L11 The Clinical Interview?

參考文獻(xiàn)：Pomerantz, A. (2013). Clinical psychology: science, practice, and culture (3rd ed.). Thousand Oaks, CA: SAGE Publications.

11.1 Clinical Interview Skills & Behaviors

Clinical Interviewing?Skills

? Quieting yourself?- not just stop speaking

- Reduce internal, self-directed thinking pattern

- Don’t be distracted by your unrelated thoughts

? Being self-aware

- Consider your interpersonal impact on others

- Be aware of your own traits and how others usually respond?to them

? Developing?a?positive?working relationship

- Interviews often happen at the start of treatment

- Attention, empathy, respect, and cultural sensitivity?can be helpful

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Clinical Interviewing Behaviors

Eye Contact; Vocal Qualities; Body Language & Posture; Verbal Tracking; Name Use; Making Behavioral; Observations, etc.

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11.2 Components of the Interview

11.2.1 Rapport

Positive, comfortable relationship between client and?interviewer

Allows client to feel safe and understood

? Built through:

Putting a client at ease?(eg chatting, SMall talks)

Acknowledging the challenges of the interview dynamic

Matching the client’s terminology,?metaphors, etc.?(verbal tracking)

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11.2.2 Techniques

? Directive Style?(Close-ended questions, short)

Ask specific, direct questions?(“When did your depression?start?”)

Pro: May get pertinent?information efficiently

Con: May not give client?opportunity to volunteer?important information

? Nondirective Style?(Open-ended questions, long)

Allow client to determine?course of interview

Pro: May be better for?building rapport

Con: May miss important?information because it did?not come up

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- Interviewer Responses

? Clarification

Questions that ensure that a psychologist understands what?the client is saying

Helps the client see that the psychologist is listening

Example: “I want to make sure I understand this correctly…”

? Confrontation?(not aggressive)

Similar to clarification but with a focus on inconsistencies

Point out the conflicting information and try to resolve?discrepancies

? Paraphrasing

Comments to ensure the client that they are being heard

Reflects the client’s words

? Reflecting feelings

Comments to recognize the client’s emotions

? Summarizing

Tying together different topics that?have been discussed

Connecting statements made at?different points

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11.2.3 Conclusions

At the end of the interview

Differ for different types of interviews, the client’s specific problems, and the setting

Can include: More Detailed Summarizing; Specific Diagnosis; Recommendations for Specific Treatment; Recommendations for AssesSMent, etc.

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11.3 Specific Types of Interviews

11.3.1 Intake Interviews

? Interviews to determine if the client needs treatment and whether the current facility can provide that treatment?- If not, enough information is obtained to determine what setting would be appropriate?(e.g., inpatient hospitalization, intensive outpatient program)

? Primary focus on the presenting problem:

- Main reason for seeking out treatment

- Details of the current problem(s)

- Mental health and treatment history

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11.3.2 Diagnostic Interviews

? Interviews focused specifically on determining the?presence of mental disorders

- Specific diagnoses

- Problem definition

- Case formulation

- Goal specification

? Vary from very unstructured to very structured

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Types of Diagnostic Interviews

? Unstructured: No standard set of questions or structured method for?integrating and summarizing obtained information

Psychologist decides:

- What topics to cover

- Screening questions

- Follow-up probes

- Rating system used for symptoms

- Means of determining diagnosis?(criteria vs. impressions)

? Structured: Very specific format for asking questions, determining followups, integrating and summarizing obtained information?- planned before interview happens

- Tied to particular sets of criteria such as DSM-5

- A manual specifies?instructions:

? What questions to ask

? What order to ask them

? How to ask them

? How to follow them up

? How to interpret answers

-?Strongest reliability & validity

- Long interview, less flexibility

? Structured Clinical Interview for DSM-5 (SCID)

- Gold standard structured diagnostic instrument

- Most disorders included (separate version for personality?disorders)

- Modular approach?- reduce time

- Training and supervision usually extensive

? Semi-Structured

- Blend of structured and unstructured approaches

- Provides:

? Areas that need to be covered

? Standard for rating symptoms

? Sometimes: “starter” questions

- Flexibility (may not provide):

? Follow-up questions/probes

? Exact wording for all questions

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11.3.3 Mental Status Exams

? Brief assesSMent of psychological and cognitive functioning?at the time of evaluation - quick, not detailed or comprehensive for diagnosis

? Involves direct questioning and the examiner’s?observations

? Used primarily in medical settings

? Not focus on personal history, background, or the presence of specific DSM symptoms; instead focus on:

- Appearance

-?Behavior?& psychomotor activity

- Attitude towards examiner

- Affect and mood

- Speech and thought

- Perceptual disturbances

- Orientation to person, place, and time

- Memory and intelligence

- Reliability, judgment, and insight

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11.3.4 Crisis Interviews

Address urgent problems and provide some immediate intervention.

? Suicide risk assesSMent

- Suicidal Ideation:?Are you thinking about killing?yourself?

- Suicide Plan: Have you thought of ways?you might hurt yourself??Do you have pills/weapons in?your house?

- Suicide Intent: saying goodbye, make plans for friends...

- Risk and protective factors

IS PATH WARM

Ideation - Threatened or communicated

Substance abuse - Excessive or increased

Purposeless - No reasons for living

Anxiety - Agitation / Insomnia

Trapped - Feeling there is no way out

Hopelessness

Withdrawing - from friends, family, society

Anger (uncontrolled) - Rage, seeking revenge

Recklessness - Risky acts, unthinking

Mood change (dramatic)

? Safety planning?- unique for each client

- Develop individualized plan to help client:

? Recognize warning signs

? Identify and use coping strategies

? Use social support

? Contact professional help

- Safety contracts or treatment commitments?sometimes developed and used in these situations: calling 911, making promises not to self-harm, etc.