module 9 Assessment Interview Flashcards
describe different types of assessment interviews and interview strategies
STRUCTURED INTERVIEWS
follow set questions. There are many of these, eg.
DICA-administered by layperson. Comes in forms for children, adolescents and their parents. Not super reliable.
DIS (diagnostic interview session)-non professional administration. variable reliability and validity.Does not correlate as nicely as would like with dsm 4/5 dx.
SADS (schedule for affective disorders & schizophrenia)-administered by professional or trained social worker. Likert scales. Gives summary scales for;
1. mood & ideation
2. endogenous features
3. depressive-associated features
4.suicidal ideation and behaviour
5. anxiety
6. manic syndrome
7. delusions/hallucinations
8. formal thought disorder.
Comes in 3 parts-past week, long term (L) and client changes (C). Also available in children form. High inter-rater reliable apart from thought disorder. Childrens SADS (K-SADS) as well as considering major depressive disorder, also considers phobias and conduct disorders. less reliable than adult version.
SCID (Structured clinical interview for the DSM)-clinician administered. one of the most frequently used formal interviews. Slightly different forms for inpatients/outpatients etc. Contains modules which may be skipped based on clinical judgement and also has some open ended questions. Wide area of modules available for testing but inter-rater dx is more variable than ideal.
CATEGORIES OF FREQUENTLY USED STRUCTURED INTERVIEWS;
1. ASSESSMENT of clinical disorders;
a) SADS
b)K-SADS
c)DIS (diagnostic interview schedule)and DISC (children) & DISA (adolescents)
d) SCID for dsm iv or now there is one for dsm v.
2. ASSESSMENT of personality disorders;
a)Structured Interview for DSM-iv Personality disorders (SIDP)
b) Personality disorder examination (PDE)
c) Structured clinical interview for DSM-3-R Personality disorders (SCID-ii)
3. FOCUSED structured interviews;
1)Anxiety disorders interview schedule (ADIS)
2) Diagnostic interview for borderlines (DIB)
3) Psychopathy checklist (PCL)
4) Structured interview for dsm-iv Dissociative disorders (SCID-D)
5) Structured interview of reported symptoms (SIRS)
6) Psychosocial pain inventory (PSPI)
7)Comprehensive drinker profile (CDP)
8) Eating disorder examination (EDE)
9) Structured interview of sleep disorders (SIS-D)
10) substance use disorders diagnostic schedule (SUDDS)
In very general terms, it is thought structured interviews have better reliability, but sometimes thought has less client rapport and inability to taper to individualizations of dx/tx plans.
UNSTRUCTURED INTERVIEWS
Poor inter rater reliability but better (sometimes) for establishing rapport, and open ended questions allow for greater understanding/exploration of individual. Able to get more nuanced info.
Need to show genuine interest/care for client. Better not to ask “why…” as often makes client defensive. So better approach is “what is your understanding of….”, “how did that make you feel…..” etc. Also best if before time, allow client to know time approaching, allow their thought to finish, provide summary of what occurred and and future possible directions etc.
Client-centred approaches emphasize the importance of staying with a client for their self-exploration, behavioral interviews emphasize antecedents and consequences of behaviours, and family therapy focusses on interactive system processes.
It is a challenge to ensure that the interviewer documentation of the interview does not misinterpret/misrepresent what has been said. It is also to be remembered that client accounts are naturally reconstructions of events, and not always accurate.
identify potential bias on the part of the interviewer and the client
Clients who are warm or easily likeable, may be judged as more competent than they are.
Confirmatory bias may occur when the interviewer believes a certain diagnosis likely, and so proceeds to elicit confirmatory evidence and ignores/does not look for denying info.
A psychologist’s preference for school of thought may similarly bias by adopting an approach most likely to confirm clinical suspicions.
Some interviewers may erroneously focus on behavioural traits as opposed to situational determinants.
Halo effect and primacy effect can also create bias.
Clients may lie, confabulate, misremember, ignore, deny or not try.
conduct an effective assessment interview.
There is no right/wrong way to conduct an interview. Some like to aim for a diagnosis, and search for diagnostic clues, compare to diagnostic criteria, take a psychiatric history, form a dx, and give px and tx plan.
Others deny the use of a formal dx, and prefer to outline a client’s coping style, social supports, family dynamics and the nature of any disabilities.
CHECKLIST FOR ASSESSMENT INTERVIEW/DIAGNOSIS (note not all may be relevant);
a) PRESENTING problem and its history:
1) description of the problem
2) initial onset
3) changes in frequency
4) antecedents/consequences
5) intensity and duration
6) previous tx
7) attempts to solve
8) formal tx
b) FAMILY background;
1) socioeconomic level
2) parents’ occupations
3) emotional/medical history
4) married/separated/divorced
5) family constellation
6) cultural background
7) parent’s current health
8) family relationships
9) urban/rural upbringing
c) PERSONAL history;
i) Infancy
1) developmental milestones
2) family atmosphere
3) amount of contact with parents
4) early medical history
5) toilet training
ii) Early and middle childhood
1) adjustment to school
2) academic achievement
3) hobbies/activities/interests
4) peer relationships
5) relationship with parents
6) important life changes
iii) Adolescence
1) all areas as per middle childhood
2) presence of acting out (legal, drugs, sexual, truancy)
3) early dating
4) reaction to puberty
5) childhood abuse
iv) early and middle adulthood
1)career/occupation
2) interpersonal relationships
3) satisfaction with life goals
4) hobbies/interests/activities
5) romantic relationships/marriage
6) domestic violence
7) medical/emotional history
8) relationship with parents
9) economic stability
10)substance abuse
v) Late adulthood
1) medical history
2) ego integrity
3) reaction to declining abilities
4) economic stability
vi) miscellaneous
1) self concept (like/dislike)
2) happiest/saddest memories
3) earliest memory
4) fears
5) somatic concerns (headaches, stomachaches etc)
6) events that create happiness/saddness
7) recurring noteworthy dreams.
If interview is recorded, should be explained, and informed consent given.
Try to be genuine, empathetic and warm. Be unassuming. Consider aspects from Biological, Psychological and Social areas whose questions may need answering. Predict person’s level of safety/what you need to do, how to help person. Use info that is reliable (is accurate) and valid (is useful).
May also need to ask if previously been in therapy what aspects they liked/didn’t like?
May need to also ask if there is anything else the client believes you should know? Also, “how can i help you?-might reveal more re client’s expectations.
Treatment plan should be a collaboration between clinician and client.
