ch6

• 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
• Clinical assessment


  Leads to a better understanding of the client
• Clinical assessment


  • Ongoing process
  • 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
• Referral question


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


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


  Impacts the choice of assessment instruments used
• Interview


  An interaction where each participant contributes and influences the other(s)
• Interview


  Falls between conversation and actual psychological test, more purposeful and organized than a conversation, but not formal or standardized like a test
• Interviewing


  An art that requires training and supervised experience
• Physical arrangements for interviews

  • Consider privacy and protection from interruption
• Note-taking


  Moderate note-taking is ideal during interviews
• Rapport


  The relationship between patient and clinician, characterized by acceptance, empathy, understanding, respect, and competence
• Communication in interviews


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

  Why they are seeking help, any pressure, their goals, and their 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


  Determines why the patient has come to the clinic/hospital and judges 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
• Case-history interview informants


  Knowledgeable adults in the patient's life that can provide additional information about the patient
• Mental status examination interview areas

  • General presentation
  • State of consciousness
  • Attention and concentration
  • Speech
  • Orientation
  • Mood and affect
  • Form of thought; formal thought disorder
  • Thought content
  • Ability to think abstractly
  • Perceptions
  • Memory
  • Intellectual functioning
  • Insight and judgment
• Crisis interview


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


  Incorporation of new technology, but has structured testing limitations
• Diagnostic interview


  Unstructured (free-form, content varies greatly) or 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
• Kappa coefficient


  The statistical index of inter-rater reliability
• Test-retest reliability


  The consistency of interview scores over time
• Suggestions for improving reliability and validity of interviews include: using a structured interview whenever possible, developing good interviewing skills, being aware of the patient's motives and expectancies, and being aware of one's own expectations, biases, and cultural values
• Becoming a skilled interviewer requires practice and good self-awareness