THE CLINICAL INTERVIEW

Multan post Graduate College Multan

 WHAT IS CLINICAL
INTERVIEW?

A clinical interview is a conversation between

a psychologists and client that is intended to help
the psychologist diagnose and treat the patient.
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INTRODUCTION

 The clinical assessment examines a client’s life in far more

detail so that accurate diagnosis, appropriate treatment plan,
problem lists and treatment goals can be made.

 Identifies client’s strengths, weaknesses, along with

appropriate level of treatment and care.
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Clinical
Interview

Characteristics of Communication
Interview Strategies

Types and Structure of Roles and Tactics Interview

Considerations and Issues

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Characteristics of Clinical Interview

 One to one conversation between a  Conversation either initiated by

professional (psychologist) and client or by psychologist
client initiated

 Professional setting  Purposeful and goal oriented

(hospital, clinic) conversation
 THE INTERVIEWER

The most pivotal element of a

clinical interview is the person who
conducts it.
 GENERAL SKILLS
• Quieting yourself – minimize excessive internal, self-
directed thought that detract from listening.
• Being self-aware – know how you tend to affect others
interpersonally, and how others tend to relate to you.
• Develop positive working relationships – can segue into
psychotherapy.
- respecting and caring attitude is key.
 SPECIFIC BEHAVIORS
• Eye contact
• Body language
• Vocal qualities
• Verbal tracking
• Referring to the client by the proper
name
 BODY LANGUAGE
General rules; face the client, appear
attentive, minimize restlessness, display
appropriate facial expressions and so on.
 VOCAL QUALITIES
Use pitch, tone, volume, and fluctuation to
voices to let clients know that their feeling
and words are being deeply appreciated.
 VERBAL TRACKING
•Ensure clients that they have been accurately
heard.

•Monitor the train of thought of client, if able

to shift topics smoothly rather than abruptly.
REFERRING TO THE CLIENT BY
THE PROPER NAME
Misuse of names in this way may be
disrespectful andbe received
microaggression. as
 OPEN-ENDED AND CLOSED-
ENDED QUESTIONS
• Open-ended questions
-Allow individualized and spontaneous responses from
clients.
-Elicit long answers that may or may not provide
necessary info.
• Close-ended questions
- Allow less elaboration and self- expression by
the client.
 PRAGMATICS OF THE
INTERVIEW
• Note taking
• Audio and Video-recording
• The interview room
• Confidentiality
 NOTE TAKING

• Little consensus about note-taking.

•Provide a reliable written record, but can

be distracting to client and interviewer.
AUDIO AND
VIDEO-
RECORDING
•Also provide a reliable record, but can be
inhibiting to clients.

• Must obtain permission.

THE INTERVIEW ROOM
Professional yet comfortable
with your clients.
CONFIDENTIALITY
Involves a set of rules or a promise that
limits access or places restrictions on
certain types of information.
 COMPONENTS OF THE
INTERVIEW
• Rapport – positive, comfortable relationship
between interviewer and client.

• Technique – what an interviewer does with

clients;
- Directive vs. Non-directive Styles
TYPES OF INTERVIEWS
• Intake Interviews
• Diagnostic Interviews
• Mental Status Exam
• Crisis Interviews
INTAKE INTERVIEWS
To determine whether to “intake”
the client into the agency or refer
elsewhere.
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Types and Structure of Clinical
Interview
1 Intake Interview  Think rules
 Why the client is looking for  Behavior (actions)
help?  Solution (handling)
 Are the competencies and  Positive (resources)
resources available to
 Small steps (increments)
help client ?
 Flexible (possibilities)
 Build rapport
 Future (control)
 Make the client at ease
 Encourage for
information
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Types and Structure of

Clinical
2- Case History
Interview
 Psychosocial history  Employment
 Detailed description of client's  Recreational/leisure
background
 Marital and Sexual history
 Birth and development
 Alcohol and drugs
 Family origins
 Physical health
 Education
 MENTAL STATUS EXAM
• Typically used in medical settings.
•To quickly assess how a client
is functioning at that time.
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Types and Structure of Clinical
Interview
 Perception
3 Mental Status Exam  Obsessions and compulsions
 Protocol for organizing  Orientation
observations of client
 Memory
 Switch to direct  Attention and concentration
questioning at the
end of interview  General Information

 General  Intelligence
appearance and
behavior  Insight and judgment

 Speech and thought

 Higher cognitive functioning

 Consciousness
 CRISIS INTERVIEWS
•Assess problem and provide
immediate intervention.
•Clients are often considering suicide
or other harmful act.
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Types and Structure of

Clinical
4 Crisis Interview
Interview Client needed to be dealt

 Emergency consultation at moment
 Unexpected life stressors  Provide reassurance,
assess the problem and
 can’t be assessed through
explore potential
lengthy psychological
resources
batteries
 Resolve problem
 can’tbe waited to access
immediately to avoid
previous history
catastrophic event to
occur
 DIAGNOSTIC INTERVIEWS
• To provide DSM diagnosis
• Structured interviews often used
 minimize subjectivity, enhance reliability
 SCID ( Structured Clinical Interview for DSM-5)
is an example
- Currently being revised for DSM-5
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Types and Structure of

Clinical
5- Diagnostic Interview
Interview
 Goal is to classify the complaints
and dysfunctions of client
 The methods for conducting
 Clinician observers: diagnostic interview vary in
 client’s behavior goals and degree of structure
 Inquires about symptoms in  Five steps in diagnostic
detail interview ( Othmer & Othmer,
 Gathers
1994)
relevant personal
and family history
 Process of Diagnostic
Interview
1- Diagnostic clues
• Helps in creating a list
possible, unexplored and
excluded disorders
• “tell me what’s troubling you”
2- Specific diagnostic criteria
• Specified questions related to
specific criteria
• “have you ever been bothered
by voices or seen things that
nobody else could hear or see ?”
3- Psychiatric history 10
• Has the client received
mental health services
• Premorbid functioning & family
history
4- Arrive at a Diagnosis
5- Prognosis
 Based upon the gathered
information, the clinician
estimates the likely future
course of disorder and
client
 Methods for conducting 11

Interview
Diagnostic
Un-structured Structured Semi-Structured

 Most probably used  Predetermined  Somewhat unstructured

questions and predetermined
 To develop
diagnostic  Set of rules to probe,  Improves rapport
formulation sequence inquiries building
 Reliability and rating the
issues responses
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Importance of Rapport
 The sense of mutual trust and
harmony that characterizes a
good relationship
(Giordano, 1997)
 Warmth and empathy
 Genuineness
 Immediacy
 Positive regard and
respect
 Self-disclosure
 Consent taking
 Confidentiality
assurance
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Communicatio
n Strategies
 Verbal strategies  Non-verbal strategies

 Reflective listening  Facial expressions

 Asking open-ended questions  Eye contact
 Affirming  Body posture
 Summarizing  SOLER (micro-skills)
 Rolling with resistance

Roles and
Tactics
 Strategies for Rolling
with resistance
 Reflective listening
 Shifting focus
 Ignore client’s negative
statement
 Agreement with a twist
 Agree with client but with
a change of direction
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 Reframing
 Offering a new and positive
interpretation of negative
information
 Emphasizing personal choice and
control
 Acknowledge the positive
choices a client makes
and improve his self-
efficacy
 Other considerations and 15
issues

1- Interviewing with children

• Praise
• Ask simple questions
• Understand local
communication norms
• Be tactful
3- Common pitfalls
• Understand silence
• Jargon pitfall
2- Cultural diversity issues
• Need to avoid the biases and
• Reassurance pitfall
influence of experiences
• Educate about communication styles of
culture where you work
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Motivational Interviewing

Express empathy Develop Avoid argumentation Roll with

& discrepancy
Support self-efficacy resistance
 Motivational Interviewing 17

 Express empathy and support self-efficacy

Stay non-judgmental and help the client towards changing themselves
 Develop discrepancy
Focus their attention towards the discrepancy in their goals and
actions
 Avoid argumentation
Rather confronting with client, show a gentle persuasive style
 Roll with resistance

Move with the resistance by challenging their thoughts

 CULTURAL COMPONENTS
• Appreciating the Cultural Context
-knowledge of the client’s culture, as well as the interviewer’s own
culture.
- for behavior described or exhibited during interview.
• Acknowledging Cultural Differences
- wise to discuss cultural differences rather than ignore.
- sensitive inquiry about client’s cultural experiences can be
helpful.
PRINCIPLES OF CLINICAL INTERVIEWS

• Remember, an intake interview is

an assessment!
• There are various types:
structured, unstructured and
semi-structured.
• Clinical interviews offer the ability to
obtain reliable information from clients.
Validity of intake interviews

• Validity refers to how well a test

measures what it is supposed to
measure.
• Our job as counselor is to gather
information from our clients.
• So, it would be appropriate for us to gather
a wide range of information as a basis to
begin our work with clients.
Strengths & Purposes of the Clinical
Interview

To communicate & clarify the
assessment process

Understand the client’s expectations

Obtain information about past and
current events in the family

Document the context, severity, an
chronicity of problem behaviors.

Use flexible procedures to ask questions

Resolve ambiguous responses
Clinical Interviews
• Usually a formally arranged meeting
• Follows rules of confidentiality
• Interview obliged to stay until end
• Has definite purpose
• Well defined relationship with specific
roles
• Interview plans/organizes his/her behavior
• Interviewer directs interaction
• Interviewer does not reaction emotionally
• Interviewer doesn't presume
Thank You! =)