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The Clinical Interview

Carolyn R. Fallahi, Ph. D.
Introduction to Clinical Psychology
The Clinical Interview
Assessment important for psychologists
Competency of a defendant
How? Tests, interviews, observations.
Neurological disorder vs. mental disorder?
Unique contribution of psychologists.

What does the clinical interview involve?

Evaluation of strengths & weaknesses
Conceptualization of problem
Thoughts about etiology?
Thoughts about alleviating the problem?
A one time shot? Noongoing.
Example case.

The Referral
Who?
Parent
Teacher
Psychiatrist
Judge
Psychologist
Poses a question

The Referral Question

Sometimes needs rephrasing.
Is this patient capable of murder?
Why is the patient having trouble in school?
Assessment
Not completely standardized set of procedures.
Describe the client in a useful way.
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General Characteristics of the interview

The Interaction
Introduce yourself & make an assessment of any potential
communication problems.
Talk about what the session will involve.
Obtained informed consent.
Get an understanding of the chief complaint or issue.
What is your understanding of the problem?
Case History Outline
Identifying data.
Reason for coming to the agency & expectations for
service.
Present situation.
Family constellation.
Early recollections.
Birth & development.
Case History Outline
Health.
Education & training.
Work Record.
Recreation & Interests.
Sexual development.
Marital & family data.
Self-description.
Choices & turning points in life.
Case History Outline
View of the future.
Anything else?
Mental Status Examination
General presentation.
State of consciousness.
Attention & concentration.
Speech: clarity, goal-directedness, language deficits.
Orientation: person, place, time
Mood & Affect
Form of thought; formal thought disorder
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Mental Status Examination

Thought content: preoccupations, obsessions, delusions.
Ability to think abstractly.
Perceptions: Hallucinations.
Memory: immediate, recent, remote
Intellectual functioning
Insight & judgment
Appearance & Behavior
Look at appearance, manners & behavior.
Keep socioeconomic group in mind.
Remember individuality.
Appearance & Personality:
High degree of attention to tidiness.
High degree of attention to fashion.
High degree of attention to flamboyant or seductive behavior.

Appearance & mental disorders

Omega sign = depression?
Long face.
Bizarre appearance is quite rare. Psychosis?
Self-neglect. Dementia? Retarded depression?
Neurological disturbance? Chronic schizophrenia?
Colorful dressing. Mania?
Somber dressing. Depression?
Behavior
Marked agitation. Anxiety? Agitated depression? Psychosis?
Mania?
Irritability. Mania? ADHD? Delirium? Stimulant abuse?
Decreased activity. Acute depression, chronic schizophrenia, mental
retardation, Parkinsons, Hypothyroidism?
Repetitive movements. Tics? Vocal productions? Tourettes?
OCD? ADHD? Intellectual disability?

Movements
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Echopraxia movements that are replicated, e.g. crossing

the legs, touching the face.
Drug intoxication? Psychosis? Schizophrenia?
Catatonic stupor.
Catatonic posturing.
Catatonic rigidity.
Waxy flexibility.
Suicidal Behavior
Self-cutting or slashing. Depression? Psychosis?
Personality disorder? Hallucinations? Delusions?
Other suicidal behavior. Depression? Factitious disorder?
Malingering? Desire for death?
Speech or talk
Articulation
Dysarthria or mumbling. Mechanical problems?
Neurological disorders?
Chronic Schizophrenia?
Fatigue, sedation, medication, intoxication?
Speech
Volume
Loud talk. Mania? Personality traits?
Quiet talk. Depression? Unassertive individual.
Speed
Rapid talk. Mania? Anxiety? Stimulants?
Slow talk. Depression? Sedation? Intoxication?
Pressure of speech/thought/talk
Increase in the speed of talk. Talk over. Mania? Stimulant
intoxication?

Pitch
High pitched talk. Anxiety? Fear? Arousal?
Constant low-pitched talk. Depression? Hypothyroidism?
Dysprosody. Depression? Schizophrenia? Brain damange?
Associated with disorders of affect.
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Mood
Definitional issues.
Sustained for months
Pervasive character
Subjectively experienced
Observable by interviewer
Is the subjective response congruent with interviewers findings?

Subjective experience
Patient experience
Objective findings
Elation, Irritability, Anxiety,
Subjective experience
Objective findings

Affect
Difference of opinion, e.g. affective versus mood
Internal feeling state.
Observation of feeling.
Subtle changes expected.
Mood & affect in depression.
Loss of emotions in Schizophrenia.
Affect assessed during the entire examination.
Appropriate affect.
Restricted and blunted affect? Flat affect?

Thought
Examined through speech.
Reflected in behavior.
o Form: arrangement of parts. Disturbances in the
logical connections between ideas.
o Formal thought disorder.
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o What is normal range? Need to let the patient

speak freely periods where there is little
structure.
o Abstract questions.
o Proverbs.
o The use of silence.
o Record verbatim examples of a formal thought
disorder in the patients file.
o Derailment: deviation in the train of thought. This
has replaced the old term, loosening of
associations.
o Tangentiality: inability to have goal-directed
associations of thought.
o Derailment. Mania? Depression? Schizophrenia?
Schizophreniform disorder? Schizotypal
personality disorder?
o Flight of ideas. Mania? Schizophrenia?
Intoxication with stimulants?
o Pressured speech.
o Incoherence. Why? Derailment? Neurological
problem? Often not due to a psychiatric disorder.
o Why not schizophrenia?
o Neologism: words are invented by the speaker or
distorted. Schizophrenia?
o Thought block or thought withdrawal. Rare
phenomenon. Thoughts withdrawn from the head
only identified if it occurs in mid-thought and if
the patient volunteers or admits on question that
the thought was lost. Differential: Schizophrenia
versus Mania.
o Perseveration & echolalia: Perseveration is the
repetitive expression of a particular word or
phrase. Echolalia: pathological repeating of
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words or phrases. Organic conditions? Mania?

Schizophrenia?
o Poverty of thought (speech): speech decreased
amount. Hyperthyroidism? Dementia? Brain
damage? Depression? Chronic Schizophrenia?
o Poverty of content: little information given.
Derailment?
o Illogicality: erroneous conclusions or internal
contradictions in thinking. Psychotic?
Intoxication?
o Content.
o Delusion: false beliefs that are sustained despite
evidence to the contrary. Somatic, persecutory,
guilt.
o Bizarre delusions.
o Grandiose delusions.
o Persecutory delusions.
o Delusions of reference.
o Delusions of control.
o Thought withdrawal.
o Thought insertion.
o Thought broadcasting.
o Nihilistic delusion.
o Somatic delusion.
o Delusions of guilt.
o Delusional jealousy.
o Erotomanic delusions.
o Mood-congruent delusion.
o Systematised delusions.
o Obsession & compulsions.
o Phobias.
o Agoraphobia.
o Social Phobia.
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o Simple Phobia.
o Hypochondria.
o Suicidal thoughts.
o Homicidal thoughts.
Perception
Perception: transferring physical stimulation into
psychological information.
Depersonalization and derealization.
Delusional mood.
Heightened perception.
Changed perception.
Hallucinations.
Non-pathological hallucinations.
Alcoholic hallucinosis.
Illusions misperceptions of stimuli. Usually transitory.

Intelligence
The ability to think and act rationally and logically.
Mental retardation.
Cognition is the new term.

Cognition
Thinking and mental processes of knowing and
becoming aware.
Cognitive testing.
Memory, orientation, concentration, & language.
Mini-mental status examination (MMSE, Folstein)
standardized & internationally accepted screening test
of cognitive functions.
Memory. Includes 3 basic mental processes. The
ability to perceive, recognize, and establish information
in the CNS, retention , and recall. Measurement
includes Immediate memory, STM, LTM.
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Tests of memory.
o History & conversation. Can the patient give a
clear account of their life from the remote to the
recent past?
o Short-term memory: repeat sequences of digits.
Reverse digits?
o Recent memory test. Have patient learn 3 or 4
unrelated words. Tell the patient that his/her
memory will be tested. Ask them to repeat to
make sure registered properly. Some minutes
later, ask to recall the words.
o Remote memory test. Some issues with what to
include. Highly learned material, like DOB can be
problematic.
o Loss of memory.
Organic origin.
Dementia.
Head injury.
Amnestic Disorder.
Loss of memory when there is a
psychological explanation: psychogenic
amnesia; psychogenic fugue; MPD;
Paramnesia; Confabulation;
depersonalization & derealization.

o Orientation.
Time, person, place.

o Attention/Concentration.
o Attention: context of consciousness. A state of
awareness of the self & environment.
Disorders that show subtle attention
problems.
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Severe disorders of attention: schizophrenia,

depressive psychosis, delirium, dementia,
brain damage, severe attention disorders.
Tests of attention: History & conversation.
Subtraction. Reversing components.
Language:
Aphasia impairment.
Dysphasia dysfunction of speech.
Brocas aphasia output sparse,
effortful, short-phrased & agrammatical.
Patient is aware of and frustrated by
his/her expressive difficulties.
Wernickes aphasia: word finding
problems & problems with
comprehension.
Conduction aphasia severe
disturbance in repetition.
Transcortical aphasia preservation of
repeating in the presence of marked
language impairment.
Nominal aphasia word finding.
Reading & writing disturbances.
Dysarthria mechanical problem.
Testing aphasia mechanics of speech;
fluency, phrase length & paraphasic
substitutions; comprehension; repetition;
naming; writing ability; reading ability.

Rapport

Insight