Clinical Interviews and Report Writing

Question 1

What are the three stages of the assessment process?

Answer 1

1. ​Information Input: collecting information from appropriate sources to address the referral question and help formulate assessment goals and working hypotheses
2. Information Evaluation: the interpretation and integration of assessment dat
3. Information Output: the biopsychosocial formulation, conclusions, and reccomendations

Question 2

What are the possible sources of bias that may influence the assessment process?

Answer 2

• Collateral Sources: eg referral sources, prior assessments
• The Assessment Process: eg the clients presentation, language or cultural differences
• The Use of Psychological Tests: eg inappropriate norms or content
• Situational Factors: eg residual impressions from previous clients

Question 3

What is validity? What are some sources of validity?

Answer 3

• Validity is whether the test measures what it says it does
• Face Validity: does the test measure what it appears to measure
  
  • eg is it clear to the test taker what the question is looking for
• Content Validity: do the items represent the domain of the construct
• Criterion-related Validity:
  
  • Concurrent: Do the results correlate with known measures
  • Predictive: Does to test relate to future performance
• Construct Validity:
  
  • Convergent: do items correlate with constructs it should
  • Divergent: do items not correlate with constructs it shouldnt
    
    • Note: divergent can indicate genuine connection

Question 4

What is Reliability? What are some sources of reliability?

Answer 4

• Reliability = consistency and low variability in scores
• Test-retest: Consistency over time
• Inter-Rater: Consistency across people
• Inter-Method: Consistency across form A and form B of a test (same content different items). Uncommon
• Internal Consistency: Correlation between items on a test
  
  • Cronbachs a = most common measure. (.9 =excellent score, required for high stakes testing, .7 -.9 Good for low stakes, <.5 Unacceptable)
  • Omega and Lambda 4 are newer measures

Question 5

What are standardisation and norms in psychological testing? What should be considered when choosing a test?

Answer 5

• Standardised tests: Administered, scored and interpreted the same way
• Standardised scores: Compares the individual score to a representative sample
  
  • Important to note the sample size, subgroups and representativeness
• In Practice - Error Reduction
  
  • Observed Value = True Value + Error. Validity, reliability and standardisation aim to reduce the error
  • Error Reduction Techniques: Correct use of tests, repeat measures, confidence intervals, latent variable modelling
• When Choosing a Test
  
  • Are the psychometric properties known, available and adequate?
  • Consider test details; purpose, literature, who can administer it, author
  • Practicality: Availability and accessibility, cost, copyright, time to administer, scoring procedures.

Question 6

What are two current trends in psychological testing?

Answer 6

1. Move away from lengthy, expensive tests, towards brief inexpensive instruments
   
   • Problem oriented tests with demonstrated psychometric properties
   • Effort toward unifying measures of the same construct so studies can be compared.
     
     • PROMIS Depression T-scores: cross link different scales
2. Integration of Technology (phones, computers and internet)
   
   • Easier administration, scoring, feedback and data
   • Easier integration of CAT, IVR (voice) and other modern methods
   • Easier integrating assessment into everyday environment (particularly for momentary time sampling)

Question 7

What common test are available in the public domain? What are the advantages and disadvanges of commercial tests?

Answer 7

• Benefits/Disadvantages
  
  • Some tests require licensing to buy reducing the likelihood of them being misused
  • Because commercial testing is a product they tend to be quite rigourous in development
  • Ongoing costs make testing inaccessible in poorer areas
• Common tests in public domain
  
  • CESD-D: Centre for Epidomiologic Studies Depression
  • HADS: Hospital Anxiety Depression Scale
  • PROMIS: Measures across many domains
• Semi-Public
  
  • APA has a database of tests online with members access (or permission request access)
  • PsycTests OVID

Question 8

What are some specific ethical issues with regard to psychological assessment?

Answer 8

1. Informed Consent of all Parties
2. Professional Standards (see reading)
3. Reliability and Validity
4. Standardisation
5. Bias
6. Self-Reflective Practice
7. Test Security
8. Automated/Electronic Testing
9. Misinterpretation by different audiences
10. Feedback, Privacy, Confidentiality and ownership of results
11. Supervision

Question 9

What are clinical interviews? What are some of the benefits and limitations?

Answer 9

• A clinical interview is a dialogue designed to diagnose and plan treatment. CI are focused and goal oriented, have clearly defined roles and time frames
  
  • Can be structured (DIS), unstructured or semistructured (SCID, SADS).
  • Eg Intake Interviews and Mental State Exams
• Benefits:
  
  • Uncover information,
  • access to verbal and non verbal information,
  • building of trust and the theraputic alliance.
• Disadvantages:
  
  • ​Client truthfullness (intended and unintended),
  • Therapist biases

Question 10

What are the 8 core components of Mental State Exams?

Answer 10

1. Appearance, Behaviour and Attitude: Starts as soon as you meet.
   
   • Sex, age, ethnicity, hygeine and self care, agitation, eye-contact, engagement
2. Mood and Affect: duration, intensity, stability, range
   
   • Mood = prolonged emotional state, internal
   • Affect = momentary, expression, observable, appropriateness?
3. Speech: Clarity, speed, volume, stream, form, quantity, quality
   
   • Related to both mood and thought
4. Thought: Themes, Quantity, Preoccupations, Forms (intellectualising, derailment)
   
   • Assess Suicidality/suicidal ideation
5. Perception: Sensory disortion, hallucinations, Illusions, Dissociation
   
   • Whether these are linked to mood
6. Cognition: Alertness, orientation, attention, memory
   
   • Intelligence (general impression, may be affected by distress)
7. Insight: Recognition of condition, compliance, labelling of symptoms
   
   • Important factor for treatment planning
8. Judgement: Capacity to make sound decisions, evaluate behaviour
   
   • Ask practical questions

Question 11

What are the main components of a psychological report?

Answer 11

1. Referral: Often very brief, captures key info ( who, when)
2. Presenting Problems; What are the current symptoms and concerns
   
   • Probe for related symptoms, coping styles, client understanding
   • Dimensions: Duration, Frequency, Intensity and Course (ABC approach)
3. Psychiatric History; What, When, Dimensions, relation to current
   
   • Treatment recieved - what has helped in the past
4. Medical History; Accidents, Chronic conditions, factors that impact interventions
5. Forensic History; Convictions, consequences, circumstances
6. Substance Use; History and type, causes, impact on life
7. Medication; what and why, impact on life and symptoms (side effects)
8. Family History; Family dynamics, structure and relations, medical history
   
   • Can be represented graphically (genogram)
9. Findings

Question 12

What is a case formulation? What are the 4 Ps?

Answer 12

• A case formulation is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment.
• Biological,psychological and social factors are identified and categorised into
  
  • Predisposing: Risk factors eg family history, personality traits, low SES
  • Precipitating: Triggering factors eg injury, acute stress, death of family
  • Perpetuating: Maintaining factors eg chronic illness, substance use, toxic family dynamic
  • Protective: Mitigating factors eg no family history, effective coping strategies, good social support
• Note that factors can be in more than one category.

Question 13

What are some definional features of case formulation?

Answer 13

1. Clarifying hypotheses about clients
2. Facilitating understanding of clients holistically
3. Prioritising needs and concerns
4. Planing interventions
5. Determining outcome criteria
6. Predicting intervention reactions
7. Predicting obstacles to progress
8. Promoting systemic thinking about resistence or lack of progress
9. Identifying patterns in reactions
10. Identifying knowledge gaps
11. Refining theoretical processes
12. Delivering coherent understanding of past, present and future
13. Forming judgements about typical and atypical client features.

Question 14

Why is monitoring progress important in CBT?

Answer 14

• Monitoring progress allows for comparisons to be mad eover time, and even subtle changes in symptomology to be identified
• Information from measures should be discussed with the client with the aim of giving feedback about progress and engaging them in discussion

Question 15

How can assessments be tailored for ongoing measurement in CBT?

Answer 15

• Assessments should be tailored to the individual in addition to assessment of the symptomology of diagnosis
• Components of individualised assessments will depend on
  
  • The formulation: eg assess beliefs thought to underpin distress
  • The goals of treatment: eg if client wishes to go outside more often this should be added as a measurement
• Assessments should occur at baseline, and can be repeated at regular intervals throughout the course of treatment (depending on length of assessment)
  
  • Ethical consideration is the time to administer

Question 16

What are SUDS?

Answer 16

• SUDS are subjective units of distress, a central tool for CBT practice
• Identifying and quantifying emotional experiences helps clients become more aware of their emotions and develop EI if necessary
• The SUDS is a visual analogue scale from 0 - 100
  
  • Must be anchored to individual (what does 50 mean)
  • Quick and easy understanding of how the client is feeling
  • Allows clients to view emotions as a range rather than on-off

Question 17

What is the history and debate regarding case formulation?

Answer 17

• Introduced in 1969 following arguments by Meyer that 1) clients with the same complaint didnt respond to the same treatments 2) high rates of comorbidity
• Both a noun and a verb; Psychodynamic = formulating, CBT = formulation
• Case formulation needs to look at modalities (neglected, prioritized)
  
  • BASIC - SID; behaviour, affect, sensation, imagery, cognition, spirituality, interpersonal, drugs
• Bottom-up vs top-down
  
  • Bottom-up; map reliable case formulation to clients problems
  • Top-Down; theory applied to case
• Crucible metaphor: Collaborative empiricism is the heat, formulation develops over time from simple ingredients, the ingredients determine the outcome

Question 18

According to craig what are the 4 purposes of clinical interviews and some types of clinical interviews?

Answer 18

• Four Purposes:
  
  • Administration; eg eligibility requirements
  • Treatment; eg differential diagosis
  • Research; eg assessing new test reliability
  • Prevention; following from treatment and research
• Types of Interviews (apart from MSEs)
  
  • Case History; focus on historical sequence, critical antecedents
  • Diagnostic; categorisation and diagnosis
  • Follow-up; Single purpose usually evaluation
  • Forensic; ie court (more investigative, less collaborative)
  • Intake; obtain preliminary data
  • Etiology; determine theoretical cause of behaviour
  • Motivational Interviewing; emphasis on feedback and self efficacy
  • Orientation; introduction to protocol, informed consent
  • Screening; brief and specified

Question 19

What factors influence clinical interviews and what are Sullivans 4 phases of a clinical interview?

Answer 19

• Influences on interviews
  
  • Client approach; 1. Voluntary/involuntary, 2. Purpose/motive 3. Expectations 4. Perception of therapist
  • Therapist Approach; 1. Theoretical orientation 2. Beliefs and values
• Sullivans Interview phases
  
  • Formal Inception; explains interview and referral
  • Reconnaisance; learns presenting complaints
  • Detailed Inquiry; further assess based on initial phases
  • Termination, Planning, Intervention.

Question 20

What are 10 interview techniques?

Answer 20

1. Questioning
2. Clarification; usually done using another technique (questioning/restating)
3. Confrontation; Pointing out descrepancies (non-hostile)
4. Exploration; seeking further information about an issue
5. Humor; in moderation to reduce anxiety
6. Interpretation; most difficult technique, clients often agree with authority
7. Reflection; Re-state clients words to demonstrate understanding
8. Re-framing; Re-phase to better reflect reality (cognitive restructuring)
9. Restatement; restate clients words to seek clearer understanding
10. Self-disclosure; don’t overdo, use for therapeutic purposes

• Silence