Abnormal Psy Ch4 notes

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Abnormal Psy Ch4 - Chapter 4

Methods of Psychosocial Assessment

4.4 Explain the interview process, clinical observation, and testing in psychosocial assessment.

During the assessment process clinicians try to collect as much information as they can about their

client. They then seek to integrate these pieces of information together into a meaningful pattern,

developing a working hypothesis about what might have gone wrong and why. This working hypothesis

will later be elaborated and confirmed, or perhaps sometimes discarded as time progresses. Typically,

assessment starts with a more global approach, such as a clinical interview. Later, more specific

(Kici & Westhoff, 2004). It may be relatively open in character, with an interviewer making moment-to-

moment decisions about his or her next question on the basis of responses to previous ones, or it may

be more tightly controlled and structured so as to ensure that a particular set of questions is covered. In

the latter case, the interviewer may choose from a number of structured, standardized interview

formats whose reliability has been established in prior research.

Structured Interviews

Structured assessment interviews follow a predetermined format. All questions are asked of each client

in a preset way, and the interviewer is not supposed to change the order of the questions or to deviate

from them in any way. Each question is structured in a manner so as to allow responses to be quantified

or clearly determined. For example, when asking about symptoms of depression, the interviewer might

follow a specific format can be an advantage, ensuring that every person assessed is asked exactly the

same questions in the same order.

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Why is this so important? One reason is that it maximizes reliability. Table 4.1 highlights this. It provides

an illustration of a situation where the parent of a child is asked the same question but with one word

changed.

Table 4.1

Imagine that a question in the interview should be read as in (a) below, but an interviewer accidentally

reads it as in (b):

Interviewer: (a) Does she often have trouble staying in her seat at school?

Interviewer: (b) Does she often have a problem staying in her seat at school?

A parent might answer the first question “yes,” but say “no” to the second question. Although the

parent might know that her daughter bounces up from her chair every few minutes, he/she does not

an unstructured or flexible format. However, many clinicians still prefer to explore and ask questions of

the patient as they see fit. There appears to be widespread overconfidence among clinicians in the

accuracy of their own methods and judgments (Taylor & Meux, 1997). Eve Every rule has exceptions, but

in most instances, an assessor is wise to conduct an interview that is carefully structured and that

provides a comprehensive review of symptoms and other issues. By using a structured assessment

format, the clinician can be sure that key questions do not get overlooked.

Semi-Structured Interviews

Commonly used in clinical (and especially in clinical research) settings is the semistructured assessment

interview. In a semi-structured interview, the interviewer is required to ask questions in a specific order

and in a specific way. Then, depending on the answer, the clinician will ask his or her own follow-up

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actually has the symptom being assessed, semistructured interviews should only be administered by

people who have undergone extensive training. The benefit of using a semi-structured interview is that

the resulting diagnoses tend to have greater validity than those obtained from structured interviews

study of 10,000 people might prefer a structured interview, whereas a clinician in a private practice

assessing one client at a time might prefer to use a semi-structured interview.

Unstructured Interviews

Unstructured assessment interviews are typically subjective and do not follow a predetermined set of

questions. The beginning statements in the interview are usually general, and follow-up questions are

tailored for each client. The content of the interview questions is influenced by the habits or theoretical

views of the interviewer. The interviewer does not ask the same questions of all clients; rather, he or

she subjectively decides what to ask based on the client’s response to previous questions. Because the

questions are asked in an unplanned way, important information needed for a DSM-5 diagnosis might

be skipped. For example, when interviewing a patient who is severely depressed, the clinician may

Clients may view unstructured interviews as being more sensitive to their needs or problems than more

structured procedures. However, this does not have to be the case. A well-conducted structured or

semi-structured interview is valuable for the patient because it is comprehensive. Most patients

appreciate this. Moreover, provided it is conducted by a skilled interviewer who is familiar with the

questions that need to be asked, a structured or semi-structured interview can sound natural and

conversational. If the assessor is unskilled, however, structured interviews may sound stilted and

excessively formal. Structured interviews do typically take longer to administer than unstructured

interviews and may include some seemingly tangential questions. Also, clients may sometimes be

frustrated by the quest

The Clinical Observation of Behavior

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signs of depression, anxiety, aggression, and the like that he or she may manifest. Ideally, clinical

observation takes place in a natural environment (such as observing a child’s behavior in a classroom or

at home), but it is more likely to take place upon admission to a clinic or hospital (Leichtman, 2009). For

for conducting observations in contrived situations. These analogue situations, which are designed to

yield information about the person’s adaptive strategies, might involve such tasks as staged role-playing,

event reenactment, family interaction assignments, or think-aloud procedures (Haynes et al., 2009).

In addition to making their own observations, many clinicians enlist their clients’ help by providing them

instruction in self-monitoring: self-observation and objective reporting of behavior, thoughts, and

feelings as they occur in various natural settings. This method can be a valuable aid in determining the

kinds of situations in which maladaptive behavior is likely to be evoked, and numerous studies also show

it to have therapeutic benefits in its own right. Alternatively, a client may be asked to fill out a more or

less formal self-report or a checklist concerning problematic reactions experienced in various situations.

Many instruments have been published in professional literature and are commercially available to

clinicians. These approaches recognize that people can be excellent sources of information about

as part of an initial evaluation but also to check on the course or outcome of treatment.

One of the most widely used instruments for assessing the presence and severity of psychiatric

symptoms in clinical settings and in psychiatric research is the Brief Psychiatric Rating Scale (BPRS). The

BPRS was originally developed as a 16-item measure (Overall & Gorham, 1962). Over the years, the

measure has been expanded. It now includes 24 items that assess such symptoms as anxiety,

depression, emotional withdrawal, guilt feelings, hostility, suspiciousness, grandiosity, and unusual

thought patterns (Lukoff et al., 1986). These items can be probed for using questions from a semi-

structured interview (Ventura et al., 1993). Table 4.2 provides an example of the questions that are used

to assess for anxiety, together with details of the anchor points for the various severity ratings.

The BPRS has been found to be an extremely useful instrument in clinical research (e.g., see Davidson et

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assessing the response of such subjects to various treatments (see Beevers & Miller, 2004; Brown et al.,

2007). Table 4.2 Brief Psychiatric Rating Scale:

statements. Do not rate observed anxiety. This is rated elsewhere.

Probe Questions:

“Have you been worried a lot during [mention time frame]? Have you been nervous or apprehensive?

(What do you worry about?)”

“Are you concerned about anything? How about finances or the future?”

“When you are feeling nervous, do your palms sweat or does your heart beat fast ( or shortness of

breath, trembling, choking)?”

[If individual reports anxiety or autonomic accompaniment, ask the following]: “How much of the time

have you been [use individual’s description]?”

“Has it interfered with your ability to perform your usual activities/work?” Ratings:

functioning.

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Moderately Severe: Frequent, but not daily, periods of anxiety with autonomic accompaniment OR

some areas of functioning are disrupted by anxiety or worry.

Severe: Anxiety with autonomic accompaniment daily but not persisting throughout the day OR many

areas of functioning are disrupted by anxiety or constant worry.

Extremely Severe: Anxiety with autonomic accompaniment persisting throughout the day OR most areas

of functioning are disrupted by anxiety or constant worry.

Source: Based on Lukoff, D., Nuechterlein, K. H., & Ventura, J. (1986). Manual for the Expanded BPRS.

Schizophrenia Bulletin, 12, 594–602. Retrieved from:

https://www.public-health.uiowa.edu/icmha/outreach/documents/BPRS_expanded.PD F

Psychological Tests

Interviews and behavioral observation are relatively direct attempts to determine a person’s beliefs,

attitudes, and problems. Psychological tests are a more indirect means of assessing psychological

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“When you are feeling nervous, do your palms sweat or does your heart beat fast ( or shortness of

breath, trembling, choking)?”

[If individual reports anxiety or autonomic accompaniment, ask the following]: “How much of the time

have you been [use individual’s description]?”

“Has it interfered with your ability to perform your usual activities/work?”

Ratings:

Not present

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Interviews and behavioral observation are relatively direct attempts to determine a person’s beliefs,

attitudes, and problems. Psychological tests are a more indirect means of assessing psychological

characteristics. Scientifically developed psychological tests (as opposed to the recreational ones that

have comparable demographic characteristics, usually determined through established test norms or

test score distributions. From these comparisons, a clinician can then draw inferences about how much

“Are you concerned about anything? How about finances or the future?”

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Very mild: Reports some discomfort due to worry OR infrequent worries that occur more than usual for

most normal individuals.

Mild: Worried frequently but can readily turn attention to other things.

Moderate: Worried most of the time and cannot turn attention to other things easily but no impairment

Severe: Anxiety with autonomic accompaniment daily but not persisting throughout the day OR many

areas of functioning are disrupted by anxiety or constant worry.

attitudes, and problems. Psychological tests are a more indirect means of assessing psychological

sometimes appear in magazines or on the Internet) are standardized sets of procedures or tasks for

2013). A subject’s responses to the standardized stimuli are compared with those of other people who

test score distributions. From these comparisons, a clinician can then draw inferences about how much