Interview Assesment Flashcards
Definition + Purpose
◦ Clinical assessment involves an evaluation of an individual’s strengths and weaknesses…
◦ A conceptualization of the problem at hand (as well as possible etiological factors)…
◦ …and some prescription for alleviating the problem
◦ All of these lead us to a better understanding of the client/patient
◦ Assessment in clinical psychology is an ongoing process
◦ Symptoms will improve/worsen
◦ Treatments will have differing effects
◦ Our ability to successfully treat psychological problems is directly related to our ability to define the problems
◦ Are interviews fair and unbiased?
◦ Are treatment suggestions based on valid research?
◦ Is the clinician considering more than one possible outcome?
General Characteristics
◦ An interaction
◦ Each participant contributes and influences the other(s)
◦ Clinician facilitates responses to gain information
◦ Interviews vs. tests
◦ An interview falls between conversation and actual psychological test
◦ It is more purposeful and organized than a conversation, but not as formal or standardized as a
test
◦ Gives wider scope for an individualized approach
◦ The art of interviewing
◦ Success of interview is in part based on skill of interviewer
Interviewing Essentials and Techniques
◦ Training and supervised experience
◦ The physical arrangements
◦ Consider privacy and protection from interruption
◦ Note-taking and recording
◦ Moderate note-taking is ideal
Five Types of Interview Questions
-Open-ended Gives patient responsibility and latitude for responding “Would you tell me about your experiences in the Army?”
-Facilitative Encourages patient’s flow of conversation “Can you tell me a little more about that?”
-Clarifying Encourages clarity or amplification “I guess this means you felt like … ?”
-Confronting Challenges inconsistencies or contradictions “Before, when you said … ?”
-Direct Once rapport has been established and the patient is taking responsibility “What did you say to your father when he criticized your choice?”
Patient’s Frame of Reference vs/ Clinician’s Frame of Reference
◦ Why is s/he seeking help?
◦ Pressured to appease someone else?
◦ Under instruction from law official?
◦ Goals
◦ Understanding of therapy/consultation
CLINICIAN
◦ Be clear about the purpose of the interview
◦ Diagnosis, recommendation, etc…
◦ Remain focused
◦ Remember the primary aim of the interview
◦ Provide closure
◦ Provide patient with information about your views, and the next steps to be taken.
TYPES of interview
- The Intake-Admission Interview
- The Case-History Interview
- The Mental Status Examination Interview
- The Crisis Interview
- The Diagnostic Interview
- The Intake-Admission Interview
◦ A two way process
- To determine why the patient has come to the clinic or hospital
EG: Does the patient have some kind of diagnosable disorder?
- To judge whether the agency’s facilities, policies, and services will meet the needs and expectations of the patient
EG: Does this institution have the facilities to treat the patient, or should they be referred
elsewhere?
The Case-History Interview
◦ A social and personal history of the individual
◦ Provides a broad background and context in which both the patient and the
problem can be placed.
◦ Covers both childhood and adulthood, and it includes educational, sexual,
medical, parental-environmental, religious, and psychopathological matters.
◦ Informants
◦ Knowledgeable adults in the patient’s life that can provide additional information about the
patient
◦ Must be aware of how these can influence patient/clinican relationship
The Mental Status Examination Interview
◦ Form of thought
◦ Thought content: preoccupations, obsessions, delusions
◦ Ability to think abstractly
◦ Perceptions: hallucinations
◦ Memory: immediate, recent, remote
◦ Intellectual functioning
◦ Insight and judgment
The Crisis Interview
◦ Purpose of the crisis interview is to meet problems as they occur and to provide an immediate resource
◦ Deflect the potential for disaster and to encourage person to enter into a relationship with the clinic or make a referral so that a longer term solution can be worked out
◦ Such interviewing requires training, sensitivity, and judgment
The Diagnostic Interview
◦ Unstructured
◦ Free-form, content varies greatly between clinicians
◦ Unreliable in terms of consistency of diagnosis
◦ Structured
◦ Standard set of questions and follow-up probes in a specific sequence
◦ All patients asked the same questions
◦ More likely that two clinicians will come to similar conclusions (high inter-rater reliability)
◦ Most commonly used is SCID (Structured Clinical Interview for Disorders in DSM…)
◦ Different sets of questions for different disorders
Referral
◦ Referral by whom?
◦ Parent, friend, teacher, psychiatrist, judge
◦ Referral question(s)
◦ What aspect of a patient’s behavior needs attention and clarification?
◦ Example: Why is John disobedient?
Referral question can be directed by…
◦ Clinician’s theoretical orientation
◦ Psychodynamic, behavioral, etc…
◦ Choice of assessment instruments
◦ Theoretical orientation impacts which assessment tools the clinician will use
Rapport & Communication
◦ A key feature of a successful clinical interview
◦ Relationship between patient and clinician
◦ Does not mean friendship
◦ More difficult in group therapy
◦ Non-judgemental
◦ Acceptance
◦ Empathy
◦ Understanding
◦ Respect
◦ Competence
Communication
◦ Beginning a session
◦ Language
◦ The use of questions
◦ Silence
◦ Listening
◦ Impact of clinician (appearance, values, etc.)
Challengues
1) Cultural competence and ethical considerations
- Get into pairs/small groups to discuss the challenges clinicians may face during interviews concerning cultural competence and ethical considerations
- Study the hypothetical scenario where cultural differences impacted clinical interviews
- Identify potential challenges that may arise due to differences in backgrounds, values or communication styles
- Discuss strategies to promote cultural sensitivity and understanding during interviews
2) Handling emotional reactions
- Remain in your pairs or small groups to reflect on emotional reactions that clinicians may experience during interviews
- Share thoughts on managing personal emotions while maintaining professionalism and empathy
- Discuss effective strategies for dealing with intense distress or resistance from clients.
Difference between Validity and Reliability
To summarize the key points on reliability and validity as presented in the document:
Reliability:
Reliability refers to the consistency of a measure or instrument. In the context of interviews and psychological assessments, reliability evaluates whether the interview or test yields consistent results across different occasions or with different assessors. There are two common types of reliability:
1. Interrater Reliability: This assesses the level of agreement between two or more raters who are evaluating the same phenomenon. High interrater reliability indicates that multiple raters agree on the diagnosis or outcome, enhancing confidence in the assessment’s accuracy. Kappa Coefficient = the statistical index of inter-rater reliability 2. Test-retest Reliability: This measures the consistency of scores when the same test or interview is administered at different points in time. For structured interviews, this is especially important to ensure that patients with consistent symptoms are assessed similarly on multiple occasions.
Validity:
Validity refers to whether an assessment measures what it is intended to measure. It evaluates the accuracy of the interview or test in capturing the psychological construct of interest. The key types of validity include:
1. Content Validity: Assesses whether the interview or test adequately covers the full domain of the construct being measured (e.g., anxiety or depression). The content should reflect all relevant aspects of the variable. 2. Predictive Validity: Evaluates how well the interview predicts outcomes in the future. For instance, an interview designed to assess depression should predict future behaviors associated with depression. 3. Concurrent Validity: Refers to the degree to which interview scores correlate with other valid measures taken at the same time. This shows whether the test is effective in real-time comparison with other diagnostic tools. 4. Construct Validity: Looks at whether the interview or test measures the theoretical construct it is designed to assess. This involves examining whether the measure relates logically and theoretically to other variables and assessments.
Key Differences:
* Reliability is about consistency—whether the same results can be replicated under the same conditions. * Validity is about accuracy—whether the assessment measures what it claims to measure.
While an interview can be reliable (consistent results over time or across raters), it is not necessarily valid if it does not accurately assess the construct of interest. For example, an interview may consistently categorize a patient, but if it is not measuring the correct disorder, it lacks validity.
Suggestions for Improving Reliability and Validity
Suggestions for Improving Reliability and Validity
◦ Whenever possible, use a structured interview
◦ If one does not exist for your purpose, consider developing one
◦ This can be done by combining previous measures
◦ Develop good interviewing skills
◦ Volunteer
◦ Be aware of the patient’s motives and expectancies
◦ Be aware of your own expectations, biases, and cultural values
