Module 2

Clinical Assessment

Dr. MA. VERONICA C. IRINGAN

Instructor

C_Outline

COLLEGE OF ARTS AND

San Mateo Municipal College
Gen. Luna St. Guitnang Bayan I, San Mateo, Rizal
SCIENCES
 Learning Objectives:
After completing this module, you should be able to:
1. Define clinical assessment
2. Describe the referral
3. Explain the importance of the interview in clinical assessment
4. Define the interview
5. Explain the importance and characteristics of the interview
6. Distinguish the types of interviews

Input Information:
1. Definition and Purpose of Clinical Assessment
2. The Referral
3. What Influences How the Clinician Addresses the Referral Question?
4. The Interview
5. General Characteristics of Interviews
6. Interviewing Essentials and Techniques Rapport Communication
7. The Patient’s Frame of Reference
8. The Clinician’s Frame of Reference
9. Varieties of Interviews
a) The Intake-Admission Interview
b) The Case-History Interview
c) The Mental Status Examination Interview
d) The Crisis Interview
e) The Diagnostic Interview
10. Reliability and Validity of Interviews Reliability Validity

REMINDER

This module is for personal and academic use of the reader

and is not intended for commercial use or sale.

Distribution to non-SMMC or uploading to other sites is PROHIBITED.

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.
Whether the clinician is making decisions or solving problems, clinical
assessment is the means to the end. For example, before physicians can
prescribe a treatment, they must first understand the nature of the illness.

The Referral
The assessment process
begins with a referral.
Someone—a parent, a teacher, a psychiatrist, a judge, or perhaps a psychologist—poses a question
about the patient.
“Why is Juan disobedient?”
“Why can’t Alicia 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.
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.
Interviewing Essentials and Techniques
An Interaction. An interview is an interaction between at least two persons. Each
participant contributes to the process, and each influences the responses of the other.
A clinical interview is initiated with a goal or set of goals in mind. The interviewer
approaches the interaction purposefully, bearing the responsibility for keeping the
interview on track and moving toward the goal.
A good interview is one that is carefully planned, deliberately and skillfully
executed, and goal oriented throughout.
Interviews are more purposeful and organized than conversation but sometimes less
formalized or standardized than psychological tests. The exceptions are the structured
diagnostic interviews
 A unique characteristic of the interview method is the wider opportunity it provides for an individualized approach that will be effective in
eliciting data from a particular person or patient. This flexibility represents both the strength and the weakness of many interviewing
techniques.
Decisions are made such as to when to probe, when to be silent, or when to be indirect or subtle test the skill of the interviewer.
Many factors influence the productivity and utility of data obtained from interviews. A mute or uncommunicative patient may not
cooperate regardless of the level of the interviewer’s skills.
Interviews versus Tests. In a sense, interviews occupy a position somewhere between ordinary conversation and tests. Interviews are more
purposeful and organized than conversation but sometimes less formalized or standardized than psychological tests.
The Art of Interviewing. Interviewing has often been regarded as an art. 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 such as to when to probe, when to be silent, or when to be
indirect or subtle test the skill of the interviewer. With experience, one learns to
respond to interviewee cues in a progressively more sensitive fashion that
ultimately serves the purposes of the interview.
Physical Arrangements
An interview can be conducted anywhere that two people can meet and interact.
Two of the most important considerations are privacy and protection
from interruptions. Because lack of privacy can lead to many
deleterious outcomes, soundproofing is also very important. If noise from a
hallway or an adjacent office intrudes, patients will probably assume that
their own voices can also be heard outside. Few patients are likely to be open and responsive under such conditions.
The office or its furnishings should not be a source of distraction.
Note-taking and Recording
All contacts with clients ultimately need to be documented. However, there is some debate over whether notes should be taken during an
interview. Although there are few absolutes, in general, it would seem desirable to take occasional notes during an interview.
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.
However, after having seen a few additional patients, the clinician may not be able to recall much from the earlier interview.
Occasionally, a patient may comment that what is said must be really important since you are taking it down. Occasionally, too, a patient
may request that the clinician not take notes while a certain topic is being discussed.

Under no circumstances should this be done without the patient’s fully informed consent.
In the vast majority of cases, a few minutes’ explanation of the desirability of taping, with an
accompanying assurance to the patient that the tape will be kept confidential (or released only
to persons authorized by the patient), will result in complete cooperation.
Rapport
Perhaps the most essential ingredient of a good interview is a relationship
between the clinician and the patient.
Rapport is the word often used to characterize the relationship between
patient and clinician.
Rapport involves a comfortable atmosphere and a mutual understanding of the
purpose of the interview. Good rapport can be a primary instrument by which the
clinician achieves the purposes of the interview.
Attitudes of acceptance, understanding, and respect for the integrity of the
patient.
It does require that patients not be prejudged based on the problems they
seek help for.
A common mistake of beginning interviewers in early interviews is to say
something like,
“There, there, don’t worry. I know exactly what you’re feeling.”
Such comments may convince clients that the interviewer does not really know how they feel. After all, how could his stranger possibly
know how I feel?
Communication
In any interview, there must be communication. Whether we are helping persons in distress or assisting patients in realizing their potential,
communication is our vehicle. The real problem is to identify the skills or techniques that will ensure maximum communication.
The clinician’s response to silence should be reasoned and responsive to the
goals of the interview rather than to personal needs or insecurities. Perhaps the
client is organizing a thought or deciding which topic to discuss next. Perhaps the
silence is indicative of some resistance. If we are concerned about impressing the
client, if we are insecure in our role, if we are guided by motivations other than the
need to understand and accept, then we are not likely to be effective listeners.
Many people, for example, when introduced to someone, cannot recall the
person’s name 2 minutes later. The most common reason for this is a failure to
listen. They were distracted, preoccupied, or perhaps so concerned about their
own appearance that they never really heard the name. Sometimes therapists are
so sure of an impression about the patient that they stop listening and thereby
ignore important new data. The skilled clinician is one who has learned when
to be an active listener.
Sometimes a clinician is professionally insecure or inexperienced.
Sometimes the patient’s problems, experiences, or conversation reminds clinicians of their own problems or threatens their own values,
attitudes, or adjustment. In one way or another, however, clinicians must resist the temptation to shift the focus to themselves. Rather,
their focus must remain on the patient.
In some instances, the patient will ask personal questions of the clinician. In general, clinicians should avoid discussing their personal
lives or opinions. But if a question is trivial, innocent, or otherwise basically inconsequential, a failure to respond directly will probably be
perceived as the worst kind of evasion.
Beginning a Session. It is often useful to begin an assessment session with a casual conversation. A brief conversation designed to relax things
before plunging into the patient’s reasons for coming will usually facilitate a good interview.
Language. Of extreme importance is the use of language that the patient can understand. It may be necessary to abandon psychological jargon
to be understood by some patients. It is also important to clarify the intended meaning of a word or term used by a client if there are uncertainties
or alternative interpretations.
The Use of Questions. Maloney and Ward (1976) observed that the clinician’s questions may become progressively more structured as the
interview proceeds. They distinguish among several forms of questions, including open-ended, facilitative, clarifying, confronting, and direct
questions. Each is designed in its own way to promote communication.

Silence. Perhaps nothing is more disturbing to a beginning interviewer than silence. However, silences can mean many things. The important
point is to assess the meaning and function of silence in the context of the specific interview. Silence is indicative of some resistance. Whether the
clinician ends a lengthy silence with a comment about the silence or decides to introduce a new line of inquiry, the response should facilitate
communication and understanding and not be a desperate solution to an awkward moment.
Listening. If we are to communicate effectively in the clinician’s role, our communication must reflect understanding and acceptance. We cannot
hope to do this if we have not been listening. For it is by listening that we come to appreciate the information and emotions that the patient is
conveying. The skilled clinician is one who has learned when to be an active listener.
Gratification of Self. The clinical interview is not the time or the place for clinicians to work out their own problems. Sometimes a clinician is
professionally insecure or inexperienced. Sometimes the patient’s problems, experiences, or conversation reminds clinicians of their own
problems or threatens their own values, attitudes, or adjustment. In one way or another, however, clinicians must resist the temptation to shift the
focus to themselves. Rather, their focus must remain on the patient. This is obviously a matter of degree. None of us is so self-controlled that our
thoughts never wander or our concentration never falters. However, the clinician–patient roles are definite and should not be confused. In some
instances, the patient will ask personal questions of the clinician. In general, clinicians should avoid discussing their personal lives or opinions.
Clinician’s Impact
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.
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.
By the same token, the establishment of rapport will be more difficult if the clinician is not
sensitive to the patient’s initial perceptions and expectations.
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.
For example, if a client should become very angry and attack the clinician’s ability,
training, or good intentions, the clinician must remember that the first obligation is to
understand. The clinician should be secure enough to distinguish between reality and
the forces that drive the patient.
Types of Interviews
It is important to note that more than one of these interviews may be administered to the same client or 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. 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.
Past Treatment History: The client reports that he has not previously sought out psychological or 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.
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 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.
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.
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

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
* * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * ** * * * * * * * * * * * * * * * *
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).
Final Note: Clinical assessment involves an evaluation of an
individual’s strengths and weaknesses, a conceptualization of
the problem at hand, and some prescription for alleviating
the problem.
The interview is the most basic and most serviceable
assessment technique used by clinical psychologists. There are two primary distinguishing factors among interviews.
First, interviews differ with regard to their purpose. In this chapter, we have discussed the intake-admission interview, the case-history
interview, the mental status examination interview, the crisis interview, and the diagnostic interview.
A second distinguishing feature concerns whether the interview is unstructured (often called a clinical interview) or structured. In
contrast to unstructured interviews, structured interviews require the clinician to ask verbatim a set of standardized questions in a
specified sequence.
Common Types of Validity That Are Assessed to Evaluate Interviews
Type of Validity Definition
Content validity - The degree to which interview items adequately measure the various aspects of the variable or construct.
Predictive validity - The degree to which interview scores can predict (correlate with) behavior or test scores that are observed or obtained at
some point in the future.
Concurrent validity - The extent to which interview scores are correlated with a related, but independent, set of test/interview scores or behaviors.
Construct validity - The extent to which interview scores are correlated with other measures or behaviors in a logical and theoretically consistent
way. This will involve a demonstration of both convergent and discriminant validity.
Suggestions for Improving Reliability and Validity
The following suggestions summarize some of the previous discussion; they should help improve both the reliability and validity of interviews.
1. 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.
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.
Key Terms to Learn
Concurrent validity. A form of criterion-related validity. The extent to which interview scores correlate with scores on other relevant
measures administered at the same time.
Construct validity. The extent to which interview scores correlate with other measures or behaviors in a logical and theoretically
consistent way. To be construct valid, an interview must demonstrate all of the aspects of validity.
Content validity. The degree to which interview items adequately measure all aspects of the construct being measured.
Criterion-related validity. The extent to which interview scores predict (correlate with) scores on other relevant measures.
Discriminant validity. The extent to which interview scores do not correlate with measures that are not theoretically related to the
construct being measured.
Interrater reliability. The level of agreement between at least two raters who have evaluated the same patient independently.
Agreement can refer to consensus on symptoms assigned, diagnoses assigned, and so on.
Predictive validity. A form of criterion-related validity. The extent to which interview scores correlate with scores on other relevant
measures administered at some point in the future.
Test–retest reliability. The consistency of interview scores over time. Generally, we expect individuals to receive similar diagnoses from
one administration to the next if the interval between administrations is short.

Source: Trull, Timothy J. Clinical Psychology 7th Edition. Belmont, CA: Wadworth. 2005
Learning Activities:
Conduct and submit report on the following:
1. The Intake-Admission Interview
2. The Case-History Interview
3. Mental Status Examination