Clinical Psychology Past Paper PDF

Clinical Psychology social, and behavioral aspects of human ​ Scientist-practitioner model (or Boulder...

Clinical Psychology social, and behavioral aspects of human ​ Scientist-practitioner model (or Boulder functioning across the life span, in varying Chapter 1: Clinical Psychology: Definition and model) cultures, and at all socioeconomic levels." (APA, Training 2012) ​ Practitioner-scholar model (or Vail Clinical Psychology Education and Training in Clinical Psychology model) o​ "Clinical psychology" first used in 1907 by Commonalities among most training ​ Clinical scientist model Lightner Witmer programs o​ Originally defined as similar to medicine, Balancing Practice and Science: The education, and sociology o​ Doctoral degree Scientist- Practitioner (Boulder Model) o​ Most enter with bachelor's, some More Recent Definitions with master's degree ▪​ Created in 1949 at a conference of o​ Tremendous growth has resulted in a very o​ Required coursework directors of clinical psychology training broad, hard-to-define field o​ Thesis/dissertation programs held in Boulder, Colorado o​ Brief definitions emphasize the study, o​ Predoctoral internship (more assessment, and treatment of people with information in later slides) ▪​ Emphasizes both practice and research psychological problems Education and Training: Specialty Tracks ▪​ Graduates should be able to competently o​ More detailed definitions (e.g., Division 12 of APA) are more inclusive and descriptive In recent decades, specialty tracks have practice (e.g., therapy, assessment) and emerged, including: conduct research APA Division 12 Definition of Clinical Psychology o​ Child ▪​ A balanced approach o​ Health - "The field of Clinical Psychology integrates Leaning Toward Practice: The Practitioner- science, theory, and practice to understand, o​ Forensic Scholar (Vail) Model predict, and nd, pre alleviate maladjustment, o​ Family disability, and discomfort as well as to promote o​ Neuropsychology ▪​ Created in 1973 at a conference in Vail, human adaptation, adjustment, and personal Three Models of Training Colorado development. Clinical Psychology focuses on the intellectual, emotional, biological, psychological, ▪​ Emphasizes practice over research  o"...graduates function in a variety of settings as ▪​ Yields the PsyD degree (not the traditional ▪​ Emerged in 1990s, primarily as a reaction teachers, researchers, and providers of clinical PhD) against the trend toward practice services... The program emphasizes the represented by Vail model integration of scientific knowledge and the ▪​ Higher acceptance rates and larger ▪​ Richard McFall's 1991 "Manifesto for a professional skills and attitudes needed to classes function as a clinical psychologist in academic, Science of Clinical Psychology" sparked ▪​ Proliferated in recent years research, or applied settings." this movement PhD Vail model example: Chicago School of ▪​ A subset of PhD institutions who strongly Professional Psychology ​ Emphasize practice and research endorse empiricism and science ​ Smaller classes "As a professional school, our focus is not strictly ▪​ Tend to train researchers rather than on research and theory, but on preparing ​ Lower acceptance rate ​ Typically in university departments practitioners students to become outstanding practitioners, ​ Offer more funding to students providing direct service to help individuals and ​ Greater success in placing students in organizations thrive." APA-accredited internships Emerging Trends in Training Clinical scientist model example: Indiana ​ Emphasize practice over research TECHNOLOGY University PsyD ​ Use of webcams for supervision "Indiana University's Clinical Training Program is ​ Larger classes ​ Computer-based assessment designed with a special mission in mind: To train ​ Greater acceptance rate ​ Competencies (outcome-based skills) first- rate clinical scientists... applicants with ​ Often in free-standing professional schools ​ Skills that a student must demonstrate ( primary interests in pursuing careers as service ​ Offer less funding to students E.g., Intervention, assessment, research, providers are not likely to thrive here." ​ Less success in placing students in etc.) Getting In: What Do Graduate Programs APA-accredited internships Sample Grad Program Website Prefer? Self-Description ​ Know your professional options Leaning Toward Science: The Clinical Boulder model example: University of ​ Take, and earn high grades in, the Scientist Model Alabama appropriate undergraduate courses  ​ Get to know your professors Other common professional activities include: ▪​ Licensure enables independent practice ​ Get research experience and identification as a member of the Diagnosis/assessment ​ Get clinically relevant experience ​ Maximize your GRE score profession Teaching/supervision ​ Select graduate programs wisely ▪​ Requires appropriate graduate Research/writing ​ Write effective personal statements coursework, postdoctoral internship, and ​ Prepare well for admissions interviews Other activities licensing exams (e.g., EPPP) ​ Consider your long-term goals How Are Clinical Psychologists Different ▪​ Each state has its own licensing Internships: Predoc and Postdoc From Counseling Psychologists? requirements Predoctoral internship Counseling Psychologists: ▪​ To stay licensed, most states require ​ Takes place at the end of doctoral training o Tend to see less seriously disturbed clients programs (before PhD or PsyD is continuing education units (CEUs) Are less likely to work in settings like inpatient awarded) Where Do Clinical Psychologists Work? hospitals ​ A full year of supervised clinical experience in an applied setting A variety of settings, but private practice is most Tend to endorse humanism more and ​ An apprenticeship of sorts, to transition common (True since 1980s) behaviorism less from student to professional Other common work settings include Tend to be more interested in vocational and Postdoctoral internship Universities career counseling ​ Takes place after the doctoral degree is Psychiatric and general hospitals How Are Clinical Psychologists Different awarded From Psychiatrists? ​ Typically lasts 1-2 years Community mental health centers Psychiatrists: ​ Still supervised, but more independence Other settings ​ Often specialized training o Go to medical school and are physicians ​ Often required for state licensure What do Clinical Psychologists Do? o Have prescription privileges (clinical Getting Licensed A variety of activities, but psychotherapy is most psychologists now have these same privileges in common ( True since 1970s) some states)  Increasingly emphasize How Are Clinical Psychologists Different ​ 1732-1822 biological/pharmaceutical rather than "talk From Professional Counselors? therapy" intervention ​ Lived in England Professional Counselors: How Are Clinical Psychologists Different Earn a master's degree ​ Appalled by deplorable conditions in From Social Workers? Complete training in 2 years "asylums" where mentally ill lived Social Workers Little emphasis on psychological testing or ​ Devoted much of his life to improving their o Tend to emphasize social factors in clients' research treatment problems May specialized in career, school, college ​ Raised funds to open the York Retreat, a o Earn a master's degree rather than a doctorate counseling model of humane treatment Training emphasizes treatment and fieldwork Evolution of Clinical Psychology over research or formalized assessment Phillippe Pinel How Are Clinical Psychologists Different ▪​ The emergence of clinical psychology ​ 1745-1826 From School Psychologists? around the turn of the 20th century was preceded by numerous important historical ​ Lived in France School Psychologists: events Tend to work in schools ​ Advocated for more humane and ▪​ These events "set the stage" for clinical Tend to have a more limited professional focus compassionate treatment of the mentally ill psychology in France than clinical psychologists (student wellness and learning) ▪​ Some pioneers in the treatment of the ​ Also introduced ideas of a case history, Frequently conduct school-related testing and mentally ill made important contributions in treatment notes, and illness classification, determine LD and ADHD diagnoses the 1700s and 1800s indicating care about their well-being Consult with adults in children's lives (e.g., Early Pioneers Eli Todd teachers, staff, parents) William Tuke ​ 1762-1832  which continues to dominate diagnosis ​ A physician in Connecticut ​ Received doctorate in 1892 in Germany today ​ At the time, there were very few hospitals ​ Psychology was essentially academic; no ▪​ Published by American Psychiatric for the mentally ill practice, just study Association, originally in 1952 ​ Burden for their care fell on families Using ​ In 1896, Witmer founded the first Diagnostic Issues Pinel's efforts as a model, he opened psychological clinic at the U. of ​ DSM-1952 humane treatment centers in US Pennsylvania ​ DSM-II-1968 Dorothea Dix ​ By 1914, there were about 20 clinics in US ​ DSM-III-1980 ​ DSM-III-R-1987 ​ 1802-1887 ​ By 1935, there were over 150 ​ DSM-IV-1994 ​ DSM-IV-TR-2000 ​ Worked in a prison in Boston, and ​ Witmer also founded the first scholarly ​ DSM-5-2013 observed that many inmates were clinical psychology journal, The ​ DSM-5-TR – 2022 mentally ill rather than criminals Psychological Clinic, in 1907 Evolution of Assessment: Diagnostic Issues ​ Traveled to various cities to persuade Evolution of Assessment: Diagnostic Issues Most drastic change in DSMs is from DSM-II to leaders to build facilities for humane DSM-III ▪​ Diagnosis and categorization of mental treatment of mentally ill illness has been central to clinical -​ Larger, including more disorders ​ Resulted in over 30 state institutions in US -​ Specific diagnostic criteria psychology from the start and other countries -​ Multi-axial system ▪​ Emil Kraepelin (1855-1926) is considered Lightner Witmer and the Creation of Clinical a pioneer of diagnosis DSM-IV-TR to DSM-5 Psychology o​ Coined some of the earliest terms -​ Removal of the multi-axial system Lightner Witmer to categorize mental illness As a general trend, as the DSM has been ▪​ Kraepelin's work set the stage for the revised, it has expanded to include a greater ​ 1867-1956 Diagnostic and Statistical Manual (DSM), number of disorders  -​ "Scientific discovery" or "social Binet's test was intended for children ▪​ MMPI (1943)-comprehensive personality invention?" David Wechsler published the Wechsler- test measuring various pathologies Currently, numerous disorders are under Bellevue in 1939, which was designed for adults consideration for inclusion in next DSM ▪​ MMPI-2 (1989)-revised and Wechsler later created tests for school-age and ("proposed criteria sets") restandardized preschool children -​ Internet gambling disorder ▪​ MMPI-A (1992)-for adolescents Revisions of Wechsler's tests are among the -​ Attenuated psychosis syndrome most commonly used today Sample MMPI and Rorschach Stimuli -​ Persistent complex bereavement -​ Nonsuicidal self-injury Evolution of Assessment: Assessment of T/F -​ others Personality I like magazines about motorcycles. Assessment of Intelligence Projective tests were among the first to emerge-clients "project" personality onto T/F ▪​ Assessment of intelligence characterized ambiguous stimuli Sometimes I lie to get what I want. the profession in early years -​ Rorschach Inkblot Method-1921 = Evolution of Psychotherapy Clients respond to ambiguous ▪​ Early debates about the definition of inkblot Psychotherapy is the most common activity of intelligence focused on "g" (a single, -​ Thematic Apperception Test clinical psychologists today, but before the general intelligence) vs. "s" (specific (TAT)-1935 = Clients respond to 1940s/1950s, it was not a significant professional intelligences) ambiguous interpersonal scenes activity ▪​ Alfred Binet's early intelligence test (1905) Evolution of Assessment: Assessment of -​ Treatment was by medical doctors, later became the Stanford-Binet Personality not psychologists Intelligence Scales, which is still widely World War II created a demand for treatment of Objective tests soon followed projectives used today psychologically affected soldiers Evolution of Assessment: Assessment of ▪​ Typically paper-and-pencil, self-report, and Intelligence more scientifically sound  -​ Wars have had many other Development of the Profession in the United States would have a influences on the evolution of common language to use when In the 1980s, assessment and psychotherapy diagnosing individuals with mental -​ Psychotherapy thrived, in part due disorders. When psychotherapy became a more common to increasing respect from medical -​ It is the handbook used by health activity in the mid 1900s, the psychodynamic professionals and insurance care professionals as the approach dominated companies authoritative guide to the diagnosis In the decades that followed, numerous other -​ The number of training programs of mental disorders. approaches arose: and new clinical psychologists -​ DSM contains descriptions, increased symptoms, and other criteria for ​ Behaviorism diagnosing mental disorders. In the 1990s and 2000s, -​ Used by clinicians and researchers ​ Humanism -​ The size and scope of the field to diagnose and classify mental continues to grow disorders, the criteria are concise ​ Family Therapy -​ Multiple training model options are and explicit, intended to facilitate an Most recently, cognitive therapy has risen to available objective assessment of symptom become the most widely endorsed singular -​ Empirical support of clinical presentations in a variety of clinical orientation techniques, prescription privileges, settings inpatient, outpatient, partial and new technologies are among hospital, consultation-liaison, Development of the Profession major contemporary issues clinical, private practice, and At the historic Boulder conference in 1949, primary care. directors of graduate training programs agreed on a dual emphasis on practice and research ➤Introduction to DSM REVISION OF DSM In the 1950s, 1960s, and 1970s, -​ The Diagnostic and Statistical Manual of Mental Disorders (DSM) -​ The APA prepared for the revision -​ Therapy approaches proliferated of DSM for nearly a descade, with was created in 1952 by the -​ More minorities entered the field American Psychiatric Association an unprecedented process of -​ Psy../Vail model programs emerged so that mental health professionals research evaluation that included a  series of white papers and 13 not carry any number attached to its a hierarchical system in which the scientific conferences supported by title. initial node in the hierarchy was the National Institutes of Health -​ DSM-I was created after World War differentiating organic brain -​ This preparation brought together II, and was partially a reaction to syndromes from "functional" almost 400 international scientists the return of military veterans from disorders which were subdivided and produced a series of the war. Many veterans showed into psychotic versus neurotic monographs and peer-reviewed non-psychotic but non- physical versus character disorders. journal articles. disorders, and a number of military -​ DSM contained a glossary of descriptions of the diagnostic categories and was the first official manual of mental disorders to focus on clinical use. medical officers from World War II DSM-II (1968) -​ DSM II listed 182 disorders, and was 134 naves lone. It was quite similar to the DSM-I -​ DSM II listed 182 disorders, and was 134 pages long. It was quite similar to the DSM-I. The term "reaction" was dropped, but the term "neurosis" was retained. -​ In the 1960s, there were many DSM-I (1952) turned their attention to the challenges to the concept of mental treatment of these disorders. (Baker illness itself. These challenges -​ The first edition of DSM (1952) was & Pickren, 2007; Pickren & came from sociologists,behavioural titled 'Diagnostic and Statistical Schneider, 2005). psychologists and psychiatrists like Manual of Mental Disorders. It did -​ The DSM-I contained 128 Thomas Szasz, who argued mental categories. Organizationally, it had  illness was a myth used to disguise -​ After a vote by the APA trustees in -​ Explicit diagnostic criteria moral conflicts. 1973, and confirmed by the wider -​ A multiaxial diagnostic assessment -​ Unlike the DSM-I, many of the new APA membership in 1974, the system. categories added in the DSM-II diagnosis was replaced with the -​ An approach that attempted to be were categories of relevance to category of "sexual orientation neutral with respect to the causes outpatient mental health efforts. disturbance". of mental disorders. Anxiety disorders, depressive -​ Homosexuality removed as a -​ It was developed with the additional disorders, personality disorders mental disorder following the goal of providing precise definitions (PDs), and disorders of protests at the 1974 annual of mental disorders for clinicians childhood/adolescence were larger convention of the APA in San and researchers. subsets than they had been in the Francisco. DSM-I. DSM-III-R (1987) DSM-III (1980) LIMITATIONS: -​ APA appointed a work group to -​ Work began on DSM-III in 1974, revise DSM-III, which developed -​ Fleiss and Spitzer concluded "there with publication in 1980. the revisions and corrections that are no diagnostic categories for -​ DSM-III heralded a paradigm shift led to the publication of DSM-III-R which reliability is uniformly high. in the history of psychiatric in 1987. Reliability appears to be only diagnosis, with its incorporation of -​ Categories were renamed and satisfactory for three categories: empirically-based, a theoretical and reorganized, and significant mental deficiency, organic brain agnostic criteria for psychiatric changes in criteria were made. Six syndrome, and alcoholism. diagnosis. categories were deleted while -​ Other criteria, and potential new others were added. Sixth printing of the DSM-II (1968) categories of disorder, were -​ Controversial diagnoses, such as -​ As described by Ronald Baver, a established by consensus during pre-menstrual dysphoric disorder psychiatrist and gay rights activist, meetings of the committee, as and masochistic personality specific protests by gay rights chaired by Spitzer. disorder, were considered and activists against the APA began in discarded. DSM-III introduced a number of important 1970. -​ "Ego-dystonic homosexuality" was innovations, including: also removed. DSM-IV (1994) disorders, feeding and catting disorders. obsessive-compulsive -​ Numerous changes were made to DSM-5 (2013) and related disorders, and the classification (e.g., disorders -​ Dr. Dilip Jeste, the then President of personality disorders. were added, deleted, and the American Psychiatric reorganized), to the diagnostic Association, released the Fifth criteria sets, and to the descriptive Edition of the Diagnostic and text. Statistical Manual of Mental -​ A major change was the inclusion Disorders on May 18, 2013 at the of a clinical significance criterion to 166th Annual Meeting of the APA at almost half of all the categories, San Francisco which required symptoms cause -​ As the process of developing the "clinically significant distress or manual progressed, the Roman impairment in social, occupational, numerical 'V' was replaced by the or other impo rtant areas of alpha numerical "5". This would functioning". facilitate subsequent revisions -​ Some personality disorder being numbered as 5.1, 5.2 and so ➤Changes in The DSM-5 diagnoses were deleted or moved forth. -​ It eliminated the axis system, -​ It is an authoritative volume that instead listing categories of defines and classifies mental disorders along with a number of disorders in order to improve different related disorders. diagnoses, treatment, and -​ Asperger's disorder was removed research. It does not claim to be the and incorporated under the ultimate or the final word in category of a autism spectrum classification of mental disorders. disorders. -​ Some examples of categories -​ Disruptive mood dysregulation included in the DSM-5 include disorder was added, in part to to the appendix. anxiety disorders. bipolar and related disorders, depressive  decrease over-diagnosis of The strength of each of the editions of problems to help in the selection of childhood bipolar disorders. DSM has been "reliability". The weakness assessment methods and -​ Several diagnoses were officially is its lack of validity. While DSM has been measures, as well as to guide the added to the manual including described as a "Bible" for the field, it is, at actual process of assessment itself. binge eating disorder, hoarding best, a dictionary, creating a set of labels Such an approach overcomes disorder, and premenstrual and defining each. many of the weaknesses of past dysphoric disorder. assessment practices, including a -​ It is based on explicit disorder "one-test-fits-all" test selection criteria, which taken together ASSESSMENT IN CLINICAL PSYCHOLOGY approach, the use of poorly constitute a "nomenclature" of validated measures, unreliable test -​ Psychological assessment as an mental disorders, along with an interpretation, and the use of tests area of emphasis has seen its ups extensive explanatory text that is with limited evidence 5 for and downs. During the 1960s and fully referenced for the first time in treatment utility (Hunsley & Mash, 1970s, there seemed to be a the electronic version of this DSM. 2007) decline in interest in psychological assessment (Abeles, 1990). Definition and Purpose of Psychological -​ It appeared that clinical psychology' Assessment ➤Conclusion is historical commitment to -​ Psychological assessment can be ​ DSM serves as the principal authority for assessment was waning. The formally defined in many ways. psychiatric diagnoses. prevailing attitude about Clinical assessment involves an ​ It also provides a common language for assessment was "Let the evaluation of an individual's or researchers to study the criteria for technicians do it!" family's strengths and weaknesses, potential future revisions and to aid in the -​ Currently, clinical psychologists a conceptualization of the problem development of medications and other more and more use an evidenced at hand (as well as possible interventions. based approach to clinical etiological factors), and some ​ DSM is an important tool for those who assessment. Evidence based prescription for alleviating the have received specialized training and assessment (EBA; Hunsley & problem; possess sufficient experience are qualified Mash, 2007) uses theory and -​ Assessment is not something that is to diagnose and treat mental illnesses. knowledge about psychological done once and then is forever  finished. In many cases, it is an question about the patient." e.g clinician's theoretical commitments. ongoing process-even an "Why is Juan disobedient?" Why For example, a psychodynamic every_x0002_day process, as in can't Alicia learn to read like the clinicians may be more likely to ask psychotherapy. Whether the other children?" "Is the patient's about early childhood experiences clinician is making decisions or impoverished behavioral repertoire than would a behavioral clinician. In solving problems, clinical a function of poor learning other cases, the information assessment is the means to the opportunities, or does this obtained may be similar, but end. Intuitively, we all understand constriction represent an effort to clinicians will make different the purpose of diagnosis or avoid close relationships with other inferences from it e.g. to a assessment. Before physicians can people who 9 might be psychodynamic clinician frequent prescribe a treatment, they must threatening?" headaches may suggest the first understand the nature of the -​ Clinicians thus begin with the presence of underlying hostility but illness. referral question. It is important that merely evidence of job stress to a -​ Aside from a few cases involving they take pains to understand behavioral clinician. For some pure luck, our capacity to solve precisely what the question is or clinicians, case-history data are clinical problems is directly related what the referral source is seeking. important because they aid in to our skill in defining them. Most of e.g the clinician may decide that the helping the client develop an us can remember our parents' stern question "Is this patient capable of anxiety hierarchy; for others, they admonition: "Think before you act!" murder?" is unanswerable unless are a way of confirming hypotheses In a sense, this is the essence of there is more information about the about the client's needs and the assessment or diagnostic situation. Thus, the question might expectations. process. To illustrate this idea, be rephrased to include -​ Assessment, then, is not a consider the following case. probabilitieswith respect to certain completely standardized set of kinds of situations. 10 procedures. All clients are not given The Referral the same tests or asked the same What Influences How the Clinician Addresses -​ The assessment process begins questions. The purpose of the Referral Question? with a referral. Someone a parent, a assessment is not to discover the teacher, a psychiatrist, a judge, or -​ The kinds of information sought are "true psychic essence" of the client, perhaps a psychologist-poses a often heavily influenced by the but to describe that client in a way  that is useful to the referral Interaction Interviews Versus Tests source-a way that will lead to the -​ An interview is an interaction -​ interviews occupy a position solution of a problem. This does not between at least two persons. Each somewhere between ordinary mean that one description is as participant contributes to the conversation and tests. Interviews good as another for a particular process, and each influences the are more purposeful and organized case. responses of the other. A clinical than conversation but sometimes THE INTERVIEW interview is initiated with a goal or less formalized or standardized set of goals in mind. The than psychological tests. -​ All professions count interviewing interviewer approaches the as a chief technique for gathering Interviewing Essentials and Techniques interaction purposefully, bearing the data and making decisions For responsibility for keeping the -​ Many factors influence the politicians, consumers, interview on track and moving productivity and utility of data psychiatrists, employers, or people toward the goal ordinary obtained from interviews. Some in general, interviewing has always conversation is less evident. A good involve the physical setting. Others been a major tool. People interview is one that is carefully are related to the nature of the sometimes take interviewing for planned, deliberately and skillfully patient. A mute or uncommunicative granted or believe that it involves executed, and goal-oriented patient may not cooperate no special skills. throughout. regardless of the level of the -​ The assessment interview is at -​ Interviewing clearly takes many interviewer's skills. once the most basic and the most forms-from fact finding to emotional -​ Several factors or skills, however, serviceable technique used by the release to cross examination. can increase the likelihood that clinical psychologist. In the hands of Interviewers are not using the interviews will be productive. a skilled clinician, its wide range of interchange to achieve either -​ Training and supervised experience application and adaptability make it personal satisfaction or enhanced in interviewing are very important. a major instrument for clinical prestige. They are using it to elicit Techniques that work well for one decision making, understanding, data, information, beliefs, or interviewer can be notably less and prediction. attitudes in the most skilled fashion effective for another, there is a General Characteristics of Interviews possible. crucial interaction between  technique and interviewer. This is privacy and protection from -​ However, after having seen a few why gaining experience in a interruptions. additional patients, the clinician supervised setting is so important; it -​ The office or its furnishings can be may not be able to recall much from enables the interviewer to achieve as distracting as loud noises and the earlier interview. Therefore, a some awareness of the nature of external clamor. There are few rules moderate amount of note-taking this interaction. Training, then, in this area, and much depends on seems worthwhile. Most patients involves not just a simple individual taste. However, many will not be troubled by it, and if one memorization of rules, but, rather, a clinicians prefer offices that are should be, the topic can be growing knowledge of the fairly neutral, yet tasteful. In short, discussed. relationships among rules, the an office with furnishings that -​ A patient may request that the concrete situation being confronted, demand attention or seem to cry clinician not take notes while a and one's own impact in interview out for comment would not be ideal certain topic is being discussed. situations. Most patients probably expect a Note-Taking and Recording certain amount of note- taking. The Physical Arrangements -​ All contacts with clients ultimately However, any attempt at taking -​ An interview can be conducted need to be documented. However, verbatim notes should be avoided anywhere that two people can meet there is some debate over whether (except when administering a and interact. On some occasions, notes should be taken during an structured interview, discussed this happens by chance an interview. Although there are few later). One danger in taking encounter with a patient on the absolutes, in general, it would seem verbatim notes is that this practice street, for example. Usually, the desirable to take occasional notes may prevent the clinician from clinician does not choose such a during an interview. A few key attending fully to the essence of the setting. But the needs of the phrases jotted down will help the patient's verbalizations. An patient, the degree of urgency in clinician's recall. Most clinicians overriding compulsion to get it all the situation, or even, in some have had the experience of feeling down can detract from a genuine instances, sheer coincidence may that the material in an interview is understanding of the nuances and make an interview of sorts so important that there is no need significance of the patient's inevitable. Two of the most to take notes that the material will remarks. important considerations are easily be remembered. -​ In addition, excessive note-taking unobtrusively, and with the patient's "rapport tricks" is likely to substitute tends to prevent the clinician from informed consent. for an attitude of acceptance, observing the patient and from understanding, and respect for the RAPPORT noting subtle changes of expression integrity of the patient. Such an or slight changes in body position. -​ Definition and Functions. Rapport is attitude does not require that the With today's technology, it is easy the word often used to characterize clinician like every patient. It does to audiotape or videotape the relationship between patient not require the clinician to befriend interviews. Under no circumstances and clinician. Rapport involves a every patient. When patients realize should this be done without the comfortable atmosphere and a that the clinician is trying to patient's fully informed consent. In mutual understanding of the understand their problems in order the vast majority of cases, a few purpose of the interview. Good to help them, then a broad range of minutes' explanation of the rapport can be a primary instrument interviewer behavior becomes desirability of taping, with an by which the clinician achieves the possible. Probing, confrontation, accompanying assurance to the purposes of the interview. A cold, and interviewer assertiveness may patient that the tape will be kept hostile, or adversarial relationship is be acceptable once rapport has -​ It may turn out that the clinician is not likely to be constructive. been established. more threatened by the recording Although a positive atmosphere is Characteristics. If the patient accepts the than the patient, especially if the certainly not the sole ingredient for clinician's ultimate goal of helping, a state of interview is likely to be examined or a productive interview (a warm yet mutual liking is not necessary. The patient will evaluated by superiors or ill- prepared interviewer will not recognize that the clinician is not seeking consultants. In some instances, it is generate the best of interviews), it personal satisfaction in the interview. Rapport is desirable to videotape certain is usually a necessary one. Patients not, as is often thought by beginning students, a interviews. In the interests of approach most interviews with state wherein the clinician is always liked or research, of training interviewers or some degree of anxiety. always regarded as a great person. Rather, it is a therapists, or of feedback to the Characteristics. Good rapport can be relationship founded on respect, mutual patient as part of the therapeutic achieved in many ways-perhaps confidence, trust, and a certain degree of process, videotaping sometimes permissiveness. has great value. Like audio -​ as many ways as there are recording, it should be done openly, clinicians. However, no bag of Characteristics. Some patients have had past Beginning a Session. It is often useful to begin particularly well, or it may indicate that the experiences that will not easily permit them to an assessment session with a casual individual is physically abusive- something that accept even genuine overtures for a professional conversation. A brief comment or question about warrants immediate intervention. relationship. But in most cases, if the clinician difficulties in finding a parking space. A, a brief perseveres in the proper role and maintains an conversation designed to relax things before attitude of respect as she or he searches for plunging into the patient's reasons for coming will The Use of Questions. Maloney and Ward understanding, the relationship will develop. A usually facilitate a good interview. (1976) observed that the clinician's questions common mistake of beginning interviewers in may become progressively more structured as Language. Of extreme importance is the use of early interviews is to say something like, "There, the interview proceeds. They distinguish among language that the patient can understand. Some there, don't worry. I know exactly what you're several forms of questio including open-ended, initial estimate of the patient's background, feeling." Rapport will come, but it will come facilitative, clarifying, confronting, and direct educational level, or general sophistication through quiet attitudes of respect, acceptance, questions. Each is designed in its own way to should be made. The kind of language employed and competence rather than through quick fixes. promote communication. And each is useful for a should then reflect that judgment. It is offensive to specific purpose or patient. Special Considerations. Rapport can be speak to a 40-year-old woman with a master's especially challenging to achieve in cases that degree in history as if she were an eighth grader. involve more than one individual or a unique It is not necessary to infantilize people seeking referral source. help; asking for help need not imply that one has a diminished capacity to understand. At the same Communication time, it may be necessary to abandon -​ In any interview, there must be psychological jargon to be understood by some communication. Whether we are patients.. helping persons in distress or Language. It is also important to clarify the assisting patients in realizing their intended meaning of a word or term used by a potential, communication is our client if there are uncertainties or alternative vehicle. The real problem is to interpretations. For example, a clinician should identify the skills or techniques that not assume he or she knows what a client means Silence. Perhaps nothing is more disturbing to a will ensure maximum by the statement She's abusive." It may indicate beginning interviewer than silence. However, communication that the individual does not treat others silences can mean many things. The important point is to assess the meaning and function of silence in the context of the specific interview. The clinician's response to silence should be reasoned and responsive to the goals of the interview rather than to personal needs or insecurities. Silence. Perhaps the client is organizing a thought or deciding which topic to discuss next. Perhaps the silence is indicative of some resistance. But it is as inappropriate to jump in and fill every momentary silence with chatter as it is to simply wait out the patient every time, regardless of the length of the silence. Whether the clinician ends a lengthy silence with a comment about the silence or decides to introduce a new line of inquiry, the response should facilitate communication and understanding and not be a desperate solution to an awkward moment. Listening. If we are to communicate effectively in the clinician's role, our communication must reflect understanding and acceptance.