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Assessment, Interviewing,

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How can we eliminate inaccurate/useless information? ... the Clinician may look at the facts related to the client's individual behavior ... – PowerPoint PPT presentation

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Title: Assessment, Interviewing,


1
Assessment, Interviewing, Observation in
Clinical Psychology
  • Dr. Kline
  • Florida State University

2
I. Clinical Assessment Questions
  • 1. What are goals of assessment?
  • 2. How is assessment carried out?
  • 3. What types of data are obtained?
  • 4. How does assessment allow us to make
    inferences regarding treatment?

3
Why do Clinicians make assessments?
  • While most individuals speculate why people
    behave the way they do, they arent formally
    trained to make assessments regarding others
    actions motives.
  • Clinical psychologists are trained to
    systematically formally examine behaviors of
    people to determine if there are mental problems,
    behavior problems, family dysfunctions,
    evidence of psychopathology.
  • By conducting assessments, Clinicians can
    determine an individuals diagnosis and the best
    course of action to treat the disorder/problem.
  • Unfortunately, while Clinicians may be more
    objective than lay individuals, they have their
    biases as well which effect the assessment tools
    they use to examine an individual possibly the
    treatment plan as well.

4
The Clinical Assessment Process
  • Clinicians gather information (data) on
    individuals in a formal systematic fashion to
    determine the problem subsequent treatment
    plan.
  • At each stage in the assessment process, the
    Clinician faces challenges such as
  • How do we gather the data?
  • How much information is enough?
  • What kinds of data are important (valuable)?
  • How can we eliminate inaccurate/useless
    information?
  • How do we put the information together to form a
    diagnosis?
  • How do we avoid our own biases coming into the
    picture?
  • Who gets to see the results of the assessment
    for what purposes?
  • How will the assessment results effect the
    clients?
  • How do we ensure confidentiality of the
    assessment?

5
Schematic view of Clinical Assessment Process
Data Processing Hypothesis Formation
Planning Data Collection Procedures
Collecting Assessment Data
Communicating Assessment Data
6
A. Clinical Assessment Issues
  • 1. Planning for Assessment
  • Before conducting a clinical assessment, we have
    to two issues to address.
  • a. What do we want to know?
  • b. How do we find out about it?
  • The answer to both questions hinges largely on
    the specific approach (psychodynamic, behavioral,
    humanistic, etc.) the Clinician is likely to
    adopt.
  • The Clinicians approach may have a large impact
    on the type of data they want to gather for their
    assessment.
  • Furthermore, the amount of data that could be
    obtained is vast (from biological to life record)
    so it would be difficult to know just how much
    data is necessary to make an accurate assessment.

7
Case Study Guide-provides a general overview of
the client
  • Levels of Assessment Some Representative Data
    from Each

1. Somatic- Blood type, RH factor, autonomic
stress response pattern, kidney liver
function, genetic data, basal metabolism, vision,
toxicology, neuroimaging data (fMRI, Cat,
Pet). 2. Physical- Ht, wt, sex, eye color, hair
color, body type 3. Demographic- Name, age,
address, phone, occupation, education, income,
marital status, of children. 4. Overt
Behavioral- Reading speed, eye-hand
coordination, frequency of fighting with
others, conversational skill, interpersonal
assertiveness, occupational competence,
smoking habits. 5. Cognitive- Response to
intelligence test items, reports on thoughts,
performance on tests of information processing
or cognitive complexity, response to tests of
reality perception and structuring. 6.
Emotional- Reports of feelings, responses to
tests measuring mood states, physiological
responsiveness. 7. Environmental- Location
characteristics of housing description of
cohabitants, job requirements
characteristics physical behavioral
characteristics of family, friends,
coworkers nature of specific cultural or
subcultural standards traditions general
economic conditions geographical location.
8
Factors Guiding Assessment Choices
  • 1. Often Case Study Guides are associated with a
    particular theoretical approach to clinical
    psychology.
  • This influences the kinds of questions data
    the Clinician will pursue.
  • E.g., a Clinician with a heavy biological
    orientation, will want to obtain biological data
    (fMRI, Pet, toxicology, etc.) to see if the
    behavior is related to an organic cause (brain
    infection, tumor, stroke, dementia, drug use,
    etc.).
  • 2. Diagnoses are also influenced by the
    theoretical approach the Clinician is adopting.
  • E.g., A Clinician with a cognitive-behavioral
    approach will not only make assessments regarding
    clients thinking skills, thought patterns, the
    maladaptive thoughts, but will tend to make
    diagnoses based on this paradigm as well
    (changing the clients maladaptive thoughts to
    reduce the problem behaviors.)
  • 3. Research on the reliability validity of
    assessment methods are used to determine which
    types of data are gathered.

9
Issues in Testing
  • A. Reliabilityconsistency with which a test
    measures what it purports to measure.
  • Types of reliability
  • inter-rated reliability
  • test-retest reliability

10
B. Validity
  • Types of validity
  • content validity-does test measure content area?
  • face validityon surface does test measure what
    its supposed to.

11
Validity contd.
  • Concurrent validity-does the index being used to
    measure a type of abnormal behavior agree with
    another index used to measure the same behavior.
  • Predictive validity-does measure accurately
    predict the occurrence of some event.

12
Goals of Clinical Assessment 3 goals
  • 1. Diagnostic Classification- Determining the
    diagnosis for the problem behavior. What is it?
  • 2. Description- understanding the social,
    cultural, physical context of behavior.
  • 3. Prediction- What will people do in a variety
    of settings based on their past behavior?

13
Why an accurate diagnosis is so important in
Clinical psychology?
  • 1. The appropriate treatment plan cannot be
    implemented until we have an accurate definition
    of what is wrong with the client.
  • 2. Research into causes of psychological
    disorders requires reliable valid
    identification of disorders accurate
    differentiation of one disorder from another
    (Nietzel et al., 2003).
  • 3. Classification allows multiple Clinicians to
    discuss a clients case or cases based on a given
    disorder accurately efficiently (i.e.,
    standardized of diagnosis).

14
Diagnostic standard in Clinical Psychology
  • In 1952, The American Psychiatric Association
    published its first official classification
    system, the Diagnostic and Statistical Manual of
    mental disorders. Several revisions have been
    made to the DSM over the years.
  • Clinicians currently use the fourth edition of
    the DSM or The DSM-IV. This version was
    published in 1994 and revised in 2000. Plans
    for a DSM-V are in the works!!
  • The DSM-IV is based on a multi-axial
    classification system.
  • Each individual is rated on 5 separate dimensions
    or axes.

15
Axis I Psychiatric disorders, excludes
personality disorders mental retardation.
  • Axis II Personality disorders mental
    retardation.
  • Axis III General medical conditions
  • Axis IV Psychosocial environmental problems.
  • Axis V Current level of functioning Global
    Assessment Scale

16
Axes I II comprise the classification of
abnormal behavior.
  • Most individuals consult a clinician for an Axis
    I condition (e.g., depression).
  • Clinician must examine if Axis II disorder is
    also present.
  • Axis II disorders make treating Axis I disorders
    more complicated.

17
Axis I Disorders
  • 1. Disorders Usually First Diagnosed in Infancy,
    Childhood, or Adolescence
  • separation anxiety
  • attention-deficit/hyperactivity disorder
  • autism

18
2. Mood disorders-disturbances in emotion and
behavior.
  • Major Depression (unipolar depression)
  • Mania
  • Bipolar disorder (Manic Depression)
  • Cyclothymia (Chronic mood disorder)
  • Dysthymia

19
3. Schizophrenia-disturbances of thought,
emotions, and behavior.
  • Different types
  • Paranoid Schizophrenia
  • Catatonic Schziophrenia
  • Undifferentiated Schizophrenia

20
4. Anxiety disorders
  • Generalized anxiety disorder (GAD)
  • Phobias
  • Panic Disorder
  • Obsessive-compulsive disorder (OCD)
  • Post-traumatic stress disorder (PTSD)
  • Acute Stress Disorder

21
5. Sexual disorders
  • Gender Identity disorder
  • Transvestism
  • Pedophilia
  • Voyeurism
  • Exhibitionism
  • Sadism/Masochism
  • Rape trauma

22
Axis II personality disorders
  • Schizoid PDperson is aloof, has few friends,
    is indifferent to praise/criticism.
  • Borderline PDerratic behavior, impulsivity, and
    instability in relationships/ mood, self-image.
  • Narcissistic PDpeople who have malignant
    grandiosity of their own self-importance.

23
Axis II (contd.)
  • Histrionic PD- marked by an overly dramatic
    display of behavior that is for show (no real
    substance underneath).
  • Antisocial PDmarked by violent acts lack of
    empathy for others.

24
2. Collecting Assessment Data Four main sources
  • 1. Interviews- Clinicians may simply ask the
    client questions to find out what is happening in
    his or her life.
  • Advantages of interviews
  • Allows Clinician to obtain a sample of the
    clients verbal non-verbal behavior in a social
    interaction.
  • No equipment is necessary to conduct an
    interview.
  • Interviews are flexible.

25
2. Observations Clinicians may want to observe
non-verbal behaviors in a variety of situations.
  • The goal here is to look at what the client is
    doing rather than what he/she is saying.
  • Clinicians may observe
  • clients eye contact
  • how distractible is the client
  • Does the client seem comfortable or agitated
  • Is the client coherent or rambling
  • Does client keep changing topic in social
    interaction?

26
3. Tests- Clinicians may administer tests to
assess a variety of abilities, functions, traits,
aptitudes.
  • Advantage of tests
  • Tests may be more reliable than interviews.
  • Tests that have been standardized, allow
    Clinicians to obtain data on a client or multiple
    clients that can be compared with individuals in
    the general population.
  • Responses on tests can be quantified, providing
    more objective data with which to make a more
    accurate assessment.

27
4. Life Records Clinicians obtain data about a
client from this life history.
  • Our life history may provide useful information
    about our past behavior.
  • Examples of life records
  • Academic transcripts, driving record, financial
    records, diaries/journals, occupational history,
    etc.
  • Advantages of Life records
  • Easy to obtain
  • You dont have to worry about memory problems or
    biases in obtaining this type of data.
  • Allows you to summarize a clients behavior over
    a long span of time.

28
3. Processing Assessment Data
  • Once the Clinician has obtained data on a client,
    they have to make an inference regarding the
    clients diagnosis subsequent treatment plan.
  • This is easier said than done, as clinical
    inference can be tricky.
  • Again, the theoretical approach of the clinician
    plays a large role in how they interpret the
    assessment data theyve obtained.

29
Three main ways Clinicians view Assessment
Information
  • 1. Samples- Clinicians may examine the raw
    behavior of the client (E.g., What the client
    did?)
  • 2. Correlates- The sample of a clients raw
    behavior may be viewed as a correlate to other
    aspects of their life (Neitzel et al., 2003).
  • 3. Signs- The raw behavior sample may be viewed
    as a sign of other less obvious client traits
    (characteristics).

30
1. Sample behavior
  • A person overdoses on pain medication in a hotel
    room one night before going to bed.
    Fortunately, the individual is saved after being
    discovered by the hotel maid and is rushed to the
    hospital.
  • The incident is the sample in this case. On this
    data alone the Clinician might infer the
    following
  • Conclude the client had access to lethal meds.
  • Client did not wish to be saved as no one was
    warned of the suicide attempt.
  • Under similar situations, the client may attempt
    suicide again.
  • ProblemsNo effort is made by the Clinician to
    ascertain why the client made the attempt in
    the first place.

31
2. Correlates- The clients behavior may be
viewed for its correlation with other
individuals behaviors.
  • The client is likely to be elderly, single,
    divorced, or widowed and lives alone with a
    physical ailment.
  • The client is or has been depressed.
  • The client has little support from family
    friends.
  • With the correlates method, the Clinician may
    look at the facts related to the clients
    individual behavior as well as the how this
    behavior is related to the Clinicians knowledge
    base of factors associated with suicide attempts.
  • Inferences are more accurate when more
    information is known about the relationships
    between variables.

32
3. Signs- The suicide attempt may be viewed as a
sign of other lesser known client traits.
  • Inferences made from sign perspective (Neitzel et
    al., 2003)
  • The clients aggressive impulses have been
    turned against the self.
  • The clients behavior reflects intrapsychic
    conflicts.
  • The pill taking may be an unconscious cry for
    help.
  • Here a Clinician with a psychodynamic approach
    makes inferences well beyond the scope of the
    assessment data in determining why the individual
    made the suicide attempt.
  • Caution the sign approach may lead to inaccurate
    inferences regarding a clients motives, actions,
    traits, etc. This is one of the fundamental
    problems using such a method. Nevertheless,
    sometimes Clinicians go with a hunch in
    explaining why a person behaved a given way.

33
4. Communicating Assessment Data
  • Once the Clinician as assessed the data they
    write up a detailed report for other Clinicians
    and professionals to view.
  • This report needs to be clear, relevant to the
    treatment outcomes proposed, and efficient for
    the treatment to be implemented.

34
II. Clinical Interviews
  • Clinicians have a conversation with the client
    with the purpose of learning more about the
    client.
  • This allows the Clinician to both observe verbal
    non-verbal behavior in a social interaction
    (providing two sources of information).

35
A. Types of Clinical Interviews
  • 1. Intake interviews- are the most common form
    of interviews in which clients come to clinicians
    because of a problem they are having.
  • Clinicians try to determine several things from
    intake interviews
  • Can I help this person?
  • Is this clients problem within my area of
    expertise?
  • Will this person benefit from treatment?
  • Can I make a diagnosis of the problem?
  • Can I establish a rapport with this person to
    treat them?

36
2. Problem-Referral Interviews
  • In these interviews, the client has been referred
    to the Clinician from another sources or agency
    (psychiatrist, court, school, employer, social
    service agency, etc.).
  • These individuals are sent to the Clinician to
    address a specific referral issue.
  • Examples include
  • Is the person stand to fit trial?
  • Is the person psychotic?
  • Is the person mentally retarded or
    developmentally delayed?
  • Is the parent fit for custody? Is the parent in
    the best interest of the child?

37
3. Orientation Interviews
  • These interviews are conducted to provide the
    client with information regarding the assessment,
    treatment, or research procedures to be
    implemented.
  • Advantages
  • 1. Client learns more about assessment
    treatment outcomes in his/her situation.
  • 2. Are important for research participants so
    that we can learn more about assessment
    treatment outcomes (e.g., efficacy of therapeutic
    methods.)

38
4. Termination or Debriefing Interviews
  • These interviews are conducted once assessment
    has been completed. Essentially, they allow the
    Clinician to convey what they found during the
    assessment.
  • E.g., following a problem-referral interview the
    clinician may have enough information to convey
    the answer the client regarding the referral
    question.
  • Yes, you are fit to stand trial!!)

39
5. Crisis Interviews
  • If a client is having a crisis (e.g., rape
    hotline, domestic abuse, etc.) where they need
    the Clinician immediately, a crisis interview may
    be conducted.
  • Crisis interviews are designed to provide
    immediate social administrative support,
    collect assessment data, and provide help as
    quickly as possible.
  • Because this is a crisis, the Clinician needs to
    be as calm as possible determine if the client
    is a danger to themselves or others. The
    Clinician may also have to determine if the
    individual needs to be hospitalized for their
    safety.

40
B. Interview Structure the most fundamental
part of an interview is its structure.
  • Structure refers to the degree to which the
    interviewer determines the content and course of
    the conversation.
  • There are two basic kinds of structure for
    interviews
  • 1. Nondirective interviews -in which the
    clinician does a little as possible to stop the
    natural flow of the conversation with the client.
  • 2. Structured interview -the interview is
    carefully planned with a systematic format.

41
Structured interviews
  • To make reliable and valid diagnoses, clinicians
    need to gather standardized information on
    patients.
  • SCID (Structured Clinical Interview)- a
    structured interview for Axis I of the DSM.
  • Questions are in prescribed order for interviewer
    to ask. The SCID is a branching interview, which
    means the patients response to one question,
    will determine the next question asked.

42
C. Stages in the Interview Basic format
  • Stage 1 Beginning the Interview The clinician
    begins the interview in a comfortable setting,
    and by trying to establish rapport with the
    client.
  • This can be done by
  • Sitting fairly close to the client (when
    possible)
  • Keeping physical barriers between the client
    Clinician to a minimum
  • Start interview with non-threatening small talk
    to allow the client time to relax
  • Review clients referral or background info so
    the Clinician may have some information on the
    client before starting the interview.
  • Provide reassurance and support.

43
Stage 2 The middle of the interview
  • The clinician should try to make the transition
    from the beginning to the middle of the interview
    as smooth as possible.
  • Non-directive tactics Most Clinicians begin the
    second stage of the interview with non-directive
    open-ended questions.
  • E.g., What brings you here today?
  • This puts onus on client allows them to direct
    the flow of the conversation.

44
Active Listening
  • Is a non-directive tactic where the clinician
    responds to the clients speech in ways that
    indicate understanding facilitate further
    communication.
  • E.g., Clinician may say something like, I see
    or Im with you, in response to a major point a
    client has just made.
  • Related to this concept is paraphrasing in
    which Clinicians restate what their clients say
    to demonstrate they are listening to them and are
    willing to give the client a chance to correct
    the comment if misinterpreted.
  • Rogers called paraphrasing reflection.

45
Reflection examples
  • Example A
  • Client Sometimes I get so mad at my boss, I
    could just kill him
  • Clinician You would just like to get rid of
    your boss altogether.
  • Example B
  • Client Sometimes I get so mad at my boss, I
    could just kill him.
  • Clinician Your boss really upsets you sometimes.
  • In Example A, the Clinician restates the clients
    remark. This does show active listening. In
    Example B, the Clinician reflects the emotion or
    feeling made in the clients remark.
  • Both versions usually will facilitate the client
    to continue discussing the program.

46
Directive techniques
  • Clinicians may also use more directive tactics to
    determine whats bothering their clients. This
    is usually done after a good rapport has been
    established so as to avoid threatening the
    client.

47
Stage 3 Closing the Interview
  • The Clinician closes the interview by making sure
    they have enough information for assessment as
    well as continuing to establish a good rapport
    with the client.
  • The clinician may reiterate what was covered in
    the interview for clarification and for the
    chance to ask more questions before closing the
    interview.
  • This allows the clinician to summarize the
    interview content and to make sure nothing was
    misunderstood or omitted.
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