CLINICAL

ASSESSMENT
MODULE 2
 LEARNING OBJECTIVES
• Define clinical assessment
• Describe the referral
• Explain the importance of the interview in clinical
assessment
• Define the interview
• Explain the importance and characteristics of the
interview
• Distinguish the types of interviews
CLINICAL ASSESSMENT

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; all of these
lead us to a better understanding of the
client.
 THE
REFFERAL
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.
Assessment, then, is not a
completely standardized set of
procedures. All clients are not given
the same tests or asked the same
questions.
 THE INTERVIEW

The assessment interview is at once

the most basic and the most
serviceable technique used by the
clinical psychologist. In the hands of a
skilled clinician, its wide range of
application and adaptability make it
a major instrument for clinical
decision making, understanding, and
prediction.
 GENERAL CHARACTERISTICS OF
INTERVIEWS

INTERVIEWS VERSUS ART OF

AN INTERACTION Interviewing has often been
TESTSa position
Interviews occupy regardedINTERVIEWING
as an art. Except in the
An interview is an somewhere between most structured, formal
interaction between at ordinary conversation and interviews, there is a degree of
least two persons. Each tests. Interviews are more freedom to exercise one's skill
participant contributes purposeful and organized and resourcefulness that is
to the process, and each than conversation but generally absent from other
influences the responses sometimes less formalized assessment procedures.
of the other. or standardized than Decisions such as when to
psychological tests. probe, when to be silent, or
when to be indirect or subtle test
the skill of the interviewer.
 INTERVIEWING ESSENTIALS
AND TECHNIQUES
PHYSICAL NOTE-TAKING
ARRANGEMENT RECORDING
All contacts with clients ultimately
Two of the most important
need to be documented.
considerations are privacy and
in general, it would seem desirable
protection from interruptions.
to take occasional notes during an
interview

RAPPORT COMMUNICATIO
N
There must be communication. Whether
Involves a comfortable atmosphere
we are helping persons in distress or
and a mutual understanding of the
assisting patients in realizing their
purpose of the interview. Good
potential, communication is our vehicle.
rapport can be a primary instrument
The real problem is to identify the skills
by which the clinician achieves the
or techniques that will ensure maximum
purposes of the interview.
communication.
 COMMUNICATION
01 04
BEGINNING A SILENCE
SESSION

02 05
LANGUAGE LISTENING

03 06
THE USE OF GRATIFICATION OF
QUESTIONS SELF
FIVE TYPES OF INTERVIEW
QUESTIONS
THE IMPACT OF THE CLINICIANS

Each of us has a characteristic impact on others, both

socially and professionally. Nearly everyone accepts
the notion that one’s own values, background, and
biases will affect one’s perceptions. Unfortunately, we
are usually more skilled at validating this notion in
others than in ourselves. Therefore, clinicians must
examine their own experiences and seek the bases for
their own assumptions before making clinical
judgments of others.
 THE CLIENT’S FRAME OF
REFERENCE
If the clinician is going to be effective in
achieving the goals of the interview, it is
essential that he or she have an idea of how the
patient views the first meeting. Only with such
awareness can the patient’s verbalizations and
behaviors be placed in their proper context.
THE CLINICIAN’S FRAME OF
REFERENCE
The general dictum here, as in any endeavor is
"Be Prepared". This implies that the clinician should have
carefully gone over any existing records on the patient,
checked the information provided by the person who
arranged the appointment, and so on.

The clinician must remain focused. However,

objectivity need not imply coldness or aloofness. Rather, it
suggests that the clinician must be secure enough to
maintain composure and not lose sight of the purposes of
the interview.
 VARIETIES
OF
INTERVIEWS
 THE INTAKE-ADMISSION
INTERVIEW
An intake interview generally has two
purposes:
(a) to determine why the patient has come to
the clinic or hospital and
(b) to judge whether the agency’s facilities,
policies, and services will meet the needs and
expectations of the patient.
 SAMPLE INTAKE INTERVIEW
Name: MORTON, Charles (fictitious name)
Age: 22
Sex: Male
Occupation: Student
Date of interview: June 1, 1998
Therapist: Luke Baldry, Ph.D. (fictitious name)

Identifying Information: The client is a 22-year old White male who is presently a full-time student at a
large midwestern university. Currently, he lives alone in an apartment and works part time at a local
grocery store.
Chief Complaint: The client presents to the clinic today complaining of “depression” that reportedly
has become worse over the past 2 weeks.
History of Presenting Problem: The client reports that he has experienced symptoms of depression
“off and on” for the past year. These symptoms include (a) depressed mood (“feeling sad”); (b) appetite
disturbance but no significant weight loss; (c) sleep disturbance (early morning awakening); (d) fatigue;
(e) feelings of worthlessness; and (g) difficulty concentrating. All of these symptoms have been present
nearly every day over the past 2 weeks.
 SAMPLE INTAKE INTERVIEW
The client reports that about 1 year ago, a longstanding romantic relationship of 4 years
ended. Following this breakup, the client reports, he became increasingly withdrawn and, in
addition to some of the symptoms noted above, experienced several crying spells.
Although his adjustment to this event became better as time progressed, the client
reports that the breakup “shook” his confidence and led to a decrease in the number of social
activities he engaged in. Further, he reports that he has not dated since. Last semester, the
client transferred to this university from a community college in another midwestern location.
He reports that the move was difficult both emotionally and academically. Specifically, being
away from his hometown, family, and friends has led him to feel more isolated and dysphoric.
Further, his grades this past semester reportedly suffered. He reports that his grades dropped
from A’s at his previous school to C’s at this university. Toward the end of this past semester
(once his probable grades in his classes became apparent), he developed an increasing
number of depressive symptoms.
 SAMPLE INTAKE INTERVIEW
Past Treatment History: The client reports that he has not previously sought out psychological of
psychiatric treatment.

Medical History: No significant medical history was reported.

Substance Use/Abuse: The client denies any current symptoms of substance abuse or dependence.
He has “tried” marijuana on three occasions in the past but denies current use. He reports drinking, on
average, three or four cans of beer per week.

Medication: The client reports that he is not currently taking any medication.

Family History: Both of the client’s biological parents are living, and he has one brother (age 20) and
one sister (age 26). The client reports that his mother suffers from depression and has received
outpatient treatment on numerous occasions. Further, he reports that his maternal grandfather was
diagnosed with depression. No substance use problems among family members were noted.

Suicidal/Homicidal Ideation: The client denied any current or past suicidal or homicidal ideation,
intent, or action.
 SAMPLE INTAKE INTERVIEW
Mental Status: The client was well-groomed, cooperative, and dressed appropriately. He was alert
and oriented in all spheres. His mood and affect were dysphoric. His speech was clear, coherent,
and goal-directed. Some attention and concentration difficulties were noted. Further, his immediate
memory was mildly impaired. No evidence of formal thought disorder, delusions, hallucinations, or
suicidal/homicidal ideation was found. His insight and judgment appear to be fair.

Diagnostic Impression
Axis I: 296.22, Major Depressive Disorder, Single Episode
Axis II: V71.09, No Diagnosis
Axis III: None
Axis IV: Problems related to the social environment; Educational problems
Axis V: GAF = 55 (current)

Recommendations: Individual psychotherapy. Cognitive-behavioral treatment for depression.

Luke Baldry,
Ph.D. Licensed Clinical Psychologist
THE CASE-HISTORY
INTERVIEW
In a case-history interview, as complete a
personal and social history as possible is
taken. The clinician is interested both in
concrete facts, dates, and events and in the
patient’s feelings about them. Basically, the
purpose of a case history is to provide a
broad background and context in which
both the patient and the problem can be
placed.
 A TYPICAL CASE HISTORY OUTLINE
1. Identifying data, including name, sex, occupation, address, date and place of
birth, religion, and education.
2. Reason for coming to the agency and expectations for service.
3. Present situation, such as description of daily behavior and any recent or
impending changes.
4. Family constellation (family of orientation), including descriptions of mother,
father, and other family members and the respondent’s role in the family in which he
or she grew up.
5. Early recollections, descriptions of earliest clear events and their surroundings.
6. Birth and development, including ages of walking and talking, problems compared
with other children, and the person’s view of his or her early experiences.
7. Health, including childhood and later diseases and injuries, problems with drugs
or alcohol, and comparison of one’s body with others.
8. Education and training, including subjects of special interest and achievement.
 A TYPICAL CASE HISTORY OUTLINE
9. Work record, including reasons for changing jobs and attitudes toward work.
10. Recreation and interests, including volunteer work, reading, and the respondent’s
report of adequacy of self-expression and pleasures.
11. Sexual development, covering first awareness, kinds of sexual activities, and view of
the adequacy of sexual expressions.
12. Marital and family data, covering major events and what led to them, and
comparison of present family of birth and orientation.
13. Self-description, including strengths, weaknesses, and ideals.
14. Choices and turning points in life, a review of the respondent’s most important
decisions and changes, including the single most important happening.
15. View of the future, including what the subject would like to see happen next year
and in five or ten years, and what is necessary for these events to happen.
16. Any further material the respondent may see as omitted from the history.
THE MENTAL STATUS
EXAMINATION INTERVIEW
A mental status examination is typically
conducted to assess the presence of cognitive,
emotional, or behavioral problems. The
general areas covered in these interviews,
along with excerpts from a sample report.
MENTAL STATUS EXAMINATION INTERVIEW OF
A 24-YEAR OLD MAN DIAGNOSED WITH
SCHIZOPHRENIA
General Outline of Mental Status Examination
I. General Presentation: Appearance, Behavior, Attitude
II. State of Consciousness: Alert, Hyperalert, Lethargic
III. Attention and Concentration
IV. Speech: Clarity, Goal-directedness, Language deficits
V. Orientation: To Person, Place, Time
VI. Mood and Affect
VII. Form of Thought; Formal Thought Disorder
VIII. Thought Content: Preoccupations, Obsessions, Delusions
IX. Ability to Think Abstractly
X. Perceptions: Hallucinations
XI. Memory: Immediate, Recent, Remote
XII. Intellectual Functioning
XIII. Insight and Judgment
 MENTAL STATUS EXAMINATION INTERVIEW OF
A 24-YEAR OLD MAN DIAGNOSED WITH
SCHIZOPHRENIA
The patient appeared disheveled and exhibited “odd” behavior throughout the interview. Although
he appeared alert, some impairment in his attention and concentration was noted. Specifically, he
experienced difficulty repeating a series of digits and performing simple calculations without the aid
of pencil and paper. No language deficits were noted, although the patient’s speech was at times
difficult to understand and did not appear to be goal-directed (not a response to the question
posed). He was oriented to person and place but was not oriented to time. Specifically, he was
unsure of the month and day. He reported his mood as “fine”; his affect appeared to be blunted. He
demonstrated some signs of formal thought disorder: tangentiality and loose associations. He
denied suicidal ideation but did report his belief that he was being “framed by the FBI” for a crime
he did not commit. When confronted with the fact that he was in a psychiatric hospital, not a prison,
he stated that this was all part of an FBI “cover-up,” so that he could be made to look “crazy.”
Although he denied hallucinations, his behavior suggested that, on occasion, he was responding to
auditory hallucinations. For example, he stared off into space and began whispering on several
occasions. His ability to abstract appeared to be impaired. For example, when asked how a
baseball and an orange are alike, he responded, “They both are alive.” The patient’s immediate and
recent memories were slightly impaired, although his remote memory was intact. It is estimated that
he is of average intelligence. Currently, his insight and judgment appear to be poor.
THE CRISIS INTERVIEW

The purpose of the crisis interview is to meet problems

as they occur and to provide an immediate resource. Their
purpose is to deflect the potential for disaster and to
encourage callers to enter into a relationship with the clinic or
make a referral so that a longer term solution can be worked
out. Such interviewing requires training, sensitivity, and
judgment. Asking the wrong question in a case-history
interview may only result in a piece of misinformation.
However, a caller who is asked a wrong question on the
telephone may hang up.
THE DIAGNOSTIC INTERVIEW

A structured diagnostic interview 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. This makes it more likely
that two clinicians who evaluate the same patient will
arrive at the same diagnostic formulation (high interrater
reliability).
 REALIABILITY AND VALIDITY OF
INTERVIEWS
The reliability of the interview is
typically evaluated in terms of the
level of agreement between at least
two raters who evaluated the same
patient or client.

The validity of the interview

concerns how well the interview
measures what it intends to
measure.
Two primary distinguishing factors
among interviews.

A second distinguishing
First, interviews feature concerns whether
differ with regard the interview is
unstructured (often
to their purpose. called a clinical interview)
or structured
 TYPES OF VALIDITY DEFINITION

CONTENT PREDICTIVE CONCURRE CONSTRUCT

VALIDITY VALIDITY NT VALIDITY VALIDITY

The degree to The degree to The extent to The extent to which

which interview which interview which interview interview scores are
items adequately scores can scores are correlated with other
measure the predict (correlate correlated with a measures or behaviors in a
various aspects with) behavior or related, but logical and theoretically
of the variable or test scores that independent, set consistent way. This will
construct. are observed or of test/interview involve a demonstration of
obtained at some scores or both convergent and
point in the behaviors. discriminant validity
future.
 IMPROVING RELIABILITY AND
1. VALIDITY
Whenever possible, use a structured interview. A wide variety of
structured interviews exist for conducting intake-admission, case
history, mental status examination, crisis, and diagnostic
interviews.

2. If a structured interview does not exist for your purpose, consider

developing one. Generate a standard set of questions to be used,
develop a set of guidelines to score respondents’ answers,
administer this interview to a representative sample of subjects,
and use the feedback from subjects and interviewers to modify the
interview. If nothing else, completing this process will help you
better understand what it is that you are attempting to assess and
will help you become a better interviewer.
 IMPROVING RELIABILITY AND
VALIDITY
3. Whether you are using a structured interview or not, certain
interviewing skills are essential: establishing rapport, being an
effective communicator, being a good listener, knowing when
and how to ask additional questions, and being a good observer of
nonverbal behavior.
4. Be aware of the patient’s motives and expectancies with regard to
the interview. For example, how strong are his or her needs for
approval or social desirability?
5. Be aware of your own expectations, biases, and cultural values.
Periodically, have someone else assess the reliability of the
interviews you administer and score.