Clinical interviewing

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effects of empathy: 1) explore issues more freely 2) exploe themselves more freely 3) enhance working alliance 4) related to pos treatment outcome.
ABC model: a problem conceptualiaton system - A - antecedents precede problem, B - behaviours constitute the problem, c) events, thoughts expereinces follow the problem.
prof & ethical issues when CI: a) self-presentation b) time c) confidentialty d) informed consent e) documentation (SOAP- ABC), f) stress management
working alliance: a psychoanalytical relationship v's - explicit or implicit prof. contract bw client and therpist.
the physical setting - consider: the room; seating arrangements (90-150 d), note-taking, video/audio taping
disadvantages of structured diag. interviews: a) lots of time and training, b) no short-cuts for experience, c) too rigid, lacks rapport, d) validity questioned
diagnostic interview: can be relaiable but invalid
MSE affect & mood: affect= emotional tone observed by interviwer, mood= self-reported mood state (last longer, changes less spontenously, is the emotional background).
attractivness: a behavioural & social relationship v's - physical appearance, behs, attitudes & personality traits.
effective interviewing; 7 vocational perspectives: 1) know thyslef 2) comfortable environment 3) listen with all senes 4) practise 5) develop skills asap, 6) know diff types of interviews 7) need to know signs & symptons of dep etc.
open questions: How or What (sometimes Where, When, Why, Who, How,What) . Cannot be answered y or n.
S&F amalgamation of treatment plans: a) BASIC ID 2) miracle q, 3) go over what client said, 4) review treatment options, 5) move toward goals 6) ask client how therapy going, 7) plan for end at outset, 8) use a termination model
assessing suicidal intent: self-report, peer or family report, & behaviour observation
suicide risk factors: depression, age, sex, race & ethnic background, religion, marital status, employment status, socioeconomic status, physcial health, social & personal factors, substance abuse, mental disorders, sexual orientation, trauma abuse history.
assessment & diagnosis problems: client deciet or misinformation; countertransference; diagnostic comobidity; report confusing sympton clusters; confounding cultural or situational factors
diagnositic interviewing: systematic series of specific q's to evaluate beh, thoughts and feelings (formal diag. interv. not generally used in clinical practise, used for research)
benefits of questions: deeper discussion; pinpoint specific info; client relief; clarify what they want to talk about
unconditional positive regard: a rogers core condition- warm regard for client as a person of unconditional self-worth & value.
resistance: a psychoanalytical relationship v's - avoiding importanat topics; recognised as negative beh: eg. reduce time in therapy, resist conversation range, isolate therapy from real life, acting up, flight into health
pull to reassurance: is NOT listening nondirectively: includes self-disclosre & reassurance
congruence: a rogers core conditions- geniune, authentic & comfortable; TF&B match.
individual & cultural differences: gender, social class, ethnicity, sexual-orientation, age, physical disabilites
forms of self-awareness: physical (voice, body etc); psychosocial (how you view yourself as relating to others)
diagnostic impressions in an intake report: include somehting about depression, anxiety, substancea abuse, eating disorders; use DSM axis'.
the body: info. gathering. to make prof. inferences; determine normal from dysfunctional (DSM; stats. infrequency; disturbing to self & others; maladaptive beh.; culturally unjustifiable.
negative attending behaviour: 1) excessive nodding, 2) too much/little eye-contact, 3) repeating last word, 4) mirroring, 5) folding arms
closed questions: Yes or No answers. Do, Does, Did, Is, Was, Are, Who, When, Where
approval/disapproval: a Directive action response-beyond agreeme/disagreemtn; sanction of TF&B; d0 not use disapproval
explanation: a Directive action response-a descriptive statement used to make something understandable; esp. the process of counselling
types of questions: open, closed, swing, indirect, projective
suggestions: a Directive action response-statement that directly or indirectly suggests changes will occur in life. used in hypnotic state or awake.
attending behaviours: foundation of interviewing, can be pos & neg.
Swing questions: can be y or no answers but requrie elaboration. Could, Would, Can, Will.(Avoid unless have good rapport, avoid with kids and teenagers)
MSE orientation & consciousness: orientation= OX3 (name, where ,date), consiousness= alert to comotosed.
CI should include: 1) prof. relationship, 2) motivated client, 3) work togehter, 4) interact verbally and nonverbally, 5) interactions influenced by personality style, attitudes & agreed goals
trustworthiness: a behavioural & social relationship v's- expressed via courteousness, explain confiden, acknow. diff. coming to therapy, manifest congruence, pos. regard & empathy, use prof manner.
intake interview: an assessment interview designed to answer q's regading problems & treatment
developmental self-awareness: conscious of ones personal history& events that have influenced persoanl development
Indirect questions: used when curious about what client is thinkng or feeling. I wonder, You must, It must
agreement/disagreement: a Directive action response- statement indicating harmony with clients opinion. Can enhance rapport, affirm clients opinion, therapist is expert, reduces client exploration. Do not use disagreement
social/interpersonal symptoms of depression: wdl from family & friends.
factors affecting intake interviews: 1) rego forms- care not to offend, 2) institutional setting- intake approach will vary, 3) theoretical orientation-influence what & how is obtained 4) prof. background & affiliation- can influence major focus
Directive action responses: persusive techs that encourage clients to change the way the think, feel & act. Explanation; suggstion; giving advcie; agreem/disagreement; urging; appr/disapproval
interviewing substance abusers: special training; 70's & 80's confrontational approach; MI - nonconf. reseach shown better; draws on Rogers; cycle through 6 stages.
liabilities of questins: interviewers interests focused on; client feels unimportant; reduces spontenatiy; defensive, passive, fosters dependency
BASIC ID: a problem conceptualiaton system- Behaviour - too often too litte; Affect - feelings, moods, emotions; Sensation - physical symptons; Imagery-internal visual process; Cognition-thinking patterns & beliefs; Interpersonal relationships- Drugs- biochem & neurol. factors
Projective questions: helps clients identify unclear TF&B. "What if"
DSM definiation of mental disorder: 1) clinically sig. beh. or psychological syndrome or pattern, 2) occurs in an individual, 3) assoc with a) present distress, b) impairment in functioning, c) sig. increased risk of death or disability
MSE reliablity, judegement, insight: reliablity= credibility & trustworthiness, judgement= does client make good vocational choices (illegal activities etc). insight= understanding of their own problem.
clinical interview: is the cornerstone of a psychological diagnostic assessment
physical symptoms of depression: increase or decrease in weight & appetite, insomnia & hypersomnia, agitation or redartation
interviewing trauma survivors: consider PTSD; CISD used for emergency personal; EMDR used to take emotional power out of traumatic memories.
treatment plans: BASIC ID; DO A CLIENT MAP; Psychotherapy treatment planner
cultural self-awareness: explore and understand clients cultural roots at an emotional level
brief intake interview: used in managed care; 1) rely on rego forms & q data obtained before meeting, 2) use more q's, less time for self-expression, 3) reduce time spent on personal history & interpersonal style.
mental status exam: a method of organising & evaluating clinical observations pertaining to mental status: evaluate current cognitive processes.
giving advice: a Directive action response- heres what you should do
feminist relationship v's: mutuality - sharing process in decsions, goals etc. & empowerment - both are human therefore more similar than different.
urging: a Directive action response- beyond advise giving; used in crisis times or for anxiety disorders (face fears).
accurate empathy: a rogers core condition- 1) intelluctual understanding of client 2) low-intensity feelings 3) imaginative imitation empathy (emp q) 4) resonate with emotional expressions
informed consent: ethical and legal mandate to inform client of nature of treatment
interpretation: a directive listening response - produce client insight or a more accurate perception of reality
intergrated approach to determining treatments: a) empircial research, b) treatment literature, c) therapist skill & expertise, d) therapist preference, e) client preference
professional issues with suicidal clients: can you work with?, consult with peers, documention, dealing with completed suicdies
self-awareness: to perform optimally must have superior psychologica, emotional and social self-awareness
mood-related symptom: 2 primary symptoms - sad or depressed mood & loss of pleasure
crisis intervention with suicidal client: listen, relationship, alternatives, seperate pain, prevention, responsible, hospitilisation?
indentification/internalisation: a psychoanalytical relationship v's - AKA modelling; indentifaction enhanced when feel understood; then feeing is internalised.
transference: a psychoanalytical relationship v's-can be pos & neg. cleint sees therapist as return of important childhood figure, thus they transfers feelings & reactions that apply to that figure.
advantages of structured diag. interviews: a) standardised, easy to adminster, b) releives clinicans of subjectivity, c) greater interrater reliability, d) suited to scientific research
question guidelines: prepare client; do not use as dominant response; make questions relevent; elicit concrete beh. examples; approach senstive areas cautiously
MSE memory & intelligence: memory= remote, recent, immediate (test with serial 7 & digit span); intelligence= educ. level, vocabulary, response to knowlege q's, social judgement q's, tests of orientation, conscousness & memory.
objectives of intake interview: 1) identify & explore main complaint and goals 2) obtain sense of interpersonal style, skills & personal history, 3) evaluate current life situation & functioning
to aleviate diagnosis problems- S&F recommend: multimethod, multirater, multisetting
specific diagnostic criteria: determine frequency, duration & intenstity; assess how difficult to control; currently expereiencing symptoms; rule out other possibilities; significatn distress?; substance intake or med cond.?
termination: occurs when both agree meeting is over. end on time; escort out, farewell gesture.
current situation & functioning in an intake report: 1) usual daily activities, 2) client self-perception & personal strengths, 3) ability to perform age related activities.
MSE - generic: 1) appearance, 2) behaviour (psychomotor activity), 3) attitude toward examiner, 4) affect & mood, 5) speech & thought, 6) perceptual distrbances,7) orientation & consciousness, 8) memory & intelligence, 9) reliablity, judgement & insight.
basic requirements for clinical interviewing: 1) master tech. knowledge, 2) be self-aware, 3) have "other awareness" 4) practise and experience
exploring suicide ideation: ask about presence or absence of suicidal thoughts
directive listening responses: 1) feeling validation, 2) interpretive reflection of feeling, 3) interpretation, 4) confrontation
psychoanalytical relationship v's: transference; countertransference; indentification& internalisation; resistance; working alliance
MSE when to use: becomes more necessay as pyschopathology increases.
behavioural & social relationship v's: expertness, attractiveness, trustworthiness
motivational interviewing: used for substance abuse; 1) bring up subject of substance, 2) ask about in detail, 3) typical day?, 4) lifestyle & stress?, 5) health?, 6) what they do and dont' like re. use, 7) past & now? 8) provide info, ask their opinion, 9) concerns? 10) next step?.
assessing suide plans: specificity, lethality, availabiltiy, proximity,
the opening: begins with first q re. their concerns. Opening statement, opening response, evaluate verbal behaviour.
feeling validation: a directive listening response - interviewer acknowledges and approves of clients stated feelings
learning sequence: 1) quiet self & focus, 2) develop rapport, 3) learn diagnostic skills and assessment
cogntive symptoms of depression: worthlessness, guilt, hopelessness (esp. for suicidal), difficulty concerntrating, recurrent thoughts of suicide/death, difficulty making decisions, inablity to see alternatives
nondirective listening responses: 1) silence, 2) pharaphrase (generic, sensory-based, metaphorical), 3) clarification (restatement, restatement in double q, recheck) 4) nondirective reflection of feeling, 5) summaristion
the introduction: begins when first see each other, ends when clinician asks why client there. Includes: ph contact, initial f-t-f meeting; establishing rapport; client fears; put client at ease; small talk, educate & evaluate expectations
expertness: a behavioural & social relationship v's- show expertise & establish authority, demonstrate competence.
diagnostic interview - balanced approach: a) warm intro, b) review problems & goals, c) history of person & problem, d) brief MSE e) reveiw current situation
objective self-awareness: listen to voice and speech patterns; facial expression, body language
positive attending behaviour: encourages free expression: 1) eye-contact, 2) body language, 3) vocal qualities, 4) verbal tracking (repeating key words & phrases)
rogers core conditions: congurence, unconditional positive regard, accurate empathy
depression - types: major (acute & severe) & dysthymic (chronic & milder)
the intake report: must consider: your audience, structure & content of report, write clear & concisely, keep it confiential, share report with client.
diagnositc interview - research conclusions: a) DSM-IV more reliable than other techs. b) more reliable the closer you stick to DSM c) more training = better diagnosis
the closing: stop gathering info.; reassure & support client; summarise crucial themes; instill hope; guide & empower: tie up loose ends.
countertransference: a psychoanalytical relationship v's - therpaist expreiences inappropriate emotional, attitudinal & beh. responses towards client.
treatment planning - resources: health ins. (must be consdiered before treatment planned, in case it runs out; check your own resources too, ie. willingness to reduce fees, refereal network, supervision etc.
MSE speech & thought: speech= rate, volume, amount, quality & disturbances; thought= delusions, obsessions, suicidal, homicidal, phobias, preoccupation with emotion.
CAGE: brief interview procedure for substance abuse; Cut down?; people Annoyed you but critisising your drinking?; ever felt Guilty about drinking?; Early morning drink?.
psychosocial treatment planning: focus on a) presenting problem & goals, b) personality style & personal history, c) current life circumstances
interview process: introduction; the opening; the body; the closing; termination
confrontation: a directive listening response - use carefully- must have working relationship
treatment planning - relationship: clinican characteristics veiwed as theraputic; books recommended ensure you have read
why diagnose?: a) helps with treatment plans, b) helps profs communicate with other profs. c) sometimes label is releif to client
treatment planning: procedure outlining theraputic techniques & processes as they are applied to individual clients
intergrated (biopsychosocial) approach: goal - respect reality and utility of diagnosis as well as respect clients unique experience.
MSE perceptual distrubances: hallucinations= false sensory perceptions or experiences; illusions= existing stimuli appears different from what they are in reality.
express uncond. positive regard: 1) keep appointments, listen compassionatley, 2) allow freedom to discuss thoughts 3) show you listen, hear & remember 4) respond with empathy to their pain, 5) accept & respect them.
interprative reflection of feeling: a directive listening response - (AKA advanced empathy) - feeling based statements that go beyond clients obvious emotional expressions
the structure & content of an intake report: a) indentifying info & reason, b) beh. observations (MSE), c) history of present problem, d) past treatment history, e) medical history, f) developmental history, g) social & family history.
empathy question: "How would I feel if I was Tom saying those things?"
medical treatment planning: aka psychiatric approach; increased in popularity, interviewer is the expert
suicide assessment: includes, depression, thoughts, plans, past attempts & intention re. suicide

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