured Conversation
- Setting a context
- Asking a mix of open and closed questions and pursuing a line of questioning
- Clarifying, reflecting and paraphrasing, to demonstrate understanding, allow for clarity, summarize the key points, and promote talking
- During these interviews, many psychologists find it useful to begin the discussion with open-ended questions, followed by closed questions
What are the major differences between assessment interviews and conversations with friends - Purpose
- AI: Gathers clinical or diagnostic information
- CF: Social connection and sharing experiences
What are the major differences between assessment interviews and conversations with friends - Structure
- AI: Guided by psychological frameworks and goals
- CF: Free-flowing and informal
What are the major differences between assessment interviews and conversations with friends -Questioning
- AI: Intentional use of open/closed questions
- CF: Natural, spontaneous exchanges
What are the major differences between assessment interviews and conversations with friends - Confidentiality
- AI: Protected by ethical and legal guidelines
- CF: No formal confidentiality obligations
What are the major differences between assessment interviews and conversations with friends - Objectivity
- AI: Psychologists maintain neutrality and minimizes person bias, by being less emotionally involved and not sharing their experience
- CF: Friends share opinions and personal biases, sharing their experiences and being emotionally involved
What are the major differences between assessment interviews and conversations with friends - Role of Listener
- AI: Active listening with professional interpretation
- CF: Mutual exchange and personal support
What are the major differences between assessment interviews and conversations with friends - Emotional Focus
- AI: Focus on client’s emotions for insight and intervention
- CF: Shared emotional expression and support
What are the major differences between assessment interviews and conversations with friends - Outcome
- AI: Used for clinical assessment, treatment planning, or diagnosis
- CF: Strengthens personal bonds or social support
Semi-Structured diagnostic interviews
- Blending of structured (standardized) and open-ended questions allows for diagnosis while allowing free-flowing conversation
- More specific questions with more goals, direction oriented, while remaining flexible and taking it as the client goes
Structured Clinical Interview for DSM-5 (SCID-5):
Most widely used in North America
Research Version
The most comprehensive interview, covering most of the DSM-5 diagnoses
The Clinician Version
A somewhat shorter interview designed to cover disorders most commonly encountered in clinical settings and practice; use specific books with all these questions they want to hit and all the information needed available
General issues in interviewing
- Skills in questioning (balancing open-ended and closed questions is hard especially at the start)
- Skills in listening (active listening, paying attention to verbal and non-verbal cues, paraphrasing)
- Asking about sensitive issues (approaching difficult issues with sensitivity and remaining open)
- Cultural sensitivity (acknowledge different styles, values and own personal biases to eliminate assumptions)
- Adapting to different clients (children, couples, families, older adults, etc.)
How to adapt to different clients
- With children ask questions using age appropriate language and use play based techniques, like toys and drawing, etc.)
- For couples use constructive dialogue to help maintain a balance between both ppl
- For families, managing group dynamics and different povs with respect for all opinions
- For OA, acknowledge cognitive, emotional, and contextual factors, with the collateral based on ability level
Pros and Cons of Unstructured Interviews
- Pros: highly flexible and client centered, builds strong rapport and trust, allows for in-depth exploration of individual experiences
- Cons: Lack of standardization reduces reliability, harder to compare responses across clients, may overlook key diagnostic criteria
Pros and Cons of Semi-Structured Interviews
- Pros: balance between structure and flexibility, standardized format improves reliability, allows for clinical judgment while maintaining diagnostic rigor
- Cons: Less spontaneous than unstructured interviews which hurts the report, can still be time-consuming, requires skill to balance structure with client-centered, individualized approach and support
Pursuing a line of questioning
- Tell me more about… (encourages collaboration)
- Can you explain what you meant by… (clarifies responses)
- Give me an example… (grounds abstract concepts into real experiences)
- What does depressed mean to you? (in cases of generalized aspects of diagnoses and pathologization of personal experiences, helps avoid assumptions)
- I want to be sure I understand…/ Help me understand what you mean by out of control… (active listening and understanding, promoting validation)
- Persist until answer is obtained, allowing for deeper meaning and insight (persistence why interviews are unlike conversations)
Problem definition questions
- Tell me what you mean by…
- What happens when… (triggers or consequences)
- Give me an example…
- Describe what it is like when…
- Tell me about last time that… (recall of incidences)
- Can explore what happens when triggers happen, understand their contexts and reactions/consequences, situations, and emotions
Problem definition questions - The three goals
- Frequency: patterns (how often does this happen), triggers and support (are there times when it is better or worse)
- Intensity: effort and difficulty (how hard is it to do) and Impacts on daily life and functioning (what is the effect)
- Duration: Onset/etiology and situational/ongoing (when did this start) and progression and chronicity (how long has it been going on)
- Super important to understand how often and for how long issues have been present for diagnosis
Benefits of Problem Definition
- Multiple perspectives (gathers well-rounded info)
- Clarifies problem scope (identifies frequency, intensity and impact of concerns)
- Guides intervention (provides valuable insights for tailoring treatment strategies
Challenges of Problem Definition
- Limited insight (some individuals may struggle to articulate their experiences, like children, older adults, etc.)
- Subjectivity (individuals define issues differently)
- Bias (multiple ppl say different perspectives than clients)
- Emotional sensitivity (have a hard time articulating problems, potentially discomfort and defensiveness)
Observations
- Provide insights into clients’ functioning and behaviours across different settings and contexts, as there may be variation
- Areas of observations with typical behaviours involve clinic (anxiety, compliance), school (social challenges, task avoidance) and home (emotional outbursts (feel safest), difficult with routine consistency, sibling conflict, more physical touch)
- Accounts for observer effect and for potential variations in symptom and behavioural variations by context
What factors may lead to inaccurate or invalid observations in these settings?
- Child factors (low energy and distress, motivation, fatigue, illness, language barriers)
- Environmental factors (distractions, testing, observer effects, unfamiliarity of setting, noise)
- Examiner factors ([confirmation] bias, subjectivity, inconsistent administration, rapport)
Advantages of Self-Monitoring
- Enhances awareness (helps indivs recognize patterns in bhvrs/symptoms)
- Encourages accountability, by tracking progress
- Supports data collection (provides realtime insights on ecological functioning)
- Facilitates Intervention Planning (guides tailored strategies based on patterns)
- Improves treatment engagement (active participation)
Challenges of self-monitoring
- Accuracy and bias issues (response may be influenced by memory issues or social desirability)
- Inconsistent recording
- Reactivity effect (temporary effects on bhvr)
- Cognitive and emotional load
- Interference w Natural Bhvr (active monitoring affects response)
Should we trust data from self-monitoring diary procedures?
- Should be cross-validated with other events, research, assessments, etc. and use some standardization to maintain validity
- Not taking it 100% to their word but maintaining accountability
- Provides real time insights
- Encourages awareness
Concerns with Self-Monitoring
- Memory and recall issues
- Inconsistent data
- Social desirability
- Reactivity
Why do some clients decide to misrepresent their experiences when completing self-monitoring tasks?
- Desire for approval (really want to impress assessor)
- Social desirability ( downplaying benefits or symptoms or exaggerating)
- Avoidance of consequences (avoiding intervention, fear of judgement and intervention)
- Cognitive barriers (emotional avoidance)
