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CHAPTER 6 – ASSESSMENT: INTERVIEWING AND OBSERVATION COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. INTERVIEWING Clinical psychologists gather assesment data by talking to clients and by observing them. Interviews are used in overlapping ways for both clinical assesment a...

CHAPTER 6 – ASSESSMENT: INTERVIEWING AND OBSERVATION COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. INTERVIEWING Clinical psychologists gather assesment data by talking to clients and by observing them. Interviews are used in overlapping ways for both clinical assesment and psychotherapy. Play a vitally important role in the development of a colloborative relationship between a psychologist and client. The most common strategy for gathering information necessary to make a diagnosis, but serve many additional purposes. Also used to obtain information for case formulation, problem definition and goal setting. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. INTERVİEWİNG Different purposes require different types of interviews that vary in their degree of structure. Unstructured Semistructured Structured In unstructured intreviews, the psychologist decides what questions to ask and to follow up on as the interview unfolds. Semi-structured interviews allow the psychologist some flexibility ind questioning and the order of questions. Highly structured interviews specify the precise ways that questions should be posed and queries made, as wellas define the types of responses necessary to score a particular symptom as present. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. INTERVIEWING AND ETHICS Mahkeme tarafından belirli bir bilgi istenmesi COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS INTERVIEWING AND ETHICS Confidentiality: The client has a right to know what will be kept confidential and under what circumstances confidentiality may be broken. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. TYPE OF INTERVIEWS 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 COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED.  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  Structured Clinical Interview for DSM-5 (SCID-5):The Structured Clinical Interview for DSM-5 (SCID-5) is a semi-structured interview guide for making DSM-5 diagnoses. It is administered by a clinician or trained mental health professional that is familiar with the DSM-5 classification and diagnostic criteria. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED.  Structured Clinical Interview for DSM-5 (SCID-5): To ensure that the major DSM-5 diagnoses are systematically evaluated. For example, the SCID can be used in clinical intake procedures or in comprehensive forensic diagnostic evaluation. To select a study population. For example, in a study of the effectiveness of a treatment for depression, the SCID-5 can be used to ensure that all of the study subjects have symptoms that meet the DSM-5 criteria for Major Depressive Disorder and that all of the subjects with a history of any Substance Use Disorder in the past 12 months are excluded. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED.  Structured Clinical Interview for DSM-5 (SCID-5): To characterize a study population in terms of current and previous psychiatric diagnoses. For example, the diagnostic data that have been obtained using the SCID interview can be utilized by researchers, practitioners, policy makers, and the general public that are interested in prevalence and incidence estimates of psychiatric disorders among certain populations. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED.  Structured Clinical Interview for DSM-5 (SCID-5): To improve interviewing skills of students in the mental health professions, including psychiatry, psychology, social work, and psychiatric nursing. For example, the SCID can provide trainees with a repertoire of useful questions to elicit information from a patient that will be the basis for making judgments about the diagnostic criteria. Through repeated administrations of the SCID, students will become familiar with the DSM- 5 criteria and at the same time will incorporate useful questions into their own interviewing repertoire. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. 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)  Recognizing signs of mental health disorders is not always easy. The Patient Health Questionnaire (PHQ) is a diagnostic tool for mental health disorders used by health care professionals that is quick and easy for patients to complete. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. PHQ Depression Module for both Diagnostic and Severity Purposes Patient: A 43-year-old woman who looks sad and complains of fatigue for the past month. 2.Over the last 2 weeks, how often have you been bothered by any of the following: Not at all Several days More than half the days Nearly every day (0) (1) (2) (3) a. Little interest or pleasure in doing things?………………..     b. Feeling down, depressed, or hopeless?………………..…     c. Trouble falling or staying asleep, or sleeping too much?     d. Feeling tired or having little energy?.........……….....…..     e.Poor appetite or overeating?......................………….….     COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. f. Feeling bad about yourself—or that you are a failure or have let yourself or your family down?…………………..     g. Trouble concentrating on things, such as reading the newspaper or watching television? ……………………..     h. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual?............. ………………………………………..     i. Thoughts that you would be better off dead or of hurting yourself in some way? …………………………………….     COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED.  GENERAL ISSUES IN INTERVIEWING 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 COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. 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-judgmental Non-blaming stance Cultural sensitivity  Knowledge of self and own culture  Knowledge of others and differences  ‘Cultural humility’ – openness to differences (without pathologizing) COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS GENERAL ISSUES IN INTERVIEWING Importance of defining the problem: Clients are often vague about presenting problems  Clinician must know what is normative behavior  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” Vague: belirsiz COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS 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 ex.)  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? COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. 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 A couple interview (or joint couple interview, or more broadly conjoint interview, joint interview or dyadic interview) is a method of qualitative research used in the social sciences, where two spouses are interviewed together. Such an interview is typically semi-structured or unstructured. Couple interviews are important in household research Interviewing families: Similar challenges as with couples – but with the difficulty of establishing rapport with many individuals at once COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED.  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 Older Adults 1. Be sure the light is on your face, not theirs. 2. Be sure the room is quiet. 3. Start by asking them what is their most important issue today. 4. Speak while looking directly at them (no distractions). COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. GENERAL ISSUES İN INTERVİEWİNG Interviewing Older Adults 5. When speaking to them, be on their level (both sitting or both standing). 6. Enhance verbal communication by adding visual and sometimes tactile stimuli (hold their hand for very important messages). 7. Start on time. 8. Have nursing personnel move patients from the waiting room to the exam room and back to the waiting room 9. Stay on schedule. 10. Complete your documentation before moving on to the next patient. 11. Do not engage in hallway or other conversations with the patient or COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED.  GENERAL ISSUES IN INTERVIEWING Interviewing children and adolescents: Using age appropriate behavior and language; not leading the child to an answer or response; less eye contact is often helpful; knowledge of current media/toys/games COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. OBSERVATIONS 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) COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED.  COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. OBSERVATIONS: SELF-MONITORING Self-monitoring: Strategy for clients to write down/log information throughout the day on a particular behavior (e.g., smoking, food intake, headache, interpersonal interaction)  Helps decrease memory errors  Provides additional information about context  Reactivity: How self-monitoring can effect the behavior being evaluated OBSERVATIONS: SELF-MONITORING Ecological Momentary Assessment: Gathering data about emotions, thoughts, behaviors or experiences through the use of a smartphone, tablet, or other device that prompts the user randomly through the day Ecological momentary assessment (EMA) involves repeated sampling of subjects' current behaviors and experiences in real time, in subjects' natural environments. EMA aims to minimize recall bias, maximize ecological validity, and allow study of microprocesses that influence behavior in real-world contexts. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED. OBSERVATIONS: SELF-MONITORING EMA studies assess particular events in subjects' lives or assess subjects at periodic intervals, often by random time sampling, using technologies ranging from written diaries and telephones to electronic diaries and physiological sensors. Technologies such as written diaries, electronic diaries, telephones, and physiological sensors are often utilized in EMA studies. EMA studies can be utilized to study a variety of topics such as depression, social support, relationships, diet, work activity and satisfaction, psychotherapy, drug use, allergies, psychological stress, medications, self-esteem, and asthma.  Used in both research as well as assessment and treatment COPYRIGHT © 2014 JOHN WILEY & SONS, INC. ALL RIGHTS RESERVED.