Clinical interviewing

1. CLINICAL INTERVIEW
BY
MUHAMMAD MUSAWAR ALI
MPHIL, ICAP
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2. Clinical Interview
Characteristics of
Interview
Communication
Strategies
Types and Structure of
Interview
Roles and Tactics
Considerations and Issues
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3. 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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4. Characteristics of Clinical Interview
 One to one conversation between a
professional (psychologist) and
client
 Professional setting (hospital,
clinic)
 Conversation either initiated by
client or by psychologist initiated
 Purposeful and goal oriented
conversation
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5. Types and Structure of Clinical Interview
1- Intake Interview
 Why the client is looking for
help?
 Are the competencies and
resources available to help
client ?
 Build rapport
 Make the client at ease
 Encourage for information
 Think rules
 Behavior (actions)
 Solution (handling)
 Positive (resources)
 Small steps (increments)
 Flexible (possibilities)
 Future (control)
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6. Types and Structure of Clinical Interview
2- Case History
 Psychosocial history
 Detailed description of client's
background
 Birth and development
 Family origins
 Education
 Employment
 Recreational/leisure
 Marital and Sexual history
 Alcohol and drugs
 Physical health
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7. Types and Structure of Clinical Interview
3- Mental Status Exam
 Protocol for organizing
observations of client
 Switch to direct questioning at the
end of interview
 General appearance and
behavior
 Speech and thought
 Consciousness
 Perception
 Obsessions and compulsions
 Orientation
 Memory
 Attention and concentration
 General Information
 Intelligence
 Insight and judgment
 Higher cognitive functioning
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8. Types and Structure of Clinical Interview
4- Crisis Interview
 Emergency consultation
 Unexpected life stressors
 can’t be assessed through
lengthy psychological
batteries
 can’t be waited to access
previous history
 Client needed to be dealt at
moment
 Provide reassurance, assess
the problem and explore
potential resources
 Resolve problem
immediately to avoid
catastrophic event to occur
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9. Types and Structure of Clinical Interview
5- Diagnostic Interview
 Goal is to classify the complaints
and dysfunctions of client
 Clinician observers:
 client’s behavior
 Inquires about symptoms in
detail
 Gathers relevant personal
and family history
 The methods for conducting
diagnostic interview vary in
goals and degree of structure
 Five steps in diagnostic
interview ( Othmer & Othmer,
1994)
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10. Process of Diagnostic
Interview
1- Diagnostic clues
• Helps in creating a list possible,
unexplored and excluded
disorders
• “tell me what’s troubling you”
2- Specific diagnostic criteria
• Specified questions related to
specific criteria
• “have you ever been bothered
by voices or seen things that
nobody else could hear or see ?”
3- Psychiatric history
• Has the client received mental
health services
• Premorbid functioning & family
history
4- Arrive at a Diagnosis
5- Prognosis
 Based upon the gathered
information, the clinician
estimates the likely future
course of disorder and client
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11. Methods for conducting Diagnostic
Interview
Un-structured
 Most probably used
 To develop
diagnostic
formulation
 Reliability issues
Structured
 Predetermined
questions
 Set of rules to probe,
sequence inquiries
and rating the
responses
Semi-Structured
 Somewhat unstructured
and predetermined
 Improves rapport
building
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12. 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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13. Communication Strategies
 Verbal strategies
 Reflective listening
 Asking open-ended questions
 Affirming
 Summarizing
 Rolling with resistance
 Non-verbal strategies
 Facial expressions
 Eye contact
 Body posture
 SOLER (micro-skills)
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14. Roles and Tactics
 Strategies for Rolling with
resistance
 Reflective listening
 Shifting focus
 Ignore client’s negative
statement
 Agreement with a twist
 Agree with client but with a
change of direction
 Reframing
 Offering a new and positive
interpretation of negative
information
 Emphasizing personal choice and
control
 Acknowledge the positive
choices a client makes and
improve his self-efficacy
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15. Other considerations and
issues
1- Interviewing with children
• Praise
• Ask simple questions
• Be tactful
• Understand silence
2- Cultural diversity issues
• Need to avoid the biases and
influence of experiences
• Educate about communication
styles of culture where you
work
• Understand local
communication norms
3- Common pitfalls
• Jargon pitfall
• Reassurance pitfall
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16. Motivational Interviewing
Express empathy
&
Support self-efficacy
Roll with
resistance
Avoid argumentationDevelop
discrepancy
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17. Motivational Interviewing
 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
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