20170309160340S2017 - 2 - Clinical Interview, Clinical Observation and Clinical Assessment

Class 2
Clinical Interview, Clinical

Observation, and Clinical Assessment
Dr. Pau Kee
Department of Psychology and Counseling
Faculty of Education and Human Development
pau_kee@copyright2016
Assessing Psychological Disorders
Assessment - collecting relevant
information in an effort to reach a
conclusion
To understand the individual
(idiographic)
To predict behavior
To plan treatment
To evaluate treatment outcome
Clinical diagnosis the process of
determining whether the individual
DSM-5
Lists approximately
400 disorders
Describes criteria for
diagnoses, key clinical
features, and related
features that are
often, but not always,
present
International Classification of Disease
(ICD) pau_kee@copyright2016
Reliability, Validity, and
Standardization
Reliable
Psychological
Assessments
are:
Valid
Standardiz
ed
Key Concepts in Assessment
Standardization
Ensures consistency in
the use of a technique
Provides population
benchmarks for
comparison
Examples include
structured
administration, scoring,
and evaluation
procedures
Psychosocial Assessment
Assessment
interviews
Three procedures
commonly used in Clinical
psychosocial observation of
assessments behavior
include:
Psychological
tests
Clinical Interview
1. Structuring the Interview
2. Introducing Yourself and Noting Possible
Communication Difficulties
- When you are interviewing clients for
treatment, bear in mind that When clients
present for an evaluation, they are often in a
great deal of emotional pain. They are often
demoralized and hopeless because their efforts
to address their problems have failed or had
only limited impact
3. Assessing the Clients Understanding of the
Interview Situation.
E.g. What have you been told about this interview?
What do you expect to happen here?
What did you think and feel before you came in here?
Id like to talk with you for a few minutes in order to ______
4. Obtaining Informed Consent
. Explain the purposes of the interview.
. Counselors role and clients role
. Confidentiality and exceptional
. Checking if the client understand the terms Would that be
all right with you? / You can stop me at any time during our
interview if you dont understand me or need to question
what I am asking you to do.
5. Other points for all interviews
a. Identifying information
. Age, sex, race/ethic background, partner status,
living situation
. Current medications prescribed, taken: Name(s),
dosage(s), frequency.
. All forms of abuse/traumatic
experience/significant events
. Major losses and grieving
. Depression symptoms and or anxiety symptoms
. Alcohol used or substance used
. Suicidal and homicidal ideation and impulse
control
. Any critical items were endorsed if you have
given the client any assessment.
b. Presenting Problem
(i) Eliciting the Chief
Concern/Presenting Problem
Would you please tell me why you are
here/came to see me/are being evaluated?
What brings you to my office/the clinic?
What concerns you most?
What has been going on?
What has happened to you?
What do you hope to have happen/come
from our meeting?
(ii) Eliciting the Clients Understanding of the
Problem
What do you think caused your problem?
Do you have an idea of why it started when it did?
How severe is your problem?
How long do you expect it to last?
What other problems has you problem caused you?
What do you fear about your problem?
(iii) Dimensionalizing the concern/problem
For how long has this been happening? (Duration)
How often does this happen? (Frequency)
When it happens, how strong is it when it starts, at its
worst, etc.? (Intensity)
What led up to its happening (antecedents, cues,
controlling stimuli, latency, sequences, progression,
chains)
What were you thinking and feeing (expectations, beliefs,
meaning, affects)
Who else was around, and what did they think and feel?
(social support, person who defined problem)
What happened next/afterward? (sequences, reinforces,
consequences)
How typical was this occasion? (development of the
problem, intensity)
Was the first time it happened different? (Clients
understanding of development)
What could have made a difference in this incident?
C. Family History
Who else in the family? Occupations of the family
members
The client's relationship with family members
Family environment
The family's history of mental health
D. Social/Educational History
The client's social development & social relationship
The client's educational history - academic background
Support systems
E. Chronological Development
Emotional
Behavioral
Physical
Cognitions
Sexual
F. Treatment History
The past treatment history included mental and
physical treatment history
G. Mental/Medical Status
The client's mental and medical status
Any medications were taken by the client?
Being hospitalized or not previously?
H. Client Goals
What client wants to work on during the following
session
6. Ending the Interview
Is there anything else that you want to add/tell me/want
me to know/understand?
Is there anything important/relevant/that matters that we
have not covered?
Do you have any questions about what we have done
today?
Do you have any questions about what the next step will
be?
You will need to make an appointment with ___ to ______
Thank you for your time and efforts in coming here and
talking to me.
I expect that you will receive some benefit from all of this.
Mental Status Exam
The Clinical Interview
Mental status exam
Appearance and behavior
Thought processes
Mood and affect
Intellectual functioning
Sensorium
Semi structured clinical interviews (DICA,
ADIS - IV)
Psychosocial Assessment
What role does psychosocial

assessment attempt to provide?
Psychological Tests
Psychological Tests
Psychological Tests
Psychological Tests
Rorschach Inkblot Test
10 inkblots - designed by Hermann

Rorschach.
1884-1922
Thematic Apperception Test (TAT)
Developed by Henry Murray (1893-1988),

Sentence-Completion Test
I wish ___________________________
My father ________________________
Sex ________________________
Drawings
Draw-a-Person (DAP) test:
Draw a person
Draw another person of the opposite
sex
Psychological Tests
Trust and Rapport Between
the Clinician and the Client
Psychological Testing and Objective Tests
Objective tests
Roots in empirical tradition
Test stimuli are less ambiguous
Require minimal clinical inference in scoring and
interpretation
Personality tests
Minnesota Multiphasic Personality Inventory (MMPI)
Extensive reliability, validity, and normative
database
General Physical Examination
Intelligence Testing
Stanford-Binet intelligence test

Deviation intelligence (IQ)
Wechsler intelligence scales
Clinical Observation
of Behavior
ABC Chart
Self-monitoring
Behavior Rating Scales
Beck Depression Inventory, BASC
Labeling Psychological Disorders
1. Critics of the DSM-5

argue that labels can
stigmatize individuals.
Asylum baseball team (labeling)

Classifying Abnormal Behavior
The Relationship Between
Assessment and Diagnosis
Treatment: How Might the
Client Be Helped?
Treatment decisions
Begin with assessment information and diagnostic
decisions to determine a treatment plan
Use a combination of idiographic and nomothetic
(broad, general) information
Other factors:
Therapists theoretical orientation
Current research
General state of clinical knowledge currently focusing
on empirically supported, evidence-based treatment
The Effectiveness of Treatment
Therapy outcome studies typically assess
one of the following questions:
Is therapy in general effective?
Are particular therapies generally
effective?
Are particular therapies effective for
particular problems?
The Effectiveness of Treatment
Meta-analysis - the average person who
received treatment was better off than
75% of the untreated subjects
Can therapy can be harmful?

5-10% of patients get worse with
treatment
Does Therapy Help?
Uniformity myth
What specific treatment, by whom, is the

most effective for this individual with that
specific problem, and under which set of
circumstances?

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Class 2

Clinical Interview, Clinical

What role does psychosocial

10 inkblots - designed by Hermann

Developed by Henry Murray (1893-1988),

Stanford-Binet intelligence test

1. Critics of the DSM-5

Asylum baseball team (labeling)

Can therapy can be harmful?

What specific treatment, by whom, is the

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