Psychodiagnostic Methods: Clinical Assessments

• Psychodiagnostic methods involve clinical interviews.
• Psychologists are like detectives trying to solve a case when conducting assessments.
• Assessments require gathering data from various sources.
• Sources of information include written tests, personal interviews, job history, and reports from other physicians, therapists, and counselors.
• A clinical psychologist compiles a "case history" or in-depth story of a person's inner and outer life.
• Past and present life situations are considered.
• Assessments for children struggling in school differ from those for suspected criminals.
• Assessments for soldiers in Afghanistan experiencing trauma differ from those seeking depression treatment.
• Military psychologists use observational or interview-type approaches to assess soldiers.
• The goal is to determine an effective immediate intervention or the need for removal and admission to a military facility.
• Psychotherapists in private settings have more assessment flexibility than those in mental health facilities or hospitals.
• Some therapists assume the same treatment works for every patient.

Diagnostic Interview

• Diagnostic interviews aim to gather information about the client.
• The assumption is that treatment interventions are premature without sufficient client knowledge.
• Two aspects of the diagnostic interview include the content and the method or process.
• Psychological workups are like general medical workups.
• Clinicians must gather and organize psychological data with rigor and detail.
• Psychological syndromes can be ascertained as reliably as general medical data.

Elements of the Clinical Interview

• Elements include Identifying Data (ID) and Chief Complaint (CC).
• Identifying Data includes age, race, gender, marital status, and referral information.
• If the client cannot cooperate, obtain information from family, friends, or medical records.
• Chief Complaint includes presenting symptoms, organized syndromically, and chronology/context.
• Answers should be recorded verbatim as bizarre complaints may point to a psychotic process.
• History of Present Illness (HPI) involves the first time the disorder was noticed and symptom onset.
• It should be recorded in the client's own words as much as possible.
• A sudden onset of symptoms may indicate a drug-induced disorder.
• Past Psychiatric History (PPH) covers substance use, prior syndromes, and treatments.
• Ascertain the extent of treatment, medications, outcomes, and doctors.
• Determine whether the illness serves any secondary purpose.
• Personal History includes information about birth and the age of the parents.
• Older mothers (>35) have a higher risk for Down syndrome.
• Older fathers (>45) may contribute damaged sperm, producing deficits, including schizophrenia.
• Childhood history includes toilet training, bed-wetting, sex play with peers, and first childhood memory.
• Separation anxiety and school phobia are associated with adult depression.
• Enuresis is associated with fire setting.
• Memories before age 3 are usually imagined.
• Adolescence includes information about a critical stage of development.
• Adults may distort emotional memories, and schizophrenia may begin in emotionally charged experiences.
• Adulthood includes role performances throughout life, the influence of sexual preference, marriage, and religion.
• Sexual History includes problems and concerns about sex life.
• It is better to ask when masturbation began than if they are masturbating
• Family History includes psychiatric and medical family history and relationship patterns.
• Medications effective in some family members may also be effective in the client.
• Comparing ID and CC can be illuminating.

Clinical Interview Methods

• Clinical interviews involve psychologists observing, questioning, and interacting with patients to elicit information.
• Interview tactics prompt the patient to talk about their life with general, open-ended questions.
• The advantage of open-ended questions is that they do not take time away from the patient with lengthy questions.
• It gives the patient control of the interview to demonstrate how s/he functions.
• It allows the patient to choose the areas that s/he is most concerned with.
• If the patient stops talking before an area is covered, further promptings may be appropriate.
• Silence gives the patient time to think and continue the narrative.
• Encouraging gestures like a nod or "yes" can be helpful.
• Asking for more information, like "Go on, please", can also be effective.
• Reflective statements echo the patient's feelings.
• Summary statements highlight what the patient has said thus far.
• Interpretations offer possible underlying meanings or feelings.
• Statements of support or reassurance can be used for fearful or uneasy patients.
• Confrontations can be used when the patient is not cooperating.
• Self-disclosure can be used when the patient is afraid of revealing themselves in a sensitive area.
• The goal of assistance is to encourage further disclosure.
• Less intensive promptings are more appropriate.
• Statements of support, confrontations, and self-disclosures should be used infrequently and only after other attempts have failed.
• Switch from open-ended to specific questions when the patient appears lost, tangential, or leaves out important details.
• Specific questions should be asked directly and clearly without suggesting answers.
• In extreme cases with confused or noninsightful patients, use a multiple-choice questioning technique.
• After covering an area, switch to a new area using a more general questioning technique.
• Avoid questions that antagonize the patient or provide an answer.
• Avoid "machine gunning," prolonged silences, or making the patient feel ill at ease.
• The interview is done on an expert-client basis and should not be a cross examination.
• It is normally used alongside other people processes
• Share the task that you have to accomplish with the client (getting information about the client in quite a number of areas in a short period of time). Try to enlist the client's help so that it becomes a collaborative enterprise in which s/he is also involved.
• As you learn more about the client, an interpretation can be attempted: Does he talk more when he is anxious? Does she talk more when discussing a particular are of her life situation? Etc. This approach can be followed with interpretations when the client starts talking excessively again.
• Reinforce the client by demonstrating your appreciation when s/he gives a concise answer,
• Extreme fear or confusion

Handling Clients

• To determine a lack of communication: Spending some time with the client
• To determine a lack of communication: Asking the client why s/he doesn't want to talk. Maybe, some interpretations can be tentatively suggested if s/he does not respond.
• Use questions that call for short and concrete answers with coufused patients
• Similar suggestions as over talkative clients can be sed with tangential or circumstantial clients

Problem Patients and Special Interview Situations

• Interviews need to be varied according to the patient's reactions, illness, and interview objective.
• Varying degrees of permissiveness and directiveness can be used.
• The approach should be changed as appropriate to the patient's personality style.
• Clinical psychologists perform functions to help people suffering from different kinds of problems.
• They use clinical interviews to assess problems and gather information for treatment.
• Information includes family history, social life, employment, financial situation, and mental health history.
• Assessments provide a comprehensive picture of the client's life, which helps in determining the diagnosis and course of treatment.

Interview approaches

• Histrionic Patients need an interviewer to be calm, reassuring, and accepting and flirtatious and over emotional behaviour
• Dependent Patients need an ordinate amount of attention and are likely to frequently schedule emergency appointments, the Interviewer needs to be firm in establishing limits while reassuring the patient that his or her needs are taken seriously and treated professionally
• Demanding need their time to be gratified, interviewer need to be firm from the outset and clearly define acceptable and unacceptable behavior, and need to be confronted with their actions so they learn to be responsible for their actions.
• Narcissistic Patients interviewers need to know Underneath surface arrogance, narcissistic patients feel desperately inadequate and fear that others will see through them. And they may be initially idealize the doctor out of a need to have their doctor be as perfect as they are, but the idealization can quickly turn to disdain when they discover the doctor is human after all.
• Suspicious Patients are should be interviewed respectfully but somewhat formal and distant and that you explain everything you do in detail so they are not suspicious of your behaviour.
• Isolated patients should treat these patients with as much respect for their privacy as possible and should avoid discussing their privacy until they agree or are comfortable with it.
• Obsessive Patients: Try to include the in their own care and treatment as much as possible. Explain in detail what is going on and what is being planned, making sure the patient can make choices in his or her own behalf.
• Help Rejecting Patients: Interviewer should take such patients' concerns seriously, but without encouraging the sick role.
• Manipulative Patients have antisocial personality disorder and lack guilt, interviewers need to be respectful and firm on limits. if inappropriate behaviour is discovered these patients must be confronted directly and held responsible for their direct actions.

Clinical Interview Structure

• Interviews need to be goal directed: address, be aware, select, listen and observe, allow sufficiencent time, be aware of anxieties and document

Tips for Diagnostic Interviews

• The relationship comes first.
• Make diagnosis a collaborative effort.
• Maintain balance in the first moments.
• Balance open-ended with checklist questions to elicit specific information while allowing for broader expression.
• Use screening questions to hone in on the diagnosis; narrow down the possibilities to fit the patient.
• Remember the significance of clinical significance; symptoms must cause distress or impairment to be considered a mental disorder.
• Conduct a risk-benefit analysis; assess if the diagnosis is more helpful or harmful to give.
• Do not misunderstand comorbidity; multiple diagnoses may not be independent or require different treatments.
• Be patient, as it may take a few hours or a while to determine the correct diagnosis.
• Do not be ashamed to use the "Unspecified" categories if symptoms don't fit into existing definitions.
• Be cautious about "Other" diagnoses for proposed conditions that have been rejected by DSM-5.
• Constantly test your subjective judgments and get more information from family members and records.
• Always document your thinking; give a clear rational for your conclusions along with reasoning and actions needed.
• Remember that the stakes are high; an accurate diagnosis leads to a good chance of help and harm if diagnoses wrongly