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CLINICAL ASSESSMENT Involves an evaluation of an individual’s strengths and weaknesses, a conceptualization of the problem at hand (as well as possible etiological factors), and some prescription for alleviating the problem. it is an ongoing process– even an everyday process, as in psychotherapy.
Before a clinician can prescribe a treatment, he/she must first understand the nature of the illness. A clinician’s capacity to solve clinical problems is directly related to his/her skill in defining them.
THE REFERRAL The assessment process begins with a referral. Questions such as: - Why is Sam disobedient? - Why can’t Jayme learn to read like the other children?
Clinicians thus begin with the referral question. It is important that they take pains to understand precisely what the question is or what the referral source is seeking.
What influences how the clinician addresses the referral question? The kinds of information sought are often heavily influenced by the clinician’s theoretical commitments. Assessments, then, is not a completely standardized set of procedures. The purpose of the assessment is not to discover the “true psychic essence” of the client but to describe that client in a way is useful to the referral source– a way that will lead to the solution of a problem..
THE INTERVIEW The assessment interview is at once the most basic and the most serviceable technique used by the clinical psychologist. Its wide range of application and adaptability make it a major instrument for clinical decision making, understanding, and prediction.
THE ART OF INTERVIEWING Except in the most structured, formal interviews, there is a degree of freedom to exercise one’s skill and resourcefulness that is generally absent from other assessment procedures. Decisions as to when to probe, when to be silent, or when to be indirect or subtle test the skill of the interviewer.
INTERVIEWING ESSENTIALS AND TECHNIQUES Physical setting Nature of the patient Training and supervised experience
Physical Arrangement Privacy and protection from interruptions. The office or its furnishings can be distracting. Many clinicians prefer offices that are fairly neutral, yet tasteful.
Note-Taking and Recording A few key phrases jotted down will help the clinician’s recall. However, any attempt at taking verbatim notes should be avoided (except when administering a structured interview). It may prevent the clinician from attending fully to the essence of the patient’s verbalizations.
Excessive note-taking tends to prevent the clinician from observing the patient and from noting subtle changes of expression or slight changes in body position. It’s easy to audiotape or videotape interviews. Under no circumstances should this be done without the patient’s fully informed consent.
RAPPORT Involves a comfortable atmosphere and a mutual understanding of the purpose of the interview. A good rapport can be a primary instrument by which the clinician achieves the purposes of the interview.
COMMUNICATION Beginning Session - casual conversation - a brief conversation designed to relax things before plunging into the patient’s reasons for coming will usually facilitate a good interview.
VARIETIES OF INTERVIEWS Intake-Admission Interview (1) to determine why the patient has come to the clinic/hospital (2) to judge whether the agency’s facilities, policies, and services will meet the needs and expectations of the patient. (3) to inform the patient of such matters as the clinic’s functions, fees, policies, procedures, and personnel.
Case-History Interview - the clinician is interested both in concrete facts, dates, and events and in the patient’s feelings about them. -it covers both childhood and adulthood, and it includes educational, sexual, medical, parental-environmental, religious, and psychopathological matters.
Mental Status Examination Interview - is conducted to assess the presence of cognitive, emotional, or behavioral problems. - it is important for clinical psychologists to be familiar with the MSE because these interviews are one of the primary modes of clinical assessment for a variety of mental health professionals (including psychiatrists).
Crisis Interview - Increasingly, clinicians have been functioning in novel settings, including: **storefront clinics **telephone hotlines specializing in advice or comfort to drug abusers, to parents who have dysfunctional children, or to persons who are just lonely.
The purpose of the crisis interview is to meet problems as they occur and to provide an immediate resource.
To deflect the potential for disaster and to encourage callers to enter into a relationship with the clinic or make a referral.
Diagnostic Interview - Structured Diagnostic Interviews consists of a standard set of questions and follow up probes that are asked in a specified sequence. - the use of structured diagnostic interviews ensures that all patients or subjects are asked the same questions.