549 Chapter 8

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549 Chapter 8
2010-10-25 22:24:30

Chapter 8
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  1. What utility does the clinical interview provide to the assessment process?
    • •Useful for:
    • –gathering information / data
    • –making predictions / hypotheses
    • –establishing rapport (using your personal skills, such as your ability to communicate effectively and your ability to establish a meaningful relationship)
    • –direct observation of the client
    • •in a “structured” setting
    • –setting a “working diagnosis”
    • •e.g., third party reimbursement
    • –clarifying information from other sources
    • •e.g., background questionnaire
  2. Characteristics of a Clinical Interview
  3. –purposeful
    • –largely controlled or driven by the interviewer
    • –direction and structure-unity
  4. Types of Interviews
    • •(1) Directive vs.non-directive
    • •(2) Structured vs.unstructured
    • •(3) Case history
    • –e.g., intake interview
    • •(4) Mental status exam
  5. Differences between a structured & unstructured interview
    • structured: highly structured. Interviewer read from a printed set of questions, using a standardized interview -asked the same questions in the same sequence. Directive-the interview is directed, guided, and controlled by the interviewer. Asks questions closed ended. e.g. Employment Interview
    • Pros: reliability runs twice as high for structured
    • Cons: Narrow & restricted

    • unstructured: unstandardized, doesn't follow a set sequence of questions. Non Directive-allows patient to direct the course of interview. Tends to comment/reflects. Ask open ended questions.
    • Pros: broad, unrestricted, unique, flexible
    • Cons:
  6. What are the advantages of conducting a structured interview? An unstructured
    interview? What are the disadvantages of each?
  7. Characteristics of effective interviews
    • (1) recognize the reciprocal nature of the interview
    • –participants will influence each other
    • •e.g., Akehurst & Vrij (1999)–increase in activity level
    • –Heller (1971) – “social facilitation”
    • •interviewers serve as models for interviewees
    • (2) cast a positive attitude
    • •e.g., warmth, genuineness, acceptance, openness…
    • (3) leave your values at the door
    • •e.g., evaluation or judgment statements
    • (4) limit probing statements / questions
    • •e.g., “Why?” questions
    • (5) open-ended vs. closed-ended questions
    • (6) try to walk a mile in the client’s shoes
    • –i.e., empathy
    • (7) monitor how you convey information
  8. When interviewing younger children, what are some considerations that should be taken into account?
    • -the younger the child, the more difficult the interview
    • -Primary purpose of the interview – establish rapport with the child
    • -allow child some latitude to drive discussion during interview
    • -use mixture of open-ended and closed-ended questions
    • -ask only one question at a time
    • -keep questions as simple as possible
    • -allow child to control physical boundary between self and examiner
    • –allow child time to respond (i.e., allow for some silence)
    • –avoid “leading” questions
    • –consider whether child may need familiar face in room during interview
    • –avoid too much eye contact
    • –don’t be too overbearing in trying to initiate conversation with child
    • –verbally reinforce child for self-disclosure
  9. Considerations for children reluctant to respond:
    • –spend additional time talking about child’s interests
    • –use slightly more open-ended questions
    • –make general observations that child will be able to refute
    • •generally results in child engaging in dialogue with examiner
  10. Developmental considerations: early childhood (2-7 years)
    • Cognitive Functioning
    • •What they see is what they believe
    • •Memory not fully developed
    • •Difficulty w/ perspective taking, theory of mind
    • Social-Emotional Functioning
    • •Behavior is right or wrong based on whether one is punished
    • •Narrow range of emotions–externalized behav. Poor self-contro
  11. Developmental considerations: Middle childhood (8-11)
    • Cognitive Functioning
    • •Adequate verbal communication skills
    • •Inductive reasoning
    • •Concrete thinking
    • •Can reverse
    • •Appearance doesn’t change volume/quantity
    • •Can see big picture of an event
    • Social-Emotional Functioning
    • •Behavior is wrong because rules say so
    • •Peer grouping important
    • •New challenges need to be mastered
    • Industry v.inferiority
  12. Interviewing adolescents considerations
    • –be more business-like in questioning
    • –use mixture of open-ended and closed-ended questions•adolescents tend to be most comfortable with open-ended questions
    • –be aware of and sensitive to developmental issues associated with adolescent period prior to making any determination•especially ED
    • –adolescents should not be held exclusively to adult norms when considering emotionality
    • •e.g., Archer (2005) – 25% of adolescents responded to original MMPI in a manner suggestive of psychotic behavior when strictly interpreted according to adult norms
    • –higher level, abstract questions may be appropriate
  13. Developmental considerations: Adolescence
    • Cognitive Functioning
    • •Formal logic/Abstract Reasoning (maybe)
    • –hypothetical
    • –what ifs
    • –false beliefs possible
    • •Systematic problem-solving
    • •Intuitive thinking
    • Social-Emotional Functioning
    • •Post conventional moral reasoning
    • –behavior wrong based on principals of conscience
    • •Identity v. role confusion
    • –Experimentation
    • •Emotional intensity/lability
    • •Peers become extremely important
  14. Considerations of Interviewing & observing a child
    • •Must observe and take notes of child characteristics while interviewing
    • –Physical
    • –Overt Behavior
    • –Social-Emotional
    • –Cognitive Functioning
  15. What is “social facilitation” and what implications does it have for a clinical interview?
    Th e participants (interviewer and interviewee) infl uence each other. Th e tendency for people to behave like the models around them is called social facilitation. Good interviewers thus can set a good tone in an interview by maintaining a warm, open, confi dent atmosphere.
  16. Interview advantages
    • (1) flexibility
    • –types of questions asked
    • –length of interview
    • –flow should be guided partially by responses of client
    • (2) observation of client under structured conditions
    • –provides window for wide range of behaviors
    • (3) build rapport
    • –trust
    • –security
    • –establish collaborative relationships
    • (4) clarification of information
    • –e.g., background questionnaire
  17. Interview disadvantages
    • (1) Data can lack reliability, consistency
    • –over time
    • –between interviewers
    • •e.g., What is your comfort zone?–i.e., behavioral covariation
    • (2) Subject to examiner distortion or bias–clinician – selective or faulty
    • recall of relevant information•lack of attention to detail?–client – often follows cues
    • he/she perceives of clinician•especially younger children
    • (3) Often difficult to determine validity of client’s statements
  18. Interview Validity considerations
    • Interview validity – i.e., accurate decision-making
    • –primacy, recency effects
    • –halo, devil effects
    • –bias to perceive psychopathology:
    • •common finding in literature – we tend to over-perceive psychopathology
    • –interviewer’s faulty recall of information
    • –interviewer’s nonverbal behavior
  19. Interview reliability
    • Interview reliability–e.g., inter-rater agreement
    • •wide variability in literature
    • –e.g., ratings of traits (.23 - .97)
    • –overall ability (-.20 - .85)
    • –Webster (1964) – different interviewers tend to look for different things
  20. How to increase the validity in Interviews
    • •Consider interview data with a “grain of salt”
    • –use to draw tentative conclusions
    • –e.g., lying is fairly common among children and adolescents
    • •more so for children referred for mental health reasons or special education
    • •Increasing the validity of clients’ responses:
    • (1) avoid accusatory or inflammatory questions
    • (2) ask any potential inflammatory questions in non-judgmental fashion
    • (3) be highly selective in determining whether to confront suspected lie
    • •“choose battles wisely”
  21. Factors that affect the Interview quality
    • •Interpersonal context
    • –Rapport, empathy, respect, expertness, attractiveness, trustworthiness
    • •Cultural context
    • –Eye contact, physical distance
    • •Behavioral context
    • –instruct client about desirable ways of responding
    • –use of reinforcement (verbal praise; use foods with caution & parental consent)
    • •Truth context
    • –Lying-avoid direct confrontation
    • •Physical context
    • –e.g., avoid physical barriers
    • (use corner of desk as barrier)