Clinical Interview

Clinical interview as a part of clinical assessment

Clinical interview

Factors that influence clinical interviewing

Goals of clinical interview

Skills for clinical interview

Methods of clinical interview

Types of clinical interview

Ethical considerations & Interviewing pitfalls

 Clinical interview as a part of Assessment
“Clinical assessment is a way of diagnosing and planning treatment for a patient that
involves evaluating someone in order to figure out what is wrong. There are many types of
psychological assessments.”
The common types of clinical assessments:

Informal Assessment
• ›Clinical Observation
• ›Unstructured Interviews
Formal Assessment
• ›Standardized Test
• ›Structured Interviews
 What is clinical Interview?
“A clinical interview is a dialogue between psychologist and client that is
designed to help the psychologist diagnose and plan treatment for the client.
It is often called 'a conversation with a purpose.”
INTERVIEWER (Psychologist)

The most pivotal element of a clinical

interview is the person who conducts it..

INTERVIEWEE (client)

A person (client) who answer the questions 

in an interview of an interviewer.
 Conversation VS Clinical Interview
• A clinical interview has a focused • In normal conversation there is no
purpose. focused purpose.
• In a clinical interview, the roles • In normal conversation, roles are
are clearly defined. not clearly defined
• Clinical interview occurs within a • In normal conversation, there is
defined time frame. no defined time frame.
Factors that Influence Clinical Interviews
Many factors influence on the productivity and utility of data obtained from
interview.
The physical setting
Note-taking and recording
Setting the right tone
Good start
Adjustment
moving rapidly through interview
Asking questions straightforwardly
 Factors (cont.,)
Considerable tact and skill must be used in handling pauses
Attempt to get beneath superficial answer
Note discrepancies in the account and check them
Handling emotional scenes tactfully
Preparedness
Potential threats of effective interviewing biasness
 Four Basic Goals of Clinical Interviewing
Perhaps the clearest way to define a clinical interview is to describe its purpose
or goals.
1. the goal of establishing (and maintaining) a working relationship or therapeutic
alliance between clinical interviewer and patient; research has suggested the
relationship between interviewer and patient is multidimensional, including
agreement on mutual goals, engagement in mutual tasks, and development of a
relational bond (Norcross & Lambert, 2011).
2. the goal of obtaining assessment information or data about patients; in situations
where the goal of the clinical interview is to formulate a psychiatric diagnosis,
the process is typically referred to as a diagnostic interview.
Four Basic Goals of Clinical Interviewing

3) the goal of developing a case formulation and treatment plan (although

this goal includes gathering assessment information, it also moves
beyond problem definition or diagnosis and involves the introduction of
a treatment plan to a patient).
4) the goal of providing, as appropriate and as needed, a specific
educational or therapeutic intervention, or referral for a specific
intervention; this intervention is tailored to the patient’s particular
problem or problem situation.
 Skills for Clinical Interviewing
 developing rapport,
 effective listening skills,
 effective communication,
 Rapport & Importance of Rapport in
Clinical Interviews
Rapport has been defined as “the sense of mutual trust and harmony that
characterizes a good relationship”.
Rapport is an essential part of a healthy therapist-client relationship.
The goal of developing a good rapport is to improve your chances for a
successful outcome, along with developing mutual trust and respect, to raise an
environment in which you and the client feel safe.
Establishing rapport can be particularly challenging when the clinician and
client come from different cultural backgrounds.
Rapport is like puzzle
 For rapport
 The professional must focus complete attention on the patient without any
telephone calls or personal concerns.
 The professional must maintain eye contact and facing the patient with an
open posture .
 The psychologist actively and carefully listens.
 The psychologist is nonjudgmental and noncritical.
 Genuine respect, empathy, sincerity, and acceptance
 Effective Listening Skills
• To fully listen to another without being distracted by your thoughts and
concerns is challenging work.
• Careful listening includes the content of what is being said and the
feelings behind what is being said.
• Listening also includes paying attention to what is not being said.
 Four Listening Responses
[Cormier and Cormier (1991)]

RESPONSE DEFINITION PURPOSE

1 Clarification A question beginning with “do you To encourage client elaboration

mean that” or “are you saying that” To check out accuracy
To clear up vague message.
2 Paraphrasing A rephrasing of the content of the To help the client focus on content of
client’s message. his or her message.

3 Reflection A rephrasing of the important part of To encourage client to express more

the client’s message. feelings. To help client determine
accurately among feelings.
4 Summarization Two or more paraphrases or reflection To tie together multiple elements.
that condense the client’s message or To identify common theme. To
the session. interrupt excessive talking.
 Communication strategies
Effective Communication:
The professional must use language appropriate to the client and avoids
the use of professional jargon.
• Verbal strategies
• Non- verbal strategies
• Congruence between verbal & non-verbal strategies
 Open-ended Questioning
Open-ended questioning
Open questions are those that cannot be answered in a few words, they encourage the
client to speak and offer an opportunity for the psychologist to gather information about
the client and their concerns.
• begin with: what, why, how or could.
For example:
1. What has brought you here today?
2. Why do you think that?
3. How did you come to consider this?
4. Could you tell me what brings you here today?
 Closed-ended Questioning
Closed-ended questions
Closed questions are questions that can be answered with a minimal response
(often as little as “yes” or “no”). They can help the counsellor to focus the client or
gain very specific information. Such questions begin with: is, are or do.
For example:
• Is that your coat?
• Are you living alone?
• Do you enjoy your job?
Client’s non-verbal behavior

Skilled clinicians read a client non-verbal behavior for clues about

client’s emotions, attitudes and behavior.
• No eye-contact by client
• Slouching in the chair with folded arms
• Fidgeting (anxiety)
Clinician’s non-verbal behavior: just as the client’s non-verbal behavior
conveys a great deal of information to the clinician, the clinician’s facial
expression and body posture say a lot to the client.
Egan (1986) uses an acronym to describe these micro-skills.
SOLER

S Squarely facing the client

O Open posture

L Lean towards the client

E Eye contact

R Relax
 Methods of Clinical Interview

• Structured interviews
• Unstructured interviews
• Semi-structured interviews
 Structured and Unstructured Clinical
Interview
 A structured interview is a type of An unstructured interview is a type of
interview in which the interviewer interview in which the interviewer
asks a particular set asks questions that are not prepared in
of predetermined questions. advance.

 In structured interviews, questions In unstructured interviews, questions

arise spontaneously in a free-flowing
are planned and created in advance. conversation.
 Clinician directed Client directed
 Tendency towards more close-ended Tendency towards more open-ended
questions questions
 Structured and Unstructured Clinical
Interview
Structured interviews are also Unstructured interviews are also
known as: known as:
• Standardized interviews • Informal interviews
• Patterned interviews • Casual interviews
• Planned interviews • Free-flowing interviews
• Formal interviews
 Semi- structured interviews
A semi-structured interview is a type of interview in which the interviewer
asks only a few predetermined questions while the rest of the questions
are not planned in advance.
Since semi-structured interviews combine both the structured and
unstructured interview styles,
they can offer the advantages of both.
Open & close-ended questions
 Structured interviews

STRENGHTS WEAKNESSES
Controlled Respondent have to give the
Can ensure questions are fully answer from selected options of
understood interview

Equal opportunity for the Limited freedom to talk

Time consuming
 Un-structured interviews

STRENGHTS WEAKNESSES
Rich data Time consuming
Understand what is important to Researcher’s bias
the client Little control
Important concepts are uncovered Attention can be shattered from main
that can eventually guide future issue
enquiries. Over freedom to talk
 Semi-structured interviews

STRENGHTS WEAKNESSES
Personalized and spontaneous Spontaneous questioning makes answer
approach difficult to evaluate.
Needed / essential data is collected Needs preparation
Flexibility It can be challenging to find an
interviewer with the right amount of
More relaxed atmosphere to collect training to conduct
data the interview properly
 Stages of interviewing
• Discussed in class by mam Rabia
 Types of clinical interviews

Clinical interviews:
1. The intake interview
2. Mental status examination.
3. Case History
4. Crisis interview
5. Diagnostic interview
6. Computer assisted interview
7. Termination interview
 Intake Interview
( Initial Assessment/ Admission Interview )

“This type of interview is usually concerned with clarification of the

patient’s presenting complaints, the steps he has taken previously to resolve
the difficulties and his expectances in regard to what may be done for him.”
 Objectives of intake interview
To identify, evaluate, and explore the client’s presenting complains
To determine whether client has resources and competence to deal with
problem.
To evaluate client’s current life situation and functioning.
During the intake interview, the clinician may determine a treatment plan.
In some cases, particular clinician may feel that he or she lacks the
expertise to best help the client. It is during the intake interview that the
clinician should refer the client to another source.
 Objectives(cont.,)
• Intake interviews, as part of the assessment phase , gather information
about the client's reasons for seeking counseling, current and past
functioning, social history and interpersonal style, and goals for
counseling.
• This information allows the therapist to develop a framework in which to
understand the clinical issues presented (diagnosis) and to collaboratively
plan the treatment goals with the client.
 Procedure (example)
• 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.
 Think Rules of Intake Interview
Think
behavior
Think Think
flexible solution

Think
rules

Think
Think future
positive
Think small
steps
 Therapist-Client relationship
During the intake interview, both parties form opinions about one
another that can be either positive or negative.
The client begins to perceive the characteristics of the therapist during this
intake interview and the clinical relationship between the two starts to
form here. 
A client’s perception of a clinician during an intake interview can either
hinder or encourage them to get further treatment.
Mental Status Exam
 Case History interview

This is type of structured interview with the focus of getting the details of
the patient’s life.

1. Identifying Data
2. Source and Reason of Referral
3. Presenting Complaints
4. Initial Observation
5. History of Present Problem
6. Background Information
7. Family history
8. History of psychiatry/medical illness in the family
9. Personal history
10. Educational history
11. Occupational history
12. Marital history
13. Medical history
 Crises Interview
It is conducted when a patient is in a significant and traumatic or life-threatening
crisis. We might encounter such a situation in an emergency room, a clinic, or a
student health service on campus.
For example- psychologist who work at the admission units pf psychiatric
hospitals or who provide emergency consultation at general hospitals often deal
with crises.
Some agencies, such as suicide hotlines or walk-in mental health centers are
created to help people in crises.
Psychologist does not have access to many of the assessment tools he or she
typically relies upon. The individual in crises cannot be asked to complete a
lengthy battery of psychological tests or provide written consent and wait a while
the clinician obtain copies of a prior mental health records.
 Goals of Crises Interview

Primary Goal: resolve the immediate problem

Secondary Goal: refer to appropriate resources
 In the case of crisis
Crisis intervention is a time-limited intervention with a specific
psychotherapeutic approach to immediately stabilize those in crisis.
The interviewer should
• be more directive (encouraging the person to phone the police);
• break confidentiality if the person is in serious and immediate danger;
• enlist the help of others (e.g., police department, ambulance).
• explore potential resources.
 Diagnostic Interview

The purpose of diagnostic interview is to elicit the information necessary to

arrive at a diagnostic formulation.
The model for diagnostic interview is, of course, a medical one. The clinician
asks a series of questions about the presence or absence of symptoms.
Patient’s symptoms and problems are examined in order to classify into a
diagnosis. the Diagnostic and Statistical Manual- V (DSM-V) is used to develop
a diagnosis. The DSM-V is used to classify and diagnose psychiatric problems.
 Five steps of Diagnostic interviewing
[Othmer and Othmer (1994)]
• In the first step clinician looks for diagnostic clues
He gave 5 in the client’s chief complaint, behavior, history
and presentation. Based upon these clues, clinician
steps in will create lists of possible psychiatric disorders,
excluded disorders, and unexplored disorders.
diagnostic • In the second step, clinician inquires about
specific diagnostic criteria.
interviewin • The third step is to get a psychiatric history.
• The fourth step is to arrive at a diagnosis.
g. • The fifth and last step is about prognosis/future
course.
 Computer-Assisted Interviews
Computers can be used to ask patients questions and record their responses.

Some patients feel more comfortable answering sensitive and embarrassing

questions via computer rather than face-to-face interview. However, some people
are uncomfortable with computers and prefer to talk with a professional.

Ethical issue: There is a confidentiality concerns when sensitive material is being

requested in a waiting room and when access to computer files is not controlled.
 Termination Interview
After completion of treatment, a termination interview may be used to evaluate the effectiveness of
treatment.
Follow up
Need session

It might focus on
how the patient experienced the treatment,
what the patient found useful or not useful,
how he or she might best deal with problems in the future.
 Ethical considerations
Confidentiality
Informed consent
Creating dependency in the client
Multiple or dual relationship with client
Questionable financial agreement
Justice
Honesty
Responsibility
 Interviewing pitfalls
(especially for beginning clinicians)

1. The authenticity pitfall

2. The jargon pitfall
3. The slave to the intake pitfall
4. The diagnostic pitfall
5. The reassurance pitfall
 The authenticity pitfall

Hearing the advice “be yourself” may seem comical to the psychology
trainee who is struggling to make sure to maintain eye-contact, express
empathy, observe the client’s behavior and to record what the client is
saying. But the advice is sound nonetheless.
Too often beginning clinicians adopt a persona when they enter the
clinical settings. They try to be their supervisor or master clinician whose
work they admire.
 The jargon pitfall

professional jargon

Asking “are you anhedonic?” will likely elicit a blank state from most
clients, but “Do you feel like you don’t enjoy the things the way you used
to?” is a question most people can understand.
 The slave to intake pitfall
Many supervisions provide a suggested outline of topics to be covered
during in an intake interview.
Intake form
Overwhelming pressure on clinician,
As a result, Clinician will miss what is important to client.
 The diagnostic label pitfall

Prior knowledge of diagnostic labels

Example ( panic disorder)(Obsessive-Compulsive disorder)
Impeded assessment process due to label
 The reassurance pitfall

• “Supportive technique”
• Client’s tragic stories can produce strong urge to do something to make client feel better.
• Reassurance need to be communicated carefully while acknowledging the reality of
client’s situation.
• Don’t worry/ I am sure everything is going to work out fine./I really appreciate your
willingness to share with me some of the painful experiences you have had/ I know that’s
not easy to discuss these kinds of things.