Chapter 6: Assessment (Interviewing & Observation) Flashcards
Limits of Confidentiality
situations in which the psychologist is legally obligated to break confidentiality by disclosing information provided by the patient to another person or agency
Open Questions
questions that allow elaborate responses and cannot be answered with a simple yes or no
Closed Questions
questions that can be answered with a single word
Microaggressions
slights, misunderstandings, and unwarranted assumptions on the part of the psychologist
Semi-Structured Interviews
interviews with a specific format for asking questions and a specific sequence in which questions are asked
Self-Monitoring
strategies to monitor one’s own behavior, emotions, and/or thoughts
Reactivity
a change in the phenomenon being monitored that is due specifically to the process of monitoring the phenomenon
What are interviews?
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
What are ways that interviews differ from social conversation?
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
What is the aim of interviews?
safe environment –> positive relationship –> gathering pertinent information
What are important aspects of interviews?
setting context
asking open and closed question; pursuing a line of questioning
clarifying, reflecting, & paraphrasing
What needs to be considered when conducting an interview?
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.
What are matters of confidentiality in interviews?
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
What is the duty to protect in interviews?
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
What is informed consent in interviews?
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
What are unstructured assessment interviews?
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
What are structured diagnostic interviews?
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
Why is having access to structured interviews not sufficient for the purposes of making a diagnosis?
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
What are the reasons that verbal responses to interviews may be suboptimal?
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
What are semi-structured interviews?
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
What can psychologist’s do during interviews to improve client comfort and disclosure?
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
What is the mental state examination?
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
What is assessed in the MSE?
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
When is MSE information useful?
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
What are active listening skills?
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
What is the stigma around mental disorders?
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
Why is it important to limit questions in an interview?
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
Why is culture important in interviews?
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
What are some differences in culture that can present in interviews?
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
How can translators/interpreters aid in assessment and treatment?
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
How can assessment interviews address client concerns?
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
What are exploring questions?
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…
What are clarifying questions?
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…
What are problem definition questions?
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?
How should sensitive issues be brought up in interviews?
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
What are important considerations when interviewing couples?
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
What are important considerations when interviewing families?
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
What are important considerations when interviewing children?
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
How do you modify interview questions when talking to children?
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
What is clinical observation?
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
What are naturalistic observations?
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
What is self-recording and monitoring?
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)
Why is patient compliance an issue in self-monitoring?
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
