Lesson 3 Assessment Interview PDF

The Assessment Interview  01 What are major issues to consider when conducting an assessment interview? FOCUS QUESTIONS What are the most common types of 02 assessment interviews? Briefly describe each...

The Assessment Interview  01 What are major issues to consider when conducting an assessment interview? FOCUS QUESTIONS What are the most common types of 02 assessment interviews? Briefly describe each type. 03 What are the similarities and differences between structured and unstructured interviews? What types of reliability and validity are 04 relevant to an evaluation of a structured interview? 05 Why is the validity of a structured diagnostic interview difficult to assess? ASSESSMENT IN CLINICAL PSYCHOLOGY Psychological assessment as an area of emphasis has seen its ups and downs.During the 1960s and 1970s, there seemed to be a decline in interest in psychological assessment (Abeles, 1990). It appeared that clinical psychology’is historical commitment to assessment was waning. The prevailing attitude about assessment was “Let the technicians do it!” Currently, clinical psychologists more and more use an evidenced based approach to clinical assessment. Evidence based assessment (EBA; Hunsley & Mash, 2007) uses theory and knowledge about psychological problems to help in the selection of assessment methods and measures, as well as to guide the actual process of assessment itself. Such an approach overcomes many of the weaknesses of past assessment practices, including a “one-test-fits-all” test selection approach, the use of poorly validated measures, unreliable test interpretation, and the use of tests with limited evidence for treatment utility (Hunsley & Mash, 2007)  Definition and Purpose of Psychological Assessment Psychological assessment can be formally defined in many ways. Clinical assessment involves an evaluation of an individual’s or family’s strengths and weaknesses, a conceptualization of the problem at hand (as well as possible etiological factors), and some prescription for alleviating the problem;  Definition and Purpose of Psychological Assessment Assessment is not something that is done once and then is forever finished. In many cases, it is an ongoing process—even an every_x0002_day process, as in psychotherapy. Whether the clinician is making decisions or solving problems, clinical assessment is the means to the end. Intuitively, we all understand the purpose of diagnosis or assessment. Before physicians can prescribe a treatment, they must first understand the nature of the illness.  Definition and Purpose of Psychological Assessment Aside from a few cases involving pure luck, our capacity to solve clinical problems is directly related to our skill in defining them. Most of us can remember our parents’ stern admonition: “Think before you act!” In a sense, this is the essence of the assessment or diagnostic process. To illustrate this idea, consider the following case.  The Referral The assessment process begins with a referral. Someone—a parent, a teacher, a psychiatrist, a judge, or perhaps a psychologist—poses a question about the patient.” e.g “Why is Juan disobedient?” Why can’t Alicia learn to read like the other children?” “Is the patient’s impoverished behavioral repertoire a function of poor learning opportunities, or does this constriction represent an effort to avoid close relationships with other people who might be threatening?”  The Referral Clinicians thus begin with the referral question. It is important that they take pains to understand precisely what the question is or what the referral source is seeking. e.g the clinician may decide that the question “Is this patient capable of murder?” is unanswerable unless there is more information about the situation. Thus, the question might be rephrased to include probabilitieswith respect to certain kinds of situations.  What Influences How the Clinician Addresses the Referral Question? The kinds of information sought are often heavily influenced by the clinician’s theoretical commitments. For example, a psychodynamic clinicians may be more likely to ask about early childhood experiences than would a behavioral clinician. In other cases, the information obtained may be similar, but clinicians will make different inferences from it.  What Influences How the Clinician Addresses the Referral Question? e.g. to a psychodynamic clinician frequent headaches may suggest the presence of underlying hostility but merely evidence of job stress to a behavioral clinician. For some clinicians, case-history data are important because they aid in helping the client develop an anxiety hierarchy; for others, they are a way of confirming hypotheses about the client’s needs and expectations.  What Influences How the Clinician Addresses the Referral Question? Assessment, then, is not a completely standardized set of procedures. All clients are not given the same tests or asked the same questions. The purpose of assessment is not to discover the “true psychic essence” of the client, but to describe that client in a way that is useful to the referral source—a way that will lead to the solution of a problem. This does not mean that one description is as good as another for a particular case.  THE INTERVIEW All professions count interviewing as a chief technique for gathering data and making decisions For politicians, consumers, psychiatrists, employers, or people in general, interviewing has always been a major tool. People sometimes take interviewing for granted or believe that it involves no special skills.  THE INTERVIEW The assessment interview is at once the most basic and the most serviceable technique used by the clinical psychologist. In the hands of a skilled clinician, its wide range of application and adaptability make it a major instrument for clinical decision making, understanding, and prediction. General Characteristics of Interviews  Interaction An interview is an interaction between at least two persons. Each participant contributes to the process, and each influences the responses of the other. A clinical interview is initiated with a goal or set of goals in mind. The interviewer approaches the interaction purposefully, bearing the responsibility for keeping the interview on track and moving toward the goal ordinary conversation is less evident. A good interview is one that is carefully planned, deliberately and skillfully executed, and goal-oriented throughout.  Interaction Interviewing clearly takes many forms—from fact finding to emotional release to cross examination. Interviewers are not using the interchange to achieve either personal satisfaction or enhanced prestige. They are using it to elicit data, information, beliefs, or attitudes in the most skilled fashion possible.  Interviews Versus Tests interviews occupy a position somewhere between ordinary conversation and tests. Interviews are more purposeful and organized than conversation but sometimes less formalized or standardized than psychological tests.  Interviewing Essentials and Techniques Many factors influence the productivity and utility of data obtained from interviews. Some involve the physical setting. Others are related to the nature of the patient. A mute or uncommunicative patient may not cooperate regardless of the level of the interviewer’s skills.  Interviewing Essentials and Techniques Several factors or skills, however, can increase the likelihood that interviews will be productive. Training and supervised experience in interviewing are very important. Techniques that work well for one interviewer can be notably less effective for another; there is a crucial interaction between technique and interviewer. This is why gaining experience in a supervised setting is so important; it enables the interviewer to achieve some awareness of the nature of this interaction. Training, then, involves not just a simple memorization of rules, but, rather, a growing knowledge of the relationships among rules, the concrete situation being confronted, and one’s own impact in interview situations.  The Physical Arrangements An interview can be conducted anywhere that two people can meet and interact. On some occasions, this happens by chance—an encounter with a patient on the street, for example. Usually, the clinician does not choose such a setting. But the needs of the patient, the degree of urgency in the situation, or even, in some instances, sheer coincidence may make an interview of sorts inevitable. Two of the most important considerations are privacy and protection from interruptions.  The Physical Arrangements The office or its furnishings can be as distracting as loud noises and external clamor. There are few rules in this area, and much depends on individual taste. However, many clinicians prefer offices that are fairly neutral, yet tasteful. In short, an office with furnishings that demand attention or seem to cry out for comment would not be ideal  Note-Taking and Recording All contacts with clients ultimately need to be documented. However, there is some debate over whether notes should be taken during an interview. Although there are few absolutes, in general, it would seem desirable to take occasional notes during an interview. A few key phrases jotted down will help the clinician’s recall. Most clinicians have had the experience of feeling that the material in an interview is so important that there is no need to take notes— that the material will easily be remembered.  Note-Taking and Recording However, after having seen a few additional patients, the clinician may not be able to recall much from the earlier interview. Therefore, a moderate amount of note-taking seems worthwhile. Most patients will not be troubled by it, and if one should be, the topic can be discussed.  Note-Taking and Recording A patient may request that the clinician not take notes while a certain topic is being discussed. Most patients probably expect a certain amount of note- taking. However, any attempt at taking verbatim notes should be avoided (except when administering a structured interview, discussed later). One danger in taking verbatim notes is that this practice may prevent the clinician from attending fully to the essence of the patient’s verbalizations. An overriding compulsion to get it all down can detract from a genuine understanding of the nuances and significance of the patient’s remarks.  Note-Taking and Recording In addition, excessive note-taking tends to prevent the clinician from observing the patient and from noting subtle changes of expression or slight changes in body position. With today’s technology, it is easy to audiotape or videotape interviews. Under no circumstances should this be done without the patient’s fully informed consent. In the vast majority of cases, a few minutes’ explanation of the desirability of taping, with an accompanying assurance to the patient that the tape will be kept confidential (or released only to persons authorized by the patient), will result in complete cooperation.  Note-Taking and Recording It may turn out that the clinician is more threatened by the recording than the patient, especially if the interview is likely to be examined or evaluated by superiors or consultants. In some instances, it is desirable to videotape certain interviews. In the interests of research, of training interviewers or therapists, or of feedback to the patient as part of the therapeutic process, videotaping sometimes has great value. Like audio recording, it should be done openly, unobtrusively, and with the patient’s informed consent. Rapport  Rapport Perhaps the most essential ingredient of a good interview is a relationship between the clinician and the patient. The quality and nature of that relationship will vary, of course, depending on the purpose of the interview. These differences will undoubtedly affect the kind of relationship that develops during the contact. Definition and Functions. Rapport is the word often used to characterize the relationship between patient and clinician. Rapport involves a comfortable atmosphere and a mutual understanding of the purpose of the interview. Good rapport can be a primary instrument by which the clinician achieves the purposes of the interview. A cold, hostile, or adversarial relationship is not likely to be constructive. Although a positive atmosphere is certainly not the sole ingredient for a productive interview (a warm yet ill- prepared interviewer will not generate the best of interviews), it is usually a necessary one. Patients approach most interviews with some degree of anxiety. Characteristics. Good rapport can be achieved in many ways—perhaps as many ways as there are clinicians. However, no bag of “rapport tricks” is likely to substitute for an attitude of acceptance, understanding, and respect for the integrity of the patient. Such an attitude does not require that the clinician like every patient. It does not require the clinician to befriend every patient. When patients realize that the clinician is trying to understand their problems in order to help them, then a broad range of interviewer behavior becomes possible. Probing, confrontation, and interviewer assertiveness may be acceptable once rapport has been established. Characteristics. If the patient accepts the clinician’s ultimate goal of helping, a state of mutual liking is not necessary. The patient will recognize that the clinician is not seeking personal satisfaction in the interview. Rapport is not, as is often thought by beginning students, a state wherein the clinician is always liked or always regarded as a great person. Rather, it is a relationship founded on respect, mutual confidence, trust, and a certain degree of permissiveness. Characteristics. Some patients have had past experiences that will not easily permit them to accept even genuine overtures for a professional relationship. But in most cases, if the clinician perseveres in the proper role and maintains an attitude of respect as she or he searches for understanding, the relationship will develop. A common mistake of beginning interviewers in early interviews is to say something like, “There, there, don’t worry. I know exactly what you’re feeling.” Rapport will come, but it will come through quiet attitudes of respect, acceptance, and competence rather than through quick fixes. Special Considerations. Rapport can be especially challenging to achieve in cases that involve more than one individual or a unique referral source. Communication  Communication In any interview, there must be communication. Whether we are helping persons in distress or assisting patients in realizing their potential, communication is our vehicle. The real problem is to identify the skills or techniques that will ensure maximum communication Beginning a Session. It is often useful to begin an assessment session with a casual conversation. A brief comment or question about difficulties in finding a parking space. A , a brief conversation designed to relax things before plunging into the patient’s reasons for coming will usually facilitate a good interview. Language. Of extreme importance is the use of language that the patient can understand. Some initial estimate of the patient’s background, educational level, or general sophistication should be made. The kind of language employed should then reflect that judgment. It is offensive to speak to a 40-year-old woman with a master’s degree in history as if she were an eighth grader. It is not necessary to infantilize people seeking help; asking for help need not imply that one has a diminished capacity to understand. At the same time, it may be necessary to abandon psychological jargon to be understood by some patients.. Language. It is also important to clarify the intended meaning of a word or term used by a client if there are uncertainties or alternative interpretations. For example, a clinician should not assume he or she knows what a client means by the statement She’s abusive.” It may indicate that the individual does not treat others particularly well, or it may indicate that the individual is physically abusive— something that warrants immediate intervention. The Use of Questions. Maloney and Ward (1976) observed that the clinician’s questions may become progressively more structured as the interview proceeds. They distinguish among several forms of questions, including open-ended, facilitative, clarifying, confronting, and direct questions. Each is designed in its own way to promote communication. And each is useful for a specific purpose or patient. Silence. Perhaps nothing is more disturbing to a beginning interviewer than silence. However, 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. To be continue...