Chapter 6: Clinical Interview

• Clinical interview


  A vital part of psychological evaluation to extract data that would not be otherwise acknowledged
• Information that concerns the interview

  • Personal info (name, age, gender, address, phone, marital status, ethnicity, education, occupation)
  • Referral source (who referred the person and why)
  • Family history
  • Medical, psychiatric and psychological history and treatment
  • Developmental history (birth and early child development)
  • Sexual history (sexual orientation, experience, problems)
  • Current complaints (e.g., symptoms)
  • Treatment goals
• Types of psychological interview by form

  • Structured
  • Semi-structured
  • Unstructured
• Structured interview


  • Follows a strict sequence of questions, often following contemporary classifications of mental disorders (e.g. ICD, DSM)
  • Ensures no vital information is missed
  • High reliance due to ICD/DSM criteria
  • Standardized and easy to use
  • Empirically driven
  • Reduced reliance on subjective factors
  • Rigidity that reduces rapport
  • No out-of-topic discussion that the interviewee may be interested in
  • Unnecessarily time-consuming
• Types of psychological interview by purpose

  • Intake
  • Diagnostics
  • Crisis
  • Mental status exam
• Intake interview


  Assesses whether the interviewee needs treatment, the type of treatment that is needed, and whether the facility is able to provide the specific treatment
• Diagnostic interview


  Aims to diagnose; to assign an accurate diagnosis considering contemporary classifications of mental disorders (e.g. ICD or DSM) via a structured approach
• Crisis interview


  Aims to (1) assess the issue (e.g. suicidal thoughts or behaviours), and (2) intervene quickly and efficiently
• Mental status examination


  Rapidly examines psychological and cognitive processes at the time of the interview
• Main categories of mental status examination

  • General appearance
  • Behaviour/psychomotor activity (e.g. agitated)
  • Affect and mood (e.g. tearful)
  • Speech and thought (e.g. talkative)
  • Perception (e.g. hallucinations)
  • Orientation to person, place, and time (e.g. if they know the date, their location)
  • Cognition and intelligence (e.g. counting backwards by 7 from 100)
  • Reliability, judgement, and insight (e.g. whether they believe they have an issue)
• Modalities of psychological interview

  • Psychoanalytical
  • Psychodynamic
  • Cognitive-Behavioural
  • Schema Therapy
  • Acceptance-Commitment
  • Positive
• Psychoanalytical modality


  • The unconscious defines thought, desire, and conflicts
  • Unstructured approach
  • Founder: Sigmund Freud
• Psychodynamic modality


  • Behaviour and emotions are driven by the unconscious
  • Semi-structured approach
  • Founders: Sigmund Freud, Carl Jung, Alfred Adler, Melanie Klein, Erik Erikson
• Cognitive-Behavioural modality


  • Core beliefs and behaviours are malleable
  • Structured approach
  • Founder: Aaron Beck
• Schema Therapy modality


  • There are subconscious obstructs against change, which could be overcome
  • Semi-structured approach
  • Founder: Jeffrey Young
• Acceptance-Commitment modality


  • Suffering is due to fixation on being in control; pathology does not exist
  • Semi-structured approach
  • Founder: Steven Hayes
• Positive modality


  • There is a positive core to any pathology or negativity
  • Semi-structured approach
  • Founder: Nossrat Peseschkian
• Components of the interview

  • Theoretical basis
  • Rapport
  • Technique
  • Style
  • Note-taking
  • Audio and video recordings
  • Interview room
  • Confidentiality
• Theoretical basis


  The interviewer needs to have relevant theoretical skills in order to perform clinical interviews, usually stemming from the modality they follow
• Rapport


  A sense of connectedness between the interviewer and the interviewee that displays empathy and allows disclosure
• Techniques and skills for the interviewer

  • Referring by the proper name
  • Demonstrating leadership
  • Using open- vs closed-ended questions
  • Paraphrasing
  • Verbal tracking
  • Clarification
  • Exemplification
  • Confrontation
  • Reflection
  • Eye contact
  • Body language
  • Vocal qualities
  • Summarization
• Directive style


  Allows the interviewer to require specific information from the interviewee and to restrict the course of the interview
• Non-directive style


  Allows the interviewee to lead the course and topic of the interview
• A proposed strategy is to incorporate both directive and non-directive styles to ensure the best results
• Note-taking may be time consuming, may obstruct vital information from being noticed, and may disturb rapport
• Audio and video recordings require a written permission and an explanation of their rationale
• The interview room needs to convey both professionalism and comfort
• Confidentiality needs to be not merely felt but discussed
• Issues with assessment


  • Objectivity
  • Malingering
  • Deception (dissimulation)
  • Cross-cultural context
  • Gender and sexuality
• Tools to increase the objectivity and rapport of an interview


  • Collateral reports
  • Documentation
  • Awareness
• Tools to Increase the Objectivity and Rapport of an Interview

  • Collateral reports
  • Documentation
  • Awareness
• Collateral reports


  Interviews held with family members, significant others, or employers to collect objective information that is otherwise hidden if the interview assesses merely the point of view of the interviewee
• Documentation


  Medical, scholar, military, or legal documents and records are vital to have the most accurate information as memory is not always reliable or objective
• Awareness


  The interviewer needs to be aware of the cultural, social, gender, and sexual circumstances of the interviewee or differences that may exist between him/her and the interviewer. The issues could be both medical (e.g., history of sexually transmitted infections) or psychological (e.g., relationship disharmony). Awareness of and openness to the LGBTQ+ community increases the rapport
• Health attitudes


  • Optimistic, unfair optimistic and careless
  • Fatalistic
  • Pessimistic and hypochondriac
  • Realistic
• Optimistic, unfair optimistic and careless attitude


  Individuals who are typically optimistic, outgoing, and enjoy the pleasures of life. They do not allocate much attention toward monitoring or analyzing their bodily functions, convinced of their perfect state. While this attitude tends to keep fear and anxiety at bay, it can also lead to dismissing early symptoms of illness and maintaining a false sense of good health. Often, excessive optimism can be a defensive response based on repressed or denied emotions
• Fatalistic attitude


  An example of displacement as a defense mechanism - "It's out of my hands and in the hands of a higher power." People who hold this belief often express, "If it's meant to be, it will happen." Their fatalism is often linked to religious prejudices or lack of trust in medicine
• Pessimistic and hypochondriac attitude


  Individuals with this kind of attitude tend to anticipate negative events, not just related to their health, but in general. They frequently observe themselves, noticing even the slightest bodily sensations and overvaluing them, searching for explanations. They insist on undergoing frequent medical check-ups, consulting with various specialists, and remain unsatisfied with their diagnosis or the lack of it. As a result, significant limitations in their social life emerge. Sometimes, patients can deceptively mislead their doctor with their complaints, leading to potential harm. If redirected to a psychologist or psychiatrist, some may take offence and seek out alternative medical specialists
• Realistic attitude


  The realistic person can manage their health, which is well within their capabilities and control. By understanding the strengths and weaknesses of their body, individuals can evaluate limitations and manageable strains. Negative signals of the body are calmly and accurately identified, enabling the individual to promptly seek out medical care. Then, symptoms can be objectively and clearly explained to their doctor, without exaggeration or downplay. A person discovers the willpower to relinquish harmful habits, embrace healthy dietary advice and routine. Health holds significant, yet not overwhelming, importance within their system of values. Usually, individuals with realistic attitude naturally internalize healthy lifestyle habits from a young age
• Dimensions of the relationship between personality and illness

  • Personality change in disease due to somatic disease itself
  • The degradation and disintegration of the individual as a result of the disease
  • Pathological response of the individual to changes in their illness
  • The challenges of daily living, specifically those related to combating the disease itself
  • Pathological personality development