Chapter 6: Assessment (Interviewing & Observation)

Question 1

Limits of Confidentiality

Answer 1

situations in which the psychologist is legally obligated to break confidentiality by disclosing information provided by the patient to another person or agency

Question 2

Open Questions

Answer 2

questions that allow elaborate responses and cannot be answered with a simple yes or no

Question 3

Closed Questions

Answer 3

questions that can be answered with a single word

Question 4

Microaggressions

Answer 4

slights, misunderstandings, and unwarranted assumptions on the part of the psychologist

Question 5

Semi-Structured Interviews

Answer 5

interviews with a specific format for asking questions and a specific sequence in which questions are asked

Question 6

Self-Monitoring

Answer 6

strategies to monitor one’s own behavior, emotions, and/or thoughts

Question 7

Reactivity

Answer 7

a change in the phenomenon being monitored that is due specifically to the process of monitoring the phenomenon

Question 8

What are interviews?

Answer 8

first point of contact between psychologist and client and/or referral source

critical first impressions are formed that will have a dramatic impact on rapport, and a professionally useful relationship (therapeutic alliance)

reasons for meeting are clarified

provides rich opportunities to gather information

requires a careful blend of diplomacy, knowledge of mental disorders and their treatment, interpersonal dynamics, and diagnostic skill

significant amount of a psychologist’s training is devoted to interview/observation techniques

Question 9

What are ways that interviews differ from social conversation?

Answer 9

the psychologist enters with explicit agenda of obtaining information necessary for accurate diagnosis and treatment planning

questions are asked more directly, and more persistently than they would be in regular conversation

discussion highly focused on the client; it is not reciprocal

important to establish both one’s credibility, and appropriate boundaries for the reminder of the assessment, and any intervention that will subsequently take place

Question 10

What is the aim of interviews?

Answer 10

safe environment –> positive relationship –> gathering pertinent information

Question 11

What are important aspects of interviews?

Answer 11

setting context

asking open and closed question; pursuing a line of questioning

clarifying, reflecting, & paraphrasing

Question 12

What needs to be considered when conducting an interview?

Answer 12

it can be quite challenging to project warmth, empathy, and openness in the context of the professional agendas outlined above

careful attention to verbal content

also make clinical observations regarding facial expression, tone of voice, physical movement, and posture, etc.

relatively difficult data to obtain through other means

observations can take place in a clinical setting, such as the psychologist office, or naturalistic settings including the client’s home, school, workplace, etc.

Question 13

What are matters of confidentiality in interviews?

Answer 13

falls under ethical principle 1: respect for dignity of individuals

under most circumstances confidentiality is both required and appropriate

exception: psychologist may not maintain confidentiality if doing so might tend to (fail to prevent) harm

comes from Tarasoff ruling, legally referred to as: Duty to Warn

must inform authorities and intended victim

the authority you inform depends on intended victims

Question 14

What is the duty to protect in interviews?

Answer 14

duty to protect falls under principle 4 –> responsibility to society

normally ethical principles are weighted in order; in this case, possibility of harm is given greater weight than right to confidentiality

Question 15

What is informed consent in interviews?

Answer 15

limits to confidentiality must be explicit from the outset

appears to have less effect on client disclosure than expected, even in forensic settings

can present self-reporting as a therapeutic measure: combined with informed consent, minimizes ethical dilemma

Question 16

What are unstructured assessment interviews?

Answer 16

a better term might be “not pre-structured”

psychologist provides content and structure based on an evolving set of hypotheses

driven by the need to gather data to pursue diagnosis

open-ended questions tend to be used more than close-ended questions

thoughtful decisions made about allowing patient to pursue an unfruitful tangent, vs redirecting focus to matters of more central importance

useful in interviews when a client has difficulty articulating specific assessment or treatment goals

another difference is the strategic use of silence: social convention teaches us to feel uncomfortable during long gaps in conversation, psychologists use those pauses quite deliberately to encourage patient reflection, and to clarify that questions cannot be avoided by simply ignoring them

Question 17

What are structured diagnostic interviews?

Answer 17

usually done according to a written protocol

a fixed set of questions is asked, and in a predetermine order

ensures that the psychologist canvasses enough information to rule in, or out, various conditions

some are very broad and cover several, if not all, DSM categories

others specifically look at mood disorders, addictions, impulse control disorders, etc

the broader they are in their intent, the longer the interviews tend to become

may pose practical obstacles in terms of scheduling and client compliance

Question 18

Why is having access to structured interviews not sufficient for the purposes of making a diagnosis?

Answer 18

they are designed exclusively for use by qualified mental health professionals who are trained to make a diagnosis

a potential problem in AB at present because HPA allows no exclusive scope of practice

large organizations may attempt to control costs by having less qualified staff conduct these interviews

Question 19

What are the reasons that verbal responses to interviews may be suboptimal?

Answer 19

children have limited concept of time

individuals from other ethnic backgrounds may lack verbal facility in the psychologist’s language

hearing and/or speech impairments can be present

linguistic concepts can be heavily biased culturally

for that reason, pictorial aides are sometimes employed

Question 20

What are semi-structured interviews?

Answer 20

a core set of questions in several areas of inquiry but contain spaces for an examiner to record elaboration, or to probe further depending on client responses

Question 21

What can psychologist’s do during interviews to improve client comfort and disclosure?

Answer 21

good basic social skills

uninterrupted attention

maintaining a respectful posture

appropriate levels of eye contact

attitude of neutrality

the physical environment should be structured so as to be relatively free of distractions, to be both emotionally and chromatically neutral, and to place clients at ease

Question 22

What is the mental state examination?

Answer 22

amongst the most basic clinical skills a psychologist develops is the ability to conduct and interpret the results on an MSE

it is correctly thought of as a semi-structured interview that follows are more-or-less consistent format

there is an expectation that clinically relevant responses will be probed in greater detail

there are certain domains invariably covered

Question 23

What is assessed in the MSE?

Answer 23

appearance (observation)

behavior (including deficiencies in self-regulation)

speech

emotion (move, affect, congruency)

thought processes (stream of thought, continuity, content, abstraction)

perception

attention

orientation (time, place, person)

memory (immediate, recent, remote)

judgment

intelligence and information

insight

Question 24

When is MSE information useful?

Answer 24

MSE information is only relevant within the context of a broader history that includes a description of the presenting complaints

other information that may prove useful in a psychological testing, interviews with collateral informants, medical information, legal information, and laboratory tests

MSE is combined with that data into a summary, on which a diagnosis, prognosis, formulation, and treatment plan is based

Question 25

What are active listening skills?

Answer 25

periodically rephrasing client verbalizations

summarizing general trends

checking with the client whether or not your perceptions are accurate; if not, be quick to acknowledge that and invite correction

often very useful to gently comment on non-verbal cues, particularly where they pertain to affect, and combine those with a restatement of client verbalizations

Question 26

What is the stigma around mental disorders?

Answer 26

stigma around mental disorders remains a significant obstacle to people pursuing treatment

when they disclose painful events, memories, and potentially embarrassing information it is important that we not assign blame and refrain from giving direct advice

both of those lower our status significantly in the eyes of a patient

Question 27

Why is it important to limit questions in an interview?

Answer 27

there is an endless array of questions one could potentially pose in the course of an interview

must be limited on the basis of the referral question, one’s own theoretical orientation, clint characteristics, and other contextual factors that describe the circumstances under which the interview is taking place

these include cultural and developmental history, prior contact with mental health and medical practitioners, educational level, traumatic events

easy to shut clients down in the early stages of treatment

Question 28

Why is culture important in interviews?

Answer 28

clients may present with a great reluctance to offer information spontaneously, believing that it is disrespectful to the psychologist

others may present with a very clear agenda and wish to fill the interview time with information that is not especially useful

some cultures have an inherent distrust of “authority figures”, while others see them as peers, or even employees

Question 29

What are some differences in culture that can present in interviews?

Answer 29

timeliness: of central importance in Western life, but may be much less important elsewhere

eye contact/duration of gaze: considered challenging or hostile if too long, evasive if too brief

discussion about family members

discomfort with open-ended questions

Question 30

How can translators/interpreters aid in assessment and treatment?

Answer 30

translators: like Google translate
interpreters: provides cultural context as well

research has shown outcomes comparable to those that take place in direct psychologist-to-patient discussion

the difficulty is in determining the credentials of the translator if the psychologist has no means of judging that

Question 31

How can assessment interviews address client concerns?

Answer 31

individuals may seek out clinical services with a vague understanding of their own motivation for doing so

may not be able to readily articulate personal reasons: can’t assume their language corresponds to our own when they tend to describe symptoms

unlike other professions, we largely share a common vocabulary with our clients, yet the meanings of those words can be quite different from client to client, and from client to therapist

must ensure that our understanding of the client’s concerns is accurate, and frequently attempt to verify those concerns using very precise language, rather than using diagnostic labels

central approach in cognitive behavioral model

Question 32

What are exploring questions?

Answer 32

tell me about…

can you explain what you mean by…

give me an example…

what does depressed mean to you?

I want to be sure I understand…

Question 33

What are clarifying questions?

Answer 33

help me understand what you mean by out of control…

tell me what you mean by…

what happens when…

give me an example

describe what it is like when…

tell me about the last time that…

Question 34

What are problem definition questions?

Answer 34

frequency: how often does it happen, are there times when it is better or worse?

intensity: how hard is it to do, what is the effect?

duration/onset: when did it start, how long has it been going?

Question 35

How should sensitive issues be brought up in interviews?

Answer 35

contrary to belief, there’s no reason to suspect that directly asking questions around suicide risk, marital breakup, fears, relapse, etc. is likely to precipitate further problems

skirting those issues will depict the psychologist as uncomfortable, and therefore not in a position to render much assistance

clients generally appreciate a direct, unapologetic exploration of their issues and frank questions around issues of self-harm and other matters that one might otherwise be reluctant to discuss

Question 36

What are important considerations when interviewing couples?

Answer 36

it is important to speak with each member individually, as well as collectively

there may be several things one partner is not willing to disclose to a therapist in the company of the other: fears, marital dissatisfaction, infidelity, abuse, plans to end the relationship

that said, the psychologist does not automatically have license to disclose that information to the other partner

all of this must be outlined in the course of obtaining a informed consent

Question 37

What are important considerations when interviewing families?

Answer 37

may be exacerbated by broad differences in the developmental level of the individuals present

e.g., children may have limited attention span, relatively less concept formation ability, and less-developed vocabulary

they frequently are attention seeking, and become easily bored if discussions between the psychologist and parents persist too long

on the other hand, acquiescing to their requests for attention can be disruptive to the therapeutic alliance between the adults and psychologist

the psychologist must obtain information from all members of the family

Question 38

What are important considerations when interviewing children?

Answer 38

given the less advanced cognitive stage, the psychologist must modify their speech and assessment techniques to reflect the needs of younger individuals, as well as anyone who is cognitively compromised for other reasons

less can be assumed about what the psychologist and patient have in common, and the psychologist must be increasingly willing to request clarification to ensure their understanding of any information disclosed

children have the same right as adults to understand the rules of confidentiality and to feel comfortable in the therapy environment

Question 39

How do you modify interview questions when talking to children?

Answer 39

children respond differently to ambiguity, or a lack of understanding, and adults

less likely to directly request clarification, and more likely to behave in a manner that appears avoidant

use of visual aids, play therapy techniques, charts, is often very helpful in improving communication and therefore rapport

sometimes children convey information most effectively when they are seemingly preoccupied by other activities that appear to adults as fidgeting

“dumbing down” questions and comments can be offensive: simply invite patients to provide you with direct feedback concerning understandability and also to interject

Question 40

What is clinical observation?

Answer 40

important to know what is relevant: if a large array of potentially relevant information is made available consider recording sessions: requires separate consent

individuals behave quite differently in the psychologist’s office than they do in the real world

the process of being evaluated also affects our presentation, even if we think we aren’t being watched

Question 41

What are naturalistic observations?

Answer 41

strategies for observing individuals in their normal environment

undertaken with the hope of minimizing assessment reactivity

observer’s role is to be attentive to information, yet not to attract the attention of, or alter the dynamics of the environment

in practice, it is impossible to do this entirely

the use of monitoring equipment such as cameras is useful because it attracts less attention than a human observer

Question 42

What is self-recording and monitoring?

Answer 42

asking clients to keep careful records of certain thoughts, feelings, and behaviors

both cost and time effective, and likely to yield richer sources of information

a number of generic tracking sheets are available expressly for this purpose

data can be easily entered into database programs to visualize trends over time, and before and after a given intervention is implemented

self-monitoring/recording can alter behavior (usually reducing it)

Question 43

Why is patient compliance an issue in self-monitoring?

Answer 43

as a rule of thumb, the complexity of the task is inversely related to patient cooperation

to use it effectively, a number of ingenious smart phone apps have been devised: not inherently more accurate than making marks on a sheet of paper, through in our culture recording them electronically may attract less attention

keep in mind, self-reports of any kind are subject to deliberate or accidental distortion: careful education about the correct use of the recording protocol, and its importance is necessary