Psychologists are not mind-readers. Like medical doctors, psychologists have to assess their patients to find out what’s wrong. In this lesson, we’ll examine the most commonly used psychological assessment: the clinical interview.
Imagine that you are a psychologist and Maria comes to see you. Just looking at her, you can’t tell what’s wrong with her or why she has come to your office. What do you do? You probably answered, ‘I talk to her, of course!’ Talking to Maria is a good first step in figuring out what’s wrong and how to treat her.A clinical interview is a dialogue between psychologist and patient that is designed to help the psychologist diagnose and plan treatment for the patient. It is often called ‘a conversation with a purpose.
‘ What’s the difference between you, as a psychologist, talking to Maria and her best friend talking to her? There are several key differences in a normal conversation and a clinical interview.First of all, a clinical interview has a focused purpose – to diagnose Maria. If she is just talking to her best friend, the conversation doesn’t have a focus and could wander around to any topic. Second, in a clinical interview, the roles are clearly defined.
You are the psychologist and Maria is the patient. As such, you might ask more questions and the interview is really only about Maria. In contrast, when Maria talks to her best friend, they probably both ask questions and they might talk about her friend’s troubles, too.Finally, a clinical interview occurs within a defined time frame.
When Maria talks to her best friend, they can start and end their conversation whenever they want. But with her psychologist, she knows that the appointment is for Tuesday from two to three in the afternoon. Let’s look closer at the types of clinical interviews, as well as how to conduct a clinical interview and the benefits and limitations of them.
Types of Clinical Interviews
Again, imagine that you are a psychologist. How might your clinical interview be different for Maria, a first-time patient, and Sarah, a long-term patient that you’ve had for years? How might it be different for Maria, who doesn’t appear to have anything wrong with her, and Bridget, a patient who is forced to come see you because she keeps talking to trees and other inanimate objects?There are many types of clinical interviews that can be used at different times and with different people.
Let’s look at two of the most common clinical interviews: the intake interview and the mental status exam.The intake interview happens the first time someone comes to see you. This is the interview where you, as the psychologist, ask what brings them to you, what their mental and physical health history is and what they would like to get out of their time with you.When you talk to Maria, for example, you might start by asking why she has come to see you.
She says that, even though everyone else sees her and thinks she’s fine, she feels like a mess. She’s stressed out all the time and has been experiencing panic attacks. You might then go on to ask questions about when the panic attacks started and ask her to elaborate on her life and problems.Remember Bridget, the woman who talks to trees? Unlike Maria, Bridget appears to have something wrong with her from the get-go. Not only that, but when you begin to talk to her, you realize that she’s not answering your questions in a logical way; she’s making no sense whatsoever.A mental status exam is a clinical interview that looks at more than just the answers to your questions. You can look at a patient’s behaviors, appearance, attitude and movements, as well as their answers to your questions.
All of these things will give you a good view of what their mental health is like. Of course, a mental status exam can be used on any patient, including those who seem lucid, like Maria, but it is often used on patients who are not able to talk clearly about their problems.
Conducting a Clinical Interview
Whether you’re doing an intake interview, a mental status exam or one of many other types of clinical interviews, there are several elements that are important. First of all, psychologists conducting clinical interviews need to offer a safe space for discussion. The client needs to be in a nonjudgmental space in order to open up. In addition, reminding a patient that you will not share their information with others unless there’s an immediate danger to the patient or someone else will help to build trust and allow the patient to be honest.Asking open-ended questions is much more valuable than asking yes or no questions.
Allowing the client time to think about and answer open-ended questions will give much better insight. For example, the closed-ended question ‘Do you feel depressed?’ can be answered with a simple yes or no. It doesn’t really give you insight into the patient’s thoughts and feelings.Compare that to the open-ended question, ‘How do you feel?’ They might say depressed, stressed out, like the weight of the world is on their shoulders, completely uninterested in all the things they used to love or any number of other things. But, the answers to the open-ended question can tell you much more about a client than a simple yes or no.
Finally, psychologists conducting a clinical interview should listen to more than just the words of the client. Non-verbal clues, like the patient’s posture and tone of voice, can tell you a lot. For example, what if you asked a client how they’re feeling and they respond, ‘I’m fine.’ The words by themselves might lead you to believe the client.
But wait! What if the client said those words in an angry tone of voice? What if she was twisting her hands around in her lap when she said them? These are signs that there’s something else going on behind the words.
Benefits and Limitations
Remember Maria? She comes into your office and wants to talk. You’ve never met Maria, and you can’t tell by looking at her what’s wrong or why she wants to see you. So, you do a clinical interview to find out more.
There are many benefits of clinical interviews. The first and most important one is to uncover information that the psychologist needs in order to diagnose and/or treat patients. In the case of Maria, you need to find out why she’s there before you can begin to help her.
But, there are other benefits to clinical interviews as well. A clinical interview gives the psychologist access to both verbal and non-verbal information about the client. As we saw, both verbal and non-verbal information can tell you a lot about a client’s state of mind.Finally, clinical interviews build trust between psychologist and client.
This trust is important during the interview, but it is equally important during treatment. If Maria is going to open up about her problems and listen to your therapeutic advice, she has to trust you. The connection made during the clinical interview directly affects the course of therapy.Despite all of the advantages of clinical interviews, there are some limitations. For example, how do you know if Maria is telling you the truth when she says that she’s been having panic attacks? Client truthfulness is a big drawback of clinical interviews. While the interview format assumes honesty, sometimes patients aren’t (or can’t be) completely honest.
Another drawback is that the psychologist might have biases that come into play when they are interviewing. For example, what if Maria admits that when she’s really stressed out, she likes to eat several hamburgers in one sitting? If you are her psychologist, and you think hamburgers are disgusting, your bias might affect how you view, and therefore, how you diagnose and treat Maria.Despite the drawbacks, though, clinical interviews are one of the best ways to assess clients, and they are often the first form of clinical assessment used by psychologists.
A clinical interview is a conversation between psychologist and client that is intended to help the psychologist diagnose and treat the patient. There are many types of clinical interviews, including intake interviews and mental status exams. Important elements of a clinical interview include an environment conducive to sharing, open-ended questions and attention to both verbal and non-verbal messages.Benefits of clinical interviews include gathering important information, access to verbal and non-verbal information about the client and building trust between psychologist and patient. However, there are some disadvantages, too, including the assumption of client honesty and the possibility of interviewer bias.
When you have completed this lesson, you should be able to:
- Define clinical interviews
- Differentiate between a clinical interview and a normal conversation
- Explain the purposes of an intake interview and a mental status exam and when each are used
- List the important elements needed for a successful clinical interview
- Describe the benefits and drawbacks of clinical interviews