Clinical Interview Skills

The Clinical Interview

• Feedback is an element common to all kinds of psychological assessment.
• Clinical psychologists provide their clients with the results of tests or interviews that have been conducted.
• Feedback can come in the form of a face-to-face meeting, a written report, or other forms.

The Interviewer

• The most pivotal element of a clinical interview is the person who conducts it.
• Skilled interviewers are masters of the technical aspects of the interview and, possess broad-based wisdom about the human interaction it entails.

General Skills

• What should be quieted is the interviewer's internal, self-directed thinking pattern.
• To the extent that interviewers are preoccupied by their own thoughts, they will struggle in the fundamental task of listening to their clients.
• Maximized is the interviewer's ability to know how he or she tends to affect others interpersonally and how others tend to relate to him or her.
• Skilled interviewers are cognizant of their unique traits, including their cultural assumptions as well as more superficial characteristics, and consider their effect on the interview process.
• Attentive listening, appropriate empathy, genuine respect, and cultural sensitivity play significant roles in developing positive working relationships.
• Positive working relationships are always a function of the interviewer's attitude as well as the interviewer's actions.

Specific Behaviors

• Eye contact facilitates listening and communicates listening.
• Eye contact is a specific behavior that requires cultural knowledge and sensitivity an appropriate amount of eye contact enables the client feels heard.
• General rules for the Interviewer's body language includes facing the client, keeping an attentive attention, minimizing restlessness and displaying appropriate facial expressions.
• The client's body language can be misinterpreted by an interviewer whose knowledge of the client's cultural background is deficient.
• Skilled interviewers have mastered the subtleties of the vocal qualities of language.
• Interviewers use pitch, tone, volume, and fluctuation in their own voices to let clients know that their words and feelings are deeply appreciated

Tracking

• Effective interviewers repeat key words and phrases back to their clients to assure them that they have been accurately heard.
• Interviewers skilled at verbal tracking monitor the train of thought implied by clients' patterns of statements.

Referring

• Presumptuous mistakes that can jeopardize the client's sense of comfort with the interviewer includes, inappropriately using nicknames, omitting a missing "middle" name, or unnecessarily using a first name with no honorifics

Observing Client Behavior

• Behaviors during an interview allows the psychologist to consider not only what the client said but how the client said it.
• "How" a client states a fact can offer important information that a psychologist can respond to during an interview and to understand the client.

Rapport

• Rapport refers to a positive, comfortable relationship between interviewer and client.
• Clients feel that the interviewers have "connected" with them and empathize with their issues.
• Interviewers put the client at ease by, engaging in small talk about innocuous topics.
• Invite clients to ask questions about the interview process to provide them with a sense of knowledge and control that can also that can improve their comfort level.
• Enhance rapport by noticing how the client uses language and then following the client's lead.
• Interviewers pick up on the client's vocabulary and, as much as possible, speak in similar terms

Technique

• Technique is what an interviewer does with clients.
• It is the tools in the interviewer's toolbox, including questions, responses, and other specific actions.

Interview Styles

• Directive questions tend to be targeted toward specific pieces of information, and client responses are typically brief.
• Direct questioning can provide crucial data that clients may not otherwise choose to discuss such as historical information, the presence or absence of a particular symptom of a disorder, frequency of behaviors, and the duration of a problem
• Indirect questioning, conversely, can provide crucial information that interviewers may not otherwise know to inquire about.
• This allows the client to expand on any elements the interviewer believes is essential.

Interviewer Responses

• Interviewing technique consists of what the interviewer chooses to say.
• The interviewer's questions and comments can span a wide range and serve many purposes.
• Common categories of interviewer responses include: open- and closed-ended questions, clarification, confrontation, paraphrasing, reflection of feeling, and summarizing.
• Open-ended questions allow for individualized and spontaneous responses from clients that tend to be relatively long.
• Closed-ended questions allow for far less elaboration and self-expression by the client but yield quick and precise answers.
• Open-ended questions are the building blocks of the nondirective interviewing style whereas whereas the directive interviewing style typically consists of closed-ended questions.

Clarification

• The purpose of a clarification question is to make sure the interviewer has an accurate understanding of the client's comments.
• Clarification questions communicate to the client that the interviewer is actively listening and processing what the client says.

Confrontation

• Interviewers use confrontation when they notice discrepancies or inconsistencies in a client's comments but focus on apparently contradictory information provided by clients.

Paraphrasing

• Paraphrasing is used simply to assure clients that they are being accurately heard by restating the content of clients' comments, using similar language.
• A paraphrase usually doesn't break new ground; instead, it maintains the conversation by assuring the client that the interviewer is paying attention and comprehending.

Reflection

• Reflections of feeling are intended to make clients feel that their emotions are recognized, even if their comments did not explicitly include labels of their feelings.
• Reflecting a client's feelings often involves an inference by the interviewer about the emotions underlying the client's words.

Summarizing

• Summarizing usually involves tying together various topics, connecting statements made at different points, and identifying themes that recur during the interview.
• Summarizing conveys to clients that they have been understood but in a more comprehensive, integrative way.

Conclusions

• The conclusion can take a number of different forms, depending on the type of interview, the client's problem, the setting, or other factors.
• Conclusions can be similar to a summarization.
• Conclusions can offer providing an initial conceptualization of the client's problem.
• Conclusions can be a specific diagnosis, or may involve recommendations for further evaluation.

Pragmatics of the Interview

• There are good reasons for taking notes.
• Written notes are more reliable than the interviewer's memory, and many clients expect the interviewer to take notes.
• The process of note taking can be a distraction both for the interviewer and for the client.
• Effects of note taking are highly dependent on the situation, including how a client interprets the use of any mode of note taking.
• Clinical psychologists may prefer to audio or video-record the session, which requires obtaining written permission from the client.
• Recordings can, with some clients, hinder openness and willingness to disclose information
• An explanation of the rationale for the recording is typically appreciated by the client.
• Interview rooms convey the message that the clinical interview is a professional activity but one in which warmth and comfort are priorities.
• A table or desk may be positioned between the chairs, small side tables may accompany each chair.
• Interview rooms facilitate gathering information and building rapport in a private setting free of interruptions.
• Clinical psychologists usually steer clear of overtly personal items such as family photos, souvenirs, and memorabilia and personal items influence the content of the interview.
• Interviewers routinely explain, policies regarding confidentiality as early as possible to clients.

Types of Interview

• Types of interviews include: Intake Interviews, Diagnostic Interviews, Mental Status Exam, and Crisis Interviews

Intake Interviews

• The purpose of the intake interview is essentially to determine whether to “intake” the client to the setting.
• These determine whether the client needs treatment, what form of treatment is needed, and whether the current facility can provide that treatment.
• Intake interviews typically involve detailed questioning about the presenting complaint.

Diagnostic Interviews

• The purpose of the diagnostic interview is to diagnose by assigning DSM diagnoses to the client's problems.
• The effectiveness of the recommendations and subsequent treatment may be increased when the interview yields a valid, specific diagnosis.
• Diagnostic interviews include questions that relate to the criteria of DSM disorders and clinical psychologists prefer structured interviews.
• A structured interview is a predetermined, planned sequence of questions that constructed for diagnostic purposes.
• An unstructured interview, involves no predetermined or planned questions, but interviewers improvise in looking for information relevant to the topic.

Mental Status Examination

• The mental status exam is employed most often in medical settings to assess how the client is functioning at the time of the evaluation.
• It captures the psychological and cognitive processes of an individual "right now".
• It includes such factors as, Appearance, Behavior/psychomotor activity, Attitude toward examiner, Affect and mood, Speech and thought, Perceptual disturbances, Orientation to person, place, and time, Memory and intelligence, Reliability, judgment, and insight
• Considerations during the mental status exam include: Level of consciousness, Orientation, Gross/fine motor movement, dress grooming
• Level of consciousness is the client's level of alertness and responsiveness to questions or other stimuli.
• Orientation is Awareness of date/time, current location, and current situation (e.g., reason for appointment).
• Gross/fine motor movement determines the client's gait, posture, manual dexterity, etc.
• Evaluates dress/grooming and hygiene, by assessing whether the client neatly dressed or more disheveled and whether they are attending to personal hygiene.
• Other considerations during the mental status examination includes Speech, Affect, Mood, Attention/working memory, Memory

Crisis Interviews

• It is designed not only to assess a problem demanding urgent attention (most often, clients actively considering suicide or another act of harm toward self or others) but also to provide immediate and effective intervention for that problem
• Quickly establishing rapport and expressing empathy for a client in crisis, especially a suicidal client, are key components of this type of interview.
• Provides an immediate, legitimate alternative to suicide can enable the client to endure what problems that feel less severe or solutions may be more viable.

Communication Drills

• Communication Drills help to enhance aspects of effective interpersonal communication with trauma survivors.
• There are four types of drills developed for this exercise: Focusing Drill 1, 2, & 3, Attitude Adjustment Drill, Acknowledgment Drill, and Closure Drill
• The objective of focusing drill #1 to hold position remaining aware of the other person as opposed to wandering messages in our mind or physical aspects of our own bodies.
• he goal of focusing drill #2 to remain attentive and still giving your attention to the other person while releasing personal internal dialogue and physical discomfort. The goal of focusing drill #3 is to reduce "reactivity" and enhance ability to remain “intentional".