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 3- Psychiatric history 10
Interview • Has the client received
mental health services
1- Diagnostic clues
• Premorbid functioning & family
• Helps in creating a list history
possible, unexplored and
excluded disorders 4- Arrive at a Diagnosis
• “tell me what’s troubling you”
2- Specific diagnostic criteria 5- Prognosis
• Specified questions related to
specific criteria Based upon the gathered
• “have you ever been bothered information, the clinician
by voices or seen things that estimates the likely future
nobody else could hear or see ?” 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
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Roles and
Tactics
Strategies for Rolling Reframing
with resistance Offering a new and positive
Reflective listening interpretation of negative
Shifting focus information
Ignore client’s negative
Emphasizing personal choice and
statement control
Agreement with a twist
Acknowledge the positive
choices a client makes
Agree with client but with and improve his self-
a change of direction 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! =)
