Clinical Interviews

Imagine that you are a psychologist and Maria comes to see you. Just looking at her, you can't tell
what's wrong with her or why she has come to your office. What do you do? You probably answered,
'I talk to her, of course!' Talking to Maria is a good first step in figuring out what's wrong and how to
treat her.
A clinical interview is a dialogue between psychologist and patient that is designed to help the
psychologist diagnose and plan treatment for the patient. It is often called 'a conversation with a
purpose.' What's the difference between you, as a psychologist, talking to Maria and her best friend
talking to her? There are several key differences in a normal conversation and a clinical interview.
First of all, a clinical interview has a focused purpose - to diagnose Maria. If she is just talking to her
best friend, the conversation doesn't have a focus and could wander around to any topic. Second, in
a clinical interview, the roles are clearly defined. You are the psychologist and Maria is the patient.
As such, you might ask more questions and the interview is really only about Maria. In contrast,
when Maria talks to her best friend, they probably both ask questions and they might talk about her
friend's troubles, too.
Finally, a clinical interview occurs within a defined time frame. When Maria talks to her best friend,
they can start and end their conversation whenever they want. But with her psychologist, she knows
that the appointment is for Tuesday from two to three in the afternoon. Let's look closer at the types
of clinical interviews, as well as how to conduct a clinical interview and the benefits and limitations of
them.

Types of Clinical Interviews

Again, imagine that you are a psychologist. How might your clinical interview be different for Maria, a
first-time patient, and Sarah, a long-term patient that you've had for years? How might it be different
for Maria, who doesn't appear to have anything wrong with her, and Bridget, a patient who is forced
to come see you because she keeps talking to trees and other inanimate objects?
There are many types of clinical interviews that can be used at different times and with different
people. Let's look at two of the most common clinical interviews: the intake interview and the mental
status exam.
The intake interview happens the first time someone comes to see you. This is the interview where
you, as the psychologist, ask what brings them to you, what their mental and physical health history
is and what they would like to get out of their time with you.
When you talk to Maria, for example, you might start by asking why she has come to see you. She
says that, even though everyone else sees her and thinks she's fine, she feels like a mess. She's
stressed out all the time and has been experiencing panic attacks. You might then go on to ask
questions about when the panic attacks started and ask her to elaborate on her life and problems.
Remember Bridget, the woman who talks to trees? Unlike Maria, Bridget appears to have something
wrong with her from the get-go. Not only that, but when you begin to talk to her, you realize that
she's not answering your questions in a logical way; she's making no sense whatsoever.
A mental status exam is a clinical interview that looks at more than just the answers to your
questions. You can look at a patient's behaviors, appearance, attitude and movements, as well as
their answers to your questions. All of these things will give you a good view of what their mental
health is like. Of course, a mental status exam can be used on any patient, including those who
seem lucid, like Maria, but it is often used on patients who are not able to talk clearly about their
problems.

Conducting a Clinical Interview

Whether you're doing an intake interview, a mental status exam or one of many other types of
clinical interviews, there are several elements that are important. First of all, psychologists
conducting clinical interviews need to offer a safe space for discussion. The client needs to be in a
nonjudgmental space in order to open up. In addition, reminding a patient that you will not share
their

The interview

In an interview the individual under assessment must be given considerable latitude in “telling his
story.” Interviews have both verbal and nonverbal (e.g., gestural) components. The aim of the interview
is to gather information, and the adequacy of the data gathered depends in large part on the questions
asked by the interviewer. In an employment interview the focus of the interviewer is generally on the
job candidate’s work experiences, general and specific attitudes, and occupational goals. In a diagnostic
medical or psychiatric interview considerable attention would be paid to the patient’s physical health
and to any symptoms of behavioral disorder that may have occurred over the years.

Two broad types of interview may be delineated. In the interview designed for use in research, face-to-
face contact between an interviewer and interviewee is directed toward eliciting information that may
be relevant to particular practical applications under general study or to those personality theories (or
hypotheses) being investigated. Another type, the clinical interview, is focused on assessing the status of
a particular individual (e.g., a psychiatric patient); such an interview is action-oriented (i.e., it may
indicate appropriate treatment). Both research and clinical interviews frequently may be conducted to
obtain an individual’s life history and biographical information (e.g., identifying facts, family
relationships), but they differ in the uses to which the information is put.

Although it is not feasible to quantify all of the events occurring in an interview,

personality researchers have devised ways of categorizing many aspects of
the content of what a person has said. In this approach, called content
analysis, the particular categories used depend upon the researchers’
interests and ingenuity, but the method of content analysis is quite general
and involves the construction of a system of categories that, it is hoped, can
be used reliably by an analyst or scorer. The categories may be
straightforward (e.g., the number of words uttered by the interviewee during
designated time periods), or they may rest on inferences (e.g., the degree of
personal unhappiness the interviewee appears to express). The value of
content analysis is that it provides the possibility of using frequencies of
uttered response to describe verbal behaviour and defines behavioral
variables for more-or-less precise study in experimental research. Content
analysis has been used, for example, to gauge changes in attitude as they
occur within a person with the passage of time. Changes in the frequency of
hostile reference a neurotic makes toward his parents during a sequence of
psychotherapeutic interviews, for example, may be detected and assessed, as
may the changing self-evaluations of psychiatric hospital inmates in relation to
the length of their hospitalization.
Sources of erroneous conclusions that may be drawn from face-to-face
encounters stem from the complexity of the interview situation, the attitudes,
fears, and expectations of the interviewee, and the interviewer’s manner and
training. Research has been conducted to identify, control, and, if possible,
eliminate these sources of interview invalidity and unreliability. By conducting
more than one interview with the same interviewee and by using more than
one interviewer to evaluate the subject’s behaviour, light can be shed on the
reliability of the information derived and may reveal differences in influence
among individual interviewers. Standardization of interview format tends to
increase the reliability of the information gathered; for example, all
interviewers may use the same set of questions. Such standardization,
however, may restrict the scope of information elicited, and even a perfectly
reliable (consistent) interview technique can lead to incorrect inferences.