Clinical

• Clinical assessment


  Evaluation of an individual's strengths and weaknesses, conceptualization of the problem at hand (including possible etiological factors), and prescription for alleviating the problem
• Our ability to successfully treat psychological problems is directly related to our ability to define the problems
• Referral


  The process of referring a patient to a clinician for assessment and treatment
• Referral sources


  • Parent
  • Friend
  • Teacher
  • Psychiatrist
  • Judge
• Referral question


  What aspect of a patient's behavior needs attention and clarification
• Referral question


  • Why is Juan disobedient?
• Clinician's theoretical orientation


  Psychodynamic, behavioral, etc.
• Clinician's theoretical orientation


  Impacts which assessment instruments the clinician will use
• Interviews


  • An interaction where each participant contributes and influences the other(s)
  • Falls between conversation and actual psychological test, more purposeful and organized than a conversation, but not formal or standardized like a test
• Rapport


  The relationship between patient and clinician, including acceptance, empathy, understanding, respect, and competence
• Elements of communication in an interview

  • Beginning a session
  • Language
  • Use of questions
  • Silence
  • Listening
  • Impact of clinician (appearance, values, etc.)
• Patient's frame of reference

  Why the patient is seeking help, any pressure, their goals, and understanding of therapy/consultation
• Clinician's frame of reference

  Being clear about the purpose of the interview, remaining focused, and providing closure
• Intake-admission interview


  To determine why the patient has come to the clinic or hospital and to judge whether the agency's facilities, policies, and services will meet the needs and expectations of the patient
• Case-history interview


  Provides a broad background and context in which both the patient and the problem can be placed, covering childhood, adulthood, educational, sexual, medical, parental-environmental, religious, and psychopathological matters
• Mental status examination interview

  Assesses general presentation, state of consciousness, attention and concentration, speech, orientation, mood and affect, form of thought, thought content, ability to think abstractly, perceptions, memory, intellectual functioning, and insight and judgment
• Crisis interview


  Purpose is to meet problems as they occur and to provide an immediate resource, to deflect the potential for disaster and to encourage the person to enter into a relationship with the clinic or make a referral so that a longer term solution can be worked out
• Computerized interviewing


  Incorporation of new technology, but with structured testing limitations
• Types of diagnostic interviews

  • Unstructured (free-form, content varies greatly between clinicians)
  • Structured (standard set of questions and follow-up probes in a specific sequence, all patients asked the same questions)
• Inter-rater reliability


  The level of agreement between at least two raters who have evaluated the same patient independently
• Test-retest reliability


  The consistency of interview scores over time
• Kappa Coefficient is the statistical index of inter-rater reliability
• Suggestions for improving reliability and validity of interviews

  • Use a structured interview whenever possible
  • Develop one if one does not exist for your purpose
  • Develop good interviewing skills
  • Be aware of the patient's motives and expectancies
  • Be aware of your own expectations, biases, and cultural values
• Becoming a skilled interviewer requires practice and good self-awareness