The field of psychology contains many terms that may be confusing and may differ from how the phrases are understood in the general culture. For example, it is not uncommon for someone to say "I am feeling depressed", or "I am anxious about life". This does not necessarily mean the person suffers from a clinical disorder, they may simply be experiencing an emotional response to a particular situation. For others, statements about feeling depressed, anxious, or having trouble with memory, focus and attention may be signs that they are struggling with these areas much more than what falls in the realm of 'normal'. Psychologists can use a variety of techniques to help determine if a person is experiencing clinical symptoms and then work with a client to develop a treatment plan. The initial process of figuring out "what is going on" typically begins with a Clinical Interview. The interview may then lead to a more complete Psychological Assessment, or may move directly into the treatment planning and therapeutic process.
What is Clinical Interview?
A clinical interview is a structured or semi-structured dialogue with the client that is focused on information gathering. Fully structured interviews follow a question template. In such an interview all clients are asked the same set of questions. This kind of interview is often done by larger organizations in an attempt to identify clients with particular issues and then match them with clinicians who have expertise in this area. These interviews are often conducted by psychology students or technicians as they are not intended to gather highly personal information about the client, and generally do not have any therapeutic value beyond that of allowing the client an opportunity to tell their story. In some cases, these interviews are transformed into paper and pencil questionnaires that may be done online before the appointment, or as a telephone interview, or while seated in the office before the first session.
Structured interviews are also used when a therapist is attempting to make a differential diagnosis. This occurs when the client has described having symptoms that might fit one or more clinical diagnosis. When this occurs, the clinician may ask a very standardized set of questions to see if the client expresses experiencing a sufficient number of symptoms to meet 'diagnostic criteria' (like having all the ingredients to make a certain kind of cake) for a particular diagnosis. The goal is to 'differentiate' or 'tell apart' on diagnosis from another. For example, the client may say that they have enough different symptoms to meet criteria for a diagnosis of Cyclothymic Disorder (a type of depression), but not Major Depressive Disorder. By being able to differentiate between potential diagnosis the client and clinician can develop a targeted and personalized treatment plan. Such personalized treatment plans are far more likely to be successful than a 'one size fits all' treatment plan, or a treatment plan that is based on using skills the clinician has training in, rather than what is known to be the best approach to treat the disorder (like asking a mechanic to fix your plumbing, they may be an awesome mechanic but that doesn't mean those skills are helpful when you have a clog under the sink).
Semi-structured interviews are the most common form of mental health interview. Here the clinician has a standard set of questions to be sure they cover the most common areas of mental health challenging. Common questions in a semi-structured interview will ask about sleep patterns, eating habits, mood, thinking processes, and communication styles. The interview is semi-structured because follow-up questions will be based on the client's response. In this way, the standard questions are used as starting points to get the conversation going, but once going the client is allowed to expand on the challenges they are experiencing so that the clinician can come to best understand the client's unique situation. Semi-structured interviews help ensure key data is gathered while allowing the client's particular challenges and goals to rise to the forefront. This helps ensure that the co-developed treatment plan is on target for the client's needs.
Clinicians may include additional information to help diagnose and develop the treatment plan. Clients may be asked to complete surveys and screeners. These are typically short questionnaires (10-20 questions) that ask the client if they are experiencing symptoms commonly seen for one type of disorder. During interviews, clinicians observe how the client responds non-verbally to various questions. Does the client become upset or angry when talking about specific events? Does the client avoid answering certain questions? What is the client's body language like? Do they look at the clinician, other people in the room (if any), do they try to divert the conversation or repeat themselves. Along with surveys/questionnaires, and observations, clinicians may also gather information about the client from other people. This is only done with the client's knowledge and permission. For example, a clinician may ask a child's parents about the child's behavior, moods, and development. They may also talk with the child's teacher to find out how the child is managing in school. Adult clients may ask the therapist to speak with their physician about medical issues that may be impacting the client's mental health, or they may bring in a partner or friend to help expand on details the client has difficulty talking about. People who provide information about the client are often referred to as 'collateral contacts'.
All of the information from clinical interviews, surveys/questionnaires, observation of the client, and collateral contacts is combined to help more fully understand the client. While many issues may be identified and treated based solely on clinical interview information, the additional sources may help shed further light on a problem increasing the chance of treatment success.
What is Psychological Assessment?
The term Psychological Assessment can be confusing. Many people use this term when talking about diagnosis and treatment planning based solely on clinical interviews and or collateral information. Psychologists may use the term assessment for this purpose, but more often Psychological Assessment refers to Psychometric Assessment, or the use of standardized tests and measurements to develop a clinical diagnosis. One can think of Psychometric Assessment as referring to the metric or 'measuring' of psychology. Psychometric Assessment is most commonly seen when third parties are involved such as the school system, courts, or insurance. The reason for using Psychological Assessment rather than basing a diagnosis on a simple clinical interview is twofold. First, Psychological Assessment is an objective assessment. This means that a person is diagnosed based on their responses to a scientifically standardized set of questions. Second, Psychological Assessment reduces the chance that the clinician's personal bias affecting the diagnosis. While many diagnoses are straightforward to make, others can be quite difficult or 'non-obvious', this is where Psychological Assessment shines.
For example, we might think that a child is 'really smart'. This is a subjective or 'opinion based' conclusion and is often determined by people comparing themselves to others. A parent may say a child is really smart compared to everyone else in her class. This may be true, but she may also be doing well because her parents spent extra time with her teaching her how to read and do basic maths before she started Grade One. The other parents in the class did not have this opportunity, so their children are learning in the classroom. The smarts one child is showing may be more a result of the extra help she received than any exceptional cognitive ability. Only cognitive or IQ testing can determine if she is actually smarter than the average child her age, and without testing all the children in her class, no-one could say she is truly the "smartest". Far too many factors other than IQ impact school performance.
Psychometric Assessment can be used to identify gifted people, individuals who need extra academic supports, or who may benefit from an alternate teaching approach (e.g. 'hands-on' learning, watching others, reading about it). Such testing may identify learning disabilities. By having such disabilities formally identified schools can apply for additional funding to provide that child with an aide in the classroom or different learning materials so that they can catch up to their peers. Psychometric Assessment may identify individuals suffering from a variety of psychological disorders such as Depression, Anxiety, Posttraumatic Stress Disorder, Bi-Polar Disorder, Schizophrenia, Alzhemiers, and so forth. Psychometric Assessment may also be used to narrow down what areas of memory, learning, planning, and reasoning have been impacted by illness, injury or disease. This information can be used to develop approaches to help the client function more normally in everyday life. Psychometric Assessment is often used as a component of Parenting and Custody Assessments, Dementia, and Competency Assessments, or to identify brain injuries.
Psychometric Assessments can only be conducted by a psychologist trained in this area. Not all psychologists can conduct Psychometric Assessments, although all clinical and counselling psychologists can perform Clinical Interviews.