CLINICAL

INTERVIEW
BY: DHUFF MATTHEUS V. ORTIZ
A REVIEW ON RELIABILITY, VALIDITY, AND
CLINICAL UTILITY
Reliability to the extent that it yields consistent, repeatable results. If its results depend
on when, where, or how the technique was administered, its reliability might be
questionable.

Validity the extent that it measures what it claims to measure

Clinical Utility
A REVIEW ON RELIABILITY, VALIDITY, AND
CLINICAL UTILITY
GENERAL SKILLS OF AN INTERVIEWER

• quieting yourself,
• being self-aware,
• and developing positive working relationships.
GENERAL SKILLS OF AN INTERVIEWER :
QUIETING YOURSELF

• Quieting yourself does not simply mean that the interviewer

shouldn’t talk much during the interview (although rambling by
the interviewer is usually not a good idea). Rather than the
interviewer’s speech, what should be quieted is the
interviewer’s internal, self-directed thinking pattern
GENERAL SKILLS OF AN INTERVIEWER : BEING
SELF AWARE

• Being self-aware is another important skill for the clinical

interviewer. This self awareness should not be confused with the
excessive self-consciousness. The type of self-awareness that
should be maximized is the interviewer’s ability to know how
he or she tends to affect others interpersonally and how others
tend to relate to him or her
GENERAL SKILLS OF AN INTERVIEWER :
DEVELOPING POSITIVE WORKING
RELATIONSHIPS
• Developing positive working relationships in many
clinical settings, an interview client is likely to become a
psychotherapy client, so a good start to the working relationship
benefits both parties
SPECIFIC BEHAVIORS : LISTENING

Listening may seem like a simple enough task, but it can

be broken down into even more fundamental building
blocks of attending behaviors (many described in Ivey,
Ivey, & Zalaquett, 2010).
SPECIFIC BEHAVIORS : ATTENDING BEHAVIORS
IN LISTENING

Eye contact. Perhaps it’s an obvious point, but

interviewers must realize the connection between
attentive listening and eye contact. Eye contact not only
facilitates listening, it also communicates listening
SPECIFIC BEHAVIORS : ATTENDING BEHAVIORS
IN LISTENING

Body language. As with eye contact, culture can shape

the connotations of body language. There are a few
general rules for the interviewer: face the client, appear
attentive, minimize restlessness, display appropriate
facial expressions, and so on.
SPECIFIC BEHAVIORS : ATTENDING BEHAVIORS
IN LISTENING

Vocal qualities. Skilled interviewers have mastered the

subtleties of the vocal qualities of language—not just the
words but how those words sound to the client’s ears. They
use pitch, tone, volume, and fluctuation in their own voices
to let clients know that their words and feelings are being
deeply appreciated.
SPECIFIC BEHAVIORS : ATTENDING BEHAVIORS
IN LISTENING

Verbal tracking. Effective interviewers are able to

repeat key words and phrases back to their clients to
ensure the clients that they have been accurately heard.
Interviewers don’t do this in a mechanical way; instead,
they weave the clients’ language into their own.
SPECIFIC BEHAVIORS : ATTENDING BEHAVIORS
IN LISTENING
Referring to the client by the proper name. It sounds simple enough, but using
the client’s name correctly is essential (Fontes, 2008). Inappropriately using
nicknames or shortening names (e.g., calling Benjamin “Benji”), omitting a
“middle” name that is in fact an essential part of the first name (e.g., calling John
Paul “John”), or addressing a client by first name rather than a title followed by
surname (e.g., addressing Ms. Washington as “Latrice”) are presumptuous
mistakes that can jeopardize the client’s sense of comfort with the interviewee
CULTURAL ISSUES DURING INTERVIEW

• Compared with traditional Western culture, Chinese culture

tends to feature far less eye contact, especially between
members of the opposite sex. Eye contact that falls within
the normal range among Western individuals may
communicate rudeness or sexual desire among Chinese
people
CULTURAL ISSUES DURING INTERVIEW

• Norms for physical touch also differ from one culture to

another, with Asian cultures typically incorporating less
than European Americans. Thus, a touch on the shoulder,
intended and received as innocuous from one European
American to another, might be received as inappropriate by
an Asian individual
CULTURAL ISSUES DURING INTERVIEW

• Individuals of Middle East and Latino/Latina cultures tend

to stand or sit closer together, whereas North American
and British people tend to maintain more space between
themselves. Tendencies such as these represent essential
knowledge for the culturally competent interviewer
COMPONENTS OF THE INTERVIEW

Rapport refers to a positive, comfortable relationship

between interviewer and client. When clients feel a
strong sense of rapport with interviewers, they feel that
the interviewers have “connected” with them and that the
interviewers empathize with their issues.
COMPONENTS OF THE INTERVIEW: RAPPORT

However, there are some specific efforts interviewers can make

to enhance the client’s experience of rapport:
1. First, interviewers should make an effort to put the client at
ease, especially early in the interview session
2. Second, interviewers can acknowledge the unique, unusual
situation of the clinical interview
COMPONENTS OF THE INTERVIEW: RAPPORT

However, there are some specific efforts interviewers can make to

enhance the client’s experience of rapport:
3. Third, interviewers can enhance rapport by noticing how the
client uses language and then following the client’s lead.
Interviewers should pick up on the client’s vocabulary and, as much
as possible, speak in similar terms (Othmer & Othmer, 1994).
COMPONENTS OF THE INTERVIEW: TECHNIQUE

These are the tools in the interviewer’s toolbox,

including:
1. Questions
2. Responses,
3. Other specific actions.
COMPONENTS OF THE INTERVIEW: TECHNIQUE
(DIRECTIVE VS NON DIRECTIVE STYLES)

Directive style get exactly the information they need by

asking clients specifically for it. Directive questions tend
to be targeted toward specific pieces of information, and
client responses are typically brief, sometimes as short as
a single word (e.g., “yes” or “no”).
COMPONENTS OF THE INTERVIEW: TECHNIQUE
(DIRECTIVE VS NON DIRECTIVE STYLES)

Non directive style allow the client to determine the

course of the interview. Without direction from the
interviewer, a client may choose to spend a lot of time on
some topics and none on others
COMPONENTS OF THE INTERVIEW: TECHNIQUE
(DIRECTIVE VS NON DIRECTIVE STYLES)

Certainly, both directive and nondirective approaches play

an important role in interviewing. Direct questioning can
provide crucial data that clients may not otherwise choose to
discuss. Indirect questioning, conversely, can provide crucial
information that interviewers may not otherwise know to
inquire about.
COMPONENTS OF THE INTERVIEW: TECHNIQUE
(DIRECTIVE VS NON DIRECTIVE STYLES-
SHORTCOMINGS)
Both directive and nondirective approaches have shortcomings as well, especially when an
interviewer relies too heavily on either one. Sometimes, directive approaches can sacrifice
rapport in favor of information. In other words, interviewers who are overly directive may
leave clients feeling as though they didn’t have a chance to express themselves or explain
what they thought was important. Although nondirective interviewing can facilitate rapport,
, it can fall short in terms of gathering specific information. Interviewers who are overly
nondirective may finish an interview without specific data that is necessary for a valid
diagnosis, conceptualization, or recommendation.
COMPONENTS OF THE INTERVIEW: TECHNIQUE
(DIRECTIVE VS NON DIRECTIVE STYLES-STRATEGIES)

Perhaps the best strategy regarding directive and nondirective

interviewing is one that involves balance and versatility (Morrison,
2008). At the outset of the interview, it may be wise to allow clients to
speak freely to communicate what they think is most important. Even
without direction from the interviewer, most clients will nonetheless
address a number of direct questions that the interviewer might have
asked
COMPONENTS OF THE INTERVIEW:RESPONSES

There are numerous common categories of interviewer

responses: open- and closed-ended questions,
clarification, confrontation, paraphrasing, reflection
of feeling, and summarizing (Othmer & Othmer, 1994;
Sommers-Flanagan & SommersFlanagan, 2009)
COMPONENTS OF THE INTERVIEW:RESPONSES

Open-ended questions allow for individualized and

spontaneous responses from clients. These responses
tend to be relatively long, and although they may include
a lot of information relevant to the client, they may lack
details that are important to the clinical psychologist
COMPONENTS OF THE INTERVIEW:RESPONSES

Closed-ended questions allow for far less elaboration and

self-expression by the client but yield quick and precise
answers. Indeed, open-ended questions are the building
blocks of the nondirective interviewing style described
above, whereas the directive interviewing style typically
consists of closed-ended questions
COMPONENTS OF THE INTERVIEW: RESPONSES

Clarification The purpose of a clarification question is to

make sure the interviewer has an accurate understanding of
the client’s comments. Clarification questions not only
enhance the interviewer’s ability to “get it,” they also
communicate to the client that the interviewer is actively
listening and processing what the client says
COMPONENTS OF THE INTERVIEW: RESPONSES

Interviewers use confrontation when they notice

discrepancies or inconsistencies in a client’s comments.
Confrontations can be similar to clarifications, but they
focus on apparently contradictory information provided
by clients
COMPONENTS OF THE INTERVIEW: RESPONSES

Paraphrasing is used simply to ensure clients that they

are being accurately heard. When interviewers
paraphrase, they typically restate the content of clients’
comments, using similar language
COMPONENTS OF THE INTERVIEW: RESPONSES

Whereas a paraphrase echoes the client’s words, a

reflection of feeling echoes the client’s emotions.
Reflections of feeling are intended to make clients feel that
their emotions are recognized, even if their comments did
not explicitly include labels of their feelings
COMPONENTS OF THE INTERVIEW: RESPONSES

Summarizing usually involves tying together various

topics that may have been discussed, connecting
statements that may have been made at different points,
and identifying themes that have recurred during the
interview.
COMPONENTS OF THE INTERVIEW: RESPONSES

The conclusion can take a number of different forms,

depending on the type of interview, the client’s problem,
the setting, or other factors. In some cases, the
conclusion can be essentially similar to a summarization
PRAGMATICS OF THE INTERVIEW: NOTE TAKING

Written notes are certainly more reliable than the

interviewer’s memory. Many clients will expect the
interviewer to take notes and may feel as though their
words will soon be forgotten if the interviewer is not
taking notes
PRAGMATICS OF THE INTERVIEW: NOTE TAKING
(WEAKNESSES)

The process of note taking can be a distraction, both

forthe interviewer, who may fail to notice important
client behaviors while looking down to write, and for the
client, who may feel that the interviewer’s notebook is an
obstacle to rapport
PRAGMATICS OF THE INTERVIEW: NOTE TAKING
(WEAKNESSES)

In some clinical situations, interviewers may be wise to

explain their note-taking behavior to clients. In particular,
a client-centered rationale for the note-taking behavior
PRAGMATICS OF THE INTERVIEW: AUDIO AND VIDEO
RECORDINGS

Written notes are not the only way of documenting an

interview. Clinical psychologists may prefer to audio- or
video-record the session. Unlike note taking, recording a
client’s interview requires that the interviewer obtain
written permission from the client
PRAGMATICS OF THE INTERVIEW: AUDIO AND VIDEO
RECORDINGS (WEAKNESSES)

While obviously providing a full record of the entire

session, recordings can, with some clients, hinder
openness and willingness to disclose information.
PRAGMATICS OF THE INTERVIEW: AUDIO AND VIDEO
RECORDINGS (WEAKNESSES)

As with note taking, an explanation of the rationale for

the recording, as well as its intended use (e.g., review by
the interviewer or a supervisor) and a date by which it
will be erased or destroyed, is typically appreciated by
the client
PRAGMATICS OF THE INTERVIEW: THE INTERVIEW
ROOM

“when choosing a room [for interviews], it is useful to

strike a balance between professional formality and
casual comfort” (Sommers-Flanagan & Sommers-
Flanagan, 2009, p. 31
PRAGMATICS OF THE INTERVIEW: CONFIDENTIALITY

When clients enter the interview room, they may have

inaccurate assumptions about the confidentiality of the
ensuing discussion. Many people incorrectly assume that any
session with a psychologist is absolutely confidential (Miller
& Thelen, 1986), when in fact there are some situations that
require the psychologist to break confidentiality
PRAGMATICS OF THE INTERVIEW: CONFIDENTIALITY

Some clients may make the opposite mistake, wrongly

assuming that their relatives, supervisors, or others will
have access to their interview records, and as a result
may choose to disclose very little about their problems
PRAGMATICS OF THE INTERVIEW: CONFIDENTIALITY

To inform their clients about confidentiality, and

especially to correct any misconceptions such as those
described above, interviewers should routinely explain
policies regarding confidentiality as early as possible.
TYPES OF INTERVIEWS

• The purpose of the intake interview is essentially to determine whether to

“intake” the client to the setting where the interview is taking place. In
other words, the intake interview determines whether the client needs
treatment; if so, what form of treatment is needed (inpatient, outpatient,
specialized provider, etc.); and whether the current facility can provide that
treatment or the client should be referred to a more suitable facility.
TYPES OF INTERVIEWS

• the purpose of the diagnostic interview is to diagnose. At the end of

a well-conducted diagnostic interview, the interviewer is able to
confidently and accurately assign Diagnostic and Statistical Manual
of Mental Disorders (DSM) diagnoses to the client’s problems.
When an interview yields a valid, specific diagnosis, the
effectiveness of the recommendations and subsequent treatment may
be increased
DIAGNOSTIC INTERVIEWS: STRUCTURED
INTERVIEWS VERSUS UNSTRUCTURED
INTERVIEWS
• A structured interview is a predetermined, planned sequence
of questions that an interviewer asks a client. Structured
interviews are constructed for particular purposes, usually
diagnostic
DIAGNOSTIC INTERVIEWS: STRUCTURED
INTERVIEWS VERSUS UNSTRUCTURED
INTERVIEWS
Unstructured interview, in contrast, involves no predetermined
or planned questions. In unstructured interviews, interviewers
improvise: They determine their questions on the spot, seeking
information that they decide is relevant during the course of the
interview (Maruish, 2008)
ADVANTAGES OF STRUCTURED INTERVIEW

1. Structured interviews produce a diagnosis based explicitly on

DSM criteria,
2. Structured interviews tend to be highly reliable,
3. Structured interviews are standardized and typically
uncomplicated in terms of administration
DISADVANTAGES OF STRUCTURED INTERVIEW

1. The format of structured interviews is usually rigid, which can inhibit

rapport and the client’s opportunity to elaborate or explain as he or she
wishes
2. Structured interviews typically don’t allow for inquiries into important
topics that may not be directly related to DSM criteria
3. Structured interviews often require a more comprehensive list of
questions than is clinically necessary, which lengthens the interview.
CRISIS INTERVIEW

• The crisis interview is a special type of clinical

interview and can be uniquely challenging for the
interviewer. Crisis interviews have purposes that extend
beyond mere assessment
CRISIS INTERVIEW

They are designed not only to assess a problem

demanding urgent attention (most often, clients actively
considering suicide or another act of harm toward self or
others) but also to provide immediate and effective
intervention for that problem.
CRISIS INTERVIEW

Quickly establishing rapport and expressing empathy for a

client in crisis, especially a suicidal client, are key components
of the interview
Suicide prevention contracts. These contracts essentially
require the client to contact the interviewer before committing
any act of self-harm
CRISIS INTERVIEW

When interviewing an actively suicidal person, five

specific issues should be assessed
CRISIS INTERVIEW

How depressed is the client?

Does the client have suicidal thoughts?
Does the client have a suicide plan?
How much self-control does the client currently appear to have?
Does the client have definite suicidal intentions?
ACKNOWLEDGING CULTURAL DIFFERENCES

When cultural differences exist between interviewer and client—which

happens quite frequently, especially if we define culture by ethnicity,
gender, religion, age, or a number of other variables—it is often wise
for the interviewer to openly acknowledge these differences. Open,
respectful discussion of cultural variables can enhance rapport, increase
the client’s willingness to share information, and help the interviewer
gain a more accurate understanding of the client’s issues