Chapter 6 Assessment: Interviewing and Observation INTRODUCTION TO CLINICAL PSYCHOLOGY 2E HUNSLEY & LEE PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UWO.

Chapter 6Assessment: Interviewing and Observation

INTRODUCTION TO CLINICAL PSYCHOLOGY 2EHUNSLEY & LEE

PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE, UWO

Interviewing and Ethics Type of Interviews General Issues in Interviewing Observations Observations: Self-Monitoring

Topics

Confidentiality: A cornerstone of psychotherapy – all information must remain private between the therapist and client

Limits on confidentiality: Danger to self Danger to others Harm to children/elders Judge superseding confidentiality (privilege)

All Canadian provinces have mandatory child protection laws

Interviewing and Ethics

Unstructured interviews: Clinician interviews the client based on a loose set of goals and questions Open questions: allow and encourage client to

answer in elaborate manner Closed questions: Yes or no questions

Semi-structured interviews: Specific questions set by clinician (or treatment clinic) that allow some flexibility in how and what the clinician asks

Type of Interviews

Structured diagnostic interviews: Very specific format for asking questions and for determining follow up questions

Structured Clinical Interview for Axis I Disorders (SCID): Designed to cover DSM disorders SCID-I: More comprehensive – covers all DSM disorders SCID-CV: Only most common disorders

Type of Interviews

Structured diagnostic interviews (cont.): Anxiety Disorders Interview Schedule (ADIS-

IV): Designed to cover in more depth DSM anxiety disorders and common co-morbid disorders

Primary Care Evaluation of Mental Disorders (PRIME-MD): Brief measure used in primary care to screen for mental disorders (brevity makes it less reliable)

Dominic Interactive – developed by Canadian researchers for children aged 6 – 11 years

Type of Interviews

Attending skills: Important components of active listening Attention to body language: eye contact, leaning

forward, head nods, etc. Absence of verbal activity Restating what the client said and checking if that

was correct Rephrasing/clarifying Non-direction reflection of feeling Summarizing

General Issues in Interviewing

Focus is on the client: Clinician does not self-disclose or convey things that they are struggling with

Respectful and non-judgemental Non-blaming stance

Cultural sensitivity Canada is an increasingly multicultural society Knowledge of self and own culture Knowledge of others and differences ‘Cultural humility’ – openness to differences

(without pathologizing)

General Issues in Interviewing

Importance of defining the problem: Clients are often vague about presenting problems Clinician must know what is normative behaviour Questions about the frequency, duration, and

intensity of the problem Questions about the meaning of the problem

e.g., Tell me what you mean by “depressed”

General Issues in Interviewing

Importance of defining the goals for treatment: Clients often do not know what therapy can do Goals must be important to the client Goals must be expressed in terms of the ways

people behave Goals must be small, simple, and achievable Goals must be in positive terms (e.g., “how would

you know if therapy worked?”)

General Issues in Interviewing

Suicide assessment: Importance of asking direct questions. For example: Specific thoughts about suicide Past attempts Plans for committing suicide (obtaining means) Ever cut yourself intentionally? What are the reasons for committing suicide Friendship or support system in place?

General Issues in Interviewing

Interviewing couples: Importance of flexibility and interpersonal skills of the clinician to deal with two individuals; also importance of structuring and directing the interview

Interviewing families: Similar challenges as with couples – but with the difficulty of establishing rapport with many individuals at once

General Issues in Interviewing

Interviewing older adults: Knowledge of life span issues without stereotyping (possible concerns with declining health, loss of autonomy, bereavement, mortality)

Interviewing children and adolescents: Using age appropriate behaviour and language; not leading the child to an answer or response; less eye contact is often helpful; knowledge of current media/toys/games

General Issues in Interviewing

Attention to many facets of the client during the interview: (e.g., client activity level, attention span, impulsivity, tone of voice, self-reflectiveness, etc. )

Direct observations: observing the client in different environments if possible (e.g., child with ADHD at school)

Observations

Self-monitoring: Strategy for clients to write down/log information throughout the day on a particular behaviour (e.g., smoking, food intake, headache, interpersonal interaction) Helps decrease memory errors Provides additional information about context Reactivity: How self-monitoring can effect the

behaviour being evaluated

Observations: Self-Monitoring

Ecological Momentary Assessment: (a.k.a. experience sampling) gathering data about emotions, thoughts, behaviours or experiences through the use of a PDA, pager, or other device that prompts the user randomly throughout the day Used in both research as well as assessment and

treatment

Observations: Self-Monitoring

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